Complex Issues That Could Arise in Supervision
There can be a variety of issues that might come up during supervision that could call for very careful management. The main concern for all therapists needs to be the safety of the patient and their overall well-being. This needs to include concern about the wider governance of this service and providing for effective and safe care. It also should be concerned about the ethics of professionals.
Some Examples of This
- Confidentiality concerns
- Breach of information
- All personal issues
- Therapists fitness to practice
- Address their capability issues like being asked to do work that could be outside of their skill range or comfort zone
- Any ethical dilemmas with the team or service
- Manage any boundary violations
Any of these kinds of issues can arise in any different area of the supervision and could require a far different course of action. Most mental health organizations do have procedures and policies that do deal with these issues including human resources departments. They can help in assisting with some of these issues on their own. However, some issues may be too difficult to handle and in these cases, the HCPC or Health and Care Professions Council might have to get involved.
Supervision is Not Personal Therapy
It is important to stress that supervision is not to be viewed by a therapist as their own “personal therapy”. This could make it a lot easier for certain boundaries to be affected if it is seen as therapy. If situations arise that a therapist needs this kind of help, it is vital that the supervisor take this to their own supervisor. This way they can provide the right kind of balance that is needed during supervision. For example, if a staff member should bring issues up such as their own substance abuse they are struggling with.
Supervisory Space Should Be a Safe Space
The space that is created by supervision does need to be a safe space for the therapist. However, there can be some case when some of the organizational changes can actually threaten this safe space. As the work roles begin to change, there sometimes can be some particular boundary issues that do affect the relationship between the supervisor and the therapist. A good example would be when reorganization puts two psychologists together in this supervision relationship, were once peers and now one is in the senior position and the other isn’t.
It is important that the supervision be a very contained and supportive relationship between the therapist and the supervisor in order for the supervision to be considered effective. In order for the goals of the supervisor and therapist to be achieved there needs to be an agreement. This agreement needs to include any circumstances that cause issues can be discussed with a third party. This is something that needs to be included in their supervision contract under “boundaries” and they need to include reference to a third party discussion when there are any of the following concerns:
- Concerns regarding the work of the therapist with their service users don’t seem to be resolved with the supervision.
- When there are concerns regarding the well-being of the therapist and it can’t be resolved through the supervision.
- When there seems to be some sort of breach of the HCPC’s “Standards of Proficiency”, “BPS Code of Conduct”, “Ethical Principles and Guidelines”, or the DCP’s “Core Purpose and Philosophy of the Profession”. This can be on the part of the supervisor or the therapist.
- When the behavior of the therapist or the supervisor might need disciplinary action.
Sociocultural Aspects Need to Be Considered During Supervision
When it comes to the supervision relationship that takes place between the therapist and the supervisor, it needs to be built totally on a mutual trust and respect. By having this type of relationship will ensure that the supervision practice will be both effective and safe. There is the possibility there will be quite high levels of personal disclosure along with strong emotions, it is vital that their relationship be a solid one and well supported.
It is also important to recognize that those who have grown up in cultures that might be sexist, racist, homophobic, or discriminatory could have issues building a relationship of trust with the supervisor. This can be especially true if both parties come from extremely different cultures. In cases such as this, it might be necessary for reallocation of the therapist or the supervisor in order to ensure that there is an outcome that is good.
The Impact of Diversity on Supervision Relationships
Solution – This can be worked with through a very open, trustful, and accepting setting.
Disabilities – This can get in the way of access, time commitment, travel, and sensory impairment.
Solution – Try to deal with more practical issues by reducing travel and ensure access to their facilities. Also, ensure there are adaptations and aids provided.
Religion/Culture – There can be big differences in their experience, knowledge, understanding, values, and conflict of belief systems.
Solution – Need to have a very open and accepting setting that offers a sense of trust. May need to reallocate the supervisor or the therapist without any prejudice.
Maternity/Pregnancy – Could be gaps in the continuity of the supervision with childcare and maternity leave.
Solution – Make sure that standards are still met, especially when it comes to supervision continuity.
Civil Partnerships/Marriage – There can be differences in their experiences, knowledge, understanding, and even values.
Solution – This can be worked with by providing an accepting, trustful, and open setting. There could be a need to reallocate the supervisor or the therapist.
Gender Re-assignment/Sexual Orientation – There can be differences in values, experiences, understanding, knowledge along with a conflict in their belief systems.
Solution – Can work towards an open, trusting, and accepting setting. May have to involve reallocating the supervisor or the therapist.