Ethics vs. Morals in Clinical Supervision
Clinical supervisors should conduct themselves ethically as they interact with supervisees. They should also safeguard the welfare of trainees by responding appropriately to make sure that supervisees’ conduct is within professional and ethical parameters. They should also maintain a sound understanding of ethical and professional codes of conduct applicable to all workers. Some of the common legal and ethical issues facing clinical supervisors include; confidentiality, due process, vicarious liability, boundary concerns, and dual relationships. Professional code of ethics mostly touches on practices that we are not supposed to engage in the workplace. This paper aims at identifying ethical and moral issues in clinical supervisions and solutions to them.
Ethics versus Morals and their Relevance to Clinical Supervision
The terms morals and ethics are used in plural and most people regard them as synonyms; however, the two terms have some slight distinction in their use. Ethics are the standards governing the code of conduct of an individual (Durkheim, 2013). Ethics is also reflecting self-consciousness on demonstrating that you are a moral human being. This definition implies the process of self-awareness and self-reflection of how a person behaves like a moral being. There are different definitions coined by different people, depending on their background and environment. Religion, law, or individual belief systems or a combination of the three dictates the definitions of the term ethics.
Conversely, the term morals in most cases are used to describe an individual’s values regarding what is wrong and what is right. Morality refers to understanding the difference between wrong and right, and finding ways of living according to the understanding(Durkheim, 2013). Contrarily, ethics refers to the philosophy of the way a group or an individual is guided by morality. The two terms have a slight difference but it is important to note that morality lays the foundation of ethics (Durkheim, 2013).Morality condemns acts such as stealing, murder, and adultery.
In clinical supervision, both terms are used because they are of equal importance to ensuring that medical practitioners carry out their duties in the right manner. Those clinical supervisors who carry out ethical operations ensure that they have the required combination of experience, practice, and education to help supervisees to become competent individuals by advancing their skills and knowledge (Campbell, 2011). Morals are also required by supervisors so that they may feel obliged to carry out their duties correctly and to treat others in the right manner. Morals help to refrain from unacceptable deeds in the medical practice.
Challenges and solutions to clinical supervision
Administrators of supervision are supposed to possess relevant skills and knowledge needed to offer high quality leadership to the supervision staff. According to Bogo, Paterson, Tufford, and King (2011), other personnel affected by the skills and knowledge possessed by an administrator include patients, support staff, supervisees, and supervisors. Supervision administrators should be well grounded in experiences, knowledge, and skills of effective supervision. They develop models of supervision and understand the procedures, techniques, and steps taken. Administrators should model their skills to ensure that they provide quality services.
Problems arise if the administration does not have interpersonal skills to supervise, counsel, and administer a good relationship with other staff members. Relationships between supervisors and administrators and those between supervisors and counselors should be based on mutual respect, a collaborative spirit, and as two-way interactions(Bogo et al., 2011). The values of administrators are reflected by the staff they supervise and through the program. In a workplace where administrators do not value ethical practices, dignity, and value other staff members, the relationship amongst themselves worsen with time. If their personal interactions are not characterized by respect and trust then operations are not carried out in the right way (Bogo et al., 2011). A collaborative leadership ensures that morals and ethics are strictly followed in clinical supervision.
Program administrators are supposed to protect the rights of clients, supervisees, and supervisors. Boswell, Kraus, Miller, and Lambert (2015) note that skills are needed to intervene in case challenges occur in the workplace. Skills and knowledge are required to ensure that proper ethics are followed. Morals are mainly determined by the culture of the organization or the kind of beliefs instilled in an individual. For instance, if clients are dissatisfied, they may need to discuss the issues with supervisors so that their appeals may be presented to the administrator. Administrators on the other hand should be in a position to listen, evaluate the case, and solve the issues fairly.
To ensure that proper ethics are followed, supervisors need adequate skills in orientation, placement, recruitment, and hiring. Such people also need to have good communication skills. Some of problems that may be encountered by supervisors include conflicts, stress, burn out, or being incompetent (Boswell et al., 2015). Supervisors should match their behavior to those they supervise.
Since clinical supervision is different from consultation and teaching, specific preparation is needed. Boswell et al. (2015) assert that supervision techniques and methods come from different mental health disciplines. Supervisors should be confident in their duties, and become responsible of their supervisees. Supervisors also need to understand their roles and what the things that are expected from them. An effective method of supervision is the use of process notes. Use of process notes ensures that nothing is left out and that each stage of training and work is carried out effectively.
Individual supervision is a cornerstone of development in professionalism because it helps to pay attention to details. One is able to understand the strengths and weaknesses of an individual (Bogo et al., 2011). Through individual clinical supervision, you can maximize on the strengths of an individual and work on the weak areas to gain competence.
When teaching new skills in supervision, the behavior of individuals should be modeled, teach one skill each time and practice the skill adequately to ensure that you are competent. Other values that should be demonstrated include honesty, respect, and commitment. The supervisees will learn to demonstrate integrity in there line of duty and also show good morals just like those passed down to them.
Moreover, supervisors can use various methods and strategies to enhance their skills. Assessment must be done to ensure that supervisees’ skills improve. Strategies to examine the performance of a supervisee should be developed to make sure that errors are corrected during assessment, treatment, or diagnosis of the client (Bogo et al., 2011). Such a strategy helps to increase the probability of successful outcomes.
There are different forms of gathering data; some of the most effective ones include reviewing the client’s history, reviewing results, and examining through videotapes, audiotapes and observations (Boswell et al., 2015). Conducting live supervision provides supervisees an opportunity to give corrective feedback about the techniques used and ways the strategies used can be improved. Live supervision helps to gain new skills, new techniques, and new modalities (Boswell et al., 2015). The live supervision strategy can be improved by conducting it immediately after the review session.
Ethical ways of Solving Clinical Supervision challenges
Development of ethical guidelines is a sign of a maturing clinical profession. The guidelines are meant to guide the practices of professionals. Additionally, they reflect values and the society where the profession is found. Some of the major ethical challenges in clinical supervision include: confidentiality issues, evaluation, dual relationships, and due process (Reamer, 2013). These issues affect the supervisor, supervisee, and the client.
Informed consent covers the relationship between therapists and clients, and between the trainee and the supervisor. Wells, Maschi, and Slater (2012) posit that to avoid unnecessary conflicts, trainees should be informed that supervision is a way of evaluating them. It iscrucial to clearly outline responsibilities and roles of both the trainee and the supervisor. Some of things that should be disclosed openly include; evaluation strategies, responsibilities of trainees and supervisors, supervisor’s theoretical orientation, and contact and name of the supervisor (Weells et al., 20112).
Confidentiality is a key ethical quality that should be maintained. During supervision, it is difficult to pass the quality to trainees. Therefore, trainees should learn that a client’s information should be confidential. To maintain confidentiality, only the first name should be used. The other major challenge is that one supervisor may be training more than one trainee hence leading to dual relationships (Wells et al., 2012). Supervisors should help trainees to understand the effects of dual relationships they are going to have with clients.
Reamer (2013) adds that trainees should be made aware of the criteria by which they will be evaluated to avoid unnecessary conflicts. They should also understand what it means mastering the set criteria. The supervisor should also ensure that he/she makes the trainees understand their rights and possible consequences of not meeting the set criteria. Evaluation of supervisees should be an ongoing process. As a supervisor, I would ensure that supervisees are regularly evaluated, that the supervisee are given an opportunity to air issues affecting them and that their opinions are taken into consideration, and that the supervisees are apprised of program regulations and academic requirements.
Social justice is a value that should be pursued by social workers especially to oppressed and vulnerable people in the society. During clinical supervision, the supervisors should be informed of the consequences of discriminating against people. Sensitivity to discrimination should be raised to encourage ethnic and cultural diversity (Wells et al., 2012). Supervisors should also make sure that they provide everyone equal access to resources, services and information which will lead to meaningful participation.
Dignity should also be maintained in the workplace as well as training processes. Supervisors should learn to treat trainees with care and respect, mindful of ethnic and cultural diversity. Conflicting issues arising should be solved in a socially responsible way consistent with ethical standards and values of the profession (Reamer, 2013). Doing so helps to pass a culture of dignified people who treat each other with respect.
Supervisors and trainees should be trustworthy as dictated by their actions. Social workers are supposed to stay aware of the profession’s ethical principles, values, missions, and practice. After gaining an understanding of what is expected from them, they should act responsibly and honestly so that they may continue promoting ethical practices in the organization.
Solutions to Clinical Supervision Issues
Borders et al. (2014) state that solution-focused clinical supervision is a proper way of solving personal management issues in clinical supervision because it identifies with behavioral and humanistic models. The method enriches human relationships that enhance development and growth. It also uses the relationship to help the individuals being supervised to make positive progress. Usually, few supervision relationships reflect pure behaviorist or humanistic model of working. The strategy promotes the idea of a genuine, warm, and trusting relationship to help people to focus on positive and achievable outcomes (Borders et al., 2014).
According to Nelson and Thomas (2012), the solution-focused therapy is about staying precise and entirely focusing on solutions with negligible emphasis on challenges faces. The solution focused approach can be used by supervisors to help them assist trainees in identifying goals, skills, and strengths. Some of the techniques applicable include using scales, questioning, following up tasks, giving constructive feedback and searching for exceptions.
Use of questions encourages the trainees to give constructive feedback that may be used to improve the methods used and the type of skills and knowledge passed to them. By identifying a supervisee’s strengths and skills, the supervisor is able to develop interest in the person thus improving their relationship (Nelson &Thomas, 2012). A scale of 0-10 can be used to assess the performance of the supervisor or supervisee to check whether they adhere to ethical guidelines.
Solution focused supervision can be used to help supervisees come up with an agenda for their work. Thomas (2013) suggests that solution focused supervision helps employees to know what is expected from them so that they may act accordingly. The approach also focuses on their strengths, learning, and abilities. Doing so helps to maintain ethical boundaries of place and time as well as professionalism. The supervisee learns to be accountable of patients and strives to offer the best services (Border et al., 2014). The supervisor also learns to remain listening so that he/she may understand what he/she should do to improve the service provided.
Ways of Preventing Future Clinical supervision Challenges
As a clinical supervisor, I would ensure that I use solution-focused approaches to avoid encountering personal management issues. This therapeutic practice working with supervisees to ensure that they uphold the best practices by practicing proper morals and ethics. This will involve paying attention to supervisees’ best intentions, interests, and goals. Another important thing to note is the trainee’s knowledge.
Some of my practices as a supervisor will include eliciting resources and strengths of supervisees, giving evidenced compliments, using of scales to develop and measure progress, develop supervisee’s preferred outcome or future, and taking note of positive movements during supervision. The other helpful solution is staying respectful and maintaining integrity. First, it is crucial to educate the supervisees about their responsibilities and roles so that they may understand what things are expected from them. They should also learn the roles and responsibilities of supervisors. Understanding one’s roles helps to avoid unnecessary conflicts and makes it easy for people to remain focused (Nelson & Thomas, 2012).
The other important thing is to understand the supervisees’ interests, strengths and weaknesses. Understanding the strengths and interests of a supervisee may help to know what to work on to ensure that they may become better. Understanding their weaknesses also helps to rectify them and turn them into strengths. Supervisees should also be informed on the code of ethics that they should adhere to and the kind of morals that they should uphold (Nelson & Thomas, 2012). Moral lessons not only need to be taught verbally but also practically.
I would also ensure that I take time to listen and act on feedback from supervisees. This gives supervisees a chance to help us to make improvements. In the process, they are also able to acquire knowledge and desirable skills. A scale can be used to rate the supervision lessons so to understand how effective they were (Campbell, 2011). The scale will also help to understand whether proper morals are upheld according to the feedback given.
Technology may affect solution-based supervision approaches. This is because most operations carried out by humans may be replaced with machines. Problem with using recent technology is that much effort will be given to maintenance of devices thus reducing the personal approach. In case of errors, it is difficult for an institution to become totally accountable (Thomas, 2013). On the other hand, providing clinical supervision from a distance reduces accountability and efficiency of operations.
Conclusion
Ethics and morals remain key issues in any society, organization, or in any group of people. In healthcare settings, ethics play a crucial role in improving the quality of service delivery. As highlighted in this paper, some of the common ethical issues in clinical supervision include due process, confidentiality, boundary concerns, dual relationships, vicarious liability, and due process. Clinical supervisors should ensure that they adhere to the set code of conduct in their practice to ensure that they provide high quality services. Moral issues should also be observed to make sure that the clients feel satisfied and that there is equality and fairness in provision of services. Both solution-focused approaches and solution-focused therapy are appropriate ways of solving clinical supervision issues.
References
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Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33(1), 26-44. doi:10.1080/07325223.2014.905225
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Nelson, T. S., & Thomas, F. N. (Eds.). (2012). Handbook of solution-focused brief therapy: Clinical applications. New York: Routledge.
Reamer, F. G. (2013). Social work values and ethics, (4th ed.). Colombia: Columbia University Press.
Thomas, F. N. (2013). Solution-focused supervision: A resource-oriented approach to developing clinical expertise. Springer Science & Business Media.
Wells, M., Maschi, T., & Slater, G. Y. (2012). Integration of research and practice: Innovations and challenges in social work programs. Social Work Education, 31(3), 331-346. doi:10.1080/02615479.2011.551827
