LEGAL & ETHICAL ISSUES
FOR
COUNSELING CENTER
TRAINING PROGRAMS
Gloria C. Saito, Ph.D.
University of California,
Berkeley
1
Introduction and Overview
Counseling Center settings: agency
issues to consider in training
unlicensed professionals
Legal and ethical issues for
supervisors
Guidelines for ethical decision-making
Case vignettes
2
Definitions: Law and Ethics
Ethical standards are “conceptually
broad in nature, few in number and
open to interpretation by the
practitioner. . . . They are . . . A call to
ethical excellence. Ethical standards
are a statement from a particular
profession to the general public
regarding what they stand for.”
(Bernard and Goodyear, 1998)
3
Definitions: Law and Ethics
“The law . . . is specific in nature and is
introduced when a particular act has been
perceived to have endangered or harmed
those whom the profession serves. . . .
The law is not concerned with the highest
standards of professional practice when
judging someone, but only in minimally
acceptable behavior.”
(Bernard and Goodyear, 1998)
4
Agency Issues for Counseling
Center Training Programs
Selection Issues
APPIC Match Policies (www.appic.org)
CAPIC Guidelines (www.capic.net)
University personnel and human
resources policies
Local, state and federal regulations
Americans with Disabilities Act (ADA)
regulations
5
Agency Issues, cont’d
Parameters for Employment and
Informed Consent –
Conditions of employment
Requirements for criminal
background checks
Stipends, number of hours per
week, evaluation process
6
Agency Issues, cont’d
“Truth in Advertising” about the program
and training offered.
Is the program designed to provide appropriate
training experiences and to meet requirements
for academic programs, licensure and/or
certification?
Is the description of the program in publicized
materials current and accurate, providing
information on the training goals and
objectives, requirements, stipends, benefits,
etc.?
7
Agency Issues, cont’d
Expectation of trainees – clear statement about
what is expected of trainees
Competency issues – agency has the duty to
assign only those clients whom the trainee is
competent to treat
Confidentiality and limits to confidentiality
Written policies and procedures to guide the agency,
supervisors and trainees in the management of clients
who are dangerous or at risk.
Due process and grievance procedures
Contextual issues: budget and staffing, licensing
laws and regulations, agency pressures and the
service delivery vs. training balance
8
Supervision Issues
Supervision defined
“An interpersonal process that typically involves a
more experienced clinician (“master”) with
oversight and evaluative responsibility for a less
experienced clinician (“apprentice”) who shares
educational and therapeutic goals. The
educational goal primarily concerns the growth
and development of professional competence by
the trainee. . . Therapeutically, supervisor and
supervisee collaborate to ensure the welfare of the
client.” (Holloway, 1992)
9
Supervision Issues
Supervision defined (again)
“An intervention that is provided by a senior member
of a profession to a junior member of that same
profession. This relationship is evaluative,
extends over time and has the simultaneous
function/purposes of enhancing the function of the
junior member, monitoring the quality of
professional services offered to clients and serving
as a gatekeeper for those who are to enter the
profession.”
(Bernard and Goodyear, 1998)
10
Legal and Ethical Issues for
Supervisors
Getting started: nuts and bolts (Board
of Psychology requirements):
Supervisory Agreement form
Supervision Disclosure form
Weekly log of activities
Verification of Experience form
11
Legal and Ethical Issues for
Supervisors
Qualifications of supervisors
demonstrated professional training and
competence in areas in which supervision is
being provided (supervisor must be competent
to see a client to whom trainee is assigned.)
formal training in supervision (Board of
Psychology regulations)
meet continuing education requirements and
have a current license
12
Legal and Ethical Issues for
Supervisors, cont’d
Duties and responsibilities of supervisors
Heavy obligation to protect the welfare of
the consumer/client
Have sufficient knowledge of each client
to monitor the work of the trainee, i.e.,
client care
Oversight of therapeutic behavior of a
less experienced, unlicensed
professional whose skills may not be
well-known or well-developed
Review and countersign client records
13
Legal and Ethical Issues for
Supervisors, cont’d
Duties and responsibilities of supervisors, cont’d
Availability in case of emergencies (be
available 100% of the time either on site or by
other means)
Keep records of supervision
Obligation to further the professional
development of the trainee by focus on skill
development as well as professional identity
issues
Provide ongoing and timely feedback as well as
formal evaluations based on actual
performance and established program
requirements
Avoid abuses of power in supervision that may
potentially result in exploitation or harm
14
Legal and Ethical Issues for
Supervisors, cont’d
Duties and responsibilities of supervisors,
cont’d
Challenge supervisee about issues that may
interfere with quality care while setting
appropriate boundaries and limits (supervision
is not therapy)
Special responsibility to structure and maintain
a supervisory relationship that “demonstrates
ethically appropriate behavior and minimizes
the potential negative quality of transference
issues.” (Upchurch, 1985)
15
Legal and Ethical Issues for
Supervisors, cont’d
Informed consent for supervision
Do trainees have a choice of supervisor, and
what are the choices? Are trainees aware of
how supervisory assignments are made?
Need for clear specification of duties,
supervision philosophy/approach, goals,
requirements, expectations, evaluation
procedures
16
Legal and Ethical Issues for
Supervisors, cont’d
Informed consent of clients
Clients must be informed about the trainee’s status and
about the supervisor’s oversight of the treatment
Supervisors must be available to clients if necessary
Supervisors must insure that trainees have informed their
clients about the parameters of counseling
Clients must give consent for procedures necessary or
required for supervision, e.g., audio or videotaping
17
Legal and Ethical Issues for
Supervisors, cont’d
Confidentiality
What’s confidential in supervision?
The trainee’s rights to privacy
What about group supervision, supervisors’
meetings, training committee meetings?
Do not require supervisee to disclose personal
information about sexual history, history of
abuse/neglect, psychotherapy, relationships
with family, peers, etc., unless this is specified
clearly in program admissions and training
materials
18
Legal and Ethical Issues for
Supervisors, cont’d
Multiple Relationships
Supervisor is guided by the principle of “DO NO
HARM”
Supervisor is in the position of power and
trainees have limited power in the relationship
Sexual Relationships between supervisor and
supervisee prohibited
Sexual attraction is inevitable and important to
discuss
Supervisor’s responsibility to teach trainees
how to handle sexual attraction issues
19
Legal and Ethical Issues for
Supervisors, cont’d
Multiple Relationships, cont’d
Supervisors should not provide psychotherapy
services to supervisees and should avoid
conflicts of interest which may impair their
judgment
Supervisors avoid dual relationships where
there is the potential for abuse of power and/or
exploitation
Supervisors avoid actions that may impair their
judgment and ability to objectively supervise
and evaluate the trainee (e.g., supervising a
friend or relative)
20
Legal and Ethical Issues for
Supervisors, cont’d
Multiple Relationships, cont’d
Supervisors maintain appropriate boundaries (what about
professional lunches, office parties, workshops,
conferences?)
Differentiate between multiple relationships that abuse
power, exploit or harm the supervisee and those that
occur in the positive context of a developing professional
relationship
Supervision and therapy and the distinction between
them: how to explore personal issues related to client
care without crossing privacy boundaries
Conflicting roles inherent in the supervisor role: mentor,
supporter, evaluator, colleague, reference
21
Legal and Ethical Issues for
Supervisors, cont’d
Due Process Issues
Policies and procedures are provided to the
supervisee by the training program and the
supervisor in writing at the beginning of the
traineeship. These include:
Trainee rights and responsibilities
Expectations, roles, rules, requirements
Procedures and process for feedback and evaluation
Formal guidelines for what happens when a trainee is
impaired, including definitions of impairment and
processes for notice, warning and appeal,
remediation, time frame for notice and appeal
Primary goal is to avoid arbitrary or capricious actions
on the part of the training program and the supervisor22
Legal and Ethical Issues for
Supervisors, cont’d
Liability Issues
Malpractice defined:
“harm to another individual due to negligence consisting
of the breach of a professional duty or standard of
care.” (Disney & Stephens, 1994)
The Good News
Why It Pays to Pay Attention
Supervisor is held responsible for supervisee’s
actions and quality of client care
23
Legal and Ethical Issues for
Supervisors, cont’d
Liability Issues
Direct Liability
Negligent supervision: supervisor’s inattention or
negligence caused the client’s damages
Supervisor or training program assigned tasks which
the trainee was not adequately trained or prepared to
carry out, and the client was harmed
24
Legal and Ethical Issues for
Supervisors, cont’d
Liability Issues, cont’d
Vicarious Liability – supervisors can be
sued and held liable even if they did
nothing wrong under the concept of
“respondeat superior” (let the master
respond”)
Final responsibility for client welfare
rests with the supervisor, not the trainee
25
Legal and Ethical Issues for
Supervisors, cont’d
Liability Issues: Vicarious Liability, cont’d
Criteria:
Trainee voluntarily agrees to work under the direction
and control of the supervisor
Trainee acts within the scope of tasks permitted by
the supervisor
Supervisor has the power to control and direct the
supervisee’s work
The act that injured the client is within the
supervisee’s scope of employment
Client has the burden to prove that an actual injury
occurred
26
Legal and Ethical Issues for
Supervisors, cont’d
Areas of Vulnerability for Supervisors
(from Campbell, 2000)
Client is not informed of supervisee’s trainee
status and the limits of confidentiality
Supervisor has incomplete information about
the client due to multiple factors (workload
issues, incomplete/inadequate communication,
trainee withholds information)
Trainee does not follow supervisor’s
recommendations, but does not disclose this
27
To Summarize:
Dilemmas for Supervisors
Issues of Hierarchy and Power
Conflicting Roles and Multiple Hats
Negotiating Boundaries
Confidentiality
28
Guidelines for Ethical DecisionMaking
Provide current and accurate information about
your program
Set standards for training and performance in
writing and communicate and discuss these with
your trainees
Provide a timely and specific process for providing
feedback and evaluation
Develop good record-keeping practices, both for
client work and for supervision
Apply standards early and consistently
Base decisions on facts, not opinion or bias, and
document behaviors
Document, document, document, but beware of
email communication
29
Seek consultation
Guidelines for Ethical DecisionMaking, cont’d
Bernard and Goodyear (1998) suggest the
following “cognitive map” for resolving ethical
dilemmas:
1. Identify the problem or dilemma
2. Identify the potential issues involved
3. Review relevant ethical guidelines
4. Obtain consultation
5. Consider possible and probably courses of
action
6. Enumerate the consequences of various
decisions
7. Decide what appears to be the best course
of action
30
Case Vignettes
Vignette #1:
The client is a 19 year-old Caucasian undergraduate woman
with a severe eating disorder (anorexia). The supervisee is
a 28 year old Caucasian woman on her predoctoral
internship. The intern has had some experience in treating
eating disorders and would like to specialize in this area.
She has done an assessment of the student’s concerns and
in addition to counseling at the University Counseling Center,
has referred the student for medical care and follow-up.
During supervision, the intern has down-played the severity
of the eating disorder, and has assured the supervisor that
the student has followed through with medical care.
While the intern is on vacation, the student comes into the CC
in crisis. It is apparent that she has not in fact followed
through with medical care. Moreover, the supervisor reviews
the record and, in her assessment, the student is more
severely impaired than the intern had indicated. The
supervisor decides to involve the student’s parents, and in so
doing, breaks confidentiality.
What are the legal and ethical issues involved in this case?
31
Case Vignettes
Vignette #2
The student is a 22 year old African American male graduate
student in Physics who comes into the Counseling Center for
an emergency drop-in appointment. The supervisee is a 30
year old Asian American male postdoctoral fellow. In doing the
assessment, it is clear to the postdoc fellow that the student is
experiencing manic and psychotic symptoms and is potentially
suicidal. The postdoc seeks consultation from senior staff
members, who strongly advise him to pursue hospitalization for
the student. The postdoc feels great empathy for the student
who is adamant that he does not want to be in the hospital. As
a result, the postdoc is reluctant to hospitalize the student, but
finally does so after many hours and numerous consultations
with staff. Senior staff are concerned that the postdoc has let
his countertransference reactions guide his behavior, thereby
prolonging the process of getting the student to the hospital.
They try to give the postdoc feedback about this, but the
postdoc feels invalidated and wronged and cannot take in the
feedback.
What are the ethical and liability issues in this case?
32
References
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Heights, MA: Allyn & Bacon.
Campbell,J.M. (2000). Becoming an effective supervisor. Ann Arbor, MI: Sheridan
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supervision. Professional Psychology: Research and Practice. 21, 37-41.
Nagy, T.F. (2005). Ethics in plain english. Washington D.C.: American Psychological
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Roberts, G.T., Murrell, P.H., Thomas, R.E. & Claxton, C.S. (1982). Ethical concerns for
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