This episode is brought to you by PAR.
PAR offers the SPECTRA Indices of Psychopathology- a hierarchical dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com/spectra.
Hey everyone. Welcome back to a clinical interview. Today, I am talking with Dr. Bryce Hella about ethical and legal perspectives on supervision.
Bryce completed her graduate degree in [00:01:00] Clinical Psychology at the Illinois Institute of Technology in 2011. She then worked in a private practice in Naperville, Illinois, and then a small hospital in Chicago before relocating to Michigan, where she’s been a director at Thriving Minds Behavioral Health for the past six years.
Dr. Hella has provided supervision for over 10 years and currently supervises practicum students, predoctoral interns, postdocs, and staff. Her areas of specialty include CBT with kids and adolescents, testing, and pediatric health psychology.
As I said, we’re talking about supervision and we dig into lots of the ethical and legal matters that we should be concerned about with supervision. And a lot of this conversation you’ll hear hinges on the idea that many of us practice supervision by what Bryce calls the osmosis model, which means that we supervise simply because we were once [00:02:00] supervised and there is a noticeable gap in training for many of us as far as supervision and developing it as a competency area.
So we talk about many things. We talk about the questions you should ask yourself before you commit to supervising; we talk about some of the top ethical and legal landmines that we can run into when we are supervising; we talk about remediation plans- when they’re needed and how to write them; and many other things.
This was a fabulous episode with, as always, plenty to take away and implement in your practice. There are plenty of resources in the show notes, so make sure to check those out and build some of your supervision skills.
If you’re a practice owner or a hopeful practice owner and you would like some support in a group environment, some support, and accountability in [00:03:00] running the business of your practice, check out The Testing Psychologist Mastermind Groups at thetestingpsychologist.com/consulting. You can schedule a pre-group call and we’ll chat and see if it’s a good fit for you. This episode is supposed to air in July, so I’m guessing new cohorts will be starting very soon. We tend to start in July and January. So check those out if you’d like some group accountability and support.
All right. Let’s get to my conversation with Dr. Bryce Hella.
Dr. Sharp: Hey, Bryce. Welcome to the podcast.
Dr. Bryce: Thank you. I’m so happy to be here.
Dr. Sharp: I’m glad to have you. We are talking about supervision, which is an incredibly important topic, but one that I am guessing a [00:04:00] lot of folks don’t put a lot of energy into, or at least the right kind of energy as we’ll see as we go through this discussion. So, glad to have you here and really excited to dive in here.
Dr. Bryce: Absolutely. I’m happy to be here and happy to talk about supervision because I agree. I think a lot of us go into it using that osmosis model; somebody supervised me, therefore I’m okay to supervise. And I think the field is seeing that that’s maybe not appropriate or okay. So I think I’m excited to talk about some things for people to think about when they’re supervising.
Dr. Sharp: I think that’s a perfect preview of our conversation, that the osmosis model is maybe not enough. Let’s leave that teaser to let people that we’re definitely going to get to that.
I do want to start though with a question that we always start with, which is why this? [00:05:00] Of everything you can focus on or care about or do a podcast interview on, why supervision in assessment?
Dr. Bryce: I feel like my interest in supervision goes back to grad school. I remember doing practicum interviews and internship interviews and people asking, “What’s your five and 10-year plan?” And I was like, “I want to be a training director. I’m really interested in the teaching aspect of it, but also in the context of a one-on-one relationship.”
Once I graduated from grad school, and as soon as I got licensed, I was thrown into supervising right away like a lot of us are. Since then, I’ve been in a few different roles. I’ve been in private practice. I’ve been in a hospital in Chicago, about six years ago, I transitioned and moved over to Michigan where I’ve been the director [00:06:00] of a private practice at one of the settings of a private practice in Michigan. And I’ve been supervising prac students, interns, postdocs, and staff over that time.
In the past two years, something that I’ve noticed particularly in the Covid era is that 99% of the time, training and supervising go really well, and it’s a really positive and valuable experience for everybody. But I think a thing that I’ve been scratching my head about and since Covid is just that, I think some trainees have missed out on some key training opportunities. If they had to pivot to virtual for a good part of their training or even for a year, that maybe there’s a little bit more of a mismatch between where we’re expecting people to be and where people are at as far as [00:07:00] their readiness to practice and things like that.
So, I’ve really been trying to look at the literature, look at the practices that we’re engaging in at our practice, and really trying to improve the supervision experience for everybody. So, I’m excited about for myself, both learning more about it, growing in that area, and then also trying to talk to people about best practices and supervision and trying to get that out into the community as well.
Dr. Sharp: That makes sense. That may be a good place to start and just build that bridge from what you’re saying around the Covid factor. I’m not sure what else to call it, but the covid factor. So you’re naming something that a lot of us have probably experienced or intuited. I’m curious what you have found, if there’s anything in the research about [00:08:00] well, like a doctoral trainee skill level. This is a hard thing to dig into because I feel like we’re just bringing it to the forefront, but it’s also something that we need to name if it’s there.
Dr. Bryce: Yeah. When I look into the research, what I can tell is a lot of a positive spin on, hey, I think we get a similar response to telehealth or telesupervision that we do in face-to-face supervision. What I think I’ve been seeing, at least in practice is, we end up having slightly more intentional conversations about things that I think people maybe would’ve observed had they been in person for training.
The example that I’ll sometimes give is, if you’re in person as psychologists in training, we’re oftentimes observing what’s going on around us and really picking up on things in that way. And so, [00:09:00] if you have never gone to the waiting room to grab a patient, or you haven’t seen 6, 10, 15 other colleagues constantly going into the waiting room to get a patient to take them back to the office, now, if you’re having that conversation for the first time when somebody is an advanced level practicum student or a staff member or a postdoc or something along those lines, you’re like, oh wow. We’re starting this conversation that I didn’t know that we would be having right now if that makes sense. From my observation and experience, I think there’s part of that that gets lost in doing telehealth from home full-time.
Dr. Sharp: Yeah. That’s such a good example that could easily fly under the radar. I would imagine if I was in your place having that conversation and just having an Oh, wow, kind of moment, but this is so true. That [00:10:00] behavior that we take for granted where you walk out and you greet someone in a waiting area and figure out what to talk about for the 15 seconds between walking from there to your office, that’s a thing that you have to practice a little bit and it does get lost.
Dr. Bryce: Absolutely. And I think, it’s not only just doing it and practicing it yourself, but also just seeing, okay, now I’ve seen a bunch of different staff members. Maybe everybody does it a little bit differently, but there are some commonalities that I can take from observing that skill or that strategy with people.
Again, when you’re not anticipating having a conversation about how to take somebody out of the waiting room and take them back to your office or whatever, it can just catch people by surprise. And now we’re talking about this thing that we weren’t anticipating talking about.
Dr. Sharp: 100%.
Dr. Bryce: We’re starting at a different step.
Dr. Sharp: So is it fair to make the leap and say that you are seeing more [00:11:00] concern with some of these “soft skills” versus the actual assessment process and clinical conceptualization and so forth? Or is it some of both?
Dr. Bryce: I don’t know what I would say for that. I will also say, a big chunk of the supervising that I do ends up being in therapy. I don’t do as much in assessment, so I can probably speak a little bit more to therapy, but it probably would be the soft skills- interpersonal skills if I could name it, absolutely.
Dr. Sharp: No, that’s reasonable. So let’s go back. I want to talk on one of those threads that you brought up, which is this idea that supervision by osmosis is not enough. I think that happens to a lot of us. [00:12:00] I’m thinking back, just personally, I had one supervision seminar on internship. Theoretically, we had a year of supervision training and I don’t know that it was as rigorous maybe as it could have been. So this really resonates with me. I think a lot of folks probably have had this experience that they’ve been supervised and then they end up supervising. Can you say more about why that’s not enough and what else there is to become a competent supervisor?
Dr. Bryce: Yeah, absolutely. Well, I think, you using the word competent is very appropriate because I think the field is seeing that supervision is its own competence just like assessment, just like research methods, just like therapy that providing supervision is its own competence. So just as we wouldn’t want to throw a psychologist out into the world [00:13:00] without training in therapy, for example, and have them do therapy out in the world, I don’t think we want to have people out there doing supervision and teaching people how to do therapy or how to do assessment without adequate training.
One of the helpful things to think about is just how did you become competent in, let’s say testing or let’s say therapy, right? What were the things that you had to do, which is oftentimes, reading, going to courses, taking classes, consulting with people, practicing, getting feedback on your therapy, and getting feedback on your assessment? So I think generally speaking, to become a competent supervisor, I think you need some combination of all of those things.
I wish I could cite my source, but [00:14:00] I think it was interesting for me to read that the half-life in our field for knowledge is somewhere around 5 or 7 years. So, if you haven’t had any training in supervision in the past 5 to 7 years, probably at least some of your skills are out of date or some of your knowledge is out of date. So thinking about at least that often, we need to be really brushing up on things to stay current.
Dr. Sharp: That might be the fact of the podcast right there. That’s a great takeaway. I think that could apply to so many, well, maybe everything that we do: we need to be updating our recommendations, our approach to assessment, our measures- basically just checking in with everything every 5 years or so.
Dr. Bryce: Absolutely.
Dr. Sharp: Yeah. As someone who’s now been in practice much longer than 5 to 7 years, I’m thinking back, doing a quick self [00:15:00] evaluation. That’s such a good point though. I think a lot of us do get into the zone and don’t break out of it easily.
Dr. Bryce: Yeah.
Dr. Sharp: Do you have any statistics on how many supervisors out there have had appropriate training in supervision? I don’t know if that even exists.
Dr. Bryce: I’m sure that it does exist. I don’t have hard data. The last time I presented to a group, I did an informal poll to see what people were saying, so take this with a grain of salt, but about a third had anything more than a grad school course or something basic level. About 27% said they had [00:16:00] no training at all in supervision. And then I think it was about 35%- 37% said just grad school or one course I think is how I divided it. So, about a third. I do have facts about at least what supervisees are saying. And in a 2015 study, about 86% of US supervisees reported that they had bad or inadequate supervision at some point in their career.
Dr. Sharp: That’s telling. It’s sobering. So going back to the piece about the clinicians, it sounds like about 60% of us are supervising with basically a course if that.
Dr. Bryce: Right.[00:17:00] Dr. Sharp: This is mind-blowing. So then if you draw the parallel between literally any other work that we do, that would be completely appalling to think that someone would be practicing therapy or assessment after having a course, if that.
Dr. Bryce: Agreed. And I think there’s an interesting piece too that is people aren’t rating it as super important once they become psychologists. They’re not rating, getting training, and supervision as something that’s important because I think even though, again, there’s been a push in the past probably 10, 15 years to really define what supervision is to make its own competency, I don’t think the practice has aligned with that. So I think there’s complacency or what have you with supervisors who are like, it’s fine. I don’t really need to get more training. Knowing how to do it is good enough.
And I think that, again, going back to[00:18:00] the covid situation, it’s like, it is enough in maybe 99% of the cases where maybe it’s not enough, but it’s in 99% of the cases where the supervisee has great training, comes in being really eager and has nothing else going on in their life that might be interfering with their work, but I think the reality is that, this fake number that I’m coming up with, 99% going really well that maybe that number is decreasing over time, that maybe people are a little bit less trained, a little bit less ready to practice.
And so then there’s this need for I think supervision and supervisors to be able to fill in some of that gap and be able to meet people where they’re at, not where we expected or hoped that they would be.
Dr. Sharp: Yeah. I know we’re going to get [00:19:00] into a lot of the nuances around supervision. I’m curious before we transition, do you have any guesses or maybe there’s data around why supervision seems to be less important to us as a competency to develop?
Dr. Bryce: I don’t know about data specifically on that. Again, I can speak to just some informal conversations that I’ve had with people. When talking to trainees coming up, I think when they think about what looks good on their CV or their resume or what’s going to give them the leg up for the next part of their career, I think people tend to focus on specialization and training and those types of things, less so. And I think there is this assumption that once I get my degree, if I want to supervise, somebody’s going to let me supervise, and it’ll be fine even if I haven’t learned how to do [00:20:00] it.
Dr. Sharp: Yeah. I wonder too, if there’s a dynamic of, it is really easy to be good enough at supervision and we don’t really know if it’s going badly unless it goes really badly. And we have a captive audience. It’s not like therapy or I don’t know, even assessment practice where we can get feedback, like a client will leave or stop coming or post a bad review or something. I mean, unless it’s very clear that it’s not going well, there’s really no feedback mechanism to let us know if we need to get better or not. I don’t know.
Dr. Bryce: Yeah, absolutely.
Dr. Sharp: Well, I would love to talk about some of the things that we could do differently. I think in our pre-podcast conversation we framed it as things that you want to think about before you say yes to supervising. I like that framework. So [00:21:00] let’s dig into that.
Dr. Bryce: When I think about one of the questions to ask yourself when you’re thinking about supervising, it makes me think about one of the questions that you asked in your podcast about taking on a postdoc, which is, what’s motivating you to do this? What’s motivating or interesting you in having a supervisee? And I think something to consider is, do I have time? And also, am I fueled by this? This is something that I enjoy. This is something that interests me. Is there some other force or pressure that’s making me think I need to be supervising?
And I also think sometimes particularly in private practice, people might think about the financial aspects. When we have different levels of supervisees, I think first of all, you have to consider that[00:22:00] it’s oftentimes a training opportunity for them. So it’s not just about the finances.
I also know at our practice, we have an APA-accredited internship, we have postdocs, and then we have prac students, and like I said, staff too, but for the practicum students, for example, they tend not to be revenue-generating folks, at least for what we have them do. They have a minimal amount of clients, have lots of supervisory needs, and those types of things. So, I think just thinking about financially is this feasible and what are you hoping to get from it because that may or may not be possible.
Dr. Sharp: It makes me think of…
Dr. Bryce: Other, oh, sorry. Go ahead.
Dr. Sharp: Yeah, sorry, I just wanted to throw in this. We have this business framework in our practice called Entrepreneurial Operating System or EOS and one of the major tenets of putting anyone in [00:23:00] any position is GWC: gets it, wants it, has the capacity for it. So I think about that a lot with supervision too.
It was like, do they get it? Do they have the skills and the knowledge and so forth to do it? Do they actually want to do it? Would it be meaningful and bring joy? And do they have the capacity for it? Do they have the time, the energy, the wherewithal, and the ability to get better? And if those three things aren’t in place in addition to the financial component, right?
Dr. Bryce: I think that’s a really nice way to frame it. Absolutely.
Other things I think to think about is, do I have training in supervision? Am I current? What do I need to do to be current or stay current- which we already touched on? Practical issue… Oh, Sorry.
Dr. Sharp: I was just going to… I’m sorry. I’ve interrupted you twice now in 30 seconds. How do you qualify training? [00:24:00] Like if someone asked that question, do I have training in supervision? If I asked myself that question, I would say, well, I had that seminar for a year on internship theoretically. So I’m curious, what should the answer to that be?
Dr. Bryce: The answer to that should probably be, I’ve had more than just that seminar. I think if you think about your licensing cycle, have you had any training in supervision since you last had to get licensed or recredentialed or something along those lines.
At our practice, I try to encourage people who are supervising to take at least one supervision course either per year or per licensing cycle depending on how many people they’re supervising or what their experience has been. But there is not, I don’t think a standard in the field of how much constitutes supervision training, which is I think probably part of the problem too, that we haven’t defined very well what that means.[00:25:00] The other practical things I think that are helpful to consider are just can you supervise? Based on your licensing level, based on who the stakeholders are. If you’re trying to bill insurance, are you qualified as somebody who can supervise? For somebody’s school program, would you be considered a qualified supervisor?
The other thing that I think is a big one to consider, which is one of those like, duh, we all know this, but it’s helpful to be reminded, is that as a supervisor, you’re responsible for all of their patients, just as if they were your own patients. So just thinking about like, do I have again, the capacity, the desire to take on that responsibility because that is a big responsibility. Which means that considering time, [00:26:00] that it’s not just going to be the one hour a week or whatever that you have set aside for supervision, that there’s going to be time outside of that.
I think again, on your other podcast about postdocs, you talked about onboarding them and all of the hours that come with getting somebody up and running in your practice or wherever you work. But then week to week, once they are up to speed, it’s going through their notes, it’s watching and reviewing tapes. It’s talking with them about their clients, but also talking with them about their career goals and those types of things. So, it does tend to be more than an hour. And I think you also have to be available for emergencies and those types of things that would happen with their clients.
The other thing, oh, go ahead.
Dr. Sharp: I can’t emphasize that enough, especially with assessment [00:27:00] supervising, you throw in report review and that quickly adds up. So you’re not just doing that hour per week on case consultation. It’s easily two more hours to review reports and all the other things that you mentioned.
Could I ask a very practical question? Since you mentioned reviewing tape, I’m curious about the technology you use to do that. Are you… yes, I’ll just leave it there.
Dr. Bryce: We do it two different ways. And I will say this has been a growth area for us as a practice too. Again, some of the requirements for people’s practicum and internships and things like that always are video, but I think we’ve tried to tighten up what we do as far as observing people because I think if people take nothing away from this, one of them is you have to observe. You can’t just [00:28:00] do supervision based on what they’re telling you coming into the office. There needs to be some level of observation.
And I even think from a legal perspective, if you ever got pulled into court and you said, oh, I’ve never actually observed them. I think that would not go over well, would be my guess. But I think there are two ways we do it:
1) Either live with them in the room. Obviously, the pro of that is that you are just there in real-time. You can feel what’s going on in the room, observe what’s going on in the room, and sometimes give them feedback in the moment if it makes sense. There’s recording and then we’ll also do just sort of like, we’ll zoom into the session. So, I’ll zoom in, but they’ll be in the session either physically or over Zoom. [00:29:00] And that tends to be what we use. So we’ll use Zoom and either have them record on Zoom and then send it through a HIPAA-compliant email server or have them upload it to our Google Drive- that’s the HIPAA-compliant Google Drive.
Dr. Sharp: Sure. Okay. That sounds good. That’s been our approach as well. I keep looking for this magical solution that’s super easy and seamless, but it’s hard to find.
Dr. Bryce: Yeah. If you find it, please, you have to do an episode on it because everybody needs to know how to make it easier.
Dr. Sharp: Right. Let me ask one other question. I’m clarifying a lot of very practical things right now, but you have so many different levels of trainees in your practice. I would imagine you’re familiar with the requirements to supervise at each level. We have doctoral [00:30:00] interns, postdocs, prac students, and with the doctoral interns, there is this guideline that someone has to be licensed for, I think, three years to be able to supervise. Is that right? And does that apply to these other levels as well?
Dr. Bryce: I think that might be a state-specific requirement. I don’t have a great answer for that because I’ve been in the process of doing a little bit of research to see what states are requiring for licensure and for supervision competence, but I haven’t figured that out yet, so I don’t have an answer for that one.
Dr. Sharp: Fair enough. Okay. I promise I will not interrupt you for at least another, oh my gosh, 60 seconds for questions.
Dr. Bryce: No, you can.
Dr. Sharp: So we’re talking about these things people need to keep in mind before they commit to supervising.
Dr. Bryce: Yes. The other thing, [00:31:00] I’ll see in a fair amount of Facebook groups and things like that for people who are interested in supervision, supervising somebody who’s not within their agency, so somebody supervising maybe they can bill insurance under some other type of provider, but for a licensing requirement, they need some other level of supervisor. For example, a social worker maybe could bill under a psychiatrist or something, but then they need to be supervised by a social worker.
I think a practical thing to consider is do you have access to the client information? Are the clients aware that that’s the supervisory arrangement? And because obviously there would be HIPAA Concerns with sharing information with somebody who’s outside of your practice and those types of [00:32:00] things, can you look at their case notes? Can you contact the clients if you need to as a supervisor? So do you have access to them? I think is something again, maybe doesn’t come up as much for people in a group practice, but somebody who’s thinking about supervising somebody who’s located elsewhere.
Dr. Sharp: Yeah, that’s a good one to keep in mind with many details that I may not have necessarily thought about. You talked about the idea in our pre-conversation about a supervisory agreement. Can you say more about that?
Dr. Bryce: Yeah. The basis of supervision is a supervisory agreement or a contract. I think of it as your informed consent for supervision. Just like you would want to get informed consent as a therapist or an assessor for [00:33:00] therapy or an assessment, you would want to have the same thing, which protects both parties, right?
So it really outlines what are the expectations of supervision, what are the supervisor’s level or areas of competence, and areas that they won’t supervise. It outlines really practical things like how often are you supervising. Are you supervising in a group or is it individual? The dates: is it a one-year contract? Is it a one-year placement? Those types of things. Are you supervising somebody because it’s an academic requirement or are you supervising somebody because there was a licensure issue and they need additional supervision, or is it because they want to respecialize? Outlining those types of things is really important in that supervisory agreement.
Dr. Sharp: Yes.
Dr. Bryce: Two other [00:34:00] things that tend to be important to include would be how they’ll be evaluated and how often; how will you give them feedback; what to do if they’re ethical or legal issues; what’s the understanding of confidentiality and what are the limits? So, supervision is not therapy. You as a supervisor, first and foremost, have a responsibility to the patient and to protect the public. So the information that somebody shares with you in supervision may or may not be confidential and private.
Another more common example would just be that I will be talking to your training director in your program and we will be talking to other supervisors about your progress and those types of things. So, [00:35:00] the things that we talk about, again, aren’t completely private and confidential.
Similar to therapy where there’s a power differential; there’s definitely a power differential in supervision, however, I think you alluded to earlier, unlike a therapy or an assessment where they can be like, oh, I don’t really like you, I’m going to stop coming, or I’m just going to fire you, or whatever, supervisees oftentimes don’t have that flexibility particularly when they’re in training. So, what will they do, and how can they manage it if there are issues that arise in supervision, is also really important to outline in that supervisory agreement.
Dr. Sharp: This all sounds good. Is there a place that one could find, not me, of course, but anyone else might be able to find a template for a supervisory contract?
Dr. Bryce: Yes. I’ll give you a few resources. I can email you a few resources after the fact. [00:36:00] If you look on APA and supervisory agreement, they have one that outlines wording and things to include. And then finally, this is probably not that important but important, just making sure everybody signs it just like they would for any other type of contract. Signed by all, talked about, everybody’s been informed. This is what it’s going to look like.
Dr. Sharp: Sure. And I’m guessing that this is something that you may go over in the first session with your supervisee, maybe the first two sessions even.
Dr. Bryce: Absolutely.
Dr. Sharp: Yeah. That makes a lot of sense. Again, this is one of those things, I’m guessing a lot of us do informal supervisory agreements, but it is important to formalize it and have it be a document and have it be a process.
Dr. Bryce: Yes. And in fact, I think there is a [00:37:00] term that I will probably define incorrectly because I did not go to law school, but a term called the standard of care, which basically says there’s an agreed-upon standard in a field that says, this is what we all agree upon as acceptable practice.
The example that I’ve heard used before is like when you go to the dentist’s office, you assume that all of the instruments that they use have been properly sanitized and that they’re using best practices to make sure that it’s clean before they’re putting it in my mouth.
So two things that from, I think a legal perspective right now in supervision would be standard of care. So if you were to have to go defend your supervision in court and you didn’t have these in place, I think it would probably be a problem. But if you didn’t have a supervisory agreement, if you didn’t [00:38:00] observe them at all, if there was no observation and if you haven’t had any training or you couldn’t demonstrate that you have training or competence in supervision, I think those would be the three biggest areas of concern from a legal perspective and supervision.
Dr. Sharp: I think those are super important. So I am going to ask you to say them again for anybody who might have been zoning out and driving or exercising or anything like that. So tell me again, Bryce, what are the three most common ethical pitfalls in supervision?
Let’s take a quick break to hear from our featured partner.
The SPECTRA: Indices of Psychopathology provides a hierarchical dimensional look at adult psychopathology. Decades of research into psychiatric disorders have shown that most diagnoses can be integrated into a few broad dimensions. The SPECTRA measures 12 clinically important constructs of depression, anxiety, social [00:39:00] anxiety, PTSD, alcohol problems, severe aggression, antisocial behavior, drug problems, psychosis, paranoid ideation, manic activation, and grandiose ideation. That’s a lot.
It organizes them into three higher-order psychopathology spectra of internalizing, externalizing, and reality impairing. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. You can learn more at parinc.com/spectra.
All right, let’s get back to the podcast.
Dr. Bryce: So I wouldn’t necessarily call these ethical. I would say these would be legal if you had to go up in court and say I am providing the agreed-upon standard of care. The minimum standard of care is for supervision it’s that there’s a supervisory agreement that I think should be written down and [00:40:00] documented, that you have observed them either live or through videotape- you didn’t just take their word for it, and that you likely have had some, and you can demonstrate training and competence and supervision in some way.
Dr. Sharp: All right. Thank you. You made that important distinction between ethical and legal pitfalls might be a nice bridge into ethical concerns with supervision. We are going to touch on that at some point, so it might as well be now.
Dr. Bryce: Absolutely. So supervisees report that there are a few common ethical pitfalls, I guess you would say, for supervision.
The first thing that they’re reporting or that they report is that the supervisor didn’t monitor the care or their intervention. So they weren’t keeping track of what was [00:41:00] going on with their clients and those types of things. So failure to monitor.
Confidentiality infractions. What I very much appreciate about trainees is they’re oftentimes fresh out of an ethics class. And so, they’re always like, can I use the client’s name? And I’m like, yes, in supervision you can use their name because I look at their notes and I need to know who you’re talking about. But confidentiality infractions.
Inability to explore other perspectives. So being the all-knowing guru type, like, this is how you do it, this is how you must do it, there are no other ways to look at it, those types of things.
Poor session boundaries and disrespectful behavior. So scheduling [00:42:00] privacy- those types of things are things that come up often.
Allowing a supervisee to use a treatment method that a supervisor has limited knowledge in. So, if all of a sudden one of my supervisees, I am trained in primarily kids and adolescents, so if one of my supervisees all of a sudden wanted to take a geriatrics case, I couldn’t ethically supervise that. That’s not an area of training for me. So if I said, oh yeah, go ahead, take it, read about it, good luck. That would be not great.
And then the last time that I presented on this topic, somebody in the audience was formerly An APEC, they were on an APEC committee, which I’m sure has like a really formal name, but sounded like the complaint committee. So, [00:43:00] interns, who had complaints about their APA accredited internship. He was on the committee that managed or dealt with those.
The number one thing that he said that interns would complain about was getting feedback that was a surprise to them. So oftentimes at the end of a term or the end of the year, the feedback might be like, you’re not going to pass this rotation or you’re not going to pass the internship. And that would come as a total surprise to people.
So I think that’s also really helpful for us to consider. If we’re telling people, you’re doing a great job, great, thanks, and then all of a sudden, but actually you haven’t lived up to this, this, this, I have all these concerns, that that should never come as a shock at the end of the quarter or end of the year evaluation.
Dr. Sharp: Mm-hmm. That’s something I would imagine a lot of people are resonating with. Just being in our field, we are typically [00:44:00] very kind or we think we’re being kind by soft-pedaling feedback that may be constructive. It’s such a good reminder that it’s that phrase clear as kind actually, and to just go from the beginning and say when things are not going well.
I’ll just maybe acknowledge that. That has been a huge growth edge for me over the years. And it’s gotten to the point finally where I, in the first one or two meetings with my supervisees will just say like, I’ve learned that being direct is a lot better than not being direct. And so, the danger of that is that I might like be too direct. Let me know if it’s too much, and I’d rather err on that side than not let you know what’s going on and let something ride when it is actually not okay or run the risk of not being as clear as I think I’m being. That’s the disclaimer, just put it out [00:45:00] there. But it’s super challenging. I think we like to give people the benefit of the doubt and, oh, maybe this is a one-time thing, or, oh, they’re getting a little bit better, so on and so forth. And it’s easy to get to the end of the semester and we’re like, ah, this is got to change.
Dr. Bryce: Right. Absolutely. I don’t think that I sent this over to you, but I will. I think we’ve come a little bit as far as being able to provide anchored feedback to people about things. I think I have a handout that has a number of ways that you can assess how the supervisee is doing. And also the flip side of that is to get feedback from them about how you’re doing as a supervisor, which I think is also really [00:46:00] important, and a helpful thing too.
So I think the example that you’re giving is like, I might be a little too direct, or sometimes that comes across wrong, is to check in with them and just say, how was it to hear? I wouldn’t have done it that way or to hear that I think you need to really work on this particular thing. Because I think, again, supervision or supervisory competence is relationship based, right?
So, it’s going to be over the course of a year or six months or whatever, that you’re establishing a relationship with them. And that’s going to be the basis for feedback and those types of things. So in that relationship, you also want to get feedback from them about how this is going just like we strive to with our clients too. So how was this assessment experience for you? [00:47:00] Did I capture what you were asking? How’s therapy going? What’s your experience? Are we talking about the things that you want to be talking about? Those types of things. So I think it’s important to think about getting feedback from the supervisee too.
Dr. Sharp: I love that. I think that’s a really nice segue too to ways that we can do that. That dips into the measurement aspect of supervision and the evaluatory component. But on both sides, are you able to speak to some of that?
Dr. Bryce: Yeah. Again, I’m going to send you a list of some of the tools that you can use. There are some nice tools out there, some that are really short, some that are really long, just like our assessment measures and things like that. Some are really broad. So I feel like many of us are familiar with that [00:48:00] APA competency benchmark for professional psychology. So like, are they at the level that you’re supposed to be at for starting practicum and starting internship and those types of things?
What I find with that as a person who’s in private practice is that there are so many broad areas that I don’t see at all. And then it doesn’t hone in on the skills that I observe or that we’re talking about. So, like I said, I’ll send you this. It has a few. So there are ways that we can provide feedback to the supervisee that they can provide feedback to the supervisor. There are multicultural supervision competency questionnaires. There are supervisory self-assessments. So what are the areas of [00:49:00] competence that you as a supervisor are weakest in and what are you going to do to remediate those?
There are also some ratings of specifically the supervision session so the supervisee can rate after the fact. How did we spend the right amount of time on the things that you wanted to talk about in that supervision session and get just a little bit more process detail-oriented feedback. And then there are a few other scales.
I have not found amazing/updated scales for observing therapy sessions from a cognitive behavioral therapy lens. I have one that I’ve used that we’ve adapted that was really old, I think it was developed by[00:50:00] one of the backs, that you can use to see how well did they set an agenda and those types of things. But I would love it if somebody had some good observation, like observing the therapy session or observing the assessment session measures.
And then there’s another, for supervisors, particularly in like a consultation or supervision of supervision role, that you can videotape your supervision and it gives you feedback on or can get feedback on your supervision.
So there are lots of measures out there. Some of them or a little too wide, in my opinion. And some of them are a little too narrow. So I think it’s finding what you need for your purposes and using that. But it does really help, I think, anchor that feedback that is so hard for us to give, right? Like I think you’re good at [00:51:00] this, and I’m not sure like, No, I think you really need to work on the case conceptualization for this particular case or I think you really need to work on agenda setting, and these types of therapy cases or something like that.
Dr. Sharp: Right. What frequency do you recommend evaluating our supervisees and ourselves?
Dr. Bryce: We should be providing them with some level of feedback at pretty much every supervision, which I think we do informally. Like, I maybe would’ve tried this, or no, I don’t know that that’s exactly what we’re looking at. I think you should take a look at this or why don’t you re-watch this video, or those types of things? So I think that kind of feedback we’re giving them all the time. Schools and training programs tend to require it [00:52:00] to maybe three times a year. I think at our practice, our aim is to provide a little bit more summative feedback quarterly and make sure that we’re watching tapes or observing at least quarterly, if not more.
Dr. Sharp: Oh, sure. That makes sense. I’ll make sure to put all those resources in the show notes that you mentioned; any of these measures that we might be able to use. Is there anything more to say about the process of supervisees giving us feedback, how to manage that approach that encourage it, make it safe?
Dr. Bryce: Yeah. I think the short answer is we as supervisors need to be having those conversations and need to be starting those conversations because of that power differential. The supervisee is not going to say, [00:53:00] Hey Jeremy, I really wanted to tell you. I didn’t like how you said that.
So, I think the burden is on us to start those conversations. And I think it’s in the context of that relationship, like asking them just informally, what’s going well, what’s not going so well? I tend not to offer a ton of readings. Is that a way that you really like to learn about things? How can we make this conducive to your needs and the way that you operate and how can we individualize it?
Yeah, so I think starting the conversation and then having it frequently and being open to feedback, right? So just like we are in, again, assessment or therapy, which sometimes it’s not always positive and you still have to hear it, right? You still have to hear it and listen and [00:54:00] weed through it and see what’s helpful and valid and all of that.
Dr. Sharp: Sure. I do want to spend a little bit of time before we wrap up on the possibility, rather, the reality of remediation plans and what happens when things really don’t go well and how we handle that to encourage the best outcome for the supervisee, but also to protect us a little bit if things go really awry.
Dr. Bryce: Absolutely. Again, I think it’s one of those things that when you get into supervision you’re just like, oh, that’s not really something that I need to be aware of. And in fact, I think it was in 2015 APA came out with some guidelines for the demands of supervision competency. And one of them is being aware of how to manage professional competency problems.
So [00:55:00] I think it’s nice to think, oh, I don’t have to think about that because that’s not going to be a problem. But I think the reality is the more you supervise, the more likely that that is to be a problem. So making sure that you have things in place to help in those situations. But first, I think, if you have a solid supervisory agreement that you can go back on and outline: here were some expectations, here’s where you’re not meeting those expectations. I think the first time that you have the conversation, it usually is informal feedback.
Hey, I noticed that your notes are weeks past due, it says in the supervisory contract or whatever that they need to be done 24 to 48 hours after the session, let’s talk about that. Let’s problem-solve that. And again, for most people, that’s where it ends, because those of us who went to school for as long as we did tend to be [00:56:00] overachievers. And if we get negative feedback, we’re like, okay, I’m going to make this right. But that’s not always the case for people.
So then I think, the next steps are typically to have some type of written plan like a performance plan, a remediation plan again, to protect everybody and also to make sure that it’s really clear: here’s what the expectations are, here’s where you’re not as competent as you’re supposed to be, or here’s where your professionalism is lacking or those types of things.
And then, a typical remediation plan should identify the area that needs remediation, have benchmarks [00:57:00] and timeframes for completion or getting back up to par, plan strategies and activities to acquire the competence, outline who’s going to be responsible for what in as detailed as you can: I’m going to be checking your notes every Wednesday at 5:00 pm. And if there are more than this number of notes missing, there’s going to be some type of consequence or additional remediation. We’re going to be doing this for four weeks, and after the four weeks, then we’ll revisit it and see if we need to do more, assessing what would constitute passing or failing the remediation plan and what the consequences will be.
Again, having a conversation or clarifying what of this is confidential or what I need to report back to your training director, your other supervisors, those types of [00:58:00] things. Making sure that all the people who need to be in on this conversation or in on this conversation and once again, getting signatures from everyone or attempting to get signatures from everyone before moving forward.
The three main areas that people oftentimes are deficient in and the typical helpful remediation plan, the ideas for how to manage that.
The first one is knowledge. So if a supervisee doesn’t seem to have the knowledge that they need to have about something, what tests would I pick for a battery? And they’ve done it several times and they still haven’t been able to do that. So if it’s a knowledge issue, oftentimes we would recommend or [00:59:00] it would be recommended to have them look at books, literature reviews, go to do workshops, additional learning in that regard.
For clinical skills, the common remediation ideas are things like reviewing tapes, role-playing, observing others, and then getting more supervision. So more supervision points of contact throughout the week or whatever. And then for the self-awareness or interpersonal skills, ideas or things like reflective practices, journaling, those types of things, writing down thoughts and feelings and things like that after sessions, pursuing one’s own therapy or sometimes like social skills training would be another remediation idea for those types of things.[01:00:00]Dr. Sharp: Great. Those are a lot of concrete ideas. I find the places where we’ve gotten tripped up in the past with both full-time employees or senior staff or admin staff and trainees is writing these plans and not being specific. So I love that you highlight we do need to be pretty specific and really try to quantify what needs to improve, how we’re going to measure that, when we’re going to measure that, what the timeline is, how much it has to improve. It’s easy to just write a plan that’s pretty vague, and then you really get stuck. Again, just speaking from personal experience, did this person actually do what we hope they were going to do because we didn’t define how we were going to measure it, you know?
Dr. Bryce: Mm-hmm. I think the other thing that made me think about too is just that most people aren’t probably writing remediation plans a lot or having to [01:01:00] come up with performance plans for the people that work for them often. And so I think it’s helpful to have a recognition that it’s okay to ask for help or to get consultation and probably a really good idea too.
So, when therapy cases or assessment cases are going south, most likely, the best practice would be for us to consult with somebody else who’s seen it, who’s done it, who can give us an outside perspective, or whatever. And I think the same thing goes when we’re in these situations because it can turn into something legal. I think showing that you’ve consulted, that you’ve asked other people, that you’ve gotten other people’s opinions and things like that, I think is always just best practice when you go into those.
And it’s not like, oh, I should know how to do this. It’s like, you probably [01:02:00] shouldn’t know how to do this because most of us don’t have to do it all that often. That’s that small percentage of cases, but similar to those high-risk therapy cases or high-risk assessment cases, if you’re not quite sure what you’re doing, getting in touch with somebody who might be more sure of what they’re doing or might be able to give you an outside perspective can be really, really helpful.
Dr. Sharp: I like that you highlight that. It’s funny. It’s got over years of practice ownership. I feel like I’ve come to expect the worst-case scenario. I just immediately, at the beginning of any relationship or situation or hiring or whatever, I’m like, what would happen if this were to be the absolute worst-case scenario?
Dr. Bryce: How can this go wrong?
Dr. Sharp: Exactly. And just getting comfortable with, for me, it’s immediately consulting your liability insurance and doing that free risk management consultation and talking to our HR [01:03:00] person. It’s just a nice one-two punch to make sure you’re covering any basis because employment stuff and training issues aside, just employment issues, I feel like, are these stickiest and most landmine-ridden parts of owning a practice because it gets tricky really fast.
Dr. Bryce: Yeah. And from a training perspective too, I think, again, keeping in mind I’m a gatekeeper to the profession, I’m a gatekeeper to the field. So my complacency with like is this bad enough that I really want to raise flags with their training director or whatever. It’s like the flip side of that is that this person continues to go on and be what is unfortunately called an incompetent psychologist in the field. And there’s a huge risk in that, you know? So I think considering the other [01:04:00] side of that when we’re thinking about, oh, but do I give them the negative feedback or whatever it’s like, but also they could be treating my neighbor’s kid in five years or whatever.
Dr. Sharp: Sure. Well, I appreciate you talking through one of the most rewarding and also one of the most potentially tricky situations or roles that we might play as psychologists. There’s so much good info here in our discussion, and I personally learned a lot. I’m going to be thinking a lot about these things that you’ve shared.
Any parting thoughts or maybe resources for folks who would love to do more training and supervision? What are your go-to options for that sort of thing?
Dr. Bryce: I’ll send you a list of some resources. There was a [01:05:00] really helpful PESI training that I did not too long ago. Now, there’s a sticker shock in that it’s 12 hours, but it’s really nice and goes through in detail and shows examples of a lot of the different things that we highlighted and talked about. And then I think of some books that I can definitely share with you so that everybody can have access to those. I’ll send you a list.
Dr. Sharp: Awesome. Thanks. Well, super grateful for your time. I was excited for our conversation beforehand and even more grateful afterward. Now that we’ve had it, this is so good. There’s so much to take away from this. So thanks for sitting down with me here, Bryce.
Dr. Bryce: Thanks for having me. And like I said, I want people to take away there are a few things that you have to be doing, and then there are other things that I think that people could do make a couple of [01:06:00] different changes and help elevate their supervision and help give trainees a better experience and all those types of things, not to scare people, but also to get people thinking about, okay, am I doing this the way that I should be, am I up to date? Am I up to speed? And how can I get there in easy, manageable ways?
Dr. Sharp: I like that. Well said. Well, thank you again.
Dr. Bryce: Thank you for having me.
Dr. Sharp: All right, y’all, thank you so much for tuning in to this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify, or wherever you listen to your podcast. And if you’re a practice owner or aspiring practice owner, [01:07:00] I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development: Beginner, intermediate, and advanced.
We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
The information contained in this podcast and on the Testing Psychologist website is intended for informational [01:08:00] and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.
Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.