July/Aug 2007

Supervisor, Beware: Ethical Dangers in Supervision
By Claudia J. Dewane, LCSW, DEd, BCD
Social Work Today
Vol. 7 No. 4 P. 34

Both supervisors and supervisees can learn from this comprehensive review of social work supervision issues.

Maintaining professional ethics in the supervisory process can pose unique challenges. The same ethical violations that can occur in a therapeutic relationship can be paralleled in a supervisory relationship. From performance evaluations to dual relationships, the supervisory relationship can be fraught with chances for uncomfortable, inappropriate, and potentially litigious situations. This article will explore ethical concerns in social work supervision, such as the following:

• “My supervisor uses me as a confidante and openly discusses another worker’s shortcomings with me, yet she never approaches the worker about it.”

• “My supervisor degrades me and makes personal comments about me—usually negative—and sometimes in front of other staff.”

• “My coworker reads all day long and doesn’t spend much time working with clients. My supervisor is unwilling to address it and said to me, ‘Mind your own business. He gets his work done. That’s all that’s important.’ It drives me crazy that I end up picking up his slack with clients.”

• “My supervisor passes work on to me even though I am overwhelmed with my own work. She dumps administrative duties on me that she should be performing. If I do them, it’s credit in the bank for me to get favors from her. I don’t like the game, but it does have benefits.”

• “I used to be best friends with a person I now supervise. Do we have to give up our friendship? I don’t see why, as long as it is after work hours.”

• “I’m a supervisor of a domestic violence agency with a shelter program. A new employee reported she is being abused by her live-in boyfriend. She feels she is in danger and would like to enter the shelter and receive counseling with us. What do I do?”

These examples were actual supervisory situations presented in a supervision workshop. Supervisor-employee relationships can potentially be ethical quagmires. Supervisors must be cognizant not only of their employees’ ethical decisions but also of their own ethical behavior. Who supervises the supervisor?

Why is this topic important? The concept of respondeat superior, based on the idea of vicarious liability, holds that a supervisor is responsible for a supervisee’s behavior. We like to think of graduate-level people as professionals, but we all know colleagues or supervisees who may make us think twice about this concept. A supervisor can be held liable for “not identifying inappropriate therapy, ignoring inappropriate behavior, or supervising in a negligent or insufficient manner” (NASW Trust, 2000).

Some employees perceive the sole job of a supervisor as making employees uncomfortable. In an educational sense, that perception is partially true. Supervisors should challenge, confront, and encourage critical thinking. One of the supervisor’s tasks is to provide professional socialization, to not only cultivate skills but also instill professional conscience. Certainly, modeling professional behavior is one way of teaching it.

An ethical concern arises when there is uncertainty or conflict about values. Values are those strongly held ideals, principles, and standards that inform decision making or actions. Generally, values relate more to what we believe; ethics relate more to how we act.

In a therapeutic relationship, ethical concerns can be viewed as an integral part of the helping relationship and can facilitate the therapeutic process. In the spirit of parallel process, ethical dilemmas can also facilitate the supervisory process and can actually be a “teachable moment,” a golden opportunity for personal insight and professional growth.

As social workers, we are fortunate to have the Code of Ethics to guide our practice. Most professional decisions can be framed against that background. How often do workers and supervisors rely on the code? A study (Munson, 2002) examined social work field instructors’ and students’ familiarity with the Code of Ethics. Fifty-nine percent of supervisors could identify code items accurately. The mean score for students was 71.1, demonstrating that the supervisees actually had more knowledge about the code than supervisors.

There is no code of ethics specific to supervision. However, it could easily be argued that every standard applies to the supervisory relationship in some way since a contemporary view in social work is that supervision is actually a form of social work practice and mutual aid (Brashears, 1995).

In addition, social work supervisors have multiple professional resources available to them. The National Association of Social Workers (NASW) has published standards for social work personnel practices and guidelines for clinical supervision. The American Board of Examiners in Clinical Social Work has published position papers on clinical supervision. Yet, there are times when these guidelines and standards differ with agency policy or norm, resulting in an ethical dilemma for the supervisor.

Today’s complex practice settings cause increasing ethical conflicts. Ethical dangers in supervision can occur in both the administrative and clinical aspects of practice. Productivity standards in a managed care environment create ethical compromises for social workers and supervisors when marketing and profit become the principles driving care—one agency gave an employee of the month award based on the number of billable hours.

Supervisors are often in the unenviable position of making difficult decisions about how to do more with less, perhaps even downsizing programs or staff, caused by reduced funding and increased costs. Workers in such an environment are under increased stress, which can lead to poor judgment. Supervisors are the important mitigating force in preventing stress-induced poor judgment.

Suing Social Workers
Historically, the social work profession has not been a major target for malpractice suits. However, the NASW reports that the number of lawsuits, as well as ethics violations and unofficial complaints, brought against social workers has recently increased.

According to the NASW Trust (2000), court awards against mental health practitioners have exceeded $1 million in a single suit. A malpractice suit or formal complaint filed by an injured party is for a wrongful or negligent act or inaction on the part of a social work professional, which deviates from the standards of professional care and results in an injury.

Being sued for malpractice is one of the most stressful events that a social worker can experience. The average claim against a social worker takes at least one year—and typically more than three years—to resolve, and supervisors are often included in suits filed against a worker or agency.

The most frequent classes of suits brought against individual social workers, according to data collected from 1990 to 2005, are ranked below in order from most to least:

• incorrect treatment;

• sexual misconduct;

• suicide or attempted suicide;

• dual relationship (nonsexual); and

• reporting of abuse to authorities.

Typically, clients sue when the following occurs:

• They are disappointed with treatment.

• They blame a negative outcome on incompetence or neglect.

• They get a bill larger than expected.

• They believe they have been exploited (dual relationship).

The Supervisor Squeeze
Supervisors are usually middle managers. Not only do they get caught in the squeeze of trying to help workers and consumers while satisfying agency demands, but they also have to balance legality, fairness, and efficiency. Typically, human service professionals value relationships, so performing this middle-manager balancing act while still trying to maintain relational approval is a recipe for mission impossible.

Most ethical conflicts fall into one or more of the following ethical “D”angers of supervision:

• dual relationships;

• documentation;

• descriptions (position);

• duty to warn;

• dilemmas;

• disciplinary action; and

• discretion.

Dual Relationships
Dual relationships are at the core of many ethical issues. Boundary problems comprise most ethical violations. The supervisor’s job is to manage his or her own attention to dual relationships with supervisees and be on the lookout for potential boundary blurring with supervisees and clients.

A dual relationship exists when a relationship other than a professional one develops. This situation can develop not only between employees and clients but also between supervisors and employees. (e.g., an employee has a side service business that the supervisor would like to use). The supervisor can manage this risk in several ways. Frederic G. Reamer, PhD, illuminates this conundrum in multiple writings (2001, 2003, 2006).

Paralleling the potential blurred boundaries between supervisor and employee are the potential boundary violations that employees commit with clients. Yet most ethical violations are not maliciously intended. Supervisors should be aware of cues to potential boundary violations, which are descriptively listed below by Walker & Clark (1999):

• Strong feelings about clients or extended sessions with clients — a pattern justified by, “This client just needs more time than others.” When personal and professional caring merge, the supervisor needs to address the worker perception and redirect the focus.

• Inappropriate communication during transportation — conversations become less professional, prompted by the informal and private atmosphere of riding in a car. The supervisor should clarify the distinction between case management and therapy services and explore role confusion.

• Off-hours telephone calls — giving out cell or home phone numbers. The supervisor should explore the goals of calls and clarify worker/client role.

• Gift giving — accepting from or giving to a particular client. The supervisor should explore the meaning of the gift and perception of changed relationship.

• Boundary problems in home — Family-based services can create ambiguous situations, and the supervisor needs to explore potentially changed relationships.

• Overdoing, overprotecting, and overidentifying — doing for a client and other signs of enmeshment. The supervisor needs to clarify whether this behavior is for client or clinician need.

• Loans, barter, sale of goods (e.g., buying goods from a client or supervisee) — There should be clear policies and procedures and unambiguous guidelines established.

• Clinician self-disclosure — sharing personal information that is not relevant to therapeutic exchange. The supervisors should explore dynamics of disclosures and potential risks (Dewane, 2005).

• Touching — touch is risky; it can be interpreted as therapeutic or traumatic (Dewane, 2005). Supervisors should confirm clear rules and ramifications regarding physical contact, explore ways of establishing rapport that do not require touch, and provide literature about the topic.

In addition to these red flags, suspicion should be raised if a worker is hiding information from a supervisor. Itzhaky (2000) advises that professional development requires unveiling of “the secret” in supervision.

In some ways, the supervisory relationship is akin to a parent-child, with its concomitant need for approval and avoidance of punishment. Transference/countertransference reactions that we pay attention to in work with clients are just as potent in the supervisory relationship. Schamess (2006) says supervisees can have “intrapsychically determined transference reactions to their supervisors... Because supervisors typically represent surrogate parents, enactments not only reflect supervisees’ unconscious affective responses to patients but also their unconscious affective responses to supervisors.”

Some supervisors can abuse this relationship by exerting undue power or condescendingly playing “Father (Mother) Knows Best” (Kadushin, 1992) with supervisees. One of the most uncomfortable violations is when supervisors, or even field instructors, try to “therapize” a supervisee (Jacobs, 1991). A classic study by Rosenblatt & Mayer (1975) found that second-year MSW students identified four objectionable styles of supervision in field instructors: constrictive (too close), amorphous (too loose), aloof (disinterested), and therapeutic (personal), which was by far the most objectionable.

Peer Today, Boss Tomorrow
Conversely, newly promoted supervisors may find it lonely at the top when they find former colleagues strangely distant. Often, supervisors are promoted from within, where they have had established coworker relationships. Kadushin, in his characterization of the supervisory relationship as “Games Supervisors Play” (1992), summarizes this reality as “they can’t party with the old gang anymore.” There will always be a power differential, making a dual relationship impossible. Kadushin also talks about how supervisors avoid exerting administrative power by pretending that all relationships are egalitarian with the game “I Am Just Like You.”

Duty to Warn
A classic example used regarding duty to warn is that workers who disclose HIV status to third parties violate confidentiality. But by observing that confidentiality, the worker may fail to prevent harm to another party (Reamer, 1998). It is impossible to adhere to both ethics standards.

The following four elements are necessary to explore the mandate of duty to warn:

• a professional relationship exists;

• there is a specific identifiable threat;

• a person has been named as a victim; and

• the professional makes a determination that the patient indeed poses a risk.

The fourth element, a professional judgment, causes the most consternation. This issue of confidentiality vs. duty to warn was aptly discussed by Heer (2006) in the context of domestic violence situations and duty to warn.

Documentation
Documentation serves several functions that supervisors oversee. We have all heard, “If it isn’t written, it didn’t happen.” But what are the consequences? Again, Reamer (2005) points the way: “Careful documentation and record keeping protect practitioners against allegations of ethical misconduct and professional negligence, guard clients’ privacy, and facilitate the delivery of high-quality services.” (p. 326)

Reamer provides guidelines for risk management related to documentation or charting categorized according to content, language, credibility, and access. The Code of Ethics has standards relevant to each. Although the primary reason for documentation should be for good clinical care, we also document for litigious reasons. Social workers should be keenly aware that we are always writing “for an audience.” (p. 331)

Since supervisors can be held liable for indiscretions of staff, if evidence of flawed supervision, perhaps monitoring workers’ documentation is evidence of good supervision. In addition, supervisors should document the date, time, and content of supervision sessions and meetings that address legal/ethical issues.

Descriptions of Job and Disciplinary Actions
At the core of many workplace conflicts are differing expectations. Clear position descriptions provide the opportunity for the supervisor to practice preemptive supervision. Recruitment efforts would be enhanced if ethics discussions were part of the hiring process. Just as we establish contracts with clients, we may consider having employees sign a performance contract so all expectations are clear. Part of that contract should be the employee’s right to routine supervision.

Even inadvertent ethical violations can result in client harm. Small acts of indiscretion are best not ignored by supervisors because they can lead to big violations. Kadushin (1992) talks about workers’ attempts to reduce the power differential inherent in a supervisory relationship when one of the games that supervisees play goes along the lines of “Evaluation Is Not for Friends.”

Performance evaluations should be proactive, not reactive. An employee should never be surprised by an annual summation of their work. Supervision should be presented and perceived as explorative, strength-based (Cohen, 1999), and a tool of professional development, not a punitive mechanism.

Dilemmas, Decision Making, and Discretion
Every day of practice brings a continuous chance for ethical dilemmas confronting both supervisors and supervisees. A supervisor has the responsibility to be well-acquainted with and have employees be familiar with the Code of Ethics. A proactive preventative stance taken by the supervisor would include being aware of not only the code but also the types of cases brought before sanctioning boards.

An educational stance that teaches and follows evidence-based decision-making models is a safeguard. Several models are available in the literature (Reamer, 1998; Berman, 2001). Berman proposes that we look at ethical dilemmas and decisions by examining the consequences of an action, the integrity (value base) of the decision, the protection of the rights of all involved, and the practicality (feasibility) of an action. Reamer suggests drafting and implementing an action plan after identifying the issue along with prioritizing conflicting values and personal biases.

Probably the most important takeaway message from any model is the paramount importance to consult and document. When deliberating a dilemma, consult with colleagues, counsel, and the literature. It is unlikely that your particular dilemma has not been addressed before in some way. Then document your consultations and decision. Regardless of the outcome of your decision, the ability to justify your actions with sound principles and thinking reduces the likelihood of a negative outcome for you or your agency. Sanctioning boards and courts look at the decision making that went into an action, not necessarily the final outcome. The means do justify the end.

Supervisees look to supervisors to solve their ethical issues. Although this job may seem like one of the onerous parts of being a supervisor, it is better than being blindsided by an ethical situation gone awry. Visionary thinking by a supervisor may even consider performing an ethics audit on his or her department or agency (Reamer, 2001). Ethics training should always be provided. And above all, remember that among the games that supervisees play, all play “Follow the Leader.”

— Claudia J. Dewane, LCSW, DEd, BCD, is a faculty member at Temple University’s Graduate School of Social Administration. She is founder of Clinical Support Associates, providing supervision, consultation, and training to professional social workers and has presented numerous workshops on clinical, supervisory, and ethical issues in social work.

References

Berman, E., Bowman, J.S., West, J.P., & Van Wart, M.R. (2001). Human Resource Management in Public Service: Paradoxes, Processes, and Problems. Thousand Oaks, CA: SAGE Publications.

Brashears, F. (1995). Supervision as social work practice: A reconceptualization. Social Work, 40 (5), 692-699.

Cohen, B. (1999). Intervention and supervision in strengths-based social work practice. Families in Society, 80 (5), 460-466.

Dewane, C. (2005). Use of self: A primer revisited. Clinical Social Work Journal, 34 (4), 543-558.

Heer, C. (2006). Ethical issues in domestic violence. Social Work Today, 6(6), 42-46.

Itzhaky, H. (2000). The secret in supervision: An integral part of the social worker’s professional development. Families in Society, 81 (5), 529-537.

Jacobs, C. (1991). Violations of the supervisory relationship: an ethical and educational blind spot. Social Work. 36 (2), 130-135.

Kadushin, A. (1992). Supervision in Social Work, 3rd ed., New York: Columbia University Press.

Munson, C. (2002). Handbook of Clinical Social Work Supervision, 3rd ed., New York: Hawthorn Social Work Practice.

NASW Code of Ethics. (1996). Washington, D.C. NASW Press.

NASW Trust. (2000).Understanding risk management. Practice pointers. Supervision. 1 (4). Retrieved here.

Reamer, F. (1998). Ethical Standards in Social Work: A Review of the NASW Code of Ethics. Washington, D.C.: NASW Press.

Reamer, F. (2001). The Social Work Ethics Audit: A Risk-Management Tool, Washington, D.C.: NASW Press.

Reamer, F. (2003). Boundary issues in social work: Managing dual relationships. Social Work. 48 (1), 121-133.

Reamer, F. (2005). Documentation in social work: Evolving ethical and risk-management standards. Social Work, 50 (4), 325-334.

Reamer, F. (2006). Self-disclosure in clinical social work. Social Work Today, 6 (6), 12-13.

Rosenblatt, A., & Mayer, J. (1975). Objectionable supervisory styles: Students’ views. Social Work, 20(3), 184-188.

Schamess, G. (2006). Transference enactments in clinical supervision. Clinical Social Work Journal, 34(4), 407-425.

Walker, R. & James Clark. (1999). Heading off boundary problems: Clinical supervision as risk management. Psychiatric Services. 50 (11), 1435-1439.