ABSTRACT
Imagine you are a clinical supervisor in an out-patient psychiatry department of a university teaching hospital One of your interns, a graduate student with training and experience working with infants and children, is providing supportive treatment to a 30-year-old married man. The client’s wife was recently admitted to the psychiatric unit of the hospital and diagnosed with major depressive disorder that began 12 days after the birth of their first child. Her husband reported she had become disorganized, unable to care for the baby, and ultimately attempted suicide. The client is distressed, tired, and overwrought. He is attempting to care for his infant son, while working full-time as an insurance agent in an office In his home. For reasons that are unclear to you or your intern, the client has declined offers of help from relatives. Your primary concerns are the father’s ability to competently care for the child and whether further
intervention is needed. You therefore pay careful attention to your intern’s evaluation and treatment of the client and his family crisis. You are satisfied with your intern’s meticulous assessment of the client’s mental status and descriptions of his feelings toward daily activities with his child. You concur with the Intern’s conclusion that the client is adequately coping with the considerable stress associated with his wife’s condition, the needs of his infant, and his job demands. Your intern follows your recommendation to encourage the client to accept the assistance of home visits from a public health nurse. He complies with this suggestion and a nurse routinely assesses the client’s and baby’s needs. Your intern confers with the visiting nurse and reports to you that despite the unexpected adversity, the client appears to be coping adequately. As a result, you are stunned when the chief resident in psychiatry informs you the client has been arrested for the death of his child and the client’s family members may file a lawsuit against you and the clinic for mismanagement of the fathers treatment and negligent supervision of an intern. You are devastated about the death of the child and filled with fear and self-recrimination when you realize you have not documented your conscientious, detailed, and consistent supervisory conferences with your intern. What do you do now? Supervisors are responsible for their supervisees’ work, unlike consultants, whose contractual arrangements are voluntary and without liability for their consultees’ performance (Schoener & Conroe, 1989). In fact, inadequate or improper supervision is among the most common causes for disciplinary actions by regulatory boards (Association of State and Provincial Psychology Boards, 1998; Reamer, 1995). It is also a growing cause of action in malpractice lawsuits. Nevertheless, many clinical supervisors are unaware of fundamental tasks associated with competent supervision. Among these are the need for written, signed contracts between the supervisor and supervisee that explicitly detail the requirements for mastery of learning objectives, including protecting confidentiality and developing relevant treatment plans. Most supervisors do not put their supervisory contracts in writing, even though misunderstandings about expectations can arise between supervisors and supervisees (Kaiser, 1997). In addition to the lack of contracts, supervisors routinely fail to document supervision sessions in which they describe the client’s assessments, treatment plans, and progress, as well as the supervisee’s performance and where remedial efforts may be needed. Lack of documentation is a serious clinical concern. Without a written chronology of the scope and effectiveness of supervision, supervisors cannot show their reasoning and efforts to improve clients’ emotional and mental health, and, most important, to
prevent harm to clients. As an experienced family therapy supervisor recently lamented: “Supervisors are at the same place psychotherapists were twenty years ago-they don’t understand the importance of documenting their supervision” (W.Bera, 2001, personal communication). The purpose of this chapter is to describe the responsibilities of clinical supervisors, demonstrate how record keeping helps supervisors fulfill their responsibilities, and clarify the characteristics and contents of good supervisory records.
