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Clinical Supervision: Legal, Ethical, and Risk Management Issues

Chapter One: Competent and Effective Clinical Supervision-Ten Myths Regarding Clinical Supervision

1. When clinical supervisors view supervision as strictly a review of cases, they ignore one of the key components of what supervision is all about, which is:

A. Skill improvement

B. Professional development

C. Personal advancement

D. None of the above

2. Supervision must be an interactive process between two professionals, and it can only reach its true potential when both parties participate openly and fully.

A. True

B. False

3. During the 70s and 80s, supervision was viewed in very similar terms as psychotherapy, with an emphasis was on self-exploration, self-development, and personal issues.

A. True

B. False

Clinical Supervision

4. Supervision is the process of moving a supervisee to the next level of attainment of skills, which may involve formal training as well as daily feedback, ___________, and refining the approach and techniques that a supervisee employs in the delivery of service.        

A. Restructuring

B. Reframing

C. Reconstructing

D. Reshaping

5. While originally the concept of supervision embodied the concept of professional leadership, the trend later shifted to professional responsibility.

A. True

B. False

Supervisory Competency

6. According to Haynes et al., which of the following is NOT one of the 10 basic elements of a competent supervisor?

A. They are trained and experienced in the areas of clinical expertise being supervised and have effective interpersonal skills

B. They are aware that supervision is a process and can adapt to individual needs as well as assume a variety of roles and responsibilities

C. They stay focused on the fact that the primary goal of supervision is to act as a consultant to the supervisee

D. They have knowledge of applicable laws, ethics, and professional regulations and document supervisory activities

The "Best" Supervisors and the "Worst" Supervisors

7. When surveyed, supervisees identified approachability and flexibility as the number one factors possessed by the "best" supervisors.

A. True

B. False


8. Formal training is a major assumption of supervisory competence, yet many supervisors have had limited or no formal training in, or understanding of, the supervisory process and dynamic.

A. True

B. False

Chapter Two: Models of Clinical Supervision-Administrative vs.Clinical Supervision

9. Administrative and clinical supervision have similar purposes, typically utilizing the same models and having congruent goals.

A. True

B. False

10. The primary goal of administrative supervision is to keep the organization ____________, and to ensure that decisions will be made on the basis of what is good for the system.

A. Functioning

B. Thriving

C. Compliant

D. Manageable

Models of Supervision

11. The ability to identify a particular model of supervision and training in that model of supervision puts the individual in a more comfortable position if ever seated in the witness stand, being deposed, or called before the licensing board.

A. True

B. False

12. The supervisory model that assumes that the supervisor knows very little but will develop skills by "hanging out" with a competent professional and being under close supervision is:

A. The Expert Model

B. The One-Size-Fits-All Model

C. The Parallel Process Model

D. The Apprentice-Master Model

The Interactional Model/Relationship Model

13. With this model, supervision is seen as a way of creating a reciprocal relationship based on mutuality of needs, so that having those needs met in the supervisory relationship would result in needs being met in the client relationship.

A. True

B. False

The Hollistic Model

14. The Holistic Model of Supervision looks at the idea of parallel processes and focuses on providing an atmosphere of:

A. Warmth, empathy, and respect

B. Safety, trust, and learning

C. Accountability, personal awareness, and power

D. Authority, kindness, and direction

Chapter Three: Supervisory Formats and Techniques-Individual Supervision

15. Individual supervision typically relies on the self-report of the supervisee, and there is always the opportunity for conscious or unconscious deception as well as limited or skewed information about what is actually going on in an individual case.

A. True

B. False

Group Supervision

16. Although group supervision has many advantages, it is generally not recommended for students in an assessment practicum where reviewing testing data and test protocols is the focus.

A. True

B. False

Team Supervision

17. Many supervisees have reported that team supervision is a great learning tool, and it may be particularly useful in dealing with problematic supervisees, supervisor/supervisee conflict situations, or dual relationships.

A. True

B. False

Case Consultation

18. The advantage of professionals consulting with with others on cases is that it:

A. Forces practitioners to coordinate information, conceptualize problems, and make assessments

B. It encourages the consultee to consider the larger context and ethical issues in a particular case

C. It enables professionals to decide on interventions in a more organized fashion

D. All of the above

Live Supervision

19. Reviewing recorded sessions with a supervisor with a supervisee promotes self-awareness and:

A. Self-correction

B. Mutual support

C. Competence

D. Open communication

Didactic Supervision

20. While supervisors must focus on case review and improving techniques, professional growth and socialization are also important development opportunities that should be included in the process.

A. True

B. False

Chapter Four: Ethical Issues in Supervision

21. If a supervisor is supervising in an ethical fashion, adhering to all the mandates and criteria spelled out in the ethics code of their profession, then he/she is sure to be supervisong in a legal fashion.

A. True

B. False

22. Supervisors have an obligation to rely on ethical codes to provide a clear answer or direction as to how supervisory activities are to be conducted.

A. True

B. False

23. According to the APA and NASW, core ethical principles include all of the following EXCEPT:

A. Beneficence, service, and fidelity

B. Responsibility, social justice, and integrity

C. Cultural awareness and enrichment

D. Justice and respect for human rights

24. In a study that reviewed disciplinary actions by state boards of psychology over a 15 year period, _____________________________ accounted for the most frequent ethical complaints.

A. Sexual violations or dual relationships

B. Unprofessional and unethical practice

C. Fraud or criminal activity

D. Negligent services

Major Issues Related to Supervision-Competence

25. The definition of competence to supervise usually includes the components of formal education, professional training, and carefully supervised experience.

A. True

B. False

26. NASW Guidelines require that supervisors have two years post masters experience in order to provide supervision.

A. True

B. False

27. Which of the following is NOT one of the elements of supervisory competence viewed across various professions?

A. Training in supervision and having appropriate supervisory experience

B. Competence in dealing with intellectual and emotional issues

C. Acquiring an appropriate level of academic and professional credentials in the area which they are supervising

D. Demonstrating clinical experience in the area being supervised

Due Process

28. An evaluation is a critically important aspect of supervision, and supervisees need to know and may have a legal right to know, in advance, about evaluation criteria and the tools by which they will be evaluated.

A. True

B. False

Informed Consent

29. Clients give informed consent to treatment, and a part of that informed consent is the awareness that the person they're receiving services from operates under supervision.

A. True

B. False

Multiple/Dual Relationships

30. Historically, multiple and dual relationships have been a major area of ethical concern for professional organizations, and the APA ethics committee has reported that over ________ of all ethics cases opened included multiple relationships as one factor.

A. 40 percent

B. 50 percent

C. 60 percent

D. 70 percent

31. A boundary crossing is a term that describes departure from commonly accepted clinical practice that may or may not benefit the supervisee, while a boundary violation is a clear departure from acceptable practice that places the supervisee or supervisory process at serious risk.

A. True

B. False

Supervisor-Supervisee Sexual Relationships

32. Ethics codes have specific prohibitions regarding sexual contact with supervisees and students, and in the case of the American Psychiatric Association, the code states that sexual contact between a supervisor and a trainee or student is always unethical.

A. True

B. False

Socialization with Supervisees

33. While social interaction between supervisors and supervisees may appear to be benign, or even beneficial, these experience may pose some ethical risks and may give the impression of favoritism toward a supervisee.

A. True

B. False

Chapter Five: Legal Issues in Clinical Supervision

34. Being responsible for the actions of others based on being in a position of authority and control is known as:

A. Vicarious liability

B. Indirect liability

C. Secondary liability

D. Collateral liability

35. In order to be considered negligent, the supervisor must intentionally fail to observe the appropriate standard of care as it relates to the supervision,

A. True

B. False


36. Malpractice is professional negligence and is therefore a tort, which is a wrong that involves a breach of a civil duty owed to someone else.

A. True

B. False

37. To establish that a supervisor has acted negligently, each of the following must be established EXCEPT:

A. There was a duty to perform an action as established by the nature of the relationship or by statute

B. There was a breach of the established duty, and direct or proximate causation of the injury

C. Damages occurred as a result of the action of the supervisor, such as physical, financial, or emotional injury or damages

D. There was a professional relationship formed, and the supervisor did not ensure that quality work was performed and clients protected


38. The concept of respondeat superior states that liability attaches to the person who had control of the supervisee at the time of the negligent act and may attach to the actions of agents, representatives, or employees if acting on the supervisor's behalf.

A. True

B. False

39. Many licensing boards have not established standards of proof and often utilize whatever criteria they feel are appropriate given the circumstances in order to protect the public from unscrupulous or incompetent practitioners.

A. True

B. False

Chapter Six: Risk Management Strategies

40. The Top 10 Risk Management Strategies for Supervision recommend that written policies are maintained, that supervisors are accessible, dependable, and available, and that supervisee competence is monitored through:

A. Management guidelines

B. Work samples

C. A supervisor contract

D. Risk assessment strategies

41. One way that supervisors can reduce legal issues is to conduct an initial assessment of the supervisees competence and assign cases that are consistent with their ability and skill level.

A. True

B. False

42. Generally speaking, when a supervisor is dealing with difficult issues with a supervisee such as transference or life style choices, it is better to acknowledge that the issues are more a matter of the supervisor's personal preferences than how the clients or organization will be impacted.

A. True

B. False

43. Effective ways of addressing supervision issues include asking for the supervisee's perception of the problem and:

A. Brainstorming potential solutions with the supervisee

B. Getting feedback from experienced colleagues

C. Reviewing organizational practices with the supervisee

D. Encouraging the supervisee to express concerns through e-mail or other written means to decrease discomfort

44. It is usually more effective and valuable to a supervisee to discuss issues in a broad sense rather than to compartmentalize a problem to one aspect of performance.

A. True

B. False

Chapter Seven: Impairment

45. A serious supervisory responsibility is that of "gatekeeping," and ensuring that individuals who are no longer competent are not harming clients by continuing to practice.

A. True

B. False

46. A supervisor's task as a gatekeeper is to distingush between what is ___________________ versus an impairment .

A. A temporary limitation

B. An oversight due to lack of experience

C. A problem in learning

D. A manageable difference in perspective

47. When a supervisee is experiencing an inability to correct skill deficits, the supervisor should recommend a leave of absence to allow time to correct these issues.

A. True

B. False

Chapter Eight: Evaluation

48. The supervisor's lack of timely feedback has become the most common basis for a formal ethics complaint regarding supervision.

A. True

B. False

49. Evaluation is a four step process, and the initial step of this process should take place:

A. Within the first three months of supervision

B. Within six weeks of beginning the supervisory relationship

C. By thirty days into the supervisory relationship

D. The first time a supervisor and supervisee meet

50. While summative evaluation has a focus of attempting to assist in skill development by identifying issues that impede clinical practice, formative feedback is an objective measure of the competence level of a supervisee based on goals and objectives.

A. True

B. False

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