Fluent Essays

Your textbook discusses multiple stages of development, starting with formal educational training, then continuing education, and on through practices of supervision and consultation. The stages of development could be compared to those of an apprentice, journeyman, and a master of a trade. In your initial post to this discussion, identify at least two practices an ethically focused practitioner would engage in for each of these stages of practice. What are some potential challenges a practitioner might encounter at each stage of his or her professional journey? Cite sources from at least one of the professional codes of ethics and from the course text to support your post. Supervisors’ and Supervisees’ Perceptions of Control and Conflict in Counseling Supervision Christopher J. Quarto ABSTRACT. The purpose of this study was to assess supervisors’ and supervisees’ perceptions of control and conflict in counseling supervi- sion. More experienced counselor supervisees perceived themselves as controlling what occurs in supervision to a greater extent than their less experienced counterparts. Although supervisors and supervisees did not perceive relational conflict to occur on a frequent basis, novice supervisors perceived themselves as experiencing a greater amount of conflict than more experienced supervisors. Participants’ perceptions of control and conflict were related to the strength of the supervisory working alliance. Im- plications of this research and recommendations for future research are dis- cussed. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2002 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Supervision, control, conflict, supervisory relationship The ways in which supervisors and supervisees interact with one an- other have received much attention from researchers in recent years Christopher J. Quarto, PhD, is Assistant Professor of Psychology at Middle Tennes- see State University, Murfreesboro, TN. Address correspondence to: Christopher J. Quarto, PhD, Department of Psychol- ogy, MTSU, P.O. Box 87, Murfreesboro, TN 37132 (E-mail: [email protected]). The Clinical Supervisor, Vol. 21(2) 2002 http://www.haworthpress.com/store/product.asp?sku=J001  2002 by The Haworth Press, Inc. All rights reserved. 10.1300/J001v21n02_02 21 http://www.HaworthPress.com http://www.haworthpress.com/store/product.asp?sku=J001 (Chen & Bernstein, 2000; Efstation, Patton, & Kardash, 1990; Hollo- way, Freund, Gardner, Nelson, & Walker, 1989; Ladany, Ellis, & Friedlander, 1999). Supervisory interaction patterns have been exam- ined from a variety of perspectives including power and involvement (Holloway et al., 1989), power and affiliation (Nelson, 1997) and complementarity (i.e., adapting one’s behavior to fit or “complement” the behavior of the other) (Chen & Bernstein, 2000; Tracey & Sherry, 1993), to name a few. Generally speaking, the results of these studies suggest that supervisory interactions can be characterized by the degree to which each person in a dyad displays and responds to behaviors in- dicative of power/submission and friendliness/hostility. Despite the fact that supervisors hold the formal power in the supervisory relation- ship, this does not mean that they exercise that power independently. It is the evolving interactions that occur between supervisors and supervisees over the course of time as well as other factors such as competence and experience of the participants that permit “shared power” (Muse-Burke, Ladany, & Deck, 2001). The purpose of this study was to examine two aspects of supervisory interaction patterns, control and conflict, as they relate to supervisor and supervisee development and the supervisory working alliance. The way in which supervisors and supervisees interact with one another is thought to be influenced by the developmental level of supervisees, and supervisors play an important role in promoting the growth and develop- ment of supervisees by providing optimal supervision environments (Stoltenberg & Delworth, 1987). Beginning supervisees prefer structure and direction from their supervisors (Worthington & Roehlke, 1979) while advanced supervisees prefer a less structured supervision environment (Heppner & Roehlke, 1984). As such, supervisors may function more as teachers with beginning supervisees and as colleagues with more advanced supervisees (Miars et al., 1983; Wiley & Ray, 1986). What has yet to be verified are the specific types of supervisory interactional patterns that define these environments and their relationship to supervisee develop- ment. Although not as much is known about supervisor development as supervisee development, there are thought to be similarities pertaining to the types of issues with which both struggle. Ellis and Douce (1994) hypothesize that beginning supervisors are more likely than experi- enced supervisors to behave in an overly controlling and structured manner. In addition, given the fact that supervisors are presumed to be “the expert,” beginning supervisors may be more sensitive to perceived threats to their authority by supervisees. Indeed, Muse-Burke et al. 22 THE CLINICAL SUPERVISOR (2001) suggest that beginning supervisors are more likely to exhibit a rigid and demanding interpersonal style as a way of establishing bound- aries with their supervisees. In a similar vein, Alonso (1983) indicates that novice supervisors feel uneasy about having to once again “start from the bottom up” with regard to learning supervisory skills after hav- ing developed a sense of competence as a therapist. The anxiety they experience may be transformed into a feeling of having to control what occurs in supervision as way to “prove” to their supervisees that they are knowledgeable and competent. Nelson and Friedlander (2001) like- wise note that supervisors who are uncertain about their competence to supervise may compensate by becoming competitive with the supervisee or exhibiting other behaviors that demonstrates one’s ability to lead. Two aspects of supervisory interactional patterns concern the degree to which participants in a dyad attempt to control what occurs between them and whether relational conflict occurs when one member of the dyad does not behave in the expected manner. When supervisors pro- vide structure in supervision, they are taking a more active role in the supervisory relationship and exerting a greater amount of relational control. If supervisees “complement” their supervisors by following their leads and otherwise behave in the “expected” manner, then there is a smooth interaction that is productive and indicative of relational har- mony as the dyad agrees on what is to be done (Tracey, 2002). On the other hand, if supervisees do not respond in a way that complements the power or control position of the supervisor, then this would set the stage for conflict. When this type of interactional pattern occurs repeatedly, it signifies that each member of the dyad is vying for a superior position in the relationship so as to determine what occurs in supervision. The aforementioned ideas have some support in the literature. For example, Tracey, Ellickson, and Sherry (1989) found that when ad- vanced supervisees and their supervisors were discussing issues that were not of a crisis nature, advanced supervisees had more positive evaluations of supervision when there was a less structured supervision environment. On the other hand, beginning supervisees preferred struc- tured supervision regardless of what topic (crisis vs. non-crisis condition) was being discussed. These results imply that advanced supervisees are more satisfied with supervision when supervisors do not exert as much control in supervision (given non-crisis topical content). McNeill, Stoltenberg, and Pierce (1985) found differences between beginning and advanced trainees (but not interns) on the dependency/au- tonomy dimension. The implication was that beginning supervisees pre- Christopher J. Quarto 23 fer their supervisors to be in control of what occurs in supervision while advanced supervisees prefer to be more self-directive and share control with their supervisors. Relational conflict in supervision has not been given much consider- ation in the research literature despite the fact that it occurs with some de- gree of frequency. Moskowitz and Rupert (1983) investigated supervisees’ perceptions of conflict in the supervisory relationship. Thirty-eight percent of the supervisees indicated that they had experienced a major conflict with a supervisor with regard to differences in theoretical orientation or approaches to take with clients, the supervisor’s style of supervision, and/or personality clashes. Despite the fact that Moskowitz and Rupert provide helpful descriptive information regarding conflict in supervi- sion, their research is limited from the standpoint of only investigating supervisees’ perceptions. It would have also been helpful to determine whether conflict was more characteristic of supervisees or supervisors who were at a particular level of experience so as to test the constructs of developmental models of supervision. Indeed, Ronnestad and Skovholt (1993) found that relational conflict and dissatisfaction with supervision may occur more frequently with advanced trainees given that these students are accumulating knowledge and experience regard- ing the counseling process but still depend on their supervisors to help them behave professionally in various situations. It is likely that the manner in which supervisors and supervisees in- teract with one another will affect the quality of their relationships and what they accomplish in supervision. In particular, the supervisory working alliance (i.e., the degree to which a supervisory dyad collabo- rates to achieve mutually agreed upon goals and tasks in addition to the strength of their emotional bond) is hypothesized to be a by-product of how control and conflict is negotiated throughout the course of supervi- sion. For example, in a study examining the relationship between complementarity and the supervisory working alliance of two supervi- sion dyads, Chen and Bernstein (2000) found that the supervision dyad with a weaker working alliance tended not to complement one another very consistently (i.e., did not follow one another’s leads when one member of the dyad brought up a topic for discussion), resulting in greater relationship conflicts. This is consistent with the findings of Tracey and Sherry (1993) who found that participants who were part of unsuccessful supervision dyads competed for relationship control as evi- denced by a greater preponderance of non-complementary interactions. It stands to reason that when there is greater harmony in relationships, as reflected by participants following one another’s leads when discussing 24 THE CLINICAL SUPERVISOR topics, there is a greater likelihood that the supervisory working alliance will solidify as there is an implicit agreement on a process level as to how the dyad will interact to achieve their particular goals. Alterna- tively, the supervisory working alliance is more likely to weaken when supervisors and supervisees compete over what is discussed as there is an implicit disagreement on a process level how they will interact to achieve the goals of supervision. The present study focuses on supervisors’ and supervisees’ percep- tions of how they interact with one another using newly developed super- visory interaction questionnaires. The questionnaires were developed in response to a recommendation of Sumerel and Borders (1996) that “[An] instrument, specifically designed to measure interactional styles of super- visors, may be needed to gather more meaningful information [about the process of supervision]” (p. 282). The questionnaires were designed to assess the extent to which participants perceive themselves to control what occurs in supervision and whether they perceive conflict as charac- teristic of their interactions. Control is defined as one’s perceived abil- ity to define and influence how another person behaves with regard to the process of supervision. For example, the supervisee may perceive the supervisor to be in control if the supervisor initiates most of the top- ics for discussion and the supervisee agrees to discuss those topics. Conflict is defined as one’s perceived refusal to behave in accordance with how another wants one to behave with regard to the process of su- pervision. Thus, the supervisor may perceive conflict if the supervisee does not discuss topics that he or she [supervisor] initiates. The research questions were as follows: 1. Will the items that were developed to measure how supervisors and supervisees perceive themselves to interact with one another result in reliable groupings of items (i.e., scales) reflective of either the supervisor or supervisee in a control position or relational conflict? 2. Will more advanced supervisees perceive themselves as exhibit- ing greater supervisory control than their less experienced coun- terparts? 3. Will novice supervisors perceive themselves as exerting greater supervisory control and experiencing greater supervisory conflict than their more experienced counterparts? 4. Will there be (a) a positive correlational relationship between su- pervisory control and the supervision working alliance and (b) a negative correlational relationship between supervisory conflict Christopher J. Quarto 25 and the supervision working alliance regardless of whose per- spective (supervisor or supervisee) is assessed? METHOD Participants A total of 72 supervisees participated in the study. Supervisees were recruited from 48 counselor education departments located in 25 states. The ages of supervisees ranged from 22 to 52 (M = 33.52, SD = 9.02); 78\% were female. The predominant ethnic background of the supervisees was Caucasian (86\%) followed by African American (6\%), Hispanic (4\%), and other (4\%). The highest degree obtained by most supervisees was bache- lors (74\%) and the majority of them were in their second (54\%) or third (24\%) year of graduate school. Supervisees were completing their practicum/internship experiences in a variety of settings including schools (33\%), university counseling centers (28\%), agencies (21\%), university psychological clinics (3\%), or other (e.g., hospital) (15\%). Some supervisees had not completed a full semester of practicum (18\%), although the majority had completed at least one (42\%) or two (18\%) se- mesters (range = 0-6). Seventy percent of the supervisees had one year or less of professional counseling experience (range = 0-10 years). A total of 74 supervisors participated in the study. The ages of supervi- sors ranged from 27 to 65 (M = 44.41, SD = 10.93); 61\% were female. The ethnic background breakdown of supervisees was similar for supervisors. Seventy-three percent of the supervisors had obtained doctoral degrees in counselor education (53\%), counseling psychology (19\%), clinical psy- chology (5\%), or other disciplines (e.g., marriage and family counseling, school counseling, social work) (23\%). A variety of theoretical orientations were represented including eclectic (37\%), humanistic (30\%), cognitive- behavioral (21\%) and psychodynamic (12\%). Supervisors varied in terms of the number of years of experience they had accumulated providing indi- vidual supervision (M = 8.63, SD = 7.32) and counseling/psychotherapy ser- vices (M = 10.00, SD = 8.55). The average number of hours spent per week providing individual supervision was 5.66 (SD = 3.56). Item Writing The initial 27 items on the Supervision Interaction Questionnaire (SIQ) were written to reflect how the constructs of control and conflict 26 THE CLINICAL SUPERVISOR are manifested in the supervisory relationship using the constructs of Tracey and Sherry (1993). In particular, the proposition that complementarity could be determined by who initiates the topic of discussion and whether the other agrees to and follows that topic was an important element in item writing. Within the items, the researcher wanted a sample of behaviors that illus- trated how one participant behaves given a particular behavior of another. For example, if supervisors attempted to engage in some type of control maneuver (i.e., defined what was to be discussed in a supervision ses- sion), then supervisees could respond by agreeing to follow the supervi- sors’ leads or otherwise challenge their attempts for control (i.e., informing supervisors that they wished to discuss another topic instead). There was a deliberate attempt not to include within the items the con- tent of supervisory discussions but, rather, how each person behaved when a topic was introduced (i.e., process-related features). The items were given to an expert (T. Tracey) affiliated with an APA-accredited counseling psychology program for preliminary evalu- ation. The expert noted that most of the items appeared to assess the aforementioned aspects of the supervisory relationship, although a few items were apparently assessing stylistic factors and were subsequently rephrased or deleted. The expert also evaluated whether an item re- flected a complementary interaction with supervisors in the control po- sition (e.g., “I follow my supervisor’s lead when he or she initiates topics during supervisory sessions”), supervisees in the control position (e.g., “My supervisor follows my lead if I decide to change the topic”), or interactions reflective of relational conflict (e.g., “My supervisor and I do not follow one another’s leads when discussing issues in supervi- sion”). Two items were deleted as they did not fit any of these catego- ries. A total of 20 items remained on the supervisee version and 18 items on the supervisor version after this initial evaluation process. The items on the supervisor and supervisee versions are identical save for whether an item is written from the perspective of the supervisor or supervisee. The items were then given to three other supervisors affiliated with APA-accredited counseling (2) and clinical psychology (1) programs for further evaluation. Changes were made with regard to scaling (agree/disagree format changed to frequency format) and the phrasing of a few items. The final version entailed participants rating themselves on the items using a Likert-type scale ranging from 1 (Almost Never) to 7 (Almost Always) with regard to how frequently participants per- ceived certain types of interactions to occur in supervision sessions. Christopher J. Quarto 27 Instrument The Supervisory Working Alliance Inventory (SWAI; Efstation, Patton, & Kardash, 1990) was selected for use in this study to assess the relationship between specific types of supervisory interactions and the supervisory working alliance. The SWAI is designed to measure the na- ture and strength of the supervisory working alliance. This instrument has two versions, one for supervisees and the other for supervisors. The SWAI-Trainee version consists of 19 items and is composed of two scales. The Rapport scale (12 items) measures supervisees’ perceptions of rapport that is developed in the supervisory relationship through sup- port and encouragement that they receive from their supervisors. The Client Focus scale (7 items) assesses the extent to which supervisees perceive their supervisors to help them understand client behaviors and dynamics. The SWAI-Supervisor version consists of 23 items and con- tains the same two scales as the trainee version (7 and 9 items, respec- tively) and a third scale entitled “Identification” (7 items) which assesses the extent to which supervisors perceive that their supervisees are attempting to identify with them (e.g., “My trainee identifies with me in the way he/she thinks and talks about his/her clients”). Alpha coefficients for the SWAI-Trainee version were .90 and .77 for the Rapport and Client Focus scales, respectively. For the SWAI-Supervisor version, alpha coefficients were .73 for Rapport, .71 for Client Focus, and .77 for identification. Strong convergent validity estimates were obtained from correlations between the scales on the two versions of the SWAI and three scales on the Supervisory Styles In- ventory (SSI; Friedlander & Ward, 1984) entitled Attractive, Interper- sonally Sensitive, and Task-Oriented. Procedure Training directors from 125 counseling programs listed in the Coun- cil for Accreditation of Counseling and Related Educational Programs (CACREP) directory were randomly selected and contacted by letter informing them of the nature and purpose of the study. Upon approval of the study, training directors were asked to distribute research materi- als (i.e., a demographic information form, supervisor and supervisee versions of the SIQ and SWAI) to up to three supervisors who were cur- rently providing individual counseling supervision to master’s program practicum or internship students or doctoral program practicum or in- ternship students. Forty-eight training directors granted permission to 28 THE CLINICAL SUPERVISOR conduct the study at their universities, which accounts for a 38\% partici- pation rate. Supervisors who agreed to participate were asked to randomly dis- tribute a questionnaire packet to one of their supervisees. Research par- ticipation was strictly voluntary and anonymity was guaranteed as participants were instructed not to write their names on the question- naires. One hundred forty-two packets were distributed to supervisors and 74 returned completed questionnaires, reflecting a 52\% response rate. Seventy-two supervisees returned completed questionnaires, re- flecting a 51\% response rate. It is important to note that even though supervisors were asked to ran- domly select supervisees to complete the research materials, it is impos- sible to ensure that they followed through with this instruction. Thus, supervisors could have selected their “best” supervisees to complete the questionnaires (in this case, “best” meaning supervisees with whom they experience the least amount of conflict), which would have con- founded the results. Likewise, obtaining results from only half of the re- spective samples of predominantly Caucasian female participants who were enrolled in (or provided supervision on behalf of) counselor edu- cation programs obviously limits the generalizability of the results. The reliability and validity of the obtained information is also suspect given that a limited number of items were included on the questionnaires and that the perceptions of participants were only sampled at one point in time. The aforementioned factors are important to consider when inter- preting the results. RESULTS Factor Analysis An exploratory factor analysis was conducted on the SIQ items; a three-factor solution accounting for 59\% of the variance was judged best in accounting for variation in the data on the SIQ-Supervisee Ver- sion, while a two-factor solution accounting for 42\% of the variance was deemed best for the SIQ-Supervisor Version. The SIQ-Supervisee and Supervisor versions both contain scales that are reflective of the supervisee controlling what occurs in supervision sessions (e.g., “It is up to me/my supervisee to decide when my supervi- sor and I/we finish discussing a particular topic”) and were subse- quently labeled “Supervisee Control.” In addition, both versions Christopher J. Quarto 29 contain scales that assess conflictual interactions or times in which the behavior of one participant does not complement or follow the behavior of the other (e.g., “My supervisor/supervisee and I do not follow one an- other’s leads when discussing issues in supervision”). These scales were labeled “Supervision Conflict.” Finally, the SIQ-Supervisee ver- sion contained an additional scale entitled “Supervisor Control” as the items that loaded highly on this scale measured instances in which su- pervisors dictate how the process of supervision evolves (e.g., “I follow my supervisor’s lead when he or she initiates topics during supervisory sessions”). Reliabilities of SIQ Scales The reliabilities of the SIQ scales were assessed using Cronbach’s al- pha. The alpha coefficients of the three scales of the SIQ-Supervisee version (i.e., Supervisee Control, Supervision Conflict and Supervisor Control) were .90, .83, and .74, respectively. Alpha coefficients for the SIQ-Supervisor version were .86 for Supervisor Control and .74 for Su- pervision Conflict. Supervisory Working Alliance Table 1 presents the correlations among the supervisor and supervisee versions of the SIQ and SWAI. Both supervisors and supervisees perceived supervision conflict to impede the development of the supervisory working alliance. Specifically, participants indicated that supervision conflict is negatively correlated with supervisors build- ing rapport with their supervisees and helping them understand their cli- ents. In addition, supervisors’ scores on the supervision conflict scale were negatively correlated with the Identification scale of the SWAI suggesting that it would be difficult for supervisees to identify with and learn from their supervisors if there was disharmony in their relation- ships. In terms of the control scales, both supervisors and supervisees per- ceived supervisor control to be related to helping supervisees gain a better understanding of their clients. Interestingly, neither supervisors nor supervisees perceived supervisor control of what occurs in supervi- sion to be related to developing rapport with their supervisees. In addi- tion, supervisors did not perceive supervisor control to contribute to supervisees being able to identify with them. Supervisees perceived a stronger relationship between their taking charge of what occurs in su- 30 THE CLINICAL SUPERVISOR pervision and supervisors building rapport with them by providing sup- port and encouragement. Experience Effects–Supervisors A one-factor analysis of variance (ANOVA) was conducted to deter- mine whether supervisors’ ratings of control and conflict in supervision varied according to their respective levels of experience providing su- pervision. Supervisor experience levels were based on years of experi- ence providing individual supervision to supervisees (Level 1 = 0-2; Level 2 = 3-5; Level 3 = 6-15; Level 4 = 16-28). The results indicated that the amount of experience providing supervision to supervisees was a significant factor with regard to supervisors’ perceptions of how much conflict occurs in supervision, F (3, 69) = 3.67, p = .01. The results of Tukey’s Honestly Significant Difference tests indicated statistically significant differences (at the .01 and .05 levels, respectively) between Level 1 (M = 2.33, SD = .73) and Level 3 (M = 1.79, SD = .44) supervi- sors and Level 1 and Level 4 (M = 1.80, SD = .41) supervisors. Spe- cifically, Level 1 supervisors perceived a greater amount of supervisory conflict than their more experienced counterparts. No experience-re- lated effects were found on the Supervisor Control scale. Experience Effects–Supervisees A one-factor analysis of variance (ANOVA) was conducted to deter- mine whether supervisees’ ratings of control and conflict in supervision Christopher J. Quarto 31 TABLE 1. Correlations Among the Supervisor and Supervisee SIQ and SWAI Scales SIQ-Supervisee Factor Scales SWAI Supervisee Scales Rapport Client Focus Supervisee Control .29* .10 Supervision Conflict �.80** �.58** Supervisor Control .17 .45** SIQ-Supervisor Factor Scales SWAI Supervisor Scales Rapport Client Focus Identification Supervisor Control �.10 .37* .05 Supervision Conflict �.41** �.39** �.28* Note. *p < .05. ** p < .01. varied according to their level of counseling experience. What consti- tutes “counseling experience” has been the subject of much debate. Es- sentially counseling experience level should be based on more than one criterion (McNeill, Stoltenberg, & Pierce, 1985). In the present study, counseling experience level was determined using two variables: the number of fully completed semesters of practica and the number of years of professional counseling experience. The data that comprised these two variables were summed for each supervisee and three catego- ries of experience level–beginning, intermediate, and advanced–were created based on these summed scores. The results indicated that counseling experience is a significant fac- tor with regard to supervisees’ perceptions of how much control they exert in supervision, F (2, 69) = 4.27, p = .01. The results of Tukey’s Honestly Significant Difference tests indi- cated statistically significant differences (at the .02 and .03 levels, respec- tively) between beginning and advanced supervisees and intermediate and advanced supervisees. Specifically, advanced supervisees perceived them- selves to be exerting more control in supervision (M = 4.86, SD = 1.01) in comparison to their less experienced peers (beginning supervisees, M = 4.35, SD = .92; intermediate supervisees, M = 4.16, SD = 1.01). DISCUSSION The results of this study indicate that supervisors and supervisees perceive distinct dimensions relating to control and conflict in counsel- ing supervision. Specifically, both supervisees and supervisors indi- cated that there are times in which supervisors control what occurs in supervision. In addition, they both admitted that conflict occurs on an occasional basis but is not a typical feature of the supervisory relation- ship. Only supervisees perceived a supervisee control dimension. This finding suggests that supervisees have a broader view of control than supervisors and perceive themselves to play an … 267 C H A P T E R 11 Efficacy of Treatment Michelle: Hi, Lynn. Do you have a minute? Lynn: Sure, Michelle. What’s up? Michelle: I’ve been working with this girl, Maria, and we have a real good working relationship, but I just don’t feel like I have a true grasp of what is going on or that I am approaching this situation the best way. I explained this to Maria, and she has given me written permission to speak with you about the case. I know you are really busy, but I was hoping that you could provide some supervision around this case to see if you feel like I’m on the right track and using the best approach. W hile our counselor, Ms. Wicks (Michelle), is certainly skilled and trained professionally, her real interest and concern for her client and her own self-awareness of the limits of her expertise have led her to seek consultation from a colleague. Approaching helping with the essential training and experience is an ethical must. However, beyond this initial training, ongoing professional development, consultation, and supervi- sion are the hallmark of the ethical professional. The ethical responsibility to be competent extends beyond the basic credentialing of a helper and includes the helper’s ability to employ treat- ment strategies that are efficacious. It is these issues of treatment efficacy and helper competency that serve as the focus for the current chapter. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 268–●–ETHICAL PRACTICE IN THE HUMAN SERVICES The chapter will review the ethics and legality surrounding the issue of competent practice and efficacy of treatment. The value of professional train- ing, action research, and referral as elements of competent practice will be highlighted. After reading this chapter you should be able to do the following: • Describe what is meant by the term competence. • Discuss the role of continuing education, ongoing supervision, and con- sultation in the continuous development of professional competence. • Describe the value of approaching practice from a reflective, action research orientation. • Discuss the conditions under which referral would appear to be the most efficacious treatment decision. • Describe legal considerations and concerns in relation to the issue of helper competence, standard of care, and treatment efficacy. ● OBJECTIVES ● PRACTICING WITHIN THE REALM OF COMPETENCE The ethical professional is called upon to accept responsibilities and employ- ment on the basis of competence and professional qualification. Table 11.1 provides the position taken by a select group of professional associations on the issue of professional practice and competency. What should be evident by reviewing Table 11.1 is that each of these organizations supports the notion that one should not engage in practices that require skills beyond those possessed. To be ethical as a helper requires that competency be developed and maintained and that the helper’s competence level be repre- sented accurately to clients, employers, and the general public. Competence Being competent means that the helper has the knowledge, skills, and abilities needed to perform those tasks relevant to that profession. To sug- gest one is competent implies that the individual is capable of performing a minimum quality of service that is within the limits of his or her training, experience, and practice, as defined in professional standards or regulatory statutes. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 11. Efficacy of Treatment–●–269 Table 11.1 Ethical Codes Addressing Helper Competence Professional Organization Ethical Principle/Standards American Counseling Association (2014) C.2.a. Boundaries of competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, dispositions, and skills pertinent to being a culturally competent counselor in working with a diverse client population. American Psychological Association (2010) 2.01. Boundaries of competence a. Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. American Association for Marriage and Family Therapy (2015) 3.10. Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies. National Association of Social Workers (2008) 4.01. Competence c. Social workers should base practice on recognized knowledge, including empirically based knowledge, relevant to social work and social work ethics. Ethical principle: Social workers practice within their areas of competence and develop and enhance their professional expertise. Social workers continually strive to increase their professional knowledge and skills and to apply them in practice. Social workers should aspire to contribute to the knowledge base of the profession. 1.04. Competence a. Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience. b. Social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 270–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Competence is defined in relative terms; that is, rather than having one clear, objective standard against which to judge a professional’s level of performance as competent or incompetent, competence is most often defined using the conduct of others within the profession as the compara- tive standard. Thus, one might ask, what would a reasonable person do in a similar situation? ● PROFESSIONAL DEVELOPMENT: KNOWING THE STATE OF THE PROFESSION Competence can be developed from formal training as might be found in graduate training or training for certification and licensure. Further, one’s own ongoing continuing education, professional reflective practice, and supervision may serve as additional resources for developing and maintain- ing competence. Formal Training Formal training occurs both at the undergraduate and graduate levels of study. Foundations of general knowledge of helping theory and skills along with research supporting intervention strategies may be acquired through undergraduate and graduate course work. However, in addition to these cog- nates, the competent practitioner must have guided practice in the applica- tion of this knowledge. In many disciplines (e.g., psychology), the doctorate along with supervised field and intern experiences is considered essential to competent independent practice. For most of the helping professions, professional organizations and/ or certifying and licensing bodies have identified both aspirational levels and mandatory levels of training as a way of defining competence. Each of these levels of governance monitor the development and application of professional practice. Colleges and universities often offer programs of training that have been shaped by the professional standards under the review of professional accrediting organizations. Professional accrediting bodies (e.g., American Psychological Association, Council for the Accredi- tation of Counseling and Related Educational Programs [CACREP]) qualify educational programs as meeting standards beyond those demanded for col- leges or universities to offer degrees and certify that these programs meet high professional standards, thus establishing the foundation for ethical practice. Beyond these school-based programs, professional organizations Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 11. Efficacy of Treatment–●–271 (e.g., American School Counseling Association, American Rehabilitation Counseling Association, Academy of Certified Social Workers) often develop aspirational codes of ethics, which while not having any internal mandatory enforcement mechanism, call their members to perform at the highest level of professional practice. Beyond the professional organization level, the professional regulatory bodies at the state and national level promulgate and enforce standards of practice through the establishment of certification and licensure standards. Often these requirements exceed those demanded for entrance into the pro- fession, requiring additional post degree experience and supervision. The definition of minimum professional training for entry-level helpers as well as the mandate to remain up-to-date on the state of the profession through continuing education varies from state to state. It is essential for the ethical helper to be knowledgeable about these standards (see Exercise 11.1). Being an ethical, competent practitioner requires not only a basic level of initial training but also the development and maintenance of this knowl- edge and these skills via continuous professional growth. The ethical helper continually strives for increased competence. The ethical helper strives to increase his or her competence by continuing to develop his or her skills and understanding of the helping process. Exercise 11.1 Licensing and Certification Requirements Directions: Since the requirements defining minimum requirements for competent practice vary from profession to profession and in many instances from state to state, it is helpful for you to be aware of the specific requirements for entrance into your particular field of practice. Step 1: Identify two arenas for professional practice (e.g., school counselor, psychologist, marriage counselor, clinical social worker, etc.). Step 2: Identify two states, one in which you intend to practice and a neighboring state. Step 3: Contact each state’s department or bureau of professional license and practice. Step 4: Complete the following grid. (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 272–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Practice Specialty 1 Practice Specialty 2 State Home State Neighboring State Home State Neighboring State Minimum Education (bachelor’s, master’s, master’s + doctorate) Supervised Experience (internship, practice, etc.) Post Degree Requirements (course work, field experience, etc.) Other Requirements (Continued) Continuing Education All the codes of conduct call for practitioners to be current with emerg- ing knowledge relevant to their professions (see Table 11.2). It is incumbent upon the ethical practitioner to upgrade knowledge and skill by participat- ing in continuing education experiences. Continuing education may be in the form of trainings through a professional conference or additional course work at the local university or courses taught through qualified associations and organizations. While the call for ongoing education and professional development is clear, the specifics are still lacking. Does this suggest a certain number of courses? Credits? Hours of supervision? Many organizations and state licensing and certifying bodies require that a number of continuing edu- cation hours be completed within a number of years. For example, in Pennsylvania, all licensed marriage and family therapists seeking renewal of their licenses are directed to gain 30 hours of continuing education every Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 11. Efficacy of Treatment–●–273 Table 11.2 Maintaining Professional Development Professional Ethical Standards Statement on Professional Development American Association for Marriage and Family Therapy (2015) 3.1. Marriage and family therapists pursue knowledge of new developments and maintain their competence in marriage and family therapy through education, training, and/or supervised experience. American Counseling Association (2014) C.2.f. Counselors recognize the need for continuing education to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. Counselors maintain their competence in the skills they use, are open to new procedures, and remain informed regarding best practices for working with diverse populations. American Psychological Association (2010) 2.03. Maintaining competence psychologists undertake ongoing efforts to develop and maintain their competence. National Association of Social Workers (2008) 4.0.l.b. Social workers should strive to become and remain proficient in professional practice and the performance of professional functions. Social workers should critically examine, and keep current with, emerging knowledge relevant to social work. Social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics. two years (http://pamft.com/for-professionals/licensure/faq/). Similarly, the State Board of Licensing for Psychologists in Pennsylvania requires psychologists to complete 30 hours of approved continuing education every two years in order to maintain and/or renew their licenses. While the spe- cific requirements vary across professions (e.g., marriage counselor, school psychologists, clinical social worker) and from state to state, similar demand for maintaining competence is built into all certification and licensing requirements. It is important for each practitioner to be aware of the stan- dards set by his or her own professional organization or those required for relicensing or recertification within the state where they intend to practice. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 274–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Supervision and Consultation Practicing within the realm of competence starts with a practitioner operating within the scope of practice. Practitioners are ethically bound to restrict their professional activities to the professions and specialties for which they have been trained and supervised. When required, they must possess the appropriate certification and licensure. Practicing within the realm of competence also means knowing when it is essential to consult and/or refer to another professional who has more experience and training with this particular type of client and or problem. The use of peer consultation, in which specific concerns can be shared with an experienced colleague, is a valuable means for maintaining compe- tence. Peer consultation may be useful in enhancing the clinical care of the client as well as acting as a risk management tool for the helper by provid- ing trusted resources (Gottlieb & Younggren, 2009). Peer consultation can provide mutual support for problematic cases. However, when consulting with colleagues regarding a client, the ethical practitioner needs to balance the need for his or her own continued support with the client’s right to maintain confidentiality. The American Psychological Association’s (APA) ethical standards, for example, state: When consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identifi- cation of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of consultation. (APA, 2010, 4.06) Even with this sensitivity to the requirements of confidentiality, the ethi- cal helper can employ a peer consult to formulate the problem, review the decisions made, and tap a different point of view on the process. Often a colleague with more experience can provide some clarity about the helping process and may even assist the practitioner to develop additional insights or adjustments in the treatment process. Consulting with a professional peer not only provides the helper a valuable resource for expanding his or her knowledge and skill but also can also serve as a valuable check and balance for the helper when the boundaries of competence may be exceeded. This is especially true when the helper’s own objectivity may be blurred (see Chapter 10). Under these Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 11. Efficacy of Treatment–●–275 conditions, the peer consultation can provide a mechanism for examining the ethical and professional issues involved (Gottlieb & Younggren, 2009). For those working within certain clinical settings, formal peer review may be incorporated as a way of maintaining professional competence and standards of care. For those serving in an independent practice, it would be valuable to develop a network of colleagues who can continue to serve as peer consultants. THE STANDARD OF CARE: APPROPRIATE TREATMENT ● Most malpractice cases turn on the question of negligence (Bennett, Bryant, VandenBos, & Greenwood, 1990). Negligence implies that the practitioner failed to meet the relevant standard of care. According to Bennett and col- leagues (1990), the question of negligence will be determined by the debate over the clinical connectedness and efficacy of the treatment that was given, along with the practitioner’s judgment in choosing it (p. 33). While there is no single prescribed way to conduct “helping,” ethi- cal guidelines establish some standards of care that must be followed. For example, sexual intimacies with clients are prohibited. Further, innovative therapy involving physical contact with clients can be the basis for malprac- tice suits, particularly when the contact is extreme (e.g., hitting, choking). While these are extreme examples that most mental health providers will not encounter, failure to properly administer and interpret tests and inven- tories, failure to warn to take appropriate steps in the face of homicide and suicide, and failure to employ appropriate methods and forms of treatment may be areas in which helpers are more likely to fall short of recognized standards of care, failing to provide appropriate treatment. Defining an Appropriate Treatment Standards of practice have not specifically been identified. There are no preordained directives for what must be done under each condition of helping. The standard of care and the definition of appropriate treatment are typically determined by comparing the practitioner’s performance with that of other professionals in the same community with comparable training and experience. There is an evolving sense of what should prevail, and it is the standard of what a reasonable and prudent practitioner may do in situations like this that sets the standard of care (see Exercise 11.2). Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 276–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Exercise 11.2 Standard of Care: A Reasonable, Prudent Response Directions: Below you will find two clinical scenarios. Read each situa- tion and contact two mental health providers in your local community and ask them what they would do in this situation. Situation 1: You are treating an individual diagnosed with AIDS. This individual has informed you that he is in and has been in a long-term relationship. The client also has informed you of the name of his partner, with whom he lives. In your most recent session, your client informs you that not only is he engaging in unprotected sex with his lover but that he has not informed his lover that he has AIDS. What do you do? Do you inform the lover? Situation 2: You have been seeing a couple for marriage counseling. You receive a subpoena for your records on the case from one partner’s lawyer. What do you do? Do you respond to the subpoena? How? Reflections: ● Did the two practitioners essentially agree on the steps to be taken? ● Did their responses seem to be in line with what you have read about confidentiality, duty to warn, informed consent, and so forth? ● Share your findings with a classmate/colleague who may have performed the exercise. Does there seem to be consistency in practitioner response that could be interpreted as a definition of standard of care? Share your findings with your classmates or colleagues. Employing Effective Treatments Beyond a generic standard of what a reasonable and prudent practitioner may do, attention has been drawn to the importance of employing tried-and- true techniques and strategies of intervention. A number of professionals and professional organizations have called for use of effective treatments, as have consumer groups. The ACA Code of Ethics, for example, notes, “Counselors have a responsibility to the public to engage in counseling practices that are based on rigorous research methodologies” (ACA, 2014, Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:51:29. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 11. Efficacy of Treatment–●–277 Introduction Section C). Or even more specifically, “When providing ser- vices, counselors use techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation” (ACA, 2014, Principle C.7.a). A similar directive is found within in the National Associa- tion of Social Workers’ (NASW) Code of Ethics, which notes, “Social workers should base practice on recognized knowledge, including empirically based knowledge, relevant to social work and social work ethics” (NASW, 2008. Principle 4.01.c). Thus, it is firmly rooted in our codes of ethics that coun- selors use techniques that are empirically based. It is clear that the ethical helper needs to be aware of the current research on treatment effectiveness and employ these strategies when and where appropriate. Defining Efficacious Providing the most effective treatment available requires professionals to keep current on the research on treatment effectiveness for their particu- lar client populations. In line with this need to identify and employ effective treatment strategies, the Task Force on Promotion and Dissemination of Psychological Procedures (1995) from the division of clinical psychology within the APA, developed criteria for determining whether a treatment should be considered empirically valid. The task force also established a list of inter- ventions that have been “well established” and a list that are “probably effica- cious,” citing the literature that supports this claim (Chambless et al. 1998). A review of those treatments that prove effective suggest that they share the following characteristics: These interventions are targeted to spe- cific problems, incorporate continuous monitoring and assessment, involve client skill development, and are generally brief, requiring 20 or fewer ses- sions (O’Donohue, Buchanan, & Fisher, 2000). As the professions and the research identify specific strategies with dem- onstrated effectiveness, these interventions become the standard of care. As such, it is essential for the ethical practitioner to not only be aware of this research and these techniques but to develop the competency required for the ethical application of these strategies. Managed Care: Compounding the Standard of Care Issue The issue of treatment efficacy is of special consideration when a prac- titioner is operating within a managed care situation (Cohen, Marecek, & Gillham, 2006). With managed care pushing for brief, more cost-effective Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) … 297 C H A P T E R 12 Evaluation and Accountability Dr. Flournoy: Hello, Ms. Wicks? Ms. Wicks: Yes. Dr. Flournoy: I am Dr. Flournoy from Children and Youth Services. Ms. Wicks: Hello. Dr. Flournoy: The Ramerez family has been referred to our service, and I understand that you have been working with Maria, here at school. I have requested that your counseling records be subpoenaed, and I simply wanted to let you know ahead of time, so that you could begin to get them in order. C ounseling records? Subpoenas? For some mental health practitioners the idea of maintaining records may be an anathema to the nature of the helping process. Further, the invitation to disclose these records as a result of a simple request, subpoena, or court order can arouse debilitat- ing anxiety. The need and ethical responsibility of keeping and maintaining records along with the inherent conflict that may exist when disclosure of these records is requested serves as the focus for the current chapter. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 298–●–ETHICAL PRACTICE IN THE HUMAN SERVICES ● OBJECTIVES The chapter will introduce you to the importance of maintaining records as both a measure of professional accountability and an essential step toward demonstrating ethical practice. After reading this chapter you should be able to do the following: • Describe the benefits of utilizing a system of evaluation within one’s practice • Define the terms formative and summative evaluation • Describe one approach to measuring outcome and goal achievement • Identify the minimal records necessary for demonstrating competent, ethical practice While it is true that no one professional can guarantee success in each and every encounter, the ethical practitioner will monitor services and adjust as required. Such a monitoring—or evaluation—be it through the informal collection of data or more formal forms, can offer direction and serve to demonstrate accountability. However, for some helpers, the concept of evaluation may be viewed as superfluous or tangential to the primary function of helping. While there is abundant evidence of the need for all mental health professionals to be able to demonstrate client progress and treatment effectiveness to the stakeholders they serve (Astra- movich & Coker, 2007), the use of a well-developed system of practice assessment simply makes good practical sense. Such a system of assess- ment and accountability not only highlights the reality of the terminal nature of the professional relationship and provides a reference point for knowing when the process has achieved its desired end (i.e., summative evaluation), but it also provides markers to guide the process (i.e., forma- tive evaluation) and thus ensure it remains on target for goal achievement. When viewed through the lens of accountability, to the client and the profession, an eval uation system becomes an essential ethical practice (see Table 12.1). ● MONITORING AND EVALUATING INTERVENTION EFFECTS Evaluation is often thought of as something that is done at the end of a process. As suggested above, for evaluation to be prescriptive it needs to be ongoing and formative as well as summative in form. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 12. Evaluation and Accountability–●–299 Table 12.1 Ethical Positions on Record Keeping Professional Organization Position on Record Keeping American Counseling Association (2014) B.6. Records and documentation a. Creating and maintaining records and documentation Counselors create and maintain records and documentation necessary for rendering professional services. b. Respect for confidentiality Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification. American Psychological Association (2010) 6.01. Documentation of professional and scientific work and maintenance of records Psychologists create, and to the extent the records are under control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional and scientific work in order to (1) facilitate provision of services later by them or by other professionals, (2) allow for replication of research design and analysis, (3) meet institutional requirements, (4) ensure accuracy of billing and payments, and (5) ensure compliance with law. 6.04. Maintenance, dissemination, and disposal of confidential records of professional and scientific work a. Psychologists maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, or in any other medium. b. If confidential information concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not be consented to by the recipient, psychologists use coding or other techniques to avoid the inclusion of personal identifiers. c. Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice. American Association for Marriage and Family Therapy (2015) 2.5. Marriage and family therapists store, safeguard, and dispose of client records in ways that maintain confidentiality and in accord with applicable laws and professional standards. (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 300–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Professional Organization Position on Record Keeping National Association of Social Workers (2008) 3.04. a. Social workers should take reasonable steps to ensure that documentation in records are accurate and reflective of services provided. b. Social workers should include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of service provided to clients in the future. c. Social workers’ documentation should protect clients’ privacy to the extent that is possible and appropriate and should include only information that is directly relevant to the delivery of services. d. Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statues or relevant contracts. Table 12.1 (Continued) Formative Evaluation Formative evaluation is evaluation that occurs as an ongoing process throughout the helping encounter. It is the gathering of feedback and data used to expedite decision-making about the current process and the upcom- ing steps and procedures to be employed. It pro vides data that give form to the ongoing process. The means of collecting formative data can range in degree of formality. For example, a practitioner may choose to use a structured survey or questionnaire at various points in the helping encounter. Or more infor- mally, the practitioner may simply set time aside to solicit feedback from the client about his or her experience in the relationship with the helper and the pro cedures employed up to this par ticular point (see Case Illustration 12.1). Case Illustration 12.1 Formative Evaluation Dr. Brown: First let me tell you how much I appreciate your open- ness and willingness to share with me some of your concerns about your social relationships and your desire Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 12. Evaluation and Accountability–●–301 to become more assertive in these. I feel very comfort- able working with you and feel that the things we have talked about in this first session have really helped us to clarify your goal and even begin developing a strategy for getting there. I think it may be helpful if we took a moment to share our perceptions on this session as a way of making future sessions more productive. I would be very inter ested in receiving your feedback about our session today. Jim: To be honest, I was very nervous when I made the appointment. However, I am really surprised how much I shared. I really feel like I can trust you. I feel very comfortable speaking with you, and that is not my style, usually. Dr. Brown: Well, that is very nice to hear, and I know from what you told me that you tend to be a private person. Jim, as you are aware, we will probably want to talk more about your fam- ily background and previous relationships as our sessions go on. How do you feel about that? (Dr. Brown checks Jim’s understanding of the help ing process.) Jim: I know that probably needs to be done. It makes me a little anxious, but as I said, I do feel comfortable with you and trust you, especially how you explained the idea of confidentiality, I just may need to go slow. Dr. Brown: That’s good feedback for me. The pace of the sessions really will be the one that feels right for you. So if we need to go slow, we will. If you want to dive into something and it seems right to me, we will. I think as long as we continue to “process” how we are doing, we can make sure we stay on track at a pace which is both productive and comfortable. (Dr. Brown checks Jim’s comfort level and takes direction.) Jim: Yeah, me too. Dr. Brown: So, while overall you are hoping to get some help with developing assertiveness skills, our immediate goal is for you to take notes on two incidents: one in which you felt you were assertive and one in which you felt (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 302–●–ETHICAL PRACTICE IN THE HUMAN SERVICES For this evaluation to truly form and give shape to the decision-making pro- cesses, it should begin with the first session. As evident in Case Illustration 12.1, the helper engaged in for mative evaluation within the first session. The approach taken by this helper provided insight into the client’s level of comfort with the interaction and his ability to engage col laboratively in the helping process. This evaluation also served as a check on the accuracy of the helper’s understanding regarding the desired goals and outcome for the helping process. The use of such a formative evaluation not only provides for helper accountabil ity but also provides the data for monitoring and increasing efficacy of treatment. Summative Evaluation Summative evaluation is the type of evaluation most typically thought of when considering goal or outcome assessment. The specific purpose of summative evaluation is to demonstrate that the action plan has reached its original objective. Summative evaluation provides the helper and the client data to determine (a) if the original goals were achieved, (b) the factors that contributed to this goal attainment, and (c) maybe even the value of this strategy versus some alternative. The articulation of clear treatment goals and the employment of summative evaluation strategies serve as invaluable sources for demonstrating treatment efficacy and helper accountability. The presence of clearly articulated goals or outcomes is essential for both formative and summative forms of evaluation. Without a clear, shared vision of where the helping process is going, it will be hard to know if it is on track or even if it has arrived. Thus, the establishment of treatment goals and objec- tives, the identification of outcome measures, and the maintenance of appro- priate responsible records serve as keystones to ethical and efficient practice. Setting Treatment Goals and Objectives While it may seem obvious that the counseling relationship and process is neither totally open ended nor aimless, as a professional encounter, our helping very unassertive. Are these the goals we agreed on? (Dr. Brown checks agreement on goals.) Jim: Yes, that’s exactly what I want to do . . . get more assertive! And I like the idea of doing some “research work” for our next session. (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 12. Evaluation and Accountability–●–303 is both intentional and directional. To be effective, it is essential that the helper, along with the client, identifies and clarifies client needs and desired goals. Research (e.g., Seijts, Latham, Tasa, & Latham, 2004) has demonstrated that the articulation of goals is essential to the problem-solving process. However, to be effective, these goals cannot be vague, overly generalized, or unrealistic. As such, it is suggested that the effective, ethical practitioner will help the client to set goals that are specific, measureable, attainable, relevant, and time bound (Parsons & Zhang, 2014). Such goals may be identified with the acronym SMART goals. Taking these into consideration for one’s own practice, the ques- tions posed in Table 12.2 will be helpful in the development of these goals. Table 12.2 Developing SMART Goals Goal Characteristics Questions to Guide Goal Setting Specific Does the goal outline exactly what you are trying to achieve? Measurable How will you know if progress is being made? How will others know if progress is being made? Is the progress quantifiable? Attainable What resources do you need to achieve this goal? Can the goal be achieved independently? Is the goal too big? If so, can the goal be broken down into smaller SMART goals? What factors or forces exist that could interfere with the achievement of the goal? What is the plan to remove or navigate these forces? Relevant How important to you is this goal? What are the positive consequences of achieving this goal? How will achieving this goal affect your personal and professional life? Time Bound Have you set a target date? Can you establish benchmarks along the way to use as evidence of progress? Is the timeline reasonable? Flexible? Source: Adapted from Zhang & Parsons (2016). Field experience: Transitioning from student to professional. SAGE Publications, Thousand Oaks: CA. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 304–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Measuring Outcome and Goal Achievement The selection of appropriate outcome measures is far from easy. Clinicians recognize that the helping process, when effective, can reveal itself in many ways—even beyond the achievement of the terminal goal. For example, while attempting to help a client cope with his social anxiety it may not be unusual to find that the client exits the relationship with a better sense of his own vocational calling or insight into his current relationships or even a desire to pursue additional growth-oriented counseling. Using more than one outcome and outcome measure increases the probability of accurately depicting the entirety of the experience. At the most fundamental level, the prac titioner can assume that one outcome reflects the nature of the presenting concern. For example, if a clinician is interested in ameliorating a presenting complaint, the nature of that complaint (e.g., test anxiety, marital dissatisfaction, depression, etc.) provides direction to the outcomes desired. After targeting the general area in which the helper expects to demonstrate impact (i.e., reduce test anxiety, increase achievement level, etc.), that partic- ular area needs to be clearly and concretely defined. It is important to realize that while there will be a primary focus for the assessing outcome (e.g., reduce the amount of client depression or increase student attention, etc.), these tar- gets may be manifested in a number of different ways and occur within a unique context. The more perspectives we take on the outcome and the more mea- sures we employ, the greater the chance we have of under standing the nature and depth of impact our practice may have produced. Consider the approach taken by the helper illustrated in the following case (Case Illustration 12.2). Case Illustration 12.2 Assessing Outcomes of Treatment With Depressed Client Alicia came to therapy because of a “constant” feeling of sadness and an inability to get moti vated about anything in her life. At the initial meeting with Alicia, Dr. Warrick attempted to identify the various ways in which her feelings of sadness were experienced and were impact ing her life. Dr. Warrick: Alicia, you have mentioned that you are not “doing anything” and you can’t get motivated. Could you tell me more about that? Alicia: Well, I have a lot of school work that should be done, and each time I sit down to do it I think, why bother, Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 12. Evaluation and Accountability–●–305 nothing is going to come out, and then I walk away from the computer and get something to eat or go to bed. Dr. Warrick: So it seems that you not only feel sad, at times, but you also have this belief that “nothing is going to work”? Alicia: That’s right! And it is not just with school stuff. If I get a call from a friend I typically go out with, I think, why bother going out, it is not going to help. And I stay home. Dr. Warrick: So one of the things that we may watch as we work together isn’t just your feelings of sadness but also the frequency of this, why bother, it’s hopeless thinking? Alicia: I don’t want to feel sad anymore, but I also understand what you mean about the thinking. Dr. Warrick: You also seem to suggest that when you are feeling this way, you avoid your friends and avoid engaging in activities (like school work)? Alicia: Yeah, I have not seen my friends in weeks. I’m sure they are annoyed. And I don’t even do housework anymore. My place is a mess. Dr. Warrick: Well, Alicia, I appreciate how open you have been with me today, and I truly feel we have taken a good step toward helping you to feel and behave the way you want to. As we continue working together, we will not only keep our eyes on your feelings of sadness with the intent of gaining some relief, but we will see if there is an increase in the frequency with which you go out with your friends or do house chores and school work. Further, we will hopefully also see a change in your thinking. Rather than thinking why bother thoughts, we will see more productive thoughts. How does that sound? Alicia: It sounds like a lot and I’m not sure that we can do this. Wow, there is that why bother thought again! (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 306–●–ETHICAL PRACTICE IN THE HUMAN SERVICES But, if I would start feeling and thinking and acting dif ferently, then I would not need to be here. Dr. Warrick: That’s good! I like the way you already attacked that thought of yours! (Continued) While most individuals recognize depression to be a mood, an affect, or a feeling, depression also manifests itself in a person’s behavior, thought processes, and interpersonal interactions. A helper, like Dr. Warrick (see Case Illustration 12.2), who may be attempting to assess the effec- tiveness of a particular medication or treatment approach on depres- sion, should assess changes not only in the client’s mood but also in the client’s behavior (e.g., doing school work), thought processes (e.g., hav- ing less frequent thoughts of suicide or thoughts of why bother), and interpersonal interactions (e.g., beginning to reengage with fam ily and friends), along with gathering information about how the client feels about these changes. Table 12.3 provides one useful way for conceptualizing the various domains in which interventions may impact the client. It is useful to con- sider gathering data in many, if not all, of these domains in an attempt to accurately evaluate the impact of practice decisions. The listing presented is an adaptation of the work of Arnold Lazarus (1989). The essence of this model is the belief that a person’s functioning or dysfunctioning is mani- fested along seven modalities: behavior, affect, sensation, images, cognition, interpersonal relationships, and biology/physiology. Lazarus represented these seven domains with the acronym BASIC ID. Using each of these com- ponents as a reference point, the helper can conceptu alize the impacts of his or her practice more broadly. Table 12.3 presents three dimensions for consideration when identifying outcomes to action research. First, modality refers to the specific arena in which this construct may be manifested (i.e., BASIC ID). The second dimen- sion, manifestation, is the place where the practitioner identifies the manner or form in which this particular target of the investigation appears. The final column, data collection techniques, identifies the types of techniques that can be useful when assessing that domain. It should be noted that while a specific method of data collection has been identified in Table 12.3, other methods may work as well. Exercise 12.1 provides an opportunity to employ to this approach with a problem of your choosing. Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . Chapter 12. Evaluation and Accountability–●–307 Table 12.3 Classification Scheme for Outcome Measures: Using an Example of a Client Experiencing Anxiety in Social Settings Modality Manifestation Sample Methods of Data Collection Behavior Withdraws from social contact Observation Affect Anxious Survey (anxiety checklist) Sensation Muscle tension Self-report (journal) Imagery Dreams about being abandoned Self-report (journal) Cognition Believes he has no right to say no Assertiveness questionnaire Interpersonal Withdraws and fails to maintain eye contact Observation, interview peers Drugs/Biology Stomach upset/blood pressure high Self-report and blood pressure recordings Exercise 12.1 Identifying Personal Outcomes Directions: Below are a number of general statements about personal improvement and growth. Select one that may be of interest to you and using the table below, identify the various manifestations of this goal achievement along with techniques for assessment. ● Become a better student ● Become more social ● Become more spiritual ● Improve general health Modality Definition Sample Methods of Data Collection Behavior Affect (Continued) Parsons, R. D., & Dickinson, K. L. (2016). Ethical practice in the human services : From knowing to being. ProQuest Ebook Central <a onclick=window.open(http://ebookcentral.proquest.com,_blank) href=http://ebookcentral.proquest.com target=_blank style=cursor: pointer;>http://ebookcentral.proquest.com</a> Created from capella on 2021-08-08 12:52:37. C o p yr ig h t © 2 0 1 6 . S A G E P u b lic a tio n s. A ll ri g h ts r e se rv e d . 308–●–ETHICAL PRACTICE IN THE HUMAN SERVICES Modality Definition Sample Methods of Data Collection Sensations Imagery Cognition Interpersonal Drugs (Continued) Record Keeping Record keeping is important not just to document service but also to guide and direct the practitioner in his or her practice decisions. Accurate, complete records can, for example, allow a practitioner to review the thera- peutic process and thus foster self-monitoring on the part of the practitioner. Thus, implicit within the discussion of evaluation and outcome measure- ment is the understanding that data will be collected and recorded for later analy sis. These data can be of various forms, including test scores, clinician observations, and notations. In whatever form they are, these data constitute a client’s record and must be handled with sensitivity. Maintaining thorough records and clinical notes is essential to the plan- ning and mon itoring of services as well as to providing data, should the interaction ever be questioned as in the case of a lawsuit. Keeping good and accurate records provides a strong foundation for counselors in the event of claims regarding legal issues and ethics violations (Mitchell, 2007). Thus, even with concern about possible requirements to disclose, experiences of inconvenience, or a practitioner’s belief in the power of his or her memory, …