WEBVTT
1
00:00:01.010 --> 00:00:03.169
Welcome back, everybody. Today we're going to be looking at
2
00:00:03.649 --> 00:00:08.060
supervisory and consultative relationships. By the way, we have three
3
00:00:08.099 --> 00:00:11.779
more podcast episodes to cover all the topics that I
4
00:00:11.820 --> 00:00:14.900
believe are going to be on there. So future episodes
5
00:00:14.919 --> 00:00:16.899
are going to get more deep into a lot of
6
00:00:16.920 --> 00:00:19.679
these topics. Hopefully they'll help you. We'll do some more
7
00:00:19.739 --> 00:00:23.539
practice questions. We'll do some vignettes that you can practice
8
00:00:23.559 --> 00:00:25.550
with as well. They're going to probably be on the EPPP.
9
00:00:26.789 --> 00:00:29.730
So stay tuned as we continue on. And like I said,
10
00:00:29.750 --> 00:00:32.909
we'll elaborate on some of these topics in the future.
11
00:00:33.070 --> 00:00:38.969
We'll expand on, for instance, Kohlberg's moral imperatives. We'll look
12
00:00:39.090 --> 00:00:43.609
at the developmental theories, the motivational theories more in depth.
13
00:00:43.630 --> 00:00:45.990
We'll look at the brain areas more in depth. So
14
00:00:46.590 --> 00:00:49.810
stay tuned for that. Today we're talking about EPPP's study guide. Oh,
15
00:00:49.829 --> 00:00:54.329
by the way, if you want some deep dive psychodynamic topics,
16
00:00:54.409 --> 00:00:59.320
make sure to go over to Psychodynamic Observations on Substack,
17
00:00:59.340 --> 00:01:03.119
where I write about psychology, human behavior, clinical concepts, and
18
00:01:03.140 --> 00:01:05.200
the ideas behind why we think and behave the way
19
00:01:05.260 --> 00:01:08.099
we do. You can subscribe for free, or you can
20
00:01:08.120 --> 00:01:11.730
get paid subscribers, which receive access to additional in-depth articles
21
00:01:12.290 --> 00:01:15.969
and other content. So join our community. All right, today
22
00:01:16.010 --> 00:01:19.069
we're going to be talking about supervisory and consultative relationships.
23
00:01:19.950 --> 00:01:23.109
Vicarious liability is one thing you'll need to know. Respondiat
24
00:01:23.329 --> 00:01:26.849
superior is a phrase you might see. It's a legal
25
00:01:26.890 --> 00:01:30.049
doctrine where a supervisor is held legally and financially responsible
26
00:01:30.090 --> 00:01:33.290
for the negligent actions, errors, or malpractice of a supervisee,
27
00:01:33.849 --> 00:01:38.049
even if the supervisor was not directly involved. Direct liability
28
00:01:38.090 --> 00:01:40.650
is legal liability incurred when the supervisor's own actions or
29
00:01:40.730 --> 00:01:45.750
omissions directly cause harm. Inadequate oversight, negligent hiring, failure to
30
00:01:45.790 --> 00:01:49.349
act on red flags, or assigning tasks beyond a trainee's
31
00:01:49.390 --> 00:01:53.310
skill level. Gatekeepers, the ethical obligation of a supervisor to
32
00:01:53.349 --> 00:01:56.920
protect the public and the profession by ensuring only competent, ethical,
33
00:01:56.969 --> 00:02:00.939
and psychologically fit candidates advance toward independent practice and licensure.
34
00:02:01.780 --> 00:02:06.620
Formative feedback, ongoing process-oriented feedback provided regularly during training to
35
00:02:06.659 --> 00:02:11.680
guide learning, identify blind spots, and develop clinical skills. Summative
36
00:02:11.719 --> 00:02:16.159
evaluation is a formal cumulative evaluation conducted at defined milestones,
37
00:02:16.319 --> 00:02:20.050
end of semester, end of rotation. to assess whether the
38
00:02:20.090 --> 00:02:25.080
trainee has met the benchmark competencies. Dual roles and multiple relationships,
39
00:02:25.139 --> 00:02:27.319
situation where a supervisor holds more than one role with
40
00:02:27.360 --> 00:02:32.590
a supervisee, supervisor and therapist, evaluator and close friend, employer,
41
00:02:33.719 --> 00:02:36.990
things of that nature, which creates an inherent risk. You
42
00:02:37.030 --> 00:02:39.650
also got the Kaplan's Mental Health Consultation, which we'll look
43
00:02:39.689 --> 00:02:43.310
at a little later. It's a four-part organizational consultational framework.
44
00:02:44.960 --> 00:02:51.750
So first thing is supervision versus consultations. So a clinical
45
00:02:51.830 --> 00:02:59.270
supervision is hierarchical, evaluative, and gatekeeping, while professional consultation is non-hierarchical, collaborative,
46
00:02:59.310 --> 00:03:05.000
and peer-to-peer. Clinical supervision, also for legal responsibilities, supervisor retains
47
00:03:05.120 --> 00:03:09.159
full ultimate responsibility for patient care, and a consultant factor
48
00:03:09.240 --> 00:03:13.979
does not assume clinical responsibility. The duration for clinical supervision
49
00:03:14.039 --> 00:03:19.120
is ongoing and contractual, while professional consultation is time-limited and episodic.
50
00:03:20.250 --> 00:03:24.490
Advice adoption, trainee must follow supervisor's directives, consultee has full
51
00:03:24.509 --> 00:03:30.740
autonomy to accept or reject advice. Governing bodies, licensing boards, APA,
52
00:03:31.120 --> 00:03:35.439
so forth. For the consultant, it's professional ethics codes and HIPAA.
53
00:03:36.900 --> 00:03:39.560
Some of the supervisor core duties, due diligence and selection,
54
00:03:39.620 --> 00:03:44.860
verify academic prerequisites, credentials, state-specific competence, adequate monitoring, minimum weekly
55
00:03:44.919 --> 00:03:51.560
face-to-face meetings accompanied by direct observation. Appropriate delegation, never delegate
56
00:03:51.580 --> 00:03:54.479
duties beyond the trainee's scope of practice or training stage.
57
00:03:54.580 --> 00:04:00.509
Comprehensive documentation, maintain clear logs detailing meeting dates, duration, cases reviewed,
58
00:04:00.569 --> 00:04:07.590
emergency ethical discussions, recommendations. Informed consent requirements, supervisee consent for
59
00:04:07.629 --> 00:04:12.629
a written training agreement outlining expectations, goals, evaluation. Clients must
60
00:04:12.680 --> 00:04:15.400
be informed in writing of the client consent prior to
61
00:04:15.419 --> 00:04:19.069
treatment that their clinician is an unlicensed trainee. informed of
62
00:04:19.110 --> 00:04:24.850
the licensed supervisor's name and contact information. Managing dual relationships.
63
00:04:24.910 --> 00:04:27.240
Dual roles must be avoided whenever possible due to the
64
00:04:27.269 --> 00:04:34.720
inherent evaluative power dynamic. Small training sites, unavoidable contexts, discuss
65
00:04:34.740 --> 00:04:39.300
the conflict openly, write clear role boundaries, and use third-party
66
00:04:39.839 --> 00:04:43.680
or objective external evaluators. We told you about Kaplan's four
67
00:04:43.740 --> 00:04:47.079
models of consultation. These will be important for the EPPP.
68
00:04:48.009 --> 00:04:52.269
Client-centered case consultation focuses on assessing and diagnosing an individual
69
00:04:52.329 --> 00:04:58.110
and recommending specific treatment strategies. Consultee-centered case consultation focuses on
70
00:04:58.170 --> 00:05:02.740
remediating the practitioner's deficits in knowledge, skill, confidence, or emotional objectivity.
71
00:05:04.319 --> 00:05:09.839
Three is the program-centered administrative consultation focuses on solving systemic
72
00:05:09.860 --> 00:05:14.540
delivery issues, policies, or program designs across an entire facility
73
00:05:14.680 --> 00:05:21.149
or team. And finally, consultee-centered administrative consultation focuses on training
74
00:05:21.209 --> 00:05:26.230
administrative organizational leadership to improve their long-term management, leadership, and
75
00:05:27.089 --> 00:05:34.430
programmatic decision-making. So four, again, are client-centered, consultee-centered, program-centered, and
76
00:05:34.509 --> 00:05:41.740
consultee-centered administrative consultation. Those are the four consultations. Here's a scenario.
77
00:05:43.389 --> 00:05:47.370
A psychology intern provides exposure and response prevention therapy to
78
00:05:47.389 --> 00:05:50.949
a client with severe OCD. The intern unilaterally instructs the
79
00:05:50.980 --> 00:05:53.959
client to engage in a reckless, non-standard exposure exercise in
80
00:05:54.040 --> 00:05:57.579
public that results in a physical injury. The intern supervisor
81
00:05:57.620 --> 00:06:00.120
had misscheduled supervision meetings for three weeks and had not
82
00:06:00.160 --> 00:06:05.079
reviewed the intern's treatment plans. The supervisor here faces what
83
00:06:05.100 --> 00:06:08.819
they call vicarious liability because the supervisee committed malpractice within
84
00:06:08.839 --> 00:06:12.250
the scope of the training placement. The supervisor also faces
85
00:06:12.290 --> 00:06:15.569
direct liability for negligent supervision, failing to meet weekly, and
86
00:06:15.649 --> 00:06:20.189
failing to review the case charts. Number two, in a
87
00:06:20.230 --> 00:06:23.430
rural community mental health clinic, the only available licensed psychologist
88
00:06:23.490 --> 00:06:26.129
is assigned to supervise a pre-doctoral intern who happens to
89
00:06:26.149 --> 00:06:30.579
be the adult child of the clinic's executive director. When
90
00:06:30.600 --> 00:06:35.019
an overlapping role cannot be eliminated... The supervisor must acknowledge
91
00:06:35.060 --> 00:06:38.360
the risk, establish written boundaries, and arrange for an independent
92
00:06:38.399 --> 00:06:41.509
external psychologist to conduct summative reviews and sign off on
93
00:06:41.550 --> 00:06:44.759
clinical evaluations to prevent bias. This would be falling under
94
00:06:45.420 --> 00:06:50.350
unavoidable multiple relationships. Alright.
1
00:00:01.010 --> 00:00:03.169
Welcome back, everybody. Today we're going to be looking at
2
00:00:03.649 --> 00:00:08.060
supervisory and consultative relationships. By the way, we have three
3
00:00:08.099 --> 00:00:11.779
more podcast episodes to cover all the topics that I
4
00:00:11.820 --> 00:00:14.900
believe are going to be on there. So future episodes
5
00:00:14.919 --> 00:00:16.899
are going to get more deep into a lot of
6
00:00:16.920 --> 00:00:19.679
these topics. Hopefully they'll help you. We'll do some more
7
00:00:19.739 --> 00:00:23.539
practice questions. We'll do some vignettes that you can practice
8
00:00:23.559 --> 00:00:25.550
with as well. They're going to probably be on the EPPP.
9
00:00:26.789 --> 00:00:29.730
So stay tuned as we continue on. And like I said,
10
00:00:29.750 --> 00:00:32.909
we'll elaborate on some of these topics in the future.
11
00:00:33.070 --> 00:00:38.969
We'll expand on, for instance, Kohlberg's moral imperatives. We'll look
12
00:00:39.090 --> 00:00:43.609
at the developmental theories, the motivational theories more in depth.
13
00:00:43.630 --> 00:00:45.990
We'll look at the brain areas more in depth. So
14
00:00:46.590 --> 00:00:49.810
stay tuned for that. Today we're talking about EPPP's study guide. Oh,
15
00:00:49.829 --> 00:00:54.329
by the way, if you want some deep dive psychodynamic topics,
16
00:00:54.409 --> 00:00:59.320
make sure to go over to Psychodynamic Observations on Substack,
17
00:00:59.340 --> 00:01:03.119
where I write about psychology, human behavior, clinical concepts, and
18
00:01:03.140 --> 00:01:05.200
the ideas behind why we think and behave the way
19
00:01:05.260 --> 00:01:08.099
we do. You can subscribe for free, or you can
20
00:01:08.120 --> 00:01:11.730
get paid subscribers, which receive access to additional in-depth articles
21
00:01:12.290 --> 00:01:15.969
and other content. So join our community. All right, today
22
00:01:16.010 --> 00:01:19.069
we're going to be talking about supervisory and consultative relationships.
23
00:01:19.950 --> 00:01:23.109
Vicarious liability is one thing you'll need to know. Respondiat
24
00:01:23.329 --> 00:01:26.849
superior is a phrase you might see. It's a legal
25
00:01:26.890 --> 00:01:30.049
doctrine where a supervisor is held legally and financially responsible
26
00:01:30.090 --> 00:01:33.290
for the negligent actions, errors, or malpractice of a supervisee,
27
00:01:33.849 --> 00:01:38.049
even if the supervisor was not directly involved. Direct liability
28
00:01:38.090 --> 00:01:40.650
is legal liability incurred when the supervisor's own actions or
29
00:01:40.730 --> 00:01:45.750
omissions directly cause harm. Inadequate oversight, negligent hiring, failure to
30
00:01:45.790 --> 00:01:49.349
act on red flags, or assigning tasks beyond a trainee's
31
00:01:49.390 --> 00:01:53.310
skill level. Gatekeepers, the ethical obligation of a supervisor to
32
00:01:53.349 --> 00:01:56.920
protect the public and the profession by ensuring only competent, ethical,
33
00:01:56.969 --> 00:02:00.939
and psychologically fit candidates advance toward independent practice and licensure.
34
00:02:01.780 --> 00:02:06.620
Formative feedback, ongoing process-oriented feedback provided regularly during training to
35
00:02:06.659 --> 00:02:11.680
guide learning, identify blind spots, and develop clinical skills. Summative
36
00:02:11.719 --> 00:02:16.159
evaluation is a formal cumulative evaluation conducted at defined milestones,
37
00:02:16.319 --> 00:02:20.050
end of semester, end of rotation. to assess whether the
38
00:02:20.090 --> 00:02:25.080
trainee has met the benchmark competencies. Dual roles and multiple relationships,
39
00:02:25.139 --> 00:02:27.319
situation where a supervisor holds more than one role with
40
00:02:27.360 --> 00:02:32.590
a supervisee, supervisor and therapist, evaluator and close friend, employer,
41
00:02:33.719 --> 00:02:36.990
things of that nature, which creates an inherent risk. You
42
00:02:37.030 --> 00:02:39.650
also got the Kaplan's Mental Health Consultation, which we'll look
43
00:02:39.689 --> 00:02:43.310
at a little later. It's a four-part organizational consultational framework.
44
00:02:44.960 --> 00:02:51.750
So first thing is supervision versus consultations. So a clinical
45
00:02:51.830 --> 00:02:59.270
supervision is hierarchical, evaluative, and gatekeeping, while professional consultation is non-hierarchical, collaborative,
46
00:02:59.310 --> 00:03:05.000
and peer-to-peer. Clinical supervision, also for legal responsibilities, supervisor retains
47
00:03:05.120 --> 00:03:09.159
full ultimate responsibility for patient care, and a consultant factor
48
00:03:09.240 --> 00:03:13.979
does not assume clinical responsibility. The duration for clinical supervision
49
00:03:14.039 --> 00:03:19.120
is ongoing and contractual, while professional consultation is time-limited and episodic.
50
00:03:20.250 --> 00:03:24.490
Advice adoption, trainee must follow supervisor's directives, consultee has full
51
00:03:24.509 --> 00:03:30.740
autonomy to accept or reject advice. Governing bodies, licensing boards, APA,
52
00:03:31.120 --> 00:03:35.439
so forth. For the consultant, it's professional ethics codes and HIPAA.
53
00:03:36.900 --> 00:03:39.560
Some of the supervisor core duties, due diligence and selection,
54
00:03:39.620 --> 00:03:44.860
verify academic prerequisites, credentials, state-specific competence, adequate monitoring, minimum weekly
55
00:03:44.919 --> 00:03:51.560
face-to-face meetings accompanied by direct observation. Appropriate delegation, never delegate
56
00:03:51.580 --> 00:03:54.479
duties beyond the trainee's scope of practice or training stage.
57
00:03:54.580 --> 00:04:00.509
Comprehensive documentation, maintain clear logs detailing meeting dates, duration, cases reviewed,
58
00:04:00.569 --> 00:04:07.590
emergency ethical discussions, recommendations. Informed consent requirements, supervisee consent for
59
00:04:07.629 --> 00:04:12.629
a written training agreement outlining expectations, goals, evaluation. Clients must
60
00:04:12.680 --> 00:04:15.400
be informed in writing of the client consent prior to
61
00:04:15.419 --> 00:04:19.069
treatment that their clinician is an unlicensed trainee. informed of
62
00:04:19.110 --> 00:04:24.850
the licensed supervisor's name and contact information. Managing dual relationships.
63
00:04:24.910 --> 00:04:27.240
Dual roles must be avoided whenever possible due to the
64
00:04:27.269 --> 00:04:34.720
inherent evaluative power dynamic. Small training sites, unavoidable contexts, discuss
65
00:04:34.740 --> 00:04:39.300
the conflict openly, write clear role boundaries, and use third-party
66
00:04:39.839 --> 00:04:43.680
or objective external evaluators. We told you about Kaplan's four
67
00:04:43.740 --> 00:04:47.079
models of consultation. These will be important for the EPPP.
68
00:04:48.009 --> 00:04:52.269
Client-centered case consultation focuses on assessing and diagnosing an individual
69
00:04:52.329 --> 00:04:58.110
and recommending specific treatment strategies. Consultee-centered case consultation focuses on
70
00:04:58.170 --> 00:05:02.740
remediating the practitioner's deficits in knowledge, skill, confidence, or emotional objectivity.
71
00:05:04.319 --> 00:05:09.839
Three is the program-centered administrative consultation focuses on solving systemic
72
00:05:09.860 --> 00:05:14.540
delivery issues, policies, or program designs across an entire facility
73
00:05:14.680 --> 00:05:21.149
or team. And finally, consultee-centered administrative consultation focuses on training
74
00:05:21.209 --> 00:05:26.230
administrative organizational leadership to improve their long-term management, leadership, and
75
00:05:27.089 --> 00:05:34.430
programmatic decision-making. So four, again, are client-centered, consultee-centered, program-centered, and
76
00:05:34.509 --> 00:05:41.740
consultee-centered administrative consultation. Those are the four consultations. Here's a scenario.
77
00:05:43.389 --> 00:05:47.370
A psychology intern provides exposure and response prevention therapy to
78
00:05:47.389 --> 00:05:50.949
a client with severe OCD. The intern unilaterally instructs the
79
00:05:50.980 --> 00:05:53.959
client to engage in a reckless, non-standard exposure exercise in
80
00:05:54.040 --> 00:05:57.579
public that results in a physical injury. The intern supervisor
81
00:05:57.620 --> 00:06:00.120
had misscheduled supervision meetings for three weeks and had not
82
00:06:00.160 --> 00:06:05.079
reviewed the intern's treatment plans. The supervisor here faces what
83
00:06:05.100 --> 00:06:08.819
they call vicarious liability because the supervisee committed malpractice within
84
00:06:08.839 --> 00:06:12.250
the scope of the training placement. The supervisor also faces
85
00:06:12.290 --> 00:06:15.569
direct liability for negligent supervision, failing to meet weekly, and
86
00:06:15.649 --> 00:06:20.189
failing to review the case charts. Number two, in a
87
00:06:20.230 --> 00:06:23.430
rural community mental health clinic, the only available licensed psychologist
88
00:06:23.490 --> 00:06:26.129
is assigned to supervise a pre-doctoral intern who happens to
89
00:06:26.149 --> 00:06:30.579
be the adult child of the clinic's executive director. When
90
00:06:30.600 --> 00:06:35.019
an overlapping role cannot be eliminated... The supervisor must acknowledge
91
00:06:35.060 --> 00:06:38.360
the risk, establish written boundaries, and arrange for an independent
92
00:06:38.399 --> 00:06:41.509
external psychologist to conduct summative reviews and sign off on
93
00:06:41.550 --> 00:06:44.759
clinical evaluations to prevent bias. This would be falling under
94
00:06:45.420 --> 00:06:50.350
unavoidable multiple relationships. Alright.
