Myths and Realities of Supervision
By: Mary Riemersma
Executive Director

The California Therapist
(September/October 2001)

Laws and Regulations
Regularly get updated licensing laws and regulations that govern the professionals for whom you will be providing supervision and carefully review the pertinent sections that address supervision issues. Whether an LMFT or other licensee, you may from time to time provide supervision for aspiring clinical social workers or psychologists. When these situations occur, you need to be knowledgeable about the laws and regulations for the other professions as well as your own. The laws and regulations for each of the professions can be obtained on the Internet, go to www.bbs.ca.gov for the licensing law and regulations for MFTs and CSWs, and go to www.dca.ca.gov/psych for psychologists. These laws and regulations are amended regularly.

Responsibilities of the Supervisor

• Sign and adhere to the attestations on the Supervisor Responsibility Statement.
  
• Ensure that the supervisee works within his/her scope of practice.
  
• Ensure that the supervisee works within his/her scope of competence.
  
• Ensure that the supervisee provides services in compliance with the law.
  
• Ensure that the supervisee provides services in compliance with the ethical standards of his/her profession.
  
• Ensure that the work setting that the supervisee is in is appropriate.
  
• Ensure that the supervisee signs the mandatory statement acknowledging his/her child abuse reporting duties.
  
• Monitor and evaluate the diagnosis and treatment decisions of the supervisee (social work profession-monitor the welfare of clients/psychology profession-monitor clinical performance and professional development).
  
• Review client/patient records.
  
• Provide some-left to your discretion-direct observation by one-way mirror, videotape, audiotape, as deemed appropriate by the supervisor.
  
• Advise or encourage your supervisee, when appropriate, to get personal psychotherapy while being careful not to take on that role.
  
• Develop a plan with your supervisee to address emergencies.
  
• Obtain the name, address, and telephone number of your supervisee's prior supervisor and employer-and then use this information to learn of the supervisee's strengths, weaknesses and areas to work on.
  
• Sign the log of hours on a weekly basis.
  

Prior to refusing to sign hours of experience, willingly give a week's written notice of your intent to not sign for hours of experience to the intern or trainee. A supervisor who has not provided such notice must sign for hours of experience obtained in good faith where such supervisor actually provided the required supervision. In fact, psychologists are subject to disciplinary action if they fail to sign hours of experience.

When supervising trainees, make sure that there is a written agreement between the school, employer and supervisor setting forth each party's responsibility.

When supervising social work associates, it is necessary, annually and at termination, to assess the ongoing strengths and weaknesses of the supervisee. Additionally, supervisors of social work associates must develop a supervisory plan that defines the goals and objectives of the supervision. This plan is to be submitted by the supervisee to the BBS within thirty days of commencing supervision. When supervising persons pursuing the psychology license, one is required to file an annual report that addresses specific criteria.

Mandatory Continuing Education
Supervisors of MFT interns and trainees are required to regularly (during each license renewal period or within the first sixty days of commencing supervision) get six-hours of continuing education in supervision. The content of the required coursework is left to the discretion of the supervisor. Your supervisee will not be penalized should you fail to take the workshop or fail to take it timely; you could, nevertheless, be disciplined by a licensing board for failing to fulfill your obligation. If you are supervising a social work associate you must, prior to commencing supervision, complete 15 hours of coursework with specified content in supervision. The content includes: familiarity with supervision literature, facilitation of therapist-client and supervisor-therapist relationships, evaluation and identification of problems, structuring to maximize supervision, knowledge of contextual variables, and the practice of social work including legal and ethical issues. Finally, persons supervising aspiring psychologists are also required to obtain six hours of training in supervision, however, one has various options including workshops, courses, supervision of supervision, or grand rounds.

Make sure your interns and trainees inform clients, at least verbally and possibly in writing prior to performing professional services, that they are unlicensed and working under supervision. Persons who supervise persons pursuing the psychologist license are, as supervisors, required to notify patients that the supervisee is unlicensed and working under supervision.
Make sure your interns and trainees do not receive any remuneration directly from patients or clients. Supervisees may only be paid by their employers and may only be paid as employees and not as independent contractors.

Be actively practicing, or at least have actively practiced therapy in the recent past. The MFT supervisor is required to have practiced psychotherapy for at least two years within the five-year period immediately preceding any supervision and have averaged at least five patient contact hours per week. The CSW supervisor is required to have practiced psychotherapy for at least two years within the five-year period immediately preceding any supervision. Psychologists have no similar requirement.
Should you be disciplined by a licensing board, you have a duty to immediately notify your supervisee(s) and cease providing supervision. Psychologists are required to notify supervisees at the time an accusation is rendered against them.

Good Things to Do
Give your supervisee a copy of the brochure, Therapy Never Includes Sex, and explain how it is to be used and where to get additional copies.

Ask, prior to hiring your supervisee, if he/she has ever had a personal relationship or fantasies of a personal relationship with a patient.

Impress upon your supervisee that personal relationships with patients will not be condoned.
Inform the supervisee that you are to be apprised of any fantasies he/she may have about a patient.

Impress upon your supervisee the need to maintain the confidences of patients.
Inform the supervisee that patient files are not to be removed from the office-if permissible, photo-copies of records may be removed as long as properly safeguarded.

Make it clear in writing and verbally that the supervisee employed in private practice is hired "at will." "At will," means he/she can likewise be fired "at will," or for any reason whatsoever, with or without cause.

Encourage supervisees to join CAMFT and to regularly utilize CAMFT's services to get telephone consultation of a legal, business or practice nature.

Provide each supervisee with a copy of CAMFT's Ethical Standards.

Myth—"Working Under Someone's License"
We regularly hear interns say that they are "working under someone's license," or likewise, we hear supervisors say, "she is working under my license." Unlicensed people do not work under another's license. Only the licensee can use his/her license. When a supervisor employs an intern, the supervisor becomes the employer and the intern becomes the employee; the supervisor uses his/her license to engage in practice, and the supervisee uses his/her intern registration number, which permits him/her to be employed in the private practice. When the supervisor provides supervision on behalf of another entity, the supervisor is responsible for providing supervision, but the intern likewise does not work under the supervisor's license.

Myth—The Supervisor is "liable" for the Intern's Acts
While it is true that the supervisor is responsible for the acts of the intern when the intern is employed in private practice, such liability does not rest with the supervisor when speaking of work settings other than private practice. In the state of California, the employer is liable for the acts of the employee. Interns who word in a private practice are employees of that private practice. It is the supervisee's status as an "employee" that creates the liability for the private practitioner/employer, not his/her status as an intern. Supervisors who are not also employers are responsible for the quality of the supervision he/she provides.

Myth—Patient Records belong to the Intern
The patients' records are the property of the employer. If the supervisor is the employer, in the case of a private practice, the records are the property of the supervisor. Interns should not be permitted, when terminating employment, to take the patients' records to the new employer. However, it may be permissible and appropriate to allow the intern or trainee to take a photocopy of the records to the new employer if the intern or trainee will continue to provide therapeutic services to the patient.

Myth—Offsite Supervision/Paying for Supervision is Unlawful
Offsite supervision, or supervision not paid for by the employer, is lawful in all work settings other than private practice. To be acceptable, however, the supervisor must have a written agreement with the employer. It must contain specific language that comes directly from regulation [California Code of Regulations Section 1833(b)(4)]. Offsite supervision is lawful for marriage and family therapists and clinical social workers as long as there is an appropriately executed letter of agreement. Supervision may not be obtained offsite, under any circumstances, by aspiring psychologists. The MFT intern or CSW associate may personally pay for the supervision, again, as long as there is a letter of agreement. (See the sidebar for a sample letter of agreement).

Myth—The Supervisor Must Be Present 50% of the Time
This provision was from the psychology licensing law and regulations, and has recently been somewhat revised. However, there is no minimum amount of time the supervisor must be present when the MFT intern, trainee or social work associate is working. Currently, in the case of the person pursuing the psychology license, the supervisor must be employed by the site where the hours are being gained at least fifty percent of the time and must be available to the supervisee 100 percent of the time.

Myth—Because the Supervisee is a Volunteer, Workers Comp Insurance is Unnecessary
Employers of supervisees, where the supervisees work on a voluntary basis, may be required to provide workers compensation insurance. Regardless of whether the employer is or is not required to provide workers compensation insurance, it should be considered and makes good sense. The failure to provide such insurance could be very costly. If the supervisee is injured on the job, the employer could be held personally liable for all of the employee's/volunteer's medical care as well as lost wages. This would apply to "psychological injuries" (work-related stress cases) as well.

Myth—The Patient "Belongs" to the Employer
Patients don't belong to either party-employer or employee. Patients have free will and may go where they wish, which means the patient can stay with the employer and be referred to another therapist, the patient can be referred elsewhere to a therapist independent of the employer or supervisee, or, the patient can follow the supervisee to the supervisee's new employment setting, providing the supervisee is going to be appropriately employed and presuming the supervisee is not being terminated for having engaged in some heinous act. All parties, in this situation, should choose to operate in the patient's best interests. Generally speaking permitting the patient to follow the supervisee to his or her new employment setting may be in the patient's best interests, as the supervisee is the one with whom the patient has developed a therapeutic relationship. Regardless, therapists who are concerned about operating in the patient's best interests will offer the various alternatives to the patient and will let the patient decide what is best. Keep in mind, however, that the employer is responsible for the patient. If the employer is a licensed therapist in private practice, the licensed therapist has responsibility for that patient, whether the supervisee leaves voluntarily or is terminated for cause. Such a supervisor has a duty to make sure that the patient is not abandoned in such a circumstance.

Reminders
Make sure your license is current and valid and not under suspension or probation. Remember, if you neglect to notify the BBS, or other licensing board, of a change of address, your license will lapse and your supervisee will not be able to count his/her hours during the period the license is lapsed. In such a case, you could be subjecting yourself to disciplinary action by a licensing board and/or the possibility of a lawsuit brought against you by your supervisee.

With one exception, you are required to be licensed in California for two years prior to providing supervision to MFT interns and trainees. Note: The only exception to the two-year license requirement is supervisors who provide supervision only to trainees at an academic institution that offers a qualifying degree program, where the supervisor has been licensed in California and in any other state, for a total of at least two years prior to commencing any supervision. Persons other than psychologists who are supervising aspiring psychologists, are required to be licensed for three years prior to commencing supervision.

A supervisor may not charge for supervision in private practice. When an intern employed in private practice is supervised by someone other than the employer, the supervisor must be employed by and practice at the same site as the intern's employer.

A supervisor may not supervise a spouse, relative, or domestic partner. The supervisor may not supervise anyone with whom he or she has a personal or business relationship. The supervisor may not do therapy with his/her supervisee, and may not supervise anyone who has previously been his/her patient.

Individual supervision means one supervisor and one person being supervised. As regulation specifies, supervision is to be "one-on-one, individual, face-to-face." One hour of individual supervision means sixty minutes of supervision.
Group supervision means a group of no more than eight persons being supervised by one supervisor. Again, the supervision, according to regulation, is to be "face-to-face." Two supervisors for a group of sixteen supervisees is not acceptable. Two hours of group supervision means one hundred twenty minutes of supervision.

Separate supervision is required for each work setting and in each week in which an intern or trainee is gaining hours of experience.

Supervision must occur within the same week that hours of experience are gained.
A supervisor may supervise an unlimited number of interns and trainees in any appropriate work setting other than private practice, but is limited to supervising two interns when those interns are employed in private practice.

Interns and trainees may only perform services as employees (IRS Form W-2) or as volunteers, and not as independent contractors (IRS Form 1099). Interns and trainees who have been hired and paid on an independent contractor basis will have their hours denied. The BBS views independent contractor status as self-employment, which is the reason such hours are denied. One may only be self-employed upon licensure. When an intern or trainee provides volunteered services in any lawful work setting other than private practice, and receives no more than a total, from all work settings, of five hundred dollars per month as reimbursement for actual incurred expenses, the hours will not be denied even though no W-2 is issued. According to law, the board may audit applicants who receive reimbursement for expenses, and the applicant has the burden of demonstrating that the payments received were for reimbursement of expenses actually incurred.

Make sure your trainees and interns only perform services at the place where their employer regularly conduct business, which may include performing services at other locations, so long as the services are performed under the direction and control of their employer and supervisor and in compliance with the laws and regulations pertaining to supervision. For example, an intern working in private practice may see a patient in the hospital or a trainee may see a person who is homebound on behalf of the agency that employs him/her.

Make sure your interns are "registered" at the time employment in your private practice begins.
Make sure your trainees and interns have no proprietary (ownership) interest in your or the employer's business. This means that interns and trainees will not pay rent, be a signer on a lease, be a signer on a joint checking account, pay the costs of running the business, pay for advertising, etc.

The Responsibility Statement for Supervisors (Section 1833.1 of the California Code of Regulations) became effective on January 1, 1991, and was revised effective January 1, 1998. Any supervisor that commenced supervision of an intern or trainee on or after January 1, 1991, is to sign the Responsibility Statement for Supervisors of a MFT Intern or Trainee. This statement is to be signed prior to supervising the intern or trainee. Trainees shall provide the Board with signed Responsibility Statements for Supervisors of a MFT Intern or Trainee upon application for intern registration. For any supervisor relationship that commenced on or after January 1, 1998, the intern or trainee should use the January 1, 1998 revised Responsibility Statement. Supervisors of social work associates are required to sign a similar Supervisor Responsibility Statement and such statement is to be mailed to the BBS within thirty days of commencing supervision. Supervisors of aspiring psychologists have no similar requirement.

For all hours gained as a trainee, the school must have a written agreement with the employer where the hours are gained. If no agreement exists, such hours cannot be counted by the trainee, no matter how good the work setting or your supervision.
For hours of experience gained on or after January 1, 1995, interns are required to achieve a ratio of one hour of individual supervision or two hours of group supervision for every ten client contact hours in each work setting. Trainees are required to achieve a ratio of one hour of individual supervision or two hours of group supervision for every five client contact hours in each work setting. Social work associates also have a ten to one ratio like MFT interns, and aspiring psychologists are required to have a ratio of ten percent of their experience in supervision-which equates to a ten to one ratio.

Issues to Consider in Advance of Commencing Supervision
How will you handle the supervision of your supervisee(s) when you are on vacation, ill, or unable to provide supervision for the week? If you are supervising in a work setting other than private practice, you should arrange for a substitute supervisor. If you are supervising in a private practice, a substitute is likely not possible as the supervisor would have to be employed by you and regularly practice at your place of business. Other options include: going on vacation simultaneously with the supervisee, arranging for the supervisee to not see clients that week, making some arrangement to provide face-to-face supervision even while out of the office, or merely not counting the hours for that week. Remember, if there is no supervision within the week, hours will not accrue.

How will supervisee fees charged to clients be established? In an agency or setting other than a private practice, the fees are likely set by the employer and are not an issue. In a private practice, the fees should be set by the supervisor/employer, while there may be input from the supervisee. Remember, this is the employer's business, and the supervisee is an employee of the employer.

How will you, the supervisor/employer, handle a termination-either initiated by the employer or initiated by the supervisee? Who "owns" the patients? Can the patients follow the supervisee to his/her new employer? What if there is no new employer? An article was previously written on this topic and can be found on the CAMFT website in the "members only" section-www.camft.org. The article is entitled, "Termination of Employment: Who owns the Patient?"

Should you have a contract/agreement with the new supervisee? If you are supervising on behalf of an entity other than in private practice, whether or not there is a contract/agreement has likely already been determined by your employer. If you are supervising in a private practice, you may want to consider a contract or an agreement. Whatever way you decide to go, it may be a situation of being "damned" if you do or "damned" if you don't. Contracts or agreements may have unintended consequences, such as, limiting your ability to terminate "at will," causing you to have to give warnings or notice that may not feel appropriate at the time you need to take action, or obligating you to provide benefits that, upon reflection, do not work.
What will be included in disclosure/informed consent statements that your supervisee(s) will use with clients? What will be included in authorization forms that you will want to provide for your supervisee(s)? It will be difficult to adequately advise your supervisee(s) if you have not developed such documents for your personal use.

Supervisors have many issues to consider prior to providing or during the course of providing supervision. This overview addresses some of the concerns that a supervisor should consider during or prior to commencing a supervisorial relationship. It does not and cannot address every situation that could potentially arise in the course of providing supervision, nor is it intended to be a substitute for independent advice or consultation. When using such an article as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained in this article. Keep in mind that members of CAMFT may always call the Association to get answers to questions of a legal, ethical or business nature. You will find CAMFT staff ready to assist you and informed about your questions about supervision. For other resources on supervision, refer to the CAMFT website-www.camft.org, "members only" section. For example, "Critical Reminders for Interns and Trainees" will provide useful information on required hours of experience, work settings and supervision concerns. You will need to acquire a password from CAMFT to access the "members only" section.

Sample Letter of Agreement