Supervision and Gatekeeping - S3E9

Dr. Aprille Woodson:

Welcome to the Voice of Counseling. I'm Dr. Aprille Woodson, here with our guest today, Mr. William Mulkey. Mr. Mulkey is a licensed professional counselor and supervisor in the upstate of South Carolina. He is currently serving as the director of a local community counseling program and maintains his own private practice in Greenville, South Carolina. He graduated with distinguished honors from Webster University with a Master of Arts Degree in counseling with an emphasis in professional mental health counseling.

Dr. Aprille Woodson:

Mr. Mulkey also attended Clemson University as an undergraduate majoring in psychology and as a graduate student studying applied sociology. He furthered his postgraduate education in behavioral analysis through the Youth Learning Center at Clemson University. Mr. Mulkey served as an adjunct professor of sociology at Limestone College for 16 years. Welcome, Bill, and thank you for joining us today to discuss the ethics of supervision and gatekeeping.

Bill Mulkey:

Thank you, Aprille.

Dr. Aprille Woodson:

So let's just jump right in. Tell me, Bill, what is counseling supervision, and what purpose does it serve?

Bill Mulkey:

Counseling supervision, within itself, it's a process in which a supervisor, who is typically seen as a senior therapist or experienced, has done additional training to be able to become a supervisor, assist in the training and supervision process of newly licensed professional counselor associates or interns, different terms for different states and territories.

Bill Mulkey:

And, this person, the senior therapist or supervisor, works with these interns or associates, the supervisees, over a span of time, approximately two years in most states. And, during that time, helping them to acquire new skills, knowledge, and ensuring that they're meeting ethical guidelines, boundaries, approaches, things of that nature. And, we also sort of serve as really the first step in the gatekeeping process in ensuring that the person who is seeking full licensure meets all the standards and ethical expectations of our practice, of our profession.

Dr. Aprille Woodson:

So, do you follow a supervision model when you're going through this process of supervision? For example, cognitive behavioral supervision?

Bill Mulkey:

I do. As many supervisors will know, there are various models of supervision. The ones like you mentioned with CBT, discrimination models, things of that nature, Adlerian. I personally utilize what is considered an integrative supervision model in which I assume roles based on the situation or the supervision session that we may be having in the integrative model.

Bill Mulkey:

I not only serve as, I guess, what would be considered a teacher. I also serve as a colleague, a counselor, sort of reiterating or reinforcing the importance of peer-to-peer consultation. And, at times, it may seem that I'm, as a client, as the supervisee, as roleplayer, going over skills, and as the client, I can, in that role, come back with my supervisee and provide input, things of that nature.

Dr. Aprille Woodson:

So, it allows you to sort of switch roles and interplay with your supervisee.

Bill Mulkey:

And that was the one thing about the integrative model that I really liked was being able to hit upon different areas and being able to move within those roles. And also, as I work with a supervisee, I often tell them that not only do they come to hopefully learn something from me, but as a clinician, I always want to learn something new from my supervisees as well, encouraging them to be able to grow as a professional and expound upon the evidence-based practice or modalities they wish to utilize from their counselors.

Dr. Aprille Woodson:

So, do you do any kind of screening before you agree to take on a supervisee? For example, do you ask for references, or do you do a consultation with a new supervisee before you have your first supervision meeting to see if it's going to be a good fit?

Bill Mulkey:

I do. I think it's really important when we're talking about taking on the role of supervisor or accepting a new supervisee. My approach personally has really been an initial, what I call a meet and greet with a potential supervisee. And I do this to allow myself and the supervisee the opportunity to determine if we would be a good fit for each other. I believe it is equally important for the supervisee to have input into what they're looking for in the supervision process.

Bill Mulkey:

And, it allows me the same opportunity to describe what I'm looking for in an associate in my expectations. Like the counseling process itself, supervision encompasses establishing a type of relationship that is designed to help the other person grow into the professional they would like to be. It is personal at many levels, but it also requires clearly establishing the role of supervisor and supervisee.

Dr. Aprille Woodson:

So, would this be considered a form of gatekeeping?

Bill Mulkey:

This could be considered an early part of the gatekeeping process as I would not want to take on the role and responsibility of the supervisor for a person that I'm not comfortable working with over an extended period of time. But that does not mean that if I chose not to supervise an associate, they would not go on to become a good counselor, but more to the point of if I do not believe I would be a good fit for them per se.

Bill Mulkey:

And as with a new client, if I don't believe I can provide the services that they may be seeking or they may require in an ethical treatment approach, ethically, I would have to refer out my... the potential supervisee to another supervisor who may be a better fit for their needs.

Dr. Aprille Woodson:

So, what type of review or evaluative process do you use in supervision?

Bill Mulkey:

I maintain a checklist, and it's one that I've created over the years, and just working with other supervisors, going through various classes, things of that nature. It's a running checklist which identifies potential strengths. I don't like to use the word weaknesses, maybe challenges or areas for improvement, but it's a checklist that I can do and almost like an employee performance evaluation.

Bill Mulkey:

I go through this. I try to do it about every six months. That will allow me four evaluations over a two-year period, but it's a written checklist that I go through. And then me and the supervisee will sit down, we'll discuss where they are in this process and my thoughts, giving them the opportunity to ask questions, potentially make changes that they feel necessary, and also to provide me some input into their thoughts about my supervision.

Dr. Aprille Woodson:

So, let's say you find there are more areas for improvement than where they're excelling. Would that frequency for that evaluative process increase more than six months, or would you just kind of review them every six months?

Bill Mulkey:

I think if it was an area that identified that I did have a concern, sure, I would want to increase the numbers or the opportunities for evaluation. I would want to communicate that with my supervisee as well. And that goes back into sort of the gatekeeping process you mentioned earlier.

Bill Mulkey:

And if there is an area of concern, one that I would really consider potentially ethically challenging, that I would want my supervisee to have that information and let them know that these are things where we're going to be checking more frequently just to keep tab on and to ensure that they're making any changes that are necessary.

Dr. Aprille Woodson:

Okay. Thank you for that. So let me ask you. Is the review process formal or informal? For example, is it verbal or in a written format?

Bill Mulkey:

Myself, personally, I guess as a supervisor, many would probably say it's more of an informal approach, but I think it's a combination. Again, sort of going into my integrative model, I do keep a written checklist of notes that I keep with all my supervisees as record and documentation of their supervision process.

Bill Mulkey:

So I would provide them with a copy of the written checklist for their own purposes or their own records, but also we would sit down and verbally discuss any concerns. And also discuss their strengths because I think that's just as important and utilizing more of the verbal approach in sessions, maybe in between the evaluated process.

Dr. Aprille Woodson:

So, how often do you obtain feedback from the supervisee on how supervision is going for them, and what does that process look like overall?

Bill Mulkey:

Sure. Personally, I think I obtain feedback in every supervision session. I'm frequently asking the associate their opinion on information discussed that was provided and to ensure that both of our efforts were productive and beneficial in the supervision process. Often, this would be more of an informal and verbal process but a process to ensure that our communication was meaningful and understood.

Bill Mulkey:

As a supervisor, I believe it is incumbent upon me to ensure that any instructions, directions, or productive criticisms are understood and accepted more as a building and learning experience and not as perceived as a slide against the associate and their skills or their role as a counselor, never wanting to lessen their efforts or make them feel inadequate in any way. So I really like for those... that feedback to me, I take it... yeah, I don't take it personally. It gives me insight to maybe areas that I may be weak or I need to improve on and some of my strengths. So I'll do that integrative process throughout.

Dr. Aprille Woodson:

I am glad you mentioned that because I was going to ask you that question. In terms of the feedback you received from your supervisee, how you make changes as... in your supervision process, what that looks like if they need more guidance from you or maybe they need more latitude in the supervision, how does that inform your supervision process?

Bill Mulkey:

And, that's a great question that, I think it's important to get that feedback from the supervisees as every supervisee is an individual, and everyone brings their own individual strengths, their own individual concerns, their opinions. So, the feedback varies from individual to individual, but it allows me to identify any concerns they may have or needs that they're seeking, allowing me to grow or make changes as needed in that process to ensure that they're getting what they're looking for out of supervision.

Dr. Aprille Woodson:

So, when you're thinking about ethics and the Code of Ethics, do you take the time to go over that with your supervisees to ensure that they are practicing ethically and following guidelines and not going outside of boundaries? How does that look when you're going through supervision with a supervisee?

Bill Mulkey:

For me, ethics is very important. Not only the ACA Code of Ethics, which here, I've incorporated into my own private practice I maintain and also utilize in my role as the director for the Epworth Center for Counseling, where I'm currently working. But working with my supervisees in ethics that is one of the first and primary things we really go over is addressing ethics as it's a definite component of my supervision process. And, not only do I address the ACA's Code of Ethics, but I also incorporate the ethics from our State Licensing Board.

Bill Mulkey:

I also find it beneficial to incorporate the Code of Ethics from other counseling professions in the process, such as a marriage, family therapy, social work, things of that nature, because there are numerous similarities between all the various counseling bodies, but there's an important lesson, learning the meaning and value behind the creation of those various codes within each of the respective professions. And recognizing that each body incorporates the respective codes to ensure client care, self-awareness, and learning to hold other members of our profession accountable for our own actions. So incorporating [inaudible 00:14:10] in the supervision process is gone over frequently.

Bill Mulkey:

And, one of my first, I guess, opening questions to my supervisees whenever we start a supervision session is, "Do you have any ethical concerns or ethical considerations we need to discuss?" Just constantly reminding them that bring it to my attention if anything is even mildly considered ethical in question or have any questions about ethics because I definitely want them to understand that. And, one of the other importance of addressing the ACA's Code of Ethics along with our state codes is also to help resolve what many of us call gray areas and ethical dilemmas that are not clearly defined.

Bill Mulkey:

And, it's to help the associate or the supervisee understand the importance of adherence to these codes because, as it is often by these codes, that we're frequently judged or held accountable. Should anyone, like clients, colleagues, the public, if they come to believe that our approach and implementation of our professional skills and counseling if they're harmful, erroneous, or not founded in recognized approaches and principles, it's these Code of Ethics that are frequently utilized as sort of a benchmark for that process. So understanding those codes are very important for new supervisees.

Dr. Aprille Woodson:

And I know that's especially important to you, Bill. And one thing I didn't mention that our audience should know, you're the co-chair for the ethics committee at the American Counseling Association, so this is a really important component for you. So I want to ask you, how long, in terms for yourself, does it take for you to know if a supervisee is or will be an ethically sound and competent counselor?

Bill Mulkey:

I wish there was an easy just sort of concrete method to identify such concerns, but it's very important, and I would like to believe that this knowledge should come early on in the supervision process. For me, not only as a supervisor but also as what I considered a seasoned clinician, by observing the work that is being done by the supervisee, reviewing their documentation, their adherence to recognized evidence-based approaches or modalities, and their ability to navigate the counseling process in an ethical manner.

Bill Mulkey:

So, observing these things and working with this person, I would like to think that my judgment or my opinion, will they be an ethically sound and competent counselor, should come early. It shouldn't take that long. And, also, by providing the associate with the various situations in which they may be required to make an ethical decision and discussing their decision-making approach or model, it helps me determine their decision-making process and importance they give to ethics overall. We'll do some role plays all throughout situations like that, allowing them to navigate the ethics process and implementing of codes and understanding them.

Bill Mulkey:

But, however, I do recognize that a newly licensed associate may not be as well versed in the Code of Ethics compared to a seasoned therapist of, let's say, five-plus years, which is sort of the minimum requirement to even begin the supervision process. But, the associates' ability to recognize that they're learning and seeking out guidance in such situations is just as important because enough cannot be said about the value of seeking out consultation and or guidance and potential ethical dilemmas.

Dr. Aprille Woodson:

Have you ever made the gatekeeping decision to not approve someone for licensure? If you did that, how did you tell them, and how far into their supervision were they?

Bill Mulkey:

Over the years as a licensed supervisor, and I've been one for 10 years and 12 if you count my two years as supervised supervision, and during that time there have been a limited number of associates that I have not recommended for full licensure. Incumbent to that decision is never easy, but a decision that is very important during such cases. As with counseling a client, sometimes it is just as important for a supervisor to seek out peer-to-peer or supervisor-to-supervisor consultation and speaking with another supervisor about my reasoning, and at times, hesitancy, is important to ensure that I'm being unbiased in such a decision and that the decision I'm making is sound and for ethical reasons.

Bill Mulkey:

One thing I've noticed over the years is the tendency for supervisors to avoid these difficult situations or conversations. And, unfortunately, they refuse to sign off on the recommendation for full licensure at the end of the time period or the acquisition of the hours needed for supervision. And, I find this to be grossly unfair to the supervisee and to be, at the least, ethically questionable. If, at any time during the supervision process, I come to the conclusion that a supervisee should not be recommended for full licensure, I believe it is important to have that discussion immediately. Clearly outlining the reasoning behind my decision and to potentially stop any harm happening to a client or other practitioners.

Bill Mulkey:

I believe it is incumbent upon all supervisors to provide such decisions or the reasoning in a clear and timely manner to the supervisee unless it is an incident, let's say, gross negligence or a blatant violation of the Code of Ethics. I believe that providing the supervisee with that information may provide them insight into changes that need to be made and hopefully being able to recover and correct what I perceive as a fault, and hopefully, they can still pursue their professional goals. Also, I believe not everyone is cut out to be a counselor, and the supervisee should be provided the opportunity to reevaluate their professional trajectory at the earliest points available.

Dr. Aprille Woodson:

I'm glad you raised this because there've been so many horror stories that supervisees are under supervision and they're not getting their monthly signatures or weekly signatures from their supervisee... supervisor, rather, and they get to the end of that period, and they're told, "I'm not going to approve you."

Dr. Aprille Woodson:

I think that it does raise some eyebrows when it comes to ethics and ethical issues for supervisors and supervisees, so I'm glad you've identified that. Do you keep a paper trail if you know a supervisee is not doing well or performing up to par? For example, let's say they're frequently late, they have cancellations with short notice, or they're not making clinically sound ethical decisions, or they're just plainly just unprofessional.

Bill Mulkey:

Sure, I do. I keep notes on every supervision session for all my associates. For me, it's just like a counseling session almost. I have the start and the end times of our supervision time together. I keep notes about any concerns as well as things that I believe my associates are doing well. When a pattern... Excuse me. When a pattern of concern is noticed, like I mentioned previously, it is incumbent upon the supervisor to bring it to the supervisee's attention. It may bring into question their behaviors and commitment to their own respective clients.

Bill Mulkey:

If they're frequently late or canceling short notice for supervision session, do I have concerns that they're doing this with their clients as well? If ever I have to have a discussion about such concerns, I ensure that it's documented in the notes. This also serves as evidence of my decision to potentially not recommend an associate for full licensure, and it shows my attempts to address such issues before they become profound or uncorrectable. Such documentation, if ever needed, can provide some level of evidence that I applied supervision skills in an ethical manner.

Dr. Aprille Woodson:

Have you ever sought out consultation regarding a supervisee's behavior or performance regarding gatekeeping?

Bill Mulkey:

Yes. Frequently. As I mentioned in the previous question, I will, prior to finalizing my decision, seek out a consultation session meeting with another licensed supervisor. Often, I probably speak with more than just one other supervisor peer about this. And, when considering gatekeeping and not only the importance of ensuring that those who receive a recommendation have established themselves as a person who has displayed those skills and acquired the knowledge to be an independently licensed professional counselor.

Bill Mulkey:

But considering those who may not receive such a recommendation is very important to ensure that my decisions are not based on some form of countertransference or projection on my part and that the decision not to make the recommendation to sound based on appropriate adherence to the supervision and ethical processes. Gatekeeping within itself is an important and integral part of becoming a licensed counselor. It is one of my duties as a supervisor to recognize that importance and to ensure that when I'm making a recommendation or, in some cases not, that I'm mindful of my responsibility in this process to further support and grow our profession.

Bill Mulkey:

As the supervisor, it is my duty to ensure that anyone I have supervised is taking on this new role appropriately. They're trained and prepared to continue the dedicated work of all the professionals who have come before them and with the understanding that they will represent a counseling profession through their individual work as a sincere responsibility.

Dr. Aprille Woodson:

And thank you for addressing that. I think it's really critically important that our supervisees and supervisors understand this process as you've laid it out. As we wrap up our session today, I want to ask you one other question about just the supervision contract. Do you have supervisees sign a contract with you prior to starting supervision with them, and does your supervision contract include any policies about gatekeeping? Tell us how important that is and what that process looks like.

Bill Mulkey:

Yes, the contract is one of the requirements for providing supervision, at least here in South Carolina where I'm licensed. But more importantly, I utilize the contract to clearly lay out my expectations and requirements for the supervision process. If developed and implemented correctly, the contract should communicate what is expected from the supervisee and on what grounds there may be a termination of the supervision process.

Bill Mulkey:

In addition, it should also clearly identify the recourse for any unethical behaviors, such as reporting such as incidents to the State Licensing Board, which really is the gatekeeping process. In my contract, I also provide to the supervisee who has signed the contract, what my role and responsibilities are as their supervisor.

Dr. Aprille Woodson:

Thank you, Bill, for joining us today, as well as our listening audience. This topic of supervision is critically important, and I'm glad you highlighted some key points on what the expectations are and what supervisors and supervises should expect. Thank you again for joining us. I'm Dr. Aprille Woodson, bringing you another informative session on the topic of ethics, supervision, and gatekeeping.

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