Ending the Cycle of Trauma: Reducing Vicarious Trauma through Trauma-Sensitive Supervision

Laura K. Jones

Clinicians often report feeling underprepared to work with trauma survivors. Well over half of the clients being seen at community mental health clinics report having experienced at least one traumatic incident during their lifetime, however, so trauma work is nearly inevitable. Supervision affords a unique opportunity to help prepare and support counselors working with traumatized clients. The supervisory relationship as well as the structure and content of supervision can be used as tools to prepare and ensure the wellbeing of both the client and the counselor.

Hearing stories of abuse, neglect, violence, and loss can be exceedingly difficult for counselors, especially counselors who themselves have a history of personal trauma (Baird & Kracen, 2006). In fact, many counselors who work with survivors can experience symptoms analogous to the posttraumatic stress disorder (PTSD) faced by their clients, with nearly 20 percent of counselors developing clinically diagnosable PTSD as a result (Meldrum, King, & Spooner, 2002, as cited by Sommer, 2008). The potential for such vicarious trauma (VT) is one of the predominant considerations in tailoring supervision for trauma counselors. Supervisors can reduce the potential for VT by providing a collaborative, strengths-based supervisory relationship that integrates ongoing discussions about VT and provides time and space for supervisees to discuss personal feelings and reactions to their work. The use of stories and metaphors has also been suggested as a possible means of facilitating discussions of vicarious reactions and helping supervisees make meaning of their feelings and experiences (Sommer & Cox, 2006).

Trauma-sensitive supervisors should likewise continually monitor supervisees for signs of VT and promote self-care both in and out of the supervisory context. Use of guided imagery, progressive relaxation, and breath work can be used during supervision for supervisees who are expressing considerable stress (Sommer, 2008). Furthermore, given the predisposition for counselors with a personal history of trauma to develop VT, there is considerable debate as to whether supervisors should or ethically can inquire about the trauma history of supervisees (West, 2010). Supervisors are cautioned to weigh strongly the advantages and disadvantages of such an inquiry, taking into consideration the particular circumstances of the individual supervisee.

A second overriding concern in trauma-sensitive supervision is the specialized knowledge needed to effectively assist trauma clients (Etherington, 2000; Sommer, 2008; West, 2010). Information related to trauma assessment, trauma-induced changes in physiology and arousal, dissociation, treatment models, recovered memories, and countertransference are integral to efficacious and beneficent work with traumatized clients. The most prevalent misstep untrained trauma counselors make is pushing a survivor to work with traumatic memories before the client is emotionally and physiologically ready. As such, one of the roles of a trauma-sensitive supervisor is to assess for gaps in the supervisee’s knowledge within these six core areas and provide avenues for training in deficient areas (Etherington, 2000). An assessment of supervisees’ knowledge of trauma theory should occur prior to contracting for supervision so requisite training can be integrated into the supervisory agreement (West, 2010). Assigning regular readings and case presentations covering areas needing further development can facilitate continuing education. In order for supervisors to adequately assess and train trauma counselors, however, supervisors themselves also need to be literate in trauma theory and practice.

Organizational factors also influence the wellbeing of both the trauma counselor and client and thus should be addressed within the supervisory context (Sommer, 2008). Dual relationships whereby the supervisor is also a boss, inadequate time for supervision, supervision not being valued, and caseloads too heavily based in trauma clients can increase the potential for VT and negatively impact the client and counselor. Given the American Counseling Associations Code of Ethics (2005), counselors are obligated to take action when agency policies and practices are damaging to clients or influence the effectiveness of counselors. Therefore, discussions of organizational impediments should occur early in supervision and efforts should be made to mitigate the difficulties.

Ongoing supervision is integral to the wellbeing of trauma counselors and beneficent care of their clients and should be tailored to the particular pedagogical and emotional needs of this population. Balancing traditional supervisory goals with the core components of trauma-sensitive supervision and the individual supervisee’s needs and developmental level can be difficult, yet additional support systems outside of the supervisory relationship can help manage the more restorative, self-care needs of trauma supervisees. Supervisors can assist supervisees in finding and building such networks and in doing so better address the multifaceted demands of trauma-sensitive supervision.

For further reading:

American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA: American Counseling Association.

Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly, 19, 181-188. doi: 10.1080/09515070600811899

Etherington, K. (2000). Supervising counsellors who work with survivors of childhood sexual abuse. Counselling Psychology Quarterly, 13, 377-389.

Sommer, C. A. (2008). Vicarious traumatization, trauma-sensitive supervision, and counselor preparation. Counselor Education and Supervision, 48, 61-71.

Sommer, C. A., & Cox, J. A. (2006). Sexual violence counselors’ reflections on supervision: Using stories to mitigate vicarious traumatization. Journal of Poetry Therapy, 19(1), 3-16. doi: 10.1080/08893670600565587

West, A. (2010). Supervising counsellors and psychotherapists who work with trauma: A Delphi study. British Journal of Guidance & Counselling, 38, 409-430. doi: 10.1080/03069885.2010.503696

Use of Cognitive-Behavioral Techniques in Clinical Supervision

Edward Wahesh, MS, LPCA, NCC

Beginning counselors often struggle with self-defeating thoughts and negative emotions related to counseling. “I cannot make mistakes as counselor!” is a common example of a belief held by counselors that can contribute to anxiety or other negative emotions. If not addressed, such thoughts and emotions can negatively influence the counselor’s ability to establish robust therapeutic relationships with clients.

Clinical supervision provides an opportunity to assist counselors in identifying the underlying irrational beliefs that diminish their ability to conduct effective therapy. Cognitive-Behavioral Therapy (CBT) has demonstrated efficacy through numerous outcome studies to treat personal problems such as depression and anxiety. The focus of CBT on how beliefs influence mood and behavior can inform the supervision of counselors. Specifically, the philosophy and techniques of CBT can be adapted by clinical supervisors for use with supervisees to increase their self-awareness and to identify and modify beliefs that interfere with their role as counselors.

An example of a CBT technique that can be adapted for use in clinical supervision is the Thought Record. Developed by JS Beck (1995), the Thought Record (originally referred to as the Dysfunctional Thought Record) provides a set of prompts that allow clients to challenge unproductive thoughts as they occur. Clients are instructed to fill out the Thought Record when they notice their mood getting worse. They record the specific situation, related automatic thoughts, associated emotions, alternative responses, and outcomes. The purpose of this exercise is to teach clients how to recognize and dispute self-defeating thoughts. Following an introduction to CBT during supervision, this exercise can be assigned as homework for supervisees to monitor and modify their problematic thoughts related to counseling. The following is an example of how a Thought Record can be completed by a beginning counselor:

Thought Record (JS Beck, 1995)

Date/Time: 11.23.2011 at 2:30pm

Situation:

1. What actual event or stream of thoughts, or daydreams, or recollection led to the unpleasant emotion?

Preparing case presentation for supervision

2. What (if any) distressing physical sensations did you have?

Felt my heart beat faster, difficulty concentrating

Automatic Thought(s):

1. What thought(s) and/or image(s) went through your mind?

I am never going to become an effective counselor

2. How much did you believe each one at the time?

80% (scale of 0-100%)

Emotion(s):

1. What emotion(s) did you feel at the time?

Anxiety

2. How intense was the emotion?

80% (scale of 0-100%)

Alternative Response:

1. Use the following questions to compose a response to the automatic thought(s) and

2. How much do you believe each response?

a. What is the evidence that the automatic thought is true?

My client shows no sign of improvement (70%)

b. Is there an alternative explanation?

Change may take longer than I assume, the client may not be ready to change (50%)

c. What is the worst that could happen and how could I cope?

Over the course of counseling, the client not only does not change, but also gets worse (40%). I can cope by speaking with my supervisor (60%)

d. What is the effect of my believing the automatic thought? What could be the effect of changing my thinking?

My thoughts make me feel anxious whenever I think about the client. My anxiety can interfere with my counseling approach. Changing my thoughts can make me more responsive to the needs of the client (60%)

e. If (friend’s [colleagues] name) was in the situation and had this thought, what would I tell her/him? What should I do about it?

I would tell my colleague that counselors cannot make clients change (70%)

Outcome:

1. How much do you now believe each automatic thought?

50% (I am never going to become an effective counselor)

2. What emotion(s) do you feel now? How intense (0-100%) is the emotion?

60% (Anxiety)

3. What will you do? [Behavioral activation]

Consult with my supervisor

Continue to monitor the presence of this and related automatic thoughts

Cognitive-behavioral techniques used in supervision can aide counselors in developing self-awareness of self-defeating beliefs and negative emotions that can hinder their clinical skills. Prior to incorporating these strategies into supervision, it is critical that supervisors possess competence in the philosophy and techniques of Cognitive-Behavioral Therapy. The following recommended readings provide supervisors with resources regarding CBT and the appropriate use of CBT in clinical supervision.

Recommended Readings for Practitioners:

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: Guilford.

Fitch, T. J., & Marshall, J. L. (2002). Using cognitive interventions with counseling practicum students during group supervision. Counselor Education and Supervision, 41, 335-342.

Kindsvatter, A., Granello, D. H., & Duba, J. (2008). Cognitive techniques as a means for facilitating supervisee development. Counselor Education and Supervision, 47, 179-192.

Newman, C. F. (2010). Competency in conducting cognitive-behavioral therapy: Foundational,

functional, and supervisory aspects. Psychotherapy: Theory, Research, Practice, Training, 47, 12-19.

Rosenbaum, M., & Ronen, T. (1998). Clinical supervision from the standpoint of cognitive-behavior therapy. Psychotherapy: Theory, Research, Practice, Training, 35, 220-230. doi:10.1037/h0087705

Power and Gender in the Supervisory Relationship

(Note: Doctoral students in CED 781a Counseling Supervision during Fall 2010 completed abbreviated literature reviews on a topic of individual interest. They wrote both a research summary and a summary for practitioners. Here, we present the summaries for practitioners. Please let us know if you have questions or suggestions for future summaries. L. DiAnne Borders)

By Elizabeth Likis-Werle, MS, LPC
Researchers and practitioners agree that power is inherently present in supervision, that power plays an important part in the supervisory relationship, and that how power is experienced can affect relationship dynamics and professional growth. What is lacking is consistent information on exactly how power interacts with gender and is experienced by both supervisors and supervisees. Is there a difference in same sex vs. opposite sex dyads in supervisor perceptions or supervisee assertiveness? To what extent do other factors like personality, culture, and individual variables contribute to power and gender differences in supervision?
Because of gendered socialization over the years, women supervisors may be reluctant to claim power as within their capacity or may not be aware of their own personal power. Some women may use power but may be less willing to identify it, as it may be viewed as a less feminine trait. The agreement on what to call power is inconsistent across disciplines, which makes measuring it difficult. Though there are a few measurements that capture the essence of power language, they are outdated and use masculine-oriented terms. We need a more relational, female infusion of terms used to describe power such as influence, social power, interpersonal interactions, empowerment, and relational connection. It would serve the counseling and supervision fields more effectively if we could embrace the term power and acknowledge its contribution to the process. Then we could measure how power is truly used and experienced in therapeutic interactions and remove the stigma of women claiming themselves as powerful, help supervisees develop more fully.
Some of the obstacles in applying our knowledge of power dynamics are:
· The research on power in supervision has small sample sizes which may have been too small to show significance differences
· Many of the studies were more than 15-20 years old. In fact, the most cited study and one of the most comprehensive studies involving gender and power in supervision was published twenty years ago (Nelson & Holloway, 1990)
· There is also conflicting information about male and female preferences for what kinds of power they use. Some of the findings indicate that, though there are not differences in supervisor style based on gender, the language used in does supervision differ depending on the gender of the supervisee. Specifically, female supervisees were less likely to get support to assert themselves from both male and female supervisors and, when given the chance, female supervisees were more likely to defer power
The question remains that if practitioners across the fields of counseling, sociology, communication, management, psychology, and social work agree theoretically and conceptually that power differentials exist and that gender plays a role in this, how then do we make progress to address the needs of female supervisees? Here are some tips for supervisors:
· Supervisors need to increase awareness of their biases around females.
· Adapt more collaborative language and style to empower female trainees in supervision.
· Become familiar with feminist supervision models to help address power imbalances.
· Recognize the need for connection and intimacy as a significant part in fostering development and growth in female supervisees.
· Check out Szymanski's (2005) Feminist Supervision Scale addressing the gender and power differentials in supervision.

For further reading, see:

Falender, C. A. (2010). Relationship and accountability: Tensions in feminist supervision.
Women & Therapy, 33, 2-41.
McHale, E., & Carr, A. (1998). The effect of supervisor and trainee therapist gender on supervision discourse. Journal of Family Therapy, 20, 395-411.

Nelson, M. L. (1997). An interactive model for empowering women in supervision. Counselor Education & Supervision, 37, 125-139.

Nelson, M. L., & Holloway, E. L. (1990). Relation of gender to power and involvement in supervision. Journal of Counseling Psychology, 37, 473-480.

Szymanski, D. M. (2005). The Feminist Supervision Scale: A rational/theoretical approach. Psychology of Women Quarterly, 27, 221-232.

Gender and Supervision

(Note: Doctoral students in CED 781a Counseling Supervision during Fall 2010 completed abbreviated literature reviews on a topic of individual interest. They wrote both a research summary and a summary for practitioners. Here, we present the summaries for practitioners. Please let us know if you have questions or suggestions for future summaries. L. DiAnne Borders)

By Lori Notestine

When many of us think about supervision, we think about how best to improve the counseling skills of our supervisees and how to help grow their skills as clinicians. The many things that run through our minds include building a relationship, giving constructive feedback, being supportive and challenging, and providing a space for growth. What may not be on our minds as we prepare for and provide supervision is the effect of gender on the interaction between the supervisor and supervisee.

Gender, primarily that of the supervisee, has been shown in numerous studies to have some effect on supervision. Although many other factors are often at play, gender has been shown to have an effect on supervision in the following ways:

• Communication style and messages are the most prevalent differences.
• Males have more task oriented speech.
• Female supervisees ask for more opinions, analyses, and evaluations of their work.
• Males ask for more suggestions from supervisors.
• Females are significantly more likely to have their suggestions built on or accepted.
• Males are encouraged to send more high-power messages than are female supervisees.
• Males perceive supervisor/supervisee relationships as better.
• Females give more praise and supportive comments to supervisors of both sexes than do male supervisees.

Implications for Practice

When it comes to identifying ways to include the topic of gender in supervision, it can be difficult to think about how to address this matter directly. In a study examining the effects of gender, ethnicity, and sexual orientation in supervision, Gatmon, Jackson, Koshkarian, Martos-Perry, Molina, and Patel (2001) identified one crucial aspect to consider when thinking about these issues within supervision. These researchers suggested that addressing these issues in a positive manner within supervision, whether the issues were specifically related to the supervisor, the supervisee, or the client, was critical to positive outcomes. The authors also noted that addressing these issues in a discriminatory or prejudicial way had negative effects on supervisory outcomes.

Some tips for discussing gender within supervision and addressing other gender related issues include the following:

• Use a developmental model of supervision and address issues within the context of the supervisee’s developmental level. For example, Bernard’s Discrimination Model may be used to facilitate growth in supervisees through interacting as a teacher, counselor, and consultant. A supervisee in the early stages of development may need the supervisor to fill a more concrete teaching role, whereas a more advanced supervisee may require the supervisor to be more of a consultant.
• Be sensitive to the effects of power differentials on supervisees.
• Use gender fair practices.
• Be appreciative of and celebrate both feminine and masculine characteristics.
• Be vigilant of any ways that gender may impact and/or influence the supervisory relationship.
• Monitor interactions with supervisees to avoid any unintentional gender biases.
• Attend to the dynamics of interactions with both male and female supervisees and develop effective strategies for encouraging the development of supervisees’ professional identity.
• Finally, when you have a supervisee who is of a different gender (or culturally different in any way), be sure to address these potential issues early in the supervisory relationship.

For Further Reading

*Most recommended for supervisor practitioners

*Gatmon, D., Jackson, D., Koshkarian, L., Martos-Perry, N., Molina, A., Patel, N. et al. (2001). Exploring ethnic, gender, and sexual orientation variables in supervision: Do they really matter? Journal of Multicultural Counseling and Development, 29, 102-13.

*Granello, D. (2003). Influence strategies in the supervisory dyad: An investigation into the effects of gender and age. Counselor Education and Supervision, 42, 189-202.

*Nelson, M., & Holloway, E. (1990). Relation of gender to power and involvement in supervision. Journal of Counseling Psychology, 37, 473-81.

Paisley, P., & ERIC Clearinghouse on Counseling and Student Services. (1994). Gender issues in supervision.

Sells, J., Goodyear, R., Lichtenberg, J., & Polkinghorne, D. (1997). Relationship of supervisor and trainee gender to in-session verbal behavior and ratings of trainee skills. Journal of Counseling Psychology, 44, 406-412. doi:10.1037/0022-0167.44.4.406.

Vonk, M., & And, O. (1996). Female MSW students' satisfaction with practicum supervision: The effect of supervisor gender. Journal of Social Work Education, 32, 415-19.

*Walker, J., Ladany, N., & Pate-Carolan, L. (2007). Gender-related events in psychotherapy supervision: Female trainee perspectives. Counselling & Psychotherapy Research, 7, 12-18.

Worthington, E., & Stern, A. (1985). Effects of supervisor and supervisee degree level and gender on the supervisory relationship. Journal of Counseling Psychology, 32, 252-262. doi:10.1037/0022-0167.32.2.252.

Cognitive Complexity for Clinical Supervisors

(Note: Doctoral students in CED 781a Counseling Supervision during Fall 2010 completed abbreviated literature reviews on a topic of individual interest. They wrote both a research summary and a summary for practitioners. Here, we present the summaries for practitioners. Please let us know if you have questions or suggestions for future summaries. L. DiAnne Borders)

By Laura Shannonhouse

Researchers indicate that counseling students with higher levels of cognitive complexity (CC) are able to take multiple perspectives, apply counseling skills more effectively, reflect more deeply on their own thinking, and recognize their own limitations. Cognitively complex counselors remain objective, accept client ideas, encourage exploration, have more confidence, tolerate ambiguity, avoid stereotyping, describe their clients in interactional terms, and form more complex case conceptualizations. Since CC is important for practitioners to consider both for the sake of the supervisees and in their own work, some practical knowledge about CC is provided.

Though CC is defined in various ways, there is consensus that there are concrete clinical gains associated with increases in CC. Granello (2010) described cognitive complexity as “the ability to absorb, integrate and make use of multiple perspectives.” Since CC tends to be domain specific (an individual may be able to think more complexly about some topics than others), it is vital for counselors supervising others’ development to become familiar with how higher (or lower) levels of CC manifest in one’s counseling if they are to effectively mentor.

CC tends to increase during counselor training, and supervisors can take steps to assess their supervisees’ current CC in order to present experiences which can foster that growth. Owen and Lindley (2010) presented sample questions that may be used in supervision to assess and promote various aspects of CC. Their paradigm incorporates three major aspects that should be developed: identification of session activities (understanding what is going on), metacognitions (reflecting on and evaluating the counseling relationship), and epistemic cognitions (views on knowledge). For practitioners, the underlying theme is one of intentionality in understanding one’s supervisees and in selecting methods to encourage their growth. Malikiosi-Loizos and colleagues reported that specific supervisory approaches work more effectively with counselors in different levels of CC.

Bloom’s Taxonomy of Educational Objectives has been used to foster CC development. Incorporating this ubiquitous educational theory enables supervisors to include questions and interventions that target CC in their supervisees. Granello and Underfer-Babalis (2004) stated that minimal training is required to understand the interventions used at each stage; supervisors can quickly understand this model and the intuitive nature is often appealing. Many of the applications are specifically tailored for group supervision. Practitioners should note that those who have used Bloom’s taxonomy for group supervision report an increased awareness of the need to attend to their own cognitive development.

There is also an argument that pre-existing characteristics position counselor trainees to develop higher order levels of thinking faster. Supervisors should recognize and foster the following: drawing upon accumulated experiences, taking multiple perspectives, and valuing ambiguity along with specific counseling techniques and the general wellness of their supervisees. Researchers have indicated that counseling experience, supervisory experience, counselor education experience, and higher degrees all contribute to one’s level of CC. Of personal significance to practitioners, Granello (2010) reported “how counselors think changes with experience.” Specifically, there appears to be a shift in practitioner CC between 5-10 and greater than 10 years of experience. Awareness of this pattern when observing colleagues and during one’s own career journey should help a practitioner’s personal development of CC.

CC, while a difficult construct to measure, is an important way to conceptualize the cognitive domain of counselor development (and has implications for the emotional and relational domains as well). The articles listed below contain several models of CC development, some of which can easily be implemented in supervisory contexts.

Recommended Readings for Practitioners:

Granello, D. H. (2010). Cognitive complexity among practicing counselors: How thinking changes with experience. Journal of Counseling and Development, 88, 92-100.

Granello, D. H., & Underfer-Babalis, J. (2004). Supervision of group work: A model to increase supervisee cognitive complexity. Journal of Specialists in Group Work, 29, 159-173.

Jennings, L., & Skovholt, T. (1999). The cognitive emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46, 3-11.

Malikiosi-Loizos, M., Gold, J., Mehnert, W., & Work, G. (1981). Differential supervision and cognitive structure effects on empathy and counseling effectiveness. International Journal for the Advancement of Counseling, 4, 119-129.

Owen, J. & Lindley, L. D. (2010). Therapists’ cognitive complexity: Review of theoretical models and development of an integrated approach for training. Training and Education in Professional Psychology, 4, 128-137.

Dual Relationships in Counseling Supervision: Implications for Practice

(Note: Doctoral students in CED 781a Counseling Supervision during Fall 2010 completed abbreviated literature reviews on a topic of individual interest. They wrote both a research summary and a summary for practitioners. Here, we present the summaries for practitioners. Please let us know if you have questions or suggestions for future summaries. L. DiAnne Borders)

By Cristina Lima

The topic of dual relationships in supervision with counseling trainees has received the attention of the professional community for decades. Ability to determine potential for ethical problems is crucial, but the ethical codes of the helping professions do not always offer concrete guidelines. Supervisors often find themselves in dual role dilemmas. Some are easier to assess and determine a course of action, such as conflicts involving romantic relationships. However, there are ambiguous situations involving social interactions or multiple professional roles when supervisors face uncertainty.

Sexual Relationships

Historically, the first concern of helping professionals in regard to dual relationships in supervision was focused on sexual relationships. Pioneer studies were important to show the prevalence of such relationships and raise awareness among professionals (Pope, Levenson, & Schover, 1979). In 1981, the American Psychological Association (APA) revised its Ethical Standards and, for the first time, stated that sexual relationships with supervisees and students were unethical. A few years later, it was clear that romantic interactions in the supervisory relationship were harmful and that the main factor associated with the risk of exploitation was the power differential between supervisor and supervisee (Glaser & Thorpe, 1986).

Social Interactions

Once the issue of sexual intimacies was settled, interest turned to non-sexual relationships, especially social interactions. The main focus of attention was the potential of harm to the working supervisory relationship because of the risk of exploitation due to the power differential, and the potential of loss of objectivity consequent to the overlapping of roles. By that time, the framework used for dual relationship between clients and therapists was assumed to be equally valid for the supervisory relationship. However, this assumption was challenged by several researchers (e.g., Bowman & Hatley, 1995; Erwin, 2000), who suggested that not all dual-relationships are harmful. Furthermore, Burian and Slimp (2000) believed that not all types of dual relationships should be avoided because of possible benefits.

Multiple Professional Roles

Besides social interactions, supervisors also were concerned with multiple professional relationships (Lamb, Catanzaro, & Moorman, 2004). Multiple professional relationships in supervision occur when there is an overlap of roles such as teacher, advisor, clinical supervisor, and administrative supervisor. These type of dual relationship, according to studies (e.g.,Tromski-Klingshirn & Davis, 2007), seem to have the potential to bring more benefits than harm to the working relationship. The conclusion is that the quality of the relationship is more important than the dual relationship per se. Professional dual relationships carry the same potential risk for exploitation and loss of objectivity; however, the risk is minimized by the fact that the multiple professional roles often share the same evaluative nature.

Professional dual relationships are often difficult to avoid. Gottlieb, Robinson, and Younggren (2007) offered recommendations for administrators, supervisors, and supervisees when facing multiple relationships. The main recommendations were to focus on the best interest of the supervisees, acknowledge power differential and evaluative roles, maintain objectivity, assess potential for harm, keep clear boundaries, and discuss the issue openly with supervisees. It seems that awareness is an important component to avoid harm.

Conclusions

Considering the lack of more specific guidelines, the major implication of this review is to emphasize the relevance of awareness among supervisors. Furthermore, special attention should be given to training of supervisors, including a clear distinction among different types of dual roles and different strategies to determine and choose appropriate course of action. Also, it is important to foster opportunities for dialogue among supervisors to discuss the ethical implications of such relationships, what constitutes harm and benefit in non-sexual relationships, and what constitutes quality supervisory relationship.

For Further Reading

Burian, B. K., & Slimp, A. O. (2000). Social dual-relationships during internship: A decision- making model. Professional Psychology: Research and Practice, 31, 332-338.

Gottlieb, M. C., Robinson, K., & Younggren, J. N. (2007). Multiple relations in supervision: Guidance for administrators, supervisors, and students. Professional Psychology: Research and Practice, 38, 241-247.

Lamb, D. H., Catanzaro, S. J., & Moorman, A. S. (2004). A preliminary look at how psychologists identify, evaluate, and proceed when faced with possible multiple relationship dilemmas. Professional Psychology: Research and Practice, 35, 248-254.

Tromski-Klingshirn, D. M., & Davis, T. E. (2007). Supervisees’ perceptions of their clinical supervision: A study of the dual role of clinical and administrative supervisor. Counselor Education & Supervision, 46, 294-304.