Supervision in Small Towns

You’ve hung your shingle. 

You’re ready to start supervision and give back to your community. 

You live in small town.

Have you considered the complexities that come with setting up shop in a small town? Reducing ethical concerns to the best of your ability is an important step in the success of your supervision business.  Let’s take a look at some concerns of rural and mountain area professionals and how to navigate them.

Avoiding Dual Roles

When working in a small town, it’s more difficult to avoid dual roles due to the limited professionals available. Roles such as being a supervisor and a therapist that colleagues want to utilize due to your particular skill set. Perhaps you run a support group and value getting referrals from colleagues to keep the group full. Maybe you offer a workshop or training in town of which a supervisee would like to participate. As you can imagine, this can pose some challenging dual roles for supervisees and colleagues with whom you choose to collaborate with due to your multiple roles within the community at large. 

Asking some questions of yourself can be a good first step to identifying any possible dual roles, now and in the future. For example, do you require supervisees to disclose to their clients that the group they’ve referred the client to participate in is run by their supervisor? 

Does a supervisee have the option to receive training from another professional when a workshop is offered?

Although some of these roles can’t be helped in wanting to grow your business and make a difference within the community, remaining mindful of any ethical dilemmas and taking steps to reduce them such as disclosing roles up front as part of transparency can be a valuable step as a professional.

Administrative vs. Clinical Supervision

Another complexity of smaller communities and supervision is the role of administrative vs. clinical supervision. Are you in multiple roles with your supervisee that would reinforce unintended authority or perceived power and control? Are you in a leadership role that evaluates performance of professionals in your area which would include your supervisee? Have you taken on a supervision role for mobile crisis and realize that the clinician you are attempting to support is a colleague in all other capacities? Are you on a panel that approves clinicians to take insurance? Are you an auditor of clinician performance for insurance reimbursement in your region? Similar to the recommendations above, disclosing your roles would be a recommended first step, followed by seeking consultation with your attorney or malpractice insurance to identify other steps to reduce ethical concerns.

Controlling Client Contact

Ethical concerns are not restricted exclusively to your role with supervisees and colleagues. What if you run into a client that is staffed frequently in supervision with your supervisee, including knowledge of intimate details of their life that would not otherwise be shared? What if you find yourself interacting with that client in the community? While volunteering? While at dinner with your family? As a business person? As the teacher of your child’s class? 

Supervisors do their best to minimize contact with clients in community settings. Another important element to reducing confidentiality violations is having your contact information and role included in your supervisee’s disclosure. By sharing who you are and the purpose of staffing information in supervision to support the clinical process, you can support clients in advocating for their needs and comfort level. Sometimes clients will identify this as of low concern with their supervisee, while other times it will result in finding another professional to staff their cases with in order for a client to feel more comfortable.

Although this is just a snippet of the complexities supervisors face in small towns, we hope they give you some context and questions to ask yourself when taking on new roles within your community. Remain curious and play through role acquisition to see what comes up. Consult with colleagues to gain perspective of any risks. And please seek consultation with your attorney or malpractice insurance to identify other steps to reduce ethical concerns.

Written by Khara Croswaite Brindle, MA, LPC, ACS