Exploring Rehabilitation Counseling Supervisors’ Role in Promoting Counselor Development of Ethical Fluency

Abstract

Clinical supervision plays an integral role in the professional development of counselors, particularly for developing their awareness of ethical service delivery and decision making. This grounded theory study queried eight rehabilitation counseling supervisors, four from a state rehabilitation agency and four from a nonprofit community rehabilitation organization. The purpose of the study was to determine supervisor perspectives regarding their role in the development of ethical decision making in their supervisees. The emergent construct from the data is termed ethical fluency. Ethical fluency is a cognitive ability representing the interaction between acculturation knowledge, fluid reasoning, and the speed and accuracy with which ethical dilemmas are recognized and processed. Supervisors in this study reported playing a key role in developing ethical fluency in counselors, and the supervisory working alliance was an integral platform from which to approach discussions on ethics. Recommendations for improved practice and future research are provided.

Keywords

clinical supervision ethics rehabilitation counseling

Research has demonstrated that ethical decision making is a fundamental competency of both rehabilitation counselors (Leahy, Muenzen, Saunders, & Strauser, 2009) and rehabilitation counseling supervisors (Thielsen & Leahy, 2001). As such, it is a required preservice training component of programs accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP; 2016). In addition, credentialing organizations (e.g., licensure boards, certification organizations) require ongoing continuing education specific to ethics (American Counseling Association, 2014; Association for Counselor Education and Supervision [ACES], 2011; Commission on Rehabilitation Counselor Certification [CRCC], 2017; National Board for Certified Counselors, 2012). Even with multiple levels of formal instruction, the supervisor has the most significant role in the development of ethical awareness and reasoning in the counselor (Kerkhoff, Hanson, Guenther, & Ashkanazi, 1997). As ethical decision making is complex and challenging, the rehabilitation counseling supervisor plays an essential role in the counselor’s development in this slow developing area of competence (Corey, Corey, & Callanan, 2007; Kocet, 2006; Lambie & Sias, 2009).

Ethics represents a knowledge area that can be taught and clinical supervision is a medium for instruction (Tarvydas, 2012). This is evident as multiple ethical decision-making models in counseling commonly include supervision or consultation as an essential part of the process (Cottone & Claus, 2000). It is important that counselors and supervisors conceptualize ethical decision making as a dynamic interpersonal process of consultation, negotiation, and arbitration between the counselor and client, facilitated by the supervisor (Lehr & Sumarah, 2004), rather than a counselor-centric process (Cottone, 2001; Passmore, 2009).

Supervisors help to shape ethical awareness and practice in a multitude of ways. The CRCC Code of Professional ethics advises rehabilitation counseling supervisors to make supervisees aware of ethical and legal standards and to adhere to these professional standards of practice (Section H.4.a; CRCC, 2017). Counselor perceptions of their supervisor’s ethics can influence the supervisory working alliance (SWA) and the realization of goals and tasks within the supervisory setting (Ellis et al., 2014; Ladany, Lehrman-Waterman, Molinaro, & Wogast, 1999; Schultz, 2011). With clinical supervision serving as the “signature pedagogy” by which the counseling professions instruct and prepare practitioners (Bernard & Goodyear, 2014, p. 1), it is critical that supervisors be purposefully and actively engaged in modeling and teaching this foundational element of practice. Supervisors have the ability to influence supervisee perceptions of ethical behavior for better or worse (Austin, 2012; Goodyear, 2014; Schultz, 2011). However, there is a tendency in rehabilitation counseling for providing clinical supervision for limited amounts of time, often 30 min or less per month, or on an as-needed basis (Herbert & Trusty, 2006; McCarthy, 2013; Schultz, Ososkie, Fried, Nelson, & Bardos, 2002). In such a context, developing appropriate ethical decision-making skills with limited direction and oversight is unlikely and evidentiary of poor modeling of ethical principles by the supervisor (Ladany, 2014).

Empirical attempts to define poor or ineffective supervision have led to previous qualitative research, but typically conducted from the supervisee or counselor point of view (Austin, 2012; Gray, Ladany, Walker, & Ancis, 2001; Herbert, 2004; Magnuson, Wilcoxon, & Norem, 2000; Nelson & Friedlander, 2001), or to define what constitutes problematic, counterproductive, unethical, or otherwise ineffective clinical supervision practices (Ellis et al., 2014; Ladany, Mori, & Mehr, 2013). As professionals should not be “permitted to ‘wing it’ in deciding ethically appropriate methods of treatment or teaching” (Ford, 2006, p. 73), it is reasonable to inquire as to how supervisors are involved in the development of the counselor’s ethical awareness.

The purpose of this grounded theory study was to discover the processes, activities, and strategies used by rehabilitation counselor supervisors in the development of ethical decision making in their supervisees. To accomplish this, the following research question was used as the focus of this investigation:

Research Question 1: How are supervisors ensuring supervisees become familiar with and implement ethical decision making as part of counselor development?

Understanding supervisors’ perceptions relative to their role as an “arbiter of ethics” (Tarvydas, 1995, p. 296) will identify contemporary practices deemed beneficial by supervisors to improve ethical decision-making skills in counselors, shed light on how supervisors are made aware of ethical dilemmas, and provide supervisors with insight into how they might improve their own practices relative to professional development and ethical decision making in the counselors they supervise.

Method

Qualitative approaches to research in vocational rehabilitation (VR), disability, and counseling in general are seen as “rich sources of information” (Hanley-Maxwell, Hano, & Skivington, 2007, p. 99) and offer the unique perspective of the participants’ experience with rehabilitation service provision (Hanley-Maxwell et al., 2007; McReynolds & Koch, 2009). Through the use of qualitative approaches, researchers are better able to understand the meaning, events, and people being studied (Denzin & Lincoln, 2005; Hanley-Maxwell et al., 2007). In addition, research conducted through qualitative designs should have “direct relevance to field settings and practitioner issues” (Hagner & Helm, 1994, p. 293). Desired supervisory qualities (Herbert, 2004) and supervisee perceptions of and needs from clinical supervision (Austin, 2012) have been studied utilizing qualitative methodologies.

Grounded theory is a qualitative methodology utilizing techniques of theoretical sampling, concurrent data collection and analysis, comparison of data during evaluation, memo writing, and integration of a theoretical construct around a core category (Charmaz, 2006; Cohen & Crabtree, 2006; Saldaña, 2015; Skeat & Perry, 2008). Grounded theory research is designed to “demonstrate relations between conceptual categories and to specify the conditions under which theoretical relationships emerge, change, or are maintained” (Charmaz, 2002, p. 675) and has been utilized in rehabilitation counseling research (Conyers, 2004; Gilbride, Stensrud, Vandergoot, & Golden, 2003; Koch, 2001; Koch, Egbert, Coeling, & Ayers, 2005). Using grounded theory design to develop a framework of ethical skill development based on data collected by the experiences of supervisors as they endeavored to increase ethical decision-making knowledge and ability in counselors matches with the intent of grounded theory and draws from the symbolic interaction inherent within clinical supervision (Charmaz, 2014).

Participants

A nonprobabilitistc, purposive sampling technique was utilized as this approach allowed for participant selection based on a predetermined set of criteria (Guest, Bunce, & Johnson, 2006). The administrators of a state VR agency and a community rehabilitation organization (CRO) were contacted in a Midwestern state to inquire as to their interest in allowing their supervisors to participate. This approach provided a sample with minimal variation, meeting specific criteria (participants had to be practicing supervisors within their agency at the time of the interview), and typical of contemporary rehabilitation counseling settings. In so doing, the researchers were able to address three of Patton’s recommendations for sample selection in qualitative studies (Patton, 1990). The rehabilitation agencies were asked to designate three to four “exemplary supervisors” for participation in a qualitative study on supervision and ethics, with no other details for reference relative to the definition of an “exemplary supervisor.” It was decided to let the referring agencies decide who fit the criteria for “exemplary supervisor.” This initial sampling method maximized authenticity by creating a sample grounded in what the agency administrative personnel determined as the competency level of supervision.

Upon receiving the names and email addresses of potential participants, the participants were contacted via email. The email outlined the purpose of the study, how the individual was referred for participation, informed them that their participation was completely voluntary, and that the administrative offices referring them would not know of their choice to participate or not participate in the study. Once participant agreement was obtained, the participants were sent a copy of the interview protocol and an appropriate time and date for the interview was scheduled.

A total of eight supervisors (four each from the State VR agency and CRO) agreed to be interviewed for this study. The eight participants comprised six females and two males; five of the participants were White/Caucasian, two were African American, and one was Asian. The experience in providing direct supervision to counselors ranged from 3 to 29 years, with a mean of 7.81 (SD = 9.22) years of experience providing supervision. Seven of the eight participants worked as VR counselors prior to becoming supervisors.

Researcher Role

Qualitative research is “grounded in subjectivity” (Morrow, 2005, p. 254); this reflects the influence of the researcher on both the participants within the study and interpretation of data. The researcher conducting the interviews has extensive experience working as a VR counselor for a state VR agency and as part of this work experience interacted frequently with CROs. The researcher also served as an assistant regional manager with supervisory responsibilities over seven other counselors; this past work experience had the potential to bias findings in the present study.

Addressing researcher reflexivity, or self-awareness (Morrow, 2005), is a critical element of qualitative research. Where qualitative research puts the interviewer in the role of learner and reflexivity is an ongoing process of self-evaluation (Creswell, 2013; Morrow, 2005), personal assumptions regarding ethics and supervision were discussed with colleagues at other academic institutions. These discussions occurred prior to and during the data collection process and again after the completion of all interviews. This allowed for the review of procedures and identified ways to minimize the influence of reflexivity. To address issues of representation, the researcher asked for clarification from participants and attempted to come into the interviews from the “stance of a naïve inquirer” (Morrow, 2005, p. 255). These steps helped to address reflexivity by providing participants with the opportunity to better explain their own values and beliefs regarding supervision and ethics, rather than the researcher simply assuming he knew what participants meant (Charmaz, 2014; Creswell, 2013; Morrow, 2005) or reinforce previous beliefs developed while serving as a rehabilitation counselor and supervisor.

Interviews

An open-ended semistructured interview process was used to examine the experiences of rehabilitation counseling supervisors related to their role in counselor development and ethical decision making. To ensure appropriateness of the semistructured interview guide (see appendix), a draft was sent to five academic research faculties in rehabilitation counselor training programs with both knowledge of the supervision literature and experience in qualitative research methodology. Feedback from these five individuals was used to further develop and enhance the interview guide so as to better solicit responses indicative of participants’ views on the relationship between clinical supervision and ethics and their roles as supervisors.

As participants in qualitative research may experience anxiety (Glesne, 2011), interviews were conducted in the professional offices of the participants in an attempt to minimize this participatory anxiety. The semistructured interview guide along with the informed consent document was sent to the participants at least 2 weeks in advance of their interview for their individual review and record keeping. At the time of the interview, the researcher reviewed the participation agreement form with the participants as well as the provision of verbal clarification on use of the digital, audio recording device and the expected use of the recording. All participants demonstrated their acceptance of the data collection procedures by affixing their signature to the agreement form. Although the use of the interview protocol helped to ensure continuity and overall flow throughout the interviews, the researcher was able to adjust questions based on participant response to allow for a flowing discussion of supervision and ethics. The researcher also engaged in active note taking as a data collection process, and results were compared against the transcribed sessions to ensure continuity.

Data Analysis

In conducting data analysis, the grounded theory methods of (a) categorical organization of information via a coding process, (b) theoretical sampling, (c) use of triangulation, (d) conceptual mapping, and (d) positioning the core phenomenon within a theoretical model (Charmaz, 2014; Creswell, 2013) were used to analyze the collected data. Coding is a general term used to classify, categorize, and summarize collected data (Charmaz, 2014; Creswell, 2013). Word-by-word coding was used in the initial heuristic analyses, and focused coding helped to form the theoretical framework (Charmaz, 2014). Memoing, a term used to describe the process of writing down ideas about the evolving theory throughout the overall process of open and axial coding (Creswell, 2013; Emerson, Fretz, & Shaw, 2011), helped to organize researcher thoughts and impressions during data analysis. Audio recordings of the interviews were used to complete the transcription process via Microsoft Word for Mac. Atlas.ti, a qualitative analysis software, and Microsoft Excel for Mac was used in the coding process.

After the primary researcher had finished transcribing and analyzing participant responses, two advanced doctoral students conducted a comparative analysis. Both the individuals had previously completed doctoral level coursework on supervision and qualitative research and possessed practical experience in providing clinical supervision and conducting qualitative research. This process of analyst triangulation, or using multiple analysts to review findings, can provide a check on selective perception and illuminate systematic bias in an interpretive analysis (Patton, 1999). These individuals were provided with transcribed copies of the interviews, the field notes and memos of the researcher, and the interview guide. They were asked to provide their own analysis of the data identifying prominent themes, both within individual responses and across participants. Upon meeting with the additional analysts and reviewing results, the core phenomenon and subcategories began to emerge and be placed within a developmental theory of clinical supervision and ethics related to ethical fluency. Theoretical sampling was then used to help “qualify and elaborate the boundaries of the categories” identified (Charmaz, 2014, p. 205). Saturation is the goal of qualitative research, but saturation is often poorly operationalized and guidelines for estimating sample size for purposively sampled interviews vary (Guest et al., 2006). Although larger populations have been suggested for grounded theory (Creswell, 2013), a certain degree of homogeneity was expected given the participants being chosen according to common criteria (Guest et al., 2006). Research has indicated that saturation can occur quickly in homogeneous groups, often after the first six to 12 interviews (Guest et al., 2006). All the three independent analysts in the triangulation process concluded that no new additional codes or data were introduced in the seventh and eighth interviews, suggesting that theoretical saturation had been achieved.

Results

Supervisors identified their primary purpose in providing supervisory intervention related to ethical practice as increasing the ability of the counselor to accurately recognize and address ethical issues in a contextually appropriate, socially sensitive, and expeditious manner. We refer to this construct as Ethical Fluency and define it as the interaction of acculturation knowledge, fluid reasoning, and speed and accuracy in processing ethical dilemmas and violations (see Figure 1.). A corollary theme impacting the supervisors’ ability to enhance ethical fluency was the SWA. Supervisors in the present study reported a perception that they were able to impact ethical fluency in those they supervised and in so doing helped to facilitate ethical knowledge and skill development of the supervisee.

Figure 1.

Components of ethical fluency.

Acculturation Knowledge

Acculturation knowledge reflects the ability of the individual to incorporate the knowledge and language of the dominant culture (Horn & Masunaga, 2006) into certain situations. In the professional setting, this reflects the ability of the professional to incorporate knowledge and language of both the profession and the agency for which they work into the ethical discussion. Supervisors reported that they were able to assist supervisees in understanding the sometimes-differing professional demands and competing interests between codes of professional ethics and agency policies. In addition, some supervisors noted the specific differences between the role of counselor and that of supervisor and indicated a lack of preparedness for stepping into the supervisor role, denoting a lack of supervisory knowledge or need for supervisory training.

Influence of agency policy

Ethical codes are established by professional associations to regulate the profession and are typically updated to provide contemporary guidance to professionals in the field (Tarvydas, Cottone, & Saunders, 2010). However, the supervisors in this study often indicated deference to agency policy rather than adherence to an ethical code. One supervisor reported a recent move from one governmental department to another and stated,

They [the new governmental department] have literature. I don’t call it a code of ethics, but there is a Pledge of Allegiance that they make their employees sign off on. It has something to do with honor and integrity and respect.

Another supervisor indicated, “We always associate ethics with policy.”

Although agency policy is designed to influence decision making and ensure continuity of services, such policies are more likely to have political underpinnings and not necessarily be grounded in ethical values and principles. Participants in this study working in the nonprofit setting suggested that their agency policy was also considered to be a workplace code of ethics, and all workers signed an agreement form stating that they would adhere to the standards located therein. Deference to agency policy may be reflective of work-based performance evaluations grounded in agency policies, as opposed to professional ethical codes, and more of a reversion to linear thought in decision making (Granello, 2010; Perry, 1970).

Need for supervisory training

A key method for learning the knowledge and language of supervision is training. Participants in this study suggested that they typically sought out supervisory positions based on a perceived increase in salary, rather than a strong match with the supervisory roles and functions. Although participants indicated an intrinsic interest in supervision and its concomitant duties, the participants suggested a steep learning curve when initially acquiring their supervisory position, for which they were often unprepared. The following statement reflects this:

I don’t think I was prepared as a supervisor to understand the difference between some of the skills that are required as a supervisor helping to guide other people’s decision-making as opposed to just making my own decisions.

Supervision has been recognized as a unique and distinct intervention in its own right (Bernard & Goodyear, 2014). Supervision techniques and knowledge are part of rehabilitation counseling core knowledge and functions, yet are distinct and require further training (Glosoff & Matrone, 2010; Herbert & Trusty, 2006; Schultz et al., 2002; Thielsen & Leahy, 2001).

Fluid Reasoning

Tasks of fluid reasoning include identifying relationships, comprehending implications, and drawing inferences in novel problems (Horn & Masunaga, 2006). The tasks of fluid reasoning closely align with the case conceptualization process, a skill supervisees feel that they can learn from supervisors (Jacobsen & Tanggaard, 2009). Comprehending implications is indicative of counselor intent and understanding the relationship between service delivery choices and potential consequences. Supervisors in the present study reported that they impacted counselor development and knowledge by helping supervisees develop case conceptualization abilities and mediating counselor intent. Attending to these tasks helped to strengthen fluid reasoning skills in their supervisees.

Case conceptualization skills

Supervisors in this study suggested that supervisees often made mistakes conceptualizing the specific case, designed less than optimal services/interventions based on this conceptualization, and proceeded with implementation of the designed service/intervention. This is representative of difficulties in navigating multiplistic thinking, where counselors are aware of multiple options but unsure of how to proceed (Granello, 2010; Perry, 1970). When clinical supervision in rehabilitation counseling focuses on counselor processing skills and case conceptualization (Herbert & Trusty, 2006; Stebnicki, 1998), it can be the medium for addressing issues prior to an ethical dilemma or violation occurring by helping with the application of ethical knowledge and theory to real life situations (Fox & Ghezzi, 2003). The importance of case conceptualization skills is reflected in the following quote:

The counselor has to be able to individually assess the situation and that’s kind of part of the challenge really, is not to have a really totally black and white theme in regards to ethical practices. Ethical practices require you to use your brain and to assess the situation and what you can do and what you cannot do.

As one aspect of clinical supervision is teaching and strengthening ethical awareness in counselors (Herbert & Trusty, 2006; Schultz, 2011), clinical supervision becomes a critical method for instruction on ethical decision-making models and ensuring subsequent implementation in practice (Herbert, 2004; Tarvydas, 1995). Not only should supervisors provide consultation when ethical concerns are identified (Cottone & Claus, 2000), but they need to make ethics a regular element of case-based discussions. The following quote demonstrates how supervisors were able to point out discrepancies in case conceptualization skills of supervisees:

Sometimes someone will bring something up, and it is glaring, as a supervisor I may see it, but as a counselor, I wouldn’t have necessarily seen it the same way, and as a supervisor now, you have to step in and say, “Let me show you where the problem is.”

Counselor intent

Supervisors indicated that fact-finding after a complaint often leads to the realization that supervisees had positive intentions in the provision/nonprovision of specific services, with a strong desire to “do good” and “not cause harm.” However, in their attempts to “do good,” counselors sometimes made choices leading to a “slippery slope.” The term “slippery slope” typically denoted the escalation of circumstances from limited ethical concern to an ethical dilemma and then onto a fully developed ethical violation. This emotion-based decision making is indicative of the sensorimotor stage of counselor development (Bernard & Goodyear, 2014), where counselors relying upon emotion-based decision making become overstimulated, which interferes with their conceptual skills. Supervisees will benefit from supervisors who can recognize this tendency and challenge it.

Many of the scenarios presented by the participants in this study were consistent with previous findings, noting the potential for counselor decisions and practices to grow from an ethical dilemma into an ethical violation (Saunders, Barros-Bailey, Rudman, Dew, & Garcia, 2007). The following quote illustrates this shift and highlights the importance of supervisees’ ethical awareness.

I think that they don’t understand the consequences or understand what could happen. I believe the best intentions are typical. I don’t think anyone is trying to be unethical or maliciously trying to be unethical or create dilemmas. I think most things come up due to not being aware of things.

Although the counselor’s intent may be good, it can lead to dilemmas or even violations. Accuracy in recognizing potential problems and making appropriate inferences for service delivery requires clinical judgment skills that are developed through supervision, particularly in new professionals (Granello, 2010).

Speed and Accuracy

Processing speed is involved in almost all intellectual tasks (Horn & Masunaga, 2006). However, as noted in the case conceptualization and counselor intent sections, errors occur. Processing speed must be accompanied by accurate recall of existing knowledge (Horn & Masunaga, 2006). Supervisors reported an ability to impact speed and accuracy in recognizing ethical dilemmas and violations by emphasizing to counselors the frequency with which ethical dilemmas are encountered, as well as teaching and applying ethical decision making in the supervisory process.

Frequency of dealing with dilemmas

Supervisors were asked to respond to the question, “How frequently do you deal with ethical issues with those you supervise?” Although some responses indicated that the word “ethics” was used infrequently (e.g., “I can’t think that I’ve ever actually said what does your code of ethics tell you about this?”), supervisors reported an almost daily pattern of discussion and reinforcement of protocols focused on equitable and timely service delivery, client respect, and confidentiality.

Service delivery, unconditional positive regard, and confidentiality are some aspects of ethical service delivery. However, competence and conduct with clients are recurring themes in ethical violations as reported by CRCC (Hartley & Cartwright, 2015; Saunders et al., 2007; Tarvydas & Barros-Bailey, 2010). In addition, supervisor responses distinguished between high- and low-frequency ethical dilemmas. Low-frequency ethical dilemmas are violations that would be deemed egregious in nature (e.g., engaging in sexual relationships with a client) and were dealt with on an irregular and infrequent basis, again parallel to previous findings (Beveridge, Garcia, & Siblo, 2015; Saunders et al., 2007). High-frequency ethical dilemmas were often reported as “minor” by supervisors. These areas centered on conduct and client relationships and are similar to previous findings of frequently reported ethical violations by Certified Rehabilitation Counselors (CRCs; Beveridge et al., 2015; Saunders et al., 2007). In addressing many of these high-frequency ethical dilemmas, the term “ethics” may not even be used as evidenced by the following quote:

When a counselor or staff of mine comes in and says I have this issue, we might initially try to lay out what are the actions here, what are the issues, and I may not always use the term ethical issues.

Although on the surface this may seem like a positive outcome, the avoidance of the word “Ethics” in the course of these discussions keeps the counselor in a state of ignorance regarding the ethical ramifications of daily practice and reduces ethical fluency.

Practical application of ethical decision-making skills

Recognizing the almost daily incidence of ethical issues, three participants in this study reported the need to develop strategies to address ethical decision making and learning beyond the regularly scheduled supervisory sessions. Case conceptualization can be enhanced through guided discovery and traditional case-based discussion (Milne & Reiser, 2016). One supervisor reported holding monthly meetings to identify and address ethical issues that supervisees were experiencing. Another supervisor suggested that the introduction of ethical decision-making models would help familiarize staff with appropriate avenues for dilemma resolution. Case studies were introduced that presented both high- and low-frequency dilemmas grounded in actual scenarios the supervisor had recently worked to resolve. Practicing the ethical decision-making process helped to develop case conceptualization skills through real-time feedback and discussion. With the supervisor serving as the moderator, these practices facilitated relativistic thought processes, where knowledge is approached contextually (Granello, 2010; Perry, 1970). This also enhanced fluid reasoning and overall ethical fluency through real-time application, which leads to stability of the ethical skill set (Granello, 2010; Perry, 1970).

SWA

The SWA consists of an established working relationship allowing for the realization of the mutually developed goals and tasks (Bordin, 1983). In addition, the strength of the SWA is one of the most important factors in the counselor development process (Ladany, Ellis, & Friedlander, 1999). Within this study, the SWA was viewed as critical for supervisors to enact effective interventions leading to prevention of future ethical problems. In essence, a strong SWA became the medium for developing and implementing supervision-related interventions focused on ethical values and principles. One supervisor commented on the value of relationships in dealing with mistakes:

I try to have a very open relationship with staff about the fact that we all make mistakes. Talk openly with all new staff and existing staff that the fact is our agency has a lot of tolerance with making mistakes.

Another supervisor mentioned the value of the working alliance but the potential for this alliance to lead to dependence:

I have to watch pretty closely so that it [the supervisor-supervisee relationship] doesn’t turn into a dependence where this individual will always want my decision-making views or my input and so maybe that’s not as common but it may be something that I’m currently working with. To make sure that I watch pretty close that I don’t do too much for the counselor and make sure that the counselor doesn’t become too dependent on me.

To counter this and facilitate the development of ethical fluency, supervisors utilized staff meetings, individual sessions with counselors, and professional development opportunities (e.g., professional conferences) as ways to disseminate and educate ethical expectations. In speaking on the utility of implementing ethical trainings within staff meetings, a supervisor stated:

I like this because some of the ethical issues are so subtle. They are so subtle and people are like, I don’t see anything wrong with this. But when you get in a group, you say, well this could be a problem. It is just to keep things fresh in your mind on what could be an ethical issue.

Furthermore, the importance of modeling ethical behavior and the potential impact of the SWA on the prevention of future dilemmas mirrors similar research findings (Austin, 2012; Schultz, 2011).

Limitations

Although the findings of the current study are informative and add to the overall body of knowledge of the relationships between supervision and ethics, the results should be considered in light of several limitations. A primary concern is the potential for participants to be uncertain regarding the confidentiality of study data and thus provide socially desirable responses. Although care was given to implement study procedures in which confidentiality and anonymity would be maintained, the participants were recommended by their respective agencies, and at some level, knowledge of participant involvement may have existed within agencies.

The participants in the present study were supervisors from a state VR agency and a community rehabilitation program located in a Midwestern state. Supervisors were recommended by their employers for inclusion in this study based on employer perception that the participants were exemplary supervisors. Although general guidelines regarding participants were recommended to referring agencies, participant recommendation relied on agency understanding of the term “good supervisor.” Such a criterion is highly subjective. Participants may have agreed to participate in the study based on a personal interest in counselor supervision and ethics, and the self-selection of participants may have resulted in response bias. Moreover, given the nonrepresentative nature of the sample, findings should not be considered transferable to a broader population of supervisors.

Discussion

During the current study, supervisors identified a number of factors that influence the development of their supervisees’ ethical fluency. The concept of fluency-based instruction has been suggested as particularly relevant to teaching adult learners (Fox & Ghezzi, 2003). Ethical fluency represents the interaction of acculturation knowledge, fluid reasoning, and speed and accuracy in evaluating ethical dilemmas and violations. The factors influencing ethical fluency within this study include the training of supervisors, frequency of dealing with ethical dilemmas, counselor intent, case conceptualization, practical application, agency policy, and the quality of the SWA. To increase the prevalence of the identified influencing factors that improve ethical fluency, two primary activities are recommended for supervisors. First, supervisors require training in clinical supervision. Second, supervisors need to inform supervisee metacognition through the investment of time in structured ethics practice and by having frequent and distinct discussions regarding ethical issues in practice.

Training for Clinical Supervisors

Ladany (2014) proposed the concept of “unethical supermodels” (p. 1097). The capacity to become a model of inappropriate ethical behavior was noted in this study within the supervisors’ responses on training. Some supervisors noted the lack of formal training provided for their position, and how there was much to learn to be prepared for their position. This reflects an adherence to the commonly mistaken idea that a good counselor will automatically be a good supervisor (Thielsen & Leahy, 2001) and not understanding that rehabilitation counseling supervision is a unique intervention and distinct practice from rehabilitation counseling (Bernard & Goodyear, 2014; Thielsen & Leahy, 2001). It also denotes a developmental process where supervisors’ knowledge and skills must be expanded upon to assist with the development of counselors and their ethical competencies. This concept is further reinforced by item H.2.a of the CRCC Code of Professional ethics (2017), which suggests that rehabilitation supervisors should regularly pursue continuing education activities. Lack of training on supervision may result in the supervisor engaging in well-intentioned, but unethical behavior, either by omission or commission. Supervisors require training to understand their own ethical responsibilities as supervisor, as well as how to facilitate the ethical development of the supervisee.

Metacognition

Similar to the aforementioned need to develop supervisory skills and abilities, Lambie, Hagedorn, and Ieva (2010) suggested that counselors need to develop their social-cognitive maturity to enhance ethical and legal knowledge, and ethical fluency within their practice. Novices tend to think linearly, while experts think contextually and with higher levels of cognitive complexity (Granello, 2010; Hillerbrand, 1989). Counselors can develop higher cognitive skills, specifically ethical decision making, by assuming more and more responsibility under the direction of a supervisor (Hillerbrand, 1989). An understanding of supervisees’ metacognition may be the supervisor’s most critical tool to assist the supervisees to improve ethical practice. Ethics instruction grounded in a metacognition approach puts the instructional emphasis on systematically expanding the context of a clinician’s cognitive processing of ethical issues, rather than learning specific standards and idiosyncratic responses to situations. As previously stated, supervisors in this study stated that supervisees often made mistakes conceptualizing specific cases, selecting appropriate services/interventions based on their conceptualization, and implementing the plan. The supervisors suggested that they played a key role in helping supervisees see connections between apparently discrepant information and shifting from a linear approach to a contextually grounded approach (Granello, 2010; Perry, 1970). Clinical supervisors have the ability to incorporate activities, grounded in theories of development, that are specifically designed to expand the context of understanding and complexity of application. To facilitate the development of metacognition skills specific to ethical fluency, supervisors need to devote time to structured ethics practice.

Investing time in structured ethics practice

Counselor professional development in ethical decision making requires the investment of time. The devotion of time can be considered an essential component of the SWA and is a requirement of ethical supervision (Section H.1.a; CRCC, 2017). In addition, devotion of time to discussion of ethics communicates the importance of ethics in practice. Of note is the limited amount of time supervisors in the present study dedicated to individual clinical supervision sessions. Previous studies also found that clinical supervision often occurred on an as-needed basis (Herbert & Trusty, 2006) or for 30 min or less per week (Schultz et al., 2002). Such limited time in direct supervisory experiences with rehabilitation counselors calls into question the supervisor’s ability to provide the feedback and evaluation to the counselor that is requisite for development (Section H.4.a; CRCC, 2017). The “as-needed” approach to supervision often results in a reactionary supervisory process that is not developmental in nature and lacks the structure necessary to facilitate the development of ethical fluency in supervisees. This puts the primary impetus for ethical awareness and decision making on the counselor and can be perceived as a lack of support from a supervisor.

It has been suggested that 1 hr per week of direct face-to-face supervision is the minimally acceptable supervisory standard (Ellis et al., 2014). The use of triadic and group-based clinical supervision is also recommended (ACES, 2011). If scheduled clinical supervision appointments are not presently utilized, supervisors need to capitalize on potential teaching moments when supervisees come with questions regarding service delivery and take time to address ethical concerns, rather than providing a simple answer to the question without elaboration. This approach of time dedication and cognitive development will help to strengthen the working alliance and optimize the discussion of problematic cases and associated ethical decision-making processes.

Frequent discussion of ethics

Participants in this study reported an almost daily opportunity to discuss elements and principles of ethics with counselors. This circadian opportunity to discuss ethics within practice demands supervisors to dedicate time to meaningful and extemporaneous conversations on ethics. Present practice would seem to suggest that ethical principles are discussed, but the language of ethics is rarely used. The infrequent identification of ethical principles, coupled with the deference to agency policy, can model a lack of importance in adhering to ethical guidelines. Supervisors must be cognizant of, and explicitly address, the interplay between policy demands and the tenets of ethical codes (e.g., acculturation knowledge). Such conversations with supervisees serve to accurately identify and address ethical principles as questions arise within the context of regular practice and service delivery. The frequent identification and discussion of ethics, and demonstrating the application of ethical knowledge and decision making within the counseling relationship will provide opportunities to discuss agency policy, codes of ethics, discrepancies between the two, and ensure counselors remain grounded in ethical principles.

Future Research

Research on ethical issues needs to expand beyond exploring violations and nonempirical discussion of ethics. Specifically, exploring how ethical principles are expressed and demonstrated within the supervisory relationships seems to have potential. Research should explore supervisor and supervisee perceptions of ethical behavior through a matched pair process where supervisor self-perception of ethical behavior could be compared with the supervisee’s perception of the supervisor to determine congruence and potential areas where training may help to increase supervisor awareness of personal behavior and potential impact on the SWA. Given the reported use of counselor forums as an instructional format in some practice settings, the role of peer-based consultation relative to ethical decision making and ethical awareness might also be explored. In addition, research should seek to identify the best practices associated with continued instruction on ethical awareness, so as to provide supervisors with activities designed specifically to enhance ethical fluency. In terms of practice setting, no participants from forensic or evaluation practices were included in the present study. Although the overall number of ethical complaints to CRCC is relatively low, forensic and evaluation practices have been identified by research as a specific violation type (Hartley & Cartwright, 2015). In response to this, the identification of ethical practices and knowledge translation techniques within private-for-profit VR practice settings may be appropriate.

Conclusion

Clinical supervision is an intervention in its own right (Bernard & Goodyear, 2014), and when utilized correctly, it has the potential to develop ethical decision-making competency in counselors (Herbert & Trusty, 2006). While previous research has focused on supervisee perception of supervisor ethical behavior (e.g., Schultz, 2011), the present study focused on the supervisor’s perception of their personal role in the identification, discussion, and ethical development of supervisees. It can be theorized that rehabilitation counseling supervisors recognize their specific role in developing ethical fluency and that rehabilitation counseling supervisors can help build ethical fluency in their supervisees by attending to acculturation knowledge, fluid reasoning, and speed and accuracy in processing ethical concerns. The categories that emerged from the supervisor responses helped to expand the need for developmental approaches within clinical supervision as a method for counselor cognitive development specific to ethical decision making. The current study reinforces the notion that rehabilitation counseling supervisors are “a major force for and arbiters of ethical practice throughout the system” (Tarvydas, 1995, p. 296). As such, they need to be cognizant of their personal ethical orientation and purposefully aware of how they hold counselors accountable for improving ethical fluency.

Footnotes

Appendix

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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