Individuals who wish to supervise interns and other practitioners must work within the limits of their competence and practiced techniques. Supervisors should be qualified to hold the position, either by demonstrating the ability to supervise or by receiving training [1]. The National Association of Social Workers (NASW), the American Psychology Association (APA), the American Association for Marriage and Family Therapy (AAMFT), the American Counseling Association (ACA), and the National Board for Certified Counselors (NBCC) all include standards in their respective code of ethics that require mental health professionals to work within their limits of knowledge [14,15,16,17,23]. While this is most clear in work with clients, it also pertains to work with other practitioners or interns as a supervisor. When using technology in their work and for supervisory purposes, mental health professionals should have the required knowledge and tools to use the technology safely and competently. When an individual uses new techniques, tools, or plans to provide services, he or she should seek additional education or supervision from a more experienced practitioner [14,15,16,17,23].

Mental health practitioners who accept the role of supervisor also accept the responsibility of helping to further the professional development of their supervisees. This includes providing supervisees with opportunities for learning, giving evaluations promptly, and providing constructive feedback during sessions. Lack of timely feedback is reported to be one of the main ethical complaints against supervisors [1]. Supervisees who are not performing at an acceptable level should first be given a plan for improvement. If a poor evaluation is given, it should not come as a surprise to the supervisee; rather, it should be the result of not meeting the terms of a previously discussed plan [1].

Mental health practitioners who accept the role of supervisor also accept the responsibility of helping to further the professional development of their supervisees. This includes providing supervisees with opportunities for learning, giving evaluations promptly, and providing constructive feedback during sessions. Lack of timely feedback is reported to be one of the main ethical complaints against supervisors [1]. Supervisees who are not performing at an acceptable level should first be given a plan for improvement. If a poor evaluation is given, it should not come as a surprise to the supervisee; rather, it should be the result of not meeting the terms of a previously discussed plan [1].

The risk of establishing a dual relationship of supervisor and therapist is increased because many strategies used in supervision are derived from strategies used in therapy [2]. Teaching supervisees how to use such strategies in clinical sessions and working through personal issues can result in a blurring of boundaries. Studies show that supervision is less effective for the supervisee when the supervisor takes on a therapist role rather than using deliberate instruction of new skills. One of the most significant grievances that supervisees have about supervisors is regarding the dual relationship of supervisor and therapist [2,19].

Supervisors have the responsibility to ensure that clients are informed when students, interns, or individuals in trainings are providing client services [1,14,15,17]. Clients have the right to choose a more experienced practitioner if they do not feel comfortable receiving services from an individual in training [1]. Failure to inform a client could result in legal action against the supervisor or supervisee [1].

There are specific payment and advertisement issues faced by supervisors and supervisees. First, supervisees are not allowed to advertise their services. Payments for services must be made directly to the supervisor or the agency at which the supervisee is working. Any business cards with the supervisee's name should make their status as an intern, trainee, or student clear. It should not appear that an uncredentialed individual provides services independently [1].

Supervisors may be exposed to charges of direct liability if their action or inaction is found to have caused injury to a client. For example, direct liability can occur when supervisors are negligent in their duties and do not properly plan and supervise client outcomes. Also, as supervisors are required to have sufficient knowledge of clients, direct liability can occur if the supervisor gives inaccurate or inappropriate advice, which is then used in therapy to the detriment of the client. This is also true if the supervisor did not fully understand the supervisee's description of the client's needs because they failed to listen carefully. Similarly, direct liability can occur if the supervisor gives tasks to the supervisee that are inappropriate for his or her level of skill. Supervisors should have good knowledge of the abilities of their supervisees and should not assign tasks outside of supervisees' training and ability [1,19,23].

Supervisors may be exposed to charges of direct liability if their action or inaction is found to have caused injury to a client. For example, direct liability can occur when supervisors are negligent in their duties and do not properly plan and supervise client outcomes. Also, as supervisors are required to have sufficient knowledge of clients, direct liability can occur if the supervisor gives inaccurate or inappropriate advice, which is then used in therapy to the detriment of the client. This is also true if the supervisor did not fully understand the supervisee's description of the client's needs because they failed to listen carefully. Similarly, direct liability can occur if the supervisor gives tasks to the supervisee that are inappropriate for his or her level of skill. Supervisors should have good knowledge of the abilities of their supervisees and should not assign tasks outside of supervisees' training and ability [1,19,23].

As mentioned, clients deserve the same standard of care regardless of whether they receive service from a licensed practitioner or from interns, students, or trainees. Supervisors who believe that clients are not receiving adequate care are required to act to protect the client. This includes thoroughly investigating complaints that clients may make about supervisees [1].

In the State of Florida, there are several requirements one must meet in order to become a qualified supervisor, according to the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling. Individuals wishing to be qualified supervisors must have taken a graduate-level academic course in supervision and a continuing education course in supervisory training that meets the requirements of rule 64B4-6.0025 (which regulates continuing education hours). Candidates must also be an AAMFT-approved supervisor or have taken a post-graduate training course for field instructors in clinical social work (for Qualified Supervisors for Clinical Social Work and Mental Health Counselor Interns) [5]. In addition, Qualified Supervisors for Clinical Social Work must have at least four years of clinical social work experience, two of which can be earned during a post-Master's clinical internship. Qualified Supervisors for Marriage and Family Therapy Interns and Mental Health Counselor Interns must have five years of clinical experience, two of which may be earned during a post-Master's clinical internship [18].

Rule 64B4-2.002 states that interns will be credited for the time of supervision if the intern received at least 100 hours of supervision in no less than 100 weeks, provided at least 1,500 hours of face-to-face psychotherapy with clients, and received at least one hour of supervision every two weeks [5].

Interns may receive group supervision; however, each hour of group supervision must alternate with an hour of individual supervision. Group supervision must be conducted with all participants present in-person. Individual supervision is defined as one qualified supervisor supervising no more than two interns, and group supervision is defined as one qualified supervisor supervising more than two and up to a maximum of six interns per group [5].

The Substance Abuse and Mental Health Services Administration (SAMHSA)'s Treatment Improvement Protocol (TIP) series outlines several effective supervision models, including [19]:

The Substance Abuse and Mental Health Services Administration (SAMHSA)'s Treatment Improvement Protocol (TIP) series outlines several effective supervision models, including [19]:

The choice of supervision model should be guided by the supervisee, particularly how he or she best learns and receives feedback, and by the setting in which provision of services is taking place. Supervisees may benefit from different models of supervision in different stages of their professional development, but supervisors often maintain the same approach to supervision regardless of the needs of supervisees or the setting [2]. Objective observation of supervisors who report modifying supervision style to match supervisees indicates that supervisors are less accommodating than they believe they are [2]. Because supervisors have been found to be inaccurate when describing their own behaviors and styles in supervision, the validity of studies that use the supervisor's opinions to rate the effectiveness of supervision styles has sometimes been brought into question [2].

Two main supervision styles have been identified: authoritative and facilitative. Various teaching styles may be organized into these two categories (Table 1) [2,13].

In one literature review, inexperienced practitioners were found to benefit more from directive styles of supervision. They also preferred supervisors who offered clear answers and more opportunities for practice. Inexperienced practitioners also preferred supervisors who were enthusiastic, showed interest in the supervisee, were dynamic and energetic, and who gave the practitioners a good model of a clinician [2]. Experienced practitioners preferred the same type of clear direction when learning new skills or when working with clients who presented more severe problems [3]. Regardless of the level of experience of the practitioner, a supportive supervisory relationship was deemed to be important to supervisees [2].

Preferred Behaviors

Non-Preferred Behaviors

The role of a supervisor is of utmost importance in the development of the supervisee's ethical practice. He or she can also be considered a gatekeeper to the profession and must maintain professional standards while also being sure that clients are receiving the best care. Because of the importance of this role, new supervisors may find it beneficial to find a mentor. A talented clinician does not always take to his or her new role as supervisor easily [19]. The SAMHSA TIP series provides helpful reminders for supervisors [19]:

The role of a supervisor is of utmost importance in the development of the supervisee's ethical practice. He or she can also be considered a gatekeeper to the profession and must maintain professional standards while also being sure that clients are receiving the best care. Because of the importance of this role, new supervisors may find it beneficial to find a mentor. A talented clinician does not always take to his or her new role as supervisor easily [19]. The SAMHSA TIP series provides helpful reminders for supervisors [19]:

Both the supervisor and the supervisee have the responsibility to properly document supervisory sessions, as well as to provide the necessary documentation required by administrative and human resources (HR) personnel, including emergency contact information and profiles for each supervisee, a supervisory logging sheet, supervision notes, and case reviews [19]. Supervisors are also responsible for informal and formal evaluations of their supervisees [19].

Upon the completion of supervisory hours (or termination of the supervisory relationship) as required by the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, qualified supervisors must complete the Verification of Clinical Experience form, available at https://floridasmentalhealthprofessions.gov/forms/clinical-exp-verification.pdf.

The general recommendation to supervisors using electronic devices in supervision is to avoid using cloud storage with client or supervisee information. If cloud storage must be used, supervisors should encrypt documents, use strong passwords, and use cloud storage that is HIPAA compliant. Use of cloud storage should be disclosed to clients and supervisees [28]. HIPAA-aligned cloud storage websites include [28]:

Common issues in the supervisory relationship (e.g., gifts, touch, eye contact, medication compliance, choice of vocabulary) are all influenced by culture. Rather than adhering to a rigid theoretical approach when dealing with these issues, it is best to seek out their cultural meaning on a case-by-case basis. Enlist the expertise of a cultural informant, if one is available. This person is generally from the same culture as the supervisee, is not an active participant in the therapy, and functions as a consultant to the professional by interpreting or identifying culture-specific issues. The Department of Health and Human Services offers trainings in cultural competence. A list of these courses is available online at https://thinkculturalhealth.hhs.gov/education/behavioral-health.

When a clinical supervisor is not available as part of employment, interns may be required to arrange to hire a supervisor on their own. Practitioners who choose to be clinical supervisors typically bill supervisees for the supervisory hour, usually charging the same fee they would charge for a clinical session with a client. This fee reflects the use of the supervisor's time and expertise. First, and perhaps most importantly, supervisors are responsible for all clients seen by a supervisee. As mentioned, supervisors can be held liable for harm to clients because of the actions or inactions of the supervisee. In addition, the supervisor must be available to help the supervisee and/or client in emergency situations or in order to ensure the best possible care of a client. Supervisors are also responsible for completing continuing education hours in order to become and remain a supervisor. Being a supervisor is an important responsibility, takes time and preparation, and can potentially have legal consequences for the supervisor.