Mandated Supervision: An Intervention for Disciplined Professionals

One of the hallmarks of a profession is the commitment to self-governance, usually by establishing minimum standards of care or practice to which members of the profession ascribe. Accordingly, the primary purpose of regulatory boards of counseling is to protect the public. Boards realize this purpose in several ways. They monitor whether licensure applicants have met the established minimum educational requirements and supervised professional experience for licensure (Gladding, 1996), and they are responsible for policing and disciplining the providers of mental health services under their jurisdiction (Walzer & Miltimore, 1993). A licensee who commits an offense that violates the legal or ethical codes adopted by that board to regulate practice is subject to the board's disciplinary authority. Disciplined providers of mental health services who do not face revocation or suspension of a license are generally permitted to continue to practice with one or more of the following requirements: participating in corrective education; obtaining therapy; agreeing to be monitored, limiting the scope of their practice, and having their practice supervised by specified colleagues (Walzer & Miltimore, 1993). Of these options, it is supervision of the disciplined practitioner to which we now turn our attention. Although supervision of practice is often cited as an appropriate part of a remedial plan in cases of impaired professionals (i.e., those who have been deemed unable to practice counseling independently) and trainees (Holloway & Neufeldt, 1995; Schoener & Gonsiorek, 1988), there are no published studies supporting its effectiveness in such cases. Actually, a review of the literature revealed scant outcome data regarding the effectiveness of supervision under any circumstance. Bickman (1999) recently labeled the statement "Clinical supervision results in more effective clinicians" as one of six myths held by mental health service providers. In their review of research related to supervision and its contributions to treatment outcomes, Holloway and Neufeldt (1995) found that the effectiveness of supervisory interventions in bringing about therapist and client changes in behavior is relatively unknown. Although there is a substantial literature base in supervision, there are barriers that hinder drawing solid inferences from the research (Goodyear & Bernard, 1998). Three such barriers identified by Goodyear and Bernard are the use of the terms supervision and training interchangeably; an absence of efficacy research in supervision; and a reliance on satisfaction measures for supervision outcomes. Similarly, Ellis, Ladany, Krengel, and Schult (1996) reviewed empirical supervision studies published between 1981 and 1993 to examine them for threats to validity. Their findings indicated that many of the results of the published studies should be interpreted with caution because of the researchers' failure to adequately address methodological threats. The purposes of this article are (a) to examine the conceptual and theoretical literature for support, in the absence of hard data, for the continued use of supervision in disciplinary cases and (b) to identify the associated benefits, risks, and implications for supervisors of disciplined professionals. MANDATED SUPERVISION In the context of disciplinary actions, the term supervision is sometimes used to refer to all types of practice oversight, including monitoring and consultation. To distinguish between the various types of oversight, we refer to the definitions of supervision and supervisor proposed by Walzer and Miltimore (1993). Supervision is "the means or process of teaching and training a health care professional through observation and discussion of practice method, theory, style, or techniques" (p. 591). Supervisor is defined as the "person designated by the department [licensing board] to teach and train a respondent through observation and discussion of practice method, theory, style, or techniques" (p. …