The Psychology Council of NSW is appointed by the NSW Governor to protect the public of NSW, by ensuring Psychologists practice safely, ethically and professionally. When a complaint is made about a Psychologist, it uses reflective, restorative and rehabilitation practices to achieve this outcome, when necessary. There are currently 10,527 registered Psychologists in NSW, 644 non-practicing Psychologists and 2,054 provisionally registered Psychologists. Approximately 180 complaints are made each year.
Psychologists can be managed by performance, health or conduct pathways, with approximately 40 cases being monitored each year, and 30 being directed to mandated supervision over this past year.
Mandated supervision generates unique, interesting and challenging processes for the supervisee and the supervisor, as it differs significantly from supervision that is generally sought for CPD or training purposes. In the latter, supervisees normally seek out a preferred supervisor for professional development, that may include but is not exclusive to skills acquisition and review, review of challenging case formulations and treatment, gaining insights and learning into areas of interest or improvement as part of a learning plan, providing reflective practice, or corrective feedback when required, and evaluating progress. It is assumed that there is a positive and collaborative working relationship, that parallels many of the processes in working with clients.
In the former however, the supervisee has to choose a PsyBA Board Approved Supervisor (BAS) that is approved by Council, and adheres to specific remediation of areas of concerns identified by performance, health or conduct assessments, requires highly focused reflective practices that relate to the professional and ethical issues identified in the complaint(s), and develops broad based professional and clinical skills and insights, that ensure the supervisee can practice safely and in accordance with the professions Code of Conduct and Practice Guidelines (APS).
The supervision engagement may start and continue with ambivalence about the supervisory process, embracement of the process as a positive remedial experience and at terms generate mixed emotional states, such as hostility, sense of coercion and yet a requirement to work collaboratively together.
It requires the supervisor to be accountable for setting up the supervision contract with the supervisee, and reporting back to the Council on progress towards SMART goals identified at the time of assessing the issues that need remediation. This involves submitting timely progress reports to Council on a monthly or quarterly basis, as stipulated by the Council, providing feedback to the Council on non-compliance with supervision, or when significant concerns are identified that bring into question the supervisee’s capacity to gain insight and benefit from the supervision process.
It is the Council’s experience that most supervisees positively embrace the directive to attend mandatory supervision, and eventually meet the stage where the condition to attend supervision under a Council program is no longer required. This can vary from as little as 6-12 months, to some years. Compliance interviews are held with delegates of the Council if a supervisee is not complying with the conditions for supervision, or may be experiencing difficulties understanding the requirements of conditions
Common complaints that can lead to mandatory supervision are poor communication, being perceived as rude, inappropriate management of informed consent and confidentiality, dissatisfaction with treatment processes and outcomes, utilising non-evidence based treatments, poor report writing and record keeping, failing to make a mandatory notification, over-servicing, inappropriate billing and business practices, lack of objectivity/biased reporting and blurring of professional and personal boundaries in the professional relationship with a client. Examples of the latter may include but are not exclusive to inappropriate communications verbally, by text, email and social media. Less common but more serious boundary violations may include inappropriate touch, personal and intimate relationships with clients (whether that be sexual or not), visiting them for coffee, providing “exposure therapy” to social events, accepting gifts, communicating after hours (eg., 1 am. emails), visiting clients in hospital without the institution’s approval and creating excessive dependency on the psychotherapeutic relationship. Having multiple and/or dual relationships, and poorly managing transference and countertransference are other common concerns. Many complaints are made in the context of family law, workers compensation and other litigation contexts, often in response to a report and its findings and the clinician’s conduct in a variety of assessment, treatment and report writing processes.
Serious misconduct such as sexual violations are managed by the HCCC (Health Care Complaints Commission), and are usually referred to the Director of Proceedings, who then determines to prosecute a complaint before NCAT (The National Civil Administrative Tribunal), with a minimum of a reprimand, but usually with a period of deregistration, if not a total ban on ever being permitted to re-register as a Psychologist, or engage in similar allied health personnel work.
The Council is fully cognisant that Psychologists can experience having a complaint made against them as very stressful. The majority of complaints are discontinued with no further action, apart from at times a letter of advice.
Those referred for mandatory supervision after an assessment in either a performance, health or conduct pathway, can experience a range of mixed psychological responses to the process such as shame, embarrassment, feeling isolated from the profession, anger, resentment, if not at times indignance.
Lack of insight and/or defensiveness do not assist the process, and pose significant challenges for the supervisee and supervisor, when reflective practice and engagement in the remediation process is paramount. There can sometimes be a blame game, such as “personal stresses made me do it”, or “the complainant was vexatious”. The Council commissioned a research study into the dimensions of the “slippery slope” phenomenon when Psychologists engaged in sexual relationships with clients in correctional facilities. This study highlights the systemic, individual and professional processes that can lead to such serious misconduct.
Supervisors who are Board Approved Supervisors (BAS) usually welcome the process of engaging with mandatory supervision, and similar to supervisees, may experience a range of psychological responses, depending on the nature of the complaint, such as surprise, curiosity, compassion, concern, to disbelief, confusion, frustration if not outrage. Managing these responses is of course part of the process of engaging the supervisee, working with the transference and countertransference that can be involved, and collaboratively working with the supervisee to develop a supervision contract, agreeing on lines of reporting to the Council consistent with the supervision conditions, negotiating fees and regular supervision times, and performing the role as gate keeper for the Council, whilst reporting on progress and challenges.
As a BAS, when you are approached by the Council and/or a supervisee to engage with the process, you will be provided with a copy of the conditions set out by Council, and negotiate with the supervisee the contract to proceed with setting goals to address the areas of need, and ensure rigorous review of reflective practice and ethical decision making that pertain to the areas of concern. It is important that the supervisee can demonstrate to the supervisor and the Council that the practitioner has developed insight into the processes that led to the complaint(s), and has the capacity to engage in remedial practices to ensure improved professional and ethical practice, that ensures the practitioner acts in accordance with the standards expected of the profession.
Reflective practice in psychological treatment and professional practice in general, is the ability to recognise and explore an understanding of the core phenomena of actions, thoughts and emotions of oneself and others, in particular the interaction with clients in assessment and treatment processes.
The PsyBA identifies supervisor competencies as having:
- Knowledge and understanding of the profession
- Knowledge of and skills in effective supervision practices
- Knowledge of and ability to develop and manage the supervisory relationship
- Ability to assess the psychological competencies of the supervisee
- Capacity to evaluate the supervisory process
- Awareness of and attention to diversity
- Ability to address the legal and ethical considerations related to the professional practice of psychology
Please refer to the new APS Guidelines on Revised Ethical Guidelines on Supervision (APS Members only).
Additional competencies (not required by PsyBA)
- Electronic and communications technology
- Business practices
BAS's need to become familiar with the Council’s policies and processes for supervision which can be accessed on its website (under Resources). These refer to:
- Compliance Policy – Supervision
- Supervisor Approval Position Statement
- Nominated Supervisor Consent Form
- Guidelines for Supervision
- Supervision Report Template
It is important when first meeting the supervisee to review the findings of the complaint, reflections and learnings from the process, whether they have changed their practice from the time the complaint was made, and what goals and activities are required to correct the errors of judgement, practice, or other areas of concern.
It is important to utilise this process to assess progress and review standards of practice that are in keeping with expectations of the profession. It is useful to ask how the supervisee feels about the process, manage the various psychological processes described earlier, ask whether they have shared their circumstance with others, and how they would feel if colleagues and peers knew about their circumstance.
Useful resources include the APS’s recommendations on ethical decision-making model, the APS Code of Ethics and appropriate guidelines, and the Professional Practice Management Standards (PPMS) for psychologists (APS members only).
The Council does not dictate models of therapeutic intervention, but requests supervisors address evidence-based practice and ethical decision making. Some of the common methods often cited in terms of supervision methods documented by BAS's include direct observation or recording of professional practice, review of files and reports, provision and review of professional reading materials, review of case conceptualisation, and tracking of progress towards competencies using a 5-point Likert scale (refer to Supervision Report template in the Council’s website Resources section).
Professor Craig Gonsalves has written extensively on setting supervision goals and guidelines, as well as outlining core competencies in psychological practice. Please click on:
https://drjeffchang.webs.com/gonsalves%20goals%20competency-based.pdf Gonsalves 2014
https://c-best.com.au/wp-content/uploads/Article-Competency-Based-Models-of-Supervision.pdf Gonsalves, Australian Psychologist (2014)
http://www.nsbep.org/downloads/ExamplesGoals.pdf Examples of goals in supervision.
Gonsalves recommends utilising the Competency Cube (see page 32, Gonsalves, 2014) to review competence types and domains, and overviews the stages of development in addressing goals and reviews of competencies in various domains. The remediation stage could be seen as an extension to the post-general or endorsement practice process.
Acknowledging the dynamic nature of the supervisory relationship in a mandated context, some micro-skills could involve reducing broad based competences to micro skills, setting SMART goals, tracking and measuring progress, noting areas of weakness and reflective practice regarding this, while developing specific plans for improvement and evidence of sustained improvement in these outcomes.
The Council would like to thank all supervisors in their important roles assisting mandated supervisees achieve their goals and reporting to the Council. If you have any questions about these processes, please do not hesitate to contact the Council’s Professional Officer on (02) 8320 6513.
Thomas O’Neill
Clinical Psychologist
Council Member