Professional Disclosure Statements For Supervisors

            Licensure requirements compel LLPCs and LLPCs to provide a professional disclosure statement to their clients. The concept of creating a professional disclosure statement for supervision practice may be new for some supervisors, but it should be seriously considered. Another name for a professional disclosure statement is a Supervision Consent form. In her workbook Becoming an Effective Supervisor (Taylor & Francis, 2000), Jane M. Campbell, Ph.D.) Says that “The purpose of this form is to acquaint you with your supervisor, to describe the supervision process, to provide structure to your supervision experience, to give you the opportunity to ask questions you may have regarding supervision, and to ensure a common understanding about the supervision process.”

            Campbell suggests developing a personal model of supervision as a basis for creating a Professional Disclosure or Supervision Consent Form. She suggests walking through the ten following steps as a guide to building such a model:

            1. Identify personal philosophy of change that guides practice.

            2. Identify goals for supervision.

            3. Define specific content areas for supervision, and describe what         supervisees must know and be able to demonstrate in each content area.

            4. Identify expectations for supervisees in each content area depending on developmental level.

            5. Assess developmental level of supervisee.

            6. Identify the developmental level of the supervisor, as well as his or her skill level and expertise in the various techniques and methods of supervision.

            7. Identify preferred style of supervision.

            8. Identify environmental and contextual factors that influence supervision: ethical and legal issues, multicultural issues, needs of clients, resources available.

            9. Identify the stage of development of the supervisory relationship.

10. Identify relationship skills, roles, methods, and techniques necessary to help the supervisee grow and develop.

            In her Sample Supervision Consent Form, Campbell suggests that the following topics be addressed: Purpose, Professional Disclosure, Practical Issues, Supervision Process, Administrative Tasks and Evaluation Ethical/Legal Issues, and Statement of Agreement. She recommends that both supervisor and supervisee sign the statement.

            Certification requirements for the Approved Clinical Supervisor Credential (ACS) require that applicants submit a Professional Disclosure Statement. This statement must contain the applicant’s: business address and phone number; listing of degrees, credentials and licenses; areas of competence for supervision; training and experience in supervision; model of or approach to supervision; evaluation procedures to be used; limits and scope of confidentiality and privileged communication; a fee schedule; how to reach the supervisor in an emergency; and a statement that the supervisor follows the relevant credentialing body’s code of ethics as well as CCE’s Standards for the Ethical Practice of Clinical Supervision.

            While Michigan Law does not require LPC supervisors to provide supervisees with a Professional Disclosure Statement for Supervision, there is value in doing so. In addition to the obvious benefit of clarifying the supervisory relationship, creating such a statement is an exercise which can help supervisors to become more organized and effective.