Cyber supervision’s time has come

Clinical supervision is undergoing a facelift, with the widespread application of the Internet to traditional face-to-face supervision and training. At the 2009 Association for Counselor Education and Supervision Conference, online teaching, counseling and supervision were key topics of interest, with 46 sessions focusing on various aspects of technology.

Clearly, the substance abuse field cannot ignore the influence of web-based technology and how best to use the Internet to enhance education, training and supervision. The key will be how to use the tools offered through technology without giving up quality.

Various professional organizations, such as the Council for Accreditation of Counseling and Related Educational Programs (CACREP), have issued standards for supervision of students in the counseling internship. While there is a plethora of research on distance learning across various disciplines, there is minimal research on the use of distance learning for counselor education and supervision. Historically, clinical supervision involved live in-session meetings and has progressed through one-way mirror, audio and videotaping as media of choice. Recently, computer-based technologies have been used to assist in the delivery of clinical supervision, eliminating the need for direct in-person contact.

Regardless of the medium of delivery of supervision, the traditional definitions of supervision still apply. My definition is “clinical supervision is a disciplined, tutorial process wherein principles are transformed into practical application and involve four foci: administrative, evaluative, supportive and clinical.” (SAMHSA’s TIP #52 has more information on definitions of clinical supervision.)

Cyber supervision’s benefits

Cyber supervision is here to stay, and supervisors need to learn to use computer-assisted supervision effectively. It is efficient, economical and convenient to both supervisee and supervisor.

Flexibility is another factor that influences outcome and perceptions of cyber supervision, in that supervisors have the capability to meet (albeit electronically) with their supervisees at any time deemed mutually beneficial. No longer can a supervisor say, “My supervisees are not located in my office but are spread throughout the state.” Now, with the proper equipment, group peer supervision can be supported with supervisees at various locations using real-time video and audio capabilities. This is especially important in rural and outlying areas.

Cyber supervision also reduces time and money spent on travel for supervisors who make on-site visits and have limited time and travel budgets. This opens the door for supervisees to select from a more diverse group of supervision and practicum sites that may provide a more beneficial learning experience.

Online supervision is a simple and straightforward process for those who are familiar with online navigation and have good typing skills. Finally, permanency of records is possible. Each supervisee can have a record of the entire supervision session for review at a later time.

There are some glitches, though. Technological failures (“Can you hear me now?”) and lack of technological experience are two potential disadvantages threatening cyber supervision. The lack of human contact is often raised as the number one objection, with limited non-verbal communication (unless one uses a webcam) and limited bonding between supervisor and supervisee.

However, a new term has entered our vocabulary: “virtual intimacy.” Research has shown that individuals are more likely to self-disclose and offer personal information online in a way they never would face-to-face. If you doubt that, go to a chat room and see what people say. There is something about the electronic shield that enables disclosure.

Other issues involve:

• Typing skills;
• Space limitations on some computers;
• Comfort with silence/inactivity during communication, and time lags between responses of supervisees; and
• Distractions from other activities occurring in the same “room.” Different from face-to-face communication, interruptions are more likely to occur during a cyber session.

Finally, there is the increased risk of confidentiality breaches posed by computer-based supervision. A major concern voiced by counselors surrounds who else might have access to this information and material. However, with firewalls and password protection, it is likely that cyber supervision is no less protected than traditional face-to-face or videotaped communication.

Ethics of cyber supervision

Ethical practices are professional standards fundamental to all clinical supervision, regardless of supervision delivery modality. The American Counseling Association (ACA) has issued its ACA Code of Ethics and offers clear guidelines for ethical practices of supervision, including technological applications to web-based counseling in general.

The National Board of Certified Counselors (NBCC) also provides principles for the use of the Internet in counseling. While both organizations do not specifically address the unique issues related to cyber supervision, ethical considerations should include confidentiality and security, informed consent, emergency contact and crisis management (duty to warn issues), and documentation issues.

Several macro-ethical principles apply to cyber supervision as well. The first is autonomy, or the right of individuals to make their own decisions and act upon them without interference from anyone else. This includes concerns about confidentiality, disclosure, documentation and record-keeping. Supervisees have a right to know how their confidential information will be handled. An informed consent statement will review the manner and specifics of supervision.

A second macro-ethical issue is fidelity, or the principle of being trustworthy and trusting. The supervision must uphold all commitments and communication in an honest and open manner, maintaining a loyalty to the supervisee and the client.

A third issue is beneficence, promoting that which is good and looking out for the well-being of the client and the supervisee. Non-maleficence demands that the supervisee and supervisor do no harm. If confidentiality is broken in any way, harm is done. One can safely handle sensitive information over the Internet if strict protocols are followed. Working on the Internet requires the supervisor to be knowledgeable about technology and aware of the ways in which information can be compromised.

What works?

Current literature on cyber supervision points to several key issues if a supervisor is to utilize this technology:

1. There are technological challenges that must be addressed. Supervisors may need training on how to access the Internet, how to download information, and how to address compatibility issues (“I have a Mac. Can I access PC data?”).
2. Small group supervision seems to be preferred to large, chat room-style supervision sessions. As the online supervision groups get bigger (more than 10 supervisees), less airtime is afforded individuals.
3. Some degree of face-to-face communication is also valuable. Relying solely on cyber supervision might give supervisees a feeling of being disconnected from their agency.
4. Trust building is critical, even as it is in face-to-face supervision. Trust is even more critical, though, when there is limited visual connection between the supervisees and supervisor.
5. Cultural variants are critical. Although cyber supervision can broaden one’s cultural perceptions through the inclusion of diverse ethnic and cultural participants, the lack of visual contact and sensitivity to cultural norms can create barriers to open disclosure in cyber supervision.
6. Generally, cyber supervisees see this delivery medium as convenient and comfortable. Although there may be generational/age differences in one’s comfort level with technology (if I want to know anything about my computer, I ask my daughters), these issues can be overcome with training. Besides, the next generation of counselors who we are training and supervising today are far more comfortable with this medium than us “old folk.” Supervisees generally feel that accessing counseling sessions through the Internet is problem-free and easy to hear and understand.

Need to get on board

The University of Georgia completed a three-year study of clinical supervision in the substance abuse field, and the results were disturbing. According to the analysis published in 2009, clinical supervisors in our field rely primarily on reviewing notes and verbal reports of supervisees (60%), do little direct observation (10 to 21%), and rarely use the Internet for supervision (less than 20%).

As mental health and addiction services merge, as is happening nationwide, addiction professionals come “one down” in the degree of supervision they have received and their limited use of technology. Clinical supervisors in the substance abuse field can no longer be “techno-peasants”—we must embrace the new media available in supervision.

The following skills are required for clinical supervisors to utilize the Internet for supervision:

 Skills in navigating online;

1. Basic typing and spelling skills;
2. Ability to express concepts/ideas without the use of non-verbal cues; and
3. Excellent communication skills.

Most importantly, we must become technologically proficient. This is familiar turf, though. Counselors and supervisors had to learn new skills 30 years ago when hotlines were introduced.It is time! Cyber supervision is a reality. Clinical supervisors, welcome to the 21^st century.

David J. Powell, PhD, is President of the International Center for Health Concerns, Inc. (www.ichc-us.org). He wrote a Management column on how addiction treatment agencies should address relapsing staff members. His e-mail address is djpowell2@yahoo.com.