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Gatekeeping Functions

Columns - Clinical Supervision

Written by David J. Powell, PhD

Tuesday, 04 March 2008

One of the primary goals of clinical supervision is to ensure quality care and to protect the welfare of the client. A part of this goal is the difficult task of gatekeeping, assessing who should and should not be a counselor.

We have an ethical responsibility to counsel some counselors out of the field. The gatekeeping function is a rarely discussed, but critical, aspect of what clinical supervisors do. Who should not be a counselor? What are the traits that would lead a supervisor to counsel someone out of the profession? How do we define unacceptable counselor behavior or attitudes? Unacceptable qualities

There are some qualities that we’d all agree indicate a person might be better off “flipping hamburgers,” working in another field. These obvious behaviors and traits include:

Causing injury to others, through verbal or physical actions
Illegal or immoral behavior
Sexual activity with clients
Mental instability

There are other, less obvious, traits and behaviors that might be more difficult to measure:

Unprofessional or inappropriate behavior. This is difficult to define. What constitutes unprofessional behavior? In whose eyes might something be deemed to be inappropriate? An easy, and perhaps glib response is “you’ll know it when you see it,” and perhaps that’s the best answer we can offer. However, codes of ethics attempt to provide some guidelines as to what’s appropriate and what’s not, such as dual relationships with clients, boundary violations, incompetence, breaches of confidentiality and other ethical impropriety
Excessive resistance, persistent high anxiety or hostility
Emotional immaturity or difficulty handling conflict
Poor interpersonal skills or lack of self-awareness
Excessive counter-transference
Problems with peers and co-workers
Acting in a manner unfitting for the profession
Judgmentalism or over-personalization of client issues
“A personality unsuitable to the profession”

What gets in our way of acting?

Once a clinical supervisor has identified issues of concern about a counselor, what ought to be done? Before we can answer this question, we first must identify what gets in our way of taking action. What are the barriers that inhibit a clinical supervisor from fulfilling their gatekeeping functions?

Fear that either that we will be criticized about our judgment; that we will not be supported by management in counseling a person out of the field; or whether we can defend our decision.
Our non-judgmental or overly humanistic approach — we want to be liked, after all we’re clinicians at heart and want to do good, not create distress for fellow counselors. However, we need to ask “who is the client?” that we’re serving. Whose needs are being met? Are we fulfilling our responsibility to the client of guarding the gate if we allow inappropriate counselors to continue to function?
Unclear expectations about what we ask of counselors.
Over-identification with a counselor — after all, we’ve all been there and know the stressors on a clinician.

There are also organizational barriers that get in our way of guarding the gate:

You’re already down in staff and are concerned that if you move a counselor out, a big vacancy will remain, placing greater strain on others to “take up the slack.”
Organizational policies — In some organizations, employees are like the old Nike missiles: they didn’t work and you can’t fire them. Legal, civil service and other constraints sometimes limit what a supervisor can legally do.
Most importantly, far too many alcohol and drug abuse organizations lack quality clinical supervision, direct observation or oversight of a counselor’s work, making supervisory action difficult. Often, a counselor’s inappropriate behavior goes unobserved and unseen.
The lack of documentation — Key questions will often be asked of a clinical supervisor by an organization’s human resources department and/or the corporate attorney: Where is the documentation? How is it that this counselor received a stellar performance appraisal six months ago and now you want to counsel them out of their job or the field? Did you follow progressive discipline? What did you do to assist the counselor in taking corrective action? As always, if it is not in writing, it didn’t happen. Show me the documentation!

What to do? There are several key steps for a clinical supervisor to take:

1. Encourage the counselor to engage in self-criticism and assessment.
2. Evaluate, evaluate, evaluate. One of the most difficult tasks of a clinical supervisor is to provide clear, concise, accurate and timely feedback to clinical staff. As I look back on my career as a supervisor, evaluating staff was not my forte. Either I over-criticized personnel, or more than likely, I under-evaluated personnel. I believe that a supervisor knows within the first three months of employment if this was a good hire. Unfortunately, far too often, we let the person slide through the probationary period and then it is more difficult to take disciplinary action, for all the reasons mentioned above.
3. Follow a standardized assessment procedure. All counselors ought to have an individual development plan, an IDP, just as all clients need to have an individual treatment plan.
4. Ask yourself these questions: Would I rehire this person if given the option? Would I be willing to be supervised by her? What clients would I be willing to refer to him? Would I want her to be my counselor if I needed help myself?

Conclusion

Gatekeeping functions are one of the most important but least discussed activities of a clinical supervisor. It is a difficult task, but as I always say, that’s why a clinical supervisor is paid so much, to fulfill these important but hard functions.

Comments

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arthur dawson - MICA Specialist CASAC

|71.247.67.xxx |2008-11-19 09:19:36

I am looking for a list of the 12 gate keeping fuction as t related to diversity
in cultures, which includes going in and out of sub cultures and being able to
fix in or fuction without conflict.If you have that listing could you please
e-mail it to me. thank you for your consideration

Y.W.	\|67.11.145.xxx \|2008-06-17 00:44:34

I have not been designated a clinical supervisor but I am an LCDC. When I first
began in this field, my supervisor gave me fair to good reviews.(I began as a
part time driver, moved into full time driver, then to House Management and
finally a CI and then LCDC. All through these years, my supervisor gave me very
precise and objective reviews. She pointed out to me things that I knew I needed
to work on but no one would call me on my "stuff"....punctuality,
deadlines, boundaries, etc...I keep the good review and the critical ones next
to my door (at home), and before I walk out the door I glance at it and Thank
her for being honest with me. It has been 2 years since I worked for her, (I
left for better pay and gave her a month's notice)yet I will cherish her
straightforward method of clinical supervision, it is what makes whom I am
today.