Art therapy supervision is an area of practice that can be rife with ethical dilemmas due to the differential in power between supervisor and supervisee. The supervisor’s explicit power is undeniable. While in training, a supervisor may have the authority to delay, or worse, derail a supervisee’s advancement through his or her training program (O’Neill, 2004).

In the professional world, a disparaging evaluation can lead to disciplinary action. Implicit power is subtle, at times, undetectable. Studies suggest that individuals in positions of authority or status tend to receive more recognition and a greater degree of compliance from individuals who perceive themselves as less powerful or less experienced (Quarto, 2003). Given these overt and covert dynamics, it is incumbent upon supervisors to exercise power in thoughtful and ethical ways. 

Legal Responsibilities in Art Therapy Supervision

Supervisors have numerous responsibilities. They promote the supervisee’s clinical growth, ensure clients receive quality care, and monitor accountability. The term vicarious liability essentially means that the supervisor is also responsible for the supervisee’s conduct and actions, as well as his or her failure to act (Dewane, 2007). Therefore, when things go awry, the burden is on the supervisor to prove the supervisee was provided with adequate supervision to maintain standards of practice within a given profession.  It follows that balancing opportunities for learning with quality client care may create tension within supervisory relationships. 

Ethical Dilemmas in Art Therapy Supervision

Ethical or professional issues can be simple or complicated. They generally fall into two categories. First, there are situations that require little or no deliberation. The supervisor must act decisively to ensure the trainee acts in accordance with established legal or professional policy. For example, if a supervisee fails to get a client’s informed consent when planning to display the client’s artwork, the supervisor must act authoritatively to prevent the ethical violation from occurring. There are two options: either the student obtains signed consent or the student does not display the artwork. The situation requires a definitive stance to mitigate legal and ethical risks. 

Research and Development in the Science Industry Art

The second type of situation is more complex. invariably, it challenges us to introduce flexibility into our approach while taking necessary measures to protect clinical integrity. As art therapists we are fortunate to have two national organizations that provide rules and procedures to guide us. The Art Therapy Credential Board provides a Code of Ethics, Conduct, and Disciplinary Action. I also found that the values set forth in the Preamble of the American Art Therapy Association’s Ethical Principles for Art Therapists (AATA, 2013) to be enormously useful when navigating through this unchartered territory. 

Balancing Learning and Quality Client Care

There are subtler circumstances that do not pose an ethical violation yet they may not meet established standards of practice. Our capacity to navigate these dilemmas is an important supervisory skill. While we are fulfilling legal and professional duties, we can also potentiate supervisee growth. The following two vignettes illustrate how power can be leveraged to build supervisor-supervisee collaboration and reveal ways to resolve difficulties by using interactive rather than hierarchical strategies.  

First example: In a supervisory session, an art therapy trainee expressed interest in working individually with a grandiose client who had impaired reality testing. She met him in a workshop during her hospital orientation. In additional to being artistic, the client enjoyed experimenting with a range of materials. He also seemed to endear himself to the student, expressing gratitude for the ways in which she helped him. The relationship was gratifying for the student who wanted to feel both valued and competent. 

The supervisor supported the student’s need for autonomy but also raised concerns about the potential clinical risks involved in working with an idealizing client. She encouraged the trainee to think about her underlying motivation for her request for individual sessions. In a non-shaming manner, she noted that it must be reassuring to work with a client who offers her a favorable assessment. The supervisor shared her knowledge that clients with idealizing transferences can polarize their perceptions, devaluing others when they perceive a narcissistic slight or feel dismissed. She asked the student to think about how she would handle this dynamic if were to emerge. 

The student voiced similar concerns. In the subsequent session, she explored various treatment options and decided to serve as a co-leader in one of the client’s groups, instead of seeing him individually. It seemed to be a thoughtful and rational decision. She could maintain the therapeutic alliance yet diffuse the potential intensity of the trainee-client relationship. The supervisor commended her thoughtful decision-making.      

Concerns proved to be well-founded. Strain in the therapeutic relationship quickly developed. Convinced that the student needed financial assistance, the client expressed a delusion that she had borrowed thousands of dollars from him and refused to pay him back. By allowing the student to play an active role in decision making, the situation became a teachable moment. Within a safe, non-shaming environment, the student was able to explore her motivations and acknowledge that her original plan might not have been in the client’s best interest. 

Second Example: In a supervision session, a supervisee who is a credentialed professional, asked her supervisor to refer a client to an expressive arts trauma group. She expressed her perception of the injustice that the woman — who on admission reported an extensive trauma history — was not receiving trauma-focused treatment. The supervisor validated the supervisee’s call for justice but reminded the supervisee that the woman is actively psychotic. The supervisor questioned whether this form of treatment might be antithetical to her treatment goals, namely, stabilization. She asked the supervisee to consider whether or not this group might be destabilizing for a vulnerable individual struggling through an acute phase of severe mental illness. 

The following week, the supervisee proposed a plan of action. Collaboratively, supervisor and supervisee decided to track the woman’s progress in treatment to assess her readiness for trauma-focused work. The supervisor demonstrated fidelity to the plan by making certain to check in each week about the status of this case. The supervisor’s sustained interest in the case as well as her acknowledgement of the supervisee’s perception of injustice holds space open for a collaborative dialogue. Rather than exercising supervisory authority to dismiss the referral, the supervisee was invited to co-construct a plan of action. This type of dynamic will most likely occur in learning environments where the supervisee feels safe, trusted, and is able to express his or her creativity.   

The Supervisory Relationship

Einstein once said: no problem can be solved from the same level of consciousness that created it.  

The goal of art therapy supervision is to foster professional development and growth in supervisees. Sadly, little can be accomplished when an intern or colleague experiences the supervisory environment as unsafe or hostile. In this circumstance, the supervisees or colleagues will feel a need to protect themselves. They may omit important facts, avoid topics and minimize their perceived failures. The following are a few ways to inspire a collaborative yet instructive approach to supervision. 

  • Review legal and professional obligations at the beginning of the supervisory relationship. It will become an integral part of their decision-making. From the outset, supervisees look to supervisors for guidance.
  • Create a routine where the focal point of supervision shifts between clinical details to larger policy and programmatic issues. This collaborative dialogue can broaden the scope of the supervisee’s clinical and administrative perspectives.   
  • Share your own strengths and weaknesses to create a non-shaming environment where students can ask questions and acknowledge their own strengths and weaknesses.
  • Invite supervisees to share their perspectives and try to teach with openness to new ways of working. Hold the supervisory space open for collaborative dialogue. 

 Conclusion

We live in a time that invites multiple perspectives and celebrates diversity. The supervisor-supervisee relationship exists between two people, and by its very nature, is dynamic, constantly changing, and gradually evolving. The same is true of our knowledge of our profession and perception of the world around us (Kegan, 1994). While a power differential is ever present in supervision, it can be used ethically to maintain standards of care and ensure clients are not harmed. Authoritative methods are essential when mitigating legal and professional risks. However, the excessive use of such power may create distress or resistance (Stevenson & Cutcliffe, 2005). Rather than conforming to the supervisor’s expectations, students can be encouraged to be co-creators of their clinical identity. We must hold the space open for their potential for originality and creativity. As art therapy supervisors, it is incumbent upon us to uphold all six ethical values: Autonomy, Nonmaleficence, Beneficence, Fidelity, Justice and Creativity. 

REFERENCES:

O’Neill, S. (2004). The social work legal issues handbook. Boston, MA: National Association of Social Workers.

Atkins, C. P. (2002). Power communication: Making an educated choice. Clinical Supervisor, 21 (2), 207-232

American Art Therapy Association. (2013). Ethical principles for art therapists. Alexandria,VA: AATA

Dewane, C.J. (2007) Supervisor beware: Ethical dangers of supervision. Social Work Today. 7 (4). 34 -38.

Kegan, R, (1994) In over our heads: the mental demands of modern life.Cambridge:  Harvard University Press.

Stevenson, C., & Cutcliffe, J. (2005) Problemizing special observations in psychiatry:Foucault, archaeology, genealogy, discourse, power/knowledge. Journal of  Psychiatric and Mental Health Nursing.13 (6), 713-721.   

Quarto, C. J. (2003) Supervisors’ and supervisees’ perceptions of control and conflict in counseling supervision. Clinical Supervisor.12 (2), 21-37.

Written by:

Deirdre Cogan
ATR-BC, ATCS, LPC, CCTP