Liability and Accountability in Psychotherapy Supervision

Abstract

The contemporary climate of medical-legal liability, and of increasing expectations of accountability from agencies that pay for psychiatric services and training stipends, has created an atmosphere within which issues of liability and accountability should be constructively addressed. The authors conducted a nationwide survey of psychiatry residency training directors and asked them to estimate the awareness of their supervisors of liability issues pertinent to the supervision of psychiatric residents learning psychotherapy. While the training directors assume that their faculty supervisors, including volunteer faculty, are familiar with issues of accountability, very few make tangible efforts to provide this information. The authors found that patients are not routinely informed of the identity of supervisors, although the patients are usually informed that a therapist is in training. The authors propose practical interventions whereby residency training programs could address the issues of faculty members’ awareness of their accountability, the education and training of supervisors, the documentation of supervisory sessions, and the attitudes and practices of psychotherapy trainees.