The morning Workshop, presented by Antolin M. Llorente, Ph.D., was a needed workshop on ethical psychological and neuropsychological assessment, focusing on diversity concerns. The Workshop was entitled:

Cross-cultural Issues in Neuropsychology: Applied Implications Impacting Assessment

Dr. Llorente spoke to a crowded and attentive audience. His style was somewhat professorial. At times I felt like I was back in graduate school. This is not a bad thing. Occasionally, we all need to step back into “Learning Mode” and away from the “cookbook” mentality of assessment techniques at professional workshops. Dr. Llorente had a very good sense of humor. The 3 hours went by quickly and, I believe he met all of his objectives.

Early in his presentation, Dr. Llorente carefully defined the terms commonly associated with diversity. He pointed out that ethnicity and race are not the same, noting that many ethnic groups are comprised of different races and vice versa. Race may be the least important variable to consider in assessment. Acculturation and assimilation may be the most important.  Research suggests that adaption, and adopting the values of a culture are very important in psychological assessment results.

Regardless of the definitions in cross-cultural issues, Dr. Llorente stressed the importance of adhering to the American Psychological Association Standards and General Principles for psychological assessment.

Specific to psychological and neuropsychological assessment with cross-cultural populations in America, Dr. Llorente pointed out that immigration patterns in America are not random, seriously affecting the standardization of psychological testing over the years. For example, the early standardization samples, in the 1940’s excluded Japanese immigrants, and the Hispanic immigration in the 1960’s was heavily weighted with Cuban immigrants, and did not include other specific Hispanic groups.

He said that use of the term “Asian” did not account for the multiple Asian cultures within that population. Specifically, he pointed out that  even some of the best measures of intelligence, excluded certain representatives in the standardization of certain age groups.

Ethics cautions are often hard to listen to for the mental health practitioner providing assessments or psychotherapy, but always necessary. No one likes to hear what they may be doing wrong.  In response to a question, he remarked that it is sometimes difficult, or impossible to adhere to all cross-cultural considerations in assessments. Dr. Llorente suggested that review of the APA Standards and General Principles is required and the Mental Health Professional must use clinical judgment on whether to provide the assessment. If the professional not comfortable in assessing the person due to cultural or other differences, then the professional should seek someone who is competent to perform the assessment.

In all cases in question, the professional should use “due-diligence” and get supervision, in attempting to understand the needs of the client and the use of appropriate assessment techniques, before agreeing to the assessment. He emphasized that (paraphrased); Cross-Cultural Psychological Assessments are not perfect now. We are required to do our best, to use good clinical judgment and follow the current APA standards to improve the reliability and validity of these assessments for the future.

Overall, this was a good workshop. People around me did have some concerns about the poor quality of the audio in his videos, and poor readability of some of his slides.

Today’s afternoon Workshop was presented by Alan Tepper, J.D., Psy.D., entitled:

Ethical Principles Related to Clinical Supervision

Dr. Tepper was enthusiastically welcomed back to the FCP Professional Workshop series and presented to a full house. In fact, this workshop was sold-out early.  Dr. Tepper is an attorney and a psychologist. He was able to switch hats as needed during his workshop. He reminded the audience that his topic was limited to supervision of mental health professionals, especially supervisees who are working towards hours for licensing credentials.

His workshop objectives included:

• Understand the potential legal exposure associated with the provision of clinical supervision.

• Become familiar with the record keeping practices associated with the provision of clinical supervision.

• Understand the boundary issues associated with the provision of clinical supervision when making referrals and recommendations.

Dr. Tepper began his Workshop by mentioning that license and supervision requirements for mental health professionals differ among the 50 states. He defined three categories of supervision:

1. Licensed mental health professional (Psychologist, Social Worker. Professional Counselor and Marriage and Family Counselor.
2. Practicum or interns working to obtain a license.
3. Unlicensed professionals, working under the license of a licensed professional.

He said that exposure to Licensing Board or legal complaints may occur at any of these levels. Then he quickly said that these complaints are very rare in the mental health profession because most professionals follow the standards.

Dr. Tepper defined the supervisory relationship as “in-the-loop” of the supervisee–patient relationship. He said that supervision is not consultation with a professional peer. He suggested that the word “supervisor” should be used only after some care thought and a clear definition of the supervisor-supervisee relationship is established and the pertinent regulations and forms have been reviewed by both parties. He also mentioned that licensing forms for the supervisee may differ for the same license, depending on when the supervisee finished the terminal degree for their profession (Masters or Doctorate).

Also important to note, is the requirement that the training status of the supervisee must be made clear to the patient/client and third-party payers. He mentioned a couple of cases where supervision was disallowed by the State Licensing Board, because this was not made clear. He also said that Board complaints may be filed against the licensed professional supervisor in these circumstances. Dr. Tepper emphasized that supervision across states is subject to the regulations in the state where the supervision occurs and, typically, supervisory violations are reported to the professional’s home State.

Another area of exposure for the supervisor is record keeping. This may occur at two levels. 1. All regulations for therapist-patient/client record keeping (session notes, evaluations, assessments, communication [including emails] etc), must be followed by the supervisee, with oversight by the supervisor. 2. The supervisor must also maintain similar records of supervisory interaction with the supervisee.

A large area of exposure for Board or legal complaints for supervisor are, as Dr. Tepper stated, in the area of Boundary/Dependency violations. While the most obvious are sexual or intimacy relationships, there are also what he calls “non-sexual” boundary violations that can lead to complaints between the supervisee and the client, or the supervisor and the supervisee. Supervision should include awareness of potential boundary violations to the supervisee. Should they occur, such violations may place the supervisor at risk for complaints. These may include employment of the supervisee by a supervisor, without clear notification of the trainee status to the patient/client or the payer, pre-payment for long periods of multiple sessions, prepayment for treatment sessions, over-friendly, non-professional use of communication including emails with icons, or use of cell phone, including texting, without informed consent and clear time boundaries (business hours?).

Dr. Tepper expressed concern that boundary violations can lead to unhealthy dependency between the supervisee and the client. The supervisor should advise the supervisee and role-model the prudent use of electronic media in the professional relationship. He also pointed out that this media is often not secure and may violate mental health privacy laws. He cautioned supervisors to advise supervisees to not provide cell phone numbers to clients. In response to a question about the diminishing use of land-line telephones, Dr. Tepper suggested the use of Google Voice, which allows two lines on a cell phone and is free. In support of Dr. Tepper’s cautions about time boundary violations with patients/clients and the supervisor-supervisee relationships, a participant reminded the audience that self-care for the mental health practitioner is an APA guideline.

In short, Dr. Tepper’s Workshop met his objectives. Again, his presentation was not “high tech” (He used a flip chart!)  Thank goodness, he did not allow Power Point to get between him and his audience.  He stated that he is “Power-Pointless.” The three hours went by very quickly and I learned a few things.  Between the humor, his presentation addressed the ethical issues of the Supervisor-Supervisee relationship. Besides, it was fun and a very satisfying workshop!

As in the past, Dr. Tepper advised all licensed MHP’s to frequently check their Board’s Websites for updates on new statutes and regulations regarding supervision requirements.