4 Ethical Considerations for Supervisors in Private Practice

Adding clinical supervision to my private practice was the best decision I ever made. However, clinical supervision carries an ethical weight that is easy to underestimate.

On the surface it looks like a professional meeting. Two clinicians in a (virtual) room, talking about cases, supporting development, maintaining standards. Straightforward enough.

But supervision is also a relationship with a significant power differential. And in private practice, that power differential becomes more complicated in ways that do not always get the attention they deserve.

These are four ethical considerations that every supervisor (or soon to be supervision) in private practice should be sitting with regularly. 

1. Dual Relationships & Boundaries 

When a clinical supervisor is also the practice owner, both relationships exist simultaneously, with the same two people, in the same room.

The supervisee is being asked to be vulnerable about clinical uncertainty and mistakes with the same person who controls their income and professional future in that setting. That tension does not disappear with good intentions.

Dual relationships require explicit acknowledgment, open conversation about their implications, and where possible, clear structural separation between clinical reflection and administrative functions.

I suggest you reflect on whether you want to offer clinical supervision internally or externally or both. You also need to ensure that if you are providing supervision to your own independent contractors, that the supervision you are providing isn’t going to be seen by the CRA as treating your ICs as employers.

2. Competency and Scope of Practice

Being clear on your limitations as a supervisor is not optional. You may feel pressure to accept all supervision requests, but staying within your scope of practice protects both you and your supervisees.

If you supervise registrants across different colleges, such as OCSWSSW and CRPO in Ontario, you need to understand each body's supervisory requirements. Scope of practice is also about knowing when to refer out.

For example, I am very clear with my supervisees that couples work is not in my zone of genius. Yes, I am trained in it, but I would not say I have the expertise to supervise complex couples work. Which is why I have another supervisor who works with us, Ilda, who loves working with couples in their own therapy practice.

3. Documentation and Liability

Take notes. Advise your supervisees to take notes. This is a non-negotiable ethical requirement.

Your documentation should capture key discussions, recommendations, and any conversations related to ethics, confidentiality, mandatory reporting, or risk. It should also be crystal clear whether you are providing clinical supervision, where you hold legal liability for the supervisee's caseload, or supervision in a consultative capacity.

A solid supervisory contract is the foundation. It outlines scope, confidentiality, documentation practices, and how concerns are managed. Without it, the supervisee cannot give genuinely informed consent.

4. Confidentiality 

Confidentiality in supervision is more complex than it first appears. When a supervisor is also the practice owner, the line between clinical reflection and administrative oversight can blur fast.

If a supervisee discloses a clinical error, is that a reflective learning moment or an administrative liability concern? Who is the health information custodian under your independent contractor agreements? If session recordings are used in supervision, is that documented in the client's informed consent?

If providing external supervision, supervisors need to ensure clinicians have this information in their informed consent process, depending on your role as discussed above. If for example, you are signing off on a RP (qualifying) supervisees direct client contact hours and they are in solo private practice, what information do you need as the supervisor to ethically sign off on those hours for the CRPO?

Know your requirements and mandatory reporting requirements as a supervisor, if you are concerned about a therapist’s conduct, or if providing external supervision, if the supervisee shares concerning ethical behaviour at the clinic where they are working. 

We need to be a safe space where therapists can be vulnerable, can admit mistakes, can admit potential boundary crossings (such as starting to have feelings for a client) so that we can support and intervene before they become boundary violations and harm the client and the therapist.

Want to go deeper on all four of these?

I discussed all of this in detail on the Your Clinical Supervisor's Coach podcast, including practical examples of dual relationships, how to create a safe space for supervisee vulnerability despite the power differential, and what ethical supervision for supervisors actually looks like.

Listen to the episode here Ready for impartial external supervision?

I offer supervision and business consultation for therapists looking to add clinical supervision to their practice and for group practice owners. 

Book an external supervision consultation