LIABILITY AND ACCOUNTABILITY IN PSYCHOTHERAPY SUPERVISION - A REVIEW,SURVEY, AND PROPOSAL

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 whic h issues of liability and accountability should be constructively addr essed. The authors conducted a nationwide survey of psychiatry residen cy training directors and asked them to estimate the awareness of thei r supervisors of liability issues pertinent to the supervision of psyc hiatric residents learning psychotherapy. While the training directors assume that their faculty supervisors, including volunteer faculty, a re familiar with issues of accountability, very few make tangible effo rts to provide this information. The authors found that patients are n ot routinely informed of the identity of supervisors, although the pat ients are usually informed that a therapist is in training. The author s propose practical interventions whereby residency training programs could address the issues of faculty members' awareness of their accoun tability, the education and training of supervisors, the documentation of supervisory sessions, and the attitudes and practices of psychothe rapy trainees.