Download Ethical Decision Making in Complex Supervisory Relationships: Multiple Relations Guidance and more Study notes Psychology in PDF only on Docsity!
Multiple Relations in Supervision: Guidance for Administrators,
Supervisors, and Students
Michael C. Gottlieb
Dallas, Texas
Kelly Robinson
University of Texas Southwestern Medical Center
Jeffrey N. Younggren
American Psychological Association Insurance Trust As fiduciaries, supervisors are to act on behalf of their supervisees; there are at least 10 provisions in the American Psychological Association Ethical Principles of Psychologists and Code of Conduct (2002) that provide guidance for those in this role. Unfortunately, there are many questions the APA Ethics Code does not answer with regard to multiple relations in supervision. The authors address a variety of problems that can arise in this professional context and offer guidance for administrators, practitioners, and students. Keywords: ethical decision making, ethics, multiple relations, risk management, supervision The lion and the calf shall lie down together, but the calf won’t get much sleep.—Woody Allen Multiple relations frequently occur between supervisors and supervisees. For the most part, these relationships are beneficial for supervisees, but there are times when complex and potentially harmful situations also may arise. In these cases, the American Psychological Association Ethical Principles of Psychologists and Code of Conduct (APA Ethics Code; 2002) often provides inad- equate guidance. In this article, we offer some guidance to assist administrators, supervisors, and supervisees in these challenging situations. Although the prohibition regarding sexual relations with super- visees is now settled (APA Ethics Code, Standard 7.07; Associa- tion of State and Provincial Psychology Boards, 2003, pp. 7– 8), other types of multiple relations are permitted because they are not necessarily harmful or unethical per se (APA Ethics Code, Stan- dard 3.05). In fact, they can be and often are beneficial (e.g., Lazarus & Zur, 2002). Although nonsexual multiple relationships frequently may be acceptable and helpful, engaging in them can create complex issues regarding boundary management. In such situations, admin- istrators, supervisors, and supervisees may be faced with intricate and very ambiguous situations that involve differing types of nonsexual multiple relationships, boundary crossings, and some- times boundary violations. Such circumstances become even more problematic when supervisors lose their objectivity and their per- sonal interests become involved. It is in these situations that the potential for harm arises (APA Ethics Code, Standards 3.06 & 3.08).
Boundaries
Boundaries refer to the “rules of the professional relationship that set it apart from other relationships” (Knapp & VandeCreek, 2006, p. 75). Gutheil and Gabbard (1993) stated that a boundary violation “represents a harmful crossing, a transgression, of a boundary” (p. 190), that such departures from accepted practice are potentially harmful and place patients and the therapeutic process at great risk. Gutheil and Gabbard also made a distinction between boundary violations and what they termed boundary crossings , which occur when a professional deviates from the strictest professional role but is not unethical per se. Later, Smith and Fitzpatrick (1995) defined this notion as a “nonpejorative term MICHAEL C. GOTTLIEB received his PhD in counseling psychology from Texas Tech University. He is a forensic and family psychologist in inde- pendent practice in Dallas, Texas. He is board certified (American Board of Professional Psychology) in family psychology, a fellow of the Amer- ican Psychological Association (APA), and a clinical associate professor at the University of Texas Health Science Center. He is a past member of APA’s Committee on Professional Practice and Standards and the Ethics Committee. His interests surround ethical decision making and the psychology–law interface. KELLY ROBINSON will receive her PhD in clinical psychology from the Graduate School of Biomedical Sciences, the University of Texas South- western Medical Center at Dallas in August 2007. She received an indus- trial engineering degree from Northwestern University and an MBA from the University of Texas at Austin. Her areas of professional interest include ethical decision making, professional development, and adult psychother- apy. JEFFREY N. YOUNGGREN received his PhD in clinical psychology from the University of Arizona. He is a clinical and forensic psychologist located in Rolling Hills Estates, California. An associate clinical professor of medical psychology at the UCLA School of Medicine, he serves as a risk manage- ment consultant for the Insurance Trust of the American Psychological Association. He is a past chair and member of the Ethics Committee of the APA and the Ethics Committee of the California Psychological Associa- tion. He currently serves as a member of the Committee on Accreditation of the APA. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Mi- chael C. Gottlieb, 12810 Hillcrest Road #B224, Dallas, TX 75230. E-mail: [email protected] Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 3, 241–247 0735-7028/07/$12.00 DOI: 10.1037/0735-7028.38.3. 241
that describes departures from commonly accepted clinical prac- tice that may or may not benefit the client” (p. 500). They cite the example of a patient who brings a Christmas gift to his or her psychotherapist. The patient “crossed a therapeutic boundary by offering something over and above the agreed-upon fee for pro- fessional services” (p. 500), and the psychotherapist must decide to refuse it or cross the boundary and accept it. In this example, crossing the boundary and accepting the gift may be beneficial, especially if doing so would be considered appropriate because of the patient’s cultural background, whereas refusing it might be viewed as offensive and potentially harmful. This example applies to psychotherapy, but similar boundary crossings may arise in supervisory relationships as well. Boundary crossings entail behavior that is a departure from accepted practice, but it is important to remember that they are common occurrences. They do not become violations unless they reflect exploitation of the supervisee, a supervisor’s loss of objec- tivity, disruption of the supervisory relationship, or the reasonable foreseeability of harm (Younggren & Gottlieb, 2004). It is only when boundary crossings lead to boundary violations that they can be exploitive (Gutheil & Simon, 2002) and place supervisees at risk (Gutheil & Gabbard, 1993).
Multiple Relationships
The APA Ethics Code (Standard 3.05[a], p. 1064) defined multiple relationships in the following manner: A multiple relationship occurs when a psychologist is in a profes- sional role with a person and (1) at the same time is in another role with the same person... or (3) promises to enter into another relationship in the future with the person.... Supervisors can play a variety of additional professional roles with supervisees that may be beneficial, such as serving on a dissertation committee, hiring a research assistant, or teaching an academic course. We presume that few would find these multiple relationships problematic, much less unethical, because in each case the supervisor remains in an evaluative capacity. Further- more, each role is fairly circumscribed and presents little potential for conflict of interest per se, as long as the supervisor retains his or her objectivity. Gutheil and Gabbard (1993) raised concerns regarding what they referred to as the “slippery slope.” According to this notion, for example, a supervisor begins down the slope when a strictly helpful, professional relationship gradually moves toward a more personal one. When this process begins, the potential for harm may arise. Hence, it is obviously safest not to start down the slope at all, but we contend that it is seldom problematic, for example, to have lunch with a supervisee, discuss current events, or travel to a professional meeting together. In fact, a sound argument can be made that such informal contacts with supervisees are beneficial, provide good opportunities for mentoring and modeling, and that there may be no slippery slope at all. Unfortunately, things are seldom so simple. Lamb, Catanzaro, and Moorman (2004) noted that there was no consensus regarding which multiple relationships were acceptable and that unacceptable ones were difficult to rec- ognize. Their conclusion prompts caution because a supervisor may not recognize that he or she is heading down the slippery slope until it is too late. Ladany, Lehrman-Waterman, Molinaro, and Wolgast (1999) examined supervisees’ perceptions of supervisors’ practices and found that more than half of supervisees reported at least one perceived ethical violation by their supervisor. Six percent of the supervisees had supervisors who violated dual-role ethical princi- ples, only 35% of supervisees discussed the ethical violation with their supervisor, and 54% discussed it with someone else. In 14% of the cases, a person of power was aware of the violation but did nothing about it. These data are sobering and lead us to conclude that the issue of multiple relationships in supervision has not been addressed ade- quately by our profession. A simple example illustrates the point: Dr. Jones’s last appointment of the day is with his supervisee Ms. Smith. When they finished, Jones noted that his family was out of town, he was going to take himself to dinner, and asked Smith if she would like to join him. She agreed, they had a pleasant dinner discussing professional issues, Jones paid the bill for both of them, and they went their separate ways. Is asking a supervisee to dinner an ethical transgression? A shared dinner typically would not be considered problematic and gener- ally is construed as potentially beneficial, but such a conclusion requires two assumptions. First, Jones’s invitation was transparent. That is, he wanted a dinner companion and nothing more. Second, Smith correctly understood Jones’s intentions. That is, she inferred nothing more from his invitation and did not take it to mean something other than what he intended. When these two assump- tions are met, we can reasonably assume that the dinner would be enjoyable and perhaps beneficial to Smith as well. Unfortunately, the exact same scenario could lead to significant difficulties either because Jones had unacknowledged personal motives or because Smith found the invitation inappropriate or coercive. This example illustrates a fundamental problem in ethical decision making. When ethical dilemmas arise, they are often less about what objectively occurred and far more about how they were perceived. Supervisees frequently rate their best supervisors as those with whom they socialized and subsequently developed personal rela- tionships (G. Schoener, personal communication, November 15, 2004). In such relationships, we presume that good boundaries are maintained; when problems arise, they are discussed openly and resolved successfully, and through this process, supervisees gain self-confidence as independent professionals. At the same time, supervisory relationships entail power differ- entials and create unique vulnerabilities for supervisees. When a supervisor’s personal needs or a supervisee’s distorted perceptions lead to an increasing number of boundary crossings, the potential for harm can develop quickly. As a result, supervisors should remain mindful that multiple relationships can be harmful and that boundaries must be managed carefully. Because psychology edu- cators serve as role models, Kitchener (1992) argued the follow- ing: implicit attitudes and explicit behavior of faculty communicate as much as course content about being ethical.... Thus, if faculty model unethical behavior it is very possible that the most influential ethical attitudes that students learn will not come from explicit ethics educa- tion but from the experiences that they have in other areas of the curriculum. (p. 190)
242 GOTTLIEB,^ ROBINSON,^ AND^ YOUNGGREN
guidance for practice. In offering some recommendations for boundary management in supervision, we make the following assumptions:
- Supervisors are fiduciaries. The fiduciary relationship re- quires trust, good faith, and honesty (Black, 1991). Supervisors are ethically and legally required to act in the best interest of their supervisees. As fiduciaries, supervisors are also mindful that they serve as role models for appropriate professional behavior in a variety of contexts.
- Fiduciaries have the power to influence supervisees. The supervisory relationship creates a power differential because the supervisee is in a dependent and vulnerable position in which he or she trusts the supervisor to work for his or her best interests. The power differential exists regardless of how close the two may be in age or level of training. For example, Oberlander and Barnett (2005) noted that a power differential exists even between gradu- ate assistants and their students.
- Even in circumstances of stated mutual agreement, Slimp and Burian (1994) argued that supervisees are not able to consent to other relationships because of the power differential. We do not take such an extreme position, but we assume that because of the power differential, boundaries are needed to protect supervisees from exploitation and harm.
- Multiple relationships are not unethical per se (APA Ethics Code Standard 3.05[a]). For example, a psychologist may teach an academic class, serve as a practicum supervisor, and be involved in general evaluation of the supervisee’s academic progress.
- Supervisors inherently play multiple roles. This is because supervisors may teach, consult, or counsel, all within the supervi- sory relationship (Bernard, 2004).
- A supervisee is safer when his or her supervisor remains in an evaluative capacity regardless of the specific role(s) he or she occupies. Vulnerability and risk of exploitation increase when multiple relationships entail greater role incompatibility (Kitch- ener, 1988).
- When a supervisor fulfills additional professional functions with a supervisee, vulnerability and risk may increase. We assume that risk increases as the number of roles increase. We presume this is true for two reasons. First, the potential for role incompat- ibility may increase (Kitchener, 1988). Second, the stakes become greater for the supervisee in proportion to the number of additional roles acquired. For example, a supervisee may be more able to manage a boundary problem with an off-campus practicum super- visor with whom he or she has no other relationship than with a faculty supervisor who plays numerous roles in his or her training.
- Maintaining clear boundaries is more important when super- visees experience professional or personal difficulties and it be- comes necessary to monitor their professional conduct more closely.
- Clarity of boundary maintenance is also more salient when supervisors experience professional or personal difficulties and it becomes necessary for administrators to monitor their professional conduct more closely.
- Relationships in addition to the supervisory one should be evaluated for potential role conflicts prior to their initiation. The contemplated relationship should be evaluated from the supervis- ee’s perspective. Because a supervisor cannot always know the supervisee’s point of view, supervisors act out of an abundance of caution on the basis of this more conservative assumption (Gottlieb, 1993).
- It is not possible to know how long the power differential continues once supervision ends. The length of time can vary on the basis of a number of personal and situational factors often unknown to the supervisor; it may last for many years.
- Adverse outcomes leading to exploitation are most often due to a supervisor’s loss of objectivity, poor judgment, incompetence, or impairment.
Recommendations
In this section, we offer some guidance for administrators, supervisors, and supervisees.
Considerations for Administrators
Administrators are not just responsible to and for individual staff and students but to their entire service delivery unit. By their management style, they create an atmosphere or culture in which people work. This culture has systemic properties such that the relations between any two individuals can affect others for whom administrators are equally responsible. Administrators assume that supervisors and supervisees will engage in multiple relationships and that supervisors will manage these relationships by maintain- ing good boundaries. Nevertheless, maintaining a healthy culture in which ethical responsibility is modeled is a task that requires vigilance and ongoing attention. In this spirit, we offer the follow- ing recommendations:
- Acknowledge power differentials. As psychologists, we are taught to treat others in an egalitarian fashion and to minimize power differentials. This aspirational principle is part of our pro- fessional tradition, and we value it because of the benefit it produces when treating patients as well as in dealing with others. At the same time, administrators can take this position only so far. In our view, it is shortsighted and dangerous for administrators to ignore or minimize power differentials just because they create inequalities. Egalitarian environments may create additional prob- lems when, for example, a supervisee comes from a culture in which people are expected to be deferent to authority. In such a milieu, he or she may be more vulnerable to exploitation than in one that is structured more clearly.
- Focus on fiduciary responsibilities and understand what this role requires. Rather than minimizing or dismissing power differ- entials, we suggest that administrators emphasize the fiduciary responsibilities of all those on their staff. A service unit is hierar- chical and based on power differentials; staff and supervisees should clearly understand that this type of structure is designed to help and protect all those involved.
- Concentrate on the evaluative function. Service units may engage in a wide variety of activities, including service delivery, research, consultation, continuing education, and social activities. Some of these activities do not and should not involve formal evaluation. Nevertheless, even seemingly innocuous activities can trigger unanticipated evaluations of a supervisee. Consider the following example: The university psychology clinic director hosts an annual Labor Day party at her home to welcome new staff, interns, and practicum students. Toward the end of the party, one of the new interns becomes
244 GOTTLIEB,^ ROBINSON,^ AND^ YOUNGGREN
slightly inebriated and behaves somewhat inappropriately. On Mon- day, two staff members are overheard discussing how the intern’s behavior at the party might impact his/his professional work. The new intern did not exhibit prudent judgment by drinking excessively at the party, but his or her evaluation should not be based on gossip either. We urge administrators to help everyone in their service unit to keep focused on the evaluative component of their work. Although this recommendation is not a panacea, we believe that mindfulness of this responsibility serves a protective function.
- Address the risks of multiple relationships directly. For a variety of reasons, some colleagues minimize the potential harm that can come from multiple relationships, including those of which they may be unaware. Administrators must resist this temp- tation by being proactive. We recommend that they establish rules and procedures regarding relational boundaries for all service unit members; however, we hope that administrators reject excessive rigidity and provide latitude for individual decision making and unintentional boundary crossings. For example, we see no reason why some multiple relationships cannot be contemplated and encouraged under certain circumstances. Providing examples of acceptable multiple relationships, such as jointly presenting a paper at a professional meeting, may help less experienced staff members better understand the issues involved. On the other hand, policies and procedures for violations should be unambiguous as a matter of protecting those in less powerful positions.
- When the possibility of someone filling multiple roles arises, determine whether additional roles can be played by other staff, faculty, or colleagues in the community. As a general rule, and consistent with Assumption 6, minimizing the number of roles any one supervisor plays reduces their exposure and risk to the super- visee.
- Relationships can change unexpectedly and inadvertently. For example, a practicum student enters her supervisor’s office and breaks into sobs concerning a personal situation that has a high likelihood of affecting her professional judgment. The supervisor, out of a desire to be humane and supportive, allows herself to move into a therapeutic role. Administrators are wise to address situations such as these and establish procedures for dealing with them as quickly as possible to minimize harm. For example, one might consider a policy of referring the supervisee to another staff member for brief counsel- ing when naturally occurring conflicts arise. Staff and supervisees should be aware of these procedures and understand that they are meant to keep them safe.
- Consider including public as well as private supervision. By its very nature, group and live supervision may reduce risk by minimizing boundary crossings (M. Bobelle, personal communi- cation, November 5, 2005).
- Create alternatives to increase student power, such as appoint- ing an ombudsperson. It is preferable that this person be outside the agency and have direct access to the administrator.
- Foster a culture in which these guidelines are modeled by staff. We agree with Handelsman, Knapp, and Gottlieb (2002) and Kitchener (1992), who stated that ethics education is not just academic but experiential as well. When staff model appropriate relational boundaries, supervisees learn more than they ever could from reading the APA Ethics Code. Offering formal and in-service training programs may enhance such understanding (see below for some suggestions).
- Expect staff to keep supervision records. Some states al- ready require records of supervision (e.g., California, Oklahoma), but many others do not, and doing so is not specifically required by the APA Ethics Code. We recommend that administrators establish the expectation that supervisors do so. To go a bit further, for example, we believe that memorializing matters, such as boundary crossings and how they were managed, is highly desirable and creates a valuable learning experience for students. When multiple relationships are contemplated, the issue should also be noted in the record. No one can be held accountable for failing to be a seer; things go wrong, but having a record of one’s prior and thoughtful consideration, consistent with good risk management, is the next best thing to a friendly witness.
Supervisor Considerations
In this section, we extend the work of Younggren and Gottlieb (2004) by applying it to the supervisor–supervisee relationship. As supervisors proceed through the following questions, we recom- mend remaining mindful of Assumption 10, that the contemplated relationship be evaluated from the supervisee’s point of view. For the purpose of this section, consider the following example: Dr. Able was a 30-year-old, female, clinical psychologist, and an assistant professor at a major research university. Despite outstanding scholarly productivity and a deep commitment to her research pro- gram, she worried about not obtaining promotion and tenure. As part of her responsibilities at the psychology clinic, she began to supervise Mr. Elder. He was a 30-year-old, male, military veteran, who was a 2nd-year doctoral student in clinical psychology. Despite being professionally inexperienced, Elder had been very responsive to Able’s supervision, and she began to think that he had great potential as a psychotherapist. One day he asked whether she would accept him as her research assistant because he was considering doing his dissertation in her area.
- Is entering into a relationship in addition to the supervisory one necessary, or should it be avoided? Supervision is a complex and sometimes long-term process. One’s initially favorable im- pression of a supervisee may be validated as time goes on. But, first impressions can change as supervisors learn more about a supervisee’s limitations or personal issues. Hence, one cannot always know what a supervisee’s training needs will be. Seem- ingly straightforward supervisory relationships may become highly complex and demanding when a supervisee finds him- or herself in a difficult clinical or personal situation that the super- visor could not have anticipated. When such circumstances arise, having additional relationships creates additional risk. Therefore, it is generally in the best interest of the supervisee for the supervisor to avoid them. If a role is to be added, it is safer to add only those that are compatible with the supervisory one. It is preferable to consider adding other kinds of relationships, such as social activ- ities, once the supervision has ended.
- Can the additional relationship(s) potentially cause harm? Harming supervisees is unethical and potentially illegal; if it were reasonable to anticipate that the proposed relationship would be harmful, pursuing it would be unacceptable. However, it is not always possible to know whether an additional relationship would
SPECIAL SECTION: MULTIPLE RELATIONS IN SUPERVISION 245
visors, and supervisees. In particular, we have emphasized three themes. First, administrators and supervisors should be proactive and take responsibility for providing information to supervisees and model appropriate ethical behavior. Second, supervisees need to become informed consumers of supervision services and feel more empowered to advocate for themselves and their peers. Third, all those involved in the supervisory process should try to foresee multiple relationship problems in an effort to prevent them. Anticipating these problems is far preferable to coping with them afterwards. We did not quote Woody Allen’s joke about lions and calves to be humorous. As administrators and supervisors, we do not con- sider ourselves to be lions. We prefer to view ourselves as shep- herds who take good care of those entrusted to us, and for the most part this is the case. But, potentially exploitive multiple relation- ships can make lions of us; when this occurs, calves are at risk. In our view, the best way to avoid becoming a lion is to always consider the calf’s eye view.
References
American Psychological Association. (2002). Ethical principles of psy- chologists and code of conduct. American Psychologist, 57, 1060 –1073. American Psychological Association Office of Program Consultation and Accreditation. (2000). Guidelines and principles for accreditation of programs in professional psychology. Washington, DC: Author. Anderson, S. K., & Kitchener, K. S. (1998). Nonsexual posttherapy rela- tionships: A conceptual framework to assess ethical risks. Professional Psychology: Research and Practice, 29, 91–99. Association of State and Provincial Psychology Boards. (2003). Supervi- sion guidelines (Rev. ed.). Montgomery, AL: Author. Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford University Press. Bernard, J. M. (2004). Fundamental of clinical supervision. Boston: Allyn & Bacon. Biaggio, M., Paget, T. L., & Chenoweth, M. S. (1997). A model for ethical management of faculty–student dual relationships. Professional Psy- chology: Research and Practice, 28, 184 –189. Black, H. C. (1991). Black’s law dictionary. St. Paul, MN: West. Burian, B. K., & Slimp, A. O. (2000). Social dual-role relationships during internship: A decision-making model. Professional Psychology: Re- search and Practice, 31, 332–338. Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision. Wash- ington, DC: American Psychological Association. Gottlieb, M. C. (1993). Avoiding exploitive dual relationships: A decision- making model. Psychotherapy: Theory, Research, Practice, and Train- ing, 30, 41– 48. Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. Ameri- can Journal of Psychiatry, 150, 188 –196. Gutheil, T. G., & Simon, R. I. (2002). Non-sexual boundary crossings and boundary violations: The ethical dimension. Psychiatric Clinics of North America, 25, 585–592. Handelsman, M. M., Knapp, S. J., & Gottlieb, M. C. (2002). Positive ethics. In C. R. Snyder & S. J. Lopez (Eds.), Handbook of positive psychology (pp. 731–744). New York: Oxford University Press. Handelsman, M. M., Knapp, S. J., & Gottlieb, M. C. (in press). New directions in positive ethics. In S. J. Lopez (Ed.), Handbook of positive psychology (2nd ed.). New York: Oxford University Press. Kitchener, K. S. (1988). Dual role relationships: What makes them so problematic? Journal of Counseling and Development, 67, 217–221. Kitchener, K. S. (1992). Psychologists as teacher and mentor: Affirming ethical values throughout the curriculum. Professional Psychology: Re- search and Practice, 23, 190 –195. Knapp, S. J., & VandeCreek, L. D. (2006). Practical ethics for psycholo- gists. Washington, DC: American Psychological Association. Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999). Psychotherapy supervisor ethical practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counsel- ing Psychologist, 27, 443– 475. Lamb, D. H., Catanzaro, S. J., & Moorman, A. S. (2004). A preliminary look at how psychologists identify, evaluate, and proceed when faced with possible multiple relationship dilemmas. Professional Psychology: Research and Practice, 35, 248 –254. Lazarus, A., & Zur, O. (2002). Dual relationships and psychotherapy. New York: Springer. Oberlander, S. E., & Barnett, J. E. (2005). Multiple relationships between graduate assistants and students: Ethical and practical considerations. Ethics and Behavior, 15, 49 – 63. Slimp, P. A. O., & Burian, B. K. (1994). Multiple role relationships during internship: Consequences and recommendations. Professional Psychol- ogy: Research and Practice, 25, 39 – 45. Smith, D., & Fitzpatrick, M. (1995). Patient–therapist boundary issues: An integrative review of theory and research. Professional Psychology: Research and Practice, 26, 499 –506. Younggren, J., & Gottlieb, M. C. (2004). Managing risk when contem- plating multiple relationships. Professional Psychology: Research and Practice, 35, 255–260. Received April 24, 2006 Revision received January 3, 2007 Accepted January 4, 2007!
SPECIAL SECTION: MULTIPLE RELATIONS IN SUPERVISION 247
