Effective Supervisory Relationships E-Book

Helen Beinart

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 427

Veröffentlichungsjahr: 2017

Beschreibung

Effective Supervisory Relationships: Best Evidence and Practice is the first book to explore in detail the Supervisory Relationship, which research has consistently found to be the most critical component of any supervisory process. Helen Beinart and Sue Clohessy – two experts in the field – draw on world-wide studies that cover all major therapeutic approaches to the Supervisory Relationship, and include detailed coverage of cultural competence and issues of effective multicultural supervision. The result is a comprehensive resource that offers cutting-edge, internationally relevant information in order to inform study, training, continuing professional development and practice.

Leseprobe

Table of Contents

Cover

Title Page

About the Authors

Preface

Acknowledgments

Part I: Effective Supervisory Relationships

1 Introduction

Definitions

Why Is the Supervisory Relationship Important?

Key Elements in Effective Supervisory Relationships

Competencies and Frameworks

Contextual Influences

2 Overview of Models of Supervision and the Supervisory Relationship

Models of Supervision

Other Models that Inform the Supervisory Relationship

Models of the Supervisory Relationship

Summary

Key Points

3 Influences on the Supervisory Relationship

Supervisor Contributions to the Supervisory Relationship

Supervisee Contributions to the Supervisory Relationship

Dyadic Influences

External Contextual Factors

Conclusions

Key Points

4 Outcomes and Measurement

What Do We Mean by Supervision Outcomes?

Impact on the Supervisee

Impact on Clients

Outcome‐Informed Practice

Measures of the Supervisory Relationship

Summary

Key Points

5 Ethical and Culturally Sensitive Practice

Ethics in Supervision and the Supervisory Relationship

Ethical Issues within the Supervisory Relationship

Ethical Decision‐Making

International Perspectives

Diversity and Cultural Competence

Models and Research Relating to Cultural Competence in Supervision

Summary and Conclusions

Key Points

Part II: Effective Supervisory Relationships

6 Good Beginnings

Getting Things Off to a Good Start

Developing a Meaningful Supervision Contract

What to Include in a Supervision Contract

Reviewing the Contract

Conclusion

Key Points

7 Giving and Receiving Feedback

Types of Feedback

Research Findings

Methods to Support Effective Feedback

Unsatisfactory Performance

Summary

Conclusion

Key Points

8 Preventing and Managing Difficulties in the Supervisory Relationship

Potential Causes for Conflict in the Supervisory Relationship

Impact of Difficulties in Supervision and the Supervisory Relationship

Preventing Problems in the Supervisory Relationship

Managing Difficulties

Implications for Practice

Conclusion

Key Points

9 Reflective Practice

What Is Reflective Practice?

Developing Reflective Practice in Supervisory Relationships and Supervision

Looking After Yourself: Developing Self‐Care and Resilience

Conclusion

Key Points

10 The Supervisory Relationship in Other Supervision Formats

Group Supervision

Types of Groups

Understanding Group Processes

Supervisor’s Relational Tasks

Remote Supervision and the Use of Technology

Key Points

11 Summary and Conclusions

Summary

Integration and Messages for Practice

Future Directions

Endnote

Appendix 1: The Supervisory Relationship Questionnaire (SRQ)

Appendix 2: The Short Supervisory Relationship Questionnaire (S‐SRQ)

Appendix 3: The Supervisory Relationship Measure (SRM)

References

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Summary of key features of supervision based on models of psychotherapy.

Chapter 03

Table 3.1 Summary of supervisor contributions to effective supervisory relationships.

Table 3.2 Summary of supervisee contributions to effective supervisory relationships.

Chapter 04

Table 4.1 Thematic analysis of supervisor competency frameworks.

Table 4.2 Guidelines for Clinical Supervision in Health Service Psychology.

Chapter 05

Table 5.1 Domains of cultural influence on supervision (Burnham & Harris, 2002).

Chapter 08

Table 8.1 Summary of potential causes of problems in the supervisory relationship.

Chapter 11

Table 11.1 Characteristics of effective and competent supervisory relationships.

List of Illustrations

Chapter 02

Figure 2.1 Holloway’s Systems Approach to Supervision model.

Figure 2.2 Kolb’s experiential learning cycle.

Figure 2.3 Beinart’s model of the supervisory relationship (supervisee’s perspective).

Figure 2.4 Clohessy’s model of the supervisory relationship (supervisor’s perspective).

Chapter 08

Figure 8.1 Resolving difficulties in the supervisory relationship. (Clohessy, 2008)

Figure 8.2 Formulating Ben & Sarah’s supervisory relationship using Clohessy’s (2008) model of the SR.

Figure 8.3 Formulating Ben and Sarah’s supervisory relationship using Beinart’s (2002) model of the SR.

Guide

Cover

Table of Contents

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Effective Supervisory Relationships

Best Evidence and Practice

Helen Beinart and Sue Clohessy

This edition first published 2017© 2017 John Wiley & Sons Ltd

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Library of Congress Cataloging‐in‐Publication Data

Names: Beinart, Helen, author. | Clohessy, Sue, 1969– author.Title: Effective supervisory relationships : best evidence and practice / Helen Beinart, Sue Clohessy.Description: Hoboken : Wiley‐Blackwell, 2017. | Includes bibliographical references and index.Identifiers: LCCN 2016059296 (print) | LCCN 2017007815 (ebook) | ISBN 9781118973639 (hardback) | ISBN 9781118973622 (paper) | ISBN 9781118973615 (pdf) | ISBN 9781118973608 (epub)Subjects: LCSH: Supervision. | Leadership–Psychological aspects. | Clinical psychology. | BISAC: PSYCHOLOGY / Clinical Psychology.Classification: LCC HM1253 .B45 2017 (print) | LCC HM1253 (ebook) | DDC 303.3/4–dc23LC record available at https://lccn.loc.gov/2016059296

Cover design: WileyCover image: © Jasmina007/Getty Images

About the Authors

Dr Helen Beinart works freelance as a supervisor and trainer, and as a Tutor on the Post‐Graduate Certificate in Supervision at the University of Oxford. Previously she was Director (Clinical and Professional) of the Oxford Institute of Clinical Psychology Training, Oxford University (1994–2013). Clinically, she worked with children, young people, and their families in health and primary care settings. She trained in Cape Town and London and qualified as a clinical psychologist from the Institute of Psychiatry in 1979. She worked in the National Health Service for 40 years as a clinician, service manager, consultant, supervisor, and trainer. Since the mid‐1990s, she has been involved in clinical psychology training, supervisor training, and research into the supervisory relationship. Prior to this she was Head of Child and Adolescent Health Clinical Psychology Services in Aylesbury and Kingston. She has chaired the Division of Clinical Psychology’s Faculty for Children and Young People, and was involved in providing psychological evidence to the Parliamentary Select Committee on Children’s Mental Health. Professionally she has held several roles within clinical psychology and has acted as national assessor for senior appointments to the profession, external examiner, adviser, supervisor, and teacher to a number of courses and services. She is author of several chapters and papers on clinical supervision and co‐editor of Clinical Psychology in Practice (2009), together with Paul Kennedy and Sue Llewelyn. She has a long‐term interest in the development of professional competence and the contribution of clinical supervision and, in particular, supervisory relationships to the development of competent practitioners.

Dr Sue Clohessy is Course Director of the Post‐Graduate Certificate in Supervision of Applied Psychological Practice, Clinical Tutor, and the lead for supervisor training at the Oxford Institute of Clinical Psychology Training, University of Oxford. She completed her clinical training on the Oxford course in 1995, and since then has worked clinically in the field of adult mental health and trauma in NHS services in Buckinghamshire, Berkshire, and Oxfordshire in the United Kingdom. She now works clinically in independent practice and offers supervision to counsellors, psychologists, and CBT (cognitive behavioral therapy) practitioners. She completed the Diploma in Cognitive Therapy at the Oxford Cognitive Therapy Centre (OCTC), Warneford Hospital, in 2000, and is an Associate of OCTC, having been involved in supervising and examining academic submissions for their courses and having chaired the Board of Examiners for their advanced diploma and MSc courses. She is accredited as a CBT practitioner and supervisor with the British Association of Behavioural and Cognitive Psychotherapies (BABCP). She completed a post‐qualification doctorate in the area of supervision and the supervisory relationship in 2008. She regularly teaches a range of professionals on supervision skills and has developed an Introduction to Clinical Supervision course for local supervisors based on national learning outcomes. She has worked with others in the clinical psychology training community on the development of national learning outcomes for advanced supervisor training, and is part of the Clinical Supervision Advisory Group. She has co‐authored chapters and papers on supervision, and has contributed to the development of measures of the supervisory relationship and supervision competence.

Preface

Supervisees who have worked with us will be familiar with the phrase “Some supervisees’ worst experiences with a supervisor may be another person’s best experience” and vice versa. This reflects our belief that the quality of the supervisory relationship (SR) is pivotal to any experience of supervision and is unique to the individuals involved. It is the idiosyncratic matching of needs, learning styles, attitudes, and values that influences the experience. For example, an independent supervisee who is used to working autonomously is likely to find a supervisory relationship with a supervisor with exacting standards and a tendency to be directive in their supervision oppressive, and may feel resentful and devalued. However, a more anxious or perfectionistic supervisee may find their SR with a supervisor who expresses clear goals and requirements and has a directive approach containing and supportive. A good supervisor, therefore, needs to be flexible enough to adjust their style for each supervisee and, of course, not all people can do this. It may, therefore, be that lack of attention to the particular needs of the supervisee and lack of flexibility are more of a problem for SRs than any particular or preferred style.

Our thoughts in this area have developed from experiencing and working with multiple SRs. Helen Beinart, in her clinical role working with children, young people, and families, supervised trainee clinical psychologists from a number of UK training programs. As she became more senior, she also supervised qualified staff from a range of professional groups. At that time, in the National Health Service’s (NHS) psychological services for children clinical, professional, and managerial supervisory roles were often conflated and the different tasks and functions of supervision needed to be clarified to effectively manage these SRs. During this period, HB became curious about the role of power and culture within the SR and noted how different supervisees needed and encouraged different emphases within their SRs. Sue Clohessy has worked clinically in adult mental health services throughout her career, and has been involved in supervising trainee psychologists and other professionals. Although there were differences in these supervision experiences, in particular relating to the expectations and the meaning of supervision for different professional groups, there were also many similarities. SC was struck by the wealth of training opportunities for developing clinical and therapeutic skills and the comparatively limited training in the skills needed to be a good supervisor. As such, she did what many supervisors have done and tried to emulate the good supervisors and the effective SRs that she had experienced.

A substantive part of both our careers has been in training roles within the Doctorate of Clinical Psychology (DClinPsych) program at Oxford, and as such our involvement in SRs has changed over the years. SC is currently a clinical tutor on the program, and HB was one of the course directors until she retired recently. The tutor role involves supporting and monitoring clinical placements, predominantly within NHS services. Supervisees normally work with one or two supervisors for a six‐month period in the context of a range of different populations (e.g., adults, children, those who are learning‐disabled, and the elderly) and clinical services (e.g., mental health, pediatric, neurodisability). Some SRs work very well and others less so, and the role of the tutor is to support and advise these SRs. Additionally, HB’s role as course director involved multiple supervisor and line management responsibilities, a complex set of tasks and functions, together with shifting power relationships that had to be negotiated and managed. Our experiences in training have offered us the privilege of working with many different SRs and of developing a bird’s‐eye view of how the dyads work more or less effectively. This has contributed to our curiosity about the relational “ingredients” needed to make SRs successful. Our roles have involved listening to different perspectives (both supervisor and supervisee) on the SR and facilitating conversations about any difficulties that may be experienced by one or both parties. This has offered a perspective on SRs that has been enriched by multiple points of view and has led to an appreciation that dyads are unique, that supervisee needs will change, and that SRs work best when there is investment and flexibility on both sides. It has led to an appreciation of the power and influence of these relationships. At their best they can be inspiring and rewarding and can shape the professional self. When they are difficult, they can be frustrating, upsetting, damaging to self‐confidence, and difficult to leave behind, their influence often felt in future SRs.

In addition to experiencing and witnessing many SRs from the outside, we have of course also been in SRs ourselves over our career pathways and, as supervisees, have found some more supportive, challenging, and conducive to learning and others less so. Additionally we have had an SR ourselves, which has had many guises including clinical, professional, research, and managerial supervision. We reflect on our own SR in the Endnote of this book and apply some of the material that we cover to exemplify how the supervision literature can be applied.

Our research interests developed from witnessing many successful, and some less successful, SRs. In particular, we became curious about the qualities of those SRs that worked more effectively than others. At this time (in the late 1990s), there was very little UK research on supervision and precious little on the SR but there were some interesting findings from the United States that pointed toward the SR being significant in supervision outcomes. There was also increasing recognition of the need to develop some more robust measures of the SR so that findings from any research that was undertaken could be more reliable and valid. Both of us have undertaken direct research into the quality of the SR, HB exploring the topic from a supervisee’s perspective and SC from the perspective of the supervisor. Our role on the DClinPsych program has meant that we have been fortunate to have talented doctoral students interested in collaborating in this research. To date, eight doctoral dissertations have been undertaken as part of our research group. Three of these studies have worked on developing published measures that have recently been highlighted as a gold standard in supervision measures. Other studies have explored the development of the SR, self‐disclosure, and how supervisees and supervisors manage difficulties within the SR (see www.oxcipt.co.uk for further details). Conducting research has also given us exposure to a different type of SR, from the perspective of both supervisee and supervisor and of research supervision. It has slowly dawned on us that the qualities inherent in effective and less effective SRs are evident in a range of different supervisory relationships, and that some of our findings (possibly with some adaptation) are applicable to a whole spectrum of different contexts.

Our experience of supporting numerous SRs, as well as our research in this area have also contributed to our enthusiasm for training others in key supervision skills, including the skills needed to establish and maintain effective supervisory relationships. We have benefited from working with our colleagues from other training programs who share a commitment to improving the quality of supervisor training and keeping supervision on the agenda in our profession. We have been involved with several national groups including Supervisor Training and Recognition, (STAR) and, later, the Clinical Supervision Advisory Group (CSAG). Our most exciting recent development, apart from writing this book, is running an Oxford University Postgraduate Certificate in Supervision for a range of professional groups. We have welcomed supervisors from clinical and applied psychology, nursing, education, psychotherapy, counseling, music therapy, and coaching, and we have mutually benefited from a rich learning environment in which we have explored the key skills needed for supervision, and how these can be applied in very different professional contexts.

We are fortunate that the research evidence to date supports our long‐held beliefs that it is the quality of the SR that is the central factor in supervision. Hence, we think that it is important enough to write a book on the SR itself rather than a general book on supervision. We hope that you will find our material interesting and applicable. The book is divided into two sections: the first part focuses on research and theory and the second is more practice‐oriented.

Acknowledgments

We would like to thank our colleagues at the Oxford Institute of Clinical Psychology Training for their interest and support in supervision over many years. We would particularly like to thank the Clinical Tutor team – Helen Jenkins, Kathryn Evans, David Dean, and Nigel King – with whom we have shared many supervision discussions. We would also like to thank our colleagues and Helen’s co‐directors of the institute at the time, Sue Llewelyn and Paul Kennedy, for their wisdom and support. We are particularly grateful to the late Paul Kennedy (1959–2016) for his help and encouragement during the recent development of the Post‐Graduate Certificate in Supervision of Applied Psychological Practice.

We have found that working closely with trainee clinical psychologists and their supervisors supporting clinical placements has significantly contributed to our understanding of supervisory relationships. These are too numerous to thank by name but we would like to acknowledge their contribution to our learning, particularly those that posed some challenges!

We have been fortunate to attract talented doctoral trainees interested in research in supervision who have contributed significantly to our research program. We would like to thank Marina Palomo, Kate Frost, Nathalie Pearce, Clare Borsay, Vivien Lemoir, and Tom Cliffe for their interest, enthusiasm, and contribution to research on the supervisory relationship. Myra Cooper, Senior Research Tutor at the Institute, has made a significant contribution to this body of work and we have greatly valued her expertise and support.

The Oxford Institute has run residential supervisor training workshops on an annual basis over many years for our colleagues, supervisors, and trainees. We have benefited hugely through learning from many facilitators including Annie Mitchell and Kay Hughes from the University of Plymouth, and Joyce Scaife from the University of Sheffield, to name but a few. Many, but not all, of the facilitators for our residential training workshops have been drawn from the national Group of Trainers in Clinical Psychology and we have greatly valued our collaboration with the Supervisor Training and Recognition Group and the Clinical Supervision Advisory Group (CSAG).

We have also learned a great deal from developing and delivering a range of teaching programs for both clinical psychology supervisors and a broad range of applied psychology and professional supervisors. We would particularly like to acknowledge what we have learned through working closely with the first two cohorts who attended the Institute’s Postgraduate Certificate in Supervision of Applied Psychological Practice.

We would like to thank our own supervisors, those who influenced us in our formative years as well as current supervisors, who continue to share their wisdom, support, and “safe challenges.”

Last but definitely not least, we would like to thank our families who have seen us through many ups and downs in life and in work, and during the preparation of this book.

Part IEffective Supervisory Relationships: Best Evidence

1Introduction

There are many books on supervision but very few that focus specifically on the supervisory relationship (SR). Best evidence to date suggests that the SR is the most significant aspect of supervision and that it contributes to improved practice, as well as supervisee efficacy, resilience, and well‐being. This book will provide the theory, research, and practice to support our readers in developing effective SRs and, in so doing, improved practice in their field of training or work.

The aim of the book is to provide cutting edge information on the SR based on current research and practice. We hope that this book will be useful and accessible to a broad range of practitioners who employ and apply psychological principles in their work, including applied psychologists, psychological therapists, mental health nurses, counselors, psychotherapists, and all those who work in health and social care (the helping professions). We consider these principles to be applicable to a broad audience, including those working in education and in the voluntary and independent sectors. For example, the coaching profession is developing rapidly and is beginning to require supervision as part of its practice. Those working in this field may find some of the material presented here very applicable.

The majority of published research on supervision draws from counseling psychology and psychotherapy, and much of the research has been conducted with those training to become applied psychologists. This is unsurprising as supervision is a central aspect of clinical and counseling psychology trainings. Supervision is also the core of training in the psychotherapy, medical, nursing, and social work professions and is a requirement for post‐qualification professional practice in the majority of the helping professions. Although much of the literature that we refer to in the book will relate to these professional groups, we believe that many of the principles outlined in the development of effective SRs will also apply to other groups, including those working in educational and academic contexts.

The unique aspect of this book is its review of the evidence, drawing out of the themes, and identification of methods to improve practice in a range of settings. The first part focuses on the evidence base, reviews models of supervision, discusses the supervisory dyad in some detail, explores measurement and supervision outcomes, and, finally, considers issues of ethics, diversity, and power in supervision. The second part explores best practice based on current theory and evidence, including practical techniques and methods to establish, develop, and maintain effective SRs. We discuss setting up SRs in a way that is likely to make them succeed, giving and receiving meaningful feedback, managing any difficulties that arise, and supporting reflective practice and ongoing learning and development. Additionally, we explore new directions in the future development of effective SRs including working with groups and on‐line.

The overwhelming finding from the emerging international evidence base within the dyadic supervision literature is that the SR is pivotal. Not only is it the vehicle through which supervision takes place but it is also the mutative aspect of supervision. This is illustrated by the following quotations from experts in the field: “good supervision is about the relationship, not the specific theory or techniques used” (Ellis, 2010, p. 106); “the supervisor–supervisee alliance has increasingly emerged as a variable of pre‐eminent importance in the conceptualization and conduct of supervision … it is widely embraced as the very heart and soul of supervision” (Watkins, 2014a, p. 19). In the latter paper, Watkins presents a challenge to the reader (and subsequent authors) when he asks if we really know what the SR is about. We hope that, by the end of this book, readers will have a clear understanding of the SR and its significance to supervision outcomes for both research and practice.

In this introductory chapter we shall discuss definitions of supervision and the SR, identify the key elements of the SR, and discuss some of the competency frameworks in this developing field.

Definitions

Before defining the SR, it is perhaps worth defining supervision itself. Proctor and Inskipp (1988, p. 4) provide a broad definition:

Supervision is a working alliance between supervisor and worker/s in which the worker can reflect on herself in her working situation by giving account of her work and receiving feedback and where appropriate, guidance and appraisal. The object of this alliance is to maximize the competence of the worker in providing a helping service.

Proctor and Inskipp (1988) identify three broad purposes of supervision, which have been widely accepted:

normative

: monitoring the quality of professional services, evaluation, gatekeeping for particular professional groups;

formative

: focusing on the development of the supervisee and enhancing professional competence;

restorative

: supporting the supervisee to express, process, and reflect on their work.

Milne (2009) describes an empirical definition of supervision, drawn from previous definitions, that aims to specify and operationalize key relationships and tasks. He defines it as

the formal provision, by approved supervisors, of a relationship based education and training that is work focused and which manages, supports, develops, and evaluates the work of colleague/s. It therefore differs from related activities, such as mentoring and therapy, by incorporating an evaluative component and being obligatory. The main methods that supervisors use are corrective feedback on the supervisees’ performance, teaching and collaborative goal‐setting. (Milne, 2009, p. 15)

Both of the above definitions of supervision place a clear emphasis on the SR; however, there are limited definitions of the SR itself within the literature. These will now be reviewed in more detail, followed by our own working definition of the SR.

Bordin (1983) developed a working alliance model, the supervisory working alliance (SWA), defined as a mutual agreement on the goals and tasks of supervision and the bonds that develop between the supervisor and supervisee. He described supervision as a “collaboration for change,” which provides a developmental context for the supervisee, the supervisor, and their work. Bordin’s definition has been widely applied and the SWA has been accepted across many modalities of supervision. As we shall see in Chapter 2, it has also received a fair amount of research support. However, as the SWA is a direct translation from his psychotherapy working alliance model (Bordin, 1979), it may not fully reflect the complexity of supervision and how the SR differs from a psychotherapy relationship. The SR may include a working alliance between supervisor and supervisee, but it is also likely to include additional relational, educational, and contextual aspects (Beinart, 2014).

Holloway (1995, pp. 41–42) provided a more detailed definition of the SR. “The relationship is a container of a dynamic process in which supervisor and supervisee negotiate a personal way of using a structure of power and involvement that accommodates the supervisee’s progression of learning.” The SR is seen as developing through phases (beginning, middle, and end), changing over time, and being organized through a supervision contract. Holloway’s model is one of the few that addresses power within the SR and that positions the development of the SR as central to broad contextual factors (supervisee, supervisor, client, and institution) and to the tasks and functions of supervision. This model will be discussed in more detail in Chapter 2.

Bernard and Goodyear (2014, p. 64) define the SR as

the supervision participants’ attitudes and feelings towards each other and the way in which those attitudes and feelings are expressed. The supervision relationship, an eminently triadic affair, encompasses such variables as the supervision alliance, attachment style, supervisory style, parallel process and personality factors.

This definition shows a clear understanding of the breadth and complexity of the SR. However, it assumes a three‐person interaction between client, therapist/supervisee, and supervisor that places it very much within a therapy context. It is clear that supervision is a dyadic interaction where there is mutual influence between supervisor and supervisee. The supervisee is pivotal in selecting the work that they present to the supervisor. This work may be about an individual client, in which case the interaction may be triadic. However, many supervision issues are much broader than one‐to‐one therapy and may include work with families, teams, and, indeed, whole organizations – there are multiple contextual factors that influence the SR and the room is often very crowded. Additionally, supervision content may include aspects of work that are not directly therapeutic, for example, teaching, research, managing conflict with other staff, and reflective personal/professional development of the supervisee. Interestingly, a recent paper on the SR (Tangen & Borders, 2016) suggests that the complexity of the SR makes it difficult to conceptualize clearly.

Our own working definition, based on our research on the unique qualities of the SR, is as follows:

The SR is a collaborative, mutual working relationship, which supports and challenges the supervisee to learn and develop their professional practice. The relationship is developmental, needs‐focused, open, and respectful. It is normally hierarchical and involves the negotiation of power. It has many functions including education, monitoring and/or evaluation, and support. The SR is influenced by multiple contextual factors including those contributed by the supervisory dyad (or group), the working context, and the wider sociocultural context. The relationship is bound by the ethics of safe practice, and acknowledges difference and diversity in order to allow the supervisee to safely disclose and explore their professional dilemmas. Key tasks in establishing and developing the relationship are contracting and feedback.

Why Is the Supervisory Relationship Important?

Interestingly, supervision research has lagged behind therapy research despite almost all therapy trials requiring supervision, at the very least, to ensure adherence to the agreed treatment protocols. The focus of research has, understandably, been on client outcomes in a range of different interventions offered (e.g., anxiety and cognitive behavioral therapy [CBT]). It has been assumed that supervision is necessary for effective treatments, but its contribution to clinical outcome has been difficult to measure, and there is currently only a small body of research. (e.g., Bambling, King, Raue, Schweitzer, & Lambert, 2006).

The importance of the supervisory alliance was noted nearly 50 years ago (Watkins, 2014a) but until recently there has not been solid enough evidence to support this. However, in recent years, best evidence points to the SR as the mutative factor in the development of effective supervision (Beinart, 2014; Watkins, 2014a); in particular, the development of a safe and supportive relationship has been shown to facilitate supervisee learning and development in a number of areas (see Chapter 3 for further discussion). Our research has focused particularly on the unique aspects of the SR that contribute to effectiveness. We have begun to unpick the contributions of supervisee and supervisor to the SR and to understand the importance of context to this relationship. We have used both qualitative and quantitative research methods to identify what it is about the SR that makes it work well and less well. It has become clear over the years that we have been doing this research, alongside supporting multiple SRs (as tutors on a doctoral training program in clinical psychology) and working within our own SRs, that there are certain elements that must be in place for these rather unusual relationships to work well. Our teaching across multiple professional groups has additionally confirmed the importance of the SR as the most significant aspect of supervision regardless of level of experience, although it does appear to carry particular significance for novice professionals. In particular, unsafe or unhelpful SRs are carried in the memory long after the event and often influence new supervisors when they begin to take on supervisory roles.

Key Elements in Effective Supervisory Relationships

It is important to take a meta‐perspective when establishing an SR in order to have a conversation about the sort of SR each party would like to establish. In essence, supervisees and supervisors are working toward a psychological contract (Rousseau, 1995) about how they wish to work together (see Chapter 6). This involves creating an environment where it is possible to share uncertainties about the work and risk disclosing mistakes in order to allow sharing and learning to take place. Our research suggests that it is particularly important to establish clear boundaries in order to develop the trust required for this level of self‐disclosure. Collaboration between supervisee and supervisor is important in order to establish clarity about roles and expectations. Supervisees need to be empowered to identify their learning needs and to explore their preferences for learning. Another important key skill is the mutual exchange of feedback and exploration of feedback preferences (see Chapter 7). In recent years the supervision literature has stressed the importance of being alert to cultural diversity in any approach to supervision and of the significance of having conversations that welcome diversity within the SR (e.g., Falender, Shafranske, & Falicov, 2014). It is also essential to consider ethical practice and to provide opportunities to engage in ethical debate and decision‐making within the SR (see Chapter 5). Ladany (2014) stresses that features of ineffectual supervision include failing to take into account of, and be sensitive to, cultural and ethical issues; boundary violations; inappropriate use of, or failure to use, models and measures of supervision; and the misuse of power. Models are discussed in detail in Chapter 2 and measurement in Chapter 4. Boundaries and power are so key to the SR that they will be referred to throughout this book; difficulties are discussed in Chapter 6.

Competencies and Frameworks

Since the mid‐2000s or so, there has been a strong competency movement within clinical supervision and a call for supervision to be seen as a professional competence in its own right and not just as an adjunct to practice. There has been strong criticism, from established experts (e.g., Falender & Shafranske, 2014; Ladany, 2014), of the assumption that being an experienced and competent practitioner makes one an effective supervisor. There are now clear competency frameworks for supervisors that have been developed and accepted in several countries. For example, in the United Kingdom the British Psychological Society (BPS) has adopted a set of learning outcomes for initial supervisor training, which are now part of the requirement to join the Register of Applied Psychology Practice Supervisors, held by the BPS. Unfortunately, for a number of reasons, supervisor training and registration is not mandatory for psychologists in the United Kingdom, which leaves some concern about quality control. This is not the case for psychological practitioners trained via the Improving Access to Psychological Therapies (IAPT) program in the United Kingdom, who are required to receive supervision by trained supervisors (Turpin & Wheeler, 2011). A set of competencies for supervisors has been developed within this program. These include a set of generic and meta‐competencies that cover all therapeutic modalities and specific competencies for a range of therapeutic modalities (e.g., CBT, systemic therapy) (Roth & Pilling, 2008). The argument presented in the IAPT guidance is that supervision is the key to providing safe, effective, evidenced‐based practice to ensure treatment fidelity. Whether this then impacts client outcomes is still a research question that needs further attention (Watkins, 2014a) and the IAPT program is in a good position to address this issue with the detailed data that it collects on routine clinical practice and outcomes.

In the United States the competency movement has gathered momentum, which has led to the development of a competency cube (Rodolfa et al., 2005) – a three‐dimensional model representing foundational (e.g., reflective practice, relationships, ethics) and functional competencies (e.g., assessment and intervention) over the phases of professional development. In particular, Falender and Shafranske (2007, p. 233) have written emphatically about the need to train and assess supervisors to meet a set of agreed competencies:

Competency based supervision is an approach that explicitly identifies the knowledge, skills and values assembled to form each clinical competency and develop learning strategies and evaluation procedures to meet criterion referenced competence standards in keeping with evidenced based practices and requirements of local clinical settings.

The American Psychological Association (APA) has not uniformly embraced the mandatory training of supervisors in order to meet competence‐based supervisor training, which is mandatory only in a handful of states in the United States. However, the APA has recently approved agreed guidelines for clinical supervision in health service psychology (APA, 2015), which is a promising development.

Australia has led the way by introducing a national program of mandatory supervisor training. In 2013 the Psychology Board of Australia (PsyBA) introduced new supervisor training requirements that apply to all psychologists who provide supervision for provisional registrants undertaking internships and higher degree placements. All supervisors are required to undertake PsyBA‐approved training in order to become an approved supervisor. PsyBA‐approved supervisor training entails at least 20 hours of training presented in three sequentially completed parts: (a) knowledge assessment; (b) face‐to‐face skills training; and (c) competency‐based assessment and evaluation. A further six hours of approved training is required every five years to maintain knowledge and skills. Board‐approved supervisors must demonstrate proficiency in the following competencies:

knowledge and understanding of the profession

knowledge of and skills in effective supervision practices

knowledge of and ability to develop and manage the supervisory alliance

ability to assess the psychological competencies of the supervisee

capacity to evaluate the supervisory process

awareness of and attention to the diversity of client groups, and

ability to address the legal and ethical considerations related to the professional practice of psychology. (Psychology Board of Australia, 2013, pp. 4–5)

All of the aforementioned supervisor competency statements, whether or not training is mandatory, stress the importance of the SR as a key competence in clinical supervision. The Clinical Supervision Advisory Group (CSAG), part of the Group of Trainers in Clinical Psychology of the BPS, has developed guidance for the training of advanced competencies for experienced supervisors. This guidance describes characteristics of experienced supervisors—the section on the development of the SR is quoted in full:

Develops effective supervisory relationships:

Facilitates a supportive, collaborative and open supervisory relationship, with clear boundaries creating a safe space, which enables disclosure by supervisee of any concerns. Takes a pro‐active stance in managing the supervisory relationship (SR), identifies and approaches any strains early on.

Acknowledges/manages complex power differentials, values difference, and invites feedback on the SR.

Values relationships in the context of training, maintaining effective relationship with the training course as well as the supervisee.

Demonstrates commitment and actively invests in supervision and the supervisee.

Promotes supervisee to take ownership of supervision as an active participant, e.g. setting agendas, goals, and reviewing learning outcomes.

Skilled and able to process the demands of managing multiple roles (e.g. educative, managerial, evaluative, supportive).

Develops supervision contracts with supervisees, and is clear about roles and responsibilities in supervision and the limits of confidentiality.

Addresses and reflects on ethical, relational and boundary issues effectively when they arise in supervision.

Achieves balance between direction and encouraging autonomy that includes appropriate risk taking, and effectively contains supervisee emotional responses to the work.

Applies models of supervision, learning and consultation and uses these to formulate and manage challenges within the SR. (Beinart & Golding, 2015, p. 32).

Of course, there is always debate and sometimes disagreement on how to describe the complex process of supervision, and multiple theories and models describe the process. Despite the growth of the competency movement, some schools of psychology argue that supervision is more of an art than a science and that much of what happens in a supervision session is intuitive, creative, and dependent on the individual chemistry within the dyad at that moment. There is also an emerging school of thought that suggests that supervisors should use mindfulness or meditative techniques to provide a safe and containing space for the supervisee (Sarnat, 2010). Applied psychologists with more scientific leanings would probably subsume these processes under the label of meta‐competencies. However, regardless of approach, and of the narrative informed by this approach, it remains incontrovertible that effective supervision takes place in the process that occurs between supervisor and supervisee, and that certain relational fundamentals need to be in place for this to occur. It is essential that we attempt to identify and define these competencies so that we can consistently educate and train effective supervisors and measure both process and outcomes achieved. This leads us on to discussing how other influences and different contexts may influence and shape the SR.

Contextual Influences

Much of the literature in clinical supervision stems from training contexts. There is more research reflecting the experiences of clinical and counseling psychologists in training than of those post‐qualification. The participants in our research are all trainee clinical psychologists on accredited UK training courses and their clinical supervisors. The supervision competencies described earlier largely refer to the competencies required for pre‐qualification training. The training context provides particular influences that are likely to impact the SR. First, the training program itself exerts an influence; in our research this was referred to as a “safety net” and a “distant presence” (Clohessy, 2008). Second, when people are in training, the role of evaluation carries particular weight as trainees/interns are aware of the possibility that they may be failed for not meeting the desired or agreed competencies of their chosen profession. Our research suggests that in effective SRs, where regular and constructive feedback is integral to supervision, evaluation is less of an issue. However, in challenging or ruptured relationships this can result in a great deal of complexity and distress, and may raise specific issues for training course staff in ethically and fairly dealing with the difficulties raised (see Chapter 8). Clearly, if a supervisee feels unsafe in their SR they are less likely to disclose difficult issues, and this has led to some interesting studies on the relationship between self‐disclosure and the SR (Ladany, Hill, Corbett, & Nutt, 1996; Lemoir, 2013). Clohessy’s model (2008) suggests that supervisees and supervisors bring their own histories, culture, and previous experience into supervision and that these form part of the context of the relationship. For further discussion about the contribution of supervisees and supervisors to the SR, see Chapter 3. Training contexts may also differ internationally; for example, in some countries training takes place in university‐based clinics, whereas in the United Kingdom clinical training is largely embedded in National Health Service (NHS) settings.

Different working and institutional contexts also have a significant impact on the SR. For example, those working in the private sector are likely to choose their supervisors to meet their specific interests or learning styles. The contract is open to negotiation and, if the supervisor does not meet the supervisee’s needs, they can end the contract and seek a more suitable arrangement. Depending on the working context, those in private practice are more likely to seek supervision for therapeutic work and the content of supervision is likely to be more case‐based, that is, focused on the individual, couple, family, team, or organization with which the supervisee is working.

Those working in the public sector, such as the NHS in the United Kingdom, are often allocated internal supervisors who may also be their managers. In some professions, for example psychotherapy and counseling, the conflation of management and clinical supervision is often deemed unacceptable. Many nurses face similar dilemmas and prefer to separate out the various supervisory roles. In clinical psychology it is not uncommon to combine different aspects of supervision. For example, it is possible to be supervised by a professional line manager who offers clinical, professional, and managerial supervision. However, in recent supervision policy guidance (Division of Clinical Psychology, 2014), it is suggested that these various roles are clarified and separated. For example, line management supervision focuses on organizational objectives and monitoring of performance in relation to these objectives. The emphasis is on the quality of the service provided. This reflects the normative role of supervision and the line manager may be from a different professional group. Professional supervision focuses on professional practice standards of a particular profession, particularly in relation to ethics and codes of conduct. Discussions are likely to include continuing professional development, personal and career development plans, professional and ethical dilemmas, team working, and relationships. Professional supervision is likely to involve a more experienced practitioner from within the profession, as its primary focus is on professional development.

Clinical supervision is seen as the primary means of maintaining, updating, and developing clinical skills in assessment, formulation, and therapeutic or other interventions. The function is to ensure safe and effective practice that follows best practice in relation to theory and research. Clinical supervision may be model‐specific; for example a practitioner may seek supervision to improve and develop specific therapeutic skills such as in cognitive behavioral therapy or systemic therapy. In reality, while it may be preferable to separate different aspects of supervision, it may be somewhat unrealistic in practice. Setting up three or four different SRs is time‐consuming and effortful, and it is our view that several of these functions can be combined within a single SR, particularly within the same profession. There is, however, a belief that combining normative, formative, and restorative elements within the same SR is challenging. We feel, however, that this is the central core of effective supervision. Supervision is challenging and its very nature lends itself to conflict—this core dynamic provides useful opportunities for learning. The key to combining these different elements is effective contracting, not just for the work to be done but also for the SR itself. The early discussions about how the dyad will manage the dynamic between restorative, developmental, and normative, evaluative, and/or managerial functions sets the tone for effective SRs, and for inviting and reviewing feedback and progress. The key skills of contracting and feedback are discussed in detail in Chapters 6 and 7. Ethical practice and valuing difference are crucial to these discussions and are so important an area in the field of supervision that they warrant detailed consideration (see Chapter 5).

Finally, in addition to the contextual influences already mentioned (training, institutional, professional, therapeutic modality, type of work)—we should also consider the broader psychosocial, economic, and cultural contexts in which we work. These influence our practice and the SR itself. Part of the current culture within health and social care is that of evidence‐based practice (Chapter 4) combined with reflective practice (Chapter 9). As authors, we are greatly influenced by our own individual personalities, identities, values and cultures, a long‐term supervisory working relationship, the culture of clinical psychology in the United Kingdom, and long careers within the NHS. We share a strong belief in public service and the creative joining of reflective evidence‐based and ethical practice. We believe that the SR is the most effective vehicle for the development of effective new practitioners and for maintaining the quality and skills of those who are more experienced. As such, the first part of this book will provide theory and evidence to support this proposition. The second half will focus on the how of developing and maintaining effective SRs over the professional life span. The nature of the writing will reflect these combined aims, with the first part presenting an academic and research focus and the second a more experiential, reflective, and practitioner‐based focus, backed up with supervisory examples.

2Overview of Models of Supervision and the Supervisory Relationship

The aims of this chapter are:

to provide an overview of models and frameworks that can be used to inform supervision;