Robert P. Reiser

A Rationale for Evidence-Based Clinical Supervision

Although modern mental health systems increasingly require evidence-based practice (EBP), clinicians continue to object to restrictions on their professional independence, which they may perceive as counterproductive, divisive and even demeaning. In the face of such deep-seated objections, do we really need to strive for an evidence-based approach to supervision? We believe so, and begin our argument by noting a colourful illustration of the problems that can exist in the absence of EBP, those of poor training, therapist drift and weak professional regulation. Next, we present EBP as a mechanism to reduce such unacceptable variability in the way that treatments are delivered. We then apply the lessons from this divisive situation to the practice of clinical supervision, outlining a rationale for an inclusive, synergistic way forward. A number of fundamental psychological motives for this integration are noted, including supervisor training that is informed by practice-based research, corrective feedback on supervision, and a supportive professional system. Illustrative examples are provided in each of these areas. It is concluded that the traditional gulf between research and practice can and should be bridged in relation to supervision.

SAGE: preliminary evaluation of an instrument for observing competence in CBT supervision

Clinical supervision plays a recognized role in facilitating practitioner development and in promoting therapeutic fidelity, but instruments that can support such activities by measuring competence in supervision are rare and often psychometrically compromised. As part of a research programme intended to raise the empirical status of supervision, we describe the initial psychometric development of a new instrument for observing competence (Supervision: Adherence and Guidance Evaluation; SAGE). This instrument is suitable for measuring CBT supervision, and can be administered by self-rating or by an independent observer. Preliminary tests of the reliability and validity of SAGE suggest that it is a promising tool for evaluating supervision. In addition, SAGE can be applied readily and has good utility. In these respects, SAGE appears to have some advantages over existing instruments, and may therefore provide a basis for enhancing research and practice in CBT supervision. Suggestions for future research on SAGE are outlined, particularly the need for a generalizability analysis.

Observing competence in CBT supervision: a systematic review of the available instruments

Government policy, like evaluations of clinical practice, indicates the growing importance of supervision in fostering practitioner development and in improving the fidelity of therapies. However, instruments with which to measure competent supervision are often problematic, thereby hampering these key activities (e.g. they are rare, rely on self-ratings by participants, and psychometric data can be limited). To contribute to progress, this paper reviews the current options for measuring competent clinical supervision by means of direct observation, a favoured approach within cognitive behaviour therapy (CBT). We systematically reviewed 10 existing instruments that were designed to observe and quantify competent supervision, focusing on three broad criteria for sound measurement (i.e. an instruments Design, Implementation, and Yield: DIY). Suggestions for future research on instruments that can fulfil the functions that are provided distinctively through direct observation are outlined.

An N = 1 Evaluation of Enhanced CBT Supervision

BACKGROUND Clinical supervision plays an essential role in the development of mental health professionals and is increasingly viewed as a discrete professional specialization. However, research has rarely addressed core issues such as the measurement and manipulation of clinical supervision, so there are very few direct comparisons between the different supervision methods. AIMS To operationalize two related approaches, cognitive-behavioural (CBT) and evidence-based clinical supervision (EBCS), demonstrate their fidelity, and then evaluate their relative effectiveness in facilitating the experiential learning of one supervisee. METHOD Within a multiple-baseline, N = 1 design, we rated audiotapes of supervision on a competence rating scale. RESULTS Findings generally favoured the EBCS approach, which was associated with higher fidelity by the supervisor and increased engagement in experiential learning by the supervisee. CONCLUSIONS This preliminary but novel evaluation indicated that CBT supervision could be enhanced. Implications follow for supervisor training and a more rigorous N = 1 evaluation.

A qualitative comparison of cognitive-behavioural and evidence-based clinical supervision

Despite the acknowledged importance of clinical supervision, controlled research is minimal and has rarely addressed the measurement or manipulation of clinical supervision, hampering our understanding and application of the different supervision methods. We therefore compared two related approaches to supervision, cognitive-behavioural (CBT) and evidence-based clinical supervision (EBCS), evaluating their relative effectiveness in facilitating the experiential learning of one supervisee. Drawing on a multiple-baseline N = 1 design, we gathered mostly qualitative data by means of an episode analysis, a content analysis, a satisfaction questionnaire, and interviews with the supervisor and supervisee. We found that the EBCS approach was associated with higher supervision fidelity and increased engagement in experiential learning by the supervisee. This case study in the evaluation of supervision illustrates the successful application of some rarely applied qualitative methods and some potential supervision enhancements, which could contribute to the development of CBT supervision.

A CBT formulation of supervisees’ narratives about unethical and harmful supervision

ABSTRACT There is growing evidence that clinical supervision may be experienced as harmful (Ellis et al., 2013). The 11 narrative accounts of supervision that form the focus of this Special Issue of The Clinical Supervisor corroborate this evidence, providing vivid and alarming accounts of supervisee experiences of unethical and harmful supervision. In order to treat these worrying reports of supervision with the seriousness that they deserve, we adopt a CBT formulation approach and apply it systematically to these narratives. First, we formulate the data contained in these narratives within a framework for judging unethical supervision. Then we develop proposed solutions to address the problems reported. Last, we describe practical implications for improvements in identifying and addressing unethical supervision and for minimizing harm to supervisees.

Peer Supervision: International problems and prospects

Clinical supervision is the least investigated, discussed and developed aspect of clinical education (Kilminster & Jolly, 2000) despite being essential within initial professional training and mandated by governments. Even the basic concepts lack precision (Martin, Kumar, & Lizarondo, 2017; Milne, 2007; White, 2017). A popular form of supervision is peer supervision, especially peer group supervision (PGS). On the basis of our summary of the available literature, we offer a logical definition of PGS, then adopt an international perspective to consider some worrying weaknesses and working solutions.

Cognitive Behavioral Therapy Supervision in a University-Based Training Clinic: A Case Study in Bridging the Gap between Rigor and Relevance

Principles and procedures for supervising cognitive behavioral therapy (CBT) were broadly defined in 2 early seminal texts almost 15 years ago (Liese & Beck, 1997; Padesky, 1996) and updated more recently (Beck, Sarnat, & Barenstein, 2008; Newman, 2010). However, the actual practice of CBT supervision often shows poor fidelity to this model (Townend, Iannetta, & Freeston, 2002) with notable deficiencies in the use of direct observation, standardized observational rating systems, and experiential methods in supervision (Milne, 2008). The advent of more specific competency statements on CBT supervision has been a significant leap forward (Falender et al., 2004; Roth & Pilling, 2008) but poses some practical challenges to clinical supervisors in terms of transferring broad competency statements into actual supervisory practice. We address the need for more rigor in CBT supervision within a university training clinic setting and outline some promising ingredients for this specification drawing on competencies, metacognition, and experiential learning theory.

Supporting our supervisors: sending out an SOS

In this Introduction to the Special Issue of the Cognitive Behaviour Therapist on clinical supervision we start by highlighting the unmet and overdue need for coherent organizational systems to support, guide and develop clinical supervisors. We identify a seven-step, cyclical model that describes how such a system might work, with particular reference to CBT supervision. These steps start with conceptualization (e.g. definition of CBT supervision) and complete the problem-solving cycle with evaluation (e.g. corrective feedback). We provide an overview of typical research and development activity for each part of this model to illustrate how a sound supervision infrastructure might best be developed. The SOS model provides a systematic approach to indicate the organizational conditions under which CBT supervision might flourish.

A survey of CBT supervision in the UK: methods, satisfaction and training, as viewed by a selected sample of CBT supervision leaders

Internationally, clinical supervision has been increasingly recognized as a core competency and an essential requirement for clinical training. Over the past 10 years, frameworks for supervision competencies have been developed and promulgated in several countries, notably the UK, USA and Australia. But what is the current status of the actual practice of CBT supervision in the UK? We conducted an internet survey with a purposive sample of n =110 accredited British Association for Behavioural and Cognitive Psychotherapy (BABCP) supervisors and trainers (a 44% response rate), selected for their assumed expertise. The results were consistent with past surveys of Townend et al. , indicating that the most frequently reported supervision methods tended to reflect many of the recommendations in widely disseminated supervision competency frameworks and recognized best practice statements. Overall, these CBT supervision leaders reported using an impressively wide range of methods, including much more frequent use of role-play, therapy recordings, and direct observation than reported in the Townend et al . surveys or in observational studies. Although satisfied in their supervisory role, respondents indicated the need for improved CBT supervisor training resources, with significant interest in developing competence instruments and group supervision methods. In conclusion, at least for this small sample of CBT supervision leaders in the UK, practice reflects international progress, but training resources are sought to maintain momentum.