Clinical supervision

Supervision is used in counselling, psychotherapy, and other mental health disciplines as well as many other professions engaged in working with people. Supervision may be applied as well to practitioners in somatic disciplines for their preparatory work for patients as well as collateral with patients. Supervision is a replacement instead of formal retrospective inspection, delivering evidence about the skills of the supervised practitioners.

It consists of the practitioner meeting regularly with another professional, not necessarily more senior, but normally with training in the skills of supervision, to discuss casework and other professional issues in a structured way. This is often known as clinical or counselling supervision (consultation differs in being optional advice from someone without a supervisor's formal authority). The purpose is to assist the practitioner to learn from his or her experience and progress in expertise, as well as to ensure good service to the client or patient. Learning shall be applied to planning work as well as to diagnostic work and therapeutic work.

Milne (2007) defined clinical supervision 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". The main methods that supervisors use are corrective feedback on the supervisee's performance, teaching, and collaborative goal-setting. It therefore differs from related activities, such as mentoring and coaching, by incorporating an evaluative component. Supervision's objectives are "normative" (e.g. quality control), "restorative" (e.g. encourage emotional processing) and "formative" (e.g. maintaining and facilitating supervisees' competence, capability and general effectiveness).

Some practitioners (e.g. art, music and drama therapists, chaplains, psychologists, and mental health occupational therapists) have used this practice for many years. In other disciplines the practice may be a new concept. For NHS nurses, the use of clinical supervision is expected as part of good practice.[1][2] In a randomly controlled trial in Australia,[3] White and Winstanley looked at the relationships between supervision, quality of nursing care and patient outcomes, and found that supervision had sustainable beneficial effects for supervisors and supervisees. Waskett believes that maintaining the practice of clinical supervision always requires managerial and systemic backing, and has examined the practicalities of introducing and embedding clinical supervision into large organisations such as NHS Trusts (2009, 2010).[4][5][6] Clinical supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles.[7]

Key issues around clinical supervision in healthcare raised have included time and financial investment.[8] It has however been suggested that quality improvement gained, reduced sick leave and burnout, and improved recruitment and retention make the process worthwhile.[9][10][11][12][13][14][15]

United Kingdom

Clinical supervision is used in many disciplines in the British National Health Service. Registered allied health professionals such as occupational therapists,[16] physiotherapists,[17] dieticians,[18] speech and language therapists[19] and art,[20] music and drama therapists are now expected to have regular clinical supervision. C. Waskett (2006) has written on the application of solution focused supervision skills to either counselling or clinical supervision work. Practising members of the British Association for Counselling and Psychotherapy[21] are bound to have supervision for at least 1.5 hours a month. Students and trainees must have it at a rate of one hour for every eight hours of client contact.

The concept is also well used in psychology, social work, the probation service and at other workplaces.

Models or approaches

There are many different ways of developing supervision skills which can be helpful to the clinician or practitioner in their work. Specific models or approaches to both counselling supervision and clinical supervision come from different historical strands of thinking and beliefs about relationships between people. A few examples are given below.

Peter Hawkins (1985[22]) developed an integrative process model which is used internationally in a variety of helping professions. His "Seven Eyed model of Supervision" was further developed by Peter Hawkins along with Robin Shohet, Judy Ryde and Joan Wilmot in "Supervision in the Helping Professions" (1989, 2000 and 2006 and 2012[23]) and with Nick Smith in "Coaching, Mentoring and organisational Consultancy: Supervision and Development" (2006 and 2013[24]) and is taught on the courses of the Centre for Supervision and Team Development as well as many other supervision training courses.

S. Page and V. Wosket describe a cyclical structure.

F. Inskipp and B. Proctor (1993, 1995) developed an approach based on the normative, formative and restorative elements of the relationship between supervisor and supervisee. The Brief Therapy practice[25] teaches a solution focused approach based on the work of Steve de Shazer and Insoo Kim Berg which uses the concepts of respectful curiosity, the preferred future, recognition of strengths and resources, and the use of scaling to assist the practitioner to progress (described in [26]). Waskett has described teaching solution-focused supervision skills to a variety of professionals[27]

Evidence-based CBT supervision is a distinctive and recent model that is based on cognitive-behaviour therapy (CBT), enhanced by relevant theories (e.g. experiential learning theory), expert consensus statements, and on applied research findings (Milne & Reiser, 2017). It is therefore an example of evidence-based practice, applied to supervision. CBT supervision meets the general definition of clinical supervision above (Milne, 2007), adding some distinctive features that reflect CBT as a therapy. This includes a high degree of session structure and direction (e.g. detailed agenda-setting), but within a fundamentally collaborative relationship. Also, there is a primary emphasis on cognitive case conceptualization, mainly through the use of case discussion, intended to develop diagrammatic CBT formulations. But discussion should properly be combined with other CBT techniques, including Socratic questioning, guided discovery, educational role-play, behavioural rehearsal, and corrective feedback. Another distinctive aspect is a focus on evidence-based principles and methods, including the use of reliable instruments for feedback and evaluation, in relation to both therapy and supervision. Perhaps the single most defining characteristic of evidence-based CBT supervision is the active and routine commitment to research methods and findings: where other approaches refer to theory and clinical/supervisory experience for guidance, evidence-based CBT supervision appeals ultimately to 'the data'. Examples of the use of relevant theories, expert consensus statements and research, together with six formally-developed supervision guidelines (illustrated through video clips), can be found in Milne & Reiser (2017).

Counselling or clinical supervisors will be experienced in their discipline and normally then have further training in any of the above-mentioned approaches, or others.

See also

References

Citations
  1. "Read The Code online - The Nursing and Midwifery Council". www.nmc.org.uk. Retrieved 2023-02-01.
  2. "clinical-supervision.com". clinical-supervision.com. Archived from the original on 2000-08-17. Retrieved 2012-02-10.
  3. White E, Winstanley J, Does clinical supervision lead to better patient outcomes in mental health nursing? Nursing Times; 106: 16, pp. 16–18, 2010.
  4. Waskett, C. Clinical Supervision using the 4S model 1: considering the structure and setting it up' Nursing Times 106: 16, pp. 12–14, 2010.
  5. Waskett C', Clinical Supervision using the 4S model 2: training supervisors to deliver effective sessions' Nursing Times 106: 17, pp. 19–21, 2010.
  6. Waskett, C. 'Clinical supervision using the 4S model 3: Keeping it going. Nursing Times 106: 18, 2010.
  7. Davis, Cynthia; Burke, Linda (September 2012). "The effectiveness of clinical supervision for a group of ward managers based in a district general hospital: an evaluative study". Journal of Nursing Management. 20 (6): 782–793. doi:10.1111/j.1365-2834.2011.01277.x. ISSN 1365-2834. PMID 22967296.
  8. "Nursing theories 2: clinical supervision". Nursing Times. 2017-11-27. Retrieved 2023-02-01.
  9. Barratt, Caroline (2017-01-18). "Exploring how mindfulness and self-compassion can enhance compassionate care". Nursing Standard. 31 (21): 55–63. doi:10.7748/ns.2017.e10671. ISSN 2047-9018. PMID 28097993.
  10. Wallbank, Sonya; Hatton, Sue (July 2011). "Reducing burnout and stress: the effectiveness of clinical supervision". Community Practitioner: The Journal of the Community Practitioners' & Health Visitors' Association. 84 (7): 31–35. ISSN 1462-2815. PMID 21941708.
  11. White, Edward (June 2017). "Clinical Supervision: invisibility on the contemporary nursing and midwifery policy agenda". Journal of Advanced Nursing. 73 (6): 1251–1254. doi:10.1111/jan.12970. PMID 27021076.
  12. Ashburner, C (2016). "Seeing things differently: Evaluating psychodynamically informed group clinical supervision for general hospital nurses". NT Research. 9 (1): 38–48. doi:10.1177/136140960400900108. S2CID 71035507.
  13. Teasdale, K.; Brocklehurst, N.; Thom, N. (January 2001). "Clinical supervision and support for nurses: an evaluation study". Journal of Advanced Nursing. 33 (2): 216–224. doi:10.1046/j.1365-2648.2001.01656.x. ISSN 0309-2402. PMID 11168705.
  14. Cutcliffe, John R.; Sloan, Graham; Bashaw, Marie (October 2018). "A systematic review of clinical supervision evaluation studies in nursing". International Journal of Mental Health Nursing. 27 (5): 1344–1363. doi:10.1111/inm.12443. PMID 29446513. S2CID 46801036.
  15. "Nursing theories 2: clinical supervision". Nursing Times. 2017-11-27. Retrieved 2023-02-01.
  16. "Occupational therapy - helping you to live life your way | BAOT/COT". Cot.org.uk. 2012-01-23. Retrieved 2012-02-10.
  17. "The Chartered Society of Physiotherapy | The Chartered Society of Physiotherapy". Csp.org.uk. Retrieved 2012-02-10.
  18. "British Dietetic Association BDA". Dietetics.org.uk. 2011-11-01. Retrieved 2012-02-10.
  19. "Home". Rcslt.org. Retrieved 2012-02-10.
  20. "British Association of Art Therapists". Baat.org. Retrieved 2012-02-10.
  21. "The British Association for Counselling & Psychotherapy". BACP. Retrieved 2012-02-10.
  22. Hawkins, P. (1985). Humanistic psychotherapy supervision: a conceptual framework. Self and Society: Journal of Humanistic Psychology, 13(2), 69–79.
  23. Hawkins, P., and Shohet, R. (2012). Supervision in the Helping Professions. (Fourth edition) Maidenhead: Open University Press/ McGraw Hill.
  24. Hawkins, P. and Smith N. (2006, second edition 2013) "Coaching, Mentoring and Organizational Consultancy: Supervision and Development." Maidenhead: Open University Press/McGraw Hill.
  25. Netrix Limited. "BRIEF - Europe's largest provider of solution focused Brief Therapy training". Brief Therapy. Retrieved 2012-02-10.
  26. "Solution focused supervision article". Northwest Solutions. Archived from the original on 2008-08-30. Retrieved 2012-02-10.
  27. Henderson, P. (Ed.), Supervisor Training: issues and approaches; Waskett; Learning to supervise using a solution focused approach. Karnac, 2009.

Sources
  • C Waskett. The SF Journey, in Therapy Today, March 2006, Vol. 17, No. 2, pp. 40–42.
  • P Hawkins, R Shohet. Supervision in the Helping Professions: an organisational, group and organisational approach; Open University Press, Maidenhead, 2nd ed 2000 3rd Edition 2006, 4th edition 2012
  • P Hawkins and N Smith(2006, second edition 2013) "Coaching, Mentoring and Organizational Consultancy: Supervision and Development." Maidenhead: Open University Press/McGraw Hill.
  • S Page, V Wosket. Supervising the Counsellor: a cyclical model; Routledge, London & New York, 1995
  • F Inskipp, B Proctor. The Art, craft and tasks of Counselling supervision, Part 1 – making the most of supervision, Cascade Publications 1993, and Part 2 – becoming a supervisor, 1995
  • C Waskett. The pluses of solution-focused supervision, in Healthcare Counselling and Psychotherapy Journal, Vol. 6, No. 1.
  • C Waskett. An Integrated Approach to introducing and maintaining supervision: the 4S model. Nursing Times,105:17, 24–26.
  • D Milne (2007). An empirical definition of clinical supervision. British Journal of Clinical Psychology, 46, 437–447.
  • D Milne & R Reiser (2017). A manual for evidence-based CBT supervision. Chichester: Wiley Blackwell.
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