Psychology Supervision

Psychological .

Image, courtesy of https://www.counselling-directory.org.uk/memberarticles/what-is-clinical-supervision

This page discusses the process of supervision in the practice of psychology. It outlines its aims, content, issues that may arise, and it’s clear benefits. However, this it is not an exhaustive overview. For further reading, the reader is directed to the references cited as the end of the document for more in-depth learning.

Definition of Supervision

Supervision is essentially a regular meeting between the supervisee psychologist and a usually more experienced senior psychologist in order to discuss and improve their practice.

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, (Milne, 2007).

And:

A specialised form of mentoring provided for practitioners responsible for undertaking challenging work with people. Supervision is provided to ensure standards, enhance quality, advance learning, stimulate creativity, and support the sustainability and resilience of the work being undertaken, The British Association for Counselling and psychotherapy, (BACP) website.  

Supervision is a routine regular practice used in various health disciplines who work therapeutically with individuals. It is a critical aspect in the practice of psychology in order to aid develop knowledge and understanding and ensure best practice.

Aims of Supervision

One of the most important aspects underpinning supervision is to ensure that clients receive a high level of quality, ethical, and safe care. It guides the supervisee in their development in order to confidently assess, treat, and manage their clients’ psychological functioning.

Supervision is a mandatory process within the practice of psychology. Guidelines about the process, content, and frequency of supervision are set out in the Health and Care Professions council, (HCPC) and the British Psychological Society, (BPS). In addition, other agencies, such as NHS Trusts and private health care organisations often have their own additional specific practice.

Supervision is an emotionally safe space that allows the supervisee the ability to critically reflect upon their practice. This process then affords the supervisee to understand their practice within their own cultural norms and individuality. By achieving this unique understanding, clients can be assured of the best quality care.

This safe space also holds and supports the supervisee in order to develop their own style, which varies from culture, background, and life experience.

Supervision also exists to help us understand exactly how their own style and life experiences interact with their practice, either positively or negatively. For example, a supervisee may have recently experienced a bereavement and have a client who they are helping through their grief. Supervision helps to identify and manage their own emotions about this parallel.

Supervision should be a supportive process, focused on the wellbeing of the psychologist whilst ensuring that their clients receive the best care. Sometimes supervision is very personal and focuses on a specific issue that the supervisee is struggling with. For example, a psychologist who is experiencing postnatal depression and requires help to manage their workload and improve motivation.

Supervision also allows healthcare professionals to progress in their careers by learning from their more experienced colleagues and receiving ongoing support. The process also supports the development or furthering of a specialist interest, for example eating disorders, obsessive compulsive disorder or pain management.

Practicing as a psychologist and working with mental health is undoubtedly a highly challenging yet rewarding position. Supervision allows professionals to practice competently and ethically, employ established and evidence-based techniques, and achieve a level of competence, confidence, and security in their practice.

A key factor that makes supervision successful, (akin to the client therapist relationship) is the relationship between the supervisor and supervisee. A supervisor should not only be experienced and knowledgeable but also supportive enough to help address their supervisee’s challenges in a manner that promotes growth.

Models of Supervision

There are a variety of models of supervision; from educational, psychodynamic, and therapeutic. This section discusses just two; though arguably the most common models. Again, the reader is directed to citations in the reference section for further and more in-depth reading.

  • Formative Normative Restorative

One of the most widely used model is that proposed by Proctor, (1987). This model describes three aspects to supervision: formative, normative, restorative.

  1. The formative (or educative) aspect of supervision relates to the supervisee’s learning, skills development and professional identity development.
  2. The normative (or managerial) refers to accountability, developing best practice principles, ethical and legal considerations, compliance with agency and organisational procedures and Professional standards for the well-being of clients.
  3. Restorative (or supportive) considers the impact of the work on the supervisee and the necessary psychological support and scaffolding required to offer professional support to the supervisee. This function can help mitigate the stresses and impacts of the work and promote practitioner well-being.
  • Cognitive Behavioural Therapy Supervision

Another model of supervision involves the application of the widely used therapeutic technique of cognitive behavioural therapy (CBT).

CBT supervision an evidence-based techniques based on applied research findings. It meets the definition given by Milne, (2007) as above and provides a neat structure for the sessions, such as agenda setting and review of homework for example.

In the CBT model there is an emphasis on cognitive case conceptualisation. Through case discussion supervision understands both clients’ and the supervisee’s practice.

Other techniques which have become the cornerstones of CBT are applied, such as Socratic questioning, (asking open-ended questions), guided discovery, role-play, rehearsal, and psychometrics.

Being evidence-based, the CBT method relies on research methods and findings and the emphasis is on data of ‘what works’, for example, the application of DBT (dialectical behaviour therapy) for emotional regulation.

Content of Supervision

  • Skills development

In psychology, supervision is a form of guidance. A supervisor helps the supervisee reflect on and thereby improve their skills. Supervisors evaluate performance and support supervisees through their learning process.

  • Instruction and teaching

A supervisor may act as a teacher and consultant in one; for example, they might introduce psychological concepts to their supervisee and help them apply those concepts to their work with clients, as well as suggest additional reading relevant to their cases.

  • Observation

Supervision may also involve observing a supervisee in practice, either via live or recorded means, which allows a supervisor to provide constructive feedback on the supervisee’s practice and performance.

  • Reflective practice

Supervision also involves a practice known as reflective practice. This also allow supervisee’s to reflect on their own unique life experiences and how these may impact on or interfere with their formulation, understanding, and treatment of their clients. This process also applies to how a supervisee may interact Interpersonally with colleagues and systemically with organisations. 

  • Professional and personal interface

A supervisee’s unique personality and experience will interplay with issues that arise in professional practice. For example, a supervisee may be working on a case where there is parallel processing

  • Role play

Role play is a powerful form of learning. The supervisor may play the role of

  • Record keeping

A supervision contract should be implemented. Typically, this should include factors such as frequency and times of supervision, the model used, and areas of focus for example, and signed and dated by both parties.

A supervision log should ideally be kept by both parties. However, a joint log can be used as long as both parties agree.

The log should include the date and duration of the session, feedback from the last session, a review of the current caseload and projects, the relevant learning or reflection points from the session, and the aims and objectives for the next session.

Record keeping is not only a helpful practice for both supervisor and supervisee, which can be referred to reflect and track progress, it keeps both parties safe in the event of any conflict or disagreement.

Issues Arising in Supervision

Issues that may arise in supervision in relation to the supervisee’s practice are wide and varied, however, broadly these can include:

  • Ethical dilemmas

An ethical dilemma represents a conflict in the supervisee’s practice. These are often recurring themes within psychology supervision. The supervisor may be struggling with whether to feedback a certain piece of information to the supervisee, for example. The therapist may be unclear as to whether a to offer a job to a relative. Or, there may be confusion as to whether confidential information should be shared in the face of a potential safeguarding concern. All such matters should be discussed within supervision, openly and transparently, with a joint conclusion agreed upon .

  • Confidentiality

Confidentiality is of paramount importance in psychological therapy. However, there may be instances, such as the need to share information in the event of risk to self or others. Supervision is critical in helping the supervisee make an informed choice about sharing information.

  • Emotional responses

We are all emotional beings and the psychologist is no different. There may be specific emotional responses to listening to a client’s experience of domestic violence, for example. Supervision enables the supervisee to process their own emotional response in a safe and supportive manner.

  • Transference

Transference refers to the unconscious transfer of a person’s interpersonal feelings about a significant someone to another person. It occurs in therapy when a client unknowingly transfers feelings about someone from their past onto the therapist. It occurs in supervision, the supervisee or the supervisors may unwittingly transfer their own internal struggles on to the other party. For example, a supervisor who has a subconscious difficulty working with sexual abuse survivors, for example, transfers that difficulty or inability to the supervisee. They essentially transplant their own shortcomings or difficulties onto the other party.

Countertransference is the therapist’s reaction to projections of the client onto the therapist. It has been defined as the redirection of a therapist’s feelings toward a client and the emotional entanglement that can occur with a client, (Fink, 2011). Examples of countertransference may include developing sexual feelings for a client or supervisee or oversharing personal information, for example.

  • Professional accommodation syndrome

Supervises may be reluctant to talk about the impact of the work on them because they feel the supervisor or organisation subtly denies them permission to do so. As such, supervisees may experience feelings of helplessness and shame in a culture where the emphasis is on toughness and coping with difficult work. In such environments the supervisee silences their discomfort often therefore the confounding the problem. Additionally, in such cultures, where the supervisee opens up and shares their difficulties they may well be met with dismissiveness, ridicule, or shame. All organisations and supervisors should be aware of this possibility and work proactively to avoid this unproductive, unhelpful, and potentially toxic culture.

  • Boundaries

Boundaries are of critical importance in supervision. Both parties should be clear as to the nature and terms of their relationship at the onset of supervision. Examples of boundary erosion may include the supervisor and supervisee being friends outside the supervisory relation or the supervisee making excessive contact outside session times. Supervisees are encouraged to ‘hold’ any difficult experiences until the next scheduled supervision session. This can be challenging especially when working with more complex cases, where there are risk and safeguarding concerns. It is also challenging during training and the early years post qualification. In such cases, it is valuable that the content of the supervision be tailored to incorporate the teaching and practice of holding techniques, such as emotional regulation or journaling for example.

  • Supervision and managerial conflict

Supervision and managerial conflicts are more applicable to supervision within organisations where the supervisor is also the supervisee’s line manager. Where this is the case, boundaries between the two roles can become blurred and confusing for both parties.

In such cases, the supervisor may have for example, pressure to increase the supervisee’s caseload, and yet has a duty of care for their wellbeing.

Additionally, the combination of supervision with line management, the supervisee may feel limited in what they can share for fear of disrupting the line management process. There Is as such a very valid argument for supervision and line management to be kept separate.

  • Trust

Trust is the arguably the foundation of any successful relationship. The supervisee must feel able to trust the supervisor to validate their experiences and steer them in the right direction to aid professional development. In turn, the supervisor must trust the supervisee to be open and transparent about their practice and development. Where trust has been eroded, it is the responsibility of both parties to address this as soon as possible. There should be an emphasis on repairing any rupture in the relationship, however if one or both parties feel the damage is irreparable, alternative supervision arrangements should be made.

  • Power dynamics

Supervisors are naturally placed in a position power and authority by the very nature of their position. The supervisee may experience unpleasant reactions in response to supervision. Where this is the case and it involves any overt or covert bullying, teasing, derogatory remarks, or toxicity. It is the responsibility of the supervisor to not use or abuse their relative position of power in the supervisory relationship. In turn, the supervisee should raise concerns in the first instance with their supervisor directly. Again, there should be an emphasis on repairing any rupture in the relationship, however if one or both parties feel the damage is irreparable, alternative supervision arrangements should be made.

Benefits of Supervision

The benefits of supervision are numerous. Including:

  • Improved client care
  • Ethical and safe practice
  • Case management
  • Professional development
  • Skills building and training
  • Adherence to statutory standards
  • Self development
  • Improved confidence
  • Increased self-efficacy
  • Enhanced wellbeing
  • Increased job satisfaction
  • Better work life balance

My Family Psychologist Supervision

My Family Psychologist provides a supervision service to assistant, trainee, and registered psychologists, as well as other relevant health and care professions. The ethos underpinning our supervision is a similar to the one we have in therapy; growth, compassion, and positivity. It is an Integrative style; using a variety of models and specifically those which are most suited to the supervisee.

In addition, given our very experienced history in forensics, there is an emphasis on good risk management. This involves teaching in risk assessment and management, and understanding, processing, and steering in all safeguarding matters.

For more information about how our supervision can help you in your practice, contact us at luisa@myfamilypsychologist.com or 07801 079 555.

References

Alonso, A. The quiet profession: Supervisors of psychotherapy. Macmillan Publishers. 1985. 

American Psychological Association. Guidelines for clinical supervision in health service psychology. 2014. Retrieved from http://apa.org/about/policy/guidelines-supervision.pdf

Bell, T, Dixon, A. Kolts, R. Developing a compassionate internal supervisor: Compassion‐focused therapy for trainee therapists. Clinical psychology & Psychotherapy. Wiley Online Library. 2017.

British Psychological SOCIETY, (BPS) Supervision Policy. Retrieved from https://shop.bps.org.uk/dcp-policy-on-supervision

British Association for Counselling and psychotherapy, (BACP). Retrieved from https://www.bacp.co.uk/membership/registered-membership/guide-to-supervision/

Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counselling Psychologist, 42(4), 434–472. 2014. Retrieved from https://doi.org/10.1177/0011000013508656

Falender, Carol, A. And Shafranske, Edward, P. Clinical Supervision: A Competency Based Approach. American Psychological Association. 2004.

Fink, retrieved from https://positivepsychology.com/countertransference-and-transference/ 2011.

Health and Care Professions Council, (HCPC). Standards of proficiency. Retrieved from https://www.hcpc-uk.org/standards/meeting-our-standards/supervision-leadership-and-culture/supervision/

Milne, D. An empirical definition of clinical supervision, British Journal of Clinical Psychology. 2007.

Milne, D. Evidence-Based CBT Supervision: Principles and Practice (BPS Textbooks in Psychology) 2nd Edition. Wiley-Blackwell. 2017.

Morrison, T. The role of the scholar-facilitator in generating practice knowledge to inform and enhance the quality of relationship-based social work practice with children and families. Retrieved from eprints.hud.ac.uk. 2009.

Proctor, B. In Marken, M and Payne, M. Supervision: A co-operative exercise in accountability, in M. Marken and M. Enabling and Ensuring. Supervision in practice, Leicester: National Youth Bureau. 1987.

If you have any questions for My Family Psychologist, contact us or call us on 07801 079555 today and discover how we can help.

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