Supervision and Clinical Psychology

Theory, Practice and Perspectives

Ian Fleming, Linda Steen, Ian Fleming, Linda Steen

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135452636
• Edition: 1
• Topic: Psychologie
• Subtopic: Klinische Psychologie

Increased attention is now being paid to the role of supervision in both pre-qualification and post-qualification practice in clinical psychology in the UK. This definitive text addresses the issues of central concern to supervisors in clinical psychology. Senior trainers and clinicians draw on relevant research and their own experience, covering: * historical development of supervision and a review of worldwide literature on supervision
* supervisory and therapy models
* maximizing supervisory resources
* supervisory training and effectiveness
* cultural and gender issues in supervision
* measuring the effectiveness of supervision
* future perspectives for supervision in clinical psychology. Supervision and Clinical Psychology provides practical advice essential for clinical psychology supervisors, as well as those in psychiatry, social work and psychotherapy.

Chapter 1
Introduction
Ian Fleming and Linda Steen

The process of supervision like all human relationships is fraught with hazards.

(Dryden, 1991:69)

Supervision is held to be an essential requirement for learning and professional development, especially within professions working with other individuals. In their review of psychotherapeutic interventions, Roth and Fonagy (1996:373) conclude that supervision is ‘an essential prerequisite for the practice of psychotherapy’. Similarly Holloway and Neufeldt (1995:207) state that ‘supervision, as a psychotherapy training method is considered critical by educators…’

It is important and exciting to consider how people experience acting as a supervisor. What are the highs and lows? What causes excitement and anxiety? What are the intrinsic rewards? Also, how are these skills and attributes acquired and learned?

Some professions have mandatory requirements concerning all aspects of supervision. The British Association for Counselling and Psychotherapy (BACP, 2002), for example, requires all its members ‘to have regular and ongoing formal supervision/consultative support’. In midwifery, there has been a statutory requirement, since 1902, for practising midwives to receive regular supervision. As will be discussed below, whilst there is a growing recognition of the role of supervision in post-qualification practice in clinical psychology, at present there is no statutory requirement for clinical psychologists to receive supervision for their clinical work, once qualified.

What is supervision?

Before proceeding, it is important to consider what is meant by the term ‘supervision’. To supervise is to ‘oversee the actions or work of [a person]’ (The Concise Oxford Dictionary of Current English, 1990).

Within the literature on clinical supervision, the term ‘supervision’ has been interpreted and defined in numerous competing ways. Some professions have produced their own definitions of ‘supervision’. The United Kingdom Central Council (UKCC), the professional body for nursing in the UK, for example, states that ‘clinical supervision brings practitioners and skilled supervisors together to reflect on practice. Supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues’ (UKCC, 1996:3).

The British Association for Counselling and Psychotherapy (BACP) defines supervision as:

a formal arrangement for counsellors to discuss their work regularly with someone who is experienced in counselling and supervision. The task is to work together to ensure and develop the efficacy of the counsellor/ client relationship. The agenda will be the counselling work and feeling about that work, together with the supervisor’s reactions, comments and confrontations. Thus supervision is a process to maintain adequate standards of counselling and a method of consultancy to widen the horizons of an experienced practitioner.

(BACP, 1996:1)

One of the crucial elements of this definition is the idea that the role of supervision is to protect the best interests of the client.

As will be discussed later in the book, other definitions of supervision derive more from specific orientations to clinical practice or explicit models of supervision than from professional ethos.

The Division of Clinical Psychology (DCP) of the British Psychological Society (BPS), whilst recognizing the importance of supervision throughout a clinical psychologist’s career, stops short either of providing a definition or of endorsing any one particular model of supervision. The recently published DCP guidance on clinical supervision states: ‘there is no one model or style of supervision that will apply to all clinical psychologists in all settings and at all times in their career’ (BPS, 2003:2).

In the absence of an agreed definition of supervision within clinical psychology, one which seems to cover many of the relevant factors is that of Bernard and Goodyear:

An intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative, extends over time and has the simultaneous purposes of enhancing the professional functioning of the junior member(s), monitoring the quality of professional services offered to the clients that she, he or they see(s), and serving as a gatekeeper for those who are to enter the particular profession.

(Bernard and Goodyear, 1992:4)

This definition relates particularly well to supervision during pre-qualification training, referring as it does to ‘a senior member of the profession’, ‘junior members of that same profession’ and the functions of evaluation and gatekeeping ‘to enter the profession’. In view of the increasing recognition of the importance of post-qualification supervision within the profession, however, it is pertinent to consider how much of Bernard and Goodyear’s definition translates to this context, where there is likely to be a greater emphasis on peer and cross-professional supervision and where there is increased onus on the supervisee to be self-evaluative. These themes will be considered throughout the book and are drawn together in the final chapter.

Clinical psychology: the service context

Within clinical psychology in Britain, increased attention is being paid to the role of supervision in both pre-qualification training and post-qualification practice. The factors that have contributed to this are discussed later after an overview of the context in which the profession of clinical psychology operates in the UK.

It is pertinent at this time to examine these issues. Initially a small and possibly precocious profession within the National Health Service (NHS), clinical psychology has grown rapidly since 1980. The membership of the Division of Clinical Psychology (of the British Psychological Society) has grown from 966 in 1980 to 4,514 in 2001. In the past 30 years there has been an almost continuous growth in both the number of clinical psychology training programmes¹ (29 in the UK currently) and the number of clinical psychologists being trained (for example, up from 189 in 1993 to 390 in 2000 in England). To illustrate this point, the Manchester programme had an annual intake of nine people when we started in post as clinical tutors in 1994; the intake in 2002 was 21. This growth is expected to accelerate over the next few years on the back of manpower forecasts and identified roles for clinical psychology within the different National Service Frameworks in NHS planning (for example, DH, 1999).

Alongside expansion and increasing demand for clinical psychologists across all areas of the NHS, there is an increasing requirement for the scrutiny of clinical practice, most recently manifested in clinical governance (DH, 1998a).

This immediately raises the issue of the effectiveness of practice, and in turn of the role played in this by supervision. It also means that the training of people in the supervisory process needs to be examined.

Why another book about supervision?

There exists already an extensive and growing library devoted to supervision in the broadest sense, and a significant ‘stack’ to supervision in clinical professions in the mental health trade. Key texts include Bernard and Goodyear (1992), Watkins (1997b), Kadushin (1992), Hawkins and Shohet (1989, 2000) and Carroll (1996). Why, you might ask, should there be any reason, other than author vanity, for an additional text?

Our starting point for this book was the absence of any text dedicated specifically to supervision in clinical psychology in the UK. This is despite the requirement for all trainee clinical psychologists to receive supervision of clinical work on placements. This requirement has been in place for many years.

More recently it has been accompanied by recommendations for qualified practitioners to also undergo supervision as part of good practice and professional development. Both the Division of Clinical Psychology’s Professional Practice Guidelines (BPS, 1995b:9) and the DCP Guidelines for Clinical Psychology Services (BPS, 1998c:31) state that supervision should be organized for clinical psychologists at ‘all levels and grades of experience’. In a similar vein, the DCP Guidelines for Continuing Professional Development (DCP, 200la:8) acknowledge that ‘all qualified clinical psychologists whatever their level of experience should have access to and be prepared to make constructive use of some appropriate supervisory facility to support their work’.

This ‘gap’ in the literature became apparent to us when, as clinical tutors on the Manchester University Clinical Psychology (Clin.Psy.D.) programme, we began to organize training for people who would supervise the programme’s trainees. In the process of developing training for supervisors on the Manchester programme we became aware of some important issues. These are outlined below and support the value of the contribution that will be made by this book.

First, most of the books devoted to supervision within mental health professional practice are focused on counselling, social work and psychotherapy. Although much can be learned from this body of work, this book will be focusing on the particular concerns of clinical psychologists. The forms of supervision that have developed within clinical psychology, and their relationships to the psychological models that make up the dominant practice of clinical psychology in the UK, will be examined within the book.

Second, it seemed to us then that there was a need to document the experience of supervision in clinical psychology within the National Health Service. This would not be opposed to that mentioned above, but would complement it. In the process of finding out what was happening, clinical psychologists could be both consulted and informed.

Third, much, but not all, of the existing literature is from North America. Whilst we are at pains to deny any parochialism, we feel that there are limitations to how much this work will generalize to working in the National Health Service in the UK. Therefore this book will have a UK focus. This is certainly not for narrow chauvinistic or parochial reasons but because the majority of clinical psychologists in the UK work in the National Health Service and we wish the book to reflect the common constraints and opportunities for supervision within the particular culture of this system. It can be argued that the NHS, through its dominant funding position for clinical psychology training in the UK, is the profession’s sponsor; therefore national directives about practice within the general NHS will affect clinical psychology practice and professional development. The editors are unsure, however, as to how generalizable is much of the experience derived from other organizations of health care.

Supervision and clinical psychology: a growing relationship

As mentioned earlier, the importance of, and requirements for, supervision varies across different health and social welfare professions. It is fair to say that only in recent years has it been accorded significance within mainstream clinical psychology.

In recent years, professional bodies representing clinical psychologists in the UK have placed increasing emphasis on continuing professional development and the role that supervision can play in this. In part this has been a response to public concerns and a perceived need to demonstrate the requirements for professionalism. This has been augmented by concerns and initiatives at a government level for a public health service, actuated in demands for clinical governance.

With the planned introduction of statutory registration for all applied psychologists in the UK, the importance of supervision within the profession is likely to increase further.

What will the reader gain from the book?

Supervision and supervisor training usually require objectives and goals so, for the sake of consistency, we include some here.

It is hoped first that the reader will be excited by the possibilities contained within supervision. This book provides a collection in one work of chapters on important aspects of supervision written by leading practitioners and trainers, all of whom have been chosen for their experience in the field of supervision.

A second aspiration is that readers will gain knowledge about the most developed forms of practice in the UK and adapt these to their own practice.

Third, the book as a whole is intended to help ease the concerns of clinicians with respect to continuing professional development (CPD). It is intended that the book will help the reader to clarify the links between supervision, CPD and clinical governance as the last takes root within the NHS. The relevance of supervision to practise will be addressed. It is also hoped that readers will recognize the value to their practice of supervising.

A fourth goal involves those concerned in the organization of clinical psychology pre-qualification training. If successful in one of its objectives this book will act as a useful source for considering training issues. By design, contributors to this book are senior members of doctoral training programme teams.

Fifth, it is hoped that this book will enable readers to decide whether they need to have and use an explicit model of supervision in order to practise effectively both as a supervisor and as a clinician.

Sixth, it is hoped that the reader will be alerted to the important ways in which individuals’ social and cultural history and features and their gender influence their supervision.

A final aspiration i...