How can the process of clinical supervision be enhanced?
It is widely recognised regular supervision is useful for psychological practitioners to offer safe and effective services. Supervision provides relationship-based education and training that supports, manages, develops and evaluates the supervisee and their work.
The skilled supervisor fosters a relationship with a supervisee that allows for openness, reflection, creativity and support. Along with creating a safe space for doubts and concerns to be raised, the responsible supervisor also considers whether the supervisee is practising in clients’ best interests, and whether they are capable to conduct their duties (the normative, formative and restorative functions of supervision).
What is considered effective in supervision is based on consensus views about best practices; the evidence base for supervision is comparatively limited. There is scope for greater integration of theory and practice to develop more effective supervision (e.g., contemporary developments in CBT training and supervision).
I’m pleased to have a recent paper published which explores how to improve supervision, informed by developments in contextual behavioural science (CBS):
Morris, E. M., & Bilich‐Eric, L. (2017). A Framework to Support Experiential Learning and Psychological Flexibility in Supervision: SHAPE. Australian Psychologist, 52(2), 104-113.
The paper was written with my colleague, Linda Bilich-Eric, who works at the Australian National University. Linda and I work in similar posts on clinical psychology training courses, as supervisors for internal placements (university psychology clinics), where the focus is on developing trainees in their fundamental professional competencies. As contextual researchers we are interested in how psychological flexibility may contribute to enhancing these training experiences.
The SHAPE Framework
In the paper we identify five supervision components, based on CBS, that may enhance supervision sessions. Our interest is how these components may promote experiential learning and psychological flexibility for supervision in general, rather than being focused on a particular area of practise or mode of therapy.
We have called this framework SHAPE (an acronym of the components):
Supervision values – connecting supervision with personal values about professional practice may increase willingness to be open about experiences such as doubt and anxiety in the supervisory space. We appreciate that expressing values does add a level of vulnerability in supervision; we think an advantage for doing this is that it enhances rapport for the supervisor and supervisee, and to provides a way to assess whether supervision behaviours are serving their stated purposes.
Hold stories lightly – we think that supervision conversations can be judged as “ways of speaking” that may or may not progress the goals of supervision (improved client outcomes, development of competencies, providing safe and effective services). The story-telling process can be noticed and remarked upon during supervision, and judged in terms of goal progression (that have been contracted for supervision). Building in this reflective stance toward languaging can help the supervisee and supervisor to remain aware that the “stories” told in supervision may be told in other ways, and that formulations/conceptualizations are usually better judged by whether they are helping the client, not matter how intellectually elegant they may seem.
Analysis of function – we argue that supervision should focus on identifying functional relationships in supervisee/client interactions, and understanding the client’s problems by discovering contextual influences (that potentially be modifiable). We think there are at least three areas to consider for functional analysis: 1) the client’s presenting problems and life circumstances, 2) the therapeutic relationship, and 3) the supervisory relationship.
Perspective-taking – strengthening flexible perspective-taking is a process and outcome of supervision. This is done by taking different points of view (time, place and person), in ways that foster experiential knowing of an observing stance across experiences, judgements and actions.This may support the supervisee to be open, aware and engaged with the challenging material they are exposed to in the course of their work.
Experiential methods – the supervisor provides opportunities for experiential learning by inviting the supervisee to engage in methods such role-play, use of imagery and metaphor, mindfulness, defusion and values clarification. Exercises can be useful to shift the process of supervision, particularly on occasions when the session conversation is having a lifeless, uncreative or repetitive feel. Experiential exercises can assist the supervisee to come into contact with a variety of thoughts, feelings and sensations, and strengthen the process of learning at a “bodily felt level”.
We have drawn upon the literature on functional analysis, psychological flexibility and rule-governed behaviour to present ideas on how supervision may be improved. The SHAPE components link to best practices in supervision and a contemporary interest in promoting experiential learning; we hope that this framework will encourage research into supervision using a contextual lens.
The full paper can be accessed here [PDF].
In future posts I will discuss the SHAPE framework components in more detail, and share experiences of using SHAPE as a supervision approach.
We’re interested in your views. What makes for effective supervision? Does a focus on experiential learning strengthen the process?
Please feel free to comment and share your perspectives.