Northumbria Research Link

1 Northumbria Research LinkCitation: james , Ian, milne , Derek, Marie-Blackburn, Ivy and Armstrong, Peter (2007) Conducting Successful Supervision: Novel Elements Towards an Integrative Approach. Behavioural and Cognitive Psychotherapy, 35 (2). pp. 191-200. ISSN 1352-4658 Published by: Cambridge University PressURL: < >This version was downloaded from Northumbria Research link : University has developed Northumbria Research link (NRL) to enable users to access the University s Research output. Copyright and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal Research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page.

2 The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: i This document may differ from the final, published version of the Research and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the Research , please visit the publisher s website (a subscription may be required.) Behavioural and Cognitive Psychotherapy, 2006, 35, 191 200 Printed in the United KingdomFirst published online 15 November 2006 Successful Supervision: Novel Elements Towardsan Integrative ApproachIan Andrew James3Ns Mental Health NHS Trust and University of Newcastle upon Tyne, UKDerek MilneUniversity of Newcastle upon Tyne, UKIvy Marie-BlackburnUniversity of Northumbria in Newcastle, UKPeter ArmstrongNewcastle Cognitive and Behavioural Therapies Centre, recent years that has been an increasing interest in supervision within the UK scognitive behaviour therapy (CBT) community.

3 This is because the role of supervision hasbegun to be recognized in relation to the delivery of effective clinical services (Department ofHealth, 1998), and because of a clear recognition of the need to ensure that CBT practitionersare competent. Perhaps less well recognized in CBT are a number of interesting educationalapproaches to supervision, ones that may make supervision more successful. This papersummarizes some of these theories from a CBT perspective. Whilst the evidence base does notyet justify being too prescriptive, it is argued that some of these theories, such as Vygotsky snotion of the Zone of Proximal Development , provide helpful prompts for reflecting on CBTsupervision. An integrative model is constructed from these theories, with illustrative examplesand suggestions for future :Supervision, zone of proximal development, integrative consequence of the success of CBT is the need to ensure that practitioners are properlysupervised.

4 As noted recently, Poorly trained, poorly supervised and badly managed therapistsReprint requests to Ian Andrew james , Consultant Clinical Psychologist, Centre for the Health of the Elderly,Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK. E-mail: 2006 British Association for Behavioural and Cognitive Psychotherapies192I. A. james et at best ineffectual and at worst dangerous (Holland, 2006, p. 1). Department ofHealth policy reflects this emphasis on staff development: ..we need to improve levelsof investment in training and education, to improve access to effectivetreatments (Department of Health, 1998, p. 46 47). Clinicians and researchers have respondedto these calls and there are now helpful guides to good supervision within the BABCP ( , 2005; Townend, 2004), within CBT ( Liese and Beck, 1997), and within the vastliterature on supervision (Watkins, 1997).

5 These accounts tend to be restricted to one ortwo theoretical perspectives and often argue for the superiority of the presented approach. Bycontrast, this paper offers a wide-ranging and theoretical overview, with the aim of encouragingreflection. However, in common with much of the literature, our emphasis is on the role oflearning and of knowledge acquisition in particular ( a formative emphasis Proctor,1986). We have selected this formative aspect in order to keep this review focused, and becauseit provides the most accessible insights from the different theoretical perspectives thought mostrelevant to CBT. As such, some of the broader aspects of supervision are not addressed here,including developmental and ethical issues and styles of supervision. For a fuller account ofsuch aspects the reader may wish to consult more comprehensive accounts ( Fleming andSteen, 2005; Watkins, 1997).

6 The work adopts a sequential approach to the question of how we might promote successfullearning within supervision. This starts with the assessment of learning needs and then goeson to examine how we might establish a baseline, work at the right developmental level, applysupervisory techniques to enhance competence, and evaluate our progress. For each of thesesteps we introduce at least one theory from the wider educational and training literature, thusoffering a relatively unfamiliar perspective on CBT supervision. In total, seven theories areput forward, with a note on their critical elements and potential contributions (see Table 1). Anillustrative, case study version of the present article is provided in a companion paper, whichattempts to demonstrate the fusion between the theoretical aspects described here ( james , milne and Morse, submitted) and the practicalities of successful supervision.

7 We start thistheoretical overview with step one of effective supervision, the assessment of learning needs(Goldstein, 1993).Step 1: Assessing learning needsAccording to Hogan and Pressley (1997), learning occurs when information is integrated intoa learner s existing knowledge base. Indeed, it appears that all learning is actually re-learning(Bransford, Brown and Cocking, 2000): the contemporary view of learning is that peopleconstruct new knowledge and understanding based on what they already know and believe (p. 10). These authors argue that this makes paying attention to what the supervisee brings tosupervision a sensible first step. With respect to most advanced CBT courses, supervisees cometo supervision with a comprehensive history of training and a wide variety of professionalcompetencies (clinical, management, Research ).

8 Hence, it makes sense for the supervisor tospend time assessing the supervisee s experiences and background early on in the supervisoryrelationship. Indeed, only the myopic supervisor ignores the supervisee s history and learningcontext. Thus, when planning a programme of learning, a well-established principle is thatthe learning should be matched to the supervisees educational needs (partly as a result ofhis/her history and the existing competencies) and learning context (the learning opportunitiesConducting successful supervision193 Table theories of supervision, key concepts and contributionsTheoryKey conceptsPotential contribution tosuccessful supervision1. Newcastle CakeStand Model(NCSM). Armstrongand Freeston, 2006).Four related tiers: primaryinputs, parameter settings,dynamic focus and learningprocess (see text for furtherexplanation).

9 Places supervision in its richcontext and details thecomponent and structuralfeatures of supervision, including who brings what to thesession. Aids the establishmentof the learning Zone of ProximalDevelopment (ZPD,Vygotsky, 1978)A learning zone is defined byestablishing a currentcompetence baseline and thenan optimal goal attainmentprofile, which clarifies thesupervisee s potentialdevelopment by the end of thelearning what the superviseebrings to the learning situation,fostering the supervisionalliance; defines personalizedgoals; focuses supervision on therequired assistance from thesupervisor ( social support).Recognizes set backs and deskilling in the learningprocess3. Summary ofsupervision skills( milne and james ,2000; milne et al.,2002)List of 13 supervisory techniques,defined in observable cognitive ( ) and behavioural( guiding experientiallearning) and affect-regulatingtechniques ( managing).

10 Competent supervision can bedefined, measured, justified,trained by reference to theapplied literature on learning andleadership (including therapy,teaching and coaching).4. Experiential learning(Kolb, 1984)The model outlines 4 modes oflearning: experiencing,reflecting, planning, andconceptualizing. Significantlearning requires that a learneruses all of the 4 modes in orderto achieve often have preferredmodes of learning ( reflection rather thanexperiencing (role play). Thusthere may be a tension betweenthe use of the 4 different , supervisor needs torecognize that successfulsupervision can beuncomfortable ( challengingthe supervisee s preferredapproach).5. Tandem Model( milne and james ,2005)A number of supervision theoriescan be construed by drawinganalogy that supervision is likeriding a tandem cycle. Thispictorial model of supervisionhighlights 7 axioms, includingthe importance of thesupervisory relationship andmutual learning a simple and concreteaccount of the essential elementsof successful supervisionoperating as a dynamic integrative andevidence-based explanation ofhow supervision works(moderators, mediators andmechanisms).)