Supervision Guide

‌Overview of Supervision and Assessment of Clinical Practice

Supervision

If you are a Cohort 14 trainee, please see the Supervision Guide 2021.

As part of the programme you will receive two hours of university-based group supervision a week, which will be held either at 10.30am - 12.30pm on Tuesday mornings or at 2.30pm – 4.30pm on Tuesday afternoons in Terms 1 & 2 and on Tuesday morning 11am - 1pm or Tuesday afternoon 3 - 5pm in Term 3. You will also receive regular individual supervision from your workplace supervisor. Over the course of the year you need to have received a minimum of 70 hours of supervision and 200 hours of supervised CBT practice.

Please note that when calculating your supervision hours for your Clinical Portfolio, it is recognised that time spent in group supervision offers greater value than simply calculating the time spent on an individual’s case, and dividing the overall time spent in the group by the number of participants.

The BABCP recommends using the following two calculations:

1: Time spent discussing a particular case in group supervision is multiplied by two.
For example, if there are three participants in a two-hour group, 30 minutes might be spent discussing each case.

30 minutes x 2 = 60 minutes’ equivalent case supervision time.

This calculation should be used for the ‘Client Summary Sheet’ and also on the ‘Overall Summary Sheet’. (see Clinical Portfolio webpages).

2: Overall group clinical supervision equivalent time is calculated in the following way:

The time spent in the group is divided by the number of participants in the group, and this time is then doubled.
For example, if there are 3 participants in the group, and the group meets for two hours; the formula would be

2 hours divided by 3 people = 40 minutes x 2 = 1 hour 20mins equivalent group supervision time.

This calculation should be used for the ‘Supervision Log’. (see Clinical Portfolio webpages).

(see Clinical Portfolio webpages).

By the end of the course, you need to have seen at least 8 completed cases (seen for 5 sessions or more from start to completion/termination of treatment) and have received 5 hours minimum of supervision, from a supervisor who is a BABCP accredited therapist, on each of these cases.  The University will provide the supervision for up to 3 of these cases and there should be a focus on one client per term.

3 of these 8 cases must be closely supervised.  This means they will need to have been formally assessed using video or live practice observation of your clinical sessions and assessed by the university to be to a reasonable standard of CBT competency in accordance with the Cognitive Therapy Scale – Revised (CTS-R). There will be a Formative CTS-R assessment of your CBT competencies in Assessment & Formulation skills at the end of term 1. There will a Summative CTS-R assessment of a full therapy session demonstrating CBT competencies at the end of Term 2, the middle of Term 3 and at the end of Term 3.  1 of the 3 closely supervised cases must be a client with PTSD.

Your Supervisors

University - there will be a rotation of University Supervisors so that you will have one supervisor for Term 1 and another Supervisor for the duration of Terms 2 & 3. Your University Supervisor will provide you with intensive skills-based supervision, helping to develop your CBT competencies.  They will supervise up to 3 clients over the year. 

Workplace - your workplace based supervision will involve skills-based and caseload supervision.  The workplace supervisor will hold an overview of all your clinical cases.  They will also support you in applying CBT theory to your cases and will be able to support you in working in your clinical setting and dealing with clinical issues such as risk. 

Both University and Workplace supervisors will be providing a dual function in their role as supervisor. They will facilitate your development as Cognitive Behavioural Therapists through skills-based supervision. They will also assess your competency as a CBT therapist via CTS-R assessment and provide Supervisor Reports at the end of each term (see Supervisor Report for details of competencies being assessed). They will be offered training in the requirements of supervision and the clinical assessment associated with the programme and will also be offered ongoing continued professional development (CPD) in CBT supervision. 

Both your Workplace and University based clinical supervisors will liaise about your progress at least once per term. They are requested to attend the Leads and Supervisors Meeting held at the university each term and may liaise again around the time of preparing your Supervisor Reports.

We have provided a supervision contract for you and both your supervisors to work through during your initial meetings to help you discuss and agree the nature and content of your supervision (see Supervision Contract).  This will form the Supervision Contract between yourself, University Supervisor and Workplace Supervisor. You are responsible for ensuring the contract is completed, signed and presented in your clinical portfolio.

Supervision Feedback

We have provided the Helpful Aspects of Supervision Questionnaire (HASQ, Milne 2008) supervisee feedback form on supervision which can be a useful tool to help you review supervision with your supervisor. During each term we ask you to provide feedback to your supervisor by using the Supervisory Relationship Questionnaire (SRQ, Palomo et al 2010). At the end of each term, we ask you to provide feedback on your experience of supervision for that term on Accelerate. If you have any concerns about your cases or supervision please do raise these with your supervisors in the first instance.

Your Role as Supervisee

In addition to filling in the clinical and supervision logs and reports, you will also need to think about your role as a supervisee.  This will include coming prepared for your supervision (see Supervision preparation form and Supervision template); preparing a Supervision Question; reviewing recordings of sessions in advance and locating the section of the recording that relates to the Supervision Question, supervision goal/CBT skill you are wanting to develop; keeping notes on discussions in supervision and carrying through jointly agreed action points (see Record of supervision).  In addition to preparation time during the week, you will have 1 hour dedicated to supervision preparation prior to your supervision session each week, from either 9.30 - 10.30am for morning supervision groups and 1.30 – 2.30pm for afternoon supervision groups (10 - 11am and 2-3pm in Term 3).  Consent to record forms for clinical and supervision sessions are included below.

In order to develop a reflective approach to the work you carry out and link theory, practice and supervision, a Reflective Practice log can be used to aid you in this process. Additionally, this may help you when writing your Case Reports and CTS-R Reflections (see course handbook) as you will have ongoing records of learning experiences from teaching, SP/SR blogs, your clinical work and your discussions/experience in supervision.

Assessment of Clinical Practice

Supervision Reports
At the end of terms 1 and 2 both university and workplace supervisors will complete formative supervisor’s reports. You will need to submit these at the end of terms 1 and 2. You must submit your supervisor reports via PDF document via Turnitin. Please note that all supervisors reports must be hand-signed and you should keep the original copies of your reports.

Clinical Portfolio
At the end of the course each programme member is required to submit a clinical portfolio (See Clinical Portfolio Handbook) which will include: your supervision contract, Summative University and Workplace Supervisors' Reports and Supervision Logs.

Guidance on the use of Supervision

In order to ensure that you make the most effective use of supervision we suggest you read this guide and the criteria included within the supervisors’ reports. In addition we have included below some suggested content of supervision and supervision methods and topics. Please also see the suggested plan for supervision sessions over the course above.

Content of supervision

• Content of supervision will focus on acquisition of knowledge, conceptualisation and clinical skills within a cognitive behavioural model(s). 
• Associated issues will also be discussed when it is relevant to do so e.g.  medication, hospitalisation, case management. 
• Identification (and collaborative change of these if appropriate) of supervisee thoughts, attitudes, beliefs and values and the impact of these on therapeutic and professional behaviour. 
• Discussion and working through relationship and process aspects of supervision. 

Supervision methods and topics

• Discussion of therapeutic relationship and engagement issues. 
• Case conceptualisation/formulation. 
• Rehearsal of therapeutic techniques e.g.  simulation, role-play. 
• Discussion about therapeutic strategies. 
• Case Presentations. 
• Homework. 
• Review of video recordings
• Direct observation of practice 
• Identification of supervisee thoughts, attitudes, beliefs with exploration of the impact of these on therapeutic and professional behaviour. 
• Review of risk and therapist/service user safety. 
• Review of clinical guidelines/manuals/protocols. 
• Review of psychoeducational material. 
• Experiential exercises. 
• Reflective practice
• Other strategies as agreed.

Formative Supervision Reports - Terms 1 and 2

To assist with assessment of your ability to use supervision and your competence, strengths and areas for improvement, the adapted Dreyfus scale (1989), as used with the CTS-R (2001), will be used as a guide to facilitate feedback on competency.

Incompetent: The therapist commits errors and displays poor and unacceptable behaviour, leading to negative therapeutic consequences.
Novice: At this level the therapist displays a rigid adherence to taught rules and is unable to take account of situational factors. He/she is not yet showing any discretionary judgement.
Advanced Beginner: The therapist treats all aspects of the task separately and gives equal importance to them. There is evidence of situational perspective and discretionary judgement.
Competent: The therapist is able to see the tasks linked within a conceptual framework. He/she makes plans within this framework and uses standardised and routinised procedures.
Proficient: The therapist sees the patient's problems holistically, prioritises tasks and is able to make quick decisions. The therapist is clearly skilled and able.
Expert: The therapist no longer uses rules, guidelines or maxims. He/she has deep tacit understanding of the issues and is able to use novel problem solving techniques. The skills are demonstrated even in the face of difficulties (e.g. excessive avoidance).

SUMMATIVE SUPERVISOR REPORT

CBT Supervision indicators to help the supervisor reflect and comment on each aspect of supervision before marking each section on the report  as ‘Satisfactory’ or ‘Unsatisfactory’.

Ability to use supervision          
Please comment on the trainee’s ability to use supervision and the supervisory relationship

Please consider the following in relation to the trainee’s skills & attitudes in relation to supervision:

• Attendance – regular/punctual?
• Completed supervision contract?
• Able to present material in an accessible way – to the supervisor & other supervisees
• To give a clear presentation of the client, to enable the group to gain a clear understanding of the clients presenting difficulties
• Demonstrate preparation for supervision: selected section of a recording/supervision question that relates to this
• Appropriate supervision question – reflecting relevant clinical issues & relevant to trainees learning
• Openness to feedback from the group
• Demonstrate ability to reflect on & learn from action points
• Ability to implement action points into clinical work & demonstrate this in the following supervision
• Ability to participate fully in the group supervision process and demonstrate professional practice within this setting – including: listening skills, respect of others in the group, showing empathy to others in the group & providing constructive criticism
• To demonstrate self awareness: ability to recognise own thoughts, feelings, assumptions, beliefs and potential impact on the therapeutic an supervisory relationship
• Use of relevant paperwork prior to & during supervision
• Able to follow up on any homework tasks set from supervision e.g. reading up on a specific model
• Learning in supervision reflect trainees goals in their supervision contract

Areas of competency/strengths

Please comment on the following areas:

Assessment and formulation       

Please comment on the trainee’s ability to:

• Identify key areas for assessment in a cognitive behavioural context
• Organise assessment detail according to diagnostic criteria
• Demonstrate an understanding of the relationship between assessment & formulation
• Ability to complete ‘hot cross bun’/maintenance formulation
• Ability to complete a developmental/longitudinal formulation & access the relevant information from the client
• Conduct a thorough risk assessment – with appropriate follow up
• Demonstrate use of generic and problem-specific clinical measures
• Able to collaboratively agree SMART goals – reflected in the formulation
• Consider engagement issues and therapeutic alliance
• Awareness of any potential difficulties that may arise, e.g. literacy, communication difficulties
• Have an understanding of the clients suitability for CBT, within the service that they are able to offer

Use of theory     

In order to help supervisors assess the ability of the trainee to appropriately apply theory to practice, whilst also appropriately deviating from protocol when necessary, it is suggested that the following questions could help structure the assessment of this:

• Which model have you used/is informing your practice?
• What is the rationale for your choice of model?
• How do your interventions relate to this model and your client’s goals for treatment?
• What is your rationale for the interventions?

It needs to be clear that trainees are applying their learning from the course direct into their clinical work and not ‘relying on’, or ‘resorting to’ using existing skills, or skills from another form of intervention.

Also, as appropriate, asking trainees to do HW on the theory that they are using with their clients and bringing this to supervision to discuss in relation to their client and to share with peers.

Techniques and skills                   

Please comment on the following:

• The trainees ability to select appropriate intervention, relevant to the model and stage of therapy
• The trainee’s ability to be flexible in the use of a range of both cognitive & behavioural techniques used/observed, e.g. DTR’s, BE’s, ERP, Positive data log, etc.
• Demonstrate a creativity with the use of techniques
• Implementation of techniques appropriate to the clients goals for therapy
• The trainees ability to demonstrate a range of skills used/observed in the process of therapy, e.g. agenda setting, negotiating homework

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