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Guidance for the Delivery of Remote Supervision

Introduction

These guidelines have been developed in light of the recent Covid-19 pandemic and a recognition that many supervisors and supervisees are now using remote supervision for the first time.

Some supervisors will have been offering supervision via telephone or video platforms for many years. These guidelines have been developed primarily as a resource for supervisors and supervisees who are new to this way of working but we hope that experienced practitioners will also find them helpful.

In these guidelines we refer to remote supervision and virtual learning environments (VLEs) interchangeably. Both are used to describe individual and group supervision provided through a telephone or a video call platform.

This document provides interim guidance and will be updated once we have had the opportunity to appraise the rapidly changing situation and have received feedback from supervisors and supervisees on the needs arising from working in this way.

General principles

Increasing numbers of therapists are receiving and delivering supervision remotely, through choice or of necessity. Whilst working remotely can raise dilemmas that may need some initial problem-solving, the supervisory components of teaching, reflection, the Socratic exploration of dilemmas and the provision of good quality, evidence-based therapy still apply.

Where remote supervision is offered and received as part of independent practice it will be important to ensure that those commissioning your services recognise remote supervision as legitimate and that your insurance policy will continue to indemnify you.

If you are working within a service, make sure that you check any guidelines for remote supervision that have been developed and which should be followed.

Frequency of supervision

At a time of considerable pressure on service delivery, it may be tempting for services to reduce access to supervision. However, the BABCP strongly advises against this. Given the additional cognitive and emotional labour involved in a move to remote therapy and reduced access to the supportive processes that team membership provides, supervision may actually need to increase.

Isolation is also likely to place additional strains on therapists and supervision is one important way to manage the effects of this. With this in mind, supervision is likely to benefit from a greater consideration of how supervisees are coping generally and any environmental and family demands they may be managing.

It is likely that during the acute phase of the response to the COVID-19 pandemic, supervision will need to augment the focus on outcomes and skills development with additional consideration of the emotional wellbeing of the supervisee and the restorative aspects of supervision. In order to do this effectively, contact between supervisor and supervisee may need to be more frequent than was previously the case.

For the purposes of working towards accreditation, the BABCP recognises VLEs as an acceptable method of supervision delivery.

Competence and good practice

As with all practice, follow the BABCP Standards of Conduct, Performance and Ethics:

www.babcp.com/files/About/BABCP-Standards-of-Conduct-Performance-and-Ethics-0917.pdf

And the principles of General Data Protection Regulations (2018):

http://gdpr-legislation.co.uk/principles

These have recently benefited from clarification in the light of the COVID-19 pandemic:

www.nhsx.nhs.uk/key-information-and-tools/information-governance-guidance/health-care-professionals

The BABCP has already published detailed guidelines for delivering therapy remotely which can be found below:

www.babcp.com/Therapists/Remote-Therapy-Provision.aspx

Contracting and boundaries

Whichever platform you are using for remote supervision be sure that your supervisee is comfortable using this method. Have a discussion about this. You might want to consider whether one or both of you wish to audio or video record the supervision; if so, this should be specified at the beginning of such sessions and the purpose of recording specified (e.g. self-reflection, supervision of supervision) along with erasure policy.

Consider reviewing your supervision contract so that it reflects any changes that virtual working will bring. Include an agreement about how supervision will be documented. This may be the same as for face to face supervision but making this explicit will be helpful.

Be clear about the purpose of supervision and whether it is part of an accreditation process. BABCP has produced guidelines for therapists working towards accreditation during the pandemic that will be useful to keep in mind.

It is important that both of you have access to a safe, private and confidential space that is free of distractions and noises.

During supervision, focus solely on the task in hand and avoid any temptation to multitask. It might be useful to place potential distractions out of reach for the duration of the supervision. Use agenda setting to help with this.

Be clear about the usual boundaries of supervision session in terms of starting on time, meeting for the agreed time and not taking other calls whilst you are working together.

Make sure you have an alternative way to contact each other (e.g. email or an alternative phone number) if the video call stalls or if you lose reception on a phone call.

It is important to follow current guidance for good supervision available:

www.babcp.com/Accreditation/Supervision.aspx

Setting up remote supervision

Don’t assume that supervision needs to be an entirely different experience when moving from a face to face to a virtual platform. The functions of CBT supervision remain the same as do the processes, methods and fundamental principles. For example, whatever platform is used, creating a context for learning that is experienced as safe, supportive, based on mutual respect and organised around a clearly defined learning agenda is crucial.

Using a VLE does introduce some differences. It is important, therefore, to consider and discuss the impact of the platform used on the delivery and experience of supervision and try to anticipate any adjustments that will be needed.

Make sure you feel competent in the medium of supervision you are offering. If you are new to a particular platform take time to familiarise yourself with it before you begin to offer supervision. It may be more helpful to start with a platform you are familiar with whilst you are developing remote supervision skills, providing that it meets data protection requirements (see below).

If you haven’t provided remote supervision before, you could practice using the platform with a friend or family member first. Allow extra time before a session to log on if you are less familiar with the technology.

Choosing a video platform

If you decide to use video calls, select your platform carefully. Things to consider include whether the platform is end to end encrypted, whether video sessions are recorded, and where they stored. Who owns any recordings made? Some video platforms record sessions and use them in an anonymised form for big data collection.

For greater security video links that are part of a paid for service are usually better. Some services have higher levels of security. We don’t endorse any particular platform but ones worth looking into may include Doxy, Zoom Pro, VSee, Skype for Business, and Microsoft Teams. As far as possible, follow your host organisations’ recommendations.

The storage of materials is particularly important if you are listening to or looking at live therapy material as part of the supervision as protecting client confidentiality is of paramount importance. It is important to ensure the security of the video platform prior to use of live materials.

Modifying supervisory methods

During remote supervision it can be useful to pay extra attention to the principles of active listening, regular summarising and checking your understanding.

You might be used to drawing out formulations in the room with your supervisee. When using a VLE, alternatives could include sending formulation diagrams in advance of the session, taking a photo during the session and emailing it, or using a work phone to text an image. Some video platforms also have features that enable you to share documents as part of the conversation, or share screens.

Remote supervision provides an excellent opportunity for skills practice when supervisees are learning how to deliver therapy using a VLE. Role playing skills that supervisees plan to use in therapy provides an excellent opportunity for experiential learning that can prepare therapists for this new way of working.

Supervisors can also model and encourage greater willingness to express doubt and uncertainty in what may be an unfamiliar and challenging working environment. Supervisees who are comfortable with this are more likely to feel confident about expressing difficulties that supervision can address. In this way, remote supervision can provide a gateway to a form of reflective learning that can strengthen the bond between supervisor and supervisee and the effectiveness of the learning experience provided.

The use of live materials

BABCP guidelines on accreditation and supervision are clear about the importance of live materials (audio or video recordings) in supervision. Initially recording remote therapy may be difficult and will need specific guidance from services who are likely to be busy negotiating other more pressing matters. Obtaining written consent for this from patients may also be more challenging with remote therapy. If not possible, try to get verbal consent as part of the recording.

Some services have decided to use video recordings, stored on military grade encrypted data sticks where both the supervisee and supervisor have the access code. These are posted to the supervisor in advance of supervision so that they can be viewed whilst remote supervision is ongoing. Over time, some video call platforms may emerge that can also manage this process to a standard that services find acceptable.

Different supervision contexts

These guidelines are written with existing supervisory relationships in mind. However, the principles will also be applicable to new supervisory relationships which may need to be developed as services take on new trainees or members of staff, and where existing supervisors become unavailable due to illness. Where a supervisory relationship is new, particular care should be taken to establish the necessary confidence and trust in the supervisor’s personal qualities and therapeutic skills that will be essential for making the relationship work.

As with face to face working, remote supervision is a collaborative process and both participants are responsible for its success. Supervisees can contribute to this process by reading appropriate material on remote therapy provision, accessing other CPD on this topic and ensuring that they bring specific questions to supervision.

Although the guidance above refers primarily to supervision provided to an individual, it is equally applicable to group supervision. Remote group supervision may bring additional challenges (as well as opportunities) in terms of managing the interactions and turn taking. Depending on confidence, prior experience and what current circumstances allow, it may be useful to develop skills in individual supervision before progressing to offering group supervision.

As with all forms of supervision, it is important that supervisors seek feedback from supervisees in order to improve their practice. Supervisors can increase the likelihood of getting useful feedback by emphasising that this is a learning curve for themselves as well and that the best way that they can improve their skills in this area is to get honest feedback.

As part of their own learning and development, it is also important for supervisors to consider opportunities for supervision of their supervision, especially if they are unfamiliar with working in VLEs.

Other helpful resources

NHS guidance on digital working

https://www.nhsx.nhs.uk/key-information-and-tools/
information-governance-guidance?fbclid=IwAR0A2wPDbu9gY9XNN8aSIOoMpED6vtAltH7q_5LQMpEk4aI_PrVn_LtBrjI

Guidance on remote working with trauma

https://www.dropbox.com/s/abgwokufn0d67hv/Guidance%20for%20PTSD%20Remote
%20Working%2018MAR%20FINAL.pdf?dl=0

Let’s Talk About CBT podcast – Coping with anxiety about coronavirus

http://letstalkaboutcbt.libsyn.com/coping-with-anxiety-about-coronavirus

BABCP guidance on remote working

https://www.babcp.com/Therapists/Remote-Therapy-Provision.aspx

NHS digital guidance

https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-governance/information-governance-alliance-iga/information-governance-resources/information-governance-and-technology-resources

Please note that additional guidance is being prepared on specific presentations and interventions, and these will be shared with members as soon as they are available.

Summary

  • The key elements of effective clinical supervision remain the same regardless of whether it is delivered face-to-face or remotely.
  • The current situation with the Covid-19 pandemic may mean that particular attention needs to be paid to the restorative function of supervision.
  • Remote supervision provides some excellent opportunities, e.g. role-playing the same skills that are being used in remote therapy.
  • Live supervision remains important but must be used via secure video platforms.
  • Changing to remote provision of supervision is an ideal time to review the supervision contract to take into account any changes that are needed.

This resource has been compiled by Dr Andrew Beck, President Elect, and Professor Sarah Corrie, Chair of the Course Accreditation Committee and includes advice from Mark Latham (Supervision SIG), Helen Macdonald (Chief Accreditation Officer) and Paul Salkovskis (President).

Published 31 March 2020