Introduction
This guide and Contract have been developed for qualified therapists to underpin their practice within all forms of Cognitive and/or Behavioural Therapy (CBT) clinical supervision. Other supervision contracts should be used for trainee therapists in conjunction with their Higher Education Institution.
We have provided a Supervision Contract Template which can be customised and edited can be used across all therapeutic contexts.
You may prefer to use the term “Supervision Agreement” as it emphasises the collaborative nature of the clinical supervision process. However, “Supervision contract” or “supervision agreement” can be used interchangeably to describe the systems, processes, models and content of supervision. Despite the formality of the document, the supervision process ought to be relaxed with an emphasis on individualised learning and high quality practice.
We have referred to the literature regarding supervision as a process to improve quality, prevent harm, interdisciplinary supervision and what makes supervision effective (Nelson et al., 2008; Tomlinson, 2015; Snowdon et al., 2017; Lee and Kealy, 2018; Rothwell et al., 2021). There is little research on the outcomes of supervisory practice, so expert professional opinion has been used when available.
We have also taken into account the views of people with personal experience of receiving CBT. Existing reviews that have found that many did not know that professional staff were supervised, with others being concerned that decisions might be made about them in supervision without their knowledge (Lambley and Marrable, 2013).
Definition of Supervision within this Guide
There are many definitions of supervision in the literature. We have used the following evidence based definition –
“The formal provision, by approved supervisors, of a relationship-based education and training that is work-focused, and which manages, supports, develops and evaluates the work of colleagues. It therefore differs from related activities, such as mentoring and therapy, by incorporating an evaluative component and by being obligatory.
The main methods that supervisors use are corrective feedback on the supervisee performance, teaching, and collaborative goal setting. The objectives of supervision are normative (e.g. encouraging emotional experience and processing) and formative (e.g. maintaining and facilitating the supervisees competence, capability and general effectiveness). These objectives could be measured by current instruments….” Milne (2009, p15-6).
Clinical supervision doesn’t include professional or caseload management.
Supervision relationship and practice
The cornerstone for the development of the supervisory relationship are the values that explicit in the Supervision Contract.
The supervision agreement can be a verbal agreement although we recommend a written document. It should record the discussions establishing how the supervisor and supervisee will work together and when reviews of the processes will take place.
Important considerations for the Supervision Contract
The use of supervision contracts has been recognised as an important approach within CBT Supervision (Townend, 2005). There are several potential benefits such as establishing clear expectations, explicit values and goals at the outset of a supervisory relationship (Amaro et al., 2020).
- An opportunity to establish the meaning of the term “CBT Supervision” and contextualise it within CBT.
- Clarification of the roles and responsibilities within CBT supervision for both the supervisee and supervisor.
- The establishment of the importance of the emotional impact and restorative function of CBT clinical supervision through support and the establishment of self-care practices.
- The establishment of the collaborative nature of CBT supervision and the importance of the supervisee(s) being an active participant in the process.
- Clarification for the involvement of service users in the CBT supervision process.
- Clarification and definition of the boundaries of the supervisory relationship, including confidentiality, documentation and communication systems with others who may have some other responsibility for the supervisee’s work.
- A forum for the promotion anti-oppressive and anti-discriminatory practice through exploration of the factors that might impact on the supervisory relationship and the psychotherapeutic work of the supervisee.
- Clarification of the models and methods of supervision that will be favoured.
- The establishment of how the relationship and supervision agreement will be reviewed and what the supervisee should do if they have any concerns about the quality of the supervision they are receiving.
- Clarification of the practical arrangements of CBT clinical supervision and any financial arrangements.
- Consideration of how the supervision arrangements will allow maintenance of accreditation eg. live supervision, marking of CTS-Rs etc, meeting Accreditation requirements, writing of Supervisor’s Reports.
Acknowledgements
Michael Townend 2023
References
Amaro, C. M. et al. (2020) ‘Clarifying supervision expectations: Construction of a clinical supervision contract as a didactic exercise for advanced graduate students’, Training and Education in Professional Psychology, 14(3), pp. 235–241. doi: 10.1037/tep0000273.
Lambley, S. and Marrable, T. (2013) ‘Practice enquiry into supervision in a variety of adult care settings where there are health and social care practitioners working together’, London: SCIE.
Lee, E. and Kealy, D. (2018) ‘Developing a Working Model of Cross-Cultural Supervision: A Competence- and Alliance-Based Framework’, Clinical Social Work Journal. Springer US, 46(4), pp. 310–320. doi: 10.1007/s10615-018-0683-4.
Michael V. Ellis (2017) Clinical Supervision Contract & Consent Statement and Supervisee Rights and Responsibilities, The Clinical Supervisor, 36:1, 145-159, DOI: 10.1080/07325223.2017.1321885
Milne, D. (2009). Evidence-based clinical supervision: Principles and practice. Blackwell Publishing; British Psychological Society. Oxford.
Nelson, M. L. et al. (2008) ‘Working With Conflict in Clinical Supervision: Wise Supervisors’ Perspectives’, Journal of Counseling Psychology, 55(2), pp. 172–184. doi: 10.1037/0022-0167.55.2.172.
Rothwell, C. et al. (2021) ‘Enablers and barriers to effective clinical supervision in the workplace: A rapid evidence review’, BMJ Open, 11(9), pp. 1–10. doi: 10.1136/bmjopen-2021-052929.
Snowdon, D. A., Leggat, S. G. and Taylor, N. F. (2017) ‘Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review’, BMC Health Services Research. BMC Health Services Research, 17(1), pp. 1–11. doi: 10.1186/s12913-017-2739-5.
Tomlinson, J. (2015) ‘Using clinical supervision to improve the quality and safety of patient care: A response to Berwick and Francis Career choice, professional education and development the Many Meanings of “Quality” in Healthcare: Interdisciplinary Perspectives’, BMC Medical Education. 15(1), pp. 1–8. doi: 10.1186/s12909-015-0324-3.
Townend, M. (2005). BABCP, Accrington.
