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In this series of blog posts, Blue Cabin’s therapeutic supervisors, Matt Stalker and Louise Wicks, and associate artist Elena Miller discuss supervision in the context of creative practice.
All of Blue Cabin’s associate artists benefit from supervision with Matt and Louise, helping the artists to maintain their own wellbeing as practitioners working in therapeutic roles.
In this first of three posts, Matt sets out the principles and practices of clinical supervision within the field of cognitive behavioural therapy (CBT) guided by a theoretical model developed in Newcastle.
Supervision is a relationship-based education (Milne, 2009) between a practitioner and a supervisor, which aims to enable practitioners to develop ‘superior vision’ – literally, to see themselves and their practice more clearly.
Supervision has three main functions: formative (developmental), normative (benchmarking/maintaining standards) and restorative (emotionally supportive).
It is regarded as a fundamental pillar of safe and effective and efficient practice in health and social work.
There is currently no single accepted model of supervision, though numerous models exist (Watkins, 2011).
The Newcastle Cakestand Model (NCSM, Freeston & Armstrong, 2006) is one such model. It was developed by expert consensus in a specialist NHS service in 2001 to conceptualise the structures and processes that support effective supervision in CBT.
The NCSM emphasises the importance of beginning by establishing the needs of the supervisee. The model proposes that considering intersections between their role, relevant prior experiences and current training status, their practitioner self (e.g. culture, values, attitudes towards their practice), the people they work with, and the context in which their work is undertaken all help to identify supervisory needs.
The curiosity and collaboration required for this initial needs analysis also helps to build the supervisory relationship, or ‘working alliance’, and helps the supervisor and supervisee agree goals and tasks.
Whilst there is almost no research literature proving that supervision directly improves outcomes for clients (see Watkins, 2020 for review), there is evidence that highlights the vital importance of the working alliance, particularly with regards to the formative aspects of supervision (e.g. Bradley et al., 2021), and showing that failures in the development and maintenance of it contribute to dissatisfactory and even harmful supervision (e.g. Vekaria, et al. 2023).
Having established the initial alliance, the NCSM then promotes its development through sessions focused on the practitioner’s work, which follow the structure and goal-directness of CBT (e.g. having an agenda for the session, identifying supervision questions to address). These sessions also use a variety of learning activities to facilitate experiential learning (Kolb, 1984).
Supervisors and supervisees can be based in different services or working contexts, and supervision can work across professional boundaries (Milne, 2009); however, the supervision will typically focus on the roles both the supervisor and supervisee practice. For example, a general nurse involved in delivering a CBT-informed wellbeing group for cardiac patients may be supervised by a psychotherapist on this aspect of their work, but would receive supervision on their nursing practice from another nurse.
This overlap in professional roles between supervisor and supervisee typically ensures there is a shared language, and a shared understanding of the roles and their functions in terms of outcomes.
This alignment is imperative if the supervisee’s needs relate to the development or maintenance of specialist technical skills.
In CBT supervision, the supervisor guides the supervisee to first identify a question linked to their recent practice, to think of a concrete example relating to this question, to establish a supervision question, and then to agree supervision activities aimed at answering it.
For example, a CBT therapist may bring a dilemma about how to manage a verbose client whose worrying aloud dominates their sessions. Supervisor and supervisee identify and shape the supervision question by considering the supervisee’s identified needs (e.g. to develop confidence in taking a lead in session when clients require it) and goals (e.g. to structure sessions more effectively, to manage the pace of sessions to end on time). The question may be, ‘How can I manage our sessions better, when I worry that interrupting this client would cause a rupture?’.
The pair may view an excerpt of a session recording illustrating the problem, or role play a recent therapy exchange. The supervisor may invite the supervisee to take the role of therapist to try out new ideas, or they may model to the supervisee how they would interrupt in such a manner that it preserves or even strengthens the therapeutic alliance.
Finally, the pair would reflect on what the supervisee had learnt, and make plans for the action they would take in future sessions.
Look out for more blog posts coming soon, giving an insight into how we use supervision within Blue Cabin.
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Matt is a psychological therapist accredited both as a therapist and supervisor by the British Association of Behavioural and Cognitive Psychotherapy (BABCP) and as a practitioner by EMDR Europe.
Matt has been associated with Blue Cabin since 2019, and has provided bespoke training for staff around the principles of attachment theory and trauma, and how to maintain wellbeing as a practitioner working in therapeutic roles. He currently provides regular supervision for Blue Cabin’s associate artists.
Find out more about Matt here.
