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Reflections on a Year of Superior Vision

CBT Therapist, Matt Stalker reflects on a year of supervision with Blue Cabin Associate Artists.

Reflections on a Year of Superior Vision

In a previous blog from April 2020, I reflected on the process of becoming involved with Blue Cabin’s Creative Life Story work, and the recognition of the potential benefits of supervision for Associate Artists. 

I discussed the observation that unless formally trained in Art Therapy or Music Therapy, supervision is not commonly offered to artists, even those engaged in therapeutic work. And yet, from the training workshops I provided to Blue Cabin staff back in February 2020, it was apparent that the distinctions between therapeutic and therapy were hazy, at least in terms of the potential to facilitate emotional experiences for participants, and the potential emotional impact of the work on practitioners. I argued that those without a grounding in biopsychosocial models of mental health and/or psychotherapy, attachment theory, the neurobiology of trauma and so forth may be at greater risk of being negatively affected by their therapeutic work than formally trained therapists, even if their work is not defined as therapy. Viewed through this lens, I would argue that supervision is imperative for artists facilitating therapeutic work to maintain safe, efficient and effective practice. 

What Is Supervision?
The term itself is a portmanteau of the words ‘superior’ and ‘vision’, meaning to see from above. I think of it as helping a practitioner to see themselves more clearly. 

Clinical supervision is a foundational element of most trained or training clinical professional’s practice. This includes practitioners of psychotherapy, psychology, social work, occupational therapy and nursing, where accessing supervision is written into job plans and is a requirement to maintain professional accreditations.

Supervision takes the form of a planned series of meetings between a designated supervisor and a practitioner, or supervisee (or supervisees) which run in parallel with the practitioner’s work with clients/service users. In this forum, practitioners discuss examples of their work, identify dilemmas and challenges and seek solutions. Supervision, fundamentally, is a reflective learning space, which is commonly held to have three functions, defined by Proctor (1987):

  • Formative (educative/developmental) – supporting the practitioner to maintain areas of strength and to continually develop in their practice
  • Normative (managerial/administrative/procedural) – supporting the practitioner to maintain standards, follow guidelines, and where possible to compare practice against recognised frameworks of competence
  • Restorative (Supportive) – supporting the practitioner to navigate the ‘emotional labour’ of their work, which may be at the individual level, organisational level, or cultural/societal level. Supporting the practitioner to consider the impact on them of their work, as well as the impact of their work on the service user

What Supervision Is Not
Supervision is not training. Supervision assumes that the practitioner is sufficiently trained to fulfil their role. It typically supports already competent practitioners to maintain or continually develop their practice. Although it is an essential component of training programmes, helping to embed learning and to integrate knowledge, skills and attitudes into practice, supervision alone would be an inefficient form of training (Barton, 2020). 

Supervision is not therapy. Although sometimes discussions focus on the practitioner – their thoughts, assumptions, actions and reactions – supervision always holds the client/service user front and centre. Supervision helps practitioners to reflect on their own thoughts, feelings and behaviours to improve the effectiveness, safeness and efficiency of their practice.

Supervision is not only about reflection. To borrow from Beck (1979) reflection in supervision is, “necessary but not sufficient” (p.45). The process of experiential learning is key in supervision. This process is often linked to the work of Kolb (1984). Kolb proposed a cyclical process wherein concrete experience is reflected upon (What happened? What did I feel/think/do?), conceptualised (How can I make sense of this? How does this fit with existing knowledge?), and plans are formed for subsequent actions (How can I use this learning going forward?). Reflection is the mechanism by which we can evaluate our actions and make adjustments based on new understandings, or new connections between things we already knew. But reflection alone does not guarantee learning or changes in thinking, feeling or action. Supervision aims to support practitioners to figure out what works, what doesn’t, and why, so that these can be intentionally repeated or avoided in future.  

Finally, supervision is not consultation, advice giving or instruction. Supervision aims to support practitioners to identify challenges and dilemmas in their practice and to generate solutions to them, but to arrive at these through reflection and meaning making.

Who can supervise whom?
The question I have held in mind for the last year of supervision for the artists has been, ‘Does it matter that I am not an artist myself? Would this be better or worse if I was?’ 

Typically, the supervisor is a more experienced member of the supervisee’s profession, or at least more experienced in the role the practitioner is receiving supervision on (e.g. a qualified psychologist trained in a given therapy supervising a nurse providing this therapy to some of their patients). 

My professional background is psychotherapy, specifically Cognitive Behavioural Therapy (CBT). The supervision I provide is guided by the Newcastle Cakestand Supervision Model (NCSM), which was devised initially for CBT supervisors by CBT therapists and supervisors. By contrast, the Associate Artists I supervise for Blue Cabin are trained and experienced variously in theatre-making, clown doctoring, masque, print-making, graphic design, puppetry and more. I know no more about these practices than any person you may stop in the street.

And so, in supervising the Associate Artists, I am challenging orthodoxy, and testing my colleague Dr Stephen Barton’s assertion he could supervise a car mechanic using NCSM, despite knowing little more about cars than where to put in the petrol.

What does supervision typically involve?
The initial period of supervision (1-2 sessions) usually focuses on contracting. I like to think of this in terms of its verb form rather than the noun: contracting as an action, rather than focusing on the contract as an object. Through conversations that explore the artists’s knowledge, skills, experiences and role, who the recipients of their work are, and the context in which this work takes place, we begin to establish a set of needs, which are likely broader than any one supervisory relationship could or should aim to meet. Therefore, what follows is a period of contracting – shrinking, narrowing – focus, and agreeing as much what we will focus on as much as what falls outwith supervision and fits better into other forums (e.g. reflective groups, further training, management meetings).

As these needs are clarified, we aim to identify goals. The supervisee and supervisor agree what the aims of supervision are, what areas of their practice the practitioner wishes to develop or maintain (e.g. adapting to online working), and what the common challenges are they encounter in their work with which they would value support (e.g. timekeeping, managing feelings of responsibility). These discussions lead to the contract itself, which of course is subject to review and change.

With all of this clear, supervision sessions then are built around addressing questions and dilemmas (or notable successes) rooted in the practitioners’ recent practice. In supervision, any given issue could be approached in a number of different ways. As such, the supervisor holds in mind the needs and goals of the supervisee, and this guides dynamic focus during conversation. For instance, a practitioner whose sessions often overrun may have an issue with feeling pressure to achieve outcomes and cramming in too much material, or it may be due to lack of assertiveness or confidence in interrupting to keep sessions boundaries. Each would require a different focus and actions.

Supervision is not just discussion. Discussion is vital to identify issues, and to eventually help consolidate learning, but often active methods are the best way to facilitate the experiential learning. These might include role play, skills practices, written tasks like pros/cons lists, imagery work, or action plans. In group supervision settings, allowing fellow supervisees to reflect on one another’s work or to offer learning from their own similar experiences is also very valuable.

Each session thus begins with a check-in, identifying issues the supervisee brings, and setting an agenda/making a plan to discuss the questions brought. Throughout the session supervisors summarise and check on supervisee learning. And each session closes with emphasis on what is being taken away.

Does this differ with Associate Artists?
Yes and no. As a CBT therapist I am trained to ask good questions, to support reflection and understanding and to generate new ideas to overcome problems. I do all of this within Blue Cabin supervision sessions just as I would with therapists. 

On the contrary, I am also trained to deliver a therapy which is flexible but within a clear structure. This draw towards structure can be at odds with the artists’ way of working and being, which has meant that I have learnt to hold the structure lightly. With my CBT trainees, I insist we pin down the question before proceeding into discussion; however, with the artists, sometimes a lengthy check-in, or a general discussion of the last block of sessions is more helpful to lead us to identify questions or foci. In this approach, my role is to be vigilant, to listen out for the spikes in emotion, the moments of uncertainty, the off-the-cuff remark that betrays something of the complexity of the artists’ feelings, and which may benefit from being made explicit.

And to reiterate the earlier point, where with therapist supervisees I am usually the relative expert in the room, I am clueless about either the rudiments or the finer points of the artists’ respective practices. I rely heavily in supervision on the artist’s own knowledge, skills and experience to help us to generate ideas, and I try to remain humble and ask those naïve questions and bring in he other artist whose expertise and experience aligns much better with their fellow supervisee than does my own. 

Outcomes from Year One:
In a recent supervision group with some of the artists, we discussed this central question, ‘Does the supervision need to be provided by an artist?’. We reflected upon whether supervision felt to them a distinct activity to reflective groups, Base Camp or their WhatsApp thread, and if so, what did they uniquely get from supervision. Supervision was indeed seen as a distinct activity, with distinct features seen as beneficial. Some of the themes are described below based on the feedback in supervision sessions:

You asked good, sometimes naïve questions
The artists valued what I would call Guided Discovery. That is, asking questions about things they know (how they feel, think, what they did, what happened) and using this to arrive at new meanings (when you did x, because of y, and z happened; what do you make of that?). My not being an artist was considered a strength. I tell trainee therapists, ‘Be Louis Theroux’, meaning, be humble, ask the naïve or seemingly obvious questions. Artists found explaining these fundamentals to me could help identify things they assumed or took for granted in their practice, and this enabled new perspectives and realisations. They also fed back that knowing I would not have different ideas about how to deliver their creative work felt better than what they imagined it might be like to be supervised by an artist. 

You slowed us down, held space, validated
Much of what I felt I did in the first year of supervision was to create a space in which the artists could slow down, listen to themselves and one another, and in which I could then offer encouragement and validation around just how complex their task is, and how skilled they evidently are. Particularly asking about feelings (both labelled emotions and body experiences) was highlighted as helpful to recognise the emotional labour and therefore to consider helpful actions (e.g. So where does that feeling of frustration go after the session ends? What do you do with that?). A number of artists commented on several different occasions that supervision had helped them to appreciate just how complex their remit is in All About Me sessions, which enabled them to be kinder to themselves.

You teased out meanings and made the implicit explicit
I was repeatedly struck by how intuitively artists made choices and took actions that I would recognise as trauma-informed (giving choice, creating safety, collaborating, offering kindness), but without realising how skilled they were, or necessarily feeling able to articulate the reasons for their choices and actions. More importantly, gut reactions and periods of discomfort were often interpreted as a sign of wrongdoing, whereas after discussion it was common for artists to conclude that the gut feeling was more a sign of something happening in the room which signalled the need to tread carefully, and this is what they intuitively did: showing compassion, patience and care. As such, often the outcome of supervision was the artist’s confidence in their judgement being bolstered, and having greater clarity on what actions to repeat in future.

You helped separate artefact from experience (outcome from process)
Owing to their commitment and compassion, many of the artists would get caught in the notion of what getting it ‘right’ meant in All About Me sessions. Discussions in various groups led us to separating artefact from experience. We explored the metaphor that an archaeologist does not require a perfectly intact pot to infer its story and glean meaning from it. In much the same way, the artists realised that their sessions were more about the experience and stimulating curiosity and relationships, and less about producing a finished artefact. This relieved a lot of pressure by clarifying their role as facilitating a process. One group of supervisees devised a “Manifesto” for their work on the basis of such discussions to help clarify what it meant to get it ‘right’. This was remarkably similar to contemporary definitions of trauma-informed care. 

You gave us language for our experiences
Similarly to making the implicit explicit, I often found that what I offered the artists was language or terminology to help label and understand their experiences. For instance, the notion of modelling safe uncertainty through creative play, and how this links to recovering from trauma.

You brought it back to the artist, and helped us recognise our responsibilities and what needed to be taken out of supervision
The artists do not do their work with care-experienced children and young people in a vacuum. They power share with Pastoral Support Workers, producers, and identified adults; they operate within the context of All About Me project, within Blue Cabin, and within the Local Authority and the broader regional and national context. It is inevitable that some of the dilemmas and challenges arising for artists need to be conceptualised in terms of overlaps and tensions between these different drivers and influences; however, to reiterate an earlier point, supervision focuses on the practitioner and their impact on the client/service user. As such, I always aimed to bring discussions back to the implications for the practitioner, and to ensure lines of responsibility ere clear. Where the issue was clearly an organisational one, or a personal issue regarding another person involved, then supervision focused on what the artist could do or needed to do to influence change in the sphere (e.g. provide feedback to the person, share concerns with or bring questions to Jenny or Dawn) or to look after themselves in light of the challenges this posed for their wellbeing.

You allowed cross-pollination
Returning to the theme of mismatch, knowing my knowledge of the artist’s creative practices was no better than a layperson, I tried to ‘cross-pollinate’ in supervision. The artists consistently reported how valuable they found it to hear from one another, to share ideas or simply to know they were not alone in feeling the challenge of the emotional labour involved in their work. 

As a scientist-practitioner, I’d have to concede this is merely anecdotal evidence from a very small sample, with no other experimental group (supervision with a supervision-trained artist) or control group (no supervision) for comparison. It would be dubious science to claim with confidence on the basis of these reports that the supervision I have provided in the last year or so is equivalent to, better or worse than either supervision from an artist or no supervision at all, or whether it leads to better functioning and/or mental health for the practitioners; however, it provides initial indications that support the original hypothesis: the artists’ work involves emotional labour, and as such there appears to be benefit from a supported reflective space which facilities experiential learning.

Matt Stalker
BABCP Accredited CBT Therapist and Supervisor
EMDR Europe Accredited Practitioner