Supervision Review, September 2005: Department of Psychological Therapies

This current review of supervision within the Department of Psychological Therapies is made within the context of Shropshire’s PCT Clinical Support review process.

In order to build up a picture of current supervision arrangements within the department, heads of service and individual clinical Psychologists working in adult mental health services were contacted and asked to give an update of their arrangements for giving and receiving supervision. The following report gives a summary of the information that was reported on from this review. This information will be used to help inform further developments in supervision arrangements within the department of psychological therapies.

Setting the Scene

Supervision within the department is arranged within the following departmental and professional guidelines:
Department of Psychological Therapies Supervision and Training Guidelines, June 2003

Sections relevant to supervision: -

Senior members of the department have produced these guidelines in an attempt to make clear the desirability and affordability of Continuing Professional Development whether it be training or supervision for all members of the department.
We shall expect a minimum standard of supervision (one hour per 20 hours per client work) but, in general, practitioners should negotiate how much supervision they need. People will be encouraged to see whether they can have their supervision needs met from within the department before accessing external supervision that requires payment.
External supervision is the equivalent to training and would be funded through training monies or the appropriate management budget. External supervision should be negotiated as needed.
Recently qualified staff will not normally be offered additional substantive training in their first two years after qualification. Supervision to ground them in clinical skills will be seen as a priority. This supervision would normally be internal.

BPS, DCP Professional Practice Guidelines (1995) on Competence
Section 1.2 Supervision:

1.2.1 “In order to maintain the quality of performance and to extend a psychologist’s range of skills, supervision should be organized for all levels and grades of experience. All aspects of professional practice should be accessible to supervisory inputs, including research activity, administrative and managerial work, service developments and the process of supervising others.”

1.2.2 “If no clinical psychologist is available with the necessary expertise and skill to provide specialist supervision for key aspects of work, clinical psychologists should seek supervision from an appropriately qualified psychologist in a neighbouring authority or from a related discipline.”

1.2.3 “The agreement to set up specialized supervision should always be ratified by the responsible manager. (See CPD Section 9.2)”

1.2.4 “More experienced clinical psychologists also have a requirement for regular supervision at the appropriate level for their experience and responsibilities. It is recommended that this be obtained from a senior colleague in clinical psychology, if necessary from outside their professional specialty or organization, to maintain and develop advanced level skills and experience. This may be achieved by creating a network of such senior staff via specialist interest group or Division branch frameworks.”

BACP (2002) Ethical framework for good practice in counselling & psychotherapy:

Maintaining competent practice: Section 7
“All counsellors, psychotherapists, trainers and supervisors are required to have regular and ongoing formal supervision/consultative support for their work in accordance with professional requirements. Managers, researchers and providers of counselling skills are strongly encouraged to review their need for professional and personal support and to obtain appropriate services for themselves.”

While it is recognized from these guidelines that there is a wide remit for supervision including research activity, administrative and managerial work, service developments and the process of supervising others, this report will concentrate on supervision of clinical work in accordance with the Clinical Support Framework.

Supervision Arrangements for Members of Staff in the Department

All members of clinical staff receive regular supervision of their clinical work. A current review of these arrangements indicated a vast array of individually tailored arrangements to meet the stage of development of the staff member; their area of clinical practice and specialist interest.

Clinical Psychologists working in Community Mental Health Teams and in the Rehabilitation Service reported receiving supervision of their clinical work at least fortnightly. Supervision arrangements included individual supervision; peer supervision; facilitated group supervision. Supervisors of the Psychologists’ clinical work came both from within the department and from external sources.

Clinical Psychologists offer a wide range of supervision both within the Department of Psychological Therapies and to staff from a range of services including:-
Supervision of Macmillan Nurses; Balint groups which offer supervision and support to G.P.s; supervision of Shelton Hospital Staff; supervision of Psychiatrists on Training Rotation; group supervision to Substance Misuse Team staff; supervision of CMHT staff individually and in groups; supervision of Primary Care Liaison Workers; supervision of staff from the Learning Disability Service and from Children and Adolescent Mental Health Services.

Clinical Psychologists also offer training placements to Clinical Psychologists in Training on Clinical Psychology Doctoral Programs based at Liverpool, Birmingham and Bangor. Clinical Psychologists have developed good links with the Shropshire/Staffordshire course, which had its first intake of trainees in October 2004. They have coordinated and/or offered training experiences in Shropshire and have helped develop opportunities for clinical experience in liaison with course staff.
Two of the Psychologists reported receiving supervision directly related to their supervision work; others reported that they consult colleagues about this work on an ad hoc basis.
Several of the Clinical Psychologists have attended and taken an active part as facilitators of the Supervisors Forum, which meets 4 times a year and offers training and support for their supervision work. This forum is open to all supervisors within the Department of Psychological Therapies.
Over the past year several Clinical Psychologists have updated their training in supervision by attending workshops based at the University of Staffordshire. These workshops have focused on Social-Constructionist models of supervision; individual learning plans; service-user issues; record keeping and evaluation of trainees’ core competencies.

Dawley and Chaddeslode House Therapy Staff receive weekly or fortnightly supervision of their individual work with additional support for specialist therapy approaches and for group facilitation. Staff offer supervision within the Department and to student counsellors on placement within the department. Supervisors have received training from a variety of sources including Staffordshire University; West Midlands Pastoral Foundation.

Counsellors in General Practice all receive: 3 hours of group supervision per month regardless of how many hours they work. This is in groups with a supervisor for each 4 counsellors.
Each counsellor also has the opportunity of one hour’s individual supervision per month.
Counsellors are able to choose either a counsellor from within the Department of Psychological Therapies; a Clinical Psychologist from within the Department or to select an independent Supervisor. They also have access to one off specialist supervision if required from the C.B.T Service; EDS, CAMH Service. Frequency of contact and model of working are agreed between counsellor and supervisor, according to individual need. Where counsellors request specialist supervision that is not readily available within local services, funding of external supervision is considered.

Staff Counsellors all receive individual supervision tailored to their needs and in accordance with BACP guidelines.

Counsellors who offer supervision all receive individual consultant supervision. They belong to peer supervision of any supervision groups that they facilitate and most attend the supervisors forum.

The Eating Distress Therapy Service described individually tailored supervision arrangements in recognition that rarely can one supervisor meet an individual’s need. The team highlighted the importance of separating supervisory roles from line-management concerns. Team members receive a mixture of specialist therapy supervision e.g. Cognitive Analytic Therapy supervision; Gestalt Psychotherapy supervision; Family Therapy supervision; Cognitive Behavioural Supervision; and general supervision/support of their psychological therapies. All staff receive some supervisory support on a weekly or fortnightly basis. Supervision arrangements vary and include one-to-one supervision and co-supervision. The qualified members of the service offer supervision to a wide range of staff working with clients who experience eating distress from both within and outside the Department of Psychological Therapies. They also offer supervision in different models of therapy e.g. Psychodynamic therapy; Client centred work.

Within the Cognitive Behavioural Therapy Service, all therapists have an hours formal one-to-one supervision fortnightly. Specialist supervision e.g. for EMDR, is accessed from outside agencies at present and paid for out of the service’s budget. Therapists normally keep a written record of supervision and learning points to support their personal CPD and accreditation requirements. Therapists also draw on informal supervision gained from the CBT communal office milieu and from joint working in therapy groups. Trainee therapists also have regular audio/taped and live clinical supervision as do other therapists very occasionally. Most supervision involves case discussion based around CBT models to address technique and therapeutic relationship aspects, but therapists also regularly draw on expertise from other practitioners using other psychotherapy approaches. Were extra funding available the service would like to support one of their staff to attend a formal CBT-based supervision course.

The Liaison Mental Health Service meets as a team weekly for peer supervision. Team members receive additional one-to-one supervision as required. Two of the team reported offering supervision to other members of the Department of Psychological Therapies and to staff from outside the department including CMHT staff and to a Macmillan Nurse Team Leader.
The team is considering methods of recording supervision contacts, in line with CPD recording as recommended by the British Psychological Society.

Marilyn Owens
Clinical Psychologist September 2005