This book outlines an evidence-based approach to supervision which finds its theoretical foundations in experiential learning. This model of supervision has been likened to the ‘Best Evidence Medical Practice Education,’ in that both models “… treat professional development in a systematic way, based on the highest quality, most relevant research” (2). While this book focuses on the mental health field, the author notes that the information presented should be relevant to everyone involved in the supervision process, regardless of their field.
The evidence-based model suggests that supervisees achieve levels of competence by learning through experience, utilizing a necessary combination of four learning modes (Kolb’s Experiential Learning Cycle, adapted). The four learning modes adopted are (1) reflection; (2) conceptualization (thinking); (3) planning; and (4) concrete experience (feeling and doing). The author suggests that this model improves upon previous models in various ways, including by having increased precision and internal consistency and by examining and specifying how supervisor-supervisee interactions may result in experiential learning.
The author argues that “professional competence is achieved most efficiently when the supervisee is given regular opportunities to use all four modes” (2-3). The supervisor must utilize a range of methods to encourage the supervisee to engage with each mode. In sum, the evidence based model suggests that “… effective and competent supervision will be characterized by the use of a range of supervision methods (e.g., collaborative goal-setting), ones which increase the supervisees’ use of the four learning modes (i.e., a structural and functional definition of effective supervision, respectively), and consequently their capacity to work competently, safely, and effectively (3).”
There is no one agreed upon definition of supervision. Multiple related definitions are available; however, the author criticizes them for their: (1) lack of specificity; (2) failure to recognize that supervision may be provided across professional boundaries; and (3) lack of emphasis on the importance of the supervisory relationship. Further, practitioner survey results suggest that supervisors are often unclear as to the nature and purposes of supervision. As such, the author suggests an improved, empirical definition of clinical supervision which is based on a systematic review of the literature. The suggested improved definition of clinical supervision is as follows:
“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 colleague[s] (precision). It therefore differs from related activities, such as mentoring and therapy, by incorporating an evaluative component (precision by differentiation) and by being obligatory. The main methods that supervisors use are corrective feedback on the supervisees’ performance, teaching, and collaborative goal-setting (specification). The objectives of supervision are ‘normative’ (e.g., case management and quality control issues), ‘restorative’ (e.g., encouraging emotional experiencing and processing) and ‘formative’ (e.g., maintaining and facilitating the supervisees’ competence, capability and general effectiveness) (specification by identifying the functions served)” (15-16).
As supervision has been defined as ‘relationship-based’ education and training, the quality of the supervisory relationship is central to the effectiveness of clinical supervision. This relationship is founded on a learning alliance between the supervisor and supervisee, and often includes elements such as shared agenda setting and participative decision-making.
The author utilizes the breakdown of supervisor behaviors that contribute to building a learning alliance suggested by Bernard and Goodyear (2004). Ways in which the supervisor can facilitate the learning alliance include:
- Appropriate confidentiality (ethical behavior);
- Basing feedback and other evaluations on the agreed objectives of supervision (evaluative practices);
- A supervisory style that includes features such as an interpersonally sensitive and task-oriented approach (style); and
- Moderate levels of supervisor self-disclosure (e.g., regarding personal experiences and struggles at work) (79).
Bernard and Goodyear (2004) also suggest attributes which are attributed to poor supervision and should be avoided. These include:
- Not revealing your own shortcomings;
- Not providing a sense of safety wherein doubts and fears can be discussed;
- Placing service needs above the supervisee’s educational needs;
- Ignoring the need for emotional support from the supervisee;
- Ignoring the supervisee’s strengths and interests; and
- Not recognizing the need to share responsibility for any interpersonal conflicts that may arise (83).
Finally, this book identifies the lack of research regarding how to best support supervisors. The author notes there appears to be no framework established which addresses how to best develop and support supervisors, and there is also a notable lack of practical supports available. The majority of practice statements and policies address how supervision itself can be delivered effectively, rather than addressing how to best support and develop the supervisors themselves.
The author suggests that the supervisor’s personal coping strategies play a critical role in addressing the demands placed on them daily. “Part of coping effectively is recognizing that supervision is an inherently stressful activity” (159). This recognition allows the supervisor to determine whether an event requires a reaction and, if so, allows them to judge whether they are able to respond effectively. The author posits that this is a preferable way of coping, as it is grounded in reality and tends to minimize the degree to which supervisors attribute difficulties to themselves.
Milne, Derek, Evidence-Based Clinical Supervision: Principles and Practice (West Sussex, UK: Wiley-Blackwell, 2009).
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