Are you sitting (un)comfortably? Action-based supervision and supervisory drift

Abstract

Action-based methods such as behavioural experiments, role-play and (by extension) ‘chairwork’ are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a ‘doing process’ to a ‘talking process’. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees’ technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods. Key learning aims As a result of reading this paper, readers should: (1) Understand why supervision sometimes drifts from being a ‘doing’ process. (2) Appreciate the value of experiential, action-based supervisory methods. (3) Feel competent using action-based methods to enhance supervisees’ clinical skills.

Supervising the delivery of cognitive behavior therapy in school settings.

“…Clinical supervision can be an essential element of the provision of effective, evidencebased CBT that improves client outcomes and enhances learning Moeller et al, 2020;Pugh & Margetts, 2020). It is obviously necessary in contexts in which clinicians are themselves receiving training.…”

“…It is obviously necessary in contexts in which clinicians are themselves receiving training. Many studies have evaluated the effectiveness of clinician training within CBT, including activities such as treatment planning, instruction and rehearsal, affective processing, and selfreflection (Pugh & Margetts, 2020;e.g., Liese & Beck, 1997). Action-based supervision includes those activities that simulate thera peutic interaction; role play may be the most familiar of these, and chair work is a more creative actionbased approach that is supported by data (Pugh & Margetts, 2020).…”

“…To the extent that it is pragmatic, clinical supervision should include actionbased activities. For maximum effect, the rationale for using these activ ities should be introduced into the supervisory relationship at the outset, the activities themselves practiced, and corrective and positive feedback given until skills are mastered (Pugh & Margetts, 2020). The clinician should also be asked to provide feedback as to the supervisor's performance of responsibilities.…”

Dialogical coaching: An experiential approach to personal and professional development.

“…Cognitive theory, for example, indicates that multisensory methods are advantageous both in terms of modifying the dysfunctional cognitive structures underlying distress (e.g., maladaptive thoughts and beliefs) and constructing functional mental representations that are preferentially retrieved in situ (e.g., adaptive thoughts and beliefs; Brewin, 2006; Teasdale & Barnard, 1993). Relatedly, theories of information-processing suggest that the immersive and evocative interventions enhance the memorability of new knowledge (Pugh & Margetts, in press ; Tangen & Borders, 2017), and models of adult learning underscore the importance of experiencing and experimentation in driving personal development (Kolb, 1984).…”

CBTsupervision behind closed doors: Supervisor and supervisee reflections on their expectations and use of clinical supervision

“…Little is known about how CBT supervision is routinely delivered, monitored or experienced and, given the strong tradition of promoting adherence to research in the field, it is concerning that what little data there are suggests that everyday practices do not always mirror expert recommendations (e.g., Alfonsson et al, 2017; Milne et al, 2009; Townend et al, 2002; Simpson‐Southward et al, 2018; Weck et al, 2017), with key normative, formative and restorative functions often being omitted (Proctor, 1994; Pugh & Margetts, 2020). For example, a study by Weck et al (2017) found that the most widely used method in supervision was case discussion, with limited opportunities to give feedback on the quality of supervisees' clinical work (e.g., video footage of therapy sessions).…”