Preface to the First Edition

One of the fascinating aspects of writing this book on evidence-based clinical supervision (EBCS) has been to experience the interplay between theory and practice in clinical supervision at a personal level, as if writing this book was one great big learning exercise. This came about because I adopted the evidence-based practice framework, a broad approach to problem-solving which required me to repeatedly adopt alternating and rather different ways of understanding supervision. As a result, I spent a year revolving around an extensive experiential learning cycle, during the time that was devoted to preparing this book. Much of this period was occupied with discussions with experts in clinical supervision, in order to develop guidelines and to continue my own research programme. But there was also the protracted process of studying relevant theories and research findings in a particularly systematic way, whilst preparing and submitting some of the articles that are embedded within this book for peer review, in relation to publishing in scientific journals. This personal journey of discovery can be seen explicitly in some passages of the book (e.g. in Chapters 3 and 9), where my grasp of similar approaches, such as cognitive-behaviour therapy (CBT) supervision, challenged my assumption that EBCS was a distinct approach. Ultimately, I reasoned that EBCS was sufficiently distinctive to merit its own brand name. For example, by comparison with CBT supervision, EBCS has a wider range of theoretical roots, entails working explicitly with the supervisee's emotional material, draws systematic analogies with related literatures (especially staff development and therapy process–outcome research), and has broader objectives than CBT (e.g. educational goals, especially the development of ‘capability’). I appreciated that these apparent distinctions may simply be differences of emphasis, as there would appear to be nothing in EBCS that is fundamentally contrary to CBT supervision. But careful scrutiny of the evidence from observations of CBT supervision and surveys of CBT supervisors indicated that EBCS really was different (Milne, 2008a). By the end of my year's adventure, I came to view EBCS as subsuming CBT supervision, as well as a range of related supervision models. This is largely due to its integrative, ‘bigger picture’ approach (i.e. seeking out the core psychological and social factors within supervision, based on a fairly general search). Indeed, the original title for this book was The Psychology of Supervision. Thus, I believe that EBCS is unique, but affords a suitable way of revitalizing CBT and related approaches to clinical supervision (i.e. modern professional practice; applied science).

The book aims to provide clinical supervisors, and those who support them, with the best-available evidence to guide their work (which is assumed to be primarily CBT in Britain), as practised within the mental health field. This includes empirical knowledge derived from the latest research, and guidance from expert consensus. Such material addresses the ‘restorative’ and ‘normative’ functions of supervision, but priority is given to the supervisor's ‘formative’ or educative role. The resultant material was also sifted and sorted by drawing on my 25 years of relevant experience, moderated by regular interaction with colleagues with a similar investment in developing supervision (at conferences, workshops, etc.). This includes the detailed feedback I received from the referees and editors of scientific and professional journals, as a result of submitting much of the original material in this book as research papers for peer review. Taken together, these aims and methods are intended to address a paradox in the supervision field. This is that, despite its manifest importance, supervision is a sorely neglected topic. As Watkins (1997) has put it, ‘something does not compute’ (p.604). This paradox has been a spur to my work, as reported in this book.

Based on this evidence-based process of attempting to make things compute, Chapter 1 reviews how supervision has been defined to date, offering a more rigorous definition, derived from a systematic review of 24 recent studies of effective clinical supervision. I describe this particular review approach, the best-evidence synthesis (and continue to draw on it in subsequent chapters). I also question the conventional historical account, which identifies Freud as the first to explicitly utilize and report clinical supervision. Rather, applying the definition of supervision precisely and delving into pre-Freudian history, it seems to me that the Ancient Greeks got there first (again!). Chapter 2 summarizes the main types of models (conceptual frameworks) that are intended to help us understand supervision. They are mainly ones that are either based explicitly on therapies (where CBT is a strong example), or on developmental models, or are supervision-specific ones. In Chapter 3, I draw on these models to propose my own EBCS approach, which (following a critical review) then colours the remainder of the book. The important role of the learning alliance in supervision is recognized in Chapter 4, alongside some challenges to its creation and maintenance (i.e. the ‘rupture and repair’ cycle; power dynamics). The first of my four EBCS guidelines is introduced here. These guidelines were designed following the National Institute for Health and Care Excellence (NICE) methodology, but revised as necessary to make the approach as relevant as possible to supervision (what we termed the NICE(R) guideline development procedure). Over a hundred clinical supervisors and tutors helped to refine these guidelines. Chapter 5 sets out the supervision cycle, namely: conducting a learning needs assessment; negotiating the objectives (learning contract); utilizing different methods of supervision; and evaluating progress. Three EBCS guidelines are introduced in this chapter, as it is the heart of routine supervision. All four guidelines are part of the EBCS training manual, which is accessible from www.wiley.com/go/milne2e. The EBCS model has been represented physically as a tandem, according to which reasoning the front wheel of the bike is controlled by the supervisor. This then casts the rear wheel (and the back seat) as the supervisee's province, set out as the Kolb (1984) experiential learning cycle. Chapter 6 details this cyclical process, furnishing supportive evidence and illustrating how supervisees are essential collaborators in the business of supervision. But this tandem duo are insufficient to develop and maintain effective supervision within complex workplace systems, so Chapter 7 reviews the ways in which supervision can be supported, especially through the dominant intervention of supervisor training. Chapter 8 returns to the task of evaluation, offering the ‘fidelity framework’ as a coherent, step-wise way to view and practise the evaluation of supervision. Implementation issues are also addressed, in order to increase the likelihood that evaluation serves a useful purpose. In the ninth and concluding chapter I tease out the main principles of EBCS, adding reflective commentaries where there is unfinished business, such as the overlap between EBCS and CBT supervision, and I offer a specification for career-long supervision.

The method I've used to tackle these chapters has also been CBT compatible, as in adopting the evidence-based practice model (Roth & Fonagy, 1996), then using it as a framework to guide a process of scholarly review, featuring:

• critically analysing and constructively re-synthesizing the research literature;
• integrating research findings with knowledge from textbooks and from formal consensus statements by experts;
• relating this knowledge-base to the contexts in which supervision occurs (e.g. organizational and professional influences on supervision);
• reviewing the nature and effectiveness of supervisor training and support arrangements;
• comparing closely related approaches to supervision; and
• auditing the fidelity of supervision, and evaluating its results.

This method enabled me to draw out numerous practical implications, and to summarize a comprehensive approach to supervision as an applied psychological science. As a result, I believe that this book is original yet accessible, detailed yet coherent, critical yet constructive. It offers a rounded rationale and a systematic guide for evidence-based supervision, and, more generally, it offers a way of making the vital business of supervision ‘compute’ (Watkins, 1997). I hope that you will also enjoy the experience of discovery, as you read the book.

Preface to the Second Edition

It gives me great pleasure to present this new edition, which includes a substantial body of additional research findings that have been published since the 2009 edition. This literature has greatly strengthened and enriched the contents of this second edition (e.g. regarding measurement tools), broadening the content to reflect the growing field of clinical supervision. It is stronger because the research literature has continued to grow, sometimes buttressed by expert consensus (e.g. competence-based supervision; evidence-based training; outcome monitoring procedures). It is broader by incorporating far more on the restorative function of supervision (i.e. supporting supervisors emotionally), and by drawing on the expertise literature (including fresh theories of experiential learning).

Also, the passage of time, and not least my continued involvement in supervision since 2009, have also enabled me to review critically the material within the first edition. Like the first edition, this new volume also benefited from my engagement in extensive experiential learning. For the two years leading up to this new edition I was co-authoring (with Robert Reiser) a manual for evidence-based CBT supervision, complete with guidelines, video demonstrations and an extensive review of the best-available evidence (Milne & Reiser, 2017). This work included linked workshops with supervisors throughout the UK, including the guideline development work. The collaborative effort involved working with the British Association for Behavioural and Cognitive Psychotherapies (BABCP) on the design and broad strategy behind the manual. In effect, the two-year stint was like an action-research project, though with the greatest emphasis on reviewing the supervision literature. Some examples of this manual are included here, and this new edition has benefited greatly from that two-year effort. Specifically, that experience further developed and refined my understanding of the status and nature of evidence-based clinical supervision. As a result, this second edition adopts a cognitive-behavioural therapy (CBT) orientation to supervision, while still exemplifying the evidence-based clinical supervision approach. It is because of this more specific focus that the title of this second edition has become Evidence-Based CBT Supervision, as well as to try to signal the strong link to the above manual. In effect, this book provides a theoretical companion to the manual, offering a much broader review of the supervision literature. However, it retains the practical emphasis of the first edition, both in its tone and through again linking to supervisor training guidelines and other resources for developing and supporting supervisors.

The net result is a much improved statement of evidence-based clinical supervision, a distinctive and much-needed perspective required to guide the essential business of supervision within modern mental health services. All-in-all, this second edition represents a much more rounded account, portraying supervision as a mature and internationally recognized specialization within professional practice (Watkins & Milne, 2014).