This edition first published 2017
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Library of Congress Cataloging‐in‐Publication Data
Names: Milne, Derek L., 1949– author. | Reiser, Robert P., author.
Title: A Manual for Evidence‐Based CBT Supervision / Derek L. Milne and Robert P. Reiser.
Description: Chichester, UK ; Hoboken, NJ : John Wiley & Sons, 2017. | Includes bibliographical references and index.
Identifiers: LCCN 2016055385 | ISBN 9781118977323 (pbk.) | ISBN 9781119030454 (epub) | ISBN 9781118977347 (ePDF)
Subjects: LCSH: Cognitive therapy–Handbooks, manuals, etc. | Behavior therapy–Handbooks, manuals, etc.
Classification: LCC RC489.C63 M54 2017 | DDC 616.89/1425–dc23
LC record available at https://lccn.loc.gov/2016055385
Cover image: (Watercolor) © itskatjas/Gettyimages; (Galaxy) © Attila445/Gettyimages
Cover design: Wiley
This book is dedicated to our families, and especially to our grandchildren,
Martha Rose Maddison and Finlay Milne Maddison (DM), and Lily (RR).
Derek L. Milne (PhD, FBPS) is a retired clinical psychologist who worked in England’s National Health Service for 33 years. During that time he specialized in staff development, including a decade as director of the doctorate in clinical psychology at Newcastle University, preceded by 12 years as a clinical tutor (Consultant to clinical supervisors) at Leeds and Newcastle Universities. Clinical supervision was a significant focus for this work, including the organization and management of placements for trainee clinical psychologists, together with workshops for clinical supervisors. This activity was preceded by providing clinical supervision to multidisciplinary NHS staff, as well as a clinical service to adults with mental health concerns. Since 1979, Derek has published 12 books, two on clinical supervision,1 over 120 papers in peer‐reviewed scientific journals, and numerous articles in professional journals. Many of these address practical issues in enhancing clinical supervision, such as clarifying conceptual models, improving measurement (especially through direct observation), conducting single‐subject (n = 1) and other evaluations, and developing supervisor training. These activities has been guided by a commitment to evidence‐based practice, drawing on a scientist‐practitioner orientation.
Robert P. Reiser is a licensed clinical psychologist in California and a Fellow of the Academy of Cognitive Therapy. His primary orientation is cognitive‐behavioral therapy, with a focus on supervising cases and treating individuals and families with complex and serious mental illnesses, including schizophrenia, bipolar spectrum disorders, and recurrent severe depression. Two of his grant‐funded clinical research projects involved close collaboration with community mental health professionals in providing supervision, clinical training, and piloting clinical interventions for individuals with serious mental illnesses. Robert has provided numerous workshops and institutes at the Association for Behavioral and Cognitive Therapies (ABCT), focused on improving supervision and training through the use of empirically supported practices.
Since 2006, he has been delighted to collaborate with Derek Milne on a series of research projects involving the development of SAGE, an instrument that assesses competence in supervision. He has written and co‐authored several journal articles and has contributed book chapters on evidence‐based approaches to clinical supervision in association with Derek for The International Handbook of Clinical Supervision. He participated as a consulting supervisor providing CBT training to VA clinicians within the CBT‐D national training program with the Veterans Administration over several years. Currently, he works as a consultant with the Felton Institute in San Francisco, providing supervision and training for clinicians and case managers using cognitive‐behavioral therapy for psychosis (CBT‐P), and supervises medical residents in the Department of Psychiatry at the University of California, San Francisco. He maintains an active interest in training and clinical supervision with eight years’ experience of running a training clinic for doctoral‐level clinical psychologists, which focused on supervising trainees providing empirically supported treatments.
I am delighted to write a foreword for this manual for CBT supervision, an evidence‐based account of CBT supervision. It is unique in providing guidelines and procedures along with an exhaustive review of the empirical literature and expert consensus. It is a very important book. The growth of high fidelity and competently practiced CBT and the expanding ability to serve new populations and complicated cases depends upon the quality of supervision and training that is provided to practitioners.
This is a quintessential scientist‐practitioner approach. It combines the best science and a bridge to effective practice. The manual provides a comprehensive training package including 6 guidelines for practitioners accompanied by a PowerPoint slideshow and 2‐3 video clips for each guideline. Each of the 18 included video clips maps onto the Roth & Pilling (2008) competencies framework for CBT supervision and onto the authors’ instrument for measuring competence in CBT supervision, SAGE.
In summary, the authors have provided an original procedural account of CBT supervision and the training of CBT supervisors. It is unlike other manuals and textbooks on the subject, as it is rigorously linked to the evidence‐base. It is worth also noting that the authors worked closely with practitioners, over 100 British Association for Behavioural and Cognitive Psychotherapies (BABCP) supervisors. Also a working committee of the BACBP provided feedback at every stage of the guidelines development.
Unique, too, is the emphasis on the role of organizational context and how this relates to the use of evidence‐based training methods. This focus has resulted in advice on supervisor training that approximates a ‘gold standard’ for CBT supervision and is attuned to the age‐old problems of generalizing such training to real world conditions. CBT supervision has lacked the robust evidence base afforded to CBT treatment and this manual stands as a corrective to that longstanding oversight.
I predict that you will find that this clinical manual of CBT supervision provides a new and particularly promising viewpoint, based squarely on the evidence‐based practice approach.
Undertaking a task as challenging and unpromising as an evidence‐based supervision manual requires a good explanation. We certainly hesitated before deciding to give it a go, but in the end we were influenced by a sense that at long last the world of clinical supervision was evolving and moving toward a new paradigm. For decades we had labored alongside enthusiastic colleagues to get supervision acknowledged as the cornerstone of professional development within the mental health professions. We now believe we have reached that threshold (Watkins & Milne, 2014), making the next phase appropriate. Recent developments in CBT supervision further increased our sense that the time was right to contribute this much‐needed manual. There was also important and timely research progress in neighboring literatures, such as those concerned with expertise, education, and staff training. This progress suggested real improvements in the way we might address CBT supervision, in such issues as facilitating learning and providing effective feedback within supervision. Similar progress was evident concerning the optimal ways to train mental health professionals, with direct relevance to training and supporting CBT supervisors (e.g., Beidas & Kendall, 2010; Rakovshik & McManus, 2010).
Another boost to our ambitions was that we felt part of a small but effective group of like‐minded professionals, all striving in the “swampy lowlands,” but with the goal of finding a firmer footing in the supervision uplands (e.g., The International Handbook of Clinical Supervision, 2014; and the special issue of The Cognitive Behaviour Therapist, 2016). We received further encouragement in our workshops for supervisors, which were met with positive responses to our ideas and materials. This led naturally to some close collaboration with the intended users of this manual in the form of over 100 CBT supervisors who helped us develop the six supervision guidelines. Linked to this operational activity we were supported by a specially convened working party of the British Association for Behavioural and Cognitive Psychotherapy (BABCP), guiding us on strategic issues.
Something else helped, and made us aware we were pushing against an open and inviting door: this was the close connection between CBT and these developments in clinical supervision. Few models in the mental health sphere can match CBT for the clarity, relevance, transferability, and empirical depth of its learning principles, ones that also apply so readily to supervision. Based on many years of working as CBT therapists, supervisors, and researchers, we felt well placed, as individuals with relevant expertise, to combine this emerging material on supervision with the principles of CBT, blending in the exciting developments in neighboring literatures. Finally, our personal history of collaboration over eight years began with our initial n = 1 study of training effects in developing supervisory competence. It continued with the development of an assessment instrument – SAGE – designed to quantify competences in CBT supervision. Our working alliance continued with more joint scientific papers, alongside a series of international workshops and conferences, whch focused on improving supervisor training through evidence‐based practices. We feel that this joint work exemplifies the kind of enriching development through experiential learning that we aim to convey in this manual.
Of course, there are other manuals on CBT supervision (e.g., Newman & Kaplan, 2016; Sudak, et al., 2016), so we needed to contribute something original. This we feel we have done by taking an evidence‐based and systematic approach. Specifically, and unlike other manuals, we have critically reviewed the existing literatures in clinical supervision and the most relevant neighboring literatures to a standard comparable to scientific journal reviews. This is indicated by our linked publications in scientific journals (e.g., a survey of CBT supervisors and trainers; Reiser & Milne, 2016), in order to conduct a needs assessment for our manual; and reviews intended to clarify how we might best make a manual effective (including supervision guidelines; Milne, 2016a; Milne 2016b; Milne & Reiser, 2016). This text is also unique in terms of providing a systematic training manual, including everything needed for trainers to deliver a CBT supervision workshop. We include things that other manuals do not offer (e.g., slideshows and road‐tested guidelines), and more varied and extensive material (e.g., video‐based demonstrations of the supervision competences, linked to the competence framework of Roth & Pilling, 2008). We also offer well‐established, proven methods of training and supervision in that this manual builds on extensive earlier work (the manual linked to the text by Milne, 2009), work which has been evaluated and developed in our own workshops and more formally (e.g. Milne, 2010; Milne & Dunkerley, 2010). In summary, we believe this manual is the best available resource for CBT supervisors, providing a carefully tailored collection of video demonstrations from a variety of supervisors and supervisees. To these we have added slideshows with suitable learning exercises and supervision guidelines, representing a far more complete and evidence‐based training resource than other CBT supervision manuals or texts. In summary, we offer a comprehensive, evidence‐based procedural account of CBT supervision that is lacking in all other textbooks and manuals.
As outlined above, we hope that this manual will contribute significantly to CBT supervision by indicating how supervisors can be trained and supported according to the best available, most firmly evidence‐based practice. We aim to reduce the gap between the hope for and reality of CBT supervision, to help to “make things compute” better in this vital professional activity (Watkins, 1997). As a result, we believe that practitioners will feel more confident and skilled, and hope that their patients will receive safer and more effective therapy.
As described more fully in chapter 1, this manual has been written primarily for workshop leaders who train CBT supervisors. However, it will also be useful to individual supervisors, and to those who support and guide trainers and supervisors (e.g., peer groups, consultants, managers, administrators, training directors), as we include suggestions and materials (e.g,. video clips and guidelines. which can be used independently by supervisors). In summary, this manual is designed to support and enhance multiple training functions, including:
We also aim to be multidisciplinary and systemic, as we recognize that supervision requires a supportive context and a suitable infrastructure (Milne & Reiser, 2016).
The introductory chapter sets out our plan for achieving these aims, but here we note how, even in our manual design, we have been guided by the available evidence. We were particularly persuaded by the literature on instructional design (e.g., de Jong & Ferguson‐Hessler, 1996), which suggested that the manual needed to address strategic, declarative, and procedural knowledge. In practice, this means that the first three chapters are strategic and academic in style, setting out our guiding principles and core theory (e.g., on the role of organizational context on training). The heart of the manual are the six guideline chapters that follow, each chapter tackling one of the elements in effective CBT supervision. They follow the standard organization of workshops by starting with the necessary didactic teaching in order to provide a foundation in declarative knowledge. This leads on to our evidence‐based recommendations, incorporating principles of experiential learning, designed to develop procedural knowledge. Together, these three complementary forms of knowledge address the best available evidence on how to train CBT supervisors and how to conduct CBT supervision effectively. Those looking for a quick procedural guide can turn straight to the relevant guideline chapter. Each guideline chapter is written in a concise and direct style (as are the six guidelines), and summarizes the evidence for each recommendation that we offer. In the final chapter we reflect on the material and draw some conclusions on the strengths and weaknesses of the manual, and on the challenges that lie ahead.
We hope that you find this approach appealing and that you can draw on this manual to improve your work.
We are hugely indebted to many colleagues and helpers for their contributions to this manual. Being part‐book and part‐manual, this is no straightforward text, and we could not have compiled it without substantial input from many helpful people. Perhaps the most sustained collaborative effort took place in developing the six supervision guidelines that form the backbone of the manual. We developed them with the help of over 100 active clinical supervisors working in the NHS in England and Scotland. In a series of supervision workshops led by Derek Milne held during 2015–2016, these supervisors – mostly CBT supervisors and BABCP members – scrutinized the draft guidelines and suggested improvements. This procedure is described in chapter 1, but here we wish to thank the supervisors for their significant and willing assistance. We cannot list them all by name, but we should at least thank those who organized the workshops and facilitated the guideline development work. They are: Edith Moon (University of Derby), Nicky Kelly (in relation to the BABCP Special Interest Group in supervision and to Canterbury & Christ Church University); Craig Thompson (University of Northumbria), Sandra Ferguson (National Education Scotland), and Pam Myles (Reading University).
The time and effort taken to record the 18 video clips that demonstrate the six guidelines were similar, but the associated stress of performing supervision in front of a camera deserves a special note of thanks. We identify all the contributors by name with their affiliated employers in the video catalogue, but wish to extend a special thank you here, as we found surprisingly few colleagues were willing to record their approach to CBT supervision.
We were also aided by colleagues in relation to the many issues we encountered along the way. Most frequently there was the challenge of locating key research studies, or of checking our grasp of the literature we had collated. Here we thank Carol Falender, Amanda Farr, Craig Gonsalvez, Russell Hawkins, and Ed Watkins. Of course, they have no responsibility for the material in this manual, which is entirely our own work. We wanted to acknowledge the Felton Institute and the California Institute for Behavioral Health Solutions as well as Sara Tai for assistance in producing several of our high quality supervision videos. We are also indebted to our video editor, Adam Gilroy (time and motion films), for his highly professional approach, and to graphic artist Angela Butler for contributing high‐quality figures and valuable advice on the design of the slideshows and the DVD cover. Finally, we owe a debt of gratitude to Andy Peart at Wiley for commissioning this manual, followed by assistance from editors Darren Reed, Roshna Mohan, and Nivetha Udayakumar. Jan Little provided tireless and valuable guidance on improving the draft text.
Another major consideration was that of trying to ensure that this manual is as useful as possible. We would like to thank a specially convened working party of the BABCP for guidance throughout the two years that it took to prepare this manual. This group was initiated and led by Mark Latham; the working party members were: Amanda Cole, Anne Garland, Sarah Goff, Mark McCartney, Linda Mathews, and Lucy Nicholas.