Role and Purpose of Clinical Supervision - Paper Example

Clinical supervision plays a vital role in both post-graduate and undergraduate medical education (Bernard and Goodyear, 2009). The primary objective of clinical supervision is to promote professional development and ensure the safety of the patient. There are varieties of definitions for clinical supervision with some defining clinical supervision as being hierarchical and evaluative and others as a form of quality assurance. However, most scholars have pointed out that clinical supervision entails three essential functions which are management, education, and support of new/ trainee clinical employees. According to Bernard and Goodyear (2009), these three features apply across different professions such as medicine, social work, nursing, psychology and counselling, educational psychology and teaching among others. This paper presents a literature review on clinical supervision with a close focus on the supervision of new or trainee counsellors. The literature review will show what has been researched and written in this field in regards to purpose, models, practice setting, structure, and content, and impact of clinical supervision on patients and new/trainee counsellors. About 90% of all research studies previously conducted on clinical supervision use descriptive/ qualitative study. Also, most of the research studies available in this field of study contain various errors related to research study design such as ambiguous research questions, unreliable incidents and inadequate samples which affect study findings

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As outlined in the BACP Ethical Framework for the Counselling Professions (BACP, 2016) clinical supervision is a universal feature of training. It is also an integral part of the accreditation and ongoing development for counselling practitioners in the United Kingdom. Supervision helps therapeutic professionals to maintain good practice (British Association for Counselling and Psychotherapy (BACO), 2016). It also ensures that they regularly reflect on how to practice effectively, guarantee their safety and that of their patients and maintain ethical practice throughout their working life. Clinical supervision ensures new/trainee counsellors assimilate good practice and procedures as required by regulatory bodies in the countries and states in which they operate. Trainee Supervision prepares new/ trainee counsellors for professional practice as well as on providing quality psychotherapeutic services.

Clinical supervision is viewed as integral to the development of both the trainee and the experienced therapist. There is a shift towards evidence-based practice, and as a result, there is more focus on practitioner accountability. There is also a cultural shift towards ensuring that patients have access to the best mental health care service. Therefore, clinical supervision is heralded as one of an essential process through which best practice in counselling psychology can be achieved. Most research studies on clinical supervision have been based on new/ trainee employers. However, there is much empirical evidence that experienced therapist also benefits a lot from the supervision process especially if they take part in supervising the new or trainee counsellors. Every training and supervisory experience are different, and the supervisor can also learn from those he or she is supervising.

Effectiveness of supervision

A research study by Stoltenberg and Mcneill (2011) revealed that supervision promotes professional, personal and clinical skill development for new/trainee counsellors. It offers diverse perspective and gives a chance to trainees to reflect on personal strengths and professional practice and challenges. The outcome of effective clinical supervision is increased expertise, clinical flexibility, and individual consciousness. Jungers and Gregoire (2013) articulated that there are three components necessary for an effective supervision relationship. The first critical element for an excellent supervision relationship is a shared agreement and understanding about goals and expectations for supervision by the trainee and the supervisor. They both should understand and mutually agree on the aims of the supervision as well as the expected outcome. The second component is shared understanding and expectations of the roles, responsibilities, work or tasks for supervisor and the new/trainee counsellor. The third and most important element is positive emotional bond and understanding relationship between the supervisor and new/ trainee counsellor/ supervisee.

A research study by Kilminster and Jolly (2010), revealed that the supervision relationship is the single most essential aspect of the effectiveness of clinical supervision. Kilminster and Jolly (2010), suggest that supervision relationship may be even more important than the supervisory method used. This is because a good relationship between the trainee and supervisor facilitates fast learning and a mentorship kind of relationship rather than superior-minority hierarchy. Clinical supervision also needs to include clear feedback. The trainee also should be given a chance to decide what she or he needs to be included in the supervision process.

Clinical supervision can be performed under various circumstances with the most common one being on-the-job where new/trainee councellors learn by observing practical tasks being carried out. In other cases, supervision can be provided in a 'one-to-one' meeting, networking exercise or peer and group supervisions with or without a facilitator. On-the-job' supervision has been described as the most efficient way of supervising new/trainee counsellors. This is because the environment in which supervision takes place profoundly affects the trainee's response as well as what he or she learns. A clinical setting provides a high-quality supervision and appropriate level of autonomy. It also provided the trainee with good social support and a variety of workload for practice purposes. A clinical supervision guide provided by Kilminster, Cottrell, Grant, and Jolly, (2007), points out that clinical supervision conducted in a clinical environment enables new clinical employees and trainees to perceive feedback positively. Feedback is an essential element of clinical supervision because the trainees and supervisors need to exchange information and receive clear feedback from each other consistently. According to the survey by Kilminster and Jolly (2010) the more trainees perceived feedback positively, the less they felt overwhelmed by the new responsibility and the better their relationship with the supervisor got.

Various research studies on the topic of clinical supervision have revealed that clinical supervisions of new/ trainee clinical employees that utilized reflective practice were considered useful. Reflection in clinical supervision is paramount for examining and identifying any experience received and its features. However, according to Carroll (2011), a reflective practice should not be solely used in supervising new/trainee counsellors because they are beginners n the field and need directions on what to do. However, the reflective practice can be used after the trainees acquire some experience, especially if the supervisor is using the developmental models of supervision.

Research has shown that the level of clinical supervision in the UK is inadequate. Counselling trainees do not receive the stipulated minimal supervision. Surveys have found out that counselling trainees are not always satisfied with the level of supervision and training they receive before they can start operating unsupervised. A case study research by Townend, Iannetta and Freeston (2012) revealed that there exists a significant disparity between supervisors' and trainees' view regarding the amount of time spent on clinical supervision. In this case study Townend, Iannetta and Freeston (2012) collected data from various clinical settings where new/ trainee clinicians were receiving supervision. The data was collected from both trainees and supervisors. The results from the case study revealed that trainees were not entirely satisfied with the structure of supervision. For instance, they thought that too much time was being spent on supervision process at the expense of career training and development. Therefore, for the effectiveness of clinical supervision, the supervisor and trainees should begin their supervision relationship by discussing and agreeing on the amount of time to be spent on various aspects. They should also discuss and agree on the structure, time plan, how and when supervision review process will be implemented, all areas to be covered and the responsibilities of each party.

Clinical supervision models for supervising new/trainee counsellors

Clinical supervision in the counselling field initially started as apprenticeship where a new or trainee counsellor with minimal skills and knowledge would learn by observing, assisting and receiving feedback from a highly accomplished counsellor (Smith, 2009). This concept was based on the assumption that an accomplished counsellor would make an excellent supervisor. Over the time, this has proved not to be the case. Some accomplished counsellors may not be great supervisors without additional training to acquire supervisory skills and knowledge. Research has shown that apprenticeship model of clinical supervision may not be a perfect training tool for new or trainee clinicians. This is because it evokes a hierarchy of power where the new /trainee counsellor views the accomplished counsellor as a higher authority rather than a mentor (Ward and House, 2008). As a result, it hinders the processes of transferring knowledge from the master clinician to the apprentice. Observing experienced clinician as they work is essential to new/ trainee counsellors but may not be sufficient in helping them become highly skilled and experienced.

New clinical supervisory models have been developed to facilitate complex exchange between the supervisor and supervisee. Adequate clinical supervision is perceived as one in which the supervisee engages in reflection on the counselling work, counsellor-client relationship as well as the supervision itself (Smith, 2009). There are many supervision models in counselling, and most of them support instrumental rather than questioning approach (Ward and House, 2008). The choice of supervision model is paramount because it affects the content and style of supervisions and this consequently impacts on the learning of the new/trainee counsellor. According to Smith (2009), supervision process and the model selected should depend on the level of trainees experience and training. The following are some of the clinical supervisory models that have been proposed by various researchers and scholars.

Psychotherapy-based supervision model- This model is based on observing, assisting and receiving feedback from the supervisor (Ward and House, 2008). The clinical supervision process follows the framework and techniques of theory or model that is followed and practiced by the supervisor. The supervisors theoretical orientation determines what the trainee will observe, interact with and the clinical data that the supervisor and trainee will find relevant throughout the supervision process. In psychotherapy-based supervision there is a free, uninterrupted flow of counselling techniques, terminology and focus between the counselling and the supervision sessions (Smith, 2009).

A developmental model of supervision- This model was first researched and proposed by Glickman where he suggested that supervision approach should be in line with the trainees conceptual...