Extracts from the Diploma 2018-19 Moderation Report - September 2019

....The trainers are to be congratulated on further consolidating the requirements and assessment structures, and expertly tutoring and facilitating the development of participants in this fifth offering of the CST Diploma Course....

‘The participants’ unanimous feedback focused on the comprehensiveness and the extensiveness of course content, the initial review of the areas, and that despite the content-richness, seldom feeling rushed, because of the tutors’ depth of knowledge, sensitivity, and skill in meeting individual learning needs’....

....As I have noted in the past, the CST Diploma course remains a feather in the cap of accredited training monitored by the ASIIP, providing a unique opportunity for supervisors from a range of backgrounds and situations to develop, deepen and extend their practice of supervision. Long may it flourish!’
Dr Karen John  - ASIIP External Moderator
 
Feedback from participants of 2018-19 Diploma:

‘…the course structure was useful in offering varying modes of learning from the more information based to the experiential’;

‘The pace was great with plenty of time to reflect – offering the course over weekends helped keep the energy going, but didn’t overwhelm us’;

‘The assignments built on each other so I felt able to track my own development and to see how far I had come since the beginning of the course’

‘Tutor support was always given in an encouraging way, with just the right pace for me’
​
‘The tutors modelled a kindness, non-judgemental and open approach to the work and to each of us which I felt was containing and provided an environment in which we could learn and play’

Supervision is a bit sneaky. We meet in private to talk about individuals who aren’t there. We’re constantly reporting, guessing, collating, imagining, putting two and two together. Some people would call this gossiping. And it is absolutely true that we often say things in supervision about a client that we wouldn’t say to their face. Imagine if one of your clients was sitting in your session with your supervisor and listening to you talking about them. How might that affect you? The degree of difference it would make to what you said, or the way you said it, could be very useful as a measure of your ethical hypocrisy.

Of course we’re not mere gossips, and we’re not sneaks either, but you take my point. It’s your well-tuned ethical sense that tells you why you’re describing a client in language you wouldn’t use if they were in the room with you. We need to know why we do this and we would be non-ethically hypocritical if we didn’t know.

Good supervision enables us to take a dispassionate and curious look not only at how ‘two-faced’ we may be, but also how we use our awareness of that duplicity. This reflective process can be awkward but it’s not agonising. We could start with the familiar notion that a hypocrite* is someone who doesn’t practise what they preach. So that’s already most of us, right? When you offer therapeutically wise and sensible ideas to your clients – about self-care and self-compassion, for example – do you genuinely apply these same things to your own daily life? Let’s not dishonour our subjective truths on this. For myself, I reckon the answer is ‘no’ about a third of the time. From discussions I’ve had with colleagues it seems that we do regularly practise some of the good stuff we preach, but we’re also quietly aware of ways we fail to ‘walk the talk’. Bringing that self-awareness into the supervisory frame is always beneficial, because where we are in some sense ‘lapsing’ or ‘falling short’ is precisely where we invigorate the natural impulse to grow and develop. In this respect, gently declaring our personal pieces of hypocrisy in supervision becomes self-motivating, not self-shaming.

We talk a lot about our clients in supervision sessions but how often do we talk about our supervision in client sessions? Hardly ever, it seems. In fact most clients probably know almost nothing about supervision other than what’s stated briefly in the counselling contract. In my experience, it’s extremely rare for anyone to ask about supervision. So in any given piece of work, it’s highly likely that both the practitioner and the client are totally silent on the matter – albeit for very different reasons. One professional rationale for the silence is that the content of supervision sessions is confidential between the parties undertaking the supervisory contract; the client is not a signatory to that specific contract, so what goes on in supervision is strictly speaking not their business. It makes sense in terms of strong containment, but the more I think about this set-up, the more intriguing it gets.

 I wonder if the practice of supervision itself isn’t a discreetly specialised form of hypocrisy. The high level of confidentiality within the consultation process allows for, and even legitimises, the application of double standards. The therapy space and the supervision space are held to be distinct. Different dialogical rules apply in each. Whatever we do and say in one place is not witnessed in the other. Confidences can become confused with secrets. Dual relationships can result in clinical collusion. And who really knows what goes on behind closed doors anyway? Things can get weird. No wonder we have such a carefully crafted set of commitments to accountability within the Ethical Framework. We might have set ourselves a nice trap there: the greater the ethical language we use to describe our professional obligations in supervisory relationships, the more we lay ourselves open to the charge of hypocritical posturing.
The traditions and conventions of supervision have evolved primarily to minimise the risk of harm, mainly to clients and also to practitioners. As a profession we’re somewhat compromised in this regard since we have almost no research-based evidence that supervision is intrinsic to the achievement of that worthy aim. We feel that it helps more than we know that it does.
Engaging in supervisory work is not unlike an act of faith: we believe in its goodness without being able to prove it other than doing it steadfastly in the belief that it’s good. The reality is that as signed-up, card-carrying members of BACP we are required to believe in it. This potentially exposes us to two particular states of active hypocrisy: practising supervision while not believing in it (completely cynical), and practising supervision while never admitting our doubts about it (secretly sceptical).
If you know how it feels to embody the second type of hypocrisy, you’ll also know the best ethical move to make is to become openly doubtful. Actually, this applies to all of us: our least worst hypocritical position is frank and fearless scepticism. Then we can honestly call ourselves good ethical hypocrites.
 
*I like the fact that the word comes to us directly from hypokrites, the old Greek word for ‘actor’. It literally means ‘speaking from underneath’ – in ancient Greece actors wore masks to indicate the character they were portraying, and acted or spoke from underneath or behind the mask. This theatrical origin is still evident in the modern use of ‘hypocrite’ to mean someone who is not what they seem: they’re a ‘bad actor’ in the sense of a person apparently acting in good faith but in reality only pretending to.
 
Jim Holloway is a senior accredited counsellor and supervisor, a Cambridge Supervision Training Associate, and a co-author of Practical Supervision: How to become a supervisor for the helping professions (JKP 2014). He contributes to 3menwithablog.com, a collaborative blog about therapy.

Whilst training counsellors on a short course about supervision, my colleagues and I became interested in how to teach the trainee supervisors to take appropriate supervisory authority both under normal circumstances, which entails developing some interventionist skills and habits for good practice, and how to manage a relationship under threat because of a major difficulty, which requires a relationship- focused approach. Adlerian ideas about the importance of monitoring whether the superiority and inferiority dynamic is being expressed, and if so, how it is happening in the supervisory relationship have become useful to our teaching. Specifically we used Dreikurs’ (1953) and Sweeney’s (1981) explanations on the inter and intra-personal dynamics that arise from an individual’s feelings of superiority and inferiority. My colleagues, who call the preoccupation with success and failure (superiority and inferiority) “the slippery pole”, introduced me to these ideas and adapted Sweeney’smodel presented in the diagram on page 45.
What do I mean by taking supervisory authority under normal circumstances? It may include many ways to relate that require immediacy, may be uncomfortable, or simply take more initiative than is normal in counselling relationships, currently the major professional role of the trainee supervisors. It relates to the task of the supervisor and the expectations of the role to protect clients and uphold standards.
Examples include:

1. making contracts for the work;
2. taking and sharing responsibility for allocating time during the supervision;
3. coping with ethical dilemmas;
4. giving feedback about the skills or approach of the supervisee;
5. writing reports or references;
6. assessing ‘fitness to practise’ together when the supervisee is facing difficult life
7. events or health problems;
8. setting up regular reviews of the supervisory relationship and its efficacy, and​ preparing well for them in advance so each person gives feedback to the other.

Examples of the relationship qualities normally required are subtle to convey, and trainees’ private logic (‘internal working models’, in the language of attachment theory) greatly affects how they hear the teaching. Specifically, and unhelpfully, trainee supervisors may conflate ‘taking authority’ with ‘being authoritarian’, a style they do not wish to implement because it would undermine some core Adlerian values about equality and encouragement, respect and regard. In the inevitably asymmetrical​ relationship that is supervision, the everyday challenge is to sustain these core values about relationship whilst undertaking the necessary tasks of supervision.
As trainers of supervisors, we need to explore the issues and model the skills involved. Especially when supervising trainee counsellors there is a real power differential arising from the tasks the supervisor has to undertake, and this can beneficially be openly acknowledged rather than denied. The Adlerian commitment to supporting clients to fulfil the tasks of their life through encouragement is paralleled in supervision, as assessment and giving feedback are core tasks for the supervisor. Furthermore, these tasks need to be done within honest exchanges and without attacking the self-worth of the supervisee. The concept of Social Interest is uniquely relevant to healthy supervisory relationships and indeed professional relationships ofall sorts, because of the emphasis on people’s “proclivity for being responsible, co- operative yet creative members of humankind” (Sweeney, 1981, p. 23).

Criteria for Best Practice

1. I have tried to develop criteria for best practice in relation to supervisory authority in both normal and difficult circumstances, and I think these include five distinct elements for trainee supervisors to consider:They need to encourage their supervisees to learn to take responsibility for preparation and for focus, so that they do not abdicate control and initiative totally to the supervisor. Often they become aware during the training of the value of this for themselves as supervisees.
2. They need to understand about ‘slippery pole’ dynamics, and how to sustain a commitment to equality and mutual respect, especially when difficult things are to be said. Social influence, leadership, mentoring and responsibility, all come within this criterion, and getting the relationship right creates safety and an enabling working alliance.T
3. They need to develop their views about the purpose of supervision, issues of power and authority, the development of an ethical stance, and an awareness of the importance of ethical principles and frameworks to approach supervisory dilemmas.
4. They need to become aware of the bases for legitimate authority. These may include expertise, role, and the professional bodies’ expectation that supervisors will keep a watchful eye on practice for the sake of the profession. There is ‘institutional power’ attached to this role even when the relationship is entirely between private practitioners: the supervisor carries responsibility for the promotion of good practice and the protection of clients.
5. They need to accept that the person undertaking the supervisory role has a right and a duty as part of the role to challenge bad or inadequate practice, and enquire about ‘fitness to practise’. Fitness to practise concerns the practitioner’s resilienceto undertake the role without doing harm to the recipient or becoming more vulnerable to fall into ethical traps because of their own life circumstances or health. With this criterion comes the expectation that the supervisor develop the skills to exercise this right whilst minimising the assault on the sense of worth of the recipient. As trainers, our role is to model and explore the skills involved, and also to engage in equally respectful relationships, even when offering feedback that we could predict would be painful or disappointing to receive. For instance, we aim to model putting the relationship first, not ducking the responsibility to be clear about standards or expectations, and being willing to share our own struggles to practise professionally. Of course as humans, we sometimes get this wrong too.

Contracting: 
Making the contract sets the tone for the relationship. Is it a basis for a working alliance? Is it comprehensive or sloppy? What leeway is there for meeting the unique needs of this supervisee as well as this supervisor? Does the supervisor feel entitled to be clear about her or his own needs, such as adequate payment, or notice for missed sessions? Does the supervisee feel entitled to be clear too, to be able to request help without having to hide their vulnerability or their skill, to be understood at their developmental stage, and so on? Contracts are crucial at the start of the supervisory relationship, and also at the start of each session, especially when the supervisee has a big agenda. The contract conveys that this is a purposeful relationship that can be monitored and reviewed by both parties regularly enough to allow uncomfortable matters to be discussed before they become impossible to speak about. Contracting is useful in counselling, and essential in supervision.

Trainees on the supervision course came with habits and expectations from their experiences as supervisees that implied that contracting is a skill that many supervisors barely deploy. Training can usefully contradict this custom and practice. Trainee supervisors can use contracting to become aware of differing learning styles, and thus of the balance between theoretically-based interventions, intuition, and use of the senses that suits them, and that a different balance may suit each supervisee. The contract can spell these out, together with pragmatics about meetings, payments, cancellations, extra contact between supervisions, and so on.

It is helpful to see managing the time during sessions as a shared responsibility. If the agenda is big, supervisor and supervisee can decide the order of topics and renegotiate if some elements take longer than anticipated. Invitations to use creativity and to focus on a specific question for supervision under each heading can invite the supervisee into
healthy habits of preparation for supervision, and build their “internal supervisor” during the process (Casement, 1985).
Power and the Taking of Authority
Power issues do need to be explored during the training to be a supervisor, add comma in which ways to address supervisee expectations are identified. If the supervisee feels inferior, fears failure, and pervades the dialogue with anxiety and excuses, blaming or complaining, the power dynamic can be discussed, and the supervisee can be invited to express their concerns and to take responsibility for their part in the interaction. This situation and this interchange may thus form a paradigm for other relationships and model direct communication in ways the supervisee may take back to the relationships with their clients. Sensitivity is required, and sometimes it cannot be made all right. Either party needs to be able to say that the relationship is not working and propose an ending, but in particular the supervisor needs to be monitoring the efficacy of the relationship and the work coming out of supervision, and they both need to commit to having regular reviews of the supervision relationship. The Adlerian insight from the slippery pole is to bring encouragement into the situation through attending todescriptions in response to the thought, “What am I doing?” rather than preoccupationwith judgement by self or other.

The word ‘supervision’ has oppressive connotations to some people. So before going any further, we need to emphasise the importance of establishing an equal, collaborative relationship between supervisor and supervisee that also has the potential to be mutually enjoyable. This is an essential value at the heart of our book Practical Supervision: How to Become a Supervisor for the Helping Professions1 and the Cambridge Supervision Training courses. Although we draw on diverse resources, our main approach rests on Adlerian ideas and values, focusing on awareness of interpersonal relating, the importance of empathy, equality, and co-operation, and the central need for, and specific skills of, encouragement.
 
‘En-courage-ment’, with courage at its heart, develops the person’s inner resources and courage and enables the building and maintenance of a constructive working relationship. The encouraging supervisor helps supervisees remove some of their self-imposed attitudinal road blocks and supports them to aim for their highest possible level of professional competence.
 
The theory and practice of encouragement was described by Alfred Adler nearly one hundred years ago, and these ideas are now extensively shared by ‘strengths based’ supervision approaches2 and ‘appreciative enquiry’3 where the supervisor and/or organisation respects, values, and positively acknowledges the ability and potential of their supervisees. As most management texts now agree, people perform best when they feel appreciated, understood, encouraged, and accepted ‘warts and all’. We can all feel shame when we make mistakes. The encouraging supervisory relationship provides a space where learning from mistakes, coping with uncertainty, and processing our emotions, are valued as normal and actually essential elements of  our professional development. An encouraging supervisor does not ignore these mistakes or uncertainties, but provides an appropriate balance between support and challenge, ensuring that the supervisory role also carries authority. This involves knowing how to be authoritative without being authoritarian. 
 
Before exploring some of the encouraging ways to put this support and challenge into practice, here are what we understand to be the three supervision tasks to be met:
 
1. To support and give courage to people engaged in emotionally demanding tasks.
2.         To make sure they know how to do what is expected.
3.         To uphold agreed standards and support the supervisee to work to them.
 
In our experience, the successful achievement of the core tasks requires the supervisor to ground their practice in these definitive essentials of supervision:
 
•           Creating a carefully negotiated working agreement between supervisor and supervisee(s).
•           Developing a supervisory relationship that has mutual trust and safety as its basis.
•           Talking openly about personal and professional values and ethics in relation to the work that is being supervised.
The working agreement
Effective supervision is a collaborative process. The co-creation of a clear contract through exploring both explicit and implicit hopes, fears, and requirements of supervisor and supervisee, lays the foundation for an encouraging, respectful and equal relationship.
The explicit contract includes such issues as organizational arrangements, codes of conduct and ethics, general practicalities such as venue, time, payment, and structures within supervision such as review processes:
The psychological or ‘implicit’ contract in supervision prevents unspoken misunderstandings bubbling away beneath the surface, such as clarifying training level,  expectations, issues of difference, learning style, ensuring boundaries, and maintenance of the supervisory alliance.
Contracting for each session
To reduce a power imbalance, it will also be important for the supervisor and supervisee to work together to clarify the agenda for each new session, so that the needs of supervisees are freshly accommodated. Some possible open questions include:
Ÿ          “What is your key supervisory question?”
Ÿ          “What do you most want to achieve in this session and how can we work together best        to achieve that?”
To maintain the encouraging equality of the relationship, supervisors can actively invite feedback from supervisees at the end of each session with such questions as:
Ÿ          “What are you taking away with you today?”
Ÿ          “What was useful about this session and what was less helpful?”
A supervisory relationship based on mutual trust and safety
Even where there is a difference in experience and expertise it is possible for supervisors to create a climate of equality and collegiality with their supervisees. This provides a potent foundation that helps supervisees have the courage to be imperfect5. Making mistakes and ‘not knowing’ are essential prerequisites for learning. Yet, as was identified in some USA based research6, trainee supervisees often avoided bringing material that could have been central to their learning; this included personal issues raised by clinical work, perceived clinical mistakes, and negative reactions to clients. This non-disclosure, which is particularly relevant with trainees, can be prevented by the supervisor at the outset of the contract saying something like:
“In supervision it is important to bring me things you are worried about, or feel you have not done quite right, or that you need to know more about. This can provide really valuable material that will invariably be useful as a base for further learning. If you avoid bringing any of these worries, I shall be concerned that you are not telling me essentials. I will be clear with you as we go along if I have any concerns about your ability to pass this course, and will discuss this with you long before I write any report.”
 
Part of what is involved in being an encouraging supervisor is to be able to name uncomfortable issues and offer clear feedback about the supervisee’s practice. Effective encouraging feedback is about enabling growth and learning and improved practice. It can be seen as an interaction, or a meeting-point between the supervisor and supervisees, rather than something that the supervisor ‘gives out’ to them. The feedback channel works best when it is two-way. One-sided feedback in supervision invariably increases a power imbalance, even when the supervisor shares positive comments.
 
Encouraging feedback is different from traditional praise or rewards, as it focuses on enabling both supervisor and supervisee to develop an inner sense of satisfaction and motivation. This involves much more than expressing positives7. Different from praise, encouragement focuses on what the person is doing, rather than how the person compares with others. Verbal encouragement can be achieved by avoiding the use of adjectival labels such as ‘good’, ‘unethical’, ‘clever’, ‘non-empathic’, and by keeping in mind the assets and intentions of the supervisee.
 
By using descriptive language and paying particular attention to verbs, the supervisor can offer feedback that is very specific, identifying what the supervisee has actually been doing, without needing to evaluate it. For example, an evaluative label: “You’re hopeless with boundaries and get far too involved with your patients” becomes: “I notice that instead of the allotted half-hour, you regularly stay for one hour with your patient, and that you made an additional home visit out of work hours when it was this patient’s birthday.”
 
From this non-attacking base, the supervisor can invite the supervisee’s own views, and then share any concerns, providing educative information and supportive challenge as appropriate.
Here respectful use of ‘signposting’ is helpful. Just as it is crucial on a motorway to be prepared for a side turning a good mile before, we can signpost our feedback in advance so it is less startling and enables a more collaborative meeting-point.
 
For example: “I’d like to discuss the ethical issue that may be involved in this situation – can we look at this now?” Further space can then be given for two-way discussion with the supervisee.
 
The use of Socratic questions can also help supervisees focus more deeply on their work, thus keeping a two-way flow of communication. This type of questioning invites the supervisee to gain insight into their own perceptions and then, ultimately, their own wisdom. For example:
 “When you say you find this young person difficult, what specifically do you mean?”
“What do you appreciate about the way you handled that?”
“How might you do things differently in future?”
 
Being able to receive feedback in a constructive way is a skill in itself, and is far from a passive process. Whether in the role of supervisor or supervisee, some form of defensiveness is likely when receiving feedback. Maybe because this triggers old feelings of shame, from which we may defend ourselves by shrinking and losing our sense of capability, or perhaps we overcompensate for our feelings of inferiority by becoming aggressive. Either way this inhibits potential learning and growth. The challenge for both supervisee and supervisor is to be able to listen openly to the feedback, and identify how, if at all, this might support future practice.
 
Supervisees will feel more able to share their mistakes and vulnerabilities if supervisors take risks to speak directly and honestly, and not put themselves on a pedestal. In addition, the supervisee must know the steps to take if they wish to make a complaint about the supervisor (this information can be clearly indicated in the initial contract).  Supervisees seldom say what the supervisor has done that was unhelpful, and so it is important that the supervisor routinely asks such questions as: “What were the most and least useful parts of today’s meeting?”
 
Ethics and authority
Part of the supervisor’s role is to act as a gate-keeper for the profession. Trainee practitioners are especially aware of this when coming for supervision, as the report the supervisor writes about their work could directly affect their entry into their chosen professional field. Whether a supervisee is in training or fully qualified, if there are concerns about their competence and resilience, the supervisor has an ethical responsibility to address the concerns, in the interests of protecting clients/patients from possible harm. The ethical position as supervisor is also one of support and care for the supervisee. So is an encouraging attitude compatible with the supervisory authority essential for effective supervisory practice?
 
At the start of this article we defined the encouraging supervisor as someone who helps supervisees remove some of their self-imposed attitudinal road blocks and supports them to aim for their highest possible level of professional competence – so yes, authority and encouragement go hand in hand. Authoritative interventions include advice-giving, providing information, and confronting. Feedback can be particularly useful when the other person has a ‘blind spot’, and is totally unaware of their motivation for what they have done or the impact of it. Often trainees fail to recognise minor ethical difficulties. When supervision can offer an encouraging and authoritative space for the supervisee to explore, ‘not know’, and ‘feel stuck’, there can be rich learning from mistakes.
 
 
It is important to distinguish between mistakes, malpractice, and poor practice. Minor mistakes are normal unintended slips in normally good practice. Malpractice arises when the practitioner meets their own needs at the expense of the workplace or people in it, and if it continues, this must be addressed as part of the ‘giving of courage’ or encouragement. Whether mistake or malpractice, the supervisor needs to address the issues with encouraging authority, and in turn, the supervisee will be more open to the feedback and guidance. 
 
The supervisor also needs to be open to stuckness, not knowing and learning from mistakes. Saying ‘I don’t know’ can be hard as a supervisor, if you feel you ought to know. It is beneficial to tolerate the discomforts of not knowing while still thinking together about an issue: this models the reflective process and demonstrates the value of reflection to the supervisee in an encouraging way.
 
Encouragement is a many-faceted process, and we see it as a vital ingredient for effective supervision. However, this fine balance between support and challenge, empathy and authority is by no means easy. We all have tendencies to move into judging and defensive positions at times, and we all make mistakes. When we can embrace these moments with compassion, it is gratifying to realize that they offer great opportunities for professional growth.
 
1. Henderson, P., Holloway, J. and Millar, A. (2014) Practical Supervision: How to Become a Supervisor for the Helping Professions. London: Jessica Kingsley Publishers.
2. Edwards, J.K. (2012) Strengths-based Supervision in Clinical Practice. London: Sage.
3. Cooperrider, D. et al (2000) Appreciative Enquiry: Rethinking Human Organization Towards a Positive View of Change. Champaign, IL: Stripes Publishing.
4. Burnham, J. (2012) ‘Developments in social GRAAACCEEESS: Visible and invisible, voiced and unvoiced.’ In Krause, B. (ed.) Mutual Perspectives: Culture & Reflexivity in Systemic Psychotherapy (pp 139-162). London: Karnac Books.
5. Dreikurs, R. (1970) ‘The Courage to be Imperfect’. In Articles of Supplementary Readings. Chicago: Alfred Adler Institute.
6. Ladany, N., Hill, C.E., Corbett, M.M., and Nutt, E.A. (1996) ‘Nature, extent and importance of what psychotherapy trainees do not disclose to their supervisors’. Journal of Counseling Psychology, 43, 10-24.
7. Millar, A. (2007) ‘Encouragement and Other Es’. Therapy Today (18)2, 40-42.