Supervision in the Mental
Health Professions
A practitioner’s guide
Supervision is of increasing significance in the practice of mental health
professionals, especially since the advent of voluntary and mandatory
registration, managed care and clinical governance. Little, however, has been
written to address the practical and theoretical needs and questions of those
involved.
In Supervision in the Mental Health Professions, Joyce Scaife, along with
her guest contributors, draws on over two decades of experience to illustrate
ways of thinking about and doing supervision. Using practical examples, she
explores often-encountered dilemmas, including:
•
How can supervisors facilitate learning?
•
What are the ethical bases of supervision?
•
What helps to create a good working alliance?
Supervision in the Mental Health Professions is a comprehensive, practical
and indispensable text for supervisors and supervisees involved in mental
healthcare, including clinical psychology, counselling, psychotherapy,
counselling psychology, psychiatry, nursing and social work.
Joyce Scaife is a Consultant Clinical Psychologist with North Derbyshire
Community Health Care NHS Trust and Director of Clinical Practice for the
Doctor of Clinical Psychology training course at the University of Sheffield.
She has over twenty years of experience as a supervisor of clinical practice.

Supervision in the Mental
Health Professions
A practitioner’s guide

administrators. 3. Mental health personnel. 4. Supervisors.
5. Personnel management. I. Inskipp, Francesca. II. Title.
RA790.5.S285 2001
362.2′068—dc21 00-059261
ISBN 0-415-20714-2 (pbk)
0-415-20713-4 (hbk)
This edition published in the Taylor & Francis e-Library, 2003.
ISBN 0-203-36094-X Master e-book ISBN
ISBN 0-203-37350-2 (Adobe eReader Format)
For George and Edith

Contents
List of illustrations ix
List of contributors x
Preface xi
Acknowledgements xii
1 Introduction 1
2 Supervision and learning 15
JOYCE SCAIFE AND JON SCAIFE
3 The emotional climate of work and the development of self 30
JOYCE SCAIFE AND SUE WALSH
4 The contracting process and the supervisory relationship:
avoiding pitfalls and problems 52
5 Frameworks for supervision 70
6 Group supervision 99
BRIGID PROCTOR AND FRANCESCA INSKIPP
7 Ethical dilemmas and issues in supervision 122
8 Use of audio and videotapes in supervision 145
9 Live supervision and observation 160
10 Creative approaches 173

Trainers’ Conference in 1973 when they were both employed as full-time
counselling trainers – Francesca at NE London Polytechnic and Brigid at
SW London College. Since then they have been engaged in the develop-
ment of counselling and supervision training as trainers, supervisors,
external assessors, consultants and writers. Joint publications include a set
of three audiotapes and two booklets entitled The Skills of Supervising and
Being Supervised, produced in 1989. In 1993 and 1995 they produced The
Art, Craft and Tasks of Counselling Supervision, two workbooks – Making
the Most of Supervision and Becoming a Supervisor, both illustrated with
audiotapes. They have both published books on counselling and counsel-
ling skills and Brigid has a new publication Group Supervision: A Guide to
Creative Practice.
Dr Jon Scaife is a lecturer in Education at the University of Sheffield. His
background is in physics and mathematics, and he became interested in
learning as a result of teaching these subjects. He is now interested in
learning and knowing per se.
Dr Sue Walsh is a senior lecturer in Clinical Psychology at the University of
Sheffield. She completed her Ph.D. at the Social and Applied Psychology
Unit, University of Sheffield and her clinical training at the University of
Exeter. Her primary interests lie in the interface between clinical and
organisational psychology.
Preface
Supervision, particularly as a component of initial training, and increasingly
as a contributory element in continuing professional development, is deeply
embedded in the cultures of the helping professions. This is despite the claim
(Holloway and Neufeldt, 1995) that there is no research on standardised and
empirically validated training programmes for supervisors. Client outcome is
the ultimate test of the effectiveness of supervision. But the relationship
between supervisor interventions and client change is subtle and complex.
Not surprisingly, attempts to account for and understand this relationship

Mike Pomerantz, Jan Hughes, Zoe Bradshaw, Linda Buchan and Liza
Monaghan.
Special thanks to Hannah, Jonny and Jon for putting up with me when I
was plugged into the keyboard rather than to their needs, and to Pat and Ray
for a peaceful and loving place in which to write.
Acknowledgements are also due for permission to reproduce illustrations
as follows: Routledge and Cassell for Figure 3.2, which was published on
page 46 of Counselling Supervision by M. Carroll in 1996 and adapted from
illustrations in Supervising the Counsellor: A Cyclical Model by S. Page and
V. Wosket in 1994; the American Counseling Association for Figure 10.2,
which was published on page 157 of volume 28 of Counselor Education and
Supervision © ACA in an article by Ishiyama in 1988: reprinted with per-
mission; Figure 6.1 which was originally published on page 57 of Supervision
in the Helping Professions by P. Hawkins and R. Shohet in 1989.
Introduction
I believe that the word ‘supervision’ conjures up a variety of ideas and
emotions in people. The prior experiences of practitioners in the helping pro-
fessions can lead them both to seek and to avoid further involvement in
the process. I have met people who have felt wounded by the words of a
supervisor twenty years earlier and are still smarting. There are others who
feel unsupported if the work context does not offer ongoing supervision
throughout their professional career.
I became interested in supervision when first faced with the prospect of
becoming a supervisor, and after my initial experience of the role. I was
worried about being ‘found out’ as an inadequate practitioner and I had the
idea that supervisors required much expertise and gravitas. Despite my pre-
qualification training, it was the first time that my clinical work had been
observed in progress by anyone and I found the experience nerve-racking.
After this I set out to ‘arm’ myself with information and ideas that would
protect me from such experiences in the future.

development.
This chapter discusses some of the different ways of viewing supervision in
order to clarify for the reader the underlying assumptions upon which the
remainder of the book is based.
What is supervision?
Aims and purposes of supervision
A distinction between the purposes and functions of supervision is helpfully
made by Carroll (1996). Following Carroll, the primary purposes of supervi-
sion are defined here as ensuring the welfare of clients and enhancing the
development of the supervisee in work. In order to effect these purposes the
supervision should perform the functions of education, support, and evalua-
tion against the norms and standards of the profession and of society. This
is the case irrespective of employment arrangements and applies both in
private practice and public service.
Many attempts have been made to define supervision, but, as with all such
attempts, none entirely does it justice:
Supervision provides an opportunity for the student to capture the
essence of the psychotherapeutic process as it is articulated and modelled
by the supervisor, and to recreate it in the counselling relationship.
(Holloway, 1992: 177)
Supervision is a working alliance between a supervisor and a worker
or workers in which the worker can reflect on herself in her working
situation by giving an account of her work and receiving feedback and
where appropriate guidance and appraisal. The object of this alliance is
to maximise the competence of the worker in providing a helping
service.
(Inskipp and Proctor, 1988: 4)
2 Supervision in the mental health professions
Supervision is that part of the overall training of mental health pro-
fessionals that deals with modifying their actual in-therapy behaviours.

The definitions of supervision listed above include the notion of the super-
visor being a more senior member of the profession, even if the supervisee is
fully qualified to practise. In contrast, attempts have been made to include
peer relationships under the definition of supervision and distinctions have
been made by the use of terms such as ‘training supervision’ ‘practitioner
supervision’, ‘peer supervision’, ‘peer consultation’ and ‘consultation’.
In this book the view is taken that whilst there are significant differences in
Introduction 3
the process of supervision when the partners in the relationships are at differ-
ent stages of their careers, there are sufficient commonalities to discuss all of
them under the term ‘supervision’. Were it obligatory for the supervisor to be
the more senior partner, it would prove extremely difficult for some counsel-
lors and therapists to arrange their mandatory ongoing supervision as their
careers progressed. Supervision here is used to describe what happens when
people who work in the helping professions make a formal arrangement to
think with another or others about their work with a view to providing the
best possible service to clients and enhancing their own personal and profes-
sional development. It thus includes what some authors have defined as
‘consultation’.
Individual and group supervision
Some definitions emphasise a one-to-one supervisory relationship. Whilst
this is the most common mode of supervision in many of the helping profes-
sions, group supervision can offer a rich tapestry for learning and develop-
ment with a range of possible formats and leadership roles, examples of
which are described in Chapter 6 by Brigid Proctor and Francesca Inskipp.
Commonality and difference of therapeutic model
Another notion is that the supervisor’s tasks are to provide and model exem-
plars from which the supervisee learns. Whilst that can be a helpful process,
the approach of this text is that it is also possible to learn from a supervisor
who draws on a different model or models from that being adopted in the

Supervision can serve formative, restorative and normative functions (see
Chapter 5).
In pre-registration training, supervision is also characterised as follows:
•
The effects of supervision are to socialise the new recruit into the
profession, to replicate institutional canons and to propagate the norms
of the profession.
•
The supervisor performs a gate-keeping function which allows for the
exclusion of those deemed to be unsuitable for membership of the
profession.
•
Supervision occurs in the context of a power imbalance in which the
evaluation of the work of those in training can have a profound impact
on their subsequent lives at work.
This is not to argue that supervision is the panacea for dealing with work
related issues; its aims and purposes can also be achieved through less formal
relationships, and the existence of the features above does not necessarily
guarantee that the aims of supervision will be achieved.
People at work have their needs met in conversations, ranging from those
that take place in the kitchen over a cup of coffee to those that occur in review
sessions with managers, in team meetings and the like. Informal conversations
and formal ones undertaken for purposes other than supervision may lead to
similar outcomes, but would not have the features designated to constitute
supervision for the purposes of this text. Nevertheless, supervision does not
have to be something that is overly special in order to achieve the aims and
meet the defined purposes. One of the most important factors in whether the
supervision is useful for these purposes is the interest that the supervisor has
in supervision and in the supervisee. When this is the case, all else is likely to
follow (Nelson, 1978; Engel, House, Pearson and Sluman, 1998).

and could be resolved by resisting contextual pressures and allowing the child
into the parental bed.
Once the client has been identified, the definition of the problem and the
decision to work towards change usually lie with the client, albeit with the
help of the therapist. Whilst the therapy may not begin with this degree of
clarity, an appraisal of motivation or capacity for change at a more or less
formal level is part of the ongoing assessment. Where the client is indefinitely
committed to no change, continuing efforts are likely to be experienced as
frustrating for the therapist, and costly for the purchaser. If the work is to be
successful, commitment to change cannot rest solely with the therapist or
supervisor. Ongoing assessment of motivation to change is the responsibility
of the therapist and supervisor.
6 Supervision in the mental health professions
The responsibility of the therapist/supervisee
Responsibilities to clients
In the therapy, the responsibility of the practitioner is to participate in and to
strive towards creating the conditions that will facilitate change for the client.
Whether or not clients respond is up to them. In addition, supervisee therap-
ists have responsibilities to act ethically and within the professional guidelines
established both by their employer and by their professional body. Actively
participating in supervision and remaining open to learning as part of con-
tinuing professional development helps therapists to ensure that they are
fulfilling these responsibilities to clients.
Responsibilities for supervision
Supervisors sometimes assume that the burden of responsibility for what
happens in supervision, and the outcomes of it, lies principally if not
exclusively with them. Supervisees also fall into the same trap and as a result
may approach supervision passively, as if it is something done to them, not
something in which they have responsibility for making sure that their needs
are met. When the responsibilities of the supervisee are abdicated, a set of

Introduction 7
•
Working out how to stay in control of feedback that might be given by
the supervisor.
•
Examining your views about having your work observed either directly
or indirectly.
•
Working out how to show your supervisor your fears and anxieties
without undue apprehension in anticipation of negative evaluation.
•
Letting the supervisor know what is proving helpful and unhelpful to
your learning and development.
•
Acknowledging errors with a view to learning from them.
The responsibilities of the supervisor
Depending on the context of the supervision, the supervisor has various
wide-ranging responsibilities for the client, the supervisee, and for ensuring
that the mores and standards of their own and the supervisee’s employing
body and any involved professional and training institutions are maintained.
For the welfare of the client
Supervisors will need to identify with whom the responsibility for case-work
lies. In pre-registration training this will often be with themselves, whereas in
post-registration arrangements it is more likely to be with the supervisee. For
example, in a survey of counsellor supervisors working in private practice,
none of the respondents regarded themselves as legally responsible for their
supervisees’ work (King and Wheeler, 1999). The location of this responsibil-
ity should influence the manner in which supervision is conducted. In the
former, supervisors will need to have a more ‘hands-on’ awareness of the
work being undertaken in order to effect their responsibilities to clients and in

determine how to act. In the face of a failure to acknowledge and act
appropriately, the supervisor may be faced with taking the matter outside
supervision, discussing how not whether to do this with the supervisee. In
private practice supervisors are particularly sensitive to the tension between
practitioners needing to stop working for personal reasons but needing to
continue practising for financial reasons (King and Wheeler, 1999).
Whilst the supervisor’s responsibility may be clear, there is evidence that
supervisors find it very difficult to take matters beyond the supervision itself.
King and Wheeler (1999) found that counselling supervisors in the UK were
very reluctant to invoke the British Association of Counsellors (BAC) com-
plaints procedure even if obliged to do so. When undertaken, the process had
been experienced as distressing for both supervisor and supervisee. King and
Wheeler advocate a cautious approach by supervisors in private practice to
agreeing to take on a supervisee, but point out that, paradoxically, counsel-
lors with less experience or skills, in whom the supervisors had least con-
fidence, might find it most difficult to obtain supervision from well-regarded
colleagues.
Supervisors need to be clear that they share responsibility for the welfare of
their supervisees’ clients, and that this may present conflicts with their
responsibilities to their supervisees. This is discussed further in Chapter 7.
To the supervisee
The supervisor cannot make the supervisee learn and develop but is respon-
sible for participating in, and working to create and manage the supervisory
process so as best to facilitate the supervisee’s learning in the service of the
work. Many of the skills required are versions of the skills of supervisees.
In addition supervisors have responsibility for the process of establishing a
contract for supervision and for being open to development of their own
knowledge and skills in the process of supervision.
Supervisors are responsible for effecting any designated tasks that arise
Introduction 9

Where the supervisee is in training it is the responsibility of the training
institution to inform the supervisor of its expectations, but subsequently it
becomes the responsibility of the supervisor to act in ways congruent with the
agreements that have been made in relation to the expectations and standards
of the training institution. Should the supervisee be required to produce case
material based on the work done under supervision, the supervisor has
responsibility for ensuring that appropriate clients are available that enable
the completion of such work. Training institutions usually require that the
supervisor make a formal assessment of the supervisee’s work. Supervisors
will need to familiarise themselves with assessment procedures and have
10 Supervision in the mental health professions
responsibility for working out how they can best carry out their role in such a
way as to include both formative and summative evaluation.
To the profession
In supervision of pre-registration training, the supervisor may also have a
significant role in and responsibility to transmit the values and standards of
the profession. This can be more or less conscious and explicit, but the under-
lying values of the profession are likely to be manifest in the way that the
supervisor thinks and acts. In a research context, this tendency to act consist-
ently with the ‘school’ in which one’s development has taken place is
described by Kuhn (1962). Ekstein and Wallerstein (1972) describe this social-
isation into the profession as the development of professional identity arising
by association with senior members of the trainee’s own professional
discipline.
In this section the responsibilities of stakeholders beyond the more
immediate triad of client/therapist/supervisor have been explored only
peripherally, but the supervision takes place in a wider context which confers
responsibilities beyond the immediate triad. In agreeing to provide supervi-
sion, by implication the supervisor accepts the responsibilities associated with
each of the agencies concerned and as a result must deal with the implications

Supervision and teaching
In supervision, it is appropriate at times for the supervisor to act as a teacher
either by giving information or by more generally focusing on the learning
of the supervisee using enquiry and exploration. The common aims of
increasing knowledge and skills are relevant to both roles. But supervision
covers a wider territory through its restorative function in which the super-
visor helps supervisees to understand and manage their emotions at work.
Supervision is also less likely to be constrained by an externally determined
curriculum. Supervisees working with clients will generate a personal
curriculum for their learning based around the specific encounters of their
day-to-day work.
Dual relationships: friendships/managerial relationships
Where participants in a supervisory relationship have no prior or ongoing
relationship that was established for other purposes, there is a greater free-
dom in which to work out the new relationship. Many people participate in
managerial supervision at work and it is a moot point to what extent this
concurrent role-relationship restricts and limits the potential achievements of
the supervision. When one person has power to influence the progression and
promotion of the other, there is bound to be some influence over what takes
place in supervision. This dual role-relationship is likely to pertain in
pre-registration training as well as in other managerial relationships. The
influence of the disparity in status may be contained by discussion during
and following the contracting process, but its influence may readily be
underestimated.
One approach to this dual relationship is for the supervisee to have supervi-
sion with both a line manager and an independent supervisor. The profession
of counselling, in particular, has recognised the benefit of such an arrange-
ment which provides a context for the exploration of issues which the
supervisee might feel uncomfortable about exploring in a managerial
12 Supervision in the mental health professions