CBT therapists in the BABCP are required to have regular supervision. This seems to imply that therapists do not know what they are doing and cannot be trusted.
The origins of the term ‘supervision’ lie in the world of education and training. But this is a different world from the world of therapy.
In the world of training, a ‘trainee’ is someone who is not fully trained yet, who has much to learn. A good way to learn is to learn on the job, by performing real tasks that are appropriate to your level of skills.
So a trainee is entrusted with simple tasks, and is overseen by a ‘supervisor’ who takes responsibility for the trainee’s work and teaches the traineee new skills. Eventually the traineee becomes fully qualified and no longer needs supervision.
A supervisor, in this context, is a fully-trained person who has two distinct roles: to take responsibility, and to teach. A supervisor is both boss and teacher.
In the world of therapy this can happen too. There are junior therapists who are not fully trained yet, and who have much to learn. A good way for them to learn is by seeing real patients and performing simple tasks. A supervisor, in this context, is a fully-trained therapist with two distinct roles: to take responsibility for the trainee’s work, and to teach.
The supervisor-traineee model breaks down, though, as the trainee therapist becomes more skilled. Eventually there must come a point where the therapist is fully trained. It would be reasonable to say that this happens when the trainee satisfies the requirements for accreditation.
Once accredited, the therapist is no longer a trainee, but fully qualified. But what’s this? According to the rules, accredited therapists still need supervision!
What’s gone wrong here is that I have lazily used the word ‘supervision’ as if it means the same thing in different contexts. It doesn’t. It means different things in different contexts.
Lazy use of the term ‘supervision’ conflates seven separate roles. Two of these roles are appropriate to trainees, and five of them are appropriate to fully trained professionals (also to trainees, to a lesser extent).
For trainees, there are these roles:
Teacher — A trainee’s supervisor teaches the trainee directly, and is responsible for managing the trainee’s other learning (like reading books and going to lectures)
Boss — A trainee’s supervisor takes responsibility for the trainee’s work. If the trainee makes a mistake, it’s the supervisor’s fault.
For fully trained professionals, there are these roles:
Mentor — A professional’s mentor is a more senior professional who acts as a source of wisdom and guidance without ever undermining the professional’s responsibility for their own work.
Consultant — A consultant is an expert who shares specific knowledge in order to address a specific problem — not for the purpose of teaching, but solely for the purpose of solving the problem.
Therapist — Therapists sometimes themselves need therapy.
In addition, there’s a sixth role that is sometimes dragged into the ‘supervision’ mess too:
Colleague — A colleague is a fellow professional of equal professional status, with whom you can exchange information and with whom you can collaborate to solve problems.
And the seventh role is at the heart of what supervision should be for professionals:
Buddy — A buddy is a special colleague whom you particularly trust and can always turn to.
What causes the mess is that the term ‘supervision’ is often used for all seven roles, muddling and distorting professional relationships.
Much of the literature on supervision is about supervising untrained juniors. This seems to cause widespread confusion, so that authors who are clearly writing about fully-trained professionals still refer to them as ‘trainees’ and write as if the only purpose of supervision is ‘learning’.
At the same time, the BABCP behaves as if all therapists, even its most senior accredited therapists, are untrained juniors who still have a lot to learn. This might be because the BABCP is too much influenced by academics whose funding derives from the training courses they run, and not enough influenced by practising therapists whose focus is on treating patients.
Organizational hierarchies like the NHS, too, prefer not to employ professionals who will stand up to managers. The idea that no professional is really fully trained and responsible is an attractive one.
The buddy role
For a fully-trained professional, the most important professional supportive role is what I have called the buddy role. Your buddy is the person you go to first when you have a problem with your professional work, and probably also when you make a breakthrough or achieve something significant.
The buddy role can be mutual, but it does not have to be. Also, your buddy can be less experienced than you or more experienced, or about the same. Significantly, your buddy does not have to be in exactly the same line of work. For example, if you are a CBT therapist your buddy might be person-centred.
Closeness and distance
The important qualities of a buddy are paradoxically both closeness and distance.
Your ideal buddy is close to you in the sense of always and unconditionally being on your side. You became enraged at your last patient and threw a mug of coffee over him? Your buddy understands, laughs with you, and agrees that it was the right thing to do under the circumstances. You despair at your boss’s inability to communicate? Your buddy despairs too.
To make this closeness happen, there has to be a strong sense of liking. This relationship exists in a fuzzy are between professional and personal. It’s not just a transaction, and yet it’s not quite a friendship.
Your ideal buddy is distant from you too, in the sense of always bringing a strong sense of perspective to your conversations. When you threw that mug of coffee, your buddy also coldly looked at the possible consequences with you. When you raged about your boss, your buddy also helped you make a plan to take the issue to senior management.
To make this distance happen, there has to be something fundamentally different in your backgrounds. If you were both taught by the same people, read the same books, practice the same form of therapy, and work for the same organization, where will the perspective come from? Ideally, your buddy’s training and day-to-day work are completely different from yours, so that there is a professional gap between you that you can never bridge. That gap creates the perspective that you need.
Professionalism amongst therapists means individual practitioners taking individual responsibility for their own work. Undue influence from the training industry (thinly disguised by its academic pretensions) and from the organizational hierarchy of the NHS tries to undermine this, and one of the ways it does so is by perverting the word ‘supervision’ to mean a mishmash of things.
Those therapists who can see through the mishmash and identify clear roles in their inter-professional relationships have set out on a path to professionalism. And those therapists who have a supervisor who is a real buddy, who combines unshakable closeness with unbridgeable perspective, are well on the way.