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Collusion in clinical supervision: literature review and case study in self-reflection

Published online by Cambridge University Press:  01 June 2009

Derek L. Milne ,
Caroline Leck  and
Nasim Z. Choudhri
Derek L. Milne*
Affiliation:
Newcastle University, and Northumberland, Tyne and Wear NHS Trust
Caroline Leck
Affiliation:
Newcastle University, and Northumberland, Tyne and Wear NHS Trust
Nasim Z. Choudhri
Affiliation:
Newcastle University, and Northumberland, Tyne and Wear NHS Trust
*
*Author for correspondence: Dr D. L. Milne, School of Psychology, Newcastle University, 4th Floor, Ridley Building, Newcastle upon Tyne NE1 7RU, UK. (email: [email protected])
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Abstract

Interpersonal dynamics are a recurring impediment to effective clinical supervision and can lead to phenomena like collusion between the supervisor and supervisee. Collusion involves both supervisor and supervisee engaging in safety behaviours that serve to conveniently avoid and escape from difficult topics and challenging methods. Whilst minimizing the short-term threat to supervisor and supervisee, collusion will tend to undermine the effectiveness of supervision and limit significantly its long-term value to patients. In order to consider how best to address collusion, we review the cognitive-behavioural therapy (CBT) and related literature on collusion, focusing on how it has been formulated and managed. We then provide a case study featuring a supervisor who was colluding with the supervisee's avoidance behaviours (i.e. filling supervision sessions with superficial reflections on his casework) by not challenging these reflections or moving to another learning mode (e.g. experimenting). We develop a CBT formulation of this pattern of supervision as part of the self-reflection process, led by a consultant. Self-reflection appeared to be a useful tool for improving the supervisor's understanding of this dysfunctional process, and strengthened the supervisor's confidence in utilizing relevant skills in the future.

Keywords

Clinical supervisioncollusionself-reflection
Type
Education and supervision
Information
the Cognitive Behaviour Therapist , Volume 2 , Issue 2 , June 2009 , pp. 106 - 114
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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References

Recommended follow-up reading

Safran, JD, Muran, JC, Stevens, C, Rothman, M (2008). A relational approach to supervision. In: Casebook for Clinical Supervision: A Competency-Based Approach (ed. Falender, C. A. and Shafranske, E.), pp.137–158. Washington, D.C: American Psychological Association.CrossRefGoogle Scholar

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