Welcome to this Special Issue of tCBT. Our focus in this special edition of the journal is on supervision. Few would argue the vital role of supervision during CBT training and beyond to ensure treatment fidelity to evidence-based protocols. I would like to take this opportunity to thank Professors Derek Milne and Robert Reiser for kindly acting as guest editors. In addition, we are grateful for their fine contributions to the supervision literature in this particular edition of the journal. Thanks too to Professor Cory Newman from the tCBT editorial board for contributing to the overarching paper provided by Professors Milne and Reiser. Thanks also to all the authors for their fine contributions and to our reviewers who gave so generously of their time to comment on the submitted manuscripts. Our intention is to publish one Special Issue a year, next year we look forward to a special edition with a focus on ‘complexity’ with guest editors Dr Claire Lomax and Dr Stephen Barton from Newcastle University.

Supervision is probably the single most effective method for helping therapists to develop competence, capability and a professional identity (Falender & Shafranske, 2004; Callahan et al. 2009; Watkins & Milne, 2014). Supervision is also perceived by supervisees as the main influence on their practice (Lucock et al.2006), and has been recognized by governments as an essential component of mental health services in the 21st century (e.g. Care Quality Commission, 2013). Paradoxically, supervisors themselves may receive inadequate support and guidance. This is an unacceptable strategic and moral oversight, one which presumably undermines the fidelity of CBT while increasing burnout: in one survey, 82% of participating supervisors expressed dissatisfaction over their support arrangements (Gabbay et al. 1999). Recent surveys of CBT supervisors indicate that despite an overall sense of satisfaction with supervision, considerably more can be done to support supervisors in terms of developing improved supervisory and training materials (Reiser & Milne, 2016). The phrase ‘something does not compute’ sums up this paradox succinctly (Watkins, 1997, p. 604).

In this Introduction to the Special Issue of the Cognitive Behaviour Therapist on clinical supervision we start by highlighting the unmet and overdue need for coherent organizational systems to support, guide and develop clinical supervisors. We identify a seven-step, cyclical model that describes how such a system might work, with particular reference to CBT supervision. These steps start with conceptualization (e.g. definition of CBT supervision) and complete the problem-solving cycle with evaluation (e.g. corrective feedback). We provide an overview of typical research and development activity for each part of this model to illustrate how a sound supervision infrastructure might best be developed. The SOS model provides a systematic approach to indicate the organizational conditions under which CBT supervision might flourish.

Internationally, clinical supervision has been increasingly recognized as a core competency and an essential requirement for clinical training. Over the past 10 years, frameworks for supervision competencies have been developed and promulgated in several countries, notably the UK, USA and Australia. But what is the current status of the actual practice of CBT supervision in the UK? We conducted an internet survey with a purposive sample of n=110 accredited British Association for Behavioural and Cognitive Psychotherapy (BABCP) supervisors and trainers (a 44% response rate), selected for their assumed expertise. The results were consistent with past surveys of Townend et al., indicating that the most frequently reported supervision methods tended to reflect many of the recommendations in widely disseminated supervision competency frameworks and recognized best practice statements. Overall, these CBT supervision leaders reported using an impressively wide range of methods, including much more frequent use of role-play, therapy recordings, and direct observation than reported in the Townend et al. surveys or in observational studies. Although satisfied in their supervisory role, respondents indicated the need for improved CBT supervisor training resources, with significant interest in developing competence instruments and group supervision methods. In conclusion, at least for this small sample of CBT supervision leaders in the UK, practice reflects international progress, but training resources are sought to maintain momentum.

This article describes the clinical supervision of Multisystemic Therapy (MST), which takes place in the context of a quality assurance and quality improvement system that is used to support the transport and implementation of MST nationally and internationally. Information is provided about the assumptions, objectives, structure, process, and content of MST supervision; training and support provided to supervisors; methods used to measure adherence to the supervision model; and, findings supporting linkages between supervision, therapist adherence, and youth outcomes. MST supervision is considered in the context of recent efforts to identify empirically supported approaches to supervision and of recent developments in implementation research.

This paper reports from a study of an intervention aimed at strengthening mental health nursing staff supervision. We developed and tested a short-term group-based meta-supervision intervention as a supplement to usual supervision. The intervention drew on action learning principles to activate and inspire supervisees to develop strategies for influencing their own supervision practices. The core ‘meta-supervisory’ process was organized round participants’ reflections on the possible benefits of supervision, their perceived barriers to realizing the benefits, and the articulation of concrete actions to overcome the barriers. In this paper, we introduce previously reported findings from the study and present two novel supplementary analyses of data from the meta-supervision process. First, we analyse a transcript of an audio recording made during the intervention, which illustrates how supervisees generate empowering psychosocial resources through the group processes. Second, we analyse supervisees’ paraphrased accounts of barriers to effective supervision and their accounts of personal projects to overcome the barriers. Barriers ‘outside’ the supervision setting primarily inspired projects aimed at creating structural change, whereas barriers ‘inside’ the supervision setting inspired projects aimed at creating individual change. The meta-supervision intervention was effective in increasing participation in supervision, but it shared the same problems of resistance and reluctance as often observed in supervision in general. In the discussion, we compare our ‘bottom-up’ approach to activating supervisees and implementing supervision practices with ‘top-down’ approaches. The meta-supervision intervention illustrated the importance of engaging supervisees in their own supervision and suggested how it can have both individual and organizational benefits.

Although clinical supervision is deemed central to the delivery and dissemination of high quality CBT, knowledge of what constitutes ‘optimal’ CBT supervision remains limited. In consequence, understanding of how best to support the development of supervisors is also restricted. This article considers the professional development needs of CBT supervisors, identifying the current context in which CBT supervision is mandated and delivered and seeking to clarify the domains of knowledge, competence and skill that must be mastered. We propose ways in which CBT supervisors might construct their professional development activities and raise questions relating to the need for a more organizationally embedded approach to the development of CBT supervisors in the current professional climate.

There is now expert consensus that directly observing the work of trainee therapists vs. relying upon self-report of sessions, is critical to providing the accurate feedback required to attain a range of competencies. In spite of this expert consensus however, and the broadly positive attitudes towards video review among supervisees, video feedback methods remain under-utilized in clinical supervision. This paper outlines some of the weaknesses that affect feedback based solely on self-report methods, before introducing some of the specific benefits that video feedback methods can offer the training and supervision context. It is argued that video feedback methods fit seamlessly into CBT supervision providing direct, accessible, effective, efficient and accurate observation of the learning situation, and optimizing the chances for accurate self-reflections and planning further improvements in performance. To demonstrate the utility of video feedback techniques to CBT supervision, two specific video feedback techniques are introduced and described: the Give-me-5 technique and the I-spy technique. Case examples of CBT supervision using the two techniques are provided and explored, and guidance as to the supervision contexts in which each of the two techniques are suitable, individually, and in tandem, are outlined. Finally, best practice guidelines for the use of video feedback techniques in supervision are outlined.

Significant progress has been made internationally in the training of clinical supervisors, yet much remains to be done, such as refining training through the improved use of video material. A review of currently available video recordings used in supervisor training indicates that they are generally used informally, are manifestly lacking in procedural detail, are narrowly applied, and lack an educational rationale or research support. After reviewing current options, a more precise, comprehensive and educationally informed framework is proposed, broadening the video options to 10 complementary applications. Systematic links are made between these applications, the core supervision competencies, and the related workshop content (especially training objectives and learning outcomes), culminating in an educational rationale for the use of video within a supervisor training curriculum. It is concluded that application of this framework can enhance the effectiveness and efficiency of supervisor training, helping to maintain progress.

NHS Education for Scotland (NES) has developed a suite of training to address the learning and development needs of supervisors of psychological therapies in the National Health Service (NHS) in Scotland and to support quality of evidence-based practice in psychological therapies, in light of the recent expansion in this area of healthcare. In parallel with the structure of the recently developed supervisory competency frameworks, an initial training package addressing generic (cross-modality) supervision competences was supplemented by the development of a training package to meet the specific needs of supervisors of CBT: NES Specialist Supervision Training in CBT (NESSST CBT). A blended learning package was developed, in light of the emerging evidence around the effectiveness of e-learning, to produce a flexible and learner-centred training package. This paper describes the development, delivery and planned evaluation methods of NESSST CBT. Lessons learned during implementation are outlined, along with key challenges regarding the future of supervision training in Scotland and the UK.

Evaluating and enhancing supervisee competence is a key function of supervision and can be aided by the use of direct assessments of clinical competence, e.g. the Cognitive Therapy Scale – Revised (CTS-R). We aimed to review the literature regarding inter-rater reliability and training on the CTS and CTS-R to present exploratory data on training raters to use this measure. We employed a systematic review. An exploratory study evaluated the outcomes of a CTS-R supervisor training workshop (n = 34), including self-reported familiarity with and confidence in using the tool, and inter-rater consistency on three CTS-R subscales, pre- and post-training. CTS and CTS-R inter-rater reliability was variable, with evidence of rater training enhancing reliability, although the form, duration and frequency of such training is unclear. The exploratory study found that supervisors rated themselves as more familiar with and confident in using the CTS-R at the end of training compared to at the beginning. However, inter-rater reliability was poor at the beginning and end of the training. Rating competence requires supervisors to make qualitative judgements, which is inherently variable. Training raters has been shown to improve rater reliability, although this was not demonstrated in the exploratory study. Practice implications and future research priorities are identified.

There has recently been an increasing call for new research and development in cognitive behavioural supervision, particularly in the area of evidence-based clinical supervision. New developments in supervision technology offer the potential to answer this call by providing greater objective measurement and corrective feedback in supervision. In this article, two new technologies that hold particular promise in this area are described: software for routine outcome measurement and videoconference for internet-based live one-way-mirror supervision. Notable challenges involved in supervision technology are discussed, and an example of technology being integrated into a graduate clinical training programme is described.

Contributors to this Special Issue of the Cognitive Behaviour Therapist have considered the kind of infrastructure that should be in place to best support and guide CBT supervisors, providing practical advice and extensive procedural guidance. Here we briefly summarize and discuss in turn the 10 papers within this Special Issue, including suggestions for further enhancements. The first paper, by Milne and Reiser, conceptualized this infrastructure in terms of an ‘SOS’ (supporting our supervisors) framework, from identifying supervision competencies, to training, evaluation and feedback strategies. The next nine papers illustrate this framework with specific technical innovations, educational enhancements and procedural issues, or through comprehensive quality improvement systems, all designed to support supervisors. These papers suggest an assortment of workable infrastructure developments: two large-scale and comprehensive initiatives, some promising proposals and technologies, and a series of local, exploratory work. Collectively, they provide us with models for further developing evidence-based cognitive-behavioural supervision, and offer practical suggestions for giving supervisors the tools and support to maximize their supervisees’ learning, and to improve the associated client outcomes. Much research and development work remains to be done, and successful implementation will require institutional and political support, as well as cross-cultural adaptations. We conclude with an optimistic assessment of progress toward addressing some of the infrastructure improvements required to adequately support supervisors.