Skip to main content Accessibility help

A qualitative comparison of cognitive-behavioural and evidence-based clinical supervision

  • Derek L. Milne (a1), Robert P. Reiser (a2), Tom Cliffe (a1), Lauren Breese (a1), Annabel Boon (a1), Rosamund Raine (a1) and Phillippa Scarratt (a1)...


Despite the acknowledged importance of clinical supervision, controlled research is minimal and has rarely addressed the measurement or manipulation of clinical supervision, hampering our understanding and application of the different supervision methods. We therefore compared two related approaches to supervision, cognitive-behavioural (CBT) and evidence-based clinical supervision (EBCS), evaluating their relative effectiveness in facilitating the experiential learning of one supervisee. Drawing on a multiple-baseline N = 1 design, we gathered mostly qualitative data by means of an episode analysis, a content analysis, a satisfaction questionnaire, and interviews with the supervisor and supervisee. We found that the EBCS approach was associated with higher supervision fidelity and increased engagement in experiential learning by the supervisee. This case study in the evaluation of supervision illustrates the successful application of some rarely applied qualitative methods and some potential supervision enhancements, which could contribute to the development of CBT supervision.


Corresponding author

*Author for correspondence: D. L. Milne, Ph.D., 4th Floor, Ridley Building 1, Newcastle University, Newcastle upon Tyne NE1 7RU, UK. (email:


Hide All
Miller, WR, Rollnick, S (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129140.
Bambling, M, King, R, Raue, P, Schweitzer, R, Lambert, W (2006). Clinical supervision: its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research 16, 317331.
Barkham, M, Stiles, WB, Lambert, MJ, Mellor-Clark, J (2010). Building a rigorous and relevant knowledge-base for the psychological therapies. In: Developing and Delivering Practice-Based Evidence (ed. Barkham, M., Hardy, G. E. and Mellor-Clark, J.), pp. 2161. Chichester: Wiley.
Beidas, RS, Kendall, PC (2010). Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice 17, 130.
Bellg, AJ, Borrelli, B, Resnick, B, Hecht, J, Minicucci, DS, Ory, M, Ogedegbe, G, Orwig, D, Ernst, D, Czajkowski, S (2004). Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH behavior change consortium. Health Psychology 23, 443451.
Bernard, JM, Goodyear, RK (2004). Fundamentals of Clinical Supervision, 3rd edn. London: Pearson.
Borckardt, JJ, Nash, MR, Murphy, MD, Moore, M, Shaw, D, O'Neil, P (2008). Clinical practice as natural laboratory for psychotherapy research. American Psychologist 63, 7795.
Bricker, J, Tollison, S (2011). Comparison of motivational interviewing with acceptance and commitment therapy: a conceptual and clinical review. Behavioural and Cognitive Psychotherapy 39, 541559.
Bryman, A (2004). Social Research Methods. Oxford University Press.
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences. New York: Lawrence Erlbaum.
DoH (1993). A Vision for the Future. London: Department of Health.
DoH (2004). Organising and Delivering Psychological Therapies. London: Department of Health.
Ellis, MV, D'Iuso, N, Ladany, N (2008). State of the art in the assessment, measurement, and evaluation of clinical supervision. In: Psychotherapy Supervision: Theory, Research and Practice (ed. Hess, A. K., Hess, K. D. and Hess, T. H.), pp. 473499. Chichester: Wiley.
Ellis, MV, Ladany, N (1997). Inferences concerning supervisees and clients in clinical supervision: an integrative review. In: Handbook of Psychotherapy Supervision (ed. Watkins, C. E.), pp. 447507. New York: Wiley.
Ellis, MV, Ladany, N, Krengel, M, Schult, D (1996). Clinical supervision research from 1981 – 1993: a methodological critic. Journal of Counselling Psychology 43, 3540.
Falender, C, Cornish JAE, Goodyear, R, Hatcher, R, Kaslow, NJ, Leventhal, G, Shafranske, E, Sigmon, ST, Stoltenberg, C, Grus, C (2004). Defining competencies in psychology supervision: a consensus statement. Journal of Clinical Psychology 60, 771785.
Falender, CA, Shafranske, EP (2004). Clinical Supervision: A Competency-Based Approach. Washington, DC: American Psychological Association.
Hawkins, P, Shohet, R (2000). Supervision in the Helping Professions: An Individual, Group and Organizational Approach. Milton Keynes: Open University Press.
Holloway, EL (1995). Clinical Supervision: A Systems Approach. Thousand Oaks, CA: Sage.
Kazdin, AE (1998). Research Design in Clinical Psychology. Boston: Allyn Bacon.
Kolb, DA (1984). Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice-Hall.
Ladany, N, Friedlander, ML, Nelson, ML (2005). Critical Events in Psychotherapy Supervision: An Interpersonal Approach. Washington, DC: American Psychological Association.
Latham, M (2006). Supervisor and training accreditation (Training Newsletter, February, p. 3). Accrington: British Association of Behavioural and Cognitive Psychotherapies (BABCP).
Llewellyn, SP (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology 27, 105114.
Liese, BS, Beck, JS (1997). Cognitive therapy supervision. In: Handbook of Psychotherapy Supervision (ed. Watkins, C. E.), pp. 114133. Chichester: Wiley.
Lipsey, MW (1990). Design Sensitivity. London: Sage.
Lister, PG, Crisp, BR (2005). Clinical supervision in child protection for community nurses. Child Abuse Review 14, 5772.
Mahrer, AR, Nadler, WP (1986). Good moments in psychotherapy: a preliminary review, a list, and some promising research avenues. Journal of Consulting and Clinical Psychology 54, 1015.
Milne, DL (2007). An empirical definition of clinical supervision. British Journal of Clinical Psychology 46, 437447.
Milne, DL (2008). CBT supervision: from reflexivity to specialization. Behavioural and Cognitive Psychotherapy 36, 779786.
Milne, DL (2009). Evidence-Based Clinical Supervision: Principles and Practice. Chichester: BPS/Blackwell.
Milne, DL (2010). Can we enhance the training of clinical supervisors? A national pilot study of an evidence-based approach. Clinical Psychology and Psychotherapy 17, 321328.
Milne, DL, James, IA (2000). A systematic review of effective cognitive-behavioural supervision. British Journal of Clinical Psychology 39, 111127.
Milne, DL, Lombardo, C, Kennedy, E, Freeston, M, Day, A (2008). Zooming in on clinical supervision. Behavioural and Cognitive Psychotherapy 36, 619624.
Milne, DL, Reiser, R, Aylott, H, Dunkerley, C, Fitzpatrick, H, Wharton, S (2010). The systematic review as an empirical approach to improving CBT supervision. International Journal of Cognitive Therapy 3, 278294.
Milne, DL, Reiser, R, Cliffe, T, Raine, R (2011). SAGE: preliminary evaluation of an instrument for observing competence in CBT supervision. The Cognitive Behaviour Therapist. Published online: 24 November 2011. doi:10.1017/S1754470X11000079.
Oliver, JR, Fleming, RK (1997). Applying within-subject methodology to the transfer of training research. International Journal of Training and Development 1, 173180.
Padesky, CA (1996). Developing cognitive therapist competency: teaching and supervision models. In: Frontiers of Cognitive Therapy (ed. Salkovskis, P. M.), pp. 266292. London: Guilford Press.
Papworth, MA, Milne, DL, Boak, G (2009). An exploratory content analysis of situational leadership. Journal of Management Development 28, 593606.
Pistrang, N, Barker, C (2010) Scientific, practical and personal decisions in selecting qualitative methods. In: Developing and Delivering Practice-Based Evidence (ed. Barkham, M., Hardy, G. E. and Mellor-Clark, J.), pp. 6590. Chichester: Wiley.
Proctor, B (1986). Supervision: a co-operative exercise in accountability. In: Enabling and Ensuring (ed. Marken, M. and Payne, M), pp. 21–34. Leicester: Leicester National Youth Bureau and Council for Education and Training in Youth and Community Work.
Roth, AD, Pilling, S, Turner, J (2010). Therapist training and supervision in clinical trials: Implications for clinical practice. Behavioural and Cognitive Psychotherapy 38, 291302.
Schoenwald, SK, Sheidow, AJ, Chapman, JE (2009). Clinical supervision in treatment transport: effects on adherence and outcomes. Journal of Consulting and Clinical Psychology 77, 410421.
Shiffman, S, Scharf, DM, Shadel, WG, Gwaltney, CJ, Dang, Q, Paton, Clark (2006). Analyzing milestones in smoking cessation: Illustration in a nicotine patch trial in adult smokers. Journal of Consulting and Clinical Psychology 74, 276285.
Tang, T, DeRubeis, RJ (1999). Sudden gains and critical sessions in cognitive-behavioural therapy for depression. Journal of Consulting and Clinical Psychology 67, 894904.
Townend, M, Iannetta, L, Freeston, MH (2002). Clinical supervision in practice: a survey of UK cognitive-behavioural psychotherapists accredited by the BABCP. Behavioural and Cognitive Psychotherapy 30, 485500.
Uys, LR, Minnaar, A, Simpson, B, Reid, S (2005). The effect of two models of supervision on selected outcomes. Journal of Nursing Scholarship 37, 282288.
Watkins, CE (1997). Handbook of Psychotherapy Supervision. Chichester: Wiley.
Watkins, CE (1998). Psychotherapy supervision in the 21st century. Journal of Psychotherapy Practice & Research 7, 93101.
Wheeler, S, Richards, K (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients: a systematic review of the literature. Counselling and Psychotherapy Research 7, 5465.
Wilson, M (2007). Can experiences of supervision be quantified? REACTS: a new tool for measuring supervisee's perceived satisfaction with clinical supervision [unpublished thesis] (available from the Psychology Department, Newcastle University).


Related content

Powered by UNSILO

A qualitative comparison of cognitive-behavioural and evidence-based clinical supervision

  • Derek L. Milne (a1), Robert P. Reiser (a2), Tom Cliffe (a1), Lauren Breese (a1), Annabel Boon (a1), Rosamund Raine (a1) and Phillippa Scarratt (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

A qualitative comparison of cognitive-behavioural and evidence-based clinical supervision

  • Derek L. Milne (a1), Robert P. Reiser (a2), Tom Cliffe (a1), Lauren Breese (a1), Annabel Boon (a1), Rosamund Raine (a1) and Phillippa Scarratt (a1)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *