Preparing for Supervision: Sample Forms and Other Materials

In This Section

Supervisee Evaluation of Supervision/Supervisor (Form)

Semester:
Practicum:
Internship:
My supervisor:

1 = strongly disagree, 5 = somewhat agree, 7 = strongly agree

Student Evaluation of Supervision
Skill	1	2	3	4	5	6	7
1. Provided me with useful feedback regarding my counseling behavior	1	2	3	4	5	6	7
2. Helped me feel at ease with the supervision process	1	2	3	4	5	6	7
3. Provided me with specific help in areas I need to work on	1	2	3	4	5	6	7
4. Enabled me to express my doubts about my counseling	1	2	3	4	5	6	7
5. Occasionally gave me a different, useful perspective on my counseling with a particular client	1	2	3	4	5	6	7
6. Helped me see my influence on the client	1	2	3	4	5	6	7
7. Adequately emphasized my strengths and capabilities	1	2	3	4	5	6	7
8. Enabled me to brainstorm alternative approaches that I might use with my clients	1	2	3	4	5	6	7
9. Made me feel accepted and respected as a person	1	2	3	4	5	6	7
10. Was able to distinguish her/his own issues from mine	1	2	3	4	5	6	7
11. Dealt appropriately with the affect in my counseling sessions	1	2	3	4	5	6	7
12. Dealt appropriately with the content in my counseling sessions	1	2	3	4	5	6	7
13. Conveyed sufficient competence to engender my trust	1	2	3	4	5	6	7
14. Appropriately addressed interpersonal dynamics us	1	2	3	4	5	6	7
15. Was open to my input and feedback about what was helpful	1	2	3	4	5	6	7
16. Helped reduce my defensiveness by his/her style	1	2	3	4	5	6	7
17. Enabled me to express my opinions about my counseling	1	2	3	4	5	6	7
18. Helped me to prepare for subsequent counseling sessions	1	2	3	4	5	6	7
19. Challenged me to accurately perceive the thoughts, feelings, and goals of my client and myself during counseling	1	2	3	4	5	6	7
20. Encouraged me to be spontaneous and creative	1	2	3	4	5	6	7
21. Provided me with suggestions for developing my counseling skills	1	2	3	4	5	6	7
22. Helped me to organize relevant data for identifying goals and planning strategies with my client	1	2	3	4	5	6	7
23. Helped me to develop increased skill in self-supervision through the use of in supervision of counseling tapes	1	2	3	4	5	6	7
24. Overall, I found supervision to be helpful to me during Practicum or Internship	1	2	3	4	5	6	7

Additional comments:

Supervisor Evaluation of Counselor Behaviors (Form)

Developed by Janine M. Bernard (1998).

Student:
Semester:
Faculty Supervisor:
Individual Supervisor:

1 = needs improvement; 2 = adequate; 3 = good; 4 = a strength of the student 5 = excels in this area

**Relationship/attending skills**
Skills	1	2	3	4	5
1. Listens carefully and communicates an understanding of the client.	1	2	3	4	5
2. Is genuine and warm with client.	1	2	3	4	5
3. Is immediate with the client.	1	2	3	4	5
4. Is respectful of, and validates, the client.	1	2	3	4	5
5. Is appropriate regarding the cultural context of the client.	1	2	3	4	5
6. Is appropriate regarding the developmental context of the client.	1	2	3	4	5
7. Uses interpersonal strengths appropriately, including humor and self-disclosure.	1	2	3	4	5
8. Is comfortable with a variety of feelings and/or issues shared by the client.	1	2	3	4	5
9. Provides support to the client when appropriate.	1	2	3	4	5
10. Challenges the client when appropriate.	1	2	3	4	5
11. Tracks the main issues presented by the client.	1	2	3	4	5

**Assessment skills**
Skills	1	2	3	4	5
12. Is able to organize session data into meaningful frameworks.	1	2	3	4	5
13. Appreciates cultural and/or developmental issues that may affect assessment.	1	2	3	4	5
14. Is able to recognize normative from problematic behavior during assessment.	1	2	3	4	5
15. Can assist the client in considering different components and sequences that make up and sustain problems.	1	2	3	4	5
16. Is able to identify cognitive components of client issues.	1	2	3	4	5
17. Is able to identify affective components of client issues.	1	2	3	4	5
18. Is able to identify behavioral components of client issues	1	2	3	4	5
19. Is able to identify systemic components of client issues.	1	2	3	4	5
20. Identifies appropriate process goals.	1	2	3	4	5
21. Can assist client in translating problems into realistic outcome goals.	1	2	3	4	5
22. Can assess one’s own performance in counseling.	1	2	3	4	5

**Relationship/attending skills**
Skills	1	2	3	4	5
23. Maintains an appropriate pace during sessions.	1	2	3	4	5
24. Uses questions skillfully.	1	2	3	4	5
25. Uses nondirective interventions skillfully.	1	2	3	4	5
26. Can direct the session in a meaningful manner.	1	2	3	4	5
27. Can deliver appropriate confrontations.	1	2	3	4	5
28. Can demonstrate an appropriate use of affective interventions.	1	2	3	4	5
29. Can demonstrate an appropriate use of cognitive interventions.	1	2	3	4	5
30. Can demonstrate an appropriate use of behavioral interventions.	1	2	3	4	5
31. Can demonstrate an appropriate use of systemic interventions.	1	2	3	4	5
32. Is able to work effectively with multiple clients.	1	2	3	4	5

**Professional skills**
Skills	1	2	3	4	5
33. Is aware of personal issues (counter- transference/parallel processes) that might impact counseling.	1	2	3	4	5
34. Demonstrates openness to and use of supervision.	1	2	3	4	5
35. Appreciates own limits without overreacting to them.	1	2	3	4	5

**Additional Aspects of Practicum Skills**
Skills	1	2	3	4	5
36. Participation in group supervision.	1	2	3	4	5
37. Written work.	1	2	3	4	5

Comments relevant to areas of strength:

Comments relevant to areas of weakness:

Counseling Session Case Notes (Form)

Counseling Session Progress Notes: First Session

Client’s first name (or pseudonym):
Counselor:
Date:

Briefly describe the client’s presenting problem.
Describe the dynamics in the session (your own reactions to the client and the interactions between you and the client).
Describe other important information that was learned during the session, including contextual information.
Describe relevant cultural or development information as it relates to the presenting problem(s).
What is your initial conceptualization of the client’s issues(s)? (Be sure that your comments are theoretically sound.)
List relevant diagnostic impressions including code and axis.
To the extent possible, describe initial treatment plan for this client.
Based on your treatment plan, what are your objectives for the next session?
Share any personal reflections on the session
Questions to the supervisor/instructor.

Counseling Session Progress Notes

Client’s first name (or pseudonym):
Counselor:
Date:

What were your objectives for this session?
Describe the dynamics in the session (your own reactions to the client and the interactions between you and the client).
Summarize the key issues discussed during the session.
Describe relevant cultural or developmental information as it relates to the session or the client’s issue(s).
To what extent were your objectives for this session met?
Explain changes (or expansions) of your conceptualization of the problem(s).
List relevant diagnostic impressions including code and axis.
Explain changes (or expansions) of your treatment plan for this client.
Based on your treatment plan, what are your objectives for the next session?
Share any personal reflections on the session.
Questions to the supervisor/instructor?

Group Work Process Notes

Group Description:
Date:
Counselor:
Group Session #:

What type of group is this? (counseling, psyco-ed, task, theme centered, open-ended, etc.) What is the theoretical approach? And why?
What were your goals and objectives for this group session?
What group dynamics did you observe? (Member roles, communication patterns, stage)
What leadership skills did you employ? (Scanning, linking, confrontation, trust-building, etc.)
Were your goals accomplished? Please explain
How do you assess the progress of this group?
Based on the stage of the group and the dynamics you observed, what are your process goals for the next session?
Questions/comments to the instructor

Supervisor Professional Disclosure Statement (Example)

Janna L. Scarborough, Ph.D., NCC, ACS
Assistant Professor, Syracuse University

Janna L. Scarborough is an assistant professor in the Counseling and Human Services Department at Syracuse University. She received her Doctorate of Philosophy from the University of Virginia. She holds the M.A.Ed. in School Counseling from Western Carolina University. Dr. Scarborough is a National Certified Counselor and Approved Clinical Supervisor. She is a member of the American Counseling Association as well as the national and state divisions of school counseling and counselor education and supervision.

Dr. Scarborough has training and experience in individual, group, and school counseling. This training and experience includes clients in age ranges from kindergarten to adulthood primarily with normal situational and developmental issues. Janna can provide supervision in these general areas. She has worked in school settings for five years and university based counseling centers for approximately two years.

Dr. Scarborough’s training in supervision includes coursework and supervised supervision in her doctoral program as well as supervision presentations at the national, regional, and local levels. Janna has experience providing individual supervision of practicing school counselors. In addition, she has experience in individual and group supervision of counselors-in-training working with legitimate clients in school and higher education settings.

Dr. Scarborough approaches supervision from a collaborative framework. The general areas that receive attention in supervision include the supervisee’s professional behaviors, counseling skills, personal awareness, and client/case conceptualization. Supervisory roles assumed by Dr. Scarborough include teacher, evaluator, consultant, and counselor. Janna follows a developmental approach to supervision primarily using the teacher role with novice supervisees and consultation with more experienced supervisees. Audio and videotapes, live observation, and case report are all utilized in the supervision process. Janna considers intentionality to be paramount in work as a counselor. As such, she works with supervisees to become aware of the thoughts and feelings that occur with respect to the counseling relationship and process. Facilitating this awareness, including attention to the motivation behind interventions, is an important aspect of her work.

Dr. Scarborough addresses the issue of evaluation as a fundamental component of supervision. She believes that evaluation is an ongoing process that is linked to care for the client, as well as the goals of the supervisee. All evaluation criteria are introduced at the beginning of the supervisory relationship, serve as training objectives, and are used throughout the process as a basis for ongoing feedback. While evaluation and feedback is embedded in the process, periodic attention, including written feedback, addressing the supervisee’s progress is important. In the academic setting, this occurs at the mid-point and end of the semester. Supervisees are asked to provide their own self-evaluation as well. Supervisees are also asked to evaluate Dr. Scarborough as well as the supervision process.

Dr. Scarborough is aware of the responsibility she has to the supervisee and the clients in the supervisee’s care. The general limits of confidentiality and privileged communication are when harm to self or others is clear and imminent, when child abuse, elderly abuse or abuse of persons with disabilities is suspected, or if court proceedings compel the supervisor to testify. Within the academic setting, confidentiality is not withheld if there is compelling evidence that the supervisee is impaired or unable to provide competent counseling services. In such instances, other faculty members are informed and the procedures established by the program are initiated. Dr. Scarborough carries liability insurance and encourages her supervisees to carry insurance as well.

Dr. Scarborough understands the value and importance of maintaining and enhancing professional skills. Therefore, she will periodically participate in supervision of her supervision. Dr. Scarborough will inform supervisees through informed consent as to the purpose of her own supervision and that their actions may be discussed with the supervisor.

No fees are charged to any supervisee if supervision occurs within the academic setting and as part of the supervisee’s training. For other supervisees, fees charged reflect the community standard and the supervisee’s ability to pay.

Supervisees are provided with Dr. Scarborough’s office address, email address, and office and home phone numbers. Supervisees are asked to call Dr. Scarborough at home if an emergency occurs after hours. Dr. Scarborough also provides each supervisee with the names and phone numbers of agencies that respond to crisis situations.

Dr. Scarborough follows the NBCC Code of Ethics and the Standards for the Ethical Practice of Clinical Supervision and provides a copy to all supervisees.

December 14, 2002

(Supervisor Signature)

Case Conference (Example)

Presenter

Student will type written portion of case presentation for each class member and the instructor. This will be read prior to verbal presentation as it gives a context for the case conference.
Verbally describe the content, events, and processes that are most salient for you at the time of the presentation. Keep this brief and focused. Describe the relationship you have developed with the client. Describe the sessions you have had thus far with the client (general topic, interventions, tone, etc.)
Focus on the particular session/issue you are presenting. Describe the content, events, and processes that occurred in the session (give context for the taped portion). Indicate what we should be listening for.
Play the tape.
Describe your explanation/interpretation for the content, events, or processes.
Describe the feelings you were experiencing toward the client in the session. How do these feelings compare with your feelings toward the client in general? What thoughts/fantasies are you aware that you were having about the client during the session?
What feelings or thoughts do you think the client was having about you?
State the specific feedback that you particularly want from the group.

Group Members

Note what the counselor did. What did you like? What were the client’s reactions to the counselor? What feelings did you have when listening to the counselor? What would have added to the session? What could have been done a different way? Was anything unhelpful? WHY?
Note what the client did. What were the client’s concerns? What feelings did you have when listening to the client? What themes were evident? Were you confused by the client at all? Did the client’s input make things clearer?
Note what the session accomplished. What would be the major accomplishment of the section you heard? Given what you know of the client, were appropriate process or outcome goals accomplished?
If this was your client, what would be reasonable and productive goals for the next session? How would you accomplish these goals?

Tapescript Critique Format (Example)

For sectional tape script: Transcribe verbatim dialogue covering 5 consecutive minutes.
Choose a section on which you want specific feedback.
Follow the criteria for evaluation of counselor response:
1. What was your intent?
2. What happened?
3. Alternative response.
Use the split page format as shown.
Begin tape scripts with a client response and end tape script with a client response.

**Sample Tapescript Critique Format**
Verbatim Dialogue	Evaluation Criteria
CL: I’ve been having a little trouble with my new job. I’m not getting along well with the people at work. CO: You’re feeling some concern about fitting in with people at work.	1. To show I care. 2. Good reflection of feeling, client continued on issue of concern. 3. You are upset that you are not getting along with people at work.
CL: Yes, it does concern me. I was hoping to make some friends, but the two girls in my office don’t get along and I’m caught in the middle.CO: Are there people at work that you do things with?	1. To gather info about getting along in setting, looking for positives. 2. Could have been stated better, led client off concern. 3. You feel distressed that you are pulled into their disagreements.
CL: Yes, there are some other people at work that I get along really well with.CO: You feel good about these relationships.	1. To reflect positively about client’s ability to have relationship with co-workers. 2. Client acknowledged relationships. Restated problem. 3. You’re pleased there are some people at work you enjoy.
CL: Yes, I do feel good about that. The problem is that the two girl’s in my office don’t like each other and they want me to take sides.	–

Guidelines for Structured Group Supervision

These are guidelines. Actual implementation of group supervision will be facilitated by the instructor/supervisor.

Borders

Counselor identifies questions about the client and/or tape segment of a session and requests specific feedback about his or her performance.
Peers are assigned (or choose) roles, perspectives or tasks for reviewing the taped segment. These tasks may include:
1. Observing counselor or a particular counseling skill
2. Assuming the role of the counselor, client, or the parent, spouse, coworker, friend, teacher, or other significant person in the client’s life.
3. Viewing the session from a particular theoretical perspective
4. Creating a metaphor for the client, counselor, or counseling process
5. Drawing a picture, graph, or using sandtray to represent the counseling process/relationship
The counselor presents the preselected taped segment.
Peers give feedback from their roles or perspectives, keeping in mind the goals and questions that were specified by the counselor. The supervisee remains silent during this exchange, but may take notes regarding comments.
1. “As the client I ….”
2. “As the counselor I….”
3. “From the perspective of Cognitive-Behavioral, I….” Or “As existential theory, I….”
4. “The picture of the counseling process that comes to mind is….”
The supervisor facilitates the discussion as needed, functioning as a moderator and process observer. The supervisor may ask the supervisee what questions he/she has, and what other information she/he might desire.
The supervisor summarizes the feedback and discussion, and the counselor indicates if supervision needs were met.

Borders, L. D. (1991). A systematic approach to peer group supervision. Journal of Counseling & Development, 69, 248-252.

Wilbur, Roberts-Wilbur, Hart, Morris, and Betz

Plea for Help: After giving a summary, the supervisee states what assistance is being requested from the supervision (e.g., I need your help with…)
Play the taped segment of the session
Question Period: The supervision group members ask the supervisee questions about the information presented in Step 1 and 2. This step allows group members to obtain additional information or clarify any misperceptions concerning the summary information. One at a time, in an orderly manner, group members ask one question of the supervisee. The process is repeated until there are no more questions.
Feedback/Consultation: The group members respond to all of the information obtained by stating how they would handle the supervisee’s issue, problem, client, etc. During this step, the supervisee remains silent but may take notes regarding the comments or suggestions. When giving feedback, group members again proceed one at a time stating how they would handle the supervisee’s dilemma. First person is used, e.g., “If this were my client, I would…” The process is repeated until there is no additional feedback.
Pause or Break: There is a 5 to 10 minute break. Group members should not converse with the supervisee during this break. This is time for the supervisee to reflect on the group’s feedback and to prepare for the next step.
Response Statement: The group members remain silent and the supervisee, in round robin fashion, respond to each group member’s feedback. The supervisee tells group members which of their statements were helpful, which were not helpful, and why they were beneficial or not.
Discussion: The supervisor may conduct a discussion of the process, summarize, react to feedback offered, process group dynamics, etc.

Wilbur, M. P., Roberts-Wilbur, J., Hart, G. M., Morris, J. R. & Betz, R. L. (1994). Structured group supervision (SGS): A pilot study. Counselor Education and Supervision, 33, 262-279.
Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nd ed.). Needham Heights, MA: Allyn & Bacon.

Ethical Decision Making

Identify and Define the Problem
1. Gather information
2. Ethical, Legal, or Moral issue (or combination)
3. What laws or policies are relevant?
Apply Code of Ethics
Consider Moral (Ethical) Principles
1. Which principles (autonomy, nonmaleficence, beneficence, justice, and fidelity) apply to the situation?
2. Rank order priority to the situation
Consultation and Review of the Literature
Generate Potential Courses of Action
1. Identify desired outcomes
2. Brainstorm
3. Consider all options – be creative
Consider Consequences of All Options
1. Evaluate each option
2. Assess the potential consequences for all parties involved
3. Eliminate options that clearly do not give desired results
4. Look for “best fit”
Select Course of Action
1. Review selected course of action to determine if it presents any new ethical considerations
2. How does course of action fit with ranking of moral principles?
3. Apply four tests…
  1. Test of Justice: Assess your own sense of fairness by determining whether you would treat others the same in this situation.
  2. Test of Publicity: Ask yourself whether you would want your behavior reported in the press.
  3. Test of Universality: Assess whether you could recommend the same course of action to another counselor in the same situation.
  4. Test of Moral Traces: Was expediency, politics, or self-interest involved in the decision?
Implement the Course of Action and Follow-Up
1. Strengthen ego and gather moral courage
2. Follow-up and reassess
3. Document

REMEMBER: Tune into your feelings, Involve your client, Take your time!!