Supervision Contract

This is not a ‘fillable’ form. If we decide to go ahead and work together, I will email you a signed copy of a simiiar form. Thank you!

Counselling Supervision Contract

Between:

       ____________________             (Supervisor)    and        ______________________   Supervisee) 

COMPETENCY EXPECTATIONS

  1. Supervision is within the competency-based framework. 
  2. Supervisee will self-assess clinical competencies (knowledge, skills, and values/attitudes) 
  3. Supervisors will consider supervisee self-assessment and compare with their own assessment based on observation and report of clinical work, supervision, and competency and will discuss performance with supervisee. 

SERVICES: 

  1. Individual supervision hours, available as necessary.
  2. Supervision of your counselling with your adult, adolescent and child clients. 
  3. Supervision will cover multiple modalities and could include review of tapes, progress notes, discussion of live observation, instruction, modelling, mutual problem-solving, and role-play as necessary. 
  4. Group supervision is not provided but we can include group sessions organized by the supervisees, attended by me. In this way supervisees learn to operate and work with groups.

COMPETANCY EVALUATION 

  1. Feedback may be offered in each supervision session.
  2. Summative evaluation – using competencies document attached – at year end.
  3. In order to successfully complete supervision, the supervisee must demonstrate good counselling skills.
  4. If the supervisee does not meet criteria for successful ACCT supervision, the supervisee will be informed at the first indication of challenge and supportive and remedial steps will be discussed between supervisee, supervisor and ACCT. 
  5. If the supervisee continues not to meet criteria for successful ACCT supervision, ACCT will decide appropriate steps.

RESPONSIBILITIES OF SUPERVISOR 

  1. Discuss selected clients, presenting complaints and treatment plans and review audio or videotapes of supervisee’s counselling sessions when requested. Challenge supervisee and problem solve as necessary and monitor supervisee’s basic attending skills. Present and model appropriate directives and ensure that ethical guidelines are upheld
  2. Sign off on ACCT client documentation when it is provided to supervisor.
  3. Intervene when supervisor believes client welfare is at risk.
  4. Maintain supervision notes.

RESPONSIBILITIES OF SUPERVISEE 

  1. Uphold ethical guidelines with their clients.
  2. Be prepared to discuss case approaches, challenges and techniques used.  
  3. Complete and store all case notes for client. 
  4. Obtain liability insurance and maintain registration with ACCT at all times.
  5. Consult with supervisor in cases of emergency. 

PROCEDURAL CONSIDERATIONS 

  1. Client information is strictly confidential and the supervisor will treat supervisee disclosures with complete discretion. 
  2. Limits of confidentiality for supervisees include ethical and legal violations as well as monitoring supervisees obligations.
  3. Annual report to ACCT describing your development, strengths and areas of concern as requested by supervisee. 
  4. The supervisee may contact the supervisor for emergency at xxx-xxx-xxxx or xxxxxxxx@xxxx.com  We will discuss alternative emergency procedures as necessary. The supervisor must be contacted in all emergency situations with clients. 

TERMS OF CONTRACT 

To the best of our ability we agree to conduct ourselves according to the ethical principles of our professional association.

Supervisor  signature: 

Date:

Supervisee signature:

Date