This is not a ‘fillable’ form, just a sample. If we decide to go ahead and work together, I will email you a signed copy of a sililar form after it is filled out. Thank you!
Counselling Supervision Contract
____________________ (Supervisor) and ______________________ Supervisee)
- Supervision is within the competency-based framework.
- Supervisee will self-assess clinical competencies (knowledge, skills, and values/attitudes)
- 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.
- Individual supervision hours: _________
- Group supervision hours: __________
- Supervision of your counselling with your adult, adolescent and child clients.
- Supervision will cover multiple modalities and includes review of tapes, progress notes, discussion of live observation, instruction, modeling, mutual problem-solving, and role-play as necessary.
- Group supervision is not provided but we can include some group sessions where I will attend if these sessions are organized by the supervisees. In this way supervisees learn operate and work with groups.
- Feedback may be offered in each supervision session.
- Summative evaluation – using competencies document attached – at year end.
- In order to successfully complete supervision, the supervisee must attain a rating of ____ (on the evaluation Likert scales).
- 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.
- If the supervisee continues not to meet criteria for successful ACCT supervision, ACCT will decide appropriate steps.
RESPONSIBILITIES OF SUPERVISOR
- 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
- Sign off on ACCT client documentation when it is provided to supervisor.
- Intervene when supervisor believes client welfare is at risk.
- Maintain supervision notes.
RESPONSIBILITIES OF SUPERVISEE
- Uphold ethical guidelines with their clients.
- Be prepared to discuss case approaches, challenges and techniques used.
- Complete and store all case notes for client.
- Consult with supervisor in cases of emergency.
- Client information is strictly confidential and the supervisor will treat supervisee disclosures with complete discretion.
- Limits of confidentiality for supervisees include ethical and legal violations as well as monitoring supervisees obligations.
- Annual report to ACCT describing your development, strengths and areas of concern as requested by supervisee.
- The supervisee may contact the supervisor for emergency at xxx-xxx-xxxx or firstname.lastname@example.org We will discuss alternative emergency procedures as necessary. The supervisor must be contacted for 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 Supervisee signature