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http://www.uakron.edu/cohttp://www.uakron.edu/colleges/educ/docs/internshiphdbk.doc

The University of Akron DEPARTMENT OF COUNSELING

MARRIAGE & FAMILY COUNSELING/THERAPYMASTER’S

INTERN & SITE SUPERVISORHANDBOOK

Revised: Spring 2010

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TABLE OF CONTENTS

INTRODUCTION........................................................................................................ 3

CRITERIA FOR INTERNSHIP........................................................................................ 4Internship Placement ………………………………………………………………………………………. 4Home-Based Criteria ……………………………………………………………………………………….. 5Out-Of-State …………………………………………………………………………………………………… 5

INTERNSHIP CLINICAL INSTRUCTION......................................................................... 6

GRADING.................................................................................................................. 7

INTERNSHIP RESPONSIBILITIESResponsibilities of the Cooperating Agency/School/University........................... 7Responsibilities of On-Site Supervisors…………………………………………………………….. 8Responsibilities of M&F Program Faculty............................................................ 8Responsibilities of the Student Intern................................................................. 9

NECESSARY FORMSMemorandum of Agreement.............................................................................. 10Sample Internship Plan…………………………………………………………………………………….. 12Examples for Types of Activity …………………………………………………………………………. 13Supervisee Equivalency Form…………………………………………………………………………… 14

Supervisee Personal Profile ………………………………………………………………………….. 16Supervisor Contract ……………………………………………………………………………………….. 17 Summary Forms ………………………………………………………………………………………………. 20Site Supervisor Evaluation ……………………………………………………………………………… 23Trainee Evaluation.............................................................................................. 26Clinical Activity Form ………………………………………………………………………………………. 30

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GUIDELINES FOR INTERNSHIP IN MFC/T

INTRODUCTIONThe supervision of Marriage and Family Counseling/Therapy Trainees is a valued and essential part of the training program for the Program. Therefore, this Handbook is provided to each site supervisor to be used as a guide to explain the internship process and requirements, supervision requirements, and to offer examples of forms required of supervisors or students during the internship experience.

The internship experience is the last phase of training for becoming a marriage and family counselor/therapist. This experience is intended to be an intensive on-the-job experience conducted in a setting as close as possible to the one in which the student will seek employment. The nature of this experience should be as similar to a regular counseling position as possible, but with much more supervision than is usually the case with an employed marriage and family counselor/therapist.

Internship occurs at the end of the sequence of core and elective courses that comprises the curriculum of the master's degree programs in Marriage and Family Counseling/Therapy. As the culminating experience of this program, the internship is designed to provide an opportunity for the student to synthesize and apply theory, practice, and research, in an actual counseling setting. While at this setting, the site supervisor serves as an important role model and mentor, guiding the intern’s clinical training.

The Department of Counseling acknowledges that your participation in this counseling internship experience requires a commitment of time and effort. The Marriage and Family Therapy Program and Internship Coordinator are available at any time to offer consultation and support. During the internship, we welcome feedback and will be happy to discuss any questions, concerns, or ideas that you wish to share.

CRITERIA FOR ADMISSION TO INTERNSHIPEligibility for admission to MFC/T Internship (5600:685) includes successful completion of all core-counseling courses including DSM-IV (5600:662) and Practicum (5600:675), as well as the approval of the MFC/T Program in which the student is enrolled. Students beginning the internship experience will have successfully completed curricular experiences and demonstrated knowledge in the core areas of marriage and family therapy (Introduction to Marriage & Family Therapy, Systems Theory, Marital Therapy, Ethics in MFT, and Assessment and Treatment Issues in MFT). In addition students will have successfully completed coursework in common core areas of counseling, (CACREP) including social and cultural diversity, human growth and development, career development, helping relationships, group theory, and a diagnosis and treatment course.

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INTERNSHIP PLACEMENTThe internship placement is based upon several conditions. First, the internship experience should be one that offers a variety of opportunities for the student, not limited to direct hours. Second, the internship site should be able to provide enough client contact hours for the intern to complete the experience in a timely manner (two-three semesters). Third, the clinical experiences offered by the site should be congruent with the student interns’ program requirements. To graduate, MFC/T students are required to complete a minimum of 500 direct hours with couples, families, individuals, and groups. All therapy must be done from a relationship perspective, and half of the direct hours must be with couples and families. Practicum hours (40+) and Team Hours (maximum of 100) are counted towards completion of these 500 direct hours. This experience should provide opportunities for students to counsel clients representative of the ethnic, lifestyle, and demographic diversity of the community. The internship placement is also based upon the availability of appropriate supervision:

The MFC/T Program is one of only several programs in the country that is dually accredited by CACREP and COAMFTE. This means that the students can sit for licensure as an MFT and a PC. It also means that supervision of MFC/T interns needs to meet criteria of both accrediting bodies and the Ohio licensure requirements to sit for the MFT and/or PC exam.

On-site supervisors must hold a PCC-S. In addition, either the PCC-S, or another licensed person at the site must have the qualifications of being a IMFT, or an AAMFT Approved Supervisor (licensed as a PCC, ISW, Psychologist, or Psychiatrist), or meet the MFC/T Program Equivalency qualifications for education, training, and supervision experience with MFTs (see Supervisor Equivalency Form enclosed).

INTERNSHIP PLACEMENT PROCESSOnce a student has selected an appropriate internship site, a letter of nomination is sent from the MFC/T Program to the site introducing the student and requesting an interview. Included with the nomination letter is the student’s resume. The student is asked not to call the site for at least two weeks to allow for proper processing of the nomination letter. At the end of two weeks, each student is then responsible for contacting the site and requesting an interview for internship placement. If the site accepts the student for placement, the Program Director should receive a letter of acceptance (on agency letterhead) from the internship site. This letter should be received before registration for internship is approved. A sample letter is enclosed on page 12. In addition, each supervisor who plans to supervise the MFT portion of the interns clinical work must submit a Supervisor Equivalency Form with resume. This form and other required documentation will be reviewed by the program and approved before placing any student at a site. This process is completed to insure appropriate supervisor knowledge, experience, and training for student interns placed at internship sites. Student interns must be covered by professional liability insurance while participating in the internship.

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HOME-BASED INTERNSHIP CRITERIAStudent intern should be enrolled in the master’s level Marriage & Family Counseling/ Therapy Program.

Student intern should initially be placed at the internship site for therapy experiences with couples and families. This initial placement is required to insure that site supervisor has evaluated the interns’ competency level and skill development as adequate to participate in a home-based therapy experience. Supervisors, or other appropriate licensed site employees, must be the lead therapist on the first several assigned home-based cases. When a new case is assigned the supervisor must go to the family’s home with the trainee the first time.

Interns should not be assigned more than one or two home-based cases. The rest of their experience should consist of cases the intern sees at the site.

Interns should have immediate access to their supervisors when at a family’s home. When a supervisor, or other appropriately licensed person, is not in attendance with the intern, the agency must make provisions for the intern to carry a cell phone to home-based appointments.

Safety Issues: Interns should not be assigned cases in which family/domestic violence is a current problem. If any family member has an active substance abuse problem, it is recommended that the family member be receiving additional services to deal with substance abuse issues in conjunction with home-based treatment.

OUT OF STATE INTERNSHIP PLACEMENTIn the event that a student wishes to meet their Internship requirements with an out-of-state placement, the following considerations should be noted. A meeting must be scheduled with the MFC/T Director to provide a rationale for the out-of-state placement. If the Director approves the out-of-state placement, the student will be responsible for independently seeking an appropriate site. An appropriate site is defined as one that can provide a minimum of two consecutive semesters of internship placement, can provide an adequate number of direct and indirect hours for completion of the internship requirement, and can provide an appropriately licensed professional with experience in supervision to supervise the student. An appropriately licensed professional is one who holds a minimum of a master’s degree in marriage and family counseling/therapy and is an AAMFT Approved Supervisor. Master’s-level interns will not be permitted to seek an out of state placement at a private practice setting.

When a student finds an appropriate site, the MFC/T Director should be contacted so that an introduction letter confirming the student’s academic status and internship needs can be sent to the site. Students who are planning to complete their internship out-of-state should be prepared to visit the site and meet with agency personnel. Once a student has been accepted at a site, a letter on agency letterhead must be sent to the MFC/T Director confirming the acceptance of the student, the proposed beginning and ending dates for the

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internship, and the supervisor’s name and professional license number. In addition, the supervisor should send their resume, a copy of their license, and their AAMFT Approved Supervisor certificate or number.

Paperwork Requirements: Interns who are meeting internship requirements at out-of-state sites will be required to complete the same department documentation requirements as students who are placed locally. These requirements include completing a Memorandum of Agreement, Internship Plan, End of Semester Evaluations, submission of bi-weekly contact hour logs, as well as other internship requirements like a clinical case presentation/paper. Other requirements may include a Personal Epistemology paper. Please check with the internship supervisor for requirements each semester.

Clinical Supervision Requirements: Out-of-state students will also be required to meet additional supervision requirements since they will not be attending departmental group supervision sessions at The University of Akron. The MFC/T Intern must receive a minimum of 2 hours of individual supervision weekly (as opposed to 1 hour of weekly individual supervision for students doing a local internship), and a minimum of 1 hour of group supervision each week.

Additional Requirements: Students that are fulfilling internship requirements at an out of state site must also document over the course of the internship experience an additional ten (10) hours of continuing education credit that relates to the counseling profession. The ten (10) hours of continuing education credit can include attendance at workshops, presentations, or completion of a course that relates to the counseling profession.

THE MFC/T PROGRAM CANNOT GUARANTEE THAT STUDENTS WHO PARTICIPATE IN OUT-OF-STATE INTERNSHIP EXPERIENCES WILL BE LICENSE ELIGIBLE IN OHIO. THE OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPIST BOARD SHOULD BE CONTACTED TO INSURE THE BOARD’S APPROVAL THAT THE OUT- OF- STATE INTERNSHIP PLACEMENT MEETS THE BOARD’S LICENSURE REQUIREMENTS.

INTERNSHIP CLINICAL INSTRUCTION

Clinical Requirements to Graduate a minimum of 500 hours (including Practicum and Team hours) of direct service

(includes Practicum and Team hours). At least 50% of the 500 hours must be with couples or families, and Team hours do not count towards these hours.

one hour of supervision for every five hours of direct client contact. Total amount of supervision hours to graduate is 100, of which 50 hours of individual supervision for master’s students is required. The remaining 50 hours of required supervision may be either individual or group supervision. Students are required to meet with their University Supervisor an average of 1 ½ hours per week for group supervision.

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time spent in the therapy room during live supervision counts as both client contact and supervision time; e.g., 1 hour of therapy plus 15 minutes pre- and 15 minutes post-session counts as 1 hour of client contact time plus 1.5 hours of individual supervision.

the opportunity for the student to become familiar with a variety of professional activities in addition to direct service (e.g., record keeping, supervision, information and referral, in service, and staff meetings).

the opportunity for the student to develop program-appropriate audio and/or videotapes of the student’s interactions with clients for use in supervision.

the opportunity for the student to gain supervised experience in the use of a variety of professional resources such as assessment instruments, technologies, print and nonprint media, professional literature, and research.

a formal clinical evaluation of the student’s performance at the end of each semester provided by the site supervisor.

Clinical Requirement to DiagnosisProgram requirements for intern students in the Marriage and Family Counseling Programs includes the appropriate use of the current edition of the “Diagnostic and Statistical Manual for Mental Disorders” and an understanding of the “International Classification of Diseases”. The internship experience must include a focus on conducting mental status examinations, and on the development and recognition of a framework for identifying symptomotology, etiology, and psychodynamics of mental and emotional disorders. (OCSWMFT Board 4757-13-01).

GRADINGThe internship pass or fail grade will be assigned by the university faculty internship supervisor with consultation or recommendations from the site supervisor taken into consideration. The grade will be based upon the site supervisor clinical evaluations at the end of each semester, the university supervisor evaluations, and completion of all internship course requirements.

Responsibilities of the Cooperating Agency/Site Supervisor: Interview potential interns. If site agrees to a placement, notify the Internship

Coordinator to this effect in writing. Designate an on-site counseling supervisor for the student intern. On-site supervisor

will complete the Supervisory Equivalency Form and return to Internship Coordinator. After review, and approval of supervisor, all contact regarding the student will be directed to the on-site supervisor.

Provide an opportunity for the intern to participate in the routine professional activities appropriate for her/his area of specialization. These may include: individual and group counseling; couples and family counseling; career counseling;

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administration, scoring and interpretation of tests for clients being counseled; use of educational, occupational, and personal-social information; consultation with staff and other agencies, referral of clients; and staff meetings.

Provide student intern with the rules and guidelines for their professional conduct at the agency/school/university.

Responsibilities of the On-Site Supervisor To be well grounded in the theory of marriage and family therapy, to use a systemic

perspective, and have clinical experience in the field. Participate in the development of and approval of the internship plan and

supervision plan, which must also be approved by the university supervisor. Sign and date the "Memorandum of Agreement", "Internship Plan", and

“Supervision Plan”. Supervise each student intern for at least one hour per week. A maximum of two

students can be supervised at any one time to meet this requirement. Individual supervision is that which occurs in groups of two or fewer students. This may include live supervision by the supervisor, while the intern is counseling the client. Live supervision includes both the preplanning and post feedback time.

Encourage the student to attend professional meetings, training sessions, and workshops.

Complete site supervisor evaluation of the intern at the end of each semester. Address issues such as diagnosis, treatment planning, goals and evaluations, in

addition to monitoring session-to-session progress. Adhere to supervision being a process, which is clearly distinguished from personal

psychotherapy or didactic instruction. Focus on the raw data from the student’s current clinical work, which is made

directly available to the supervisor through such means as written clinical materials, direct observations, and video and audiotapes. Supervision that relies solely on written clinical materials or verbal reports does not meet adequate standards.

Responsibilities of Marriage and Family Program Faculty Approve students for internship registration and placement through the MFC/T

Program. Provide an MFC/T Program Faculty Supervisor who will be the contact person for

student intern and site during the internship experience. Insure that University Internship Supervisor meets with the program interns for an

average of three hours every other week at the University for group supervision. Monitor the student intern's performance through consultation with the site

supervisor when needed. Assign course grades. Work closely with the participating agency/school/university to ensure that the

internship is a reciprocal arrangement benefiting all who are involved.

Responsibilities of the Student Intern

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Arrange through the MFT Program Director to register for the internship. The student is responsible for meeting deadlines to insure appropriate placement.

Attend on-campus, group supervision sessions in conjunction with the internship. Complete and send to OCSWMFT Board the Supervision Training agreement at

beginning of supervision and Internship Evaluation form at end of internship. Complete all requirements for the group supervision portion of the internship,

including evaluation of site/site supervisor at the end of each semester. Prepare proposed plan for internship experience. The plan should include the

student's goals, the activities to achieve the goals, a plan for assessing the experience, and scope of practice.

Perform the counseling and internship functions agreed to in the internship plan, as well as other functions as directed by the Site Supervisor.

Continuously work to improve his/her performance in response to feedback made by the Site Supervisor.

Meet at least one hour per week with the site supervisor for critique of work, including direct and indirect service. An attempt should be made to videotape or audiotape all therapy sessions.

Keep a daily log of client contact hours, indirect service hours, and supervisory hours in accordance with the University supervisor's guidelines.

Secure appropriate liability insurance. Be consistent with the requirements of the agency/school/university in regard to

grooming, punctuality, etc. Demonstrate behavior in accordance with the highest ethical and professional

standards. Obtain written consent for all clients before treatment begins. Obtain written

parent/guardian consent for all clients under the age of 18. Commit to the Agency/School and to the Department of Counseling to fully

participate and meet all internship requirements.

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MEMORANUDUM OF AGREEMENTThe University of Akron MFC/T Program

Date: ______________Agency Representative: _________________________ University Representative: ______________________Student: _____________________________________

This agreement will be effective for a period from __________ to __________.

Purpose: The purpose of this agreement is to provide a qualified graduate student, who has met appropriate Program requirements, for an internship experience in the field of counseling.

The Marriage & Family Counseling/Therapy Program shall be responsible for the following:1. Selecting a student who has successfully completed all the prerequisite coursework and can show proof of obtaining professional liability insurance.

2. Designating a qualified licensed faculty member as the Internship Supervisor who will work with the AGENCY in coordinating the internship experience.

3. Notifying the student that he/she must adhere to the administrative policies, rules, standards, schedules and practices of the AGENCY.

4. Supporting the AGENCY and notifying the Student Intern, if such an occasion arises that AGENCY deems Student Intern’s placement no longer appropriate.

The AGENCY shall be responsible for the following:1. Providing the Intern with an overall orientation to the Agency's specific services necessarily for the implementation of the Internship experience.

2. Designating a qualified appropriate licensed professional as Site Supervisor. The Site Supervisor will be responsible, with the approval of the Administration of the AGENCY/SCHOOL, for providing opportunities for the Intern to engage in a variety of counseling activities (program appropriate) under supervision, and for evaluating the Intern’s performance.

3. Providing the Intern with adequate workspace, telephone, office supplies, and staff support to conduct professional activities.

4. Providing the University access to Intern’s clinical work via audio, video taping, live observation, case consultation, or case notes.

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The STUDENT INTERN shall be responsible for the following:1. Attesting to having read and understood the American Counseling Association, and the American Association for Marriage and Family Therapy, ethical standards. Student Intern will practice counseling in accordance with these standards. Any breach of these ethics or any unethical behavior on Student Intern’s part will result in removal from Internship, a failing grade, and documentation of such behavior will become part of the permanent academic record.

2. Agreeing to adhere to the administrative policies, rules, standards, and practices of the internship site.

3. Agreeing to inform immediately, both AGENCY and UNIVERSITY Supervisors regarding concerns or issues as related to the internship experience or clinical work.

4. Understanding that a passing grade in Internship is contingent upon having demonstrated a competent skill level, as well as completion of all required paperwork, and clinical hours.

EQUAL OPPORTUNITY: It is agreed by all parties that there will be no discrimination on the basis of race, color, nationality, or ethnic origin, age, sex, or creed.

FINANCIAL ARRANGEMENTS: There are no financial stipulations in this agreement.

TERMINATION: It is understood and agreed by the parties hereto that the AGENCY has the right to terminate the Internship experience of the student whose health status is detrimental to the services provided the patients/clients of the AGENCY. Further, AGENCY has the right to terminate the use of the AGENCY by the INTERN if, in the opinion of the Site Supervisor, or other Agency Representative, Intern’s behavior is detrimental to the operation of the AGENCY, and/or patient/client care. Such action will not be taken until the grievance against any INTERN has been discussed with the INTERN and with the UNIVERSITY Supervisor.

The names of the responsible individuals charged with the implementation of this contract are as follows:

______________________________________________ __________AGENCY Supervisor DATE

______________________________________________ __________UNIVERSITY Internship Supervisor DATE

_____________________________________________ __________STUDENT INTERN DATE

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INTERNSHIP PLANMarriage and Family Program

The University of Akron

Date: ___________________________________

Agency: _________________________________

Supervisor: ______________________________

Student Intern: ___________________________

Scheduled Weekly Individual Supervision Time: ___________________________

Scheduled Weekly Group Supervision Time: ______________________________

Scheduled Weekly Block Hours of Direct Hours: ________________________________________________________________________________________________________ Objectives Activities

1.Agency daily functioning 1.Atend weekly staff meetings.

2.Intake, assessment, & 2.Evidenced in therapy process,treatment planning process. record keeping, & supervision.

3.Theory and skill development. 3.Evidenced by theory application and therapy process.

4.Using DSM diagnostic criteria. 4.Evidenced in treatment plans& supervision discussions

5.Learn about evaluation and research 5.Help collect, organize, activities of the agency. review or analyze data. 6.Participate in program-specific training, 6.Attend all relevant training opportunities for workshops and presentations. opportunities.

7.Use a variety of resources such as 7.Participate with professional literature, computer programs, theory, therapy, and supervision & referral sources. modalities.

8.Participate in the formal evaluation 8.Perform competently & process & follow ethical codes. ethically and complete paper-

work in a timely manner.

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TYPES OF SUPERVISION, DIRECT & INDIRECT ACTIVITY HOURS

SUPERVISION ACTIVITY Live Video Audio Case Consultation Other

DIRECT SERVICE ACTIVITY Intake Interview Couples Counseling Family Counseling Individual Counseling Group Counseling Psychological Testing Career Counseling

INDIRECT SERVICE ACTIVITY Writing Intake Reports Writing Case Notes Completing Forms Workshops and Staff Meetings Writing Treatment Plans Professional Reading Scoring Standardized Tests Telephone Intakes

SUPERVISOR EQUIVALENCY FORM

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Name: _________________________ Agency: ____________________

Highest Degree: M.S. or M.A. Ph.D.

Ohio License: Independent MFT Professional Clinical Counselor Independent Social Worker

Psychologist Psychiatrist Other State License

DETERMINATION OF SUPERVISORY STATUSCategory One:1. Are you an AAMFT Approved Supervisor? Yes No

2. Are you an AAMFT Supervisor-in Training? Yes No

If you answered Yes to either of these questions this form is completed. You are granted approved supervisory status for the University of Akron MFC/T Master’s Program. You are required to submit a copy of your resume, copy of your license, and verification of AAMFT of supervisory status to complete this process. If you did not answer yes to either question please proceed to the next set of questions. _______________________________________________________________________Category Two:1. Are you a licensed independent marriage and family therapist with three years’ post degree experience in the field of marriage and family therapy? Yes No

If you answered yes to this question this form is completed and you are granted approved supervisory status for the University of Akron MFT Master’s Program (OH 4757-29-01, COAMFT 152.02). You are required to submit a copy of your resume and state license.

Date: ________________________________________Signature: ____________________________________Approval Date: ________________________________Signature of Program Faculty: ____________________________________________________________________________________________

If your experience does not fit either Category One or Two, please complete the second page of the Supervisory Equivalency Form. Supervisors that are not AAMFT Approved Supervisors, AAMFT Supervisors-In-Training, or licensed Independent Marriage and Family Therapists must meet equivalency status in order to supervise masters or doctoral interns in the University of Akron’s Marriage and Family Program.

EDUCATION, TRAINING, & EXPERIENCE IN MFT

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EDUCATION in MFTHave completed two courses in MFT, or can evidence extensive nonacademic training in MFT (i.e., at least 25 continuing education units). Please list universities attended and courses completed, or list dates, topics, and number of continuing education credits accrued. Documentation may be requested for accreditation purposes._______________________________________________________________________________________________________________________________________________________________________________________________________________TRAINING and EXPERIENCE in MFTHave a minimum of three years of clinical experience with couples and families. Please list type of clinical experiences and place of experience._______________________________________________________________________________________________________________________________________________________________________________________________________________

SUPERVISION in MFT(Equivalency criteria must include training in MFT supervision).

MFT SUPERVISION EDUCATION & TRAININGPlease list education and/or training; include dates, and courses, workshops, or continuing education credits in MFT supervision._______________________________________________________________________________________________________________________________________________________________________________________________________________

MFT SUPERVISED SUPERVISION EXPERIENCE or SUPERVISON OF MFT’sA minimum of two years being supervised as a marriage and family supervisor. Please list supervisor’s name and site where experience took place.________________________________________________________________________________________________________________________________________________________________________________________________________________________OR A minimum of ten years supervising MFT students. Please list site(s) where supervision took place and dates.__________________________________________________________________________________________________________________________________________

Return this completed form, a resume, any documentation such as copies of license, certificates, transcripts, etc. to the University of Akron, Department of Counseling (Marriage and Family Program) Carroll Hall.

Approved Denied Date: ________ Program Faculty Signature: ______

SUPERVISEE PERSONAL PROFILE

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Date: _________________________

Supervisee Name: ____________________________________________

Internship Site Address: ____________________________________Site Phone # and email: _______________________________________

Home Address: _____________________________________________Home Phone and email: _______________________________________

Degrees/Majors and Colleges Attended:__________________________________ __________________________________________________________________ ________________________________

Licenses or Credentials:__________________________________________________________________

Current Academic Program: __________________________________________

Malpractice Insurance Carrier and Expiration Date: ______________________

If employed, what is your current position: ______________________________

Previous work or volunteer related experience related to a helping profession:________________________________________________________________________________________________________________________________________Have you ever been suspended or terminated from employment or a volunteer experience in the human services field? If yes, please explain: ___________________________________________________________________________________________________________________________________________________Are there any specific life experiences, family or personal information, or otherinformation that you would like a supervisor to be aware of to better supervise you?______________________________________________________________________________________________________________________________________ What type of learning style fits best for you:___________________________________________________________________From past supervision experiences, what would you like repeated, and what would you like to avoid: _____________________________________________________________________________________________________________________________

GUIDELINES FOR DEVELOPING A SUPERVISION CONTRACT

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Each supervisor and student intern should complete a supervision contract. The purpose of the supervision contract is: to clarify goals, establish parameters of supervision and establish evaluation methods.

Space VariablesPlace of Meeting

Time VariablesFrequencyDuration each week Duration of contractDay and timeVacation TimesCancellationsMake-up Times

GoalsExpectations of SupervisorExpectations of SuperviseeFocusType of Supervision:

RecordingsCase NotesAudiotapesVideo tapesVerbal Report (structured or unstructured presentations)

PaperworkFormat for case filesWhere should they be stored?When should they be presented to supervisor?Other relevant agency forms

Feedback and Evaluation ToolsSuperviseeSupervisor

Adapted from Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of Clinical Supervision. NY: Allyn & Bacon.

SAMPLE SUPERVISION CONTRACT

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This contract will guide the work of (Intern)____________________ and (Supervisor) ____________________ for the time period _______________________.The terms herein are agreeable to both parties, and subject to revision if necessary.

LOGISTICAL CONSIDERATIONS:Supervision will occur on (day)__________at (time)__________, starting on (month/day)__________ and ending on (month/day)___________. Meetings will take place (building/room) __________. Both parties are expected to be punctual for supervision.

Should either (Intern)__________ or (Supervisor)__________ need to miss a session, a make-up meeting will be scheduled (time/day)_________. Supervisor will be responsible for informing supervisee of any scheduled holiday or agency closing times or days.

In the event that (Intern)__________ needs to contact (Supervisor)__________, these contact number are provided:

Phone Number during business hours:Phone Number after business hours:Email address:Other Agency Emergency Contact Person:

In the event that (Supervisor)__________ needs to contact (Intern)__________, these contact numbers are provided:

Phone Number during business hours:Phone Number after business hours:Email address:Other Emergency Contact Person:

SUPERVISOR EXPECTATIONS:Arrive promptly for each supervision session.Discuss all concerns regarding client sessions and/or supervision experience and ask for assistance when needed.Be open to discuss alternatives for client care, including different theoretical conceptualizations, techniques, diagnoses, and treatment plans.Be prepared for supervision by having available updated case notes and prioritized list of issues to address.

SUPERVISEE EXPECTATIONS:1. Identify areas of skill strength, as well as areas for improvement.2. In particular I am asking for assistance in the following areas:

-application of theory to treatment.-appropriately confronting clients when needed.

SUPERVISION GOALS:

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1. To work simultaneously to maximize ________ development as a counselor, while preserving the welfare of her/his clients.2. To be available and supportive of __________ while also managing the evaluative duties of supervision.3. To learn to move with facility and appropriateness between the roles of consultant, teacher, and counselor as the specific situations within the supervision sessions suggest (Bernard and Goodyear, 1992).4. To practice various models of supervision judiciously within supervision sessions.

SUPERVISEE GOALS:1. To be more at ease during the counseling process by building my self-confidence by not concentrating so much on what I am supposed to do as a counselor, but instead to listen to the clients and enter their worlds. 2. To be able to deal with resistance successfully through much practice and by realizing that I should not be working harder than the client.3. To be able to effectively confront the client by improving my listening skills so I can pick up on discrepancies and question when needed.4. To use open-ended questions more, by practicing using them in daily life.5. To be more empathetic to the client by setting aside my problems and focusing only on the client’s thoughts and feelings.6. To know and practice the application of appropriate theoretical orientations, as well as when to use certain techniques and to be able to use them effectively.

Student Intern and Supervisor have read and agree to the above terms. Both reserve the right to discuss alterations of this contract at any time.

___________________________________(Student Intern)

___________________________________(Supervisor)

___________________________________(Date)

WEEKLY SUPERVISION SUMMARY FORM

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Date: ___________________

Supervisee’s Name: ___________________________________________

Supervisor’s Name: ___________________________________________

Case Number or Client Name: __________________________________

Client Session Number: ___________________

Type of Supervision: Case Report_____ Video_____ Audio _____ Live _____

Developing or Completed Treatment Plan (Please circle)Theoretical Orientation:

Supervisee Concerns:

Goals for next session:

Are there any risk management issues to be aware of for this case?__________Informed Consent__________Parental Consent__________Within Interns Ability Level or Scope of Practice__________Within Supervisor’s Area of Knowledge/Experience__________Child Abuse (physical, emotional, sexual)__________Risk of harm to self or other(s)__________Duty to Warn Issues__________Domestic Violence Issues__________Substance Abuse Issues__________Medical or Psychological Records Request__________Medical or Psychiatric Assessment Needed__________Other Systems Involvement __________Additional Releases Needed__________Referral Considerations

Process Observations: ______________________________________________________________________________________________________________________________________________________________________________________Supervisee Strengths and Areas for Improvement: _____________________________________________________________________________________________________________________________________________________________Supervisor Recommendations: ___________________________________________________________________________________________________________

SUPERVISORY RECORD FORM

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Date: _______________________

Supervisee: ____________________________Supervisor: ______________________

Case Number:Supervisee Concern:Supervision Goals

Case Number:Supervisee Concern:Supervision Goals:

Case Number:Supervisee Concern:Supervision Goals

Case Number:Supervisee Concern:Supervision Goals

Supervisory Activity1. Supporting Documents:

Case Notes Reviewed:Tape/Audio Review:

2. Theoretical Issues

3. Process Observations

4. Self of Therapist Issues

5. Treatment Evaluation:

Supervisor Recommendations1. Treatment

2. Training Issues

3. Risk Management Issues

4. Other Comments

MFC/T TRAINEE EVALUATION (end of semester)

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Trainee Name: ______________________________ Date: _______________Supervisor Name: ___________________________

Please rate the above named trainee on each of the following items based on the scale below:

5 = Very strong, this comes naturally for him/her.4 = Strong, in this area.3 = The trainee is competent in this area.2 = The trainee is inconsistent in this area- should continue to work on this skill1 = This trainee is weak in this area - needs additional supervision.N/A = I am not able to assess the trainee on this competency at this time.

Attending to Therapeutic Relationship

N/A

Wea

k

Nee

ds W

ork

Com

pete

nt

Stro

ng

Ver

y St

rong

The trainee creates an atmosphere of acceptance and understanding. N/A 1 2 3 4 5

The trainee attends to clients’ emotional climate in order to build trust.

N/A 1 2 3 4 5

The trainee engages clients in the therapeutic process. N/A 1 2 3 4 5

The trainee develops mutually agreeable goals for therapy. N/A 1 2 3 4 5

The trainee recognizes and attends to split alliances within relational therapy.

N/A 1 2 3 4 5

Addressing Family ProcessThe trainee identifies problematic relational interactions among family members.

N/A 1 2 3 4 5

The trainee integrates individual and medical models of functioning within a systemic perspective

N/A 1 2 3 4 5

The trainee determines boundaries, hierarchies, & patterns within families.

N/A 1 2 3 4 5

Remaining Aware of the Larger SystemThe trainee develops treatment approaches from a range of theoretical perspectives.

N/A 1 2 3 4 5

23

The trainee identifies psychosocial and environmental influences on each client.

N/A 1 2 3 4 5

The trainee coordinates therapy with relevant individuals and institutions. N/A 1 2 3 4 5

The trainee addresses external influences that affect family functioning.

N/A 1 2 3 4 5

Designing and Conducting TreatmentThe trainee can determine who should attend therapy and in what configuration.

N/A 1 2 3 4 5

The trainee facilitates therapeutic involvement of all necessary participants in treatment.

N/A 1 2 3 4 5

The trainee matches the needs of the client with an appropriate therapeutic approach.

N/A 1 2 3 4 5

The trainee integrates information from a variety of sources to develop a treatment plan.

N/A 1 2 3 4 5

The trainee establishes a sequence of treatment processes in a treatment plan.

N/A 1 2 3 4 5

The trainee assists the client to change their perspective of the presenting complaint to facilitate solutions.

N/A 1 2 3 4 5

The trainee helps the client to identify strengths and resources that assist therapy.

N/A 1 2 3 4 5

The trainee assists the client in developing effective problem-solving abilities.

N/A 1 2 3 4 5

The trainee helps a client to alter problematic relationship patterns. N/A 1 2 3 4 5

The trainee tailors therapy to a client’s developmental needs. N/A 1 2 3 4 5

The trainee modifies treatment techniques to the cognitive level of a child or adolescent.

N/A 1 2 3 4 5

The trainee responds appropriately to a client’s culture or ethnicity. N/A 1 2 3 4 5

The trainee respects a client’s sexual orientation in order to enhance the process of change.

N/A 1 2 3 4 5

24

Evaluating Ongoing Process and OutcomesThe trainee utilizes published books or articles to guide the therapeutic process.

N/A 1 2 3 4 5

The trainee modifies the treatment plan based on information about client’s progress.

N/A 1 2 3 4 5

The trainee utilizes ongoing assessment to monitor the nature and severity of a client’s problems.

N/A 1 2 3 4 5

The trainee assesses a client’s interests and abilities using published standardized tests.

N/A 1 2 3 4 5

The trainee can interpret client’s standardized test results related to published norms.

N/A 1 2 3 4 5

The trainee can evaluate clients’ outcomes for the need to continue or terminate therapy.

N/A 1 2 3 4 5

Thinking about PracticeThe trainee has a theory of how change occurs. N/A 1 2 3 4 5

The trainee recognizes how his/her assumptions about human nature influence therapy.

N/A 1 2 3 4 5

The trainee integrates supervisor/team communications into treatment.

N/A 1 2 3 4 5

Maintaining Professional EthicsThe trainee recognizes when personal biases may influence the therapeutic process.

N/A 1 2 3 4 5

The trainee recognize when consultation with a colleague or supervisor is appropriate.

N/A 1 2 3 4 5

The trainee understands the ethical codes of the profession. N/A 1 2 3 4 5

The trainee maintains adequate and timely clinical records. N/A 1 2 3 4 5

The trainee can discuss how fiscal responsibility, confidentiality, and legal issues can influence the therapeutic process.

N/A 1 2 3 4 5

25

The trainee describes the therapeutic process to clients so that they can make informed decisions about treatment.

N/A 1 2 3 4 5

The trainee makes appropriate referrals to other professionals. N/A 1 2 3 4 5

Assessment and DiagnosisThe trainee can recognize and evaluate an adult client who is depressed.

N/A 1 2 3 4 5

The trainee can recognize and evaluate a child or adolescent client who is depressed.

N/A 1 2 3 4 5

The trainee can assess an adult client’s behavior based on DSM-IV criteria.

N/A 1 2 3 4 5

The trainee can assess a child or adolescent client’s behavior based on DSM-IV criteria.

N/A 1 2 3 4 5

The trainee can recognize and evaluate an adult client who has an anxiety disorder.

N/A 1 2 3 4 5

The trainee can recognize and evaluate a child or adolescent client who has an anxiety disorder.

N/A 1 2 3 4 5

The trainee can distinguish a client who has a personality disorder. N/A 1 2 3 4 5

The trainee can identify a client who has a developmental disorder. N/A 1 2 3 4 5

The trainee can assess the level of risk of harm that a client’s behaviors pose. N/A 1 2 3 4 5

What do you believe are this trainee’s strongest clinical skills?

On which skills do you think this trainee should most focus during supervision at this time?

If you have specific concerns regarding this trainee’s skills please describe them on the back of this form, or contact Patricia Parr, Program Director, MFC/T Program, The University of Akron – Email: pparr@uakron.edu Phone: 330-972-8151.

26

TRAINEE SELF-EVALUATION FORM

NAME: ______________________________DATE: _______________________________

Please rate yourself on each of the following items based on the scale below:

5 = I am very strong in this area; this comes naturally for me.4 = I am strong in this area; though still have uncertainty with some clients.3 = I am generally competent in this area, but I am continuing to work on this skill.2 = I am inconsistent in this area. I am continuing to work on this skill.1 = I am weak in this area. I need additional supervision and guidance.N/A = I am not able to assess this competency at this time.

Attending to Therapeutic Relationship

N/A

Wea

k

Inco

nsis

tent

Com

pete

nt

Stro

ng

Ver

y St

rong

I create an atmosphere of acceptance and understanding. N/A 1 2 3 4 5

I attend to clients’ emotional climate in order to build trust. N/A 1 2 3 4 5

I engage clients in the therapeutic process. N/A 1 2 3 4 5

I develop mutually agreeable goals for therapy. N/A 1 2 3 4 5

I recognize and attend to split alliances within relational therapy. N/A 1 2 3 4 5

Addressing Family ProcessI identify problematic relational interactions among family members. N/A 1 2 3 4 5

I integrate individual and medical models of functioning within a systemic perspective

N/A 1 2 3 4 5

I determine boundaries, hierarchies, and patterns within families. N/A 1 2 3 4 5

Remaining Aware of the Larger SystemI develop treatment approaches from a range of theoretical

N/A 1 2 3 4 5

27

perspectives.I identify psychosocial and environmental influences on each client.

N/A 1 2 3 4 5

I coordinate therapy with relevant individuals and institutions. N/A 1 2 3 4 5

I address external influences that affect family functioning. N/A 1 2 3 4 5

Designing and Conducting TreatmentI can determine who should attend therapy and in what configuration. N/A 1 2 3 4 5

I facilitate therapeutic involvement of all necessary participants in treatment.

N/A 1 2 3 4 5

I match the needs of the client with an appropriate therapeutic approach.

N/A 1 2 3 4 5

I integrate information from a variety of sources to develop a treatment plan.

N/A 1 2 3 4 5

I establish a sequence of treatment processes in a treatment plan. N/A 1 2 3 4 5

I assist the client to change their perspective of the presenting complaint to facilitate solutions.

N/A 1 2 3 4 5

I help the client to identify strengths and resources that assist therapy. N/A 1 2 3 4 5

I assist the client in developing effective problem-solving abilities. N/A 1 2 3 4 5

I help a client to alter problematic relationship patterns. N/A 1 2 3 4 5

I tailor therapy to a client’s developmental needs. N/A 1 2 3 4 5

I modify treatment techniques to the cognitive level of a child or adolescent.

N/A 1 2 3 4 5

I respond appropriately to a client’s culture or ethnicity. N/A 1 2 3 4 5

I respect a client’s sexual orientation in order to enhance the process of change.

N/A 1 2 3 4 5

Evaluating Ongoing Process and OutcomesI utilize published books or articles to guide the therapeutic process. N/A 1 2 3 4 5

28

I modify the treatment plan based on information about client’s progress.

N/A 1 2 3 4 5

I utilize ongoing assessment to monitor the nature and severity of a client’s problems.

N/A 1 2 3 4 5

I am able to assess a client’s interests and abilities using published standardized tests.

N/A 1 2 3 4 5

I can interpret client's standardized test results related to published norms.

N/A 1 2 3 4 5

I evaluate clients’ outcomes for the need to continue or terminate therapy.

N/A 1 2 3 4 5

Thinking about PracticeI have a theory of how change occurs. N/A 1 2 3 4 5

I recognize how my assumptions about human nature influence therapy.

N/A 1 2 3 4 5

I integrate supervisor/team communications into treatment. N/A 1 2 3 4 5

Maintaining Professional EthicsI recognize when my personal biases may influence the therapeutic process.

N/A 1 2 3 4 5

I recognize when consultation with a colleague or supervisor is appropriate.

N/A 1 2 3 4 5

I understand the ethical codes of the profession. N/A 1 2 3 4 5

I maintain adequate and timely clinical records. N/A 1 2 3 4 5

I can discuss how fiscal responsibility, confidentiality, and legal issues can influence the therapeutic process.

N/A 1 2 3 4 5

I can describe the therapeutic process to clients so that they can make informed decisions about treatment.

N/A 1 2 3 4 5

I make appropriate referrals to N/A 1 2 3 4 5

29

other professionals.

Assessment and DiagnosisI can recognize and evaluate an adult client who is depressed. N/A 1 2 3 4 5

I can recognize and evaluate a child or adolescent client who is depressed.

N/A 1 2 3 4 5

I can assess an adult client’s behavior based on DSM-IV criteria. N/A 1 2 3 4 5

I can assess a child or adolescent client’s behavior based on DSM-IV criteria.

N/A 1 2 3 4 5

I can recognize and evaluate an adult client who has an anxiety disorder.

N/A 1 2 3 4 5

I can recognize and evaluate a child or adolescent client who has an anxiety disorder.

N/A 1 2 3 4 5

I can distinguish a client who has a personality disorder. N/A 1 2 3 4 5

I can identify a client who has a developmental disorder. N/A 1 2 3 4 5

I can assess the level of risk of harm that a client’s behaviors pose. N/A 1 2 3 4 5

What do you believe are your strongest therapy skills?

With which skills do you think that you need the most assistance from your supervisor?

Please feel free to share any additional positive comments or concerns that you might have about this internship experience or supervision on the back of this form, or by personally contacting the Program Director, Dr. Parr at 972-8151 or pparr@uakron.edu

30

CLINICAL ACTIVITY FORMName:   Week:  Date:   Sem/Yr:  

Date Client Contact Began:  

The hours on this form include:

Master’s = 500 total direct clinical hours

PrePracticum = 50 hours of raw data supervision = 50 hours of case consultation supervision

Practicum Doctoral = 1000 clinical hours doubled (1000/100/100)

Internship = 100 raw data supervision

= 100 case consultation supervision CLIENT CONTACT HOURS

  Individual Group Couple FamilyIndividual 0.00 0.00 0.00 0.00Co-Therapy 0.00 0.00 0.00 0.00TOTALS: 0.00 0.00 0.00 0.00

  Individual Couple FamilyAlternative (Team) Hours 0.00 0.00 0.00

SUPERVISION HOURS: Minimum of 50/100 *Raw Data Hours (Live, Video, Audio)  Case Report Live* Video* Audio* Individual 0.00 0.00 0.00 0.00Group 0.00 0.00 0.00 0.00Alternative(Team) 0.00 0.00 0.00 0.00TOTALS: 0.00 0.00 0.00 0.00

Alternative (Team) Hours

0.00 Direct Hours 0.00

Supervision Hours 0.00

Total Cumulative Direct Relational Hours, minus team hours: 0.00Total Cumulative Direct Individual/Group Hours, minus team hours: 0.00Total Cumulative Alternative (Team) Hours: 0.00

31

Total Cumulative Supervision Hours: 0.00Total Cumulative Raw Data Supervision 0.00

TRAINEE SIGNATURE: _________________________________________

SUPERVISOR SIGNATURE: _____________________________________