Supervisee Evaluation

Supervisee/CSW:

Supervisor:

From

Enter date here

The present level of each skill should be rated as follows:
s Strength
/ Ability commensurate with level of training
? Insufficient data
n Needs improvement (must specify)
na Not applicable

Any rating of “needs improvement” must be accompanied by specific recommendations in the comments section. Supervisors are encouraged to provide narrative commentary as much as possible.

I. CONTRIBUTES TO CLINICAL TEAM

Conscientious; fulfills responsibilities without reminders, is productive

Accepting and cooperative toward staff at all levels; forms positive relationships

Establishes effective supervisory alliance

exercises good judgment in seeking help

exercises good judgment when acting independently

contributes to task completion and cohesion in meetings

exhibits increased autonomy over course of year

outside communications reflect positively on agency

II. CAPACITY FOR PROFESSIONAL DEVELOPMENT

approaches supervision in open and collaborative manner.

acknowledges impact of own feelings and cultural values on practice

appropriately self-critical; accurate assessing self

incorporates new ideas and critical feedback

motivated to learn (information and help-seeking)

actively participates in diagnostic teams and seminars

appropriately questions and challenges colleagues and supervisors

demonstrates improvement in skills over course of year

conduct consistently reflects knowledge of and conformance to NASW ethical principles and state laws.

III. GENERAL PSYCHOTHERAPY SKILLS

A. CASE MANAGEMENT SKILLS

documents services fully but concisely

assesses nonpsychological needs

initiates referrals as needed

completes documentation adequately and in according the agency policy

able to network and coordinate services with external agencies and other service providers

B. ASSESSMENT SKILLS

1. Therapeutic Alliance:

conveys warmth, genuineness, empathy

conveys credibility

facilitates depth of self-disclosure

establishes alliance with all family members

respects client as whole person with strengths and needs

maintains objectivity

able to include cultural variables in alliance building

2. Data Gathering Skills:

aware of impact of own behavior and culture on client behavior

understands cultural background in client’s presentation

assesses dangerousness to self and others

handles child maltreatment issues appropriately

recognizes and understands nonverbal communication

recognizes and understands metaphorical communication

understands clinical process issues

assesses risk appropriately and with evidence-based practices

3. Diagnostic-Analytic Skills:

conceptualizes and organizes data from definite theoretical view

recognizes impact of multicultural variables on psychological differences and response to treatment

incorporates empirical findings in literature in diagnostic formulation

generates accurate differential diagnosis

develops assessment plan to rule out differential diagnosis

generates accurate case formulation integrating development, self-report, interview- process, projective, and other data

communicates findings orally in case presentations

generates accurate and timely written reports

C. INTERVENTION SKILLS

1. Maintains Working Alliance:

tracks or reflects (particularly affect) client statements in session

maintains client’s motivation to work (without overwhelming or client becoming dependent)

balances tracking functions with guiding functions consistent with theoretical perspective

demonstrates multicultural competence

maintains appropriate case load

2. Focuses Therapy:

formulates realistic short and long-term behavioral goals

formulates methods for achieving outcome

establishes shared sense of outcome and process goals with client

fosters positive expectations of hope

recognizes therapeutic impasses

realistic in assessing and re-assessing progress and revising formulation and diagnosis as indicated

interventions are consistent with theoretical formulation

interventions are culturally and ethically appropriate

interventions potentiate change

able to focus on process issues in session

interventions are prescriptive vs. generic

interventions reflect basic knowledge of cognitive-behavioral, dynamic, time limited, crisis intervention, and systemic interventions

3. Understands Interpersonal Process Issues:

uses personal response to client to aid assessment

selectively responds to accurate self-report, distortions, and client-therapist demands

responds appropriately to metaphoric and nonverbal content

recognizes and highlights underlying affect, cognition, or themes from content

accurately intuits culturally meaningful behavior

able to accept direct observation and constructive feedback

4. Biopsychosocial Assessment:

able to accurately reflect client’s strengths and needs

able to accurately integrate findings in a comprehensive report

able to formulate a dynamic conceptualization of client functioning

is sensitive to cultural issues in terms of appropriateness of the instruments selected with the interpretation of data

able to generate appropriate diagnosis(es) and treatment recommendations based on the results of the assessment

EVALUATOR COMMENTS:

Based on Hall-Marley (2000), an evaluation form used to give feedback to supervisees. Sections include contributions to clinical team, capacity for professional development, general psychotherapy skills (case management, assessment, intervention), and evaluator comments.

Reprinted in Falender, C.A., & Shafranske, E.P. (2004). Clinical Supervision: A Competency-based Approach. Washington, D.C.: APA.