SUPERVISOR EVALUATION FORM

Supervisee Name

Supervision Period

Supervision period final

Supervisor Name

Date of Evaluation

Purpose: To provide the supervisor with an understanding of his/her job performance in relation to the supervisee, to suggest areas for improvement, to permit the student to offer feedback to the supervisor in a written form that is based on a set of clearly and previously established criteria, and to increase the supervisor’s competence as a supervisor.

Performance Level Rating Scale: Based on current assessment and progress of supervisionand expectations of supervisee:
3 – much more of this is needed
2 – it would be desirable to have somewhat more.
1 – it would be desirable to have a little more
0 – this area is satisfactory

Directions:Utilizing the Rating Scale above, place the appropriate number on the lineprovided at the end of each item.

Evaluation Items
The supervisor is able to:

1. Be flexible and responsive to your changing needs

2. Establish an atmosphere of acceptance and psychological safety

3. Call attention to errors in a tactful manner;

4. Recognize and accommodate to your level of experience and style of learning

5. Refrain from indiscriminate use of praise

6. Provide opportunities for you to question, challenge or doubt

7. Encourage you to explore the implications of your interventions

8. Encourage you to formulate your understanding of the case material

9. Make specific suggestions when you need them

10. Not foster undue dependence on your part

11. When asked, present a clear, theoretical rationale for suggestions

12. Clearly inform you of legal issues

13. Clearly inform you of ethical issues

14. Be sensitive to the requirements placed on you by your agency

15. Admit errors and/or limitations without undue defensiveness

16. Be concrete and specific in comments

17. Facilitate your understanding of countertransference reactions to your clients

18. Seek consultation when it is needed

19. Summarize and/or highlight major points of supervisory session

20. Be reached in case of emergencies

21. Help you formulate the dynamics of the client

22. Listen sensitively to you

23. Help clarify and define the nature of problem(s) you are having in your work

24. Be clear about the limits of the supervisory relationship

25. Deal explicitly with the formal evaluation process

26. Through role-playing or other suitable techniques, to help you more effectively intervene with your client

27. Be straightforward with you regarding areas in which you need Improvement

28. Be clear with you about the differences between supervision and psychotherapy

29. Maintain an appropriate focus in your sessions

30. “Be there” to meet your needs and not impose his/her issues on you

31. Be open to discussing any difficulties between the two of you which are hindering your learning

32. Clearly define the nature, structure, expectations, and limitations of the supervisory relationship

33. Make decisions and take responsibility when appropriate

34. Make you feel s/he genuinely want to help you learn

36. Provide you with general knowledge about professional psychology

37. Be sensitive and adaptive to the stresses you are experiencingas a supervisee

Summarize the supervisor’s strengths and weaknesses as you currently view them and make suggestions for ways in which your supervisor could further facilitate your learning.

This Supervisor Feedback form is based on that given by Hall-Marley (2001) as an instrument to provide feedback to supervisors on the supervisee’s experience of supervision. The form consists of sections including atmosphere for learning, supervision style, supervision conduct, and supervision impact. It is recommended a supervisor feedback form be used a minimum of four times duringeachyearandideally,morefrequently. Itisatoolinestablishingadialogueandafeedbackloopwhichshouldenhancethe supervisoryalliance.(FoundinAppendicesofFalender,C.A.,&Shafranske,E.P.(2004).ClinicalSupervision: ACompetency- based Approach. Washington, D.C.: APA.)