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SUPERVISOR EVALUATION FORM
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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
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
2. Establish an atmosphere of acceptance and psychological safety
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
3. Call attention to errors in a tactful manner;
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
4. Recognize and accommodate to your level of experience and style of learning
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
5. Refrain from indiscriminate use of praise
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
6. Provide opportunities for you to question, challenge or doubt
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
7. Encourage you to explore the implications of your interventions
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
8. Encourage you to formulate your understanding of the case material
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
9. Make specific suggestions when you need them
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
10. Not foster undue dependence on your part
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
11. When asked, present a clear, theoretical rationale for suggestions
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
12. Clearly inform you of legal issues
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
13. Clearly inform you of ethical issues
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
14. Be sensitive to the requirements placed on you by your agency
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
15. Admit errors and/or limitations without undue defensiveness
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
16. Be concrete and specific in comments
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
17. Facilitate your understanding of countertransference reactions to your clients
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
18. Seek consultation when it is needed
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
19. Summarize and/or highlight major points of supervisory session
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
20. Be reached in case of emergencies
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
21. Help you formulate the dynamics of the client
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
22. Listen sensitively to you
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
23. Help clarify and define the nature of problem(s) you are having in your work
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
24. Be clear about the limits of the supervisory relationship
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
25. Deal explicitly with the formal evaluation process
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
26. Through role-playing or other suitable techniques, to help you more effectively intervene with your client
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
27. Be straightforward with you regarding areas in which you need Improvement
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
28. Be clear with you about the differences between supervision and psychotherapy
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
29. Maintain an appropriate focus in your sessions
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
30. “Be there” to meet your needs and not impose his/her issues on you
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
31. Be open to discussing any difficulties between the two of you which are hindering your learning
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
32. Clearly define the nature, structure, expectations, and limitations of the supervisory relationship
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
33. Make decisions and take responsibility when appropriate
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
34. Make you feel s/he genuinely want to help you learn
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
36. Provide you with general knowledge about professional psychology
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
37. Be sensitive and adaptive to the stresses you are experiencingas a supervisee
1 – it would be desirable to have a little more
2 – it would be desirable to have somewhat more
3 – much more of this is needed
0 – this area is satisfactory
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.)
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