Template

Agreement for Professional Supervision

The template below is designed to assist you to meet the New Zealand Psychologists Board’s requirements in relation to continuing competence.

Please note that the template is a suggestion only and you may wish to modify it to suit your own supervision choices and circumstances.

For information on supervision for psychologists, refer to the NZPsS handbook “Professional Practice of Psychology in Aotearoa New Zealand.” Evans, I., Rucklidge J., O’Driscoll. M. (eds) (2007) New Zealand Psychological Society. This book can be purchased from the New Zealand Psychological Society and formed the basis for much of the information used in the template below.

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Template Agreement

Supervisor:………………………………………

Supervisee:……………………………………..

Contract period: from………………..to……………………….

The contract is subject to revision at any time upon request by eithersupervisor or supervisee.

Purpose: e.g.

  • Monitor and promote the welfare of clients seen by the supervisee
  • Promote self reflection and personal awareness
  • Assist in the identification of professional and personal needs and strengths
  • Promote professional development and identify future goals and resources for learning
  • Promote professional ethics
  • Promote development and growthin specific areas e.g. cultural competence

Values: e.g.

  • The supervision relationship will reflect values important to the supervisor and supervisee e.g. values of respect, trust, compassion, honesty, integrity

Format of supervision:e.g.

  • group, individual, peer
  • live, electronic, case discussionetc

Frequency and length of supervision sessions:

Venue:

Records: e.g.

  • Notes will be made on each supervision session by the supervisor and supervisee
  • The notes will remain accessible to both the supervisor and supervisee
  • All notes will be securely stored.

Evaluation: e.g.

  • Evaluation of the supervision will occur as an ongoing part of the supervision process
  • More formal evaluation may take place at an agreed date

Supervisee Agreements / Supervisor agreements
The Supervisee agrees to: e.g.
  • Be available at agreed times
  • Come prepared for each session
  • Have gained clients’ permission to bring issues related to their work to supervision
  • Openly and honestly discuss their work and their responses to it
  • Bring to the supervisor’s attention any issues of risk
  • Be open to change and alternative methods of practice and follow through agreed actions
  • Abide by the Code of Ethics for Psychologists and professional standards
  • Provide feedback and express concerns and issues that arise in relation to the effectiveness of the supervision process
  • Co-operate with the supervisor in the resolution and management of any differences which may arise
  • Manage dual relationships appropriately
/ The Supervisor agrees to: e.g.
  • Be available at agreed times
  • Be open and honest with the supervisee
  • Give constructive feedback, guidance and support
  • Appropriately challenge the supervisee to promote reflection
  • Intervene as appropriate in situations of risk e.g. impacting on the supervisee and/or client(s)
  • Abide by the Code of Ethics for Psychologistsand professional standards when providing supervision
  • Undertake supervision of their own work
  • Manage dual relationships appropriately
  • Co-operate with the supervisee in the resolution and management of any differences which may arise
  • Keep abreast of theoretical, research and professional developments in their field
  • Develop their own competence including cultural competence

Confidentiality e.g.

Matters discussed in supervision will remain confidential and will not be discussed with any other party unless either party becomes aware of information related to issues of safety which could adversely effect themselves or others.

Resolution of conflict e.g.

Conflicts and concerns arising in the supervision relationship will be managed by

  • Openly discussing the issue
  • Keeping notes of the conflict and its resolution
  • In the event of non-resolution, nominating an agreed third party
  • In the event of unsafe practice that cannot be resolved appropriately within or between the parties involved, the supervisor and supervisee will reserve the right to inform a third party. This will only occur with the full knowledge of the parties involved.

Name…………………………………..Signed…………………………….Date………

Name…………………………………..Signed…………………………….Date………