Supervisor Evaluation Form

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Supervisor Evaluation Form

This form should be completed for each supervisor you have had during the previous training year. When you receive this form, you should also receive instructions about what time period to consider in choosing the supervisors to evaluate. Fill out one separate form for each supervisor who has provided any clinical guidance to you in the defined time interval. You should only complete this form if you are a pre-doctoral or other trainee in the Ph.D. Program in Clinical Science at USC.

If you are filling out this form electronically, you will need to save it under a different name so you can forward it to us. Please do that now and click the box when you have finished resetting the name of the file.

I have reset the file name.

You may elect to have your responses be reported only in aggregate form, or you may elect to allow your supervisor to see the individual responses without having them connected with your identity. Of course, if you are the only student supervised in a particular year, the supervisor is likely to know your identity.

I elect to have my responses shared individually with my supervisor

I elect to have my responses shared only in aggregate form with my supervisor

If you have any concerns about a supervisor, please bring them to the attention of one of the following people:

Barry Reynolds, Ph.D., Executive Director, Psychological ServicesCenter

Robert Gore, Ph.D., Associate Director of Clinical Training

Gayla Margolin, Ph.D., Director of Clinical Training

Margaret Gatz, Ph.D., Chair, Department of Psychology

In general, if you have concerns about a supervisor, you should bring them to the attention of someone higher in the chain of command. This form should be turned in to a person higher in the chain of command than the person you are evaluating. Thus, evaluations of Barry Reynolds or Robert Gore should go to Gayla Margolin, and evaluations of Gayla Margolin should go to Margaret Gatz.

1.What is your name?

2. What is the name of the supervisor you are evaluating?

3. For what semester(s) are you completing this evaluation? Give semester(s) (Fall, Spring, Summer) and year(s) (check all that apply)

Fall, 2008

Spring, 2009

Summer, 2009

Fall, 2009

Spring, 2010

4. What year were you in the programsequence when you had this supervisor? You should exclude any leaves of absence when you response (i.e., if you entered in 2001 and took Fall, 2002 through Summer, 2003 as a leave of absence, you would be a second year student in Fall, 2003 when you returned).

1. First year

2. Second year

3. Third year

4. Fourth year

5. Fifth year and beyond

6. Post-internship

7. Post-doctoral

5. What was the context of supervision? Check only one.

1. Group supervision

2. Dyad supervision

3. Individual supervision

4. A mix of individual and non-individual supervision

4. Other [5.4s]__

6. What was the focus of the supervision? (check all that apply)

1. supervision of individual psychotherapy

1a. adults

1b. older adults

1c. children

2. supervision of family psychotherapy

3. supervision of marital or relationship psychotherapy

4. supervision of group psychotherapy

5. supervision of psychological testing or assessment

7. How many times did your supervisor sit in or observe you or listen to tapes of your cases? Check the best response.

1. Never

2. Some of the supervision sessions

3. Many supervision sessions

4. Most supervision sessions

5. All supervision sessions

8. Please rate your supervisor’s apparent level of interest in supervision.

1. Very uninterested

2. Somewhat uninterested

3. Neutral

4. Somewhat interested

5. Very interested

9. Other[8.9s]___

9. What type of feedback did your supervisor give you? (Check all that apply)

1. Frequent verbal feedback

2. Infrequent verbal feedback

3. Verbal feedback only at the end of the semester or year

4. Frequent written feedback

5. Infrequent written feedback

6. Written feedback only at the end of the semester or year

7. No verbal feedback

8. No written feedback

10. Please rate your supervisor’s ability to give feedback.

1. This was generally done badly

2. This was sometimes done badly

3. This was generally done well

4. This was consistently done well

5. This was areal strength – excellent

9.1. N/A

9.2. Other [10.9s]_____

11. Did your supervisor handle logistics well (i.e., keeping appointments, scheduling supervisory sessions, etc.)?

1.Logistical problems were a significant issue

2. Logistical problems were a regular issue

3. Logistical problems were an occasional issue

4. Logistical problems were a rare issue

5. There were no logistical problems

Please rate the extent to which your supervisor did each of the following things:

Never
0 / Sometimes
1 / Frequently
2 / N/A
9
12. Roleplayed techniques to use in treatment or assessment
13. Suggested readings
14. Helped me reflect productively on the professional-client relationship
15. Helped me reflect productively on the supervisor/supervisee relationship
16. Helped me formulate treatment/assessment goals
17. Gave concrete suggestions – or helped me develop concrete ideas - about how to meet goals with clients
18. Helped me to utilize quantitative indices of treatment progress
19. Went over assessment results
20. Spent time with me reviewing assessment reports that I had written
21. Helped me develop assessment skills
22. Helped me develop treatment skills
23. Helped me think about my personal reaction to cases
24. Helped me learn how to conceptualize cases
25. Helped me think about ethical and legal issues
26. Helped me think about issues related to cultural, ethnic, racial, or other forms of diversity
27. Helped me utilize relevant empirical literatures in my cases
28. Helped me implement empirically supported treatments or empirically supported principles of treatment

Please rate the extent to which you found each of the supervisory activities previously mentioned helpful (if they were done) or the extent to which you wish they had been done (if they were not).

If it was done, how helpful was it? / If it wasn’t done, do you wish it had been?
Not at all helpful
0 / Somewhat helpful
1 / Moderately to extremely helpful
2 / Yes, I wish it had been done
-2 / No, glad it wasn’t done
-1
29. Roleplayed techniques to use in treatment or assessment
30. Suggested readings
31. Helped me reflect productively on the professional-client relationship
32. Helped me reflect productively on the supervisor-supervisee relationship
33. Helped formulate treatment or assessment goals
34. Gave concrete suggestions as to how to reach goals with clients
35. Helped me develop concrete ideas about how to meet goals with clients
36. Helped me utilize quantitative indices of treatment progress
37. Went over assessment results
38. Spent time with me reviewing assessment reports that I had written
39. Helped me develop assessment skills
40. Helped me develop treatment skills
41. Helped me think about my personal reactions to cases
42. Helped me learn how to conceptualize cases
43. Helped me think about legal and ethical issues
44. Helped me think about issues related to cultural, ethnic, racial, or other forms of diversity
45. Helped me utilize relevant empirical literatures in my cases
46. Helped me implement empirically supported treatments or empirically supported principles of treatment
47. Watched/listened to tapes or video of work in session with me
48. Watched/listened to tapes or video before our supervision so we could discuss
49. Did live observation of my work
50. Did co-therapy with me or demonstrated assessment work with actual clients

51. Would you recommend this supervisor to fellow students?

3. Yes, without hesitation

2. Yes, but with hesitation

1. No

52. If you have hesitation about recommending this supervisor, feel free to give more information here:_____

53. Overall, how would you rate this supervisor?

4. Extraordinary

3. Very good

2. Acceptable

1. Unacceptable[53.1x]. Please Explain____

54. What were your supervisor’s major strengths? What was most helpful in supervision?

55. In what areas could your supervisor improve?

56. If there are any questions you wish you had been asked or any other comments you’d like to add, please use this space below to describe

57. Do you know of any potentially good supervisors you’d like to recommend to the program? If so, please list below.

Thank you for your time! It is very helpful to future students that you share this information.