1

Peer Supervision Form for Case Presentations

Instructions: This form is to be completed by the Peer Supervisor. The Peer Supervisee should turn in the completed Peer Supervision Form to the Faculty Supervisor and to the presenting peer. Circle the number representing your assessment of the Supervisee’s level with regard to each category. For the comments section, be brief and specific, but do not leave the comments section blank. Last, complete the “Strengths” and “Areas for Improvement” portions of the Peer Supervision Form. Please type all of your comments. Discuss your ratings and comments with the Supervisee at the conclusion of the Case Presentation.

Peer Supervisor:

Peer Supervisee:

Date:

1. Content/Coverage: The overall report is thorough and complete. All of the information included in the Case Presentation Outline (see Practicum Manual) is included in the Peer Supervisee’s case presentation.

1 2 3 4 5

Poor Average Excellent

Comments:

2. Organization/Preparedness: The Supervisee appeared to be prepared for the counseling session and her work reflected a competent level of organization.

1 2 3 4 5

Poor Average Excellent

Comments:

3. Clarity: The Supervisee’s verbal and/or written discussion of the Case were clear and easy to comprehend.

1 2 3 4 5

Poor Average Excellent

Comments:

4. Conceptualization: The Supervisee’s assessment of the client appears to be based upon sound counseling theory and principles. Client strengths are identified and described. The process diagram is specific, clear, and relevant to the client’s view of the presenting problem.

1 2 3 4 5

Poor Average Excellent

Comments:

5. Conclusions are logically drawn: Treatment goals, as well as applied and planned interventions, follow logically from the client’s view of the presenting problem and the Supervisee’s assessment. Descriptions of goals and interventions are consistent with assessment (e.g., if the assessment emphasizes a behavioral concern the goals and interventions are also behavioral).

1 2 3 4 5

Poor Average Excellent

Comments:

6. Openness to Feedback: The Supervisee includes three to five questions that solicit “specific” Peer Supervisor feedback on aspects of the counseling process and case conceptualization (e.g., assessment, goals, interventions, etc.). The Supervisee is open to considering or adopting suggestions and other forms of constructive feedback.

1 2 3 4 5

Poor Average Excellent

Comments:

7. Please respond to the counselor’s questions for feedback (included at the end of the case presentation template).

Question feedback:

Counselor Strengths:

Areas for Improvement:

Any final comments not captured by this feedback form: