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Supervisee Evaluation of Supervision Form

Internship Faculty Supervisor

Semester/Year ______

Faculty Supervisor ______

Directions: Supervisee/counseling student evaluates faculty supervisor by placing an X in box at END OF SEMESTER. Complete electronically on computer by placing cursor on site and hit “insert” button on computer. Highlight inserted commentsin electric blue. Send completed form as a WORD attachment to the departmental secretary ().Secretary will remove email name/address prior to sending to faculty. Place your name/ “supervision evaluation”/ internship / semester & year in subject line of email.

Supervisory Relationship
and Tasks / Almost
Never
1 / 2 / 3 / 4 / AlmostAlways
5
1. My supervisor prepared me for clinical supervision by explaining our roles, his/her intentions, expectations and methods of evaluations at the beginning of our supervisory relationship.
Comments:
2. My supervisor spends an average of 1 hour/week in individual or group supervisory sessions.
Comments:
3. My supervisor listens to parts of my counseling tapes & gives feedback.
Comments:
4. I feel comfortable working with my supervisor.
Comments:
5. My supervisor treats me with respect.
Comments:
Supervisory Relationship
and Tasks / Almost
Never
1 / 2 / 3 / 4 / Almost Always
5
6. My supervisor listens to me and my counseling rationales with clients.
Comments:
7. I feel like I can share my shortcomings, errors, insecurities and vulnerabilities with my supervisor.
Comments:
8. My supervisor gives me helpful feedback for my counselor development.
Comments:
9. I have learned many new counseling approaches and skills from my supervisor.
Comments:
10. My supervisor is open to helping me learn a variety of counseling styles/models and techniques & doesn’t push only one counseling model.
Comments:
11. My supervisor gives me feedback on paperwork, including case recording such as progress notes, treatment plans and assessment/discharge summaries.
Comments:
12. I have disagreed with more than one suggestion or mandate from my supervisor as to how to counsel a client.
Comments: / Almost
Never
1 / 2 / 3 / 4 / Almost Always
5
13. I believe some of my supervisor’s actions in one or more situations were unethical or illegal and I was undecided whether to confront him/her.
Comments: / Almost
Never
1 / 2 / 3 / 4 / Almost Always
5
14. My supervisor gave me little to no helpful feedback & I feel lost.
Comments: / Almost
Never
1 / 2 / 3 / 4 / Almost Always
5
15. I feel like my supervision sessions are a waste of time.
Comments: / Almost
Never
1 / 2 / 3 / 4 / Almost Always
5

Supervisee Comments

How do you think the clinical supervision could be improved?

Notable strengths of clinical supervisor:

Would you recommend this supervisor to another counselor-in-training? Yes __ No __

Comments:

Would you recommend this field site to another counselor-in-training? Yes __ No __

Comments:

SMS Department of Rehabilitation Studies -East Carolina University 08-12-16