Master of Counselling
Clinical Supervisor Feedback Form
To be completed by the Monash Student and submitted on Moodle to the University
Supervisor at the conclusion of placement.
A separate evaluation form is to be completed for each agency and supervisor
Student's name: ___________________________________________________________________
Clinical Supervisor’s name - Individual: __________________________________________________
Clinical Supervisor’s name: - Group (if relevant) __________________________________________
Period: From: ________________________to: ___________________________________________
Placement: _______________________________________________________________________
Date: ____________________________________________________________________________
Introduction
The ‘Supervisor Feedback Form’ offers students the opportunity to evaluate their placement. It will thus be
helpful to the ongoing re-evaluation of the placement agency and supervisor for future students. The form also
provides a useful format for critical and constructive discussion of the student's placement experience. The form
is intended for the sole use of the students and the University Supervisor and aims to facilitate effective
communication and help ensure the placement experience for the student is optimized.
The rating scale is provided to indicate your response to each item. The range of responses varies from 1 to 5,
where:
1 = very unsatisfactory, 2 = unsatisfactory, 3 = satisfactory, 4 = good, and 5 = very good.
Please use the Comments section to expand your responses. The areas covered by the form are A: Organisation
of the placement; B: Therapy Supervision; C: Assessment Supervision; and D: General. Specific areas relevant to
a particular setting may be added to the form.
A. Organisation of the placement:
1.
The degree to which you have been familiarised with the organisation and structure of your placement
setting.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
2.
Degree to which your role has been formalised in terms of your expectations and the supervisor's
expectations of you.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Therapy Supervision
3.
Empathy – The supervisor's willingness to actively enter and understand the student's frame of reference
within a therapeutic context.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
4.
Support – The degree to which the supervisor functions in a supportive role in supervising therapy.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Feedback – The supervisor's willingness to discuss constructively the issues relating to the student's
performance and the relationship between the student's personal approach and the therapeutic process.
5.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
6.
Problem-solving – Degree of assistance given for specific problematic therapeutic situations.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
7.
Education:
a.
The degree to which the supervisor advocates particular approaches based on a coherent
framework.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
b.
The degree to which the supervisor has added to the student's critical understanding of the therapeutic
process and the effectiveness of therapy.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
c.
Extent to which the supervisor has taught practical skills relevant to the particular training
situation.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
8.
Stimulation:
a.
The degree to which the student was stimulated to be innovative and creative in his/her
therapeutic work.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
b.
The degree to which the supervisor conveys his/her commitment to and enthusiasm for his/her own
therapeutic endeavours to the student.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
9.
In what specific areas of therapy has the supervision been most useful? (specify)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
B. Assessment Supervision
10. Student's increased use and understanding of counselling assessments during placement.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
11. Assistance given in the selection, application and interpretation of tests or techniques.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
12. Critical evaluation of counselling reports
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
General
14. The level of interest shown by the supervisor in student's activities during placement.
1
2
3
4
5
Comments:
____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
15. The supervisor's willingness to help the student cope with and advise on liaising with other professionals in
the placement setting.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
16. The overall degree to which the student feels the supervisor has contributed to his/her development as an
effective clinician.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
17. In which of the following areas has the supervisor been most helpful to the student? (tick)
Counselling/psychotherapy
Ethics
Administrative
Consultation
Community work
Exposure to multidisciplinary team work
Professional issues
Formal education
Other (specify)
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
18. Your overall evaluations to whether the specific objectives of your placement have been met.
1
2
3
4
5
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
19. What other issues would you consider to be important in the provision of valuable supervision?
Comments:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please submit this on Moodle to your Monash University supervisor on completion of
your placement.
DO NOT forward to the Professional Experience Office, as it will only be returned to you.
The information on this form is collected for the primary purpose of evaluating the practicum placements you have undertaken as part of your degree. Other
purposes of collection include attending to administrative matters, corresponding with you and statistical analyses. If you choose not to complete all the
questions on this form it may not be possible for the Faculty of Education to provide quality placement experiences for students. You have a right to access
personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal
information or inquire about the handling of your personal information, please contact the University Privacy Officer on 9905 6011.