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http://www.uakron.edu/colleges/educ/docs/internshiphdbk.doc
The University of Akron
DEPARTMENT OF COUNSELING
MARRIAGE & FAMILY COUNSELING/THERAPY
DOCTORAL
INTERN & SITE SUPERVISOR
HANDBOOK
Revised: Spring 2010
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TABLE OF CONTENTS
INTRODUCTION .......................................................................................................
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CRITERIA FOR INTERNSHIP .......................................................................................
COAMFTE Standards……………………………………………………………………………………….
Internship Placement ………………………………………………………………………………………..
Internship Process …………………………………………………………………………………………
Out-Of-State ……………………………………………………………………………………………………
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INTERNSHIP CLINICAL INSTRUCTION ........................................................................
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GRADING ................................................................................................................
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INTERNSHIP RESPONSIBILITIES
Responsibilities of the Cooperating Agency/School/University ...........................
Responsibilities of On-Site Supervisors……………………………………………………………..
Responsibilities of M&F Program Faculty ...........................................................
Responsibilities of the Student Intern ................................................................
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NECESSARY FORMS
Memorandum of Agreement .............................................................................
Sample Internship Plan……………………………………………………………………………………..
Examples for Types of Activity ………………………………………………………………………….
Supervisee Equivalency Form……………………………………………………………………………
Supervisee Personal Profile …………………………………………………………………………..
Supervisor Contract ………………………………………………………………………………………..
Summary Forms ……………………………………………………………………………………………….
Record Forms …………………………………………………………………………………………………..
Site Supervisor Evaluation ……………………………………………………………………………….
Trainee Evaluation .............................................................................................
Clinical Activity Form ……………………………………………………………………………………….
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GUIDELINES FOR INTERNSHIP IN MFC/T
INTRODUCTION
The supervision of Marriage and Family Counseling/Therapy Doctoral Trainees is a valued
and essential part of the training program for the Program. Therefore, this Handbook is
provided to each site supervisor to be used as a guide to explain the internship process and
requirements, supervision requirements, and to offer examples of forms required of
supervisors or students during the internship experience.
The internship experience is the last phase of developing skills in the areas of clinical,
research, supervision, and teacher training for degree requirements. This experience is
intended to be an intensive on-the-job experience conducted in a setting as close as possible
to the one in which the student will seek employment.
Internship occurs at the end of the sequence of core and elective courses that comprises the
curriculum of the doctoral degree in Marriage and Family Counseling/Therapy. As the
culminating experience of this program, the internship is designed to provide an
opportunity for the student to synthesize and apply theory, practice, and research, in an
actual counseling setting. While at this setting, the site supervisor serves as an important
role model and mentor, guiding the intern’s clinical training.
The Department of Counseling acknowledges that your participation in this counseling
internship experience requires a commitment of time and effort. The Marriage and Family
Therapy Program and Internship Coordinator are available at any time to offer
consultation and support. During the internship, we welcome feedback and will be happy
to discuss any questions, concerns, or ideas that you wish to share.
COAMFTE STANDARDS FOR INTERNSHIP
320.
Clinical Experience
320.01
Before graduating from the doctoral program, doctoral students will have
completed 1000 hours of direct client contact equivalent to that which they
would be receiving from an accredited program.
The MFC/T Program upholds the traditional approach and informs students that
they must complete 1000 supervised, direct client contact hours. From the
MFC/T Program website, “Students are expected to maintain clinical activity
throughout their program. Students must accumulate 1000 client contact hours
and a minimum of 200 hours of supervision by the end of their program in order
to fulfill graduation requirements.”
(uakron.edu/colleges/educ/counseling/index.php.)
Doctoral students who can document that their previous supervised clinical
practice is comparable to that which would be received in a COAMFTE
accredited program, may petition the program to waive some of the required 1000
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direct client contact hours. It should be noted, it will be rare that any student
admitted to the MFT Doctoral Program will have more than 300-500 clinical
hours waived.”
Clinical contact hours accrued during the doctoral program are completed through
clinical teams behind the mirror, advanced practicums, field experiences, and the
internship experience.
330.
Internship
330.01
There will be an internship, not to be counted toward the didactic course
requirements.
Doctoral Internship (5600:785) meets this requirement. It is a separate course
that is not counted toward the didactic requirements.
330.02
The internship is to provide doctoral students with a supervised full-time
experience of at least nine months duration, emphasizing relationally focused
practice and/or administrative/academic/research.
The Doctoral Internship (5600:785) must be taken for a minimum of two
semesters (nine months) and must be at a site that can provide relationally focused
practice and/or administrative/academic/research (dependent upon how many
clinical hours a student needs to complete to fulfill the 1000 hour program
requirement). Currently, a major placement of doctoral interns is at St. Thomas
Medical Center in the Department of Psychiatry.
330.03
The majority of requirements in Areas VII, VIII, IX, and XI will be
completed before the beginning of the internship.
The Program requires that a majority of core program coursework is completed
before enrolling for Internship (5600:785).
330.04
An AAMFT Approved Supervisor, State Approved Supervisor, or the
equivalent will supervise the intern’s clinical work.
Doctoral internship clinical work is supervised by an AAMFT Approved
Supervisor, State Approved Supervisor, or “Program Equivalent” supervisor.
340: Site Requirements
340.01
The program will maintain clear and ongoing relationships with all
internship site(s), which will be specified in a written document.
The Internship Memorandum of Agreement outlines the relationship and
responsibilities of the site, site supervisor, student intern, and the university
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supervisor. These signed agreements must be completed as an Internship
requirement.
340.02
Activities of each intern will be documented at the internship site(s). These
records will be made available to the marriage and family therapy program.
Activities of each intern are documented on-site and are available to the MFC/T
Program. Also, interns must submit a documentation of clinical hours form to the
university internship supervisor at the end of each semester. From the MFC/T
Intern and Supervisor Handbook: “Keep a daily log of client contact hours,
indirect service hours, and supervisory hours in accordance with the University
supervisor's guidelines.”
340.03
The institution sponsoring the internship site(s) will have been in operation
for at least two years.
All approved doctoral internship sites are required to meet this standard.
Internship site(s) will provide adequate facilities and equipment for the
intern to carry out designated responsibilities.
Internship site(s) are required to provide adequate physical resources for
the intern to function appropriately.
340.05
Mechanisms for student evaluation of internship site(s) and supervision, and
site evaluation of the intern's performance, will be demonstrated.
Forms for the evaluation of internship site(s) and supervision, as well as the onsite supervisor’s evaluation of each intern’s performance are found in the MFC/T
Intern and Site Supervisor Handbook.
340.06
Documentation of liability insurance for interns will be confirmed. Liability
insurance may be provided by the internship site(s), the marriage and family
therapy program, or the intern.
MFC/T interns are responsible for their own liability insurance. A copy of the
receipt from the insurance company must be produced and verified by the
University Supervisor.
340.07
Internship site(s) will publish and adhere to policies prohibiting
discrimination on the basis of age, culture, ethnicity, gender, physical ability,
race, religion, sexual orientation, and socioeconomic status.
MFC/T interns are placed at public agencies, with public funding, and publish and
adhere to nondiscrimination policies.
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340.08
The internship supervisor will be available to the intern for at least
one hour of supervision per week.
Internship site supervisors are required to meet individually with interns
for at least one hour per week. As stated in the MFC/T Intern and Site
Supervisor Handbook: “Meet at least one hour per week with the site
supervisor for critique of work, including direct and indirect service. An
attempt should be made to videotape or audiotape all therapy sessions.”
340.09
The internship supervisor will be clearly senior in experience
Internship supervisors are clearly senior inexperience to interns. All
interns hold appropriate license, and supervisory status.
INTERNSHIP PLACEMENT
The MFC/T Program is not responsible for finding internship sites. It is the student’s
professional responsibility to seek out sites that meet program requirements. However,
the MFC/T Program does have a number of pre-approved sites and will provide contact
information upon request.
The internship placement is based upon several conditions. First, the internship experience
should be one that offers a variety of opportunities for the student, not limited to direct
hours. Second, the internship site should be able to provide enough client contact hours for
the intern to complete the clinical experience in a timely manner (two-three semesters).
Third, the clinical experiences offered by the site should be congruent with the student
interns’ program requirements. To graduate, MFC/T students are required to complete a
minimum of 1000 hours with couples, families, individuals, and groups. All therapy must
be done from a relationship perspective, and half of the direct hours must be with couples
and families. Practicum hours (40+) and Team Hours (maximum of 200) are counted
towards completion of these 1000 direct hours. This experience should provide
opportunities for students to counsel clients representative of the ethnic, lifestyle, and
demographic diversity of the community. The internship placement is also based upon the
availability of appropriate supervision.
*The marriage and family program does grant supervisor equivalency for those
individuals who are independently licensed, and are not AAMFT approved supervisors if
they meet the appropriate program requirements. Please review Supervisor Equivalency
Form for these requirements.
INTERNSHIP PLACEMENT PROCESS
Once a student has been approved for a specific internship site, a letter of nomination is
sent from the MFC/T Program to the site introducing the student and requesting an
interview. Included with the nomination letter is the student’s resume. The student is
asked not to call the site for at least two weeks to allow for proper processing of the
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nomination letter. At the end of two weeks, each student is then responsible for contacting
the site and requesting an interview for internship placement. If the site accepts the
student for placement, the Program Director must receive a letter of acceptance (on agency
letterhead) from the internship site. This letter must be received before registration for
internship is approved. A sample letter is enclosed on page 12. In addition, each supervisor
must submit a Supervisory Equivalency Form with resume and zeroxed copy of their
license, unless this is a pre-approved site. This form and other required documentation
will be reviewed by the program and approved before placing any student at a site. This
process is completed to insure appropriate supervisor knowledge, experience, and training
for student interns placed at internship sites.
OUT OF STATE INTERNSHIP PLACEMENT
It is strongly encouraged that MFC/T doctoral students not seek out-of-state internship
placements for several reasons. First, there is no guarantee that the Ohio Counselor, Social
Worker, and Marriage and Family Therapist Board will approve the hours obtained outof-state as meeting the requirements to sit for licensure for MFT or PC, or that the Board
will allow a licensed MFT or PC to use this experience to count toward their terminal
license of IMFT or PCC. Second, it is very difficult for students to maintain a steady
progression towards completion of their dissertation when away from their advisor and
cohort support group.
In the event that a student does request to meet their Internship requirements with an outof-state placement, the following considerations should be noted. A meeting must be
scheduled with the MFT Director to provide a rationale for the out-of-state placement. If
the Director approves the out-of-state placement, the student will be responsible for
independently seeking an appropriate site. An appropriate site is defined as one that can
provide a minimum of two consecutive semesters of internship placement, can provide an
adequate number of direct and indirect hours for completion of the internship
requirement, and can provide an appropriately licensed Ph.D. mental health professional
with AAMFT Approved Supervisor status to supervise the student
When a student finds an appropriate site, the MFC/T Director should be contacted so that
an introduction letter confirming the student’s academic status and internship needs can
be sent to the site. Students who are planning to complete their internship out-of-state
should be prepared to visit the site and meet with agency personnel. Once a student has
been accepted at a site, a letter on agency letterhead must be sent to the MFC/T Director
confirming the acceptance of the student, the proposed beginning and ending dates for the
internship, and the supervisor’s name and professional license number. In addition, the
supervisor should send their resume, a copy of their license and supervisor certificate, and
a completed Supervisor Equivalency Form to the Internship Coordinator.
Paperwork Requirements:
Interns who are meeting internship requirements at out-of-state sites will be required to
complete the same department documentation requirements as students who are placed
locally. These requirements include completing a Memorandum of Agreement, Internship
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Plan, Agency Report, other required paperwork and presentations, end of semester
evaluations, and submission of bi-weekly contact hour logs. Please check with the
internship supervisor for requirements each semester.
Additional Requirements:
Students that are fulfilling internship requirements at an out of state site must also
document over the course of the internship experience an additional ten (10) hours of
continuing education credit that relates to the marriage and family profession. The ten
(10) hours of continuing education credit can include attendance at workshops,
presentations, or completion of a course that relates to the profession.
The Marriage and Family Program cannot guarantee that students who participate in outof-state internship experiences will be license eligible in Ohio. The Ohio Counselor, Social
Worker and Marriage and Family Therapy Board should be contacted to insure the
Board’s approval that the out of state internship placements meets the Boards licensure
requirements.
INTERNSHIP CLINICAL INSTRUCTION

completion of the required 1000 hours (including Practicum and Team hours) of
direct service with clients appropriate to the program of study.

one hour of supervision for every five hours of direct client contact. By the end of
internship students should have acquired 200 hours of supervision which includes
the cumulative total from a master’s program. Of these 200 hours, 100 hours must
be raw data supervision (live, audio, or videotape).

time spent in the therapy room during live supervision counts as both client contact
and supervision time; e.g., 1 hour of therapy plus 15 minutes pre- and 15 minutes
post-session counts as 1 hour of client contact time plus 1.5 hours of individual
supervision.

the opportunity for the student to become familiar with a variety of professional
activities in addition to direct service (e.g., record keeping, supervision, information
and referral, in service, and staff meetings).

the opportunity for the student to develop program-appropriate audio and/or
videotapes of the student’s interactions with clients for use in supervision.

the opportunity for the student to gain supervised experience in the use of a variety
of professional resources such as assessment instruments, technologies, print and
nonprint media, professional literature, and research.

a formal clinical evaluation of the student’s performance at the end of each semester
provided by the site supervisor.
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GRADING
The internship pass or fail grade will be assigned by the university faculty internship
supervisor with consultation or recommendations from the site supervisor taken into
consideration. The grade will be based upon the site supervisor clinical evaluations at the
end of each semester, the university supervisor evaluations, and completion of all
internship course requirements.
Responsibilities of the Cooperating Agency/Site Supervisor:
 Interview potential interns. If site agrees to a placement, notify the Internship
Coordinator to this effect in writing.
 Designate an on-site counseling supervisor for the student intern. On-site supervisor
will complete the Supervisory Designation form and return to Internship
Coordinator. After review, and approval of supervisor, all contact regarding the
student will be directed to the on-site supervisor.
 Provide an opportunity for the intern to participate in the routine professional
activities appropriate for her/his area of specialization.
 Provide student intern with the rules and guidelines for their professional conduct
at the agency/school/university.
Responsibilities of the On-Site Supervisor
 To be well grounded in the theory of marriage and family therapy, to use a systemic
perspective, and have clinical experience in the field.
 Participate in the development of and approval of the internship plan and
supervision plan, which must also be approved by the university supervisor.
 Sign and date the "Memorandum of Agreement", "Internship Plan", and
“Supervision Plan”.
 Supervise each student intern for at least one hour per week. A maximum of two
students can be supervised at any one time to meet this requirement. Individual
supervision is that which occurs in groups of two or fewer students. This may
include live supervision by the supervisor, while the intern is counseling the client.
Live supervision includes both the preplanning and post feedback time.
 Encourage the student to attend professional meetings, training sessions, and
workshops.
 Complete site supervisor evaluation of the intern at the end of each semester.
 Address issues such as diagnosis, treatment planning, goals and evaluations, in
addition to monitoring session-to-session progress.
 Adhere to supervision being a process, which is clearly distinguished from personal
psychotherapy or didactic instruction.
 Focus on the raw data from the student’s current clinical work, which is made
directly available to the supervisor through such means as written clinical materials,
direct observations, and video and audiotapes. Supervision that relies solely on
written clinical materials or verbal reports does not meet adequate standards.
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Responsibilities of Marriage and Family Program Faculty
 Approve students for internship registration and placement through the MFC/T
Program.
 Provide an MFC/T Program Faculty Supervisor who will be the contact person for
student intern and site during the internship experience.
 Insure that University Internship Supervisor meets with the program interns biweekly at the University for group supervision.
 Monitor the student intern's performance through consultation with the site
supervisor when needed.
 Assign course grades.
 Work closely with the participating agency/school/university to ensure that the
internship is a reciprocal arrangement benefiting all who are involved.
Responsibilities of the Student Intern
 Arrange through the MFC/T Program Director to register for the internship. The
student is responsible for meeting deadlines to insure appropriate placement.
 Attend on-campus, group supervision sessions in conjunction with the internship.
 Confirm and complete necessary paperwork requirements for the OCSWMFT
Board.
 Complete all requirements for the group supervision portion of the internship,
including evaluation of site/site supervisor at the end of each semester.
 Prepare proposed plan for internship experience. The plan should include the
student's goals, the activities to achieve the goals, a plan for assessing the experience,
and scope of practice.
 Perform the counseling and internship functions agreed to in the internship plan, as
well as other functions as directed by the Site Supervisor.
 Continuously work to improve his/her performance in response to feedback made
by the Site Supervisor.
 Meet at least one hour per week with the site supervisor for critique of work,
including direct and indirect service. An attempt should be made to videotape or
audiotape all therapy sessions.
 Keep a daily log of client contact hours, indirect service hours, and supervisory
hours in accordance with the University supervisor's guidelines.
 Secure appropriate liability insurance.
 Be consistent with the requirements of the agency/school/university in regard to
grooming, punctuality, etc.
 Demonstrate behavior in accordance with the highest ethical and professional
standards.
 Obtain written consent for all clients before treatment begins. Obtain written
parent/guardian consent for all clients under the age of 18.
 Commit to the Agency/School and to the Department of Counseling to fully
participate and meet all internship requirements.
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MEMORANUDUM OF AGREEMENT
The University of Akron MFT Program
Date: ______________
Agency Representative: _________________________
University Representative: ______________________
Student: _____________________________________
This agreement will be effective for a period from __________ to __________.
Purpose: The purpose of this agreement is to provide a qualified graduate student, who has
met appropriate Program requirements, for an internship experience in the field of
counseling.
The Marriage & Family Counseling/Therapy Program shall be responsible for the following:
1. Selecting a student who has successfully completed all the prerequisite coursework and
can show proof of obtaining professional liability insurance.
2. Designating a qualified licensed faculty member as the Internship Supervisor who will
work with the AGENCY in coordinating the internship experience.
3. Notifying the student that he/she must adhere to the administrative policies, rules,
standards, schedules and practices of the AGENCY.
4. Supporting the AGENCY and notifying the Student Intern, if such an occasion arises that
AGENCY deems Student Intern’s placement no longer appropriate.
The AGENCY shall be responsible for the following:
1. Providing the Intern with an overall orientation to the Agency's specific services
necessarily for the implementation of the Internship experience.
2. Designating a qualified appropriate licensed professional as Site Supervisor. The Site
Supervisor will be responsible, with the approval of the Administration of the
AGENCY/SCHOOL, for providing opportunities for the Intern to engage in a variety of
counseling activities (program appropriate) under supervision, and for evaluating the Intern’s
performance.
3. Providing the Intern with adequate workspace, telephone, office supplies, and staff support
to conduct professional activities.
4. Providing the University access to Intern’s clinical work via audio, video taping, live
observation, case consultation, or case notes.
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The STUDENT INTERN shall be responsible for the following:
1. Attesting to having read and understood the American Counseling Association, and the
American Association for Marriage and Family Therapy, ethical standards. Student Intern
will practice counseling in accordance with these standards. Any breach of these ethics or any
unethical behavior on Student Intern’s part will result in removal from Internship, a failing
grade, and documentation of such behavior will become part of the permanent academic
record.
2. Agreeing to adhere to the administrative policies, rules, standards, and practices of the
internship site.
3. Agreeing to inform immediately, both AGENCY and UNIVERSITY Supervisors regarding
concerns or issues as related to the internship experience or clinical work.
4. Understanding that a passing grade in Internship is contingent upon having demonstrated
a competent skill level, as well as completion of all required paperwork, and clinical hours.
EQUAL OPPORTUNITY: It is agreed by all parties that there will be no discrimination on
the basis of race, color, nationality, or ethnic origin, age, sex, or creed.
FINANCIAL ARRANGEMENTS: There are no financial stipulations in this agreement.
TERMINATION: It is understood and agreed by the parties hereto that the AGENCY has the
right to terminate the Internship experience of the student whose health status is detrimental
to the services provided the patients/clients of the AGENCY. Further, AGENCY has the right
to terminate the use of the AGENCY by the INTERN if, in the opinion of the Site Supervisor,
or other Agency Representative, Intern’s behavior is detrimental to the operation of the
AGENCY, and/or patient/client care. Such action will not be taken until the grievance against
any INTERN has been discussed with the INTERN and with the UNIVERSITY Supervisor.
The names of the responsible individuals charged with the implementation of this contract are
as follows:
______________________________________________
AGENCY Supervisor
__________
DATE
______________________________________________
UNIVERSITY Internship Supervisor
__________
DATE
_____________________________________________
STUDENT INTERN
__________
DATE
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INTERNSHIP PLAN
Marriage and Family Program
The University of Akron
Date: ___________________________________
Agency: _________________________________
Supervisor: ______________________________
Student Intern: ___________________________
Scheduled Weekly Individual Supervision Time: ___________________________
Scheduled Weekly Group Supervision Time: ______________________________
Scheduled Weekly Block Hours of Direct Hours: __________________________
______________________________________________________________________________
Objectives
Activities
1.Agency daily functioning
1.Atend weekly staff meetings.
2.Intake, assessment, and
treatment planning process.
2.Evidenced in therapy process,
record keeping, and supervision.
3.Theory and skill development.
3.Evidenced by theory application
and therapy process.
4.Using DSM diagnostic criteria.
4.Evidenced in treatment plans
and supervision discussions
5.Learn about evaluation and research
activities of the agency.
5.Help collect, organize,
review or analyze data.
6.Participate in program-specific training,
opportunities for workshops and presentations.
6.Attend all relevant training
opportunities.
7.Use a variety of resources such as
professional literature, computer programs,
and referral sources.
7.Participate with
theory, therapy, and supervision
modalities.
8.Participate in the formal evaluation
process and follow ethical codes.
8.Perform competently and
ethically and complete paperwork in a timely manner.
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TYPES OF SUPERVISION, DIRECT & INDIRECT ACTIVITY HOURS
SUPERVISION ACTIVITY
 Live
 Video
 Audio
 Case Consultation
 Other
DIRECT SERVICE ACTIVITY
 Intake Interview
 Couples Counseling
 Family Counseling
 Individual Counseling
 Group Counseling
 Psychological Testing
 Career Counseling
INDIRECT SERVICE ACTIVITY
 Writing Intake Reports
 Writing Case Notes
 Completing Forms
 Workshops and Staff Meetings
 Writing Treatment Plans
 Professional Reading
 Scoring Standardized Tests
 Telephone Intakes
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SUPERVISOR EQUIVALENCY FORM
Name: _________________________
Agency: ____________________
Highest Degree:
M.S. or M.A.
Ph.D.
Ohio License:
Independent MFT
Professional Clinical Counselor
Independent Social Worker
Psychologist
Psychiatrist
Other State License
DETERMINATION OF SUPERVISORY STATUS
Category One:
1. Are you an AAMFT Approved Supervisor?
Yes
No
2. Are you an AAMFT Supervisor-in Training?
Yes
No
If you answered Yes to either of these questions this form is completed. You are
granted approved supervisory status for the University of Akron MFT Master’s and
Doctoral Programs. You are required to submit a copy of your resume and
verification from AAMFT of supervisory status to complete this process. If you did
not answer yes to either question please proceed to the next set of questions.
_______________________________________________________________________
Category Two:
1. Are you a licensed independent marriage and family therapist with three years
post degree experience in the field of marriage and family therapy?
Yes No
If you answered Yes to this question this form is completed and you are granted
approved supervisory status for the University of Akron MFT Masters and Doctoral
Programs (OH 4757-29-01, COAMFT 152.02). You are required to submit a copy
of your resume and state license.
Date: ________________________________________
Signature: ____________________________________
Approval Date: ________________________________
Signature of Program Faculty: ____________________
________________________________________________________________________
If your experience does not fit either Category One or Two, please complete the
second page of the Supervisory Equivalency Form. Supervisors that are not
AAMFT Approved Supervisors, AAMFT Supervisors-In-Training, or licensed
Independent Marriage and Family Therapists must meet equivalency status in
order to supervise masters or doctoral interns in the University of Akron’s
Marriage and Family Program.
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EDUCATION, TRAINING, & EXPERIENCE IN MFT
EDUCATION in MFT
Have completed two courses in MFT, or can evidence extensive nonacademic
training in MFT (i.e., at least 25 continuing education units). Please list universities
attended and courses completed, or list dates, topics, and number of continuing
education credits accrued. Documentation may be requested for accreditation
purposes.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
TRAINING and EXPERIENCE in MFT
Have a minimum of three years of clinical experience with couples and families.
Please list type of clinical experiences and place of experience.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
SUPERVISION in MFT
(Equivalency criteria must include training in MFT supervision).
MFT SUPERVISION EDUCATION & TRAINING
Please list education and/or training; include dates, and courses, workshops, or
continuing education credits in MFT supervision.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________
MFT SUPERVISED SUPERVISION EXPERIENCE or SUPERVISON OF MFT’s
A minimum of two years being supervised as a marriage and family supervisor.
Please list supervisor’s name and site where experience took place.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
OR
A minimum of ten years supervising MFT students. Please list site(s) where
supervision took place and dates.
_____________________________________________________________________
_____________________________________________________________________
Return this completed form, a resume, any documentation such as copies of license,
certificates, transcripts, etc. to the University of Akron, Department of Counseling
(Marriage and Family Program) Carroll Hall.
Approved
Denied
Date: ________
Program Faculty Signature: ______
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SUPERVISEE PERSONAL PROFILE
Date: _________________________
Supervisee Name: ____________________________________________
Internship Site Address:
____________________________________
Site Phone # and email: _______________________________________
Home Address: _____________________________________________
Home Phone and email: _______________________________________
Degrees/Majors and Colleges Attended:
__________________________________
__________________________________
________________________________
________________________________
Licenses or Credentials:
_________________________________
_________________________________
Current Academic Program: __________________________________________
Malpractice Insurance Carrier and Expiration Date: ______________________
If employed, what is your current position: ______________________________
Previous work or volunteer related experience related to a helping profession:
____________________________________________________________________
____________________________________________________________________
Have you ever been suspended or terminated from employment or a volunteer
experience in the human services field? If yes, please explain: _____________
___________________________________________________________________
___________________________________________________________________
Are there any specific life experiences, family or personal information, or other
information that you would like a supervisor to be aware of to better supervise you?
___________________________________________________________________
___________________________________________________________________
What type of learning style fits best for you:
___________________________________________________________________
From past supervision experiences, what would you like repeated, and what would
you like to avoid: _______________________________________________________
______________________________________________________________________
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GUIDELINES FOR DEVELOPING A SUPERVISION CONTRACT
Each supervisor and student intern should complete a supervision contract. The
purpose of the supervision contract is: to clarify goals, establish parameters of
supervision and establish evaluation methods.
Space Variables
Place of Meeting
Time Variables
Frequency
Duration each week
Duration of contract
Day and time
Vacation Times
Cancellations
Make-up Times
Goals
Expectations of Supervisor
Expectations of Supervisee
Focus
Type of Supervision:
Recordings
Case Notes
Audiotapes
Video tapes
Verbal Report (structured or unstructured presentations)
Paperwork
Format for case files
Where should they be stored?
When should they be presented to supervisor?
Other relevant agency forms
Feedback and Evaluation Tools
Supervisee
Supervisor
Adapted from Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of Clinical
Supervision. NY: Allyn & Bacon.
19
SAMPLE SUPERVISION CONTRACT
This contract will guide the work of (Intern)____________________ and
(Supervisor) ____________________ for the time period _______________________.
The terms herein are agreeable to both parties, and subject to revision if necessary.
LOGISTICAL CONSIDERATIONS:
Supervision will occur on (day)__________at (time)__________, starting on
(month/day)__________ and ending on (month/day)___________. Meetings will
take place (building/room) __________. Both parties are expected to be punctual
for supervision.
Should either (Intern)__________ or (Supervisor)__________ need to miss a session,
a make-up meeting will be scheduled (time/day)_________. Supervisor will be
responsible for informing supervisee of any scheduled holiday or agency closing
times or days.
In the event that (Intern)__________ needs to contact (Supervisor)__________, these
contact number are provided:
Phone Number during business hours:
Phone Number after business hours:
Email address:
Other Agency Emergency Contact Person:
In the event that (Supervisor)__________ needs to contact (Intern)__________, these
contact numbers are provided:
Phone Number during business hours:
Phone Number after business hours:
Email address:
Other Emergency Contact Person:
SUPERVISOR EXPECTATIONS:
Arrive promptly for each supervision session.
Discuss all concerns regarding client sessions and/or supervision experience and ask
for assistance when needed.
Be open to discuss alternatives for client care, including different theoretical
conceptualizations, techniques, diagnoses, and treatment plans.
Be prepared for supervision by having available updated case notes and prioritized
list of issues to address.
SUPERVISEE EXPECTATIONS:
1. Identify areas of skill strength, as well as areas for improvement.
2. In particular I am asking for assistance in the following areas:
-application of theory to treatment.
-appropriately confronting clients when needed.
20
SUPERVISION GOALS:
1. To work simultaneously to maximize ________ development as a counselor,
while preserving the welfare of her/his clients.
2. To be available and supportive of __________ while also managing the evaluative
duties of supervision.
3. To learn to move with facility and appropriateness between the roles of
consultant, teacher, and counselor as the specific situations within the supervision
sessions suggest (Bernard and Goodyear, 1992).
4. To practice various models of supervision judiciously within supervision sessions.
SUPERVISEE GOALS:
1. To be more at ease during the counseling process by building my self-confidence
by not concentrating so much on what I am supposed to do as a counselor, but
instead to listen to the clients and enter their worlds.
2. To be able to deal with resistance successfully through much practice and by
realizing that I should not be working harder than the client.
3. To be able to effectively confront the client by improving my listening skills so I
can pick up on discrepancies and question when needed.
4. To use open-ended questions more, by practicing using them in daily life.
5. To be more empathetic to the client by setting aside my problems and focusing
only on the client’s thoughts and feelings.
6. To know and practice the application of appropriate theoretical orientations, as
well as when to use certain techniques and to be able to use them effectively.
Student Intern and Supervisor have read and agree to the above terms. Both
reserve the right to discuss alterations of this contract at any time.
___________________________________(Student Intern)
___________________________________(Supervisor)
___________________________________(Date)
21
WEEKLY SUPERVISION SUMMARY FORM
Date: ___________________
Supervisee’s Name: ___________________________________________
Supervisor’s Name: ___________________________________________
Case Number or Client Name: __________________________________
Client Session Number: ___________________
Type of Supervision: Case Report_____ Video_____ Audio _____ Live _____
Developing or Completed Treatment Plan (Please circle)
Theoretical Orientation:
Supervisee Concerns:
Goals for next session:
Are there any risk management issues to be aware of for this case?
__________Informed Consent
__________Parental Consent
__________Within Interns Ability Level or Scope of Practice
__________Within Supervisor’s Area of Knowledge/Experience
__________Child Abuse (physical, emotional, sexual)
__________Risk of harm to self or other(s)
__________Duty to Warn Issues
__________Domestic Violence Issues
__________Substance Abuse Issues
__________Medical or Psychological Records Request
__________Medical or Psychiatric Assessment Needed
__________Other Systems Involvement
__________Additional Releases Needed
__________Referral Considerations
Process Observations: ________________________________________________
___________________________________________________________________
___________________________________________________________________
Supervisee Strengths and Areas for Improvement: _______________________
___________________________________________________________________
___________________________________________________________________
Supervisor Recommendations: ________________________________________
___________________________________________________________________
22
SUPERVISORY RECORD FORM
Date: _______________________
Supervisee: ____________________________Supervisor: ______________________
Case Number:
Supervisee Concern:
Supervision Goals
Case Number:
Supervisee Concern:
Supervision Goals:
Case Number:
Supervisee Concern:
Supervision Goals
Case Number:
Supervisee Concern:
Supervision Goals
Supervisory Activity
1. Supporting Documents:
Case Notes Reviewed:
Tape/Audio Review:
2. Theoretical Issues
3. Process Observations
4. Self of Therapist Issues
5. Treatment Evaluation:
Supervisor Recommendations
1. Treatment
2. Training Issues
3. Risk Management Issues
4. Other Comments
23
Trainee Evaluation Form – Supervisor Report
Trainee Name: ______________________________
Supervisor Name: ___________________________
Date: _______________
Please rate the above named trainee on each of the following items based on the
scale below:
5 = Very Strong in this area with all clients; this comes naturally for him/her.
4 = Strong in this area, though still may have times of difficulty with some clients.
3 = Competent in this area, but s/he should continue to work on this skill.
2 = Inconsistent in this area; often displays weakness and uncertainty in this area.
1 = Weakness in this area; needs additional supervision and guidance.
N/A = I am not able to assess the trainee on this competency at this time.
The trainee creates an atmosphere of
acceptance and understanding.
The trainee attends to clients’
emotional climate in order to build
trust.
The trainee engages clients in the
therapeutic process.
The trainee develops mutually
agreeable goals for therapy.
The trainee recognizes and attends to
split alliances within relational
therapy.
Very Strong
Strong
Competent
Needs Work
Weak
N/A
Attending to Therapeutic Relationship
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
3
4
5
3
4
5
3
4
5
4
5
Addressing Family Process
The trainee identifies problematic
relational interactions among family
N/A 1
2
members.
The trainee integrates individual and
medical models of functioning within a N/A 1
2
systemic perspective
The trainee determines boundaries,
N/A 1
2
hierarchies, & patterns within families.
Remaining Aware of the Larger System
The trainee develops treatment
N/A 1
2
3
approaches from a range of theoretical
24
perspectives.
The trainee identifies psychosocial and
environmental influences on each
client.
The trainee coordinates therapy with
relevant individuals and institutions.
The trainee addresses external
influences that affect family
functioning.
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
Designing and Conducting Treatment
The trainee can determine who should
attend therapy and in what
N/A 1
2
configuration.
The trainee facilitates therapeutic
involvement of all necessary
N/A 1
2
participants in treatment.
The trainee matches the needs of the
client with an appropriate therapeutic N/A 1
2
approach.
The trainee integrates information
from a variety of sources to develop a
N/A 1
2
treatment plan.
The trainee establishes a sequence of
treatment processes in a treatment
N/A 1
2
plan.
The trainee assists the client to change
their perspective of the presenting
N/A 1
2
complaint to facilitate solutions.
The trainee helps the client to identify
strengths and resources that assist
N/A 1
2
therapy.
The trainee assists the client in
developing effective problem-solving
N/A 1
2
abilities.
The trainee helps a client to alter
N/A 1
2
problematic relationship patterns.
The trainee tailors therapy to a client’s
N/A 1
2
developmental needs.
The trainee modifies treatment
techniques to the cognitive level of a
N/A 1
2
child or adolescent.
The trainee responds appropriately to
N/A 1
2
a client’s culture or ethnicity.
The trainee respects a client’s sexual
N/A 1
2
orientation in order to enhance the
25
process of change.
Evaluating Ongoing Process and Outcomes
The trainee utilizes published books or
articles to guide the therapeutic
N/A 1
2
3
process.
The trainee modifies the treatment
plan based on information about
N/A 1
2
3
client’s progress.
The trainee utilizes ongoing assessment
to monitor the nature and severity of a N/A 1
2
3
client’s problems.
The trainee assesses a client’s interests
and abilities using published
N/A 1
2
3
standardized tests.
The trainee can interpret client’s
standardized test results related to
N/A 1
2
3
published norms.
The trainee can evaluate clients’
outcomes for the need to continue or
N/A 1
2
3
terminate therapy.
Thinking about Practice
The trainee has a theory of how change
N/A 1
2
occurs.
The trainee recognizes how his/her
assumptions about human nature
N/A 1
2
influence therapy.
The trainee integrates supervisor/team
N/A 1
2
communications into treatment.
Maintaining Professional Ethics
The trainee recognizes when personal
biases may influence the therapeutic
N/A 1
2
process.
The trainee recognize when
consultation with a colleague or
N/A 1
2
supervisor is appropriate.
The trainee understands the ethical
N/A 1
2
codes of the profession.
The trainee maintains adequate and
N/A 1
2
timely clinical records.
The trainee can discuss how fiscal
responsibility, confidentiality, and
N/A 1
2
legal issues can influence the
therapeutic process.
4
5
4
5
4
5
4
5
4
5
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
26
The trainee describes the therapeutic
process to clients so that they can make N/A
informed decisions about treatment.
The trainee makes appropriate
N/A
referrals to other professionals.
1
2
3
4
5
1
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
2
3
4
5
Assessment and Diagnosis
The trainee can recognize and evaluate
N/A 1
an adult client who is depressed.
The trainee can recognize and evaluate
a child or adolescent client who is
N/A 1
depressed.
The trainee can assess an adult client’s
N/A 1
behavior based on DSM-IV criteria.
The trainee can assess a child or
adolescent client’s behavior based on
N/A 1
DSM-IV criteria.
The trainee can recognize and evaluate
an adult client who has an anxiety
N/A 1
disorder.
The trainee can recognize and evaluate
a child or adolescent client who has an N/A 1
anxiety disorder.
The trainee can distinguish a client
N/A 1
who has a personality disorder.
The trainee can identify a client who
N/A 1
has a developmental disorder.
The trainee can assess the level of risk
N/A 1
of harm that a client’s behaviors pose.
What do you believe are this trainee’s strongest clinical skills?
On which skills do you think this trainee should most focus during supervision at
this time?
If you have specific concerns regarding this trainee’s skills please describe them on
the back of this form, or contact Patricia Parr, Program Director, MFC/T Program,
The University of Akron – Email: pparr@uakron.edu Phone: 330-972-8151.
27
TRAINEE SELF-EVALUATION FORM
NAME: ______________________________
DATE: _______________________________
Please rate yourself on each of the following items based on the scale below:
5 = Very Strong. This area comes naturally for me with all types of client problems.
4 = Strong. I am generally strong in this area; rarely have difficulty with this issue.
3 = Competent. I am competent in this area, but I still need to work on this skill.
2 = Inconsistent. This is an area I need more supervision and guidance.
1 = Weakness. This is a weakness for me; I need more supervision and guidance.
N/A = I am not able to assess this competency at this time.
I create an atmosphere of acceptance
and understanding.
I attend to clients’ emotional climate
in order to build trust.
I engage clients in the therapeutic
process.
I develop mutually agreeable goals
for therapy.
I recognize and attend to split
alliances within relational therapy.
Very Strong
Strong
Com-petent
Inconsistent
Weak
N/A
Attending to Therapeutic Relationship
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
3
4
5
3
4
5
3
4
5
4
5
4
5
4
5
Addressing Family Process
I identify problematic relational
N/A
1
2
interactions among family members.
I integrate individual and medical
models of functioning within a
N/A
1
2
systemic perspective
I determine boundaries, hierarchies,
N/A
1
2
and patterns within families.
Remaining Aware of the Larger System
I develop treatment approaches from
N/A
1
2
3
a range of theoretical perspectives.
I identify psychosocial and
environmental influences on each
N/A
1
2
3
client.
I coordinate therapy with relevant
N/A
1
2
3
28
individuals and institutions.
I address external influences that
affect family functioning.
N/A
1
2
Designing and Conducting Treatment
I can determine who should attend
N/A
1
2
therapy and in what configuration.
I facilitate therapeutic involvement
of all necessary participants in
N/A
1
2
treatment.
I match the needs of the client with
an appropriate therapeutic
N/A
1
2
approach.
I integrate information from a
variety of sources to develop a
N/A
1
2
treatment plan.
I establish a sequence of treatment
N/A
1
2
processes in a treatment plan.
I assist the client to change their
perspective of the presenting
N/A
1
2
complaint to facilitate solutions.
I help the client to identify strengths
N/A
1
2
and resources that assist therapy.
I assist the client in developing
N/A
1
2
effective problem-solving abilities.
I help a client to alter problematic
N/A
1
2
relationship patterns.
I tailor therapy to a client’s
N/A
1
2
developmental needs.
I modify treatment techniques to the
cognitive level of a child or
N/A
1
2
adolescent.
I respond appropriately to a client’s
N/A
1
2
culture or ethnicity.
I respect a client’s sexual orientation
in order to enhance the process of
N/A
1
2
change.
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
4
5
4
5
4
5
Evaluating Ongoing Process and Outcomes
I utilize published books or articles
N/A
1
2
3
to guide the therapeutic process.
I modify the treatment plan based on
N/A
1
2
3
information about client’s progress.
I utilize ongoing assessment to
monitor the nature and severity of a
N/A
1
2
3
client’s problems.
29
I am able to assess a client’s interests
and abilities using published
standardized tests.
I can interpret client's standardized
test results related to published
norms.
I evaluate clients’ outcomes for the
need to continue or terminate
therapy.
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
Thinking about Practice
I have a theory of how change
occurs.
I recognize how my assumptions
about human nature influence
therapy.
I integrate supervisor/team
communications into treatment.
N/A
1
2
3
4
5
N/A
1
2
3
4
5
N/A
1
2
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
Maintaining Professional Ethics
I recognize when my personal biases
may influence the therapeutic
N/A
1
2
process.
I recognize when consultation with a
colleague or supervisor is
N/A
1
2
appropriate.
I understand the ethical codes of the
N/A
1
2
profession.
I maintain adequate and timely
N/A
1
2
clinical records.
I can discuss how fiscal
responsibility, confidentiality, and
N/A
1
2
legal issues can influence the
therapeutic process.
I can describe the therapeutic
process to clients so that they can
N/A
1
2
make informed decisions about
treatment.
I make appropriate referrals to other
N/A
1
2
professionals.
30
Assessment and Diagnosis
I can recognize and evaluate an adult
N/A
1
2
client who is depressed.
I can recognize and evaluate a child
N/A
1
2
or adolescent client who is depressed.
I can assess an adult client’s behavior
N/A
1
2
based on DSM-IV criteria.
I can assess a child or adolescent
client’s behavior based on DSM-IV
N/A
1
2
criteria.
I can recognize and evaluate an adult
N/A
1
2
client who has an anxiety disorder.
I can recognize and evaluate a child
or adolescent client who has an
N/A
1
2
anxiety disorder.
I can distinguish a client who has a
N/A
1
2
personality disorder.
I can identify a client who has a
N/A
1
2
developmental disorder.
I can assess the level of risk of harm
N/A
1
2
that a client’s behaviors pose.
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
3
4
5
What do you believe are your strongest therapy skills?
With which skills do you think that you need the most assistance from your
supervisor?
Please feel free to share any additional positive comments or concerns that you
might have about this internship experience or supervision on the back of this form,
or by personally contacting the Program Director, Dr. Parr at 972-8151 or
pparr@uakron.edu
31
CLINICAL ACTIVITY FORM
Name:
Date:
Date Client Contact Began:
Week:
Sem/Yr:
The hours on this form include:
Doctoral = 1000 total direct clinical hours
= 100 hours of raw data supervision
= 100 hours of case consultation supervision
PrePracticum
Practicum
Internship
CONTACT HOURS
Individual
0.00
0.00
0.00
Individual
Co-Therapy
TOTALS:
Alternative (Team) Hours
SUPERVISION HOURS:
Individual
Group
Alternative(Team)
Doctoral Student
TOTALS:
Alternative (Team)
Hours
Group
0.00
0.00
0.00
Individual
0.00
Couple
0.00
0.00
0.00
Family
0.00
0.00
0.00
Couple
0.00
Family
0.00
Minimum of 50/100 Raw Data Hours (Live, Video, Audio)
Live
Video
Audio
Case Report
(Raw Data)
(Raw Data)
(Raw Data)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Direct Hours
0.00
Supervision Hours
Total Cumulative Direct Relational Hours, minus team hours:
Total Cumulative Direct Individual/Group Hours, minus team hours:
Total Cumulative Alternative (Team) Hours:
Total Cumulative Supervision Hours:
Total Cumulative Raw Data Supervision
Trainee Signature: ___________________________
Supervisor Signature: _________________________
0.00
0.00
0.00
0.00
0.00
0.00