Template
Agreement for Professional Supervision
The template below is designed to assist you to meet the New Zealand Psychologists
Board’s requirements in relation to continuing competence.
Please note that the template is a suggestion only and you may wish to
modify it to suit your own supervision choices and circumstances.
For information on supervision for psychologists, refer to the NZPsS handbook
“Professional Practice of Psychology in Aotearoa New Zealand.” Evans, I., Rucklidge
J., O’Driscoll. M. (eds) (2007) New Zealand Psychological Society. This book can be
purchased from the New Zealand Psychological Society and formed the basis for
much of the information used in the template below.
………………………………………
Template Agreement
Supervisor:………………………………………
Supervisee:……………………………………..
Contract period: from………………..to……………………….
The contract is subject to revision at any time upon request by either
supervisor or supervisee.
Purpose: e.g.


Monitor and promote the welfare of clients seen by the supervisee
Promote self reflection and personal awareness



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Assist in the identification of professional and personal needs and
strengths
Promote professional development and identify future goals and
resources for learning
Promote professional ethics
Promote development and growth in specific areas e.g. cultural
competence
Values: e.g.

The supervision relationship will reflect values important to the
supervisor and supervisee e.g. values of respect, trust, compassion,
honesty, integrity
Format of supervision: e.g.


group, individual, peer
live, electronic, case discussion etc
Frequency and length of supervision sessions:
Venue:
Records: e.g.



Notes will be made on each supervision session by the supervisor and
supervisee
The notes will remain accessible to both the supervisor and supervisee
All notes will be securely stored.
Evaluation: e.g.


Evaluation of the supervision will occur as an ongoing part of the
supervision process
More formal evaluation may take place at an agreed date
Supervisee Agreements
Supervisor agreements
The Supervisee agrees to: e.g.
The Supervisor agrees to: e.g.

Be available at agreed times

Be available at agreed times

Come prepared for each

Be open and honest with the
session


Have gained clients’
permission to bring issues
related to their work to
supervision
Openly and honestly discuss
their work and their responses
to it
supervisee

Give constructive feedback,
guidance and support

Appropriately challenge the
supervisee to promote
reflection

Intervene as appropriate in
situations of risk e.g.
impacting on the supervisee
and/or client(s)

Bring to the supervisor’s
attention any issues of risk

Be open to change and
alternative methods of practice
and follow through agreed
actions

Abide by the Code of Ethics for
Psychologists and professional
standards when providing
supervision

Abide by the Code of Ethics for
Psychologists and professional
standards

Undertake supervision of their
own work

Provide feedback and express
concerns and issues that arise
in relation to the effectiveness
of the supervision process

Manage dual relationships
appropriately

Co-operate with the supervisee
in the resolution and
management of any
differences which may arise

Keep abreast of theoretical,
research and professional
developments in their field

Develop their own competence
including cultural competence


Co-operate with the supervisor
in the resolution and
management of any
differences which may arise
Manage dual relationships
appropriately
Confidentiality e.g.
Matters discussed in supervision will remain confidential and will not be
discussed with any other party unless either party becomes aware of
information related to issues of safety which could adversely effect
themselves or others.
Resolution of conflict e.g.
Conflicts and concerns arising in the supervision relationship will be managed
by
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

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Openly discussing the issue
Keeping notes of the conflict and its resolution
In the event of non-resolution, nominating an agreed third party
In the event of unsafe practice that cannot be resolved appropriately
within or between the parties involved, the supervisor and supervisee
will reserve the right to inform a third party. This will only occur with
the full knowledge of the parties involved.
Name…………………………………..Signed…………………………….Date………
Name…………………………………..Signed…………………………….Date………