Sisu Counseling Services
Tina Lips, LPC, NCC, ACS
Bridge City Counseling Offices
tina@sisucounseling.com
712 SE Hawthorne Blvd. #100
Portland, OR 97214
503-317-8913
FAX: 503-327-8005
Supervision Professional Disclosure Statement
Philosophy and Approach: My approach to supervision is based on the development of a mutually
respectful and professional relationship. I utilize a developmental and integrated model of supervision. A
primary goal will be to establish a working alliance, with the goal of supporting development of your selfawareness and skills as a professional. Attention will be paid to case conceptualization, diagnostic
evaluation, treatment planning, ethical and legal issues, multicultural and diversity considerations, record
keeping and termination.
The clinical supervision relationship is a professional one. There will be no interactions that conflict with
maintaining an objective and professional relationship that is for the benefit of your clients and you. If
situations arise that will require significant interaction outside the supervisory relationship they will be
discussed openly and a plan will be devised to address potential conflicts of interest or biased
interactions; at all times the integrity of the supervisory relationship will be a priority in order to not
compromise client care and objective assessment of your clinical practices.
The Goals of Clinical Supervision:
 To work together to facilitate in-depth reflection on issues and items affecting practice and client care
 To develop professionally and personally in order to increase clinical expertise
 To place client needs first and foremost and then development of professional needs of supervisee.
 To develop individual and customized goals for the supervisee to enhance professional skills and
personal improvement
 To address issues of transference and counter transference in the counseling relationships as they
arise for the supervisee
 To follow and abide by the Code of Ethics of the State of Oregon, the ACA and ACS in our work
together as well as any professional governing associations you may belong to.
Clinical Experience: I have been a practicing clinician since 2006 and practice from a Feminist and
Existential theoretical perspectives as well as an Adlerian family systems approach however utilize
interventions from a variety of theories to best meet the needs of clients. I am certified as QPRT suicide
prevention counselor. I have experience in trauma counseling, domestic violence counseling for both
victims and perpetrators and sexual abuse recovery for children, teens and adults. I am experienced
working with individuals ages 5+, couples, families and groups. I have received additional training as a
play therapist and am trained in diagnosis of children and teens as well as adults. I am trained at the tier 2
level in Collaborative Problem Solving by the Think Kids organization. I have received post-graduate
training in Dialectical Behavior Therapy. Currently, I am the contracted clinical supervisor of a local
community agency providing family therapy and skill building to families involved with DHS – Child
Welfare as well as an adjunct instructor at Concordia University, Western Seminary and Multnomah
University.
Professional Credentials and Education: I am a licensed professional counselor registered in the State
of Oregon since 2010 (C2484) and am an approved clinical supervisor-candidate with the Oregon Board
of Professional Counselors and Therapists. I am a certified NCC counselor (#278365) through NBCC and
hold an ACS credential from the CCE. I am a member of the ACA and ORCA. My graduate studies were
conducted at Western Seminary and I earned my MA in counseling in 2008. My undergraduate studies
were conducted in Psychology at Portland State University and I earned a B.S. Psychology in 1994. I
have received 30 hours of clinical training in supervision from Portland State University.
Confidentiality: It is our joint responsibility to maintain the highest level of confidentiality for clients. They
need to be informed of exceptions to confidentiality, including being informed of supervision. Clinical
supervision records maybe subject to subpoena by the courts or viewed by employer if clinical
supervision is a part of the employment contract. Clinical supervision records demonstrating dates, times
and duration of supervision appointments are available upon request for employers or professional
boards.
You Agree to:
 Place client needs and welfare as the top most priority and then professional and personal
development
 Come prepared to sessions; developing an agenda, audio/video tapes ready to review and preparing
any necessary notes
 Take responsibility for professionalism in clinical supervision, use time wisely and be punctual
 Be willing to learn, be open to feedback and challenge, as well as give rationale for treatment and
interventions used.
 Ensure all correspondence to/from state licensing board get routed to the supervisor so that the
supervisor is fully aware of license status and all situations referenced to the licensee
I Agree to:
 Keep all information revealed in clinical supervision sessions private except for:
o If supervisee engages in unsafe, unethical or illegal practice
o Repeated failure to attend supervision sessions
o If clients are placed at risk due to supervisee’s negligence or poor client care
o Supervisee does not abide by state or national licensing standards or Code of Ethics of
related professional bodies
o Supervision sessions may be discussed with clinical supervisor’s supervisor or professional
consultants
o Provide ongoing reports to licensing boards and relevant education institutes
 I will provide supportive feedback that challenges and empowers you to improve your clinical skills
 Evaluations will be provided verbally in an ongoing fashion and written evaluation quarterly or upon
request by you or your relevant licensing boards or education institute
 I will continue my own professional development on a regular and ongoing basis including but not
limited to contracting with a supervisor to oversee my own supervisory and clinical practice.
Fees: Individual supervision is billed at the rate of $80/hour. Group supervision will be billed at $40/90
minute session. If you are a registered intern you are responsible for assuring you schedule the required
supervision based on your direct contact hours. We will decide together if you need additional supervision
to care effectively for your clients. Phone consultation is complimentary for the first 15min/week and then
prorated at $80/hour thereafter. It is important to keep appointments and respect time allotment. There
may be a charge of 50% of the hourly fee for “no show” appointments under certain circumstances;
please call to reschedule if you are unable to keep an appointment for emergency reasons.