Danielsen Institute Clinic Doctoral Internship in Psychology
Intern Evaluation Form
__ Mid-year
__ Final/Exit
Intern Name: _________________________________________________
Primary Supervisor: _______________________________________
Secondary Supervisor: __________________________________________
Competencies and Ratings with Basis for Rating
Ratings:
C = Demonstrates competence at an intermediate or advanced level for an entry-level psychologist
P = Demonstrates progress toward intermediate to advanced competence
N = Has not demonstrated competence in this skill or domain at this time
U = Unable to rate/no opportunity to observe.
Basis for Ratings [list all that apply, e.g., (D,O,T,S)]
(D) = direct observation
(W) = work sample
(T) = tape review
(S) = supervisory or seminar participation
(P/P) = pre-post assessment instrument
(O) = other, which requires specification
Thresholds:
Successful completion of internship requires:
a) 80% of final ratings must be “C” (excludes appropriate “U” ratings)
b) No major grievances or serious problems.
c) Completion of training activities and responsibilities.
d) The Director of Training may make exceptions to these guidelines, in favor of the intern, if appropriate.
Goal 1: Development of intermediate to advanced skills1 in individual psychological treatment for adults.
Objective 1.1: Demonstrate competence in conducting thorough intake evaluations and diagnostic interviews.
Primary Supervisor
Intake Team Rep
Competency 1.1.1 Intern establishes rapport with the client
Competency 1.1.2 Intern conducts thorough intake evaluations.
 Intern clarifies the client’s symptoms and why the client sought
treatment at this time.
 Intern identifies current psycho-bio-socio-spiritual stressors and
resources.
 Intern appropriately assesses mental status and risk.
1
References to skill level in this document refer to skills appropriate for an entry-level psychologist.
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
Intern identifies latent or potential issues, symptoms, etc. which need
further exploration.
 Intern attends to cultural factors, diversity, and power dynamics in the
client’s history and in the intake process.
Competency 1.1.3 Intern makes an appropriate intake assessment and
presentation.
 Intern makes an efficient, focused presentation to the intake team.
 Intern makes an appropriate provisional DSM-IV diagnosis.
 Intern formulates the case in a manner which assists with disposition
and treatment planning.
 Intern identifies areas which need further exploration and possible
assessment strategies.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 1.2: Demonstrate competence in providing effective individual psychotherapy for adults in an outpatient setting.
Competency 1.2.1 Intern builds and sustains the therapeutic alliance.
 Intern collaborates with the client.
 Intern demonstrates empathic attunement.
 Intern works through ruptures in the alliance.
 Intern demonstrates sustained commitment to client well-being.
Competency 1.2.2. Intern attends to cultural and social identity factors.
 Intern considers and explores socio-cultural issues.
 Intern communicates respect for client values, beliefs, and traditions.
 Intern demonstrates awareness and reflexivity regarding her/his own
social identity and cultural history.
 Intern attends to dynamics of difference and power in the session and
in the client’s life.
Competency 1.2.3. Intern integrates historical and contextual factors into
treatment.
 Intern observes possible links between current experiences and
relevant personal or cultural history.
 Intern observes the context(s) within which the client experiences
difficulty or recovery.
 Intern assists the client to consider the adaptations he/she made due
to prior experiences.
 Intern assists the client to appreciate his/her resiliency and strengths.
Competency 1.2.4. Intern demonstrates an ability to use psychological
theory, psychological research, and other professional/scientific resources
to inform practice..
 Intern demonstrates a thorough knowledge of one treatment approach
or orientation.
 Intern identifies and utilizes scientific/professional resources to inform
clinical work.
 Intern attends to and assesses her/his therapeutic effectiveness.
Competency 1.2.5. Intern demonstrates on-going case formulation and
treatment planning which attends to the whole person, including the
complex interplay of bio-psycho-socio-spiritual dimensions.
Competency 1.2.6. Intern works effectively with emotions and process
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dynamics in treatment.
 Intern works effectively with affect/ emotions.
 Intern works effectively with process, including latent or unconscious
dynamics (transference, projection, etc.), dissociation, flooding, etc.
 Intern attends to her/his own reactions, and modulates/utilizes them
appropriately.
 Intern demonstrates skill, discernment, and creativity when making
interventions.
Competency 1.2.7. Intern manages risk and acuity appropriately.
Comments (particular strengths, areas for growth, suggestions for
development; staff should initial their comments):
Goal 2: Develop intermediate to advanced skills in group or couples therapy with adults.
[Group or couples depending on training track]
Group
Objective 2.1: Demonstrate competence in assessment, formulation, and intervention with groups.
Group Supervisor(s)
Competency 2.1.1. Intern is familiar with types of group therapies and is able to differentially
select group type to match varied client populations, presenting issues, and treatment goals.
Competency 2.1.2 Intern is able to formulate and clearly articulate the purpose of the group
as perceived by the clinic and the therapist
Competency 2.1.3. Intern is able to make use of and uphold the group contract in preparing
clients for group membership and in ongoing facilitation of the group therapy.
Competency 2.1.4. Intern attends to factors of group composition (e.g.
heterogeneity/homogeneity, common needs and interests)
Competency 2.1.5 Intern accurately assesses psycho-bio-social-spiritual characteristic of
individual clients in order to make discerning, well-matched dispositions to particular groups.
Competency 2.1.6. Intern builds rapport and a therapeutic alliance with individual group
members and the group as a whole.
Competency 2.1.7. Intern establishes goals with individual members and the group as a
whole.
Competency 2.1.8. Intern is able to apply theoretical models and research-based knowledge
about group therapies to clinical practice with group.
Competency 2.1.9. Intern is able to evaluate the outcomes of group therapy (e.g. group
development, improved communication, mutual aid, and achievement of individual and group
goals).
Competency 2.1.10 Intern attends to and works with cultural differences and power dynamics
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as they pertain to individual group members, group dynamics, and co-leadership dynamics.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 2.2: Demonstrate competence in working with ethical and practice issues which arise when providing services to
groups.
Group Supervisor(s)
Competency 2.2.1. Intern is able to work effectively in a co-leadership team (e.g. establishing
good communication with co-leader, sharing tasks equitably, and developing the capacity to
reflect on co-leader interventions and dynamics and their impact on the group).
Competency 2.2.2 Intern demonstrates understanding of and ability to work with
 Group culture
 Individual member’s roles
 Identifying and fostering group strengths
 Facilitating the process of mutual aid
 Helping the group to deal with conflict, taboo subjects, avoidance, etc.
 The relationship between group process and content
 Stages of group development
Competency 2.2.3 Intern is able to identify ethical dilemmas in group therapy practice and
engage in the ethical decision making when necessary.
Competency 2.2.4. Intern maintains ethical behavior and appropriate boundaries in conducting
group therapy.
Comments on these competencies: (particular strengths, areas for growth, suggestions for development; staff should initial their
comments):
Couples/Family
Objective 2.1: Demonstrate competence in assessment, formulation, and intervention with couples/families.
Couples Supervisor(s)
Competency 2.1.1 Intern demonstrates an understanding of systems theory and an awareness
of circular causality in actual couple/family interaction patterns.
Competency 2.1.2 Intern demonstrates an ability to construct a 3-generational genogram with
a couple/family.
Competency 2.1.3. Intern demonstrates an ability to identify and include cultural, contextual,
and religious/spiritual factors when formulating a couples or family case.
Competency 2.1.4 Intern attends to and works with cultural factors, cultural differences, and
power dynamics when working with couples or families.
Competency 2.1.5. Intern demonstrates an ability to form and sustain a therapeutic alliance
with couples/families.
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Competency 2.1.6. Intern demonstrates an ability to communicate and sustain multi-directed
partiality.
Competency 2.1.7. Intern demonstrates an ability to assist couples or families to shift from
adversarial blaming to empathy, acceptance, and problem solving.
Competency 2.1.8. Intern demonstrates familiarity with and an ability to apply techniques from
at least two schools of family therapy, e.g. systems theory, object relations, Gottman Sound
Marital House, Emotionally-focused Couples Therapy, narrative therapy, etc.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 2.2: Demonstrate competence in working with ethical and practice issues which arise when providing services to
couples/families.
Couples Supervisor(s)
Competency 2.2.1. Intern demonstrates an awareness of unique ethical issues in
couples/family therapy, e.g. confidentiality and informed consent with multiple clients.
Competency 2.2.2. Intern demonstrates an ability to modulate countertransference and
maintain appropriate boundaries when conducting couples/family therapy.
Comments (particular strengths, areas for growth, suggestions for development; staff should
initial their comments):
Goal 3: Development of intermediate to advanced skills in psychological assessment.
Objective 3.1. Demonstrate competence in administering, scoring, and interpreting several major cognitive/intelligence tests,
neuropsychological tests, and personality tests.
Testing Supervisor
Competency 3.1.1. Intern demonstrates ability to administer, score, and interpret intelligence
and cognitive assessments, e.g. WAIS-IV.
Competency 3.1.2. Intern demonstrates ability to administer, score, and interpret the
Rorschach (Exner)
Competency 3.1.3. Intern demonstrates ability to administer, score, and interpret other
projective measures, e.g., TAT, sentence completion.
Competency 3.1.4. Intern demonstrates ability to administer, score, and interpret major
personality and/or psychopathology measures, e.g., MMPI-2, MCMI-III, and 16 PF.
Competency 3.1.5. Intern demonstrates ability to administer, score, and interpret the
Woodcock-Johnson-III.
Competency 3.1.6. Intern demonstrates ability to administer, score, and interpret other
neuropsychological instruments,, e.g. TOVA, Rey-O, Colin Trails A&B, Wisconsin Card Sort,
VSAT, Stroup Colin & Word.
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Competency 3.1.7 Intern attends to cultural factors and diversity in designing, administering,
and scoring psychological batteries.
Comments (particular strengths, areas for growth, suggestions for development; staff should
initial their comments):
Objective 3.2. Demonstrate competence in integrating and interpreting test results in clinically useful ways.
Testing Supervisor
Competency 3.2.1. Intern demonstrates ability to integrate and interpret data from multiple
instruments and sources in a meaningful and nuanced manner.
Competency 3.2.2. Intern attends to cultural and diversity issues when interpreting and
integrating test results.
Comments (particular strengths, areas for growth, suggestions for development; staff should
initial their comments):
Objective 3.3. Demonstrate competence in providing ethical, useful testing feedback to clients or referring parties.
Testing Supervisor
Competency 3.3.1. Intern demonstrates ability to write thorough, integrated test reports.
Competency 3.3.2. Intern demonstrates ability to provide testing feedback in a thorough,
helpful manner.
Competency 3.3.3. Intern attends to cultural factors, diversity, and power when providing
testing feedback via reports or consultations..
Comments (particular strengths, areas for growth, suggestions for development; staff should
initial their comments):
Goal 4: Development of intermediate level skills in the practice domains of supervision, consultation, and evaluation.
Objective 4.1. Demonstrate knowledge of theory and practice principles for supervision.
Primary Supervisor
Secondary Sup
Competency 4.1.1. Intern demonstrates knowledge of theory and practice
issues for supervision.
Competency 4.1.2 Intern demonstrates awareness and sensitivity to
culture, power, and difference in supervision.
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Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 4.2. Demonstrate knowledge of theory and practice principles for program evaluation.
Primary Supervisor
Secondary Sup
Competency 4.2.1. Intern demonstrates knowledge and/or skills in
program evaluation.
Competency 4.2.2 Intern demonstrates awareness and sensitivity to
culture, power, and difference as relevant to program evaluation.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 4.3. Demonstrate knowledge of theory and practice principles for consultation.
Competency 4.3.1. Intern demonstrates knowledge of theory and practice
issues in consultation.
Competency 4.3.2. Intern demonstrates awareness and sensitivity to
culture, power, and difference in consulting contexts.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Goal 5: Development of intermediate to advanced skills in assessing and engaging spiritual, religious, theological, and
existential (SRTE) factors in clinical practice.
Objective 5.1. Demonstrate a basic knowledge base of, and reflective attitude regarding, SRTE resources and perspectives.
Primary Supervisor
Secondary Sup
Competency 5.1.1. Intern demonstrates curiosity, respect, humility, and
critical reflection regarding SRTE issues, perspectives and practices in
clinical work.
Competency 5.1.2. Intern demonstrates relevant knowledge for working
with SRTE issues in clinical practice. Relevant knowledge may include:
 knowledge of religious, cultural, philosophical, or theological
systems;
 awareness of SRTE issues, themes, and practices; or
 knowledge of relevant psychological literature regarding
SRTE issues and resources in clinical practice (e.g., specific
approaches for working with SRTE issues and/or cultural
systems, literature on religious coping, psychology of
religion, positive psychology, etc.).
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
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Objective 5.2. Demonstrate awareness of one’s own SRTE history, values, beliefs, or meaning system, and attention to the
ways in which one’s identity informs and affects clinical practice.
Primary Supervisor
Secondary Sup
Competency 5.2.1. Intern demonstrates awareness of her/his own SRTE
history, values, and identity, and incorporates her/his values and identity
into professional practice in congruent and ethical ways.
Competency 5.2.2 Intern demonstrates an ability to engage and work
respectfully with diverse SRTE values, worldviews, or practices in clinical
practice.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 5.3. Demonstrate an ability to work with SRTE issues and factors in psychotherapy in a constructive, empowering
manner.
Primary Supervisor
Secondary Sup
Competency 5.3.1. Intern is aware and respectful of individual and
cultural differences when engaging SRTE issues and resources in clinical
practice.
Competency 5.3.2 As indicated, intern
 assists the client to evaluate both the positive/constructive and
the negative/problematic aspects of his/her religious or spiritual
history.
 assists the client to clarify and consider what is meaningful to
that client.
Competency 5.3.3. Intern incorporates SRTE dimensions in formulation
and treatment planning as appropriate, even when SRTE issues are not
the overt focus of treatment.
Competency 5.3.4. Intern demonstrates skill in addressing SRTE issues
and incorporating SRTE resources into interventions.
Comments on these competencies: (particular strengths, areas for growth, suggestions for development; staff should initial their
comments):
Goal 6: Consolidate one’s professional identity as appropriate for an entry level psychologist.
Objective 6.1. Demonstrate professional responsibility and follow-through.
Primary Supervisor
Secondary Sup
Competency 6.1.1. Intern demonstrates professionalism.
Competency 6.1.2 Intern demonstrates responsibility and follow-through
in clinical administration. This includes:
 paperwork
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 attendance and participation in meetings
 caseload
 fees and balances.
 insurance/authorizations.
Competency 6.1.3 Intern demonstrates ethical practice and complies with
relevant laws, ethics codes, and administrative policies and procedures.
Competency 6.1.4. Intern seeks consultation when appropriate.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 6.2. Demonstrate investment in professional growth and professional identity.
Primary Supervisor
Secondary Sup
Competency 6.2.1. Intern demonstrates awareness of and attention to
professional identity, including guiding values and ethics, strengths,
interests/preferences, areas for growth, and limitations.
Competency 6.2.2. Intern demonstrates a commitment to on-going
learning and formation.
 Intern engages in training/learning opportunities.
 Intern practices scholarly inquiry by producing and/or utilizing
research, literature, and other professional resources
 Intern identifies goals and strategies for continued
growth/development.
Competency 6.2.3. Intern demonstrates awareness of professional issues
and engagement with professional organizations or other relevant
resources.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Objective 6.3. Demonstrate maturity and interpersonal skills as relevant to professional practice.
Primary Supervisor
Secondary Sup
Competency 6.3.1. Intern demonstrates appropriate interpersonal skills in
professional interactions, e.g., respectfulness, assertiveness, collaboration,
constructive conflict management, etc.
Competency 6.3.2 Intern demonstrates reflexivity (reflection about oneself
and one’s participation in interactions).
Competency 6.3.3. Intern attends to self-care.
Comments (particular strengths, areas for growth, suggestions for development; staff should initial their comments):
Summary Comments (Raters should identify their comments by initials or name):
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Signature of Primary Supervisor:
Comments by Intern:
Intern Signature:
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