My Clinical Supervision Contract (last update- May, 2023). This is the contract I use when conducting clinical supervision. I offer clinical supervision, case consultation and supervision of supervision. I also facilitate clinical supervision courses.
Clinical Supervision Contract
XXX.XXX.XXXX (voice) XXX.XXX.XXXX (cell) 732.XXX-XXXX (home)
Emergency Contact: If imminent danger of client to self or other, call 911 first! Then contact me at my cell or home number.
INFORMATION AND CONSENT FOR SUPERVISION
This document is designed to inform you about my education background, theoretical orientation and experience as a counseling supervisor, as well as to ensure you understand our professional relationship. Although providing this document is part of an ethical obligation to my profession, more importantly, this document is part of my commitment to you to keep you fully informed of every part of your supervision experience. Please know that our relationship is a collaborative one and I welcome any questions, comments or suggestions at any time.
BACKGROUND
Education: Doctor of Theology (D.Th) in Multifaith Spiritual Direction from Capstone University, Master of Education (M.Ed) in Rehabilitation Counseling from the University of Georgia and a Bachelor of Science (B.S.) in Mental Health and Human Services from Georgia State University.
License/Certifications: I am a a Licensed Mental Health Counselor in the State of New York and a Licensed Professional Counselor in the State of New Jersey. I am an Approved Clinical Supervisor, and a Board Certified Telemental Health Provider. I am also credentialed as a coach and hold certificates in several other healing arts modalities including Reiki and aromatherapy.
Experience: I have worked in mental health day-habilitation and job coaching facilities; I have been a therapeutic foster parent; I have provided clinical supervision and oversight for agencies providing services to adults with developmental disabilities; I have co-facilitated groups of survivors of sexual abuse and domestic violence. I have worked with homeless and addicted in formal and informal settings and have provided numerous forensic evaluations to the courts on behalf of child and family services and private litigation. I have held the position of Ethics Chair on two state chapter organizations of the American Counseling Association. I have also contracted with a large EAP conducting online (email) solution focused counseling.
SPECIALTIES AND THEORETICAL ORIENTATION
Historically, my most specialized skills are related to online therapy and cyberculture. As a coach educator, I also specialize in therapist as coach ethics as well as integrating intuition, alternative healing modalities and psychospiritual approaches into mental health practice.
My theoretical orientation is primarily based on psychodynamic theory. Within the supervisory context, I also utilize contemplative writing, Socratic questioning and a dydactic approach. My supervisory style is inclusive, progressive, inter-spiritual, and holistically based.
SUPERVISORY RELATIONSHIP
The client-therapist relationship as well as the supervisee-supervisor relationship is of critical importance to facilitate growth. Therefore it is very important to me to provide a safe atmosphere for you to ask questions and view therapeutic “mistakes” as invaluable learning experiences.
If you have a particular theoretical orientation that I do not have training or expertise in, I will likely answer questions and facilitate the process from my theoretical orientation/psychospiritual lens and offer referrals to training and other professionals who may be more able to assist you in developing additional skills apart from my expertise.
I provide face-to-face supervision via video to individuals who are fully licensed/registered to practice psychotherapy. I also utilize phone, email and synchronous chat as an adjunct to face-to-face. All communications are secured on my end via landline phone or encrypted measures. I ask that you do the same to maintain proper levels of security and confidentiality.
I will not participate in any form of sexual contact with you and I will not engage in social interactions which would compromise the supervisor-supervisee relationship.
It is not my intention to delve into any personal issues that may be influencing your professional development. I ask that you let me know immediately if you feel I am crossing any personal boundaries. However, you may wish to consider individual therapy to address any personal issues that are affecting your ability to be objective with your clients. One’s own therapeutic process, I believe, is essential to fully understand the perspective of the client. If at any point you need a referral to a counselor for personal reasons, I will provide you with that information.
GOALS AND OBJECTIVES
- Promote the development of the supervisee’s professional competence
- Promote the welfare of clients seen by the supervisee
- Fulfill the requirements toward state licensure if applicable
CONTEXT AND CONTENT/PROCESS
- Individual supervision to meet monthly for a total of up to 12 hours per calendar year
- Case consultation and didactic training will be utilized
- Feedback will be provided at each session
DUTIES AND RESPONSIBILITIES
Supervisor
- Encourage ongoing professional education
- Challenge Supervisee to validate approach and techniques used
- Offer alternative approaches for the supervisee
- Intervene where client welfare is at risk
- Ensure ethical guidelines and professional standards are maintained
- Obtain consultation when necessary
- Appropriately document each session
- Obtain and maintain appropriate liability/malpractice insurance
Supervisee
- Uphold ethical guidelines and professional standards including requirements set forth by the state licensing board
- Discuss client cases with the aid of written case notes or video/audio tapes
- Validate approach and techniques use
- Be open to change and consideration of alternative methods of practice
- Consult supervisor or designated contact person in case of emergency
- Maintain a commitment to counselor education and the counseling profession
- Obtain and maintain appropriate liability/malpractice insurance
Fees will be negotiated based on hourly rate. Fees are posted on my website. Your signature below indicates that you have read this supervision agreement. By signing this consent you also agree to abide by the ethical codes of your credentialing body or state board.
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Supervisee Date
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Supervisor Date
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