Mid-Semester Supervisor Evaluation of Intern

Semester*

Academic Year

Your Name*

Your Email*

Training Track*

Year in Program*

Supervision Format*

Status- (please select the status that applies to you)*

Describe the developmental level and major strengths of supervisee.*

Describe the key areas discussed in supervision.*

Recommended areas of focus for the remainder of the semester.*

Discuss any area of concerns.*

Directions: Please select a rating for each skill area. Rating Scale 1 = Needs improvement – difficulty gaining competency in this skill area 2 = New skill area 3 = Beginner level – basic competency in this area of clinical practice 4 = Intermediate level – effective in this area of clinical practice 5 = Advanced level – very effective in this area of clinical practice NEI = Not enough information

I. CONCEPTUAL & PERCEPTUAL SKILLS (SLO 2.1)

A. Knowledge Base*

B. Familiarity with Therapy Models*

C. Awareness of Diversity Issues*

D. Recognition of Relational Patterns*

II. EXECUTIVE SKILLS (SLO 2.2)

A. Joining*

B. Basic Therapeutic Skills*

C. Assessment*

D. Hypothesizing*

E. Treatment Planning*

F. Intervention Strategies*

G. Integration of Models*

III. PROFESSIONAL SKILLS (SLO 2.3)

A. Session Management*

B. Supervision Responsibilities*

C. Ethical Issues*

D. Paperwork*

E. Professional Behaviors*

IV. EVALUATION SKILLS (SLO 2.4)

A. Evaluation of Therapeutic Progress*

B. Evaluation of Self as Therapist*

V. PERSONAL SKILLS (SLO 2.5)

A. Personal Qualities of the Therapist*

This evaluation has been adapted from: Nelson, T.S. & Johnson, L.N. (1999). The Basic Skills Evaluation Device. Journal of Marital and Family Therapy, 25, 1, 15-30.

Name of Supervisee*

First Last

Supervisee Email*

When you hit submit, a copy of your completed form will be emailed to you and your supervisee to discuss together.

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