Yesterday I blogged my Psychotherapy Informed Consent and today I am blogging my Clinical Supervision Contract- for the Online Therapy Institute’s archives, of course. Many of you know I am no longer practicing psychotherapy but this is the contract I use when conducting clinical supervision/consultation. While I am not practicing psychotherapy, I do still offer clinical supervision and I facilitate clinical supervision courses and the Certified Cyber Therapist course.
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 in Multifaith Spiritual Direction (D.Th) from SCA University of Theology and Spirituality, 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.
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. I have facilitated groups for juveniles in the court system, and have provided numerous forensic evaluations to the courts on behalf of child and family services and private litigation. I obtained many hours of supervision toward my own licensure through my training and affiliation with Prevent Child Abuse Georgia (formerly Georgia Council on Child Abuse). I have held the position of Ethics Chair on two state chapter organizations of the American Counseling Association. I have maintained a face-to-face and online private practice and also contracted with a large EAP conducting online (email) solution focused counseling.
SPECIALTIES AND THEORETICAL ORIENTATION
I have training in family violence with specific skills related to adult survivors of sexual abuse. I have specialized training in the treatment of PTSD and dissociative disorders as well as specialized training in the provision of a variety of evaluations such as child custody, substance abuse and domestic violence. In addition, I have training and experience in developmental disability agency settings with both administrative and clinical management skills. My most specialized skills are related to the provision of online therapy as well as other topics related to the use of technology in mental health, including internet and cybersex addictions and cyberculture. I also specialize in Therapist as Coach ethics as well as integrating alternative healing modalities and spirituality into mental health practice.
My theoretical orientation is primarily based on psychodynamic theory but I utilize solution-focused and other eclectic counseling techniques as well. I pull from other orientations as beneficial and necessary.
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 and offer referrals to other professionals who may be more able to assist you in developing additional skills apart from my expertise.
Part of my style of supervision involves teaching (didactic model) but part of the process is often experiential. I utilize supervision based models and methods that combine psychodynamic (patient-centered classical) and developmental models.
I provide face-to-face supervision in individual and group settings. I also utilize phone, video, email and synchronous chat as an adjunct to face-to-face as well as a primary supervisory process. 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.
As part of my supervisory responsibilities, I will sign off on all your hours and fill out the necessary recommendation forms from state or credentialing bodies, provided those bodies have agreed upon our supervisory plan.
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 face-to-face for a total of up to 50 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 techniquest 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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