Instrument
Weekly Verbal Feedback
Direct, in-session feedback anchored to observable behavior and to the supervisee's stated goals.
Section VII
A clinical supervision agreement clearly defines the expectations, goals, and responsibilities of both supervisor and supervisee at the individual and organizational level.
The supervision contract packet provides documentation to ensure client safety, support supervisee professional growth, and confirm academic, ethical, and licensure progress (Center for Credentialing & Education, 2016, 2021, 2026; Bernard & Goodyear, 2019). This contract serves both initial and ongoing licensure or certification, and compliance with professional standards. My supervision coursework has equipped me to develop comprehensive documentation covering informed consent, confidentiality, ethical practice, and supervision structure (Bernard & Goodyear, 2019; Mercer University, n.d.).
This supervision contract packet outlines my professional disclosure statement in alignment with Approved Clinical Supervisor (ACS) requirements (Center for Credentialing & Education, 2016). The Mercer University clinical internship and practicum agreement (Mercer University, n.d.) and the supervisee bill of rights from Bernard and Goodyear (2019) are included verbatim. The packet also contains both formative and summative assessment tools for tracking and evaluating supervisee growth. The appendices provide a sample introductory supervision activity and a concise outline of a standard supervision session under my guidance (Bernard & Goodyear, 2019; Mercer University, n.d.).
Appendix A
This document provides clear guidelines for your practicum and internship experience. As your supervisor for this semester, I will provide individual and group supervision. Please review all included materials and references, as they outline the ethical and legal responsibilities of both counselors and supervisors. This document will answer questions, explain protocols, outline qualifications, address safety planning, and define the supervisory relationship. Expectations for supervision sessions are included, along with ethical standards based on the American Counseling Association Code of Ethics. Both formative and summative evaluation processes will be used throughout your training as a supervisee.
I hold an associate license as a mental health counselor (APC, GA) and national counselor certification through the National Board for Certified Counselors (NBCC). My clinical experience includes work in community and inpatient settings, including partial residential treatment. You will receive one hour (60 minutes) of individual supervision with me per week, and 90 minutes of group supervision — with a maximum of four supervisees per group — with a fully licensed clinical supervisor. I have completed graduate-level supervision training and specialize in Dialectical Behavior Therapy and its adaptations: standard DBT, Radically Open DBT (RO-DBT), DBT for PTSD (DBT-PTSD), and DBT for Children (DBT-C). My clinical interests include trauma, development, and wellness in marginalized populations. My primary modalities include DBT, RO-DBT, DBT-PTSD, DBT-C, attachment-based interventions, family systems training, and psychoeducation.
My supervisory approach meshes an attachment-based framework — focused on building a secure, responsive supervisory alliance and attending to trust, vulnerability, power dynamics, and multicultural systems — with Cognitive-Behavioral Supervision (CBS), which provides the structure for challenging clinical assumptions, teaching behavioral strategies, and using interventions such as behavioral activation and mindfulness. Together this meshed approach balances relational depth with practical skills for working with the complex cases we are most likely to sit with — emotional dysregulation and trauma. My goal is to help new clinicians become culturally competent, emotionally attuned, and skilled in supporting clients and families. I value peace, support, collaboration, and community, and I am committed to supporting each supervisee in reaching their clinical and professional goals. I will also provide resources — treatment plans, manuals, books, intervention guides, family-systems materials, and additional tools — to support your growth.
For each supervision session, be prepared to identify clear goals, bring questions about your cases, and follow up on previously discussed cases. Identify areas for professional or academic growth to improve client care and address different populations. Evaluation will be both formative and summative throughout your development as a clinician.
The supervision fee is covered through your semester tuition and fees. If you choose to continue supervision after graduation or outside of the academic setting, fees will be determined by the supervising clinician and the counseling practice.
I have thoroughly read and understand the above policies and disclosure statements regarding the expectations of the supervisor and supervisee, including compliance with all ethical codes. In the event of supervisor incapacitation or death, it is the responsibility of the supervisee to maintain all supervision and clinical documentation. The supervisee must ensure all documentation is signed and submitted before the next supervision session to meet required timelines.
Supervisee Name (print)
Supervisee Signature
Date
Supervisor Name (print)
Supervisor Signature
Supervisor Email
Supervisor Address
Supervisor Work Number
Supervisor Cell Phone Number
Supervisor Emergency Contact
Appendix B
Memorandum of Agreement by and between the Graduate Program in Clinical Mental Health Counseling, College of Professional Advancement at Mercer University (the "Program") and the "Site," for a defined period, beginning on and ending on the agreed dates. The Site and the Program agree as follows.
Site representative must initial next to each responsibility.
Student to initial next to each responsibility.
For the Site
Signature of Site Supervisor
Title: __________________
Date: __________________
For Mercer University
Signature of University Supervisor / Clinical Coordinator
Title: __________________
Date: __________________
For the Student
Signature of Student
Title: __________________
Date: __________________
Revised 07.09.19
Appendix C
The purpose of the Bill of Rights is to inform supervisees of their rights and responsibilities in the supervisory process.
The supervisory relationship is an experiential learning process that assists the supervisee in developing therapeutic and professional competence. A professional counselor supervisor who has received specific training in supervision facilitates professional growth of the supervisee through:
The supervisee has the right to be informed of the supervisor's expectations of the supervisory relationship. The supervisor shall clearly state expectations that may include:
A supervisor is a professional counselor with appropriate credentials. The supervisee can expect the supervisor to serve as a mentor and a positive role model who assists the supervisee in developing a professional identity. The supervisee has the right to work with a supervisor who is culturally sensitive and is able to openly discuss the influence of race, ethnicity, gender, sexual orientation, religion, and class on the counseling and the supervision process. The supervisor is aware of personal cultural assumptions and constructs and is able to assist the supervisee in developing additional knowledge and skills in working with clients from diverse cultures.
Since a positive rapport between the supervisor and supervisee is critical for successful supervision to occur, the relationship is a priority for both. In the event that relationship concerns exist, the supervisor or supervisee will discuss concerns with one another and work towards resolving differences. Therapeutic interventions initiated by the supervisor or solicited by the supervisee shall be implemented only in the service of helping the supervisee increase effectiveness with clients. A proper referral for counseling shall be made if appropriate.
The supervisor shall inform the supervisee of an alternative supervisor who will be available in case of crisis situations or known absences.
The supervisee shall be encouraged to determine a theoretical orientation that can be used for conceptualizing and guiding work with clients. The supervisee has the right to work with a supervisor who is responsive to the supervisee's theoretical orientation, learning style, and developmental needs.
The weekly supervisory session shall include a review of all cases, audiotapes, videotapes, and may include live supervision. The supervisee is expected to meet with the supervisor face-to-face in a professional environment that ensures confidentiality.
During the initial meeting, the supervisee shall be provided with a copy of the formal evaluation tool(s) that will be used by the supervisor.
The supervisee shall receive verbal feedback and/or informal evaluation during each supervisory session. The supervisee shall receive written feedback or written evaluation on a regular basis during beginning phases of counselor development. Written feedback may be requested by the supervisee during intermediate and advanced phases.
The supervisee should be recommended for remedial assistance in a timely manner if the supervisor becomes aware of personal or professional limitations that may impede future professional performance.
Beginning counselors receive written and verbal summative evaluation during the last supervisory meeting. Intermediate and advanced counselors may receive a recommendation for licensure and/or certification.
Appendix D
Formative assessment happens in-session and between sessions. It is designed to guide learning in real time, not to sort the supervisee at term's end. The following instruments are used in every supervision cycle and are documented in the session note.
Instrument
Direct, in-session feedback anchored to observable behavior and to the supervisee's stated goals.
Instrument
Time-stamped review of a supervisee-selected segment, with one supervisor-selected segment per month.
Instrument
Structured practice of specific micro-skills (reflection of meaning, C-SSRS, boundary-setting, mandated-report scripting).
Instrument
Written conceptualization scored on presenting concerns, theoretical frame, treatment plan, cultural considerations, and risk.
Instrument
Verbal WAI-S style check at weeks 4, 10, and 16. Low scores are treated as data about supervision, not about the supervisee.
Instrument
Strengths, growth edges, and agreed action items entered in the supervision note within 24 hours.
Appendix E
Clinical Mental Health Counseling Final Supervision Evaluation
8
Exceeds Expectations
Demonstrates strong (exceeding a beginning professional counselor's) knowledge, skills, and dispositions in the specified competencies.
6
Meets Expectations
Consistent, proficient knowledge, skills, and dispositions. Beginning counselors should be at this level by the end of practicum/internship. Below this level triggers a collaborative remediation plan.
4
Near Expectations
Inconsistent, limited knowledge and skills. At final evaluation, has not demonstrated competencies needed to progress. Remediation may be necessary.
2
Below Expectations
Limited or no evidence of competencies. At final evaluation, has not demonstrated readiness to progress. Remediation may be necessary.
F.1
Comments
F.2
Comments
F.3
Comments
F.4
Comments
F.5
Comments
F.6
Comments
F.7
Comments
Foundations
Comments
Contextual Dimensions
Comments
Practice
Comments
Please note the counseling student's areas of strength, which you have observed:
Please note the counseling student's areas that warrant improvement, which you have observed:
Please comment on the counseling student's general performance during their clinical experience to this point:
Counseling Student
Name (print) / Date
Signature
Site Supervisor
Name (print) / Date
Signature
Supervising Instructor
Name (print) / Date
Signature
Appendix F
For the initial supervision session, consider playing a game in which the clinician hides clues around the office, with each clue tailored to different aspects of counseling practice or theory. For example, a clue could be a picture of a serene landscape paired with a mindfulness or DBT theme, or a bubblegum shaped like a brain to represent CBT, accompanied by a related hint. Before the first supervision, the supervisee should complete an interest form listing their favorite counseling theories, preferred counseling techniques, and areas of clinical interest, in addition to any personal preferences such as favorite place or activity. The supervisor can then use this information to create clues and small items that reflect both clinical and personal interests, fostering engagement and connection.
The purpose of this activity is to gain a deeper understanding of the supervisee's interests, strengths, and preferred counseling theories and skills. It also allows the supervisor to observe how the supervisee responds to different supervision styles — direct, collaborative, verbal, or written. By using clues related to various clinical approaches, the supervisor can assess the supervisee's comfort with different modalities and identify if certain tasks cause anxiety or excitement, as well as which client populations the supervisee may enjoy working with. This playful activity can be especially effective for supervisees who prefer experiential or interactive learning.
The clues provided to the supervisee should relate to different aspects of culture, religion, upbringing, or socioeconomic status for both the supervisee and the supervisor. This approach supports a deeper mutual understanding and gives the supervisor insight into how the supervisee's background may influence clinical decision-making. While this activity is best done in person at the individual level, it can also be adapted for individual, dyadic, or group supervision formats.
Appendix G
The expectations for a supervisee within the supervision space are to complete all documentation and informed consent prior to the beginning of supervision. It is imperative that the supervisee knows what they are consenting to regarding supervision agreements and the scope of the supervisor's practices. This includes completing professional disclosure, understanding what will be evaluated, and following the protocol for obtaining a new supervisor for licensure or within a specific counseling setting. Whether in academia as a practicum or internship, or in a clinical environment such as inpatient, outpatient, or in-home programming, the supervisee should be well informed and arrive prepared with a clear understanding of the tasks required to meet supervision goals and progress toward licensure or professional objectives.
A first supervision meeting can be broken down into the following steps. These steps help establish rapport, clarify expectations, and lay a strong foundation for ongoing supervision. Each is designed to support a full one-hour session.
Take time to introduce yourself and invite the supervisee to share about themselves. Discuss background, interests, and prior experiences. Begin establishing a positive, open relationship.
Explain the supervision process, structure, and goals. Review supervision style, expectations, and the roles and responsibilities of both parties. Clarify questions about the supervision agreement and informed consent.
Ask the supervisee how they feel about starting supervision. Invite them to share hopes, concerns, or questions. Provide reassurance and support as needed.
Collaboratively set goals for supervision. Discuss what the supervisee hopes to achieve, skills or competencies they want to develop, and how progress will be measured.
Emphasize the importance of self-care in clinical work. Ask how the supervisee currently manages stress and balance, and discuss strategies to support well-being.
Review any necessary paperwork, documentation, or forms. Go over processes and answer logistical questions about scheduling, communication, and expectations.
Invite the supervisee to share perceived strengths, interests, and areas for growth. Discuss how supervision can support development in these areas.
Allow time for the supervisee to ask questions about supervision, expectations, or their clinical work. Summarize next steps and set an agenda for the next meeting.
Offer positive feedback and recognition. Highlight strengths or progress noticed over the past week of completing documentation — begin to establish a pattern of praise.
Review cases from the supervisee's caseload as they begin to receive them. Discuss the topic identified at the start of the session — problem-solving, psychoeducation, support, evaluation, complex case review, or licensure questions.
Bibliography