We would greatly appreciate your completion of this survey. It is important for us to understand your consultation experience. Your responses will in no way affect your relationship with ICSW. Please provide a response to each question.

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1. Who was your clinical consultant? (Required.)

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2. What is the date of this evaluation? (Required.)

Date

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3. What Practicum was this for you? (Required.)

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4. Please rate your experience with this consultant.

The consultant is knowledgeable about psychodynamic psychotherapeutic techniques. (Required.)

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5. The consultant improved the quality of my psychodynamic thinking. (Required.)

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6. The consultant effectively guided my use of psychodynamic psychotherapy. (Required.)

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7. The consultant helped create a culture for learning / fostering growth (for example - trust, respect, engagement, flexibility, enthusiasm). (Required.)

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8. The consultant provided specific feedback to guide my learning. (Required.)

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9. The consultant encouraged autonomy while providing guidance. (Required.)

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10. The consultant kept appointments. (Required.)

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11. The consultant’s expectations were clear (for example - verbal discussions, written report). (Required.)

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12. The consultant guided the integration of classroom content with clinical cases. (Required.)

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13. Overall, I learned (Required.)

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14. Overall, I rate this consultant as (Required.)

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15. Narrative

Which aspects of this consultation were most valuable to your overall learning experience?

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16. What changes/improvements would you recommend?

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