2018-19 Intern evaluates Supervisor

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* 1. Your name:

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* 2. Semester of evaluation

Fall

Spring

Summer

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* 3. Year of evaluation

2016

2017

2018

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* 4. Name of site

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* 5. Supervisor's name and degree

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* 6. **Please rate the extent to which your supervisor...

	Not at all	Slightly	Somewhat	Quite a lot	A great deal
Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy.	Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy. Not at all	Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy. Slightly	Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy. Somewhat	Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy. Quite a lot	Enhanced your self-confidence through support, encouragement, and granting you the right amount of autonomy. A great deal
Developed a strong working alliance with you.	Developed a strong working alliance with you. Not at all	Developed a strong working alliance with you. Slightly	Developed a strong working alliance with you. Somewhat	Developed a strong working alliance with you. Quite a lot	Developed a strong working alliance with you. A great deal
Gave you effective feedback, including both affirmation and constructive criticism, as needed.	Gave you effective feedback, including both affirmation and constructive criticism, as needed. Not at all	Gave you effective feedback, including both affirmation and constructive criticism, as needed. Slightly	Gave you effective feedback, including both affirmation and constructive criticism, as needed. Somewhat	Gave you effective feedback, including both affirmation and constructive criticism, as needed. Quite a lot	Gave you effective feedback, including both affirmation and constructive criticism, as needed. A great deal
Demonstrated skill in various methods of supervision.	Demonstrated skill in various methods of supervision. Not at all	Demonstrated skill in various methods of supervision. Slightly	Demonstrated skill in various methods of supervision. Somewhat	Demonstrated skill in various methods of supervision. Quite a lot	Demonstrated skill in various methods of supervision. A great deal
Was adaptable and flexible.	Was adaptable and flexible. Not at all	Was adaptable and flexible. Slightly	Was adaptable and flexible. Somewhat	Was adaptable and flexible. Quite a lot	Was adaptable and flexible. A great deal
Helped you with case conceptualization.	Helped you with case conceptualization. Not at all	Helped you with case conceptualization. Slightly	Helped you with case conceptualization. Somewhat	Helped you with case conceptualization. Quite a lot	Helped you with case conceptualization. A great deal
Remained steady and predictable.	Remained steady and predictable. Not at all	Remained steady and predictable. Slightly	Remained steady and predictable. Somewhat	Remained steady and predictable. Quite a lot	Remained steady and predictable. A great deal
Had a sense of humor, and expressed it appropriately.	Had a sense of humor, and expressed it appropriately. Not at all	Had a sense of humor, and expressed it appropriately. Slightly	Had a sense of humor, and expressed it appropriately. Somewhat	Had a sense of humor, and expressed it appropriately. Quite a lot	Had a sense of humor, and expressed it appropriately. A great deal
Was clear and direct, even if it meant discussing areas of conflict in your relationship.	Was clear and direct, even if it meant discussing areas of conflict in your relationship. Not at all	Was clear and direct, even if it meant discussing areas of conflict in your relationship. Slightly	Was clear and direct, even if it meant discussing areas of conflict in your relationship. Somewhat	Was clear and direct, even if it meant discussing areas of conflict in your relationship. Quite a lot	Was clear and direct, even if it meant discussing areas of conflict in your relationship. A great deal
Demonstrated an ability for self-evaluation and was open to feedback from others.	Demonstrated an ability for self-evaluation and was open to feedback from others. Not at all	Demonstrated an ability for self-evaluation and was open to feedback from others. Slightly	Demonstrated an ability for self-evaluation and was open to feedback from others. Somewhat	Demonstrated an ability for self-evaluation and was open to feedback from others. Quite a lot	Demonstrated an ability for self-evaluation and was open to feedback from others. A great deal
Helped you understand and value human diversity.	Helped you understand and value human diversity. Not at all	Helped you understand and value human diversity. Slightly	Helped you understand and value human diversity. Somewhat	Helped you understand and value human diversity. Quite a lot	Helped you understand and value human diversity. A great deal
Demonstrated awareness of and commitment to ethical principles.	Demonstrated awareness of and commitment to ethical principles. Not at all	Demonstrated awareness of and commitment to ethical principles. Slightly	Demonstrated awareness of and commitment to ethical principles. Somewhat	Demonstrated awareness of and commitment to ethical principles. Quite a lot	Demonstrated awareness of and commitment to ethical principles. A great deal
Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others	Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others Not at all	Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others Slightly	Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others Somewhat	Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others Quite a lot	Helped you become more aware of yourself, including your strengths and weaknesses and the impact you have on others A great deal

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* 7. Below you will find thecompetency areas that guide our training model. Please rate the extent to which your supervisor helped you grow in each competency area. Notice that there is a Not Applicable column, which should be used for competencies that were not relevant to your training site.

	Not helpful at all	Slightly helpful	Somewhat helpful	Quite helpful	Very helpful	N/A
Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination)	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) Not helpful at all	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) Slightly helpful	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) Somewhat helpful	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) Quite helpful	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) Very helpful	Relationship Competency (e.g., facilitates therapeutic alliance, communicates empathy, demonstrates active listening, facilitates appropriate termination) N/A
Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis)	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) Not helpful at all	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) Slightly helpful	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) Somewhat helpful	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) Quite helpful	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) Very helpful	Assessment Competency (e.g., obtains psychosocial history, conducts mental status exam, provides case conceptualization, administers and interpret psychological testing, provides DSM diagnosis) N/A
Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client)	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) Not helpful at all	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) Slightly helpful	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) Somewhat helpful	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) Quite helpful	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) Very helpful	Intervention Competency (e.g., develops treatment plan, uses a variety of responses such as questions, reflections, and so on, implements specific treatment techniques, facilitates client skill development, attends to client’s affect, tracks with client) N/A
Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures)	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) Not helpful at all	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) Slightly helpful	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) Somewhat helpful	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) Quite helpful	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) Very helpful	Research and Evaluation Competency (e.g., understands current research related to assessments and interventions, aware of psychometric standards related to assessment procedures) N/A
Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals)	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) Not helpful at all	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) Slightly helpful	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) Somewhat helpful	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) Quite helpful	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) Very helpful	Consultation and Education Competency (e.g., able to solicit and give feedback to others, communicates effectively, works well in collaborative relationships with other professionals) N/A
Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee)	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) Not helpful at all	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) Slightly helpful	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) Somewhat helpful	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) Quite helpful	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) Very helpful	Management and Supervision Competency (e.g., understands models of supervision, relates well with supervisee, provides appropriate support, useful structure, and helpful feedback to supervisee) N/A
Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues)	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) Not helpful at all	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) Slightly helpful	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) Somewhat helpful	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) Quite helpful	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) Very helpful	Diversity Competency (e.g., demonstrates sensitive to client diversity issues, respectful of cultural differences, treatment plans and reports identify and address diversity issues) N/A
Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation)	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) Not helpful at all	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) Slightly helpful	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) Somewhat helpful	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) Quite helpful	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) Very helpful	Religious and Spiritual Diversity Competency (e.g., understands religious faith systems and how they relate to services offered by professional psychologists, respectful of religious and spiritual issues in assessment, intervention, supervision, and consultation) N/A

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* 8. Additional comments (strengths and weaknesses)

** Most of these items are adapted from the supervision competencies identified by Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC. American Psychological Association.