SUPERVISOR EVALUATION FORM

Supervisee Name____________________________________

Supervision Period_____________________to____________________

Supervisor Name_____________________________ Date of Evaluation___________

Purpose: To provide the supervisor with an understanding of his/her job performance in relation to the supervisee, to suggest areas for improvement, to permit the student to offer feedback to the supervisor in a written form that is based on a set of clearly and previously-established criteria, and to increase the supervisor’s competence as a supervisor.

Performance Level Rating Scale: Based on current assessment and progress of supervision and expectations of supervisee:

3 – much more of this is needed

2 – it would be desirable to have somewhat more

1 – it would be desirable to have a little more

0 – this area is satisfactory

Directions: Utilizing the Rating Scale above, place the appropriate number on the line provided at the end of each item.

Evaluation Items

Supervisor is able to:

1. Be flexible and responsive to your changing needs _______

2. Establish an atmosphere of acceptance and psychological safety _______

3. Call attention to errors in a tactful manner _______

4. Recognize and accommodate to your level of experience and style

of learning _______

5. Refrain from indiscriminate use of praise _______

6. Provide opportunities for you to question, challenge or doubt _______

7. Encourage you to explore the implications of your interventions _______

8. Encourage you to formulate your understanding of the case material _______

9. Make specific suggestions when you need them _______

10. Not foster undue dependence on your part _______

11. When asked, present a clear, theoretical rationale for suggestions _______

12. Clearly inform you of legal issues _______

13. Clearly inform you of ethical issues _______

14. Be sensitive to the requirements placed on you by your agency _______

15. Admit errors and/or limitations without undue defensiveness _______

16. Be concrete and specific in comments _______

17. Facilitate your understanding of countertransference reactions

to your clients _______

18. Seek consultation when it is needed _______

19. Summarize and/or highlight major points of supervisory session _______

20. Be reached in case of emergencies _______

21. Help you formulate the dynamics of the client _______

22. Listen sensitively to you _______

23. Help clarify and define the nature of problem(s) you are

having in your work _______

24. Be clear about the limits of the supervisory relationship _______

25. Deal explicitly with the formal evaluation process _______

26. Through role-playing or other suitable techniques, to help you

more effectively intervene with your client _______

27. Be straightforward with you regarding areas in which you need

improvement _______

28. Be clear with you about the differences between supervision

and psychotherapy _______

29. Maintain an appropriate focus in your sessions _______

30. “Be there” to meet your needs and not impose his/her issues on you _______

31. Be open to discussing any difficulties between the two of you

which are hindering your learning _______

32. Clearly define the nature, structure, expectations, and limitations

of the supervisory relationship _______

33. Make decisions and take responsibility when appropriate _______

34. Make you feel s/he genuinely want to help you learn _______

35. Be a good role model for you _______

36. Provide you with general knowledge about professional psychology _______

37. Be sensitive and adaptive to the stresses you are experiencing

as a student _______

Summarize the supervisor’s strengths and weaknesses as you currently view them and make suggestions for ways in which your supervisor could further facilitate your learning.

__________________________________________________________________________

Hall-Marley (2001) developed this Supervisor Feedback form as an instrument to provide feedback to supervisors on the trainee’s experience of supervision. The form consists of sections including atmosphere for learning, supervision style, supervision conduct, and supervision impact. It is recommended a supervisor feedback form be used a minimum of four times during the training year and ideally, more frequently. It is a tool in establishing a dialogue and a feedback loop which should enhance the supervisory alliance.

(Also included in Appendices of Falender, C.A., & Shafranske, E.P. (2004). Clinical

Supervision: A Competency-based Approach. Washington, D.C.: APA.