Supervisee Evaluation of Supervisor and Supervision Form — Northeastern Oklahoma Psychology Internship Program

Supervisee Evaluation of Supervisor and Supervision

To allow improvements in the internship experience from year to year, we request your feedback and suggestions. This type of feedback in such a limited group, by its nature, does not allow for anonymity. However, the results of this survey will be sealed until you have received your final evaluation. Your answers cannot be used against you. Your opinions and feedback is valued and taken seriously.

Date

YYYY

Supervisor's Name

First Name

Last Name

Dates of Supervision

Supervisor was accessible

Supervisor was knowledgeable

Supervisor was personable

Supervisor was flexible

Supervisor was prompt

Supervisor modeled professionalism with clear boundaries

Supervisor demonstrated openness and receptivity to feedback

Supervisor established clear and reasonable expectations of me

Supervisor demonstrated adherence to all NOPIP, agency, ethical, licensing, and legal codes and principles

Supervisor provided supervision within the boundaries of his/her supervisory competence

Supervisor demonstrated and/or modeled psychological theory, therapy, assessment, and techniques

Supervisor used techniques such as live observation, reviewing taped sessions, giving direct suggestions and advice, providing didactic experiences, modeling, etc. in order to assist supervisee in the development of competencies of individual and group therapy and psychological assessment

My supervisor helped me to develop professionally by providing both challenge and support

My supervisor’s feedback encouraged me to keep trying to professionally improve

I felt comfortable discussing my areas of weakness with my supervisor

My supervisor modeled openness to learning as a continuous, developmental, life-long process

Supervisor comments

Individual supervision was in accordance with the individual supervision contract

Supervision followed the theory of a developmental sequence (e.g. activities progressed from prescriptive and supportive with structure to flexible with increasing autonomy)

Supervision included the review of supervisee’s actual work samples

When necessary, supervision explored supervisee values, beliefs, interpersonal biases and conflicts considered to be sources of countertransference in the context of case materials in a knowledgeable, professional, and sensitive manner

When necessary, supervision explored supervisee’s personal issues in terms of the effect of these issues on clients and professional functioning in a knowledgeable, professional, and sensitive manner

Ongoing evaluation of supervisee was in accordance with the individual supervision contract

Supervision included ongoing informal formative evaluation completed in a professional and sensitive manner

When necessary, supervision included ongoing formal formative evaluation in a professional and sensitive manner

Supervision included summative evaluation in a professional and sensitive manner

The supervision I received helped me grow as a professional

The supervision I received helped me better see the complexities of and nuances in my cases

The supervision I received helped to improve my ability to conceptualize my cases

The supervision I received helped me to examine, modify, and refine my approaches to therapy

The supervision I received helped me professionally develop in the competencies of individual and group therapy

The supervision I received helped me professionally develop in the competency of psychological assessment

The supervision I received helped me professionally develop in the competency of professional development

I am satisfied with the supervision I received

Supervision Comments

The supervisory relationship included open communication

The supervisory relationship included two-way feedback

The supervisory relationship facilitated a positive learning relationship

The supervisory relationship was characterized by acceptance, trust, and respect

Supervisory Relationship Comments

Supervisee Evaluation of Supervisor and Supervision

NOPIPLaureate Institute for Brain ResearchC/O Robin Aupperle, Ph.D.6655 S. Yale AvenueTulsa, OK 74136

NOPIP
Laureate Institute for Brain Research
C/O Robin Aupperle, Ph.D.
6655 S. Yale Avenue
Tulsa, OK 74136