2 COUNSELING SESSION FEEDBACK FORM –F ELECTRONIC (E) VERSION

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2 COUNSELING SESSION FEEDBACK FORM –F ELECTRONIC (E) VERSION

Supervisor-Supervisee Counseling Session Feedback Form

2


Counseling Session Feedback Form –F


Electronic (E) Version


Supervisee (include email address) ___________________________________ Date ________________


Supervisor ____________________________________ Semester/Year ___________________________


Faculty Instructor __________________________ Practicum/ Internship (highlight)


Client Initials ____ Date of Session _______ Individual/ Group Supervision Time (highlight) _________


Directions for Clinical Supervisor: Optional form to be used at the discretion of the supervisor. Use “/ ” mark to indicate the number of times used for each of the *microskills observed during reviewed segment of taped/live counseling session. Highlight inserted comments in electric blue and send electronic copy to supervisee and faculty instructor. Put supervisee name/ “CSF”/ practicum or internship/ semester & year in email subject line.


Counseling Interventions


Number of Times Used

(*microskills)

Needs Improvement

Acceptable

Very Good

Not Observed

*Open-ended questions






*Closed questions






*Paraphrases






*Reflection of feelings






*Summarizations






*Interpretations






*Confrontations






*Counselor self-disclosure






*Tuning into nonverbal

body language






*Information giving






Use of silence






Use of motivational interviewing/stage of change






Problem identification






Mutual goal setting






Use of bibliotherapy






Use of homework assignments/exercises






Psychoeducation






Other (e.g. use of humor, empty chair, role playing, counseling theories)






Therapeutic climate/alliance (e.g. rapport, trust)






Overall empathy







Counseling Interventions


Number of Times Used

(*microskills)

Needs Improvement

Acceptable

Very Good

Not Observed

Case Recording






Progress notes






Assessment summary






Treatment plan






Discharge Summary /Termination report







General Comments:


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