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:
SMS Department of Rehabilitation Studies - East Carolina University Rev. 09-03-11
3 RECTANGLE 10 LINE 11 LUTHERAN COUNSELING AND FAMILY
3A–1–1 PRINCIPALS—AIDING ABETTING COUNSELING COMMANDING OR PROCURING (ARTICLE 77)
85402 GROUP COUNSELING COURSE SCHEDULE – SPRING 2009 THIS
Tags: counseling session, empathy counseling, session, version, electronic, counseling, feedback