FREIES KONTO

Clinical Supervision Survey Questions + Sample Questionnaire Template

The clinical supervision survey is created to survey doctoral internship sites such as APA, COAMFTE and other such accredited programs. This in-depth survey template was created by industry leaders that have a holistic knowledge and understanding of doctoral internship programs. This survey has multiple questions that help collect demographic information about how the supervisor and supervisee for programs like clinical psychology, counseling psychology, rehab psychology, school psychology and family & marriage therapy. You can also use these survey questions to collect in-depth feedback about the supervision methods of a supervisor and the most effective steps and methods of developing an effective clinical supervision program.


Considering your complete experience with this clinical supervision program, how likely would you be to recommend us to a friend or colleague?
Very Unlikely
Very Likely
Please select the appropriate form to complete.

DEMOGRAPHICS
Highest Degree Earned:
Sex:
Age
Professional Credentials (licensed or certified):
Professional Membership:
Number of years practicing psychotherapy:
Number of years practicing supervision:
Theoretical Orientation:
Ethnicity:

Please provide as accurate a response as possible, recognizing that some responses will be approximations.
Courses in supervision
Textbooks read
Journal articles read
Workshops attended
Supervision cases while a practicum student
Supervision cases while an intern
Supervision cases since completing your degree
Hours of post-degree supervision-of-supervision (if known)

How formative were the following to your practice for supervision?
Not at all helpful
Slightly helpful
Moderately helpful
Very helpful
Extremely helpful
Clinical supervision
Personal therapy
Mentors
Supervision of your supervision
Workshops
Readings
Academic classes
Practicum

Please state your agreement with the below on the supervision you provide?
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Facilitate the personal growth of the supervisee
Facliate the development of technical skills by the supervisee
Establish a collaborative relationship with the supervisee
Focus on solving clinical issues and problems
Maintaining the frame or structure of supervision
Ensure ethical conduct and practice by the supervisee
Give advice, sometimes before fully understanding the clinical situation
Facilitate the development of a professional identity by the supervisee
Address therapeutic issues of supervisee
Evaluate the supervisee's skills
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Strong enforcement of supervisor-supervisee boundaries and roles
Provide emotional support to the supervisee
Facilitate the development of a solid theoretical foundation in the supervisee
Demonstrate patience and flexibility with the supervisee
Closely manage cases
Difficulty being prepared or prompt for supervision sessions
Provide conceptual and technical guidance
Encourage the supervisee to develop his/her own style of therapy
Avoid confronting problems
Discourage supervisees from ideas and interventions that will not work
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Ensure the safety of the client
Regularly read publications and attend workshops on supervision
Pass on your knowledge and experience
Openly address issues of diversity, discrimination, and use of power


DEMOGRAPHICS
Highest Degree Earned:
Sex:
Age
Current program:
Current professional credentials (licensed or certified):
Is this your first supervised clinical experience?
If not, how many years of supervised practice have you completed?
Theoretical orientation:
Ethnicity:


Please provide as accurate answers as you can, realizing that some responses will be approximations.
Times per month
Hours per month
Times per month
Hours per month
How available is supervision outside of set supervision times?
What is the primary format for supervision?
What is your supervisor's theoretical orientation?

How descriptive are the following statements of your supervisor and the supervision you receive?
Not at all
Somewhat
A great deal
Facilitates your personal growth
Facilitates your development of technical skills
Maintains a collaborative relationship with you
Gets distracted by trying to solve clinical issues and problems in your cases
Maintains the frame or structure of supervision
Ensures your ethical conduct and practice
Gives advice before fully understanding the clinical situation
Facilitates the development of your professional identity
Blurs supervision and therapy
Evaluates your skills
Not at all
Somewhat
A great deal
Rigidly enforces supervisor-supervisee boundaries and roles
Provides emotional support
Facilitates your development of a solid theoretical foundation
Demonstrates patience and flexibility
Micromanages cases
Has difficulty being prepared or prompt for supervision sessions
Provides conceptual and technical guidance
Encourages you to develop your own style of therapy
Avoids confronting problems
Discourages you from ideas or interventions s/he does not like or thinks may not work
Not at all
Somewhat
A great deal
Ensures the safety of the client
Neglects ongoing training in supervision
Passes on his/her knowledge and experience
Appropriately addresses issues of diversity in supervision
Has harassed or discriminated against you because of your gender, race, ethnicity, religion, age, or sexaul orientation
I have learned a lot from this supervisor
This has been a very positive supervision experience
I would definitely recommend this supervisor to other interns
Is there any other feedback you would like to provide?

Thank you for taking the time to complete this survey! Your responses are anonymous and confidential. 

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