Practicum Handbook Summer 2012

8/12/2019 Practicum Handbook Summer 2012

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Xavier University

Counseling Practicum Handbook

COUN 773

Counseling Practicum

Department of Counseling3800 Victory Parkway

Cincinnati, Ohio 45207-3226Phone (513) 745-3655

Fa (513) 745-2!20

Updated Summer 2012

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Cincinnati, Ohio 45207-3226

Phone (513) 745-3655Fa (513) 745-2!20

Dear Student,

This handbook is designed to familiarize you with the content, reuired forms, procedures, andthe e!pectations for "#U$ %%&, "ounseling 'racticum( The "ounseling 'racticum course is designed asa Uni)ersity super)ised e!perience that meets regularly according to the schedules you will see on theenclosed sample syllabi( *hile you will be e!pected to work with actualclients seeking counselingassistance, this courses differs from the +00 clock hour internship reuirements in the program( The

basic purpose of practicum is to help students learn foundational and advanced counseling skills underthe primary supervision of Xavier Faculty in cooperation with the site supervisor. The basic purpose ofinternship is to help students learn the full range of services and duties at a selected site under the

primary supervision of a site based supervisor.

Requiredprereuisites for enrolling in these courses include, at minimum and with noe!ceptions, satisfactory completion of the following courses or their eui)alent-

"#U$ .&& "ounseling Theories and Techniues"#U$ .&+ /roup 'rocess"#U$ .% 'sychological chie)ement Tests

"#U$ +&1 "ounseling 3ssues 4thics"#U$ ++ "ounseling 're'racticum

lso, you will note from the enclosed syllabus, the workload for this course issignificant(Students are strongly encouraged to limit their enrollment in other program courses while in)ol)ed with"#U$ %%&(

The practicum e!perience is an important process by which students begin to directly apply theircounseling skills( The learning that occurs from such courses is e!cellent preparation for the integrati)einternship and later practice as a professional counselor( *e wish you well5

Sincerely,

Dr( 6utch 7osey, '""S, $"""linical "oordinator

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Table of Contents

/eneral 8euirements9"ourse :ormats(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( ;

Summer 'racticum Schedules, T6 Testing, 6ackground "hecks((((((((((((((((((((((((((((((((((((((((((p( .

3dentifying "lients 7iability 3nsurance((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( +

4thical "onsiderations(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( %

4lectronic 8ecording 'rocedures(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( < &&

Se)en Steps to Start 'racticum =======================((p(

3nformed "onsent :orm(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( 10

uthorization for 8elease of 3nformation===================((p( 11

7etter of 3ntroduction to School9"ommunity sources(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( 12

"ounseling State ppro)al :orms(((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((((p( 1&1ecti)es for the e!periences, and forpro)iding these to the :acility Asee attachmentB(

2( The super)isee will be responsible for scheduling time to complete a minimum of ;0 directser)ice hours in collaboration with the :acility( The student is e!pected to participate in a

reasonable amount of additional super)ision and training at the facility based onrecommendations of the site super)isor(

&( The Uni)ersity will pro)ide close super)ision of the super)isee according to "ouncil onccreditation for "ounseling and 8elated 4ducation 'rogram A""84'B standards, #hio"ounselor, Social *orker and @arriage and :amily Therapy A#"S*@:TB 6oard standardsand #hio Department of 4ducation standards( The student is reuired to meet with theuni)ersity super)isor a minimum of one hour per week in indi)idual or triadic super)ision andparticipate in group super)ision on a)erage 1(. hours per week(

;( The :acility will pro)ide super)ision of the student on site by ualified, competent, andappropriately credentialed personnelK these persons will be designated as Monsitesuper)isors(N During practicum, on site super)ision is to be scheduled as needed and inaccordance with :acility policies(

.( The :acility will help coordinate appropriate releases of information for circumstances whereclient sessions are electronically recorded( These audio or )ideo tapes are for the sole purposeof counselor de)elopment( 3f an ethical issue arises during tape re)iew by a uni)ersitysuper)isor, the onsite super)isor will be contacted by the uni)ersity super)isor(

+( #nsite super)isors will pro)ide the student additional instruction as needed for the student toperform specific assigned tasks(

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%( #nsite super)isors will monitor documentation of counseling sessions and )erify that alldocumentation has been completed appropriately and in a timely manner and securely storedas the practicum site(


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a)ier Uni)ersity

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Xavier 8niversity

GOAL OF PRACTICUM

The goal of counseling practicum is to provide graduate level counseling students

with a closely supervised clinical experience to practice professional counseling

utilizing best practice approaches and ethical decision making skills throughout theexperience.

COURSE OBJECTIVES

Students will understand and apply ethical considerations with their clients

throughout the duration of this practicum experience.

Students will understand and comply with minimal expectations for course

mandated by theOhio Department of Education, theOhio Counselor, Social Worker

and Marriage and Family Therapy Board, theKentucky Counseling Board, the

Kentucky Department of Educationand theCouncil on Accreditation for Counselingand Related Education Programs.

Students will learn counseling techniques to successfully open, conduct, and close

a counseling interview. Students will demonstrate these skills via audiotape and

class role play.(Cf. Practicum Evaluation Supervisee Form)

Students will fully participate in a close supervised experience and develop a

working relationship with the assigned supervisor.

Students will understand the general principles and methods of case

conceptualization, assessment, and/or diagnosis of mental and emotional status.

Students will learn and apply appropriate case consultation and referral

techniques.

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COUN 773

Counseling Practicum

$ntent Form

T"is form s"oul# be complete# an# file# in t"e semester prior to t"e one in &"ic" %ou plan on

ta>ing t"e course'

NameJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ

5##ressJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ

Da% P"oneJJJJJJJJJJJJJJJJJJJJJ,)ening P"oneJJJJJJJJJJJJJ

,mailJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ

$ &oul# li>e to enroll in Counseling Practicum for t"e Fall / !pring / !ummer please circle one2

semester A@JJJJ'

Please c"ec> t"e follo&ing8

JJJ $ &ill "a)e complete# COUN 033* COUN 034* COUN 07B* COUN 431* an# COUN 44B Pre

Practicum prior to enrolling in Counseling Practicum'

JJJ $ "a)e recei)e# an# rea# t"e Counseling Practicum Handbook.

JJJ $ un#erstan# t"at $ am responsible for i#entif%ing m% o&n practicum site for access to

clients to fulfill t"e @ cloc> "our #irect ser)ice requirement'

% plan for obtaining appropriate practicum site / clients is as follo&s8 use t"e bac> of t"is

s"eet if necessar%2

Return to8Dr' 9utc" +ose%

Clinical Coor#inator

Department of Counseling

.a)ier Uni)ersit%

Cincinnati* O"io 0A@73AA4

0132 701@37

lose%rK .a)ier'e#u

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!ample !%llabus

XAVIER UNIVERSITY

COURSE TITLE: Counseling Practicum

SEMESTER: Summer 2012

COURSE NUMBER: COUN 773CREDIT HOURS: 3

DAY & TIME: Tuesdays and Thursdays 4:00 6:00 P.M.

LOCATION OF CLASS: Hailstones 7

INSTRUCTOR: Dr. Butch Losey, PCC-S, NCC

OFFICE LOCATION/PHONE: Hailstones 213 513-745-1037

E-MAIL ADDRESS: [email protected]

OFFICE HOURS: T or Th 3:00-4:00, and by appt.

Supervisors:

Donita Jackson ([email protected])

Sherri Grooms ([email protected])

Shelly Baxter ([email protected])

Mardi Fallon ([email protected])

COURSE DESCRIPTION:

This course addresses the Clinical Instruction requirements for the 2009 CACREPStandards for School and Community Counseling Programs. This practicum

experience involves completing recorded interviews with bona fide clients and

producing appropriate client reports and student self-evaluation forms. Note: all

students are expected to have COUN 533, COUN 536, COUN 631, COUN 579, COUN

669 successfully completedpriorto enrolling in COUN 773. Students in COUN 773

must carry liability insurance purchased through the University. Students must

complete a total of 40 clock hours of counseling sessions with approximately four

clients, 8 hours of which must be recorded on CD or other device for supervisor

review. Students will also be expected to lead a group counseling experience. Progress

notes on the other sessions are due on a regular basis.

COURSE OBJECTIVES:

Students will understand crisis inter)ention and suicide pre)ention models, including the use of

psychological first aid strategies A1(/(g(B

Student will demonstrates the ability to use procedures for assessing and managing suicide risk AD(+B

Student will demonstrates appropriate use of culturally responsi)e indi)idual, couple, family, group,

and systems modalities for initiating, maintaining, and terminating counseling AD(.B

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Student will apply current recordkeeping standards related to clinical mental health counseling

AD(%B

Student will understands counseling super)ision practices, and processes A/(1(eB

Student will understand ethical standards of professional organizations and credentialing bodies, and

applications of ethical and legal consideration in professional counseling A/(1(>B

Student will understand counselor characteristics and beha)iors that influence helping processes

A/(.(bB

Student will understand essential inter)iewing and counseling skills A/(.(cB

Student will understand counseling theories that pro)ide the student with models to conceptualize

client presentation and that help the student select appropriate counseling inter)entions A/(.(dB

Student will understand a systems perspecti)e that pro)ides an understanding of family systems

theories and related inter)entions A/(.(eB

'rinciples of group dynamics, group process components, group members? roles and beha)iors,

therapeutic factors of group work A/(+(aB and appropriate selection criteria and methods A/(+(dB

Direct e!periences in which students participate as group members in a small group acti)ity,

appro)ed by the program, for a minimum of 10 clock hours o)er the course of one academic termA/(+(eB

Cnows the principles, models, and documentation formats of biopsychosocial case

conceptualization and treatment planning A"(%B Uses the principles and practices of diagnosis, treatment, referral, and pre)ention of mental and

emotional disorders to initiate, maintain, and terminate counseling AD(1B

@aintains information regarding community resources to make appropriate referrals A""84' :(1B

DETAILED EXPLANATION OF MINIMUM REQUIREMENTS:CACREP RequirementsCACREP requires the following:

1. The practicum experience will include a total of 100 direct and indirect hours.. A total of !0 hours of direct ser"ice with #ona fide clients must #e completed.

$. The practicum experience will include group counseling.!. %roup super"ision will occur at 1.& hours per wee' o"er the course of the practicum.&. (ndi"idual or triadic super"ision will occur one hour per wee' during the practicum.). A final e"aluation report will #e generated on each student in practicum.

*tate of +hio and ,entuc'- epartments of Education/oth departments defer to CACREP standards to fulfill practicum requirement.

*tate of +hio Counselor *ocial or'er and 23T /oard(n addition to following CACREP standards the rules for the +C*23T #oard include:

1. *tudents should register their practicum with the state on a prescri#ed form #- the

#oard within $0 da-s of #eginning the practicum.. hen primar- super"ision for practicum occurs with the uni"ersit- a student ma- #e

super"ised #- a doctoral student an 4PC5 PC or 4PCC5 PCC under the instruction of an4PCC with super"ision endorsement.

$. hen primar- super"ision occurs at the practicum site the practicum super"isor must#e an 4PC5PC6* or 4PCC5 PCC6*.

!. hene"er a student is diagnosing or treating mental and emotional disorders a studentmust #e under the super"ision of an 4PCC5PCC6*.

&. At the end of the practicum a student shall complete a practicum report form within $0

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da-s of completing the practicum.

7a"ier Policies and Requirements for Communit- Counselors1. The uni"ersit- shall assist students in fulfilling their o#ligations to the +C*23T #oard

,entuc'- /oard of Professional Counselors and +hio and ,entuc'- epartments ofEducation. The student is responsi#le for filing an- prescri#ed forms #- the state. Theuni"ersit- is not responsi#le for ensuring the prescri#ed forms are completed or "erif-that the state #oard recei"ed the required documents. This is the sole responsi#ilit- ofthe student.

. hen a student chooses a practicum site where the diagnosis and treatment of mentaland emotional disorders is required or the site is #illing for hours completed #- thestudent at the site the student will "erif- that an 4PCC6* or PCC6* is a"aila#le at thesite to ser"e as the official training super"isor. This means the practicum trainingsuper"ision agreement will #e coordinated #etween the site super"isor and the studentsuper"isee. The 7a"ier super"isor will ser"e as the e"aluator for the practicumexperience in cooperation with the site super"isor. (n these instances the studentunderstands that the site super"isor has the legal authorit- to determine whether astudent ma- pass the practicum course.

$. hen counselor trainee status is requested #- a site #ut does not include the diagnosisand treatment of mental and emotional disorders nor #illing for ser"ices the sitesuper"isor ma- ser"e as the training super"isor. (f the site super"isor cannot ser"e inthis capacit- the uni"ersit- super"isor shall ser"e as the training super"isor to pro"idecounselor trainee status.

In all cases, the instructor requests copies of training supervision agreements to verify whoholds primary responsibility for the counselor trainees licensure status during practicum.

REQUIRED TEXT:

Cormier, Nurius & Osborn (2009). Interviewing Strategies for Helpers: Fundamental

Skills and Cognitive Behavioral Interventions (6thed). Pacific Grove, CA:

Brooks/ Cole Publishing.

INSTRUCTIONAL METHODS AND ACTIVITIES:

Students will participate in individual and small group (1 training supervisor: 4

student ratio), and large group learning activities throughout the semester under the

direction of the faculty and training supervisors. Individual supervision with the lead

instructor is conducted on a case by case basis. The laboratory for this course is the

identified site whereby counseling services will take place under supervision.

ASSIGNMENTS/EXAMINATIONS:

Students must demonstrate basic active listening skills in role play scenarios toadvance in this course. Failure to successfully demonstrate active listening skills as

outlined in Cormier, Nurius & Osborn may result in a recommendation to repeat the

course the following semester.

Students are required to:

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Signature Assignment:

1. Clinical Record 3i"e indi"idual counseling session recordings are required forsu#mission. These sessions must #e "ideo recordings 8(n case of school polic-precluding "ideo recording arrangements must #e made #- the student with thesuper"isor and professor9. +ne in vivosession will also #e required as part of a li"e6super"ision session as either a mem#er of a reflection team or as a counselor trainee.

*tudents will turn in a complete client record to document the treatment for this client.The client record will #e re"iewed #- their 7a"ier super"isor and modifications made assuggested #- the super"isor. This is a time to shine; with -our documentation ande"er- step should #e made to ma'e this record the #est it can #e. The signatureassignment will #e graded on the qualit- of the clinical record and #ased on thefollowing ru#ric:

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and Counselor *elf6E"aluation for each session. Each group session will ha"e a %roupProgress


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#oundar- with a client or "iolated an ethical code. All #oundar- crossings and #oundar-"iolations are managed #- the instructor on a case #- case #asis.

. ifferentiate #etween super"isor directi"es and super"isor suggestions. A directi"e ma-include the phrase in the next session ( need -ou toB; while a suggestion ma- #echaracteri@ed #- in the next session -ou ma- want to tr- this approachB;

. Pro"ide timel- accurate and complete documentation to a super"isor for re"iew. Allprogress notes and documentation of client contact must #e signed #- a uni"ersit-super"isor.

10.4earn to self6e"aluate during the counseling process. *elf6e"aluation is a component ofsuper"ision that is connected to the philosoph- of the reflecti"e practitioner. The 7a"ier>ni"ersit- epartment of *chool and Communit- Counseling #elie"es reflecti"epractitioners compliment the pursuit of excellence in training and educationcharacteristic of the uni"ersit-. *tudents shall also plan adequate personal time for restand relaxation during the semester. A successful practicum experience usuall- in"ol"esgood planning.

4ia#ilit-All students practice counseling in practicum under the um#rella super"ision of the instructor.This means the instructor holds legal lia#ilit- for student wor'. At the same time practicum isaimed at student growth and de"elopment it is also a gate'eeping process for the profession.*tudents that demonstrate impairment through emotional insta#ilit- mental illness su#stancea#use other addictions or unethical #eha"ior ma- #e as'ed to terminate their practicum.

ComplaintsAll clients ha"e the right to follow a formal complaint process. This includes complaintprocesses alread- in place at a school or agenc- as well as contacting the Practicum (nstructorat 7a"ier >ni"ersit-.

All students ha"e the right to follow the formal complaint process found in the studenthand#oo'.

All site super"isors ha"e a dut- to report an- concerns a#out 7a"ier super"isees to the>ni"ersit- instructor.

ATTENDANCE POLICY:

Graduate students are training to be professional helpers responsible for the welfare

of clients in need. Attendance in professional counseling courses is required to

evaluate the readiness and preparedness of each student to enter the profession.

Attendance and participation constitute a significant portion of your final grade.

Attendance means arriving for class on time and staying for the duration of the class.

Participation means preparing for class by reading required texts/materials and

periodically entering into class discussion.

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Attendance at all scheduled practicum sessions is mandatory. Students must

understand faculty carry legal liability for all clients seen by students in this course.

Therefore, scheduling vacations, weddings, and other self selected events during

scheduled classes is considered unacceptable. Students who have multiple

obligations other than Praxis exams ought to consider withdrawing and taking the

course at a later date. A student who misses more than 1 class in a semester may be

subject to possible action by the instructor, which includes, but is not limited to:

Recommendation to withdraw from the class.Additional assignments(s) to complete the class.

Reduction in 10% of class grade.

Any other action deemed appropriate by the instructor.

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Sc,ed)leate Content CACREP >E

2a- (ntroduction

Course requirements Paperwor'

*uper"ision 2odel Practices and

Processes: *uper"isor5*uper"isee Rolein class

*uper"ision Contract

Expectations

Clinical ocumentation

Philosoph- of Counseling

?%.1.e

2a- 10 Communication: Content Thin'ing

3eeling 4e"els of Empath- 2DE

Constructionist Concepts (t e ou and ( statements

*tructure of 3irst *ession5ongoing

sessions

Esta#lishing a relationship *-stems Theor- and (nter"enti"e

(nter"iewing (nformed Consent

%.&.c.&%.1.=.%.&.#%.&.e

2a- 1& Practice 4i"e *uper"ision and ReflectionTeams in Class 8using 4u'e scenario9Record ,eeping *tandards: Progress


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Fune ? *uper"ision group to re"iew "ideos %.&.c%.1.e

4i"e *uper"ision:%rooms5/axter

Fune 1 Planning for (nternship: Gand#oo'sdisseminated.e"eloping a plan for %roups(*P*pecial Education: (EP Process 8onita9G(PPA53ERPA

C?%.1.g%.1.=.

2id6CourseE"aluations ue

Fune 1! %.&.c%.1.e

Dideo $4i"e *uper"ision:3allon5Fac'sonTheor- Paper ue

Fune 1 %.&.c%.1.e


Fune 1 Termination of *er"icesProfessional credentialing includingcertification licensure2ental Gealth and *chool Counselorswor'ing together 8awn9

Records 2anagement and *26(D in the*choolRole /lending in *choolsEthical (ssuesGow to support the school counselor

.1.?%.1.=

Fune ) %.&.c%.1.e

Dideo !4i"e *uper"ision:3allon5Fac'son

Fune %.&.c%.1.e


Ful- $ %.&.c%.1.e

Dideo &4i"e *uper"ision:3allon5Fac'son

Ful- & %.&.c%.1.e


Ful- 10 %.1.e (ndi"idual E"aluationwith r. 4ose- H*uper"isor83allon5Fac'son9

Ful- 1 %.1.e (ndi"idual E"aluationwith r. 4ose- H

*uper"isor8%rooms5/axter9

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Li0e S)"er0iion Sc,ed)led Clae

!:006 Class meets in Gailstones ?!:$06 Class #rea's up in small groups 84i"e *ession group Pre6*ession 2eeting9&:006 Client session #egins for li"e super"ision

In!r)c!or Con!ac! In/or*a!ion

In!r)c!ion /or e*er(encie:

1. A"oid meeting with clients at odd or unusual hours e.g. *aturda- E"ening after ) p.m.'. Do no! )e e*ail !o a 2)e!ion a3o)! clien!44444$. ecide if -ou ha"e a concern that must #e answered immediatel- or one that ma- wait

till class time.!. Contact -our primar- super"isor. A primar- super"isor is the super"isor that is presentl-re"iewing -our wor'.

&. (f -our primar- super"isor is una"aila#le contact r. 4ose-. Allow 16 hours for a returncall.

). (f r. 4ose- is una"aila#le call an- super"isor until -ou reach someone who canrespond to -our emergenc-.

?. Err on the side of safet- for -our student5client.

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T5EOR6 OF COUNSELIN7 PAPER

The philosoph- of counseling that -ou descri#ed in -our Practicum class is a unique andd-namic account of -our thoughts and #eliefs a#out counseling and its impact on the humancondition. A philosoph- is not a theor-. A philosoph- ser"es as a foundation to theor-. (n thispaper please descri#e the counseling theor- that -ou currentl- choose to em#race andexplore for the coming semester. >se graduate le"el writing s'ills.

1. hat is the theor- and what are the most important characteristicsI. hat attracted -ou to this theor- initiall-I$. hat do -ou hope to accomplish #- using -our chosen approachI!. Gow do -ou predict that this theor- will wor' in -our particular counseling en"ironmentI

Posing the a#o"e questions to -ourself or tal'ing a#out these with someone else will help -ouachie"e a coherent idea a#out -our theoretical orientation at this point in time.

%i"e the papers to -our 7> super"isor. our super"isor will re"iew and send it to r. 4ose-.

Ge will return the papers to -ou and -our super"isor.

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COUN!,+$NG PR5CT$CU

Tec"nical Consi#erations for Recor#ing

*tarting 3all 011 all recordings need to #e digital. The recordings ma- #e uploaded to#lac'#oard -our personal 7a"ier des'top or copied to a memor- stic'.

hen #eginning and ending the recording #e sure to allow se"eral seconds for the recorder to#egin and end J there is often a time lag at these points.

Test to see that -ou are recording and the sound is good. 2an- good counseling sessionsha"e #een lost #ecause the counselor thoughta recording was #eing made. The recordingmust #e audi#le to the super"isor. (f it is not audi#le -ou will #e as'ed to record anothersession.

o not place the recorder on heaters air conditioning units or in areas where it pic's up louddistracting noises.

o not place a digital recorder close to a computer monitor or another electronic de"ice toa"oid possi#le interference.

Place the recorder somewhere #etween -ou and -our client. Proper placement is important sothat #oth parties ma- #e heard.

Please ha"e recordings a"aila#le #- the date assigned.

Di(i!al recordin( o/ eion8 alon( 9i!, *an- ad0an!a(e /or !,e !)den! and !,e)"er0ior8 re2)ire addi!ional conidera!ion !o en)re con/iden!iali!- /or !,e clien!.


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Gui#elines for =riting $nitial ReportUse t"is format for t"e first session &it" eac" client2

Counselee8 :irst name or initials D# $#T US4 "734$T?S 7ST $@4

Counselor8 Lour full name(

!ource8 Fow was the client referred to youQ

Date of !ession8 VVVVVV Start TimeVVVVV 4nd TimeVVVVV

+engt" of !ession8

in minutes2

9ac>groun# Data8 ge, grade, family, background of family, pre)ious counseling or contacts, howlong youW)e known client, etc( nything that will help to identify and understandclient better( :actual data( 3f se)eral inter)iews, do background again, add whathappened since(

5ssessment Data8 $ame of tests, date, norming data, grades, etc( 3nclude any test results( 3f nonea)ailable, simply state that test data is not a)ailable(

Purpose of !ession8 Lours or client?s, or bothK the agenda, intended or de)eloped in the inter)iewKmaybe se)eral, e(g(, to discuss failing grades Ayour purposeB, to )entilate feelingsabout father AclientWsB(

Description of !ession8 The narrati)e description of the inter)iew summarized( $ot a transcript, not oneparagraph but se)eral(

Counselor 5ssessment8$on)erbal beha)ior during inter)iew, signs of ner)ousness,your client reactions, eye contact, )oice changes, crying,

emotions e!pressed or displayed, etc( "ompare to earlierinter)iew, if any, to before taping, after taping, etc(

Prognosis8 *hat will happen as a result of your counseling sessionQ Fow did you e!pect it

all to turn outQ n intelligent guess of what will happen to the client, what he orshe will do, etc( *hat you ha)e done(

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! 5 P + ,!c"ool Counselor

$nitial Client Report

"ounselee- Tony Date of 3nter)iew- 99

"ounselor- Lour $ame Time of Session in @inutes

Source- "ounselor 8euest

6"C/8#U$D DT-

Tony is a second semester th grader( Fe is 1; years old and li)es at home with his parents( Fe has one olderbrother and one older sister( Tony is an adopted son and is aware of this( Fis father, a college graduate, isemployed by the :ederal /o)ernment and his mother is a housewife( This is TonyWs second )isit with thecounselor( 're)iously @rs( C( had contacted the principal about some situations at the C( home( She told theprincipal, who later shared this information with the counselor with @rs( C(Ws appro)al, that Tony may ha)e aneating disorder and that she belie)ed that he might feel somewhat unwanted at home( She came to the principal toseek his help Athough she asked that Tony not be informed of her )isitB( During TonyWs first session with the

counselor his academic record and some of his school problems were discussed( This inter)iew was basicallyfactual and the counselor hoped to facilitate a feeling of ease and comfort so that Tony might feel comfortable todiscuss some of the problems that his mother spoke about with the principal(

SS4SS@4$T DT

Fis semester grades were-

4nglish " Social Studies 3 "8eading 6 Spanish 3 "lgebra " Fealth 6

Fis grades for the most recent + week marking period are-

4nglish " Social Studies 3 3 AincompleteB8eading 6 Spanish 3 Dlgebra : Fealth "

The results of the Stanford chie)ement Test, taken in @arch 1


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'U8'#S4 #: TF4 S4SS3#$-

This inter)iew was limited by TonyWs reluctance to discuss certain issues( #riginally the counselor had hoped todiscuss his unwillingness to show his parent?s his report card but Tony was reluctant to del)e into this topic e)enafter a direct uestion by the counselor( s a result the counselor belie)es that the inter)iew was really toounstructured and that, upon relistening to the tape, there really seemed to be no purpose to this session e!cept tolet Tony talk about a lot of different things(

D4S"83'T3#$ #: TF4 S4SS3#$-

The inter)iew began with a discussion of his recent academic results, especially his algebra grade( Tony seemedto want to stay on the factual le)el of his report( Fe stated that he put much emphasis on grades, perhaps toomuch, but that he did not much )alue the alpha code teachers can use to comment upon classroom beha)ior andacademic work(

*hen approached about not showing his report card to his parents, Tony hesitated to respond and then switchedback to his academic record( *hen the counselor asked Tony if he would rather not talk about not showing hisreport card, he briefly talked about the reaction he might get at home( 6ut then he began to discuss is fatherWseducational background which seemed to be an ob)ious attempt to be e)asi)e as there had been nothing

mentioned about this earlier( The counselor felt that this was not going to yield any information and instead ofterminating the inter)iew or keeping on this topic, he instead asked Tony if he had gi)en any thought about futureplans(

The boy spoke at length about how he was interested in lifesa)ing and emergency work, especially because of hisfatherWs in)ol)ement in the local )olunteer life suad( Tony discussed his most recent si! weeks in Fealth classwhen firstaid was studied( 6ecause of is interest he was disappointed in this course because he considered theatmosphere to be )ery poor for learning( Fe thought that the instructor was, in some ways, not as skilled as heATonyB was in firstaid(

s the inter)iew ended, the counselor attempted to refocus Tony on his report card and return the inter)iew tothis original topic( Tony simply said that he knew he had to show it to his parent sooner or later( pparently he

considered this a sufficient response, as he got up at this point and began to walk towards the door(

"#U$S47#8 SS4SS@4$T-

#ne aspect of TonyWs beha)ior the counselor thought significant was the tone of his )oice during the inter)iew( 3twas )ery tight and sounded Yner)ous(N Se)eral times he sounded as if he were ha)ing difficulty speaking(

@oreo)er, he was constantly sniffing his nose and rubbing his eyes( *hile he did not cry during the inter)iew, thecounselor thought that his )oice belied a real sense of ner)ousness and discomfort( Tony stated that he had sinustrouble and that was why his nose was running and his eyes were watering( Tony had more direct eye contactduring this second )isit but still sometimes a)oided looking at the counselor(

Tony was cleanly dressed, though his appearance at times, is somewhat unkempt( Fe is slightly obese(

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Client Name8

'8#/$#S3S-

6ased on the results of the inter)iew, the counselor feels that Tony does ha)e some concerns which he is not

re)ealing( "ertainly his grades and academic performance are important to him, but these seem to be only part ofthe problem( @oreo)er, the counselor belie)es that the academic problems ha)e been sufficiently dealt with Aatutor for him in Spanish, a restructuring of his classes for ne!t yearB so that if they were his ma>or concerns,TonyWs recent inter)iew is difficult to interpret, especially his ner)ousness( 'erhaps Tony is unable to feelcomfortable with this particular counselor( possible suggestion would be that someone else in the departmenttalks with him( 6ased on two inter)iews with Tony, plus what was re)ealed by his mother, this counselor feels thatTony needs to talk more about concerns other than grades( Fowe)er, he gi)es no indication that he would bewilling to do so(

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! 5 P + ,!elf ,)aluation

Ato be completed after e)ery session with a clientB

Counselor Name Lour $ame

Client $nitials T

Date of $nter)ie& JJJJJJJJJJJJJJJJJJJJJ

Client !ession Number JJJJJJJJJJJJJJJJJJJJJ

T"ings $ #i# &ell in t"is inter)ie& inclu#e- A/i)e specifice!amplesB

3 attempted to be supporti)e of the client and respond to his significant statements( 3 demonstratedinterest in helping Tony and used humor to help him feel at ease during the session(

% plans to impro)e in t"e net session inclu#e- A/i)e specific e!amplesB

fter listening to the recording, 3 felt that 3 did not sufficiently e!plore why Tony had not shown hisreport card to his parents( @oreo)er, 3 felt that 3 left the entire inter)iew too unstructured which allowedTony the opportunity to a)oid discussing this situation( t least twice 3 could ha)e pursued this topicfurther in a nonthreatening manner( :or e!ample, when Tony picked up his report card and started totalk about it rather than discuss the idea introduced by me, 3 let Tony a)oid responding to the topic athand( The second instance occurred when Tony switched to his fatherWs school background( 3 made a

brief attempt to redirect him to the original topic, but again Tony a)oided this(

3n summary, while the inter)iew ga)e Tony a chance to talk about some concerns, grades, and aspects ofteacher beha)ior in the classroomK 3 felt that the inter)iew did not achie)e its stated purpose( This lack ofsuccess was directly related to my dependence upon closed uestions rather than acti)e listening skills(

3 need to decrease the use of closed ended uestions and increase acti)e listening skills(

uestions for m% super)isor inclu#e8

3 am struggling with the difference between open ended and closed ended uestions( 3t seems the client

needs more direction from me( *hat is my role with this client when the parent are reuesting particularresultsQ

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! 5 P + , Communit% Counselor

$nitial Client Report

Counselee8 6eth Time of !ession in inutes-

Counselor8 Lour $ame

!ource8 "ounselor reuest

Date of $nter)ie&8

9ac>groun# Data8 The client is a 1yearold "aucasian female who is currently in her first year ofcollege in "incinnati( She is from a small town in northeastern #hio and sherecently mo)ed to "incinnati( She li)es with her aunt(

5ssessment Data8 The client has ne)er been in counseling before and therefore a psychological

assessment has not been completed( She stated that she is currently on academicprobation from the uni)ersity because of her first semester grades( She is alsofailing her math course this semester(

Purpose8 This inter)iew allowed the counselor to de)elop skills practicing se)eraltechniues( The client used this time to work through her feelings in regards toschool and her life at this point( She knows she is not succeeding in the schoolarena, yet she feels she has learned so much in the past year about herself( Theclient is torn between telling her parents that she is not doing well in schooland facing the disappointment that they may e!press to her(

Description8 The client discussed the pressure that she places upon herself to do well in college

as well as the pressure she feels from her parents to e!cel( The client seemed )eryintrospecti)e throughout the tape and appeared to be aware of her emotions ande!pectations for herself( Fer )erbal skills allowed her to e!press herself in ameaningful manner on a consistent basis( The client is e!ploring both negati)eand positi)e points in her situation and she is willing to assess the )alidity of each(

*hen the client first began the inter)iew, she spoke mostly of the negati)e aspectsof her school situation( Fowe)er, as the inter)iew continued, her focus turned toher accomplishments since mo)ing to "incinnati( These include findinga peer group and simply taking care of herself( The pride she feels in meetingthese nonacademic goals was e)ident by the manner in which her face lit up in

discussing them( Throughout the course of this inter)iew the client was able torealign her focus to some of the possibilities that lie ahead once she faces herparents? disappointment(

Page 1 of A

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Client Name8

5ssessment8 The client is an attracti)e woman but she does appear younger than her stated ageKshe is )ery small in stature and physiue( She was dressed casually for theinter)iew and was )ery neat and well groomed( The client did appear ner)ous atthe start of the inter)iew as e)idenced by her fiddling with her car keys, which sheput down and stated, M3 can?t stop messing with these(N She was, howe)er, )erycooperati)e and willing to engage with this counselor( s the session continued,

the client seemed to rela! and her hands rested on her lap( The client appears to beable to process her thoughts in a logical manner(

Prognosis8 6ased on the inter)iew, it is likely that the client will tell her parents about hersituation in school soon( The situation has been troubling the client as e)idencedby the distress she showed when she described her predicament( She appears todesire a resolution but she said she wants to make this decision on her own(Therefore, gi)en the client?s discussion, it seems that she may decide her futureplans before talking to her parents so that their opinion does not influence her asmuch( The client emphasized the great )alue she places upon the independenceshe has gained by li)ing away from home and she especially does not want to let

that disappear from her life(

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A of A

! 5 P + ,

!elf ,)aluation for Ei#eo !essions

Counselor Name JJJJJJJJJJJJJJJJJJJJJ

Client $nitials JJJJJJJJJJJJJJJJJJJJJ



T"ings $ #i# &ell in t"is inter)ie& inclu#e- A/i)e specifice!amplesBThe counselor impro)ed her skills in this session by using acti)e listening more often( 3ncreasing theseresponses is the counselor?s goal for future sessions( 3 tried limiting my habitual use of the word MUmNand think that 3 impro)ed during this inter)iew(

% plans to impro)e in t"e net session inclu#e- A/i)e specific e!amplesB3 tended to ask closed uestions( 3 am learning to reconsider and assess if the answer to those uestionswill be helpful in any way( Using acti)e listening was difficult because it seemed that the inter)iew wassimply going in circles at some points( t those times, 3 wanted to use another inter)ention but was at aloss for what to do(

3 noticed that 3 still ha)e the tendency to use the word MrightN to affirm what the person is saying( 3caught myself a couple of times after 3 had said it and realized that it >ust flows out as easily as simplynodding in agreement(

3n past sessions 3 was ner)ous and watched the clock for the entire session( Fowe)er, in this tape 3 wentto the other e!treme( 3 forgot to look at the clock at the start of the session and soon realized 3 did notknow the ending time( The inter)iew actually lasted about .0 minutes( The time on the tape seemed togo by much faster than anticipated( 'erhaps 3 was less ner)ous and therefore, the time elapsed morenaturally(

/oals for the ne!t session include assisting the client in how she may wish to approach her parents withthis


Fow can 3 begin to establish therapeutic goals with the client when the client seems to be talking aboutso many issues at one timeQ

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Uni0eri!- S)"er0iorS)"er0iee A(ree*en!Xa0ier Uni0eri!-

Prac!ic)*

This agreement ser"es as "erification and a description of the uni"ersit- #ased counselingsuper"ision pro"ided #- KKKKKKKKKKKKKKKKKKKKKKKKKKK8>ni"ersit- *uper"isor;9 to

KKKKKKKKKKKKKKKKKKKKKKKKKKKKK 8*uper"isee;9 a %raduate Counseling *tudent enrolledin Practicum at 7a"ier >ni"ersit-for the Summersemester 2012.

(. Purpose %oals and +#=ecti"es:a. 2onitor and ensure welfare of clients seen #- *uper"isee

#. Promote de"elopment of *uper"iseeLs professional counselor identit- and competence

c. 3ulfill academic requirement for *uper"iseeLs practicum

d. 3ulfill requirements in preparation for *uper"iseeLs pursuit of counselor licensure

((. Context of *er"ices:a. +ne 819 cloc' hour of indi"idual or group super"ision wee'l- #eginning Fune ? and

ending Ful- 1th. Exceptions to the one hour rule will #e made #- the Practicum(nstructor Dr. )!c, Loe-

#. (ndi"idual super"ision will #e conducted on the campus of 7a"ier >ni"ersit-. Phone or

we# #ased super"ision will #e utili@ed as needed.

c. Cogniti"eJ#eha"ioral methods interpersonal process recall progress notes and role

pla-s will #e used in super"ision

d. Regular re"iew of written clinical documentation counseling digital "ideo and li"e6

super"ision in wee'l- indi"idual super"ision

(((. 2ethod of E"aluation:a. 3eed#ac' will #e pro"ided #- the *uper"isor during each indi"idual or group session

and a formal e"aluation using the Practicum *uper"isor or *uper"isee E"aluation

standard e"aluation form will #e conducted at the conclusion of the Summersemester

#. *pecific feed#ac' pro"ided #- *uper"isor will focus on *uper"iseeLs demonstrated

counseling s'ills and clinical documentation.

c. *uper"isee will e"aluate *uper"isor at the close of the *ummer semester using the

epartment of Counseling standard e"aluation form for e"aluating super"isors. A

narrati"e e"aluation will also accompan- the o#=ecti"e e"aluations

(D. uties and Responsi#ilities of *uper"isor and *uper"isee:Supervisor

a. Examine client presenting complaints and treatment plans

#. Re"iew "ideos of *uper"iseeLs counseling sessions #oth during and5or outside of

regularl- scheduled super"ision sessions

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c. *ign off on all client documentation

d. Challenge *uper"isee to =ustif- approach and techniques used

e. 2onitor *uper"iseeLs #asic attending s'ills

f. Present and model appropriate directi"es

g. (nter"ene when client welfare ma- #e at ris'

h. Ensure American Counseling Association 8ACA9M American *chool Counseling

Association 8A*CA9M and +hio Counselor *ocial or'er and 2arriage and 3amil-

Therapist /oard Code of Ethics are upheld.

i. *uper"isor will 'eep (nstructor appraised of student progress and challenges throughout

the semester

*uper"isee:a( >pholdC, SC and !CS"#$% &oard Code of Ethics

#. Re"iew counseling session "ideos in preparation for wee'l- super"ision. Derif-recording is clearl- audi#le for #oth super"iseeLs "oice and clientLs "oice

c. Complete all progress notes within ! hours of session

d. /e prepared to discuss all client casesNha"e client files current and completed client

case notes and counseling session recordings read- to re"iew in wee'l- super"ision

sessions

e. %i"e super"isor chart to read and re"iew notes. *uper"isee ma- 'eep a cop- of notes

as needed to continue sessions.

f. Fustif- client case conceptuali@ations made and approach and techniques used

g. Consult with Counseling Center staff and *uper"isor in cases of emergenc-

h. (mplement super"isor- directi"es in su#sequent sessions

C. *uper"iseeLs 4earning +#=ecti"es 'optional( to be completed by Supervisee and reviewedby Supervisor):+#=. 1:KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

+#=. :KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK+#=. $:KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

D. Procedural Considerations:a. *uper"iseeLs written case notes and treatment plans and audio recordings will #e

re"iewed and e"aluated within a wee' time frame #etween super"ision sessions

#. (ssues related to *uper"iseeLs professional de"elopment will #e discussed

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c. *essions will #e used to discuss issues of conflict and failure of either part- to a#ide #-

directi"es outlined in this agreement. (f concerns of either part- are not resol"ed in

super"ision r. 4ose- will #e consulted

(n e"ent of emergenc- *uper"isee is to contact *uper"isor at the office8 9 KKKKKKKKKKKKKKKKKKKKKK or at home 8 9 KKKKKKKKKKKKKKKKKKKKKK or #- cellphone 8 9KKKKKKKKKKKKKKKKKKKKKKKKKKKKK.

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Progress Notes

!elf,)aluation

Termination Report

Students are reuired to complete progress notes for each counseling session after the initial session

report( These forms are used for the 2ndsession and thereafter until termination(

These progress notes ser)e two purposes( #ne is to monitor the client?s wellbeing( The other is to ser)eas a log of the counselor9client interactions(

The termination report ends the legal liability that you, your practicum site and a)ier Uni)ersity holdfor your client(

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Pro(re No!e

Client (nitials KKKKK *ource of Referral KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK

Counselor


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Group !ession Note

/roup $ame- VVVVVVVVVVVVVVVVVVVV Date- VVVVVVVVVVVVVVVV

"ounselor $ame- VVVVVVVVVVVVVVVVV Session O-VVVVVVVVVVVV

Session start time- VVVVVVVV Stop time- VVVVVVVVV

3ssues9concerns9topics discussed in groupsession-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

"ounselor ssessment of /roup 'rocess Ai(e(, dynamics and inter)entionsB, and content Ai(e(, clientresponsesB-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

"ounselor ssessment of Self- Ai(e(, what counselor did well, areas in need ofimpro)ementB-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

'lan :or $e!t /roup Session nd9#r 8ecommendations for

treatment-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

/roupttendees-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV Date- VVVVVVVVVVVVVVVVVVV"ounselor Trainee

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV Date- VVVVVVVVVVVVVVVVVVVSuper)isor

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!elf ,)aluation for Ei#eo !essions

Counselor Name JJJJJJJJJJJJJJJJJJJJJ

Client Name JJJJJJJJJJJJJJJJJJJJJ



T"ings $ #i# &ell in t"is inter)ie& inclu#e- A/i)e specifice!amplesB

% plans to impro)e in t"e net session inclu#e- A/i)e specific e!amplesB


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! 5 P + ,Termination Report

"ounselee- Tony Termination Date- 99"ounselor- Lour $ame

SU@@8L #: "#U$S473$/

Tony completed si! sessions of counseling with this counselor including one family consultation withTony and his mother( Tony was originally referred to the counselor by his mother through the schoolprincipal( 3nitial concerns included the mother?s report that Tony may ha)e an eating disorder, that hemay feel unwanted at home and that he is ha)ing difficulty in a few courses( 6ased on an initialassessment the following goals were established for counseling with Tony- A1B ssist Tony in de)elopinga method to discuss his grades with his parents A2B ssess progress in academic performance following a& week tutoring period A&B 'ro)ide a forum for Tony to talk about any concerns that may be impacting

his school performance(

"#U$S47#8 3@'84SS3#$S

Tony is a 1; year old second semester thgrader e!hibiting symptoms of a mild depression and amoderate an!iety disorder( The mother?s concern that Tony has an eating disorder may need furtherconsideration by a physician( Fe reports a decreased appetite and may not be eating appropriate foods(Tony e!periences periods of restlessness during the day both at home and school( Fe finds that hebecomes easily fatigued and has difficulty concentrating in classes( :inally, he reports periods ofirritability inconsistent with beha)ior prior to this year( :or e!ample, Tony tore up his report card whenhe saw a grade less than a 6, he destroyed model cars that he built in the past year and freuently locked

himself in his room( lthough many of the symptoms described are not atypical for a 1; year old male,the symptoms are less characteristic of Tony and ha)e persisted for the last si! months( 3n addition,Tony indicates he wishes that he felt more moti)ated to complete his school work and en>oy thecompanionship of friends and family( Fe does report he feels lo)ed by his parents, howe)er, he does notbelie)e his father understands him(

'8#/84SS T#*8D /#7S

Tony became more at ease discussing his concerns with this counselor by the & rdsession( The followingprogress was achie)ed toward specific goals- A1B The counselor met with Tony and his mother for afamily consultation( Tony agreed to allow his parents to open his grade report at the end of thissemester( Fis mother agreed to talk with Tony about his grades and stated she and his father would notbelittle him, rather try to understand what he needs to do to impro)e( A2B Tony remains on track withtutoring sessions for courses where he has e!perienced the most difficulty( A&B Tony disclosed he has apoor self image, coupled with feelings of an!iety about dating girls and de)eloping friendships with thesame se!( Fe admitted there is some pressure from his father to be more masculine and athleticalthough Tony reports his father is )ery o)erweight and lacks self control with his diet( Tony wants tobe more physically acti)e and attracti)e to the opposite se!( Tony has made plans to consult with anathletic trainer who is a friend of his older brother(

84S#$ :#8 T48@3$T3#$ $D 84:4887S

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This school counselor agreed to meet with Tony for si! &0 minute sessions and offer a referral for furthercounseling if necessary( The student?s mother has made arrangements for Tony to meet with a pri)atepractice counselor and his family physician to further assess a possible depressi)e and9or an!ietydisorder, and rule out any type of eating disorder( The school counselor will be a)ailable forconsultation with the clinical counselor and brief appointments related to Tony?s progress in classes(

'8#/$#S3S

Tony?s decline in academic performance is most likely influenced by social and de)elopmentalconcerns, mild pressure in his home en)ironment and possible de)elopmental depression and an!iety("ontinued counseling and medical inter)ention will be helpful in alle)iating symptoms that may inhibitacademic and social performance at school( The prognosis for Tony is good with continued use offamily and social ser)ice support systems(

VVVVVVVVVVVVVVVV VVVVVVVVVVVV VVVVVVVVVVVVVVVVVVVVV"ounselor Signature and "redentials Date

VVVVVVVVVVVVVVVVVVVVVVV VVVVV VVVVVVVVVVVVVVVVVVVVVSuper)isor Signature and "redentials Date

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5ssessment of Performance

*ritten assessment of student performance in 'racticum is recorded on the following forms-

1( Super)isee 4)aluation :orm2( a)ier Super)isor 4)aluation :orm

&( Site Super)isor 4)aluation :orm

The a)ier Super)isor 4)aluation :orm is identical to the super)isee e)aluation form, so it is notincluded in the handbook(

The student will use the following Super)isee 4)aluation :orm as a guide for e)aluation criteria in thecourse( The student will complete this e)aluation form at the end of the semester as part of the formale)aluation process for the course( Super)isors will complete a similar form for the student( 8esults willbe discussed in final meeting between the instructor, super)isee and super)isor(

@id term e)aluations are informal discussions between the super)isor and super)isee about their skill

performance following the completion of the third recording(

The student will recei)e a self addressed stamped en)elope from the instructor mid semester( The sitesuper)isor will return the Site Super)isor 4)aluation :orm )ia mail to the course instructor to beincluded in the student?s o)erall course e)aluation(

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Mid-Course Evaluation

(Completed by Supervisee and Site Supervisor)

1( :ar below e!pectationsneeds impro)ement, a concern2( 6elow e!pectationsneeds some impro)ement to meet standards&( cceptablemeets standards at a)erage le)el for 'racticum 33 students;( bo)e e!pectationsperforms abo)e a)erage le)el for 'racticum 33 students

$Z$ot applicable

Skill rea'rocedural

VVVV #pens session smoothlyVVVV 'ro)ides informed consentVVVV 3dentifies important concerns in the sessionVVVV 3dentifies risk issues and reports to super)isorVVVV :ollows policy and procedures of an educational or agency setting regarding harm to others,

substance abuse, and child abuse(VVVV bility to end session smoothly

VVVV 'ro)ides appropriate referrals when necessary

5ttending %ehavior

VVVV "ounselor demonstrates interest in clientVVVV bility to establish a rhythm and pace compatible with the clientVVVV "ounselor is able to manage silence appropriately

9istening 6esponsesVVVV "larificationVVVV 'araphraseVVVV 8eflection of feeling A4mpathyB

VVVV Summarization

:nfluencing 6esponsesVVVV #pen JuestionVVVV "losed JuestionVVVV 3nterpretation Ad)anced 4mpathyBVVVV 3nformation /i)ingVVVV 3mmediacyVVVV Self DisclosureVVVV "onfrontation9 'erception "heck9 "hallenging Statement

!ounselor and !lient 6elationshipVVVV bility to mi! and balance responses in sessionVVVV Demonstrates patience with clientVVVV 4stablishes a collaborati)e working relationship with clientVVVV bility to set goals with client and mo)e toward action in problem sol)ing(VVVV bility to facilitate decision makingVVVV bility to e)aluate counselor client relationship

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'lease comment on the following aspects of 'racticum 33 as these relate to your e!perience(

pplicability of classroom discussion=

8ele)ance of topics co)ered in classroom sessions=

Topics you might like to co)er=

*orkload=

Super)ision group work=

3ndi)idual super)ision Ain person, recorded sessionsB=

*hat you like=

*hat you would like to change Aand suggestions for impro)ementB=

ny other comments, thoughts, ideas, complaints=

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XAVIER UNIVERSI!"RACICUM EVA#UAI$N

SU"ERVISEE %$RM

'racticum super)isee nameVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Date of e)aluationVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

a)ier Super)isorVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

'racticum SiteVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

#nSite Super)isor $ameVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

3nstructions- Lour super)isor will be asked to complete an e)aluation form designed to assess yourperformance during your practicum( This form is pro)ided to you to help you assess your ownperformance( 3t is essentially identical to the one gi)en to your super)isor( The form will become partof your permanent record for this course and may be considered in assigning a grade for practicum(

'lease answer each item using the scale pro)ided( Space is pro)ided following each category group forspecific comments( There is also space at the end of the form for general comments( 3f you feel itwould be helpful to put anything into conte!t from the outset, please feel free to do so-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

nswer code

$- $ot applicable or $ot enough information to form a >udgment

1( :ar below e!pectationsneeds impro)ement, a concern2( 6elow e!pectationsneeds some impro)ement to meet standards&( cceptablemeets standards at a)erage le)el for 'racticum 3 students;( bo)e e!pectationsperforms abo)e a)erage le)el for 'racticum 3 students

I& 'asi Course ReuirementsVVVV rri)es on time consistentlyVVVV 3nforms super)isor and makes arrangements for absencesVVVV "ompleted assigned course papers on time

VVVV 8esponsi)e to norms for professional beha)ior in a uni)ersity settingVVVV Demonstrates e)idence of reading te!t by completing assignmentsVVVV 'articipated in role play e!ercises as needed

"omments-

Suggested areas for further study-

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II& Et*ial A+areness and CondutVVVV Cnowledge of general ethical guidelinesVVVV Cnowledge of ethical guidelines for agency or school placementVVVV Demonstrates awareness and sensiti)ity to ethical issuesVVVV 'ersonal beha)ior is consistent with ethical guidelinesVVVV "onsults with super)isor about ethical issues if necessary

"omments-


III& ,no+lede and #earnin

( Cnowledge of "lient 'opulationVVVVCnowledge of client population at beginning of practicum

VVVVCnowledge of client population at end of practicum

6( Cnowledge of Treatment pproachesVVVVCnowledge of treatment approaches at beginning of practicumVVVVCnowledge of treatment approaches at end of practicum

"( Cnowledge of Treatment SettingVVVVCnowledge of treatment setting at beginning of practicumVVVVCnowledge of treatment setting at end of practicum

D( 7earning

VVVV8ecepti)e to learning when new information is offeredVVVVcti)ely seeks new information from super)isor and peer groupVVVVbility to learn and understand new informationVVVVUnderstanding of concepts, theories, and informationVVVVbility to apply new information in a school or clinical setting

"omments-


+0


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IV& S.ill /evelopment.( :ar below e!pectationsneeds impro)ement, a concern+( 6elow e!pectationsneeds some impro)ement to meet standards%( cceptablemeets standards at a)erage le)el for 'racticum 3 students


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V& Response to SupervisionVVV 'repared for super)ision meetingsVVV 8ecepti)e to feedback from super)isorVVV Understands information communicated in super)isionVVV Successfully implements suggestions from super)isorVVV ware of areas that need impro)ementVVV *illingness to e!plore personal strengths and weaknesses

"omments-


VI& Interations 0it* ClientsVVVV ppears comfortable interacting with clientsVVVV 3nitiates interactions with clientsVVVV "ommunicates effecti)ely with clientsVVVV 6uilds rapport and respect with clientsVVVV 3s sensiti)e and responsi)e to client?s needsVVVV 3s sensiti)e to cultural differencesVVVV 3s sensiti)e to issues of gender differences

"omments-


VII& Interations 0it* ColleauesVVVV ppears comfortable interacting with other practicum colleaguesVVVV 3nitiates interactions with colleaguesVVVV "ommunicates effecti)ely with colleaguesVVVV 4ffecti)ely con)eys information and e!presses own opinionsVVVV 4ffecti)ely recei)es information and opinions from others

"omments-


+2


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VIII& /oumentationVVVV 8eliable and accurate record keepingVVVV *ritten or )erbal reports are accurate and factually correctVVVV *ritten or )erbal reports are presented in a professional mannerVVVV 8eports are clinically usefulVVVV Documentation is timely Aought to be completed within 2; hours of appointmentB

"omments-


#)erall, what would you identify as your strong pointsQ

*hat would you identify as areas in which you need to impro)eQ

Do you belie)e you are prepared for 'racticumQ

Do you belie)e you are ready to continue study in the Department of "ounseling at a)ier Uni)ersityQ

Super)isee signature-VVVVVVVVVVVVVVVVVVVVVVVVVV Date-VVVVVVVVVVVVVVVVVV

+&


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.a)ier Uni)ersit%

!ite !uper)isor Practicum Final ,)aluation Form

Super)isor $ame- U Student $ame-please print& (please print&

Super)isor Signature-

ddress-

'hone- Date-

'lease complete the following by placing a checkmark in the appropriate column.

5t present t"e practicum stu#ent un#er m% super)ision8 /##D :38 '##8 $9

1( Fas an awareness of his9her own strengths and limitations

2( Uses super)ision for personal and professional growth(

&(Fears and understands the super)isor?s feedback duringsuper)ision(

;(#penly and appropriately communicates with thesuper)isor(

.( 8eadily seeks super)isory direction when needed(

+( 3nitiates appropriate working relationships with clients

%( :ollows ethical procedures Ae(g( confidentialityB in clientrelationships and in regard to organization issues(


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.5E$,R UN$E,R!$TH

,E5+U5T$ON OF PR5CT$CU !UP,RE$!OR

"#U8S4 $@4- "ounseling 'racticum $N!TRUCTOR- Dr( 6utch 7osey!,,!T,R-VVVVVVVVVV

Super)isor $ame-VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

!UP,RE$!$ON GROUP ,E5+U5T$ON

1( #)erall, what were the strengths of the super)ision group sessionsQ

2( Fow could the super)ision group sessions be impro)edQ

!UP,RE$!OR ,E5+U5T$ON

1( *hat were the strongest aspects of this super)isorQ

2( *hat changes or impro)ements would you recommend for this super)isorQ 6e specific(

P+,5!, R5T, T(, FO++O=$NG

Felpfulness of super)isor feedback-VVVVVery helpful VVVVVFelpful VVVV@inimally helpful VVVV$ot helpful at all

'lease e!plain-

Felpfulness of super)isorled acti)ities and role plays-VVVVVery helpful VVVVVFelpful VVVV@inimally helpful VVVV$ot helpful at all

'lease e!plain-

Ao)erBPlease list an% a##itional comments* concerns* or fee#bac> "ere'

+.


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Prac!ic)* S!)den! S)r0e-De*o(ra",ic In/or*a!ion

*lease provide the following demographic information(

7ender

;;;;;; 2ale KKKKKK 3emale

A(e

KKKKKK 06& KKKKKK )6$0 KKKKKK $16$& KKKKKK $)6!0 KKKKKK !0O

Pro(ra*

;;;;;; Communit-52ental Gealth Trac'

KKKKKK *chool Counseling Trac'

Prac!ic)* Si!e

KKKKKK +n6campus counseling center KKKKKK *chool

KKKKKK Communit-5agenc- KKKKKK +ther 8please specif-9

E


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Prac!ic)* S!)den! S)r0e-

To the practicum student:

This sur"e- is helpful in determining practicum studentsL perceptions of their experiencesneeds and concerns as #eginning clinicians. Please ta'e a few moments to answer thefollowing questions.

Using the following scale, please rate the following statements as they relate to you:

= > ? ' 1Al9a- Mo! o/ !,e !i*e Occaionall- Seldo* Ne0er

1. ( find that ( am "er- anxious #efore a session with a client. & ! $ 1. ( dou#t m- a#ilities to #e a competent and effecti"e counselor. & ! $ 1$. ( experience significant anxiet- #efore and5or during group sessions. & ! $ 1!. ( ha"e trou#le winding down after a da- at m- practicum site. & ! $ 1&. ( tend to ruminate a#out clients wondering if ( did or said the right; thing. & ! $ 1). ( ha"e difficult- asserting m-self with clients. & ! $ 1?. ( internali@e the stress ( experience as a #eginning counselor. & ! $ 1

. ( ha"e a positi"e support s-stem to help me manage m- stress. & ! $ 1

Below is a list of potential educational topics to be taught during future practicum courses.Please rate the degree of helpfulness of the topics using the following scale:

= > ? ' 1E

&. e"eloping a support networ'. & ! $ 1). Techniques for managing self6dou#t and increasing self6efficac-. & ! $ 1?. *elf6exploration exercises. & ! $ 1. Communit- support resources. & ! $ 1

+%


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!elfRating b% t"e !tu#ent Counselor

Date- VVVVVVVVVVVVV "ounselor- VVVVVVVVVVVVVVVVVVVVV "lient- VVVVVVVVVVVVVVVV

Directions8:ollowing a counseling session, please answer the following uestions(

Preparation for t"e $nter)ie& H,! L NO

1( *as 3 physically in good condition and mentally alertQ VVVV VVVV VVVV 2( *as 3 able to spend the entire session with the clientQ VVVV VVVV VVVV &( *as pro)ision made for pri)acy and reasonable freedom from interruptionQ VVVV VVVV VVVV ;( Did 3 ha)e the physical space arranged where we meet so as to suggest welcome and an atmosphere conduci)e to counselingQ VVVV VVVV VVVV.( Did 3 ha)e a background of a)ailable data about the client that

would help me understand him9her better in the inter)iew butwould not pre>udice meQ VVVV VVVV VVVV +( Did 3 ha)e an understanding of pertinent client information so as to personalize informational processes with the clientQ VVVV VVVV VVVV %( *as 3 ready to see the client?s point of )iew, be genuinely helpful, and maintain pri)acy and confidentialityQ VVVV VVVV VVVV

"omments-

9eginning t"e $nter)ie&

1( *as 3 sensiti)e to the client and did 3 use an appropriate approachQ VVVV VVVV VVVV2( *as 3 able to create an atmosphere in which the client was

stimulated to take responsibility for their thoughts9feelings9beha)iorsQ VVVV VVVV VVVV

&( *as 3 successful in maintaining open communication between usQ VVVV VVVV VVVV;( *as 3 rela!ed and genuine with my )erbal and non)erbal

communicationQ VVVV VVVV VVVV

"omments-

This material was adapted from C( Dimick and :( Crause A1


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De)elopment of t"e $nter)ie& Hes L No

1( Did you create an atmosphere that allowed the client to e!pressnegati)e feelingsQ VVVV VVVV VVVV

2( Did the client ha)e the opportunity to release tensionQ VVVV VVVV VVVV &( *as my attitude one of reflecting ob>ecti)ity while e!pressing

caringQ VVVV VVVV VVVV

;( *as 3 sincere and did 3 show genuine respect for the clientQ VVVV VVVV VVVV .( *as my own attitude, as far as 3 know, free from biasQ VVVV VVVV VVVV +( Did 3 follow the leads Acues both )erbal and non)erbalB

suggested by the clientQ VVVV VVVV VVVV %( Did 3 help the client to clarify and e!pand upon positi)e feelingsQ VVVV VVVV VVVVecti)es to work onQ VVVV VVVV VVVV 11( *as the counseling session structured according to a specific

counseling theoryQ VVVV VVVV VVVV

12( Did 3 use accepted and appropriate treatment modalitiesand counseling techniues based on recognized theoreticalorientations and outcome researchQ VVVV VVVV VVVV

1&( Did 3 work entirely under my scope of knowledge, training andlicenseQ KKKK KKKK KKKK

"omments-

Planning for t"e Net !ession

1( *as 3 able to make appropriate treatment recommendationsQ VVVV VVVV VVVV 2( Did 3 facilitate the formulation of a treatment planQ VVVV VVVV VVVV &( Did 3 establish a treatment contract with the client and

make a concerted effort to ensure their needs, related to therapy, ha)e been integrated into the planQ VVVV VVVV VVVV ;( Did 3 terminate the therapeutic relationship at an appropriate

timeQ VVVV VVVV VVVV .( *as 3 sensiti)e to and knowledgeable about the impact of

multicultural issues and di)ersity on my client?s particularproblems and concernsQ VVVV VVVV VVVV

+( *as 3 fle!ible and knowledgeable in determining populationappropriate counseling techniues and therapeutic inter)entionsQ VVVV VVVV VVVV

%( Fa)e 3 identified techniues that might be considered for ne!tsessionQ VVVV VVVV VVVV


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Fa (513) 745-2!20

$nterns"ip at a Glance8 C"ec>list

Note: Start this rocess the semester be!ore beginning your "nternshi e#erience'

Successful completion of "#U$ %%&

3ntent :orms can be found in the back of this handbook

"omplete 3ntent :orm and return with resume attached

Schedule appointment with Dr( 7osey

@eet with Dr( 7osey and recei)e the 3nternship Fandbook

"onfirm 'lacement

8eturn 3nitial 'aperwork Asee 3nternship FandbookB

ttend 3nternship Seminar "lass

3f you will not complete your internship by the end of the semester you must

reuest an e!tension from the "linical "oordinator

'rogress will be monitored through your attendance at regularly scheduled

oncampus meetings

Dr' 9utc" +ose%

Clinical Coor#inator

Department of Counseling

P"one8 0132 701@37

lose%rK.a)ier'e#u

%0


71/75

!C(OO+ COUN!,+$NG !U,R $NT,RN!($P

Students can apply for summer internship Applying does not mean that the reuest will automaticallybe grantedB( The decision to grant summer internship will depend on the student?s need and number ofstudents applying( The summer internship option is only a)ailable to students continuing their placementfrom the spring semester or starting early to participate in acti)ities such as indi)idualized or group workwith students, scheduling, or staff training( Students will be reuired to register and attend classes thatare offered Eune 1.ththrough Euly 1.th( 3f all of the Summer 3nternship "riteria below are met, you canapply using the application form on the ne!t page(

Summer 3nternship "riteria-

1( Lou were enrolled in the spring session #8 your site has reuested that you start early for aspecific reason(

2( Lou will not be completing all your internship hours in the summer term(

&( Lour super)isor will be at the site and a)ailable(;( Lou will ha)e a regular schedule and will not be working from home(

%1


72/75

Application for School Counseling Summer Internship

Date Submitted_______________________________________________

Student Name________________________________________________

Site_______________________________________________________

Site Supervisor_______________________________________________

Do all of the following apply to your request?

[ ] You were enrolled in the spring session O your site has requested that you start early for aspe!ifi! reason" #f an early start is requested$ you plan to be enrolled in the fall semester"

[ ] You will not be !ompleting all your internship hours in the summer term"

[ ] Your supervisor will be at the site and available"

[ ] You will have a regular s!hedule and will not be wor%ing from home"

eason for applying for Summer #nternship &use additional paper as needed'(

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

________________________________________Signature Date

%2


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Cincinnati, Ohio 45207-3226

Phone (513) 745-3655Fa (513) 745-2!20

$ntent Form

linical !ental "ealth ounseling linical #nternship

"omplete this form at least one semester before beginning your internship( 'lease attach a resume(

$ame- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

ddress- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Daytime phone number- VVVVVVVVVVVVVVVVVVVVVVVV

"ell phone number VVVVVVVVVVVVVVVVVVVVVVVVVVVV

4mail VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

'lease list your areas of interest (for e=ample, drugalcohol, eating disorders, college studentpopulation, career, employee assistance, children, adolescents, adults, families&-

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV


Do you already ha)e an internship siteQ VVV yes VVV no3f so, please state name and address of the institution-



*hat type of clinical counseling site are you seeking for your internshipQ

1( VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

2( VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

&( VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV3 would like to begin internship fall9spring9summer (please circle one&semester of 20VVV(

'lease submit this form to Dr( 6utch 7osey Aoffice located in Failstones 21&B( Lou will be contacted byDr( 7osey to schedule your initial appointment regarding your clinical internship(

3r. %utch 9osey

!linical !oordinator

%&


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3epartment of !ounseling

%;


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Fa (513) 745-2!20

$ntent Form

School ounseling #nternship

"omplete this form at least one semester before beginning your internship( 'lease attach a resume(

$ame- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

ddress- VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Daytime phone number- VVVVVVVVVVVVVVVVVVVVVVVV

"ell phone number VVVVVVVVVVVVVVVVVVVVVVVVVVVV

4mail VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV

Do you already ha)e an internship siteQ VVV yes VVV no

3f so, please state name and address of the institution-

VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV


*hat type of school counseling site are you seeking for your internshipQ(check all that apply&

Practicum Handbook Summer 2012

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Transcript of Practicum Handbook Summer 2012