Mpsy Practicum Manual 2017 Uagm Rev Uak Mar2019

MPsy Practicum Manual
Counseling Psychology Training Program

Revised: MAR 2019 UAK
Practicum Manual M. Psy.
Table of Contents
ACKNOWLEDGMENT OF RECEIPT AND UNDERSTANDING ............................................................. 4
COUNSELING PSYCHOLOGY TRAINING PROGRAM ......................................................................... 5
COURSES ......................................................................................................................................... 5
GOALS.............................................................................................................................................. 6
CRITERIA FOR APPROVED PRACTICUM SITES AND TRAINING ........................................................ 7
REQUIREMENT FOR THE APPROVAL OF A PRACTICUM SITE ........................................................................ 8
PRACTICUM REQUIREMENTS FOR STUDENTS ................................................................................ 9
PRACTICUMS I-II .......................................................................................................................... 9
PRACTICUM III –IV ..................................................................................................................... 10
PRACTICUM III:.............................................................................................................................. 10
PRACTICUM IV: PSYCHOTHERAPEUTIC INTERVENTION II ......................................................................... 12
PROGRESS EVALUATION (PRACTICUM III AND IV)........................................................................ 13
STUDENT EVALUATIONS................................................................................................................... 13
EVALUATION OF RELATIONS COMPETENCE .......................................................................................... 13
SITE AND SUPERVISOR EVALUATION ................................................................................................... 13
GRADING OF THE COUNSELING PSYCHOLOGY PRACTICE ............................................................ 13
ETHICAL STANDARDS .................................................................................................................... 13
DRESS CODE .................................................................................................................................. 14
DOCUMENTATION OF CLINICAL ACTIVITIES ................................................................................. 14
SUPERVISION................................................................................................................................. 14
DOCUMENTATION OF TIME IN CLINICAL TRAINING ..................................................................... 15
EVALUATION FORMS .................................................................................................................... 15
GUIDELINES AND PROCEDURES .................................................................................................... 15
DUAL ROLE OF PRACTICUM SUPERVISORS NOT ALLOWED.......................................................... 16
ASSIGNMENT OF PRACTICUM SITES ............................................................................................. 16
HANDLING CLINICAL EMERGENCIES ............................................................................................. 16
PRACTICUM PROCESS GENERAL SCHEDULE ................................................................................. 18
APPENDIX A: SUPERVISION CONTRACT ........................................................................................ 19
APPENDIX B: SUPERVISION LOG ................................................................................................... 25
APPENDIX C: EVALUATION OF STUDENTS COMPETENCIES .......................................................... 27
APPENDIX D: ASSESSMENT OF PRACTICUM STUDENT COMPETENCIES ...................................... 31
2
Practicum Manual M. Psy.
APPENDIX E: SUPERVISOR EVALUATION FORM ........................................................................... 39

APPENDIX F: EVALUATION OF PRACTICUM SITE .......................................................................... 43
APPENDIX G: EVALUATION OF CASE CONCEPTUALIZATION PROCESS FORM & EVALUATION OF
PSYCHOLOGICAL ASSESSMENT PROCESS FORM .......................................................................... 45
APPENDIX H: REMEDIAL PLAN FORM ........................................................................................... 48
APPENDIX I: DIRECT OBSERVATION DEFINITION AND GUIDELINES ............................................. 50
3
ACKNOWLEDGMENT OF RECEIPT AND UNDERSTANDING
I, ___________________________________________, Practicum Student of the Graduate Psychology

Student’s Name and Id Number
Program have read the Practicum Manual. I understand the implications that the Graduate Practicum
requires. I make the compromise to abide to the policies and procedures that are presented in this
manual. I also agree to adhere to the APA Code of Ethics and the Puerto Rico Psychology Board Code of
Ethics. If I don’t understand any policy stated in this document, I make the commitment to communicate
it to my primary supervisor and/or my Practicum Coordinator.
__________________________________ ______________
Student Signature Date
Note: This document must be included in the Practicum Record

Practicum Manual MPsy
COUNSELING PSYCHOLOGY TRAINING PROGRAM

A major objective of the Counseling Psychology Training Program (CPTP) is to enable students to
acquire the required competencies for the practicum in counseling psychology, which include assessment,
diagnosis, counseling/psychotherapy and other professional interventions. In addition, the program
strives to enhance students’ professional development through identification with Counseling Psychology
as a professional specialty and the incorporation of the American Psychological Association (APA) ethical
principles and standards for practice. In order to comply with program objectives, students are required
four semesters of practicum. This manual will describe the goals and procedures for the practicum
experience.
COURSES
The practicum component of the program has been structured in a sequential manner to foster
the progressive acquisition of clinical skills. The sequence is presented below.
Number of
Practicum
Practicum Coding and Name Year & Semester
Hours
PSYC 550-Practicum I: Initial Interview and Psychological Contract Year 1: Term 4 30
PSYC 551-Practicum II: Conceptualization and Intervention Planning Year 2: Semester 1 50
PSYC 574-Practicum III: Psychotherapeutic Intervention I Year 2: Semester 2 220
PSYC 599-Practicum IV: Psychotherapeutic Intervention II Year 3: Semester 1 220
During the fourth term of the first year, students register in PSYC 550 where they will develop
basic interviewing and counseling skills. During the second year students register in PSYC 551 where they
will complete a minimum of 50 hours on the development of conceptualization and basic intervention
planning skills. This experience will provide students the opportunity to practice clinical skills within the
safe environment offered by the Standardized Patient Program.
Following the approval of PSYC 551, students will complete 490 hours of clinical practicum in a
designated clinical site while they are registered in PSYC 574* and PSYC 599 clinical practicum. The clinical
experience in practicum sites allows students to have a deeper exposure to clinical work and to spend
more time in the acquisition and refinement of clinical skills as well as in performing cognitive assessment
procedures. Students have the opportunity to practice case conceptualization and treatment planning at
5
their practicum sites. The instructional component of PSYC 600 focuses on the discussion and application
of interventions, especially in Counseling Psychology techniques. At their practicum sites, students
perform intake assessments, mental status examinations, case conceptualizations, treatment plans, and
provide individual or group counseling and psychotherapy. A licensed counseling or clinical psychologist
supervises students at their practicum sites.
*The Cognitive Assessment Course (PSYC 505) is a prerequisite for PSYC 574. This course includes 30 hours
of practicum, which students must complete to pass the course.
GOALS
The APA Accreditation Handbook describes the goals of practicum training as facilitating the
development of knowledge and skills in the following areas:
1. Understanding of and commitment to professional and social responsibility as defined by the
statutes of the ethical code of the profession.
2. The capability to conceptualize human problems.
3. Awareness of the full range of human variability within the dimensions of Puerto Rico.
4. Understanding of one’s own personality and biases and of one’s impact upon others during
professional interaction.
5. Skills in relevant interpersonal interactions such as systematic observation of behavior,
interviewing, psychological testing, psychotherapy, counseling, and consultation.
6. Contribution to current knowledge and practice.
7. Application of different theoretical models in evidence based practices (EBP).
In addition, the following list specifies Counseling Psychology Training Programs (CPTP) goals for
practicum training. Students will:
1. apply ethical principles and the ethical decision making model in interactions at their setting
2. gain knowledge of the structure and routine associated with a counseling setting, as well as fully
participate as a professional in the setting
3. use assessment strategies in defining and appraising client concerns, including behavioral
observations, interviewing skills and/or formal tests
4. work with clients in goal setting and identify ways to evaluate whether these goals have been
achieved
6
5. demonstrate knowledge and use of basic counseling skills including:

a. attending skills
b. empathy
c. application of theory and change in the evidence based interventions
6. appropriately use supervision and consultation in on-site supervision by:
a. conducting case discussions
b. reviewing sessions tapes
c. identifying problem areas
d. incorporating feedback from the supervisor
e. interacting with clients
f. interacting with other professionals
7. use the practicum experience to continue developing their competence in dealing with diversity
issues in counseling by:
a. examining awareness of self and issues in diversity
b. developing skills to incorporate in counseling with diversity
c. gaining knowledge of other’s experiences and contexts
8. focus, in class, on refining their skills in case conceptualization, differential diagnosis and the
preparation of treatment plans
CRITERIA FOR APPROVED PRACTICUM SITES AND TRAINING

Practicum sites must be familiar with and approved by the CPTP following these criteria:
1. The practicum site must be a service agency with training as one of its major functions.
Psychological services at the location should conform to all relevant APA standards and guidelines
and the regulation and code of ethics of the Puerto Rico Board of Examiners.
2. The site should provide students with a high degree of access to professional psychologists who
will serve as appropriate role models.
3. The site should provide at least:
a. 16 hours of practicum experience per week, including at least 8 hours of client contact
per week.
b. One (1) hour of individual supervision by a licensed doctoral level psychologist per week.
7
c. Other practicum activities that may include attending investigations, case conferences,
report writing, taking clinical notes, etc.
4. Practicum sites should not require more than 25 hours of students’ time per week. However, in
negotiation with practicum site supervisors, students may choose to commit more time to their
practicum activities according to their training interests and needs, and in consideration of other
demands, they may have.
5. The beginning and end of the practicum will be established by the Practicum Site taking in to
consideration that the semester starts in January or August, and that they need to fulfill their
responsibilities of providing the minimum academic requirements established by the program
before the end of the semester (May or December), nevertheless the student must continue at
the Practicum Site until they have completed all their clinical load.
Requirement for the Approval of a Practicum Site

The program welcomes and encourages the gesture of students in increasing the approved
practicum sites. For a Practicum Site to be approved by the Counseling Psychology Program the agency
must abide by the criteria presented in the previous section, fill and sign the Practicum Agreement and
the Acknowledgment of Receipt and Understanding, and with the following process.
1. Student requesting a new center or an Agency must submit the following information with at
least three months before the beginning of the practicum experience. (Since practicum
centers may not necessary be approved on time, students shall apply to other approved
centers in order to enhance the possibility of admittance to an approved center by the
commencement of the semester).
a. Name of the Agency/Institution
b. Postal and Physical Address, telephone, fax and email
c. Puerto Rico Treasury Department Commerce Registration Number
d. Employer ID Number
e. Agency Director’s Name and email
f. Primary and Secondary Supervisors Curriculum Vitae, phone number and email
g. Primary and Secondary Supervisors Psychology License
2. The Practicum Coordinator will review the application and will present to the program
associate dean for final approval.
3. The Practicum Coordinator will contact the Agency for the signature of the practicum contract
8
4. Once approved by the Associate Dean, and the contract is signed by the Agency, the
application will be submitted to UAGM administration for processing
5. The Counseling Psychology program will process the malpractice insurance with SUAGM
Administration
6. NO STUDENT WILL BE APPROVED TO BEGIN AT THE PRACTICUM AGENCY WITHOUT AN
APPROVED AND SIGNED CONTRACT BY ALL PARTIES AND WITHOUT THE ISSUANCE OF THE
MAL PRACTICE INSURANCE.
7. Practicum centers in which all legal and administrative procedures and documentation have
not been officially approved 15 days prior to the commencement of the academic semester
in which the practicum is to be taken will not be available as practicum centers during such
semester and the student will have to resort to other centers for placement.
PRACTICUM REQUIREMENTS FOR STUDENTS

1. Students are required two semesters of practicum (PSYC 574 and PSYC 599) at an approved
practicum site.
2. The two-semester required practicum experience cannot be waived.
3. Student must have taken Practicum PSY 550 and PSYC 551 prior to Practicum III.
4. Waivers for these requirements must be formally submitted in a written format. Requests for
waivers must include the requirement that the student is requesting to be waived from, and
compelling reasons for the waiver. These must be submitted to the Practicum Coordinator, who will
assess and requests approval from the Associate Dean.
5. Practicum III must be approved with a P grade prior to beginning Practicum IV.
6. Compulsory attendance to meetings and seminars scheduled by the Practicum Coordinator.
Activities could be scheduled during the day. The student must make arrangements to attend to the
scheduled activity. If the student cannot participate in the scheduled activity, he/her must attend to
a continued education activity and provide proof of participation to the Practicum Coordinator.
7. Students must make arrangements at their workplace to adjust to their practicum site attendance
necessity.
PRACTICUMS I-II
 Practicum I: Initial Interview and Psychological Contract
9
o PSYC 550: Didactic and experience approach in the development of skills related to the
establishment of the therapeutic relationship (self-evaluation, control of feelings, attitudes
and prejudices towards the client and behavior), and the initial interview.
o Practice hours: 30
o Student Evaluation Criteria: B is the minimum required grade for the PSYC 550 practicum.
Students must pass Practicum I to enroll in Practicum II.
o Practicum Professor must create a Student Record with the following documents:
 Acknowledgement of Receipt and Understanding (page 4)
 Evaluation of Student’s Competencies (Appendix C)
 Samples of student’s work at class and evaluation criteria
Students are responsible of creating the file and deliver it to the practicum professor at
the beginning of the semester. The practicum professor must deliver the complete record to the
Practicum coordinator at the end of the semester.
 Practicum II: Conceptualization and Intervention Planning
o PSYC 551: This course provides the prospective counseling psychologist the necessary
experience to deal with the diagnosis, conceptualization, and development of a psychological
intervention plan within in the code of ethics of the profession.
o Practice Hours: 50
o Student Evaluation Criteria: B is the minimum required grade for the PSYC 551 practicum.
Students must pass Practicum II to enroll in Practicum III.
o Practicum Professor must create a Student Record with the following documents:
 Acknowledgement of Receipt and Understanding (page 4)
 Evaluation of Student’s Competencies (Appendix C)
 Samples of student’s work at class and evaluation criteria
Students are responsible of creating the file and deliver it to the practicum professor at
the beginning of the semester. The practicum professor must deliver the complete record to the
Practicum coordinator at the end of the semester.
PRACTICUM III –IV

Practicum III:
o PSYC 574: This practicum offers students direct experience in psychological intervention.
Individual, couples and family assessments, as well as counseling and psychotherapy provide
10
students the opportunity to apply different theoretical models in evidence-based

interventions. A minimum of 220 hours of clinical practice and 30 hours of didactic course
meeting are required.
o Passing Criteria
 Practice hours: a minimum of 220 hours and at least 90 hours of direct clinical contact
(40% for face-to-face contact).
 Minimum requirements, at the end of semester: students must prove intermediate
level competence of clinical skills following the evaluation guidelines stated in the
Assessment of Practicum Student Competencies in Appendix C. To achieve such
competencies students will complete as many assessment and/or interventions as
the supervisor understands necessary.
 Student Evaluation Criteria: students must approve both the didactic requirement of
the course and the clinical competencies required in the Practicum Site. Student must
obtain a minimum of 80% on both evaluations to approve the practicum.
 Student Documentation: All documentation required for the practicum file will be
collected by the Practicum Professor and delivered to the Practicum Coordinator at
the end of the semester. The required documents include the:
o Acknowledgement of Receipt and Understanding (page 4)
o Supervision Contract (Appendix A)
o Supervision Log (Appendix B)
o Assessment of Practicum Student Competencies
o Evaluation of Student Competencies
o Practicum Program Evaluation by Students
o Evaluation of Case Conceptualization Process Form from two (2)
different cases.
o Evaluation of Psychological Assessment Process Form from two (2)
different cases. If the Practicum Center does not provide
Psychological Assessment, the Center must certify it, at the beginning
of the semester, with a formal letter to the Practicum Coordinator.
11
Practicum IV: Psychotherapeutic Intervention II

o PSYC 599: This practicum provides students the opportunity to enhance the
psychotherapeutic intervention skills acquired in PSYC 574. Emphasis is given to the
integration of knowledge and skills on evidence based practices in psychological interventions
and ethical issues solving models. A minimum of 220 hours of clinical practice is required.
o Passing Criteria
 Practice hours: a minimum of 220 hours and at least 90 hours of direct clinical contact
(40% for face-to-face contact).
 Minimum requirements, at the end of semester: students must demonstrate
intermediate level competence of the clinical skills following the evaluation guidelines
stated in the Assessment of Practicum Student Competencies in Appendix C. To
achieve such competencies, the student will complete as many assessment and/or
interventions as the supervisor understands necessary.
 Student Evaluation Criteria: students must approve the clinical competencies
required for the Practicum Experience with at least 80% or more. Failure to meet the
minimum requirement will result in a NP.
 Student Documentation: All required documentation for the practicum file will be
collected by the Practicum Coordinator during the semester on the established dates.
The required documents include the:
o Acknowledgement of Receipt and Understanding (page 4)
o Supervision Contract (Appendix A)
o Supervision Log (Appendix B)
o Assessment of Student Practicum Competencies
o Evaluation of Student Competencies
o Practicum Program Evaluation by Students
o Evaluation of Case Conceptualization Process Form from two (2)
different cases.
o Evaluation of Psychological Assessment Process Form from two
(2) different cases. If the Practicum Center does not provide
Psychological Assessment, the Center must certify it, at the
beginning of the semester, with a formal letter to the Practicum
Coordinator.
12
PROGRESS EVALUATION (Practicum III and IV)

Student Evaluations
Students receive two performance evaluations from their site supervisor each semester. The first
evaluation is conducted during the middle of the semester and the second at the end of the semester.
The supervisor will use the evaluation form included in Appendix D. Students will also be evaluated by the
professor twice during the semester for the didactic part of the Practicum (PSYC 574) using the evaluation
form included in Appendix C.
Evaluation of Relations Competence
The supervisor and the professor will also complete and submit the Relations Competence Area
of the Student Evaluation for each supervisee twice during the semester. Any concern in this area will
receive immediate attention by the Universidad Ana G. Méndez Counseling Psychology Program (CPP)
and the program’s administration.
Site and Supervisor Evaluation
The student will evaluate the practicum site and the work done by the clinical supervisor at the
end of the practicum experience. The evaluation form is included in Appendix E & F.
In each practicum, the student has the responsibility to obtain and submit all the evaluations and
other practicum requirements to the CPP. No grade will be posted in the student’s transcript until all
evaluation forms have been submitted.
GRADING OF THE COUNSELING PSYCHOLOGY PRACTICE

Practicum hours are credited by the office of the CPP, based on the practicum log that the student
must submit each month through the www.time2track.com web site, which is verified and approved by
the student’s clinical supervisor. If the student’s performance is evaluated as satisfactory by the practicum
supervisor and the professor and the number of hours logged for the semester is acceptable, the CPP will
certify the student’s practicum approval by using the designated “Approve” (AP) or “Not Approved”
(N/AP). In special circumstances, an “In Progress” (IP) can be granted. Each case has to be consulted with
the Practicum Coordinator prior to registering the grade.
ETHICAL STANDARDS
Students will abide by the ethical standards of the American Psychological Association and the
Regulations and Ethic of the Puerto Rico Psychology Board of Examiners with regards to professional
13
behavior and to the delivery of clinical services. Students will follow all Universidad Ana G. Méndez
(UAGM) rules and regulations and will conduct themselves according to the applicable legal standards.
Any concern about the student’s professional behavior in the clinical setting will be addressed according
to UAGM policies and due process.
The safety of clients and issues related to dual relationships are considered among the most
important aspects of ethical behavior to be observed by all students. It is the student’s responsibility to
evaluate the potential of danger to him /herself or others in the clients served. Likewise, situations related
to child or elderly abuse need to be reported according to the applicable law. Issues regarding domestic
violence and abuse to women and children in any form will be handled with utmost care.
DRESS CODE
The way that students dress to attend their clinical sites has particular significance at different
levels. Adequate clothing transmits a sense of professionalism and respect for patients and the
professional staff at the training site. Attire should be consonant with the practice settings, weather and
time of day. Shorts, sneakers, jeans, skin-tight female pants that expose portions of the body are
unacceptable clothes to be worn at the practicum sites. However, when predominantly working with
children, less formal clothing are usually permitted as well as when the specific situation requires it. Male
students are encouraged to consider using long or short sleeves shirts and a tie.
DOCUMENTATION OF CLINICAL ACTIVITIES

Student will document each intervention that they have performed with a patient, collaterals or
with any other person involved in the case. The student will use whichever system is required by their
Practicum site. When the Practicum Site does not promote a particular system, students are
recommended to utilize SOAP. Students need to remember that failure to document sessions or crucial
information about the patients being served constitutes a serious infraction to their ethics of clinical
practice.
SUPERVISION
Students will have at least one hour of individual supervision each week. Students may cancel a
supervision appointment only when the circumstances that prompts such cancellation justifies such
action. Any supervisor may require objective proof of such justification. All supervisory session will be
documented and countersigned by the supervisor in the Supervision Log (Appendix B). During each
14
practicum experience, the supervisor must perform live supervision/direct observation of the supervisee
performance in at least four different cases. This experience must be properly documented. See appendix
I for further details on direct observation.
DOCUMENTATION OF TIME IN CLINICAL TRAINING

Students will report their Clinical Practice Hours to and obtain certification from their site
supervisor each month. Clinical Practice Hours research experience will be reported using the electronic
platform required by the Graduate Program. Students will assume the cost of accessing the webpage. A
fee will be billed to the student in their registration during PSYC 575 (Practicum III) that will pay for the
access to the platform for one year. After students have registered their clinical hours, they will ask their
clinical supervisor to verify and validate the information they have reported. Once verified, the
information on the web page will be sent to the CPP and stored in the student’s file. Hours that are not
validated at the digital platform by the clinical supervisor will not count for the minimal hour’s
requirement.
EVALUATION FORMS
In addition to the monthly log, practicum students have the responsibility of obtaining and
submitting all the original required evaluations on time to the CPP office. These include the:
 Supervision Contract: at the beginning of every year (Appendix A)
 Student Evaluation by Supervisor: mid and end of semester (Appendix C)
 Evaluation of Relation Competency by Supervisor: one each semester (Appendix C)
 Site and Supervision Evaluation by Student: end of semester (Appendix D & E)
GUIDELINES AND PROCEDURES

Students are encouraged to learn about the variety of available practicum sites so they can select
a suitable site that fits their training interests and needs and can optimize their practicum experience.
Students should consider the type of clientele the setting serves, the nature of the activities they will be
involved in, the models for assessment and intervention represented by the practicum site staff, and any
minimal requirements that the Practicum Site may have (e.g., some sites require students to make a two-
semester commitment or to have additional training in assessment). Information about the practicum
15
sites is available at the program administrator’s office. Students are encouraged to consult their selection
of practicum sites with their Practicum Coordinator and adviser.
DUAL ROLE OF PRACTICUM SUPERVISORS NOT ALLOWED.

Students should not be supervised by a supervisor who has been or is currently working with them
as a therapist or counselor.
ASSIGNMENT OF PRACTICUM SITES

Practicum assignments are typically selected in May and November for the following two
semesters. Students are required to submit requests to the practicum coordinator in March for the August
placement and in October for the January placement. The Practicum Coordinator organizes the practicum
assignments for students requesting practice with the goal of optimizing the “fit” between the students’
training needs and their expressed interests with the demands of and the opportunities provided at the
various training sites. Most practicum sites may request an interview with prospective students to ensure
that they are well-informed on what the site has to offer and to ensure a good “fit” between their interests
and skills and the opportunities and demands of the practicum setting. Students must pass thru, at least,
three interview process at three different sites. Students are informed of their practicum assignments by
the end of December and May respectively. Students must be aware that the final selection for a
practicum site is contingent to the approval of such site.
It is the responsibility of the Graduate Program to have a list of approved practicum sites so that
the student may apply. Students are not guaranteed acceptance to practicum sites. Therefore, it is
required that students apply to at least three (3) practicum centers in order to enhance the possibilities
of selection. Those students that are not accepted will have to re-apply for the following practicum cycle.
It is expected that unaccepted student meet with the practicum coordinator to assess the possible
competency’s deficiencies that may have contributed for him/her not being accepted.” In special
circumstances, students may be allowed to propose new practicum sites. However, the final approval of
such sites relies on such site to meet the minimum requirements established by the graduate program.
Such approval must have been completed before the initiation of the practicum semester.
HANDLING CLINICAL EMERGENCIES

Students will identify the site supervisor designated to assist them in handling crisis/emergency
situations. Students will request a copy of the procedures utilized in their Practicum site to address
16
emergencies. Cases that may be potentially dangerous or at risk of deteriorating will immediately be
supervised by the corresponding supervisor. If the site supervisor is not available at the time when the
emergency occurs, students will call a Universidad Ana G. Méndez supervisor or advisor for instructions
and support. In the absence of such person, the student will contact the CPP. If contact with this person
through the cellular phone is not possible, the student will call the Program’s office and contact the
Program Director or any other clinical professor available.
17
PRACTICUM PROCESS GENERAL SCHEDULE

ACTIVITY For practicum For practicum BY WHOM
beginning in beginning in January
August
Practicum Coordinator By the first Friday By the third Friday of Practicum
notifies and offers students of April October Coordinator
practicum site.
Student submission of March 15 October 15 Student
practicum application
placement form
Submission of March 15 for October 15 for January Student or Agency
documentation for the August Placement placement
approval of new practicum
sites
Students are given clearance April November Students
for interview at sites.
Evaluation of Practicum By the third Friday By the third Friday of Site Supervisor
Experience (mid semester) of October of the March of the same Professor
same semester semester Students
Final Evaluation for A week before the A week before the last Site Supervisor
Practicum Experience last day of the day of the academic Professor
academic semester semester Students
18
APPENDIX A: SUPERVISION CONTRACT

Universidad Ana G. Méndez
Supervision Contract
Name of Supervisee: ________________________________________

Supervisor: __________________________ Training Site: ___________________________
Degree: ________ Specialty: ____________________ License #_________
Supervisor Phone: ___________________ Supervisor Email: ___________________________
Instructions:
This contract must be filled and signed within the first week of the practicum experience
between the supervisee and the primary supervisor. A copy of this contract with the practicum goals
must be submitted to the Practicum Coordinator within the first two weeks of the Practicum.
1. Goals of Supervision
a. Monitor and ensure welfare and protection of clients of the Supervisee.
b. Gatekeeper for the profession to ensure competent professionals enters.
c. Promote development of Supervisee's professional identity and competence.
d. Provide evaluative feedback to the Supervisee.
2. Structure of Supervision
a. The primary supervisor during this training period will be ____________________, who
will provide ______ hours of supervision per week. The delegated supervisor(s) during
this training period will be ______________________________, who will provide _____
hours of supervision per week.
b. Structure of the supervision session: supervisor and supervisee preparation for
supervision, in-session structure and processes, live or video observation _____times
per ______ semester (minimum of four times per semester; twice per evaluation
period).
c. Limits of confidentiality exist for supervisee disclosures in supervision. (e.g., supervisor
normative reporting to graduate programs, licensing boards, training teams, program
directors, upholding legal and ethical standards).
d. Supervision records are available for licensing boards, training programs, and other
organizations/individuals mutually agreed upon in writing by the supervisor and
supervisee.
19
3. Duties and Responsibilities of Supervisor

a. Assumes legal responsibility for services offered by the supervisee.
b. Oversees and monitors all aspects of client case conceptualization and treatment
planning, assessment, and intervention including but not limited to emergent
circumstances, duty to warn and protect, legal, ethical, and regulatory standards,
diversity factors, management of supervisee reactivity or countertransference to client,
strains to the supervisory relationship.
c. Ensures availability when the supervisee is providing client services. Be available to the
supervisee in person or electronically 100% of the time when the supervisee are
rendering professional services, or arrange the availability of a qualified supervisor
d. Reviews and signs off on all reports, case notes, and communications.
e. Develops and maintains a respectful and collaborative supervisory relationship within
the power differential.
f. Practices effective supervision that includes describing supervisor’s theoretical
orientations for supervision and therapy, and maintaining a distinction between
supervision and psychotherapy.
g. Assists the supervisee in setting and attaining goals.
h. Provides feedback anchored in supervisee training goals, objectives and competencies.
i. Provides ongoing formative and end of supervisory relationship summative evaluation
on forms available at the Practicum Manual.
j. Informs supervisee when the supervisee is not meeting competence criteria for
successful completion of the training experience, and implements remedial steps to
assist the supervisee’s development.
k. Discloses training, licensure including number and state(s), areas of specialty and special
expertise, previous supervision training and experience, and areas in which he/she has
previously supervised.
l. Reschedules sessions to adhere to the legal standard and the requirements of this
contract if the supervisor must cancel or miss a supervision session.
m. Maintains documentation of the clinical supervision and services provided.
n. If the supervisor determines that a case is beyond the supervisee’s competence, the
supervisor may join the supervisee as co-therapist or may transfer a case to another
therapist, as determined by the supervisor to be in the best interest of the client.
20
o. The beginning and end of the practicum will be established by the Practicum Site taking
in to consideration that the semester starts in January or August, and that they need to
fulfill their responsibilities of providing the minimum academic requirements
established by the program before the end of the semester (May or December),
nevertheless the student must continue at the Practicum Site until they have completed
all their clinical load.
4. Duties and Responsibilities of the Supervisee

a. Understands the responsibility of the supervisor for all supervisee professional practice
and behavior.
b. Implements supervisor directives, and discloses clinical issues, concerns, and errors as
they arise.
c. Identifies to clients his/her status as supervisee, the name of the clinical supervisor, and
describes the supervisory structure (including supervisor access to all aspects of case
documentation and records) obtaining client’s informed consent to discuss all aspects of
the clinical work with the supervisor.
d. Attends supervision prepared to discuss client cases with completed case notes and
case conceptualization, client progress, clinical and ethics questions, and literature on
relevant evidence-based practices.
e. Informs supervisor of clinically relevant information from client including client
progress, risk situations, self-exploration, supervisee emotional reactivity or
countertransference to client(s).
f. Integrates supervisor feedback into practice and provides feedback weekly to supervisor
on client and supervision process.
g. Seeks out and receives immediate supervision on emergent situations. Supervisor
contact information: ____________________________________.
h. If the supervisee must cancel or miss a supervision session, the supervisee will
reschedule the session to ensure adherence to the legal standard and this contract.
i. The beginning and end of the practicum will be established by the Practicum Site taking
in to consideration that the semester starts in January or August, and that they need to
fulfill their responsibilities of providing the minimum academic requirements
established by the program before the end of the semester (May or December),
21
nevertheless the student must continue at the Practicum Site until they have completed
all their clinical load.
A formal evaluation of the student competencies will be conducted on: _____________ for the mid
semester evaluation when a review of the specific goals (described below) will be made and a final
evaluation of the student competencies will be held on _______________.
We, _______________________ (supervisee) and ____________________________ (supervisor) agree
to follow the parameters described in this supervision contract and to conduct ourselves in keeping with
the Puerto Rico Psychology Licensing Board Code of Ethics and Regulations, American Psychological
Association Ethical Principles and Code of Conduct and all applicable federal and/or state law.
Dates Contract is in effect: Start date: _____________ End date: ________________
Mutually determined goals and tasks by Supervisor and Supervisee to accomplish (and updated upon
completion).
___________________________ _____________
Primary Supervisor Signature and License num. Date
___________________________ _____________
Supervisee Signature Date
22
Practicum Supervision Goals

Within the first week of the practicum experience, the supervisee and the supervisor must establish the
specific goals to be addressed during this period. These goals should take into account supervisee
previous experiences, strengths and areas to improve, and supervisor’s areas of competence. The goals
should be revised periodically in supervision.
The following goals are established by the graduate program to ensure a proper supervision
relationship. These goals are not negotiable.
Goal 1:
Establish a scheduled supervision. A supervisee must receive a minimum of one hour of individual (face
to face) supervision per week with the primary supervisor. Tele-supervision is not acceptable at this
level.
Task for Supervisee:

1. Establish with the supervisor a specific time during the week when the individual supervision
will take place.
2. Is the responsibility of the supervisee to assist prepared for supervision and to record the issues
addressed during the supervision in the form provided in Appendix B of this manual.
3. If a supervision cannot be held, the supervisee must coordinate a new appointment for the
individual supervision during the same week
Task for Supervisor
1. Establish with the supervisee a specific time during the week when the individual supervision
will take place.
2. If a supervision cannot be held, the supervisee must coordinate a new appointment for the
individual supervision during the same week
Goal 2:
At least one time per semester, the supervisor will participate in a live session (e.g. in the same room,
thru video monitor, or two way mirror) with the supervisee. The supervisor will observe thru direct
observation (e.g. one-way mirror, live video or video recording) one session of, at least, three different
cases per semester. These activities must be logged in the supervision log on Appendix B.

1. A proper consent must be signed by the client to inform that these activities will take place.
2. ______________________________________________________________________
3. ______________________________________________________________________
Task for Supervisor
1. Review the consent informing the client of these activities.
2. ______________________________________________________________________
3. ______________________________________________________________________
23
Specific goals established by the primary supervisor with the supervisee. These goals can be
periodically reviewed. Add as many pages as needed.
If new goals has been established, send a copy to the Practicum Professor immediately.
Goal ______:
_____________________________________________________________________________________
____________________________________________________________________________________
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
Task for Supervisor
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
Goal ______:
_____________________________________________________________________________________
____________________________________________________________________________________
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
Task for Supervisor
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. ______________________________________________________________________________
24
APPENDIX B: SUPERVISION LOG

Supervision Log
Name of Supervisee: _________________________________

Primary Supervisor: __________________________ Training Site: ___________________________
Degree: ___________ Specialty: ________________________ License #___________
Primary Supervisor Phone: ___________________ Supervisor Email: ___________________________
Supervision
Format Supervisee Supervisor
Date Duration Issues Addressed
Individual (I) or Initials Initials
Group (G)
25
Supervision
Format Supervisee Supervisor
Date Duration Issues Addressed
Individual (I) or Initials Initials
Group (G)
Note: Add as many pages as needed. This log must be submitted to the Practicum Coordinator with the mid semester and final evaluation.
26
APPENDIX C: EVALUATION OF STUDENTS COMPETENCIES

Counseling Training Psychology Program
Evaluation of Student’s Competencies
PSYC 574
Student Name: _____________________________ Student #: _____________

Professor’s Name: _______________________________________
Professor’s Signature: ____________________________________
This evaluation should be performed by the PSYC 575 Practicum Professor who will only evaluate the
student’s performance in class.
Instructions: Use the following rating scale to rate your supervisee.

1 2 3 4 5
Unsatisfactory Needs improvement Adequate Good Excellent
PART I
EVALUATION OF STUDENT CLINICAL COMPETENCIES IN CLASS
Basic Conceptualization Skills
1. ______Coherently summarizes client concern(s) and possible contributing/relevant factors.
2. ______Articulates a general plan for addressing the client’s concern in therapeutic work.
3. ______Description of interventions is consistent with actual behavior observed on videotape.
4. ______Demonstrates awareness and understanding of process factors by describing their presence or
possible impact on the therapeutic relationship or work.
5. ______Able to reflect upon and analyze the activities of the therapy hour.
Basic Intervention Skills

6. ______Interprets: offers possible explanations for certain behaviors, feelings, and thoughts.
7. ______Confronts: appropriately challenges client to look at discrepancies and conflicting messages.
8. ______Is sensitive to timing and appropriateness of interventions.
9. ______Maintains facilitative balance between support and challenge.
10. ______Works at uncovering and intensifying client affect when appropriate.
11. ______Works at helping client manage affect when appropriate.
12. ______Makes appropriate use of immediacy in therapy hour.
13. ______Integrates material into meaningful theme or coherent goal for session.
27
Openness to Supervision/Training
14. ______Is open to feedback and suggestions.
15. ______Accepts responsibility for learning.
16. ______Prepares for supervision (e.g., has questions/topics ready, queued video, etc.).
17. ______Is willing to examine and critique own work.
18. ______Willing to self-disclose and/or explore personal issues that affect counseling process.
19. ______Able to articulate own sense of clinical strengths.
20. ______Able to articulate own sense of clinical limitations.
21. ______Explores issues of professional identity for self.
22. ______Utilizes language that demonstrates sensitivity to cultural, gender, and sexual orientation
issues.
Sensitivity to Diversity Issues

23. ______Utilizes language that demonstrates sensitivity to cultural, gender, and sexual orientation
issues.
24. ______Demonstrates comfort in raising issues of difference or diversity during sessions.
25. ______Asks questions or offers suggestions that help clients to think about how systemic issues may
impact on their presenting concerns.
26. ______Directly addresses issues of difference between therapist and client along salient dimensions in
therapy.
27. ______Brings up and processes issues of cultural difference and diversity.
*To score, add all the points and write these in the appropriate space at the end of the document.
PART II
EVALUATION OF STUDENT’S COMPETENCY OF RELATIONS
Instructions: Use the following rating scale to rate your student on the following table.
Rating Explanation:
5 = Excellent: Student’s performance was at an exceptionally high level.
4 = Very Good: Student’s performance was solidly competent, clearly above average, and
characterized by absence of difficulties.
3 = Good: Student’s performance was basically competent and fulfilled requirements. There were
no major problems and the work was adequate.
2 = Satisfactory with Possible Concerns: Student’s performance was acceptable, but there were
some weaknesses or concerns which, though minor, might require some remediation or corrective
action, as noted in the comment section.
28
1 = Satisfactory with Concerns: Student’s performance was minimally acceptable; there was a
major problem or some minor difficulties that identify a need for remediation/corrective action,
as noted in the comment section.
0 = Unsatisfactory: Student’s performance was unacceptable; there were several major problems
that identify a need for remediation/corrective action, as noted in the comment section.
Dimension Rating Comments

Please explain any score of ‘1’, ‘2’, or ‘0’
1. Respectful Interpersonal Behavior
Towards Supervisor(s) Peers
2. Punctuality/Attendance
3. Level of Participation/Preparedness
4. Use/Integration of Theory with
Practice
5. Clinical Sensitivity
6. Sensitivity and Awareness
7. Insight and Use of Self
8. Appropriate Affect Modulation
9. Ethical Competence
10. Professional Values and Attitudes
11. Organizational and Systems
Awareness
12. Openness to Feedback
13. Written and Communication Skills
Total Points
29
Summary of Evaluation of Student Competencies
Part Total Points Percentage

Part I: Clinical Competencies
(135 points)
Part II: Relations Competency
(65 points)
Total
(200 points)
To pass this part of the Practicum the student must obtain at least 80% on the evaluation performed by
the professor.
__________________________________ ______________________
__________________________________ ______________________
Practicum Professor Date
Received and filed by
__________________________________ ______________________
Practicum Coordinator Date
30
APPENDIX D: ASSESSMENT OF PRACTICUM STUDENT COMPETENCIES

Assessment of Practicum Student Competencies
Student: _________________________________________
Supervisor: _______________________________________
Period of Supervision: ______ Mid Term _______Final
Agency: _________________________________________________________________
Instructions
Please rate each item according to the scale provided below and sign in the appropriate signature block
and return this form to the Practicum Coordinator. Please discuss all of these ratings with the student, and
compare the student’s self-assessment on these dimensions with your ratings. In your feedback, it is
important to give specific examples if you have concerns about progress; it is also important to give clear
examples of what you think the student does well. Please use the feedback sessions to plan what you and
the student would like to emphasize in his/her continued training. If there are significant concerns about
performance on any dimensions, you need to decide whether the student is passing at this point in the
training (see target goals in each signature block). If not, please contact the Practicum Coordinator as soon
as possible.
Please indicate below what modalities/work samples you have used to obtain information for making your
evaluations.
__ Observation during team meetings
__ Review of written work samples
__ Consultation with other clinical supervisors
__ Consultation with team members other staff
__ Role Play
__ Student’s self-report
__ Audio record
__ Video record
__ One way mirror
__ Direct, live observation
__ Other: _____________________________________
31
Supervisor:
Use the scale below to rate from 1 to 10. Track-specific competencies may be added. To obtain that rating,
within the past month, the student should have consistently display the specific quality/skill in every
clinical area and/or know when he/she needs to consult.
Student:
Use these self-assessments to guide development of training plan.
Scale
Master Level Students
1-2 (Novice) = Inexperienced in this capacity and is still developing basic skills; cannot identify problems
but open to discussion in supervision (master level students at the beginning of the practicum 3 or
above)
3-5 (Intermediate) = Developing some skills to function independently; can identify problems to discuss in
supervision (master level students at the end of practicum 4 or above; MAXIMUM SCORE FOR MASTER
STUDENTS).
Doctoral Level Students

6-8 (Advance) = Functions independently most of the time but requires supervision for difficult situations
(only can be given to doctoral students or above).
9-10 (Advance- Independent level) = Student functions fully independently in this capacity almost all the
time (can only be given to interns or above).
All Level Students

U (unsatisfactory) = Student is experiencing significant difficulties in developing skills to function
independently in this capacity and is unable/unwilling to discuss problems in supervision or change
practices according to suggestions.
Competencies
I. Research
Competency Score
1 Use empirically supported psychotherapeutic techniques:
2 Describe theoretical basis and goals of chosen treatment approach
Applies current theoretical and research knowledge (e.g., process and outcome
3 research) relevant to the practice of psychology in the clinical setting including
accessing and applying scientific knowledge bases
4 Demonstrates the substantially independent ability to critically evaluate research

Comments:
32
II. Ethical and Legal Standards
Competency Score
1 Work in an ethical manner in accordance with the ethics code and all relevant laws.
2 Recognize ethical dilemmas as they arise
3 Apply ethical decision-making processes in order to resolve the dilemmas
4 Maintain appropriate professionalism and boundaries.

5 Recognize limits of own expertise and seek appropriate consultation.
6 Assess people at- risk and intervene appropriately.
7 Maintain the person’s confidentiality.

Comments:
III. Cultural and Individual Diversity

Competency Score
Present an understanding of how their own personal/cultural history, attitudes, and
1 biases may affect how they understand and interact with people different from
themselves
Poses knowledge of the current theoretical and empirical knowledge base as it

2 relates to addressing diversity in all professional activities including research,
training, supervision/consultation, and service
3 Support the inclusion of all persons

Cultivate awareness of one’s own biases and limitations; seek consultation as
4
needed.
5 Assess cultural factors to ensure formulation of relevant treatment.
6 Conduct treatment in preferred communication style and language of the person.
7 Remove institutional barriers to participation by all persons.
8 Teach persons the necessary skills to overcome cultural barriers.
33
Demonstrate the ability to independently apply their knowledge and approach in

9 working effectively with the range of diverse individuals and groups encountered
during internship
Comments:
IV. Professional values, attitudes, and behaviors

Competency Score
Actively seek and demonstrate openness and responsiveness to feedback and
1
supervision
Behave in ways that reflect the values and attitudes of psychology (including
2 integrity, deportment, professional identity, accountability, lifelong learning, and
concern for the welfare of others)
3 Engage in self-reflection regarding one’s personal and professional functioning
Engage in activities to maintain and improve performance, well-being, and

4
professional effectiveness
Respond professionally in increasingly complex situations with a greater degree of

5
independence as they progress across levels of training
Comments:
V. Communications and interpersonal skills

Competency Score
1 Interact effectively with administrative staff and manage conflict
Produce and comprehend oral, nonverbal, and written communications that are
2
informative and well-integrated;
Demonstrate effective interpersonal skills and the ability to manage difficult

3
communication well
4 Use time management skills to prioritize.
34
5 Write timely, complete progress notes and reports

6 Demonstrate a thorough grasp of professional language and concepts
Comments:
VI. Assessment
Competency Score
Select and apply assessment methods that draw from the best available empirical
1
literature and that reflect the science of measurement and psychometrics
Collect relevant data using multiple sources and methods appropriate to the
2 identified goals and questions of the assessment as well as relevant diversity
characteristics of the service recipient
3 Interpret and integrate test result.
Communicate orally and in written documents the findings and implications of the
4
assessment in an accurate and effective manner sensitive to a range of audience
Demonstrates knowledge of functional and dysfunctional behaviors, including

5
consideration of client strengths and psychopathology
Applies the knowledge of client strengths and weakness to assessment process with
6
sensitivity to cultural and individual differences
Comments:
VII. Intervention
Competency Score
1 Understand differential diagnosis and case conceptualization
2 Develop adequate conceptualizations.
35
3 Facilitate development of specific achievable therapeutic goals.

4 Develop action steps for the achievement of goals.
5 Develop and maintain a positive working alliance

6 Formulate goals/problems consistent with treatment approach
7 Structure therapy sessions consistent with treatment approach
8 Modify treatment plan based on ongoing evaluation.
9 Conduct appropriate therapy termination.

Demonstrate the ability to apply the relevant research literature to clinical decision
10
making
Modify and adapt evidence-based approaches effectively when a clear evidence-
11
base is lacking
Evaluate intervention effectiveness, and adapt intervention goals and methods
12
consistent with ongoing evaluation
Comments:
VIII. Supervision
Competency Score
1 Is aware of self-limitations;
2 Maintain an effective, professional supervisory relationship.
3 Is well prepared for supervision (e.g. prepares video, etc.).
4 Seek consultation or suggest alternative supervision plans as appropriate.

Comments:
36
IX. Consultation and interprofessional/interdisciplinary skills
Competency Score
Demonstrate knowledge and respect for the roles and perspectives of other
1
professions
Is aware of self-limitations; seek consultation or suggest alternative supervision

2
plans as appropriate.
3 Shows knowledge of the unique client care roles of other professionals
Is able to effectively communicate with other professionals in accordance with their

4
unique client care roles
Is able to effectively communicate with individuals and their families related to the
5
services offered.
Comments:
37
Summary of Assessment of Student Clinical Competence

Please calculate the average score of each competency area and write it down in the proper space. Then
calculate the Global Rating Score by obtaining the average score of all areas.
Overall Rating
I. Research (40pts)
II. Ethical and Legal Standards (70pts)

III. Cultural and Individual Diversity (90pts)
IV. Professional Attitudes, Values and Behavior (50pts)
V. Communications and Interpersonal Skills (60pts)
VI. Assessment (60pts)
VII. Intervention (120pts)
VIII. Supervision (40pts)

IX. Consultation and Interprofessional/Interdisciplinary skills (50pts)
Global Rating Score (580pts)

To pass this part of the Practicum the student must obtain a minimum score of 80% in each competency
assessed and on the overall evaluation performed by the supervisor for practicum III (PSYC 574) and
Practicum IV (PSYC 599). For Practicum III & IV: An average score of 80% or more in each required area of
competency is an acknowledgement that the practicum student has reach the minimum level expected by
the program at this level.
Student Name: ____________________________
__________________________________ ______________________
Practicum Supervisor Name: ________________________________
__________________________________ ______________________
Practicum Supervisor Date
Received and filed by
__________________________________ ______________________
Practicum Coordinator Date
38
APPENDIX E: SUPERVISOR EVALUATION FORM
School of Social Science & Communications
Supervisor Evaluation Form

Supervisor: ________________________________ Date: _________________
Practicum Site: ___________________________________ Training Year: ________________
Please review each category and specific item on the following pages and rate according to the scale
following each item. There are several examples under each item; these are provided to help you focus
your assessment of skill level. However, they are not meant to be comprehensive list of skills or to imply
that supervisors need to be effective in all areas at the same level. The final rating should represent an
aggregate across several skills represented by the main statement of each item. Not every item will be
relevant to your settings; you can check “not applicable” as needed. There are three categories: aspect
of the supervisory relationship, facilitation of training experience, and cultural and individual diversity.
After you rate the specific items for each category, there is space for general comments on that
category. Please enter enough narrative to anchor your ratings. Attach the appropriate signature page.
Please discuss your feedback with your supervisor(s), along with his or her feedback about you. In the
feedback, it is helpful to give specific examples if you have concerns or suggestions for change. It is also
helpful to give clear examples of what you think the supervisor does well.
Modalities: Please indicate below what modalities you have experienced in your work with this
supervisor. Check of all that are applicable:
___ Supervisor listened to your reports of services
___ Supervisor reviewed audio recordings of service
___ Supervisor reviewed videotape of service
___ Supervisor did direct, live (one way mirror) observation of service
___ Direct observation of supervisor in services
___ Experience during group supervision sessions
___ Joint participation during team meetings
___ Co-intervention conducted by Supervisee and Supervisor
___ Reviewed of written material
___ Other_____________________________________________________________________
Instructions: Rate in a scale from 1 (poor) to 5 (excellent)
39
Aspect of the Supervisory Relationship Rating
1 2 3 4 5 NA
1. Supervisor facilitates establishment and maintenance of
collaborative supervisory relationship:
a. clearly discusses expectations regarding the supervisory
relationship.
b. invites comments about the quality of the supervisory
relationship on an ongoing basis.
c. responds to your feedback in a non- defensive manner.
2. Supervisor demonstrates empathy, respect, and understanding of

supervisees experience:
a. understands your stated needs in an open manner, despite

the limitations of the settings.
b. respects your boundaries/privacy.
c. demonstrates emphatic understanding of personal and

interpersonal struggles related to the demands of the training
program.
d. demonstrates sensitivity and respect of supervisees’
cultural/individual background.
3. Supervisor is available for supervision:
a. collaborates to schedule and adequate amount of time for

supervision.
b. is available and accessible when needed including
impromptu consultations and crisis.
c. helps you establish alternative source of consultation when
unavailable or when specialty consultation is indicated.
d. participates actively during supervision sessions.

e. communicates enthusiasm about and commitment to
supervision.
4. Supervisor is amenable to working through conflicts, disagreements,
or differences in opinions with supervisee:
a. supervisor openly addresses conflicts or problems in a
constructive manner.
b. when conceptual disagreements arise, supervisor
negotiates them in a nonjudgmental.
c. if an impasse occurs, supervisor arranges for mediation to
facilitate conflict resolution.
40
Facilitation of Training Experience Rating
1 2 3 4 5 NA
1. Works with you to reach the training goals in your clinical setting:
a. provides clear expectations for your role and performance.
b. helps you to identify your own training needs and goals for
rotation.
c. assists in meeting your training goals.
d. helps you to understand intern exit competencies and
training goals.
2. Provide Feedback on your performance that helps you to develop
your clinical skills:
a. helps you identify your specific strengths and competencies.

b. provides feedback on your performance and written work is
constructive and specific.
c. provides opportunities for direct supervision of your clinical

work (e.g., through live observation, review of audio
recordings, co-treatment).
d. facilitates your accurate self-assessment (e.g., skill level,

limits of competence, and need for consultation, interpersonal
interactions, diversity issues, and other blind spots).
3. Provide supervision and guidance in all stages of the treatment

process:
a. helps prepare you for various types of persons, problems,

and staff relationship.
b. helps with case conceptualizations, treatment planning, and
working through impasses in treatment.
c. helps you to recognize your emotional responses to the

clinical process and address personal issues that may interfere
with effectiveness.
d. helps you to understand and address termination issues.
e. discusses legal and ethical standards in clinical work and
helps you to apply this knowledge in clinical situations.
41
Cultural and Individual Diversity Rating

1 2 3 4 5 NA
1. The supervisor exhibits knowledge of and respect for cultural and
individual diversity in clinical intervention and research:
a. has respect for diversity and at least basic awareness of
providing culturally competent services.
b. is aware of his/her limitations of knowledge of cultural and
individual diversity.
c. is helpful in seeking out additional information about diverse
groups and effective therapeutic interventions with persons of
different backgrounds.
d. models the process of consultations with colleagues about
diversity issues when needed.
e. is aware of his/her own struggles with persons of diverse
backgrounds and beliefs.
f. is aware of his/her own cultural identity, world view, and
value system brought
Comments
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________
Signatures:
Student: ___________________________________________ Date________________________
Supervisor: _______________________________________ Date________________________
Practicum Coordinator: _____________________________ Date________________________
42
APPENDIX F: EVALUATION OF PRACTICUM SITE
Evaluation of Practicum Site
Student __________________________________________ Date_______________________
Primary Supervisor: ___________________________________ Training Year_____________
Practicum Site: _____________________________________
Please discuss all of these ratings with your Supervisor. If you have concerns about any aspect of the
program, please give examples.
Scale
1 - Training needs not met
2 - Training needs somewhat met
3 - Training needs adequately met
4 - Training needs exceeded
NA – Not Applicable
Aspect Rating
1. Overall organization of training program.
2. Workload is challenging but not excessive.
3. Training plan is meeting goals, expectations, and training needs.
4. Expectations are clear.
5. Reactions, concerns, and problems are addressed adequately.
6. Adequate feedback regarding performance and progress
7. Adequate opportunity for skills development.
8. Sufficient opportunity for input into training needs.
9. Environment is conducive to learning.
10. Environment is conducive to interrelationships among peers.
11. Resources are adequate (e.g., space, computers, and supplies).
43
12. Treated in a professional manner.
13. Effective working relationships with support staff.
14. Grievance Procedure were in place and followed by the Agency.
15. Amount of supervision support and availability.
16. Didactic experience and literature resources.
17. Opportunities training and support for clinical work.
18. Opportunities, training and support for teaching/supervision.
19. Opportunities training and support for research.
20. Incorporating and applying knowledge of culture and other diversity issues
in training.
21. Training in professional, ethical and legal issues.
22. Overall satisfaction with program structure.
Comments
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____
Signatures
Student____________________________________ Date___________________________
Supervisor_________________________________ Date__________________________
Practicum Coordinator_________________________ Date___________________________
44
APPENDIX G: EVALUATION OF CASE CONCEPTUALIZATION PROCESS FORM & EVALUATION OF
PSYCHOLOGICAL ASSESSMENT PROCESS FORM
45
Psychology Graduate Program
Evaluation of Case Conceptualization Process
Student: _______________________________ Case Record Number: __________

Date: _______________ Supervisor: ________________________
Instruction: Rate the student's competence in the Case Conceptualization Process.
Needs
Improvement Reg Good Exc.
Report Writing
Demographics 0 1 2 3 4 5 6 7 8 9 10
Present Illness & History of the Present Illness 0 1 2 3 4 5 6 7 8 9 10
Relevant History 0 1 2 3 4 5 6 7 8 9 10
Mental Status 0 1 2 3 4 5 6 7 8 9 10
Conceptualization Process
Selected Theory/Model (Evidence Based Model) 0 1 2 3 4 5 6 7 8 9 10
Integration (Integration of Model with Client's HPI and History) 0 1 2 3 4 5 6 7 8 9 10
Main Concern Analysis (Identify and analyze in a clinical perspective the main
0 1 2 3 4 5 6 7 8 9 10
concern of the client)
Diagnostic Impression
Diagnostic Impression (DSM-5) 0 1 2 3 4 5 6 7 8 9 10
Strengths, Weakness & Prognosis (relative to the client) 0 1 2 3 4 5 6 7 8 9 10
Treatment Plan
Goals (Long and Short Term) 0 1 2 3 4 5 6 7 8 9 10
Techniques (Relative to the model and client's needs) 0 1 2 3 4 5 6 7 8 9 10
Treatment Sessions (relative to client's need, diagnosis and treatment model) 0 1 2 3 4 5 6 7 8 9 10
Style, Grammar, Communication (professional, well written and organized) 0 1 2 3 4 5 6 7 8 9 10
Score _______ / 130

Comments:
Practicum Student Signature: _________________________________ Date: __________
Supervisor Signature & Lic Num.: ______________________________ Date: __________
46
Psychology Graduate Program
Evaluation of Psychological Assessment Process
Student: ________________________________ Case Record Number: ___________

Date: ___________________ Supervisor: _______________________________
Instruction: Rate the student's competence in the Psychological Assessment Process.
Needs Improvement Reg Good Exc.

I. Instrument Selection
(the student selected the instruments relevant to the referral and with adequate 0 1 2 3 4 5 6 7 8 9 10
standardization)
II. Administration of the Instruments
(the student performed the assessment according to the standardization 0 1 2 3 4 5 6 7 8 9 10
procedures)
III. Report Writing
Demographic Data
0 1 2 3 4 5 6 7 8 9 10
(name, DOB, chronological age, etc.)
Referral Motive
0 1 2 3 4 5 6 7 8 9 10
(it is clearly stated who, for what and why is referred)
Relevant History
(relevant data of the examinee; developmental, health, academic, familiar/social, 0 1 2 3 4 5 6 7 8 9 10
occupational; presented in chronological order in past tense)
Clinical Observations
(mental status, observation of the examinee during the assessment process, in past 0 1 2 3 4 5 6 7 8 9 10
tense)
Test Results
(test's results are presented in relevance order presenting a brief description of the 0 1 2 3 4 5 6 7 8 9 10
test, areas measured and level. Table can be used with proper explanation)
Summary/Conclusion
(begin stating the referral motive and presenting a brief summary of important data
0 1 2 3 4 5 6 7 8 9 10
of the examinee history; assessment result integration with diagnostic impression. It
should answer the referral motive.)
Recommendations (relevant and organized) 0 1 2 3 4 5 6 7 8 9 10
IV. Clinical Impressions (assess the integration between the referral, the examinee
0 1 2 3 4 5 6 7 8 9 10
history and the diagnostic impression)
V. Grammar, Style, Communication (professional style, consistency, presented in
0 1 2 3 4 5 6 7 8 9 10
an organized manner and without grammar errors)
Total Score _______ / 110
Comments:
Practicum Student Signature: _______________________________ Date: __________
Supervisor Signature & Lic Num.: ____________________________ Date: __________
47
APPENDIX H: REMEDIAL PLAN FORM
48
Counseling Psychology Program
Graduate Student Remedial Plan

Student Name: _____________________ Meeting Date:
Student Id.: ______________
Supervisor/Advisor:
Area of Concern (attach evidence):

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________
Proposed Remedial Plan (with due dates):

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________
________________________ ______________________________
Student Signature Supervisor/Advisor Signature
Date Date
______________________________ ___________________________
Remedial Plan Resolution (attach evidence)
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________ ______________________________
Student Signature Supervisor/Advisor Signature
Date ______________ Date ______________
Cc: Academic file _____

Practicum/Internship file _____
49
APPENDIX I: DIRECT OBSERVATION DEFINITION AND GUIDELINES
American Psychology Association’s Standards of Accreditation (2015)

Standard II.B.3.d
Required practicum training elements
a. Practicum must include supervised experience working with individuals who are diverse with a variety
of presenting problems, diagnoses, and issues. The purpose of practicum is to develop the requisite
knowledge and skills for graduates to be able to demonstrate the competencies defined above. The
doctoral program needs to demonstrate that it provides a training plan applied and documented at the
individual level, appropriate to the student’s current skills and ability, that ensures that by the time the
student applies for internship, the student has attained the requisite level of competency.
b. Programs must place students in settings that are committed to training, provide experiences consistent
with health service psychology and the program’s aims, and enable students to attain and demonstrate
appropriate competencies.
c. Supervision must be provided by appropriately trained and credentialed individuals.
d. As part of a program’s ongoing commitment to ensure the quality of its graduates, each practicum
evaluation must be based in part on direct observation of the practicum student and her/his developing
skills (either live or electronically).
APA SOA, Implementing Regulation C-14 Direct Observation (2015)

Definitions and Guidelines:
Direct observation provides essential information regarding trainees’ development of competencies, as
well as the quality of the services provided, that cannot be obtained through other methods. This allows
supervisors to provide a more accurate assessment and evaluation of observable aspects of trainees’
competency development regarding one or more profession-wide and program-specific competencies
associated with that training experience.
Direct observation includes in-person observation (e.g., in room or one-way mirror observation of client
contact an intake or test feedback session), live video streaming, or video recording. Programs may
utilize audio recording, but audio recording alone is not sufficient to meet the requirements of direct
observation. In the rare event or special circumstances where audio recording is the only feasible
method of meeting this requirement, the program must explain any the unique circumstances (e.g.,
supervisor with visual impairment) and why direct observation as defined above is not possible, as well
as how the observation being performed is consistent with the spirit of this IR.
To these ends, all accredited programs must verify that direct observation is conducted by the
immediate supervisor responsible for the activity or experience being evaluated.
As indicated in the SoA (Standard II.B.3.d), a doctoral program must utilize direct observation as part of
practicum evaluation. Each separately evaluated practicum is considered a unique or separate training
experience and thus requires direct observation as part of the evaluation process.
50

Mpsy Practicum Manual 2017 Uagm Rev Uak Mar2019

Uploaded by

Copyright:

Available Formats

Mpsy Practicum Manual 2017 Uagm Rev Uak Mar2019

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mpsy Practicum Manual 2017 Uagm Rev Uak Mar2019

Uploaded by

Copyright:

Available Formats

MPsy Practicum Manual

Counseling Psychology Training Program

APPENDIX E: SUPERVISOR EVALUATION FORM ........................................................................... 39

I, ___________________________________________, Practicum Student of the Graduate Psychology

it to my primary supervisor and/or my Practicum Coordinator.

Note: This document must be included in the Practicum Record

COUNSELING PSYCHOLOGY TRAINING PROGRAM

5. demonstrate knowledge and use of basic counseling skills including:

CRITERIA FOR APPROVED PRACTICUM SITES AND TRAINING

Requirement for the Approval of a Practicum Site

PRACTICUM REQUIREMENTS FOR STUDENTS

PRACTICUM III –IV

students the opportunity to apply different theoretical models in evidence-based

Practicum IV: Psychotherapeutic Intervention II

PROGRESS EVALUATION (Practicum III and IV)

GRADING OF THE COUNSELING PSYCHOLOGY PRACTICE

DOCUMENTATION OF CLINICAL ACTIVITIES

DOCUMENTATION OF TIME IN CLINICAL TRAINING

GUIDELINES AND PROCEDURES

DUAL ROLE OF PRACTICUM SUPERVISORS NOT ALLOWED.

ASSIGNMENT OF PRACTICUM SITES

HANDLING CLINICAL EMERGENCIES

PRACTICUM PROCESS GENERAL SCHEDULE

APPENDIX A: SUPERVISION CONTRACT

Name of Supervisee: ________________________________________

3. Duties and Responsibilities of Supervisor

4. Duties and Responsibilities of the Supervisee

Practicum Supervision Goals

Task for Supervisee:

Task for Supervisee:

Task for Supervisee:

Task for Supervisor

Task for Supervisee:

Task for Supervisor

APPENDIX B: SUPERVISION LOG

Name of Supervisee: _________________________________

APPENDIX C: EVALUATION OF STUDENTS COMPETENCIES

Student Name: _____________________________ Student #: _____________

Instructions: Use the following rating scale to rate your supervisee.

Basic Intervention Skills

Sensitivity to Diversity Issues

Dimension Rating Comments

Summary of Evaluation of Student Competencies

Part Total Points Percentage

Received and filed by

APPENDIX D: ASSESSMENT OF PRACTICUM STUDENT COMPETENCIES

Assessment of Practicum Student Competencies

Doctoral Level Students

All Level Students

4 Demonstrates the substantially independent ability to critically evaluate research

II. Ethical and Legal Standards

2 Recognize ethical dilemmas as they arise

3 Apply ethical decision-making processes in order to resolve the dilemmas

4 Maintain appropriate professionalism and boundaries.

7 Maintain the person’s confidentiality.

III. Cultural and Individual Diversity

Poses knowledge of the current theoretical and empirical knowledge base as it

3 Support the inclusion of all persons

Student Name: _________________ Student #: _

Student: ___________________ Date

Supervisor: _______________ Date

Practicum Coordinator: _____ Date

Student ____________________ Date_

Primary Supervisor: _______________________ Training Year_