counselor education program department of leadership and...

Revised January 2016

Counselor Education Program

Department of Leadership and Counselor Education

Masters of Education

School Counseling

Clinical Mental Health Counseling

Practicum and Internship Manual

The University of Mississippi

School of Education

P.O. Box 1848

University, Mississippi 38677-1848

(662) 915-7069

1


T ab le of C on ten t s

Introduction ………………………………………………………………………………………………2

Program Faculty ……………………………………………………………………………………….…3-4

Overview ………………………………………………………………………………………………….. 5

General Guidelines ………………………………………………………………………………….………5

Practicum/Internship Responsibilities ……………………………………………………………...…….….6

Practicum Hours Requirements …………………………………………………………...……………….. 6

Impairment in Practicum …………………………………………………………………………………... 6

Internship Hours Requirements ……………………………………………………………………………..7

Impairment in Practicum …………………………………………………………………………………....7

Practicum/Internship Forms and Documentation …………………………………………………………...8

Practicum Application Instructions ………………………………………..……………...………………...8

Practicum and Internship Forms ………..……...…………………………………………………. ........... .9

Practicum Student Filing Checklist .…………………………………..……………………...……….9

Internship Student Filing Checklist …………………………………………………………………..10

Practicum Application Form ………………………..………………………………….……..….………..11

Practicum Site and Supervisor Information Sheet…………….….……………………………..……….....12

Practicum/Internship Contract ……………………………………………………………….…..………...13

Practicum/Internship Contract Addendum …………………………………………………….…………. 16

Basic Counseling Skills Feedback Sheet-R…………………………………….…………….…. .............. 17

Professional Counseling Performance Evaluation-R ………………………………………………. …… 19

Weekly Counseling Log …………………..…………………….……………………………………….. 22

Multicultural Awareness, Knowledge, & Skills Survey –Couns. Ed.-Revised (MAKSS-CE-R)………… 24

Career Adapt-Abilities Inventory (CAAI) …………………………………………….……………….… 26

Evaluation of Site Supervisor. ………………………………………………………...……….............… 27

Evaluation of Site Form …………..………...……………………………………….………...………… 29

Site Visitation Form …………………….………………………………………………....…………….. 30

2


COUNSELOR EDUCATION PROGRAM

PRACTICUM and INTERNSHIP INTRODUCTION

The Counselor Education Program at the University of Mississippi is accredited by the Council

for the Accreditation of Counseling and Related Educational Programs (CACREP) for the School

Counseling, Community Counseling, and Counselor Education Ph.D. programs. All of the requirements

for practicum and internship are based on CACREP standards. This manual contains critical information

for students completing the clinical sequence (Practicum and Internship) and is the central information

source for students, doctoral student supervisors, program faculty, and site supervisors regarding the

clinical sequence. All forms to be used by students and their supervisors can be found in this handbook.

The practicum and internship experiences are an important part of counselor training. These

experiences are critical because they provide a means for students to apply their knowledge and

counseling skills to the professional practice of counseling. Practicum is the first experience, where

graduate students are placed in a school or community site with supervision and have an opportunity to

continue development of counseling skills and learn other professional responsibilities and skills.

Internship is the last phase of training and is a transitional phase leading to the professional world. These

two field experiences provide students with an opportunity to work in an appropriate site as a counseling

professional while being supervised.

During the practicum and internship experiences, it is important that students select sites that are

appropriate to their career goals. Students will work closely with the department practicum/internship

coordinators to choose a site. The sites utilized by our program are chosen for the service they give to

their consumers and for the learning opportunities they provide to our students. When sites agree to

allow students to train with them, they do so realizing their responsibility to promote the educational and

developmental process of counseling students. The program realizes that these training experiences have

a dual role, and the program works diligently to insure that the needs of the agency and students are both

met during the practicum and internship experiences.

3


Program Faculty

Practicum and internship students in The University of Mississippi Counselor Education Program are supervised by the following faculty. Faculty offices are located on the first floor of Guyton Hall. The telephone number for the department office is 662-915-7069. Each faculty member can also be reached by

telephone directly. Their direct office numbers and email addresses are listed below:

Suzanne M. Dugger, Ed.D.

Professor of Counselor Education and Program Coordinator

Contact Information: Education:

Office Location: 139 Guyton A. B., Harvard University

Telephone: 662-915-8821 M.A., Central Michigan University

Email: [email protected] Ed.D., Western Michigan University Dr. Dugger experience includes 5 years of experience as a school counselor, 3 years as a college counselor, 7 years in private practice, and 25 years as a counselor educator. Her teaching and research interests include career counseling, counseling children, school counseling, the counseling process, diagnosis and treatment planning, and doctoral education.

Alexandria K. Kerwin, Ph.D., LPC, NCC

Assistant Professor of Counselor Education

Contact Information: Education: Office Location: 142 Guyton B.A., The University of Southern Mississippi Telephone: 662-915-2342 M.S., The University of Southern Mississippi Email: [email protected] Ph.D., Idaho State University

Dr. Kerwin has experience as a mental health counselor in a K-12 school-based setting, adolescent offenders program, and in university counseling centers. She also has worked as a community-based advocate for refugees. Courses you are likely to take from Dr. Kerwin are Introduction to Professional Counseling, Lifespan Development, and Addictions. Her research interests include professional identity, social justice, and counselor education.

Mandy L. Perryman, Ph.D.


Contact Information: Education: Office Location: 143 Guyton B.A., Louisiana Tech University Telephone: 662-915-7816 M.A., Nicholls State University Email: [email protected] Ph.D., University of New Mexico Dr. Perryman has experience counseling children, adolescents and adults and providing play therapy. Courses you are likely to take from Dr. Perryman include Counseling Skills, Group Counseling, and Multicultural Counseling. Her research interests include eating disorders/disordered eating and compassion fatigue and wellness.

mailto:[email protected]



4


Marc Showalter, Ph.D., LPC-S

Assistant Clinical Professor of Counselor Education

Contact Information: Education: Office Location: 145 Guyton B.S., Harding University Telephone: 662-915-5376 M.S., University of Central Arkansas Email: [email protected] Ph.D., The University of Mississippi Dr. Showalter’s teaching and research interests include counseling relationships, college counseling, and supervision. He also serves as the Clinical Coordinator at the Counselor Education Clinic for

Outreach and Personal Enrichment.

Amanda M. Winburn, Ph.D.


Contact Information: Education: Office Location: 109 Guyton B.S., Kentucky Wesleyan College Telephone: 662-915-8823 M.Ed., Indiana University Email: [email protected] Ed.S., The University of Mississippi

Ph.D., The University of Mississippi

Dr. Winburn’s teaching and research interests include school counseling, at-risk students, bullying and play therapy. She also serves as the Assessment Coordinator for the Counselor Education Program. Her professional experiences include working as a social worker, career counselor, school teacher, and school counselor. Potential courses include counseling skills, organization and administration of school counseling, practicum, and internship.



5


Overview of the Practicum and Internship Manual

This manual is designed to be the central source for information concerning the practicum and internship

experiences in the counseling program at The University of Mississippi. All users of the manual are

encouraged to read the entire manual so that each may possess a thorough understanding of the entire

practicum and internship process.

General Guidelines

1. Selection of practicum and internship sites is coordinated by the Practicum/Internship

Coordinators in collaboration with faculty advisors.

2. Practicum applications must be submitted to the Community Counseling or School Counseling

Practicum Coordinator by mid-term of the semester prior to beginning practicum. The

coordinators will advise applicants regarding their eligibility for Practicum.

3. After eligibility has been approved, practicum applicants will meet with the appropriate

Practicum Coordinator to discuss placement availability and appropriateness for candidate,

agency, and program needs. Faculty advisors may also provide input in this process.

4. Applicants will then schedule an interview with the recommended site and supervisor, and meet

with the site supervisor and other appropriate individuals. During the interview, candidates will

provide a resume and a copy of the Practicum/Internship contract. If the site supervisor,

principal/director, and candidate are in agreement with the terms of the contract, the contract

should be signed and returned to the appropriate Practicum Coordinator.

5. All contracts and placements should be secured and on file by the end of the semester.

6. All practicum and internship hours accrue only during The University of Mississippi academic

calendar dates, unless prior written agreement has been made.

7. All practicum and internship students are required to obtain and provide proof of liability

insurance prior to beginning practicum and/or internship. Insurance must remain active during

the entire period of practicum and internship. Liability insurance is available free to students

with paid membership to the American School Counselor Association as well as the American

Counseling Association. In addition, teacher associations and other professional groups provide

group liability insurance. A background check must be submitted prior to the beginning of the

semester.

8. Candidates may change sites only after consultation and with approval of the appropriate

Practicum/Internship Coordinator.

9. Successful completion of COUN 693 is required to enroll in COUN 695.

6


Practicum/Internship Student Professional Role and Responsibilities

1. Adhere to the ethical guidelines of the American Counseling Association, American Mental

Health Counselors Association, and/or the American School Counselor Association at all times.

2. Follow all protocols, rules, and policies of the site.

3. Consult with site supervisor and/or university supervisors as needed.

4. Actively participate in weekly supervision with site supervisors, doctoral student supervisors,

and the group supervision class.

5. Adhere to the hourly guidelines stated in the contract.

6. Complete necessary evaluations and weekly counseling logs.

7. Maintain active professional liability insurance.

8. A background check must be submitted.

Doctoral Student Supervisor Responsibilities

1. Meet all doctoral program requirements for eligibility to provide supervision to master’s

students.

2. Provide weekly individual and/or triadic supervision with assigned students.

3. Participate in mid-term and final evaluations of students, completing appropriate evaluation

forms for submission to the assigned Practicum/Internship instructor.

4. View video recordings of supervisee work.

5. Meet weekly with the appropriate Practicum/Internship instructor.

6. Follow through with supervisory recommendations and guidelines.

6


Practicum Hours Requirements

Practicum students are required to complete a minimum of 100 clock hours during the practicum

experience, 40 direct service hours and 60 indirect service hours. Direct service hours may include

individual, group, couples, and family counseling as well as presentation of classroom guidance lessons.

Indirect service hours may include treatment planning and documentation, supervision, outreach,

training, and administrative duties.

The time commitment for practicum is approximately 12 to 16 hours per week, and time on site will be

scheduled in collaboration with the site supervisor. From time to time, practicum students may be asked

to provide additional hours on site for special events or situations.

Impairment in Practicum

Some of your practicum experiences may trigger emotional and/or behavioral responses outside of your

everyday experiences. At times you may feel some deeper emotional experiences that interfere with your

ability to be an effective counselor and which may benefit from counseling or other therapeutic

interventions. Practicum is not an appropriate forum to share these experiences. Should you have these

types of emotional experiences you are expected to seek professional services (i.e., University

Counseling Center or private services). In the event that your instructors believe that you are having

these types of experiences during practicum in ways that interfere with your ability to be an effective

counselor, we are ethically and legally bound to take steps to protect you and possibly make disclosures

of your situation to faculty, site supervisors, and/or administration. In addition, we may initiate student

retention and remediation procedures should we deem the experiences to be impeding your performance

as a practicum student.

Some professional definitions of impairment include:

• Overholser and Fine (1993). Impairments may include a serious deficit(s) in any of the

following:

1. factual knowledge

2. generic clinical skills

3. orientation-specific technical skills

4. clinical judgment

5. interpersonal attributes

• Frame and Steven-Smith (1995). Impairment may include:

1. not being open, flexible, positive, and cooperative

2. not willing to accept and use feedback

3. not aware of impact on others not demonstrating an ability to deal with conflict, accept

personal responsibility, and express feelings effectively and appropriately

7


Internship Hours Requirements Internship students are required to complete a minimum of 600 clock hours during the internship

experience, 240 direct service hours and 360 indirect service hours. Direct service hours may include

individual, group, couples, and family counseling as well as presentation of classroom guidance lessons.

Indirect service hours may include treatment planning and documentation, supervision, outreach,

training, and administrative duties.

The time commitment for Internship is approximately 32 to 40 hours per week and time on site will be

scheduled in collaboration with the site supervisor. From time to time, internship students may be asked

to provide additional hours on site for special events or situations.

Impairment in Internship

Some of your internship experiences may trigger emotional and/or behavioral responses outside of your

everyday experiences. At times you may feel some deeper emotional experiences that interfere with your

ability to be an effective counselor and which may benefit from counseling or other therapeutic

interventions. Internship is not an appropriate forum to share these experiences. Should you have these

types of emotional experiences you are expected to seek professional services (i.e., University

Counseling Center or private services). In the event that your instructors believe that you are having

these types of experiences during internship in ways that interfere with your ability to be an effective

counselor, we are ethically and legally bound to take steps to protect you and possibly make disclosures

of your situation to faculty, site supervisors, and/or administration. In addition, we may initiate student

retention and remediation procedures should we deem the experiences to be impeding your performance

as an internship student.

Some definitions of impairment:

• Overholser and Fine (1993). Impairment may include a serious deficit(s) in any of the following:

1. factual knowledge

2. generic clinical skills

3. orientation-specific technical skills

4. clinical judgment

5. interpersonal attributes

• Frame and Steven-Smith (1995). Impairment may include:

1. not being open, flexible, positive, and cooperative

2. not willing to accept and use feedback

3. not aware of impact on others

4. not demonstrating an ability to deal with conflict, accept personal responsibility, and express

feelings effectively and appropriately

8


Practicum Application Instructions

The Practicum Application Form is to be completed by the candidate and submitted to the Practicum

Coordinator by mid-term of the semester prior to beginning practicum.

The Practicum Site and Supervisor Sheet is to be completed by the candidate and submitted to the

Practicum Coordinator by the end of the semester prior to beginning practicum.

Professional liability insurance is required for all candidates. Proof of insurance must be submitted to

the Practicum Coordinator before any candidate may begin practicum. A background check is required.

Failure to complete and/or submit the forms on time will delay the candidate’s progress and may delay

the candidate one (1) year in beginning practicum.

9


Pr ac tic u m and Inter nshi p For m s

The following is a checklist of required forms to be completed and submitted to your

practicum/internship instructor. Practicum/internship instructors will forward the completed forms to

the appropriate Practicum Coordinator for review and placement in your permanent student file.

Practicum Filing Checklist

Pre-Practicum:

Practicum Application Form

Practicum Site & Supervisor Information Sheet

Professional Liability Insurance Declaration page

Signed Practicum Contract (with site)

Signed Practicum Contract Addendum (if applicable)

Signed Supervision Agreement

Background Checks

Mid-Semester (10th

Week) Practicum: Mid-Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Site Supervisor

Mid-Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Practicum Instructor

Mid-Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Doctoral Student Supervisor

Mid-Semester PCPE-R by Site Supervisor

Mid-Semester PCPE-R by Practicum Instructor

Mid-Semester PCPE-R by Doctoral Student Supervisor

Mid-Semester Weekly Counseling Log by Candidate

End of Semester Practicum:

End of Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Site Supervisor

End of Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Practicum Instructor End of Semester Basic Counseling Skills Feedback Sheet (BCSFS-R) by Doctoral Student

Supervisor

End of Semester PCPE-R by Site Supervisor

End of Semester PCPE-R by Practicum Instructor

End of Semester PCPE-R by Doctoral Student Supervisor

Evaluation of Site by Candidate

Evaluation of Site Supervisor by Candidate

End of Semester Weekly Counseling Log by Candidate

Site Visitation Form by Practicum Instructor

10


Internship Filing Checklist

Mid-Semester Internship:

Mid-Semester PCPE-R by Site Supervisor

Mid-Semester PCPE-R by Internship Instructor

Mid-Semester Weekly Counseling Log by Candidate

End of Semester Internship:

End of Semester PCPE-R by Site Supervisor

End of Semester PCPE-R by Internship Instructor

Career Adapt-Abilities Inventory (CAAI) by Candidate

Evaluation of Site by Candidate

Evaluation of Site Supervisor by Candidate

End of Semester Weekly Counseling Log by Candidate

Site Visitation Form by Internship Instructor

11


School Counseling Practicum/Internship Application Form

Candidate Information

Practicum Student’s Name: Date: __________________

Address: Phone: _________________

________________________________________________ __ Work: _________________

University e-mail: @go.olemiss.edu Cell:

Professional membership(s): _____________________________________________________

Professional Insurance Co. Name & Policy #: _______________________________________

Candidate Academic Program Status

Completion of all listed coursework with a grade “B-” or higher is required to begin the Practicum Sequence

The candidate listed above must have successfully completed COUN 690 with a grade of “B-” or higher in order to

enroll in Practicum COUN 693.

Course Number Course Name Year Semester Completed

COUN 639 Introduction to the Counseling Profession Fall COUN 643 Group Procedures (Taken w/Prac) Spring COUN 683 Counseling Theory I Fall COUN 688 O&A – School (Taken w/Prac) Spring COUN 690 Counseling Skills Fall COUN 670 Multicultural Counseling (Taken w/Prac) Spring

12


Mental Health Counseling Practicum/Internship Application Form

Candidate Information

Practicum Student’s Name: Date: __________________

Address: Phone: _________________

____________________________________________________ Work: _________________

University e-mail: @go.olemiss.edu Cell:

Professional membership(s): _____________________________________________________

Professional Insurance Co. Name & Policy #: _______________________________________

Candidate Academic Program Status

Completion of all listed coursework with a grade “B-” or higher is required to begin the Practicum Sequence

Course Number Course Name Year Semester Completed

COUN 639 Introduction to the Counseling Profession Fall COUN 670 Multicultural Counseling Spring COUN 643 Group Procedures Spring COUN 683 Counseling Theory I Fall COUN 685 O&A (Clinical Mental Health) (Taken w/Prac) Spring COUN 690 Counseling Skills Fall

The candidate listed above must have successfully completed COUN 690 with a grade of “B-” or higher in order to

enroll in Practicum COUN 693.

13


Practicum Site & Supervisor Information Sheet

Practicum Student’s Name: _________________________________ Date: _________________

Site Name: _____________________ ______________

Site Mailing Address: _____________________________________________________________

City: ____ _ _ __ State: ____ Zip Code: _____________

Site Supervisor: __________________________________________

Title: ______________________

E-mail: _______________________________ Phone: _________________

Supervisor’s Education Degree:

Years of Experience as a Counseling Professional: _______

Supervisor’s Licensure and/or Certification: (Check all that apply)

MS Licensed School Counselor MS Licensed Professional Counselor

National Certified School Counselor National Certified Counselor

Other ______________________________

Type of Services at Site: (Check all that apply)

Individual Counseling Group Counseling Family Counseling

Couples Counseling Classroom Guidance

Other: ____________________________________

Hours and Days Candidate will be working at Site: (Circle days you plan to be onsite)

Hours on these days:

M T W Th F

______________________________________________________________________________

______________________________________________________________________________

14



Counselor Education Program

Practicum/Internship Contract

This contract constitutes an agreement between the University of Mississippi Counselor Education Program and a

school or community agency which will serve as a clinical training site for our students. Each member involved in

this agreement, including a site supervisor, school principal or agency director, a counseling master’s or Ed.S.

student, and a university faculty member will sign the contract after having read it in its entirety.

Description of hours for practicum and internship:

In accordance with the Council for the Accreditation of Counseling and Related Educational Programs’

(CACREP) standard that describes practicum and internship as a developmental sequence, students will begin their

practicum at the start of the fall semester. During the first part of the fall semester, (approximately ten (10) weeks),

practicum students may complete approximately 12 hours weekly at a site, with a maximum of 16 hours per week.

Students will not be allowed to complete more than the maximum number of hours during this initial period in

order to provide ample time for developing their initial clinical skills. At the ten (10) week point of the fall

semester, students may request to be evaluated for their readiness to begin internship. If the site supervisor, the

clinical professor, and a doctoral student supervisor-in-training concur (as evaluated using the PCPE) that the

student demonstrates the appropriate level of skills, he or she may begin to move into internship. At this point,

students will be allowed to complete additional weekly hours at their sites with approximately 32 but no more than

40 hours completed per week for the remainder of the fall semester and the spring semester. Under no conditions

should students complete more than 16 hours per week during practicum or more than 40 hours per week during

internship. Students may not begin to accrue internship hours until they have successfully completed the practicum

final evaluation.

For Ed.S. students, your internship hours will be congruent with the normal hours of employment at your school.

Description of taping requirement for practicum and internship:

The University of Mississippi Counselor Education Program requires students to video tape sessions with clients,

after obtaining written consent to taping. Videotaping provides the highest level of supervision and assists students

in their development as professional counselors. During the Site Supervisor Orientation held early each fall

semester, the Basic Counseling Skills Feedback Sheet (BCSFS-R) and the Professional Counselor Performance

Evaluation (PCPE-R) will be reviewed.

Starting/Ending dates for practicum and internship:

Per CACREP standards, students must receive weekly group supervision from a faculty member or a doctoral

supervisor-in-training under the direct supervision of a faculty member. Therefore, practicum will begin on the

first day of classes of the fall semester and end of the last day of classes of the fall semester. Students may begin

to accrue internship hours at the ten (10) week point of the fall semester contingent upon a successful review of

their developing counseling skills. Internship will continue on the first day of classes in the spring semester and

end on the last day of classes in the spring semester. For the current years, these dates are:

Fall semester is from August 22 through December 2, 2016

Spring session is from January 23 through May 5, 2017

Summer semester is from May 30 through July 26, 2017

Should you wish to work at your site during times when Ole Miss is not in session, you will need to obtain written

permission from your Principal/Agency Director and your site supervisor by having them sign the Contract

Addendum.

15


During practicum/internship, the Counselor Education Program Faculty Liaison agrees to:

1. facilitate communication between university and site;

2. notify the student that he or she must adhere to the administrative policies, rules, standards, schedules,

and practices of the site;

3. notify the student that he or she must adhere to the ethical codes of the American Counseling Association

and/or the American School Counselor Association at all times;

4. be available for consultation with both site supervisor and student;

5. provide 1.5 hours of weekly group supervision during the course of the semester and to assign a grade for

the course.

During practicum and internship, the Practicum Site agrees to:

1. assign a site supervisor who (a) has a master’s degree in an appropriate mental health or school counseling

area, has 2 years’ post-master’s degree experience, and who holds appropriate licensure and/or

certification; (b) has time for and interest in the training of a counseling student; (c) will regularly review

student tapes; (d) will provide one hour of weekly individual supervision; and (e) will attend Site

Supervisor Orientation;

2. provide opportunities for the student to engage in a variety of counseling activities under supervision

(suggested counseling-related experiences included in the “Activities” section below);

3. provide the student with adequate confidential work space, telephone, office supplies, and support to

conduct professional activities;

4. complete the appropriate evaluation forms in accordance with guidelines provided during the Site

Supervisor Orientation.

5. contact the counselor education program faculty liaison immediately if any problem should arise with the

student’s performance;

6. provide the program faculty liaison with a current resume for the site supervisor.

During practicum/internship, the site supervisor will be the primary supervisor. The site supervisor is the first

person the student should contact in the event of an emergency regarding client well-being. Critique and feedback

provided to the student during faculty-led group supervision should be utilized in consultation with the site

supervisor. The training activities (checked below) will be provided for the student in sufficient amounts to allow

an adequate evaluation of the student’s level of competence in each activity.

16


Activities

____

____

Individual Counseling

Group Counseling

____

____

Staff Meetings

Individual/Group Supervision

____ Couples/Family Counseling ____ Outreach Activities

____

____

Intake Interviewing

Psychoeducational Activities

____

____

Parent/Teacher Conferences

Data Driven MEASURE/SPARC

____ Case Documentation ____ Building/Grade Level Meetings

____

____

Consultation

Assessment

____

____

Teacher Support Team Meetings

Classroom Guidance Lessons

____ Case Staffings ____ Other (Please list)

After having read this contract, all involved parties demonstrate their agreement to adhere to this contract by

signing below. Please keep a copy of this contract for your records.

Site Supervisor Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

Agency Director/ Printed name: _____________________________________________

Principal Signature:

Telephone: Email:

Date:

Faculty Liaison Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

Candidate Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

17


Practicum/Internship Contract Addendum

During time periods in the academic year when The University of Mississippi is not in session (i.e., August -

May), students may work at their sites and accrue hours if the following conditions are agreed upon:

1. The site agrees to provide sole supervision during these times.

2. The university agrees to provide back-up consultation as needed.

3. The site understands that, during these times, students are not under the jurisdiction of The University of

Mississippi and the university assumes no responsibility to students including supervision, liability, and so

forth, except as outlined above.

4. Students may accrue practicum/internship hours only if the above criteria have been met and written

agreement has been documented below.

After having read this contract addendum, all involved parties demonstrate their agreement to adhere to this

contract by signing below. Please keep a copy of this contract for your records.

Site Supervisor Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

Agency Director/ Printed name: _____________________________________________

Principal Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

Faculty Liaison Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email:

Candidate Printed name: _____________________________________________

Signature: ___ _ _ _ _ __ Date: ____________

Telephone: Email: ________________________

18


Practicum

Basic Counseling Skills Feedback Sheet – R

Student Name:

Rater’s Name:

On Site Supervisor

Mid Semester

Practicum Instructor

End of Semester

Student ID:

Date:

Doctoral Student Supervisor

GUIDELINES

Please rate student performance on

each skill listed using the following

ratings:

N/O = Not observed but not required by the situation 1 = Not observed when required by the situation 2 = Demonstrated rarely

3 = Demonstrated inconsistently

4 = Demonstrated consistently

5 = Demonstrated consistently and to a level of expertise normally

indicative of one beyond this level of training/expertise

When giving a rating of 1, please indicate the reason using the feedback section.

Attending Score Qualified Ratings Attending Avg.

ATTENDING Specific Skill Rating

1. Body Language & Appearance

Maintains open, relaxed, confident posture. Leans forward when talking. Maintains

professional dress.

N/

O

1

2

3

4

5

2. Eye Contact

Maintains appropriate eye contact. N/

O 1 2 3 4 5

3. Minimal Encouragers

Uses prompts (uh huh, okay, right) to let the client know s/he is heard. Uses silence

helpfully. Uses nods and body gestures to encourage client to talk.

N/

O

1

2

3

4

5

4 Vocal Tone

Matches the sense of the session and session goals. Vocal tone communicates caring and

connection with the client.

N/

O

1

2

3

4

5

5. Verbal Tracking

Staying on topic that client presents. Repeats key words or phrases. N/

O 1 2 3 4 5

Basic Listening Score Qualified Ratings Basic Listening Avg.

BASIC LISTENING Specific Skill Rating

6. Selective Attending

Selectively attend to key aspects of client communication. N/

O 1 2 3 4 5

7. Directions and Encouraging Client to Talk

Uses “tell me more…about” or similar statements that encourage the client to talk about

specific aspects of the client’s communication.

N/

O

1

2

3

4

5

8. Paraphrasing (Reflections of Content)

Engages in brief, accurate, and clear rephrasing of what the client has expressed. N/

O 1 2 3 4 5

9. Reflecting Feeling/Meaning

States succinctly the feeling experienced by the client (You feel or You feel when

Feeling/Meaning statements are personalized to the client in “you feel” statements.

N/

O

1

2

3

4

5

10. Summarizing

Makes statements at key moments in the session that capture the overall sense of what

client has been expressing.

N/

O

1

2

3

4

5

19


Student Name: Rater’s Name: Date:

Deepening Session Score Qualified Ratings Deepening Session Avg.

DEEPENING THE SESSION Specific Skill Rating

11. Using Immediacy

Recognizes here-and-now feelings, expressed verbally or nonverbally, of the client or the

counselor. Can be related to the counselor-client relationship (“As we talk about , I

sense you are feeling . I’m feeling about how you are viewing the problem right

now.”)

N

/

O

1

2

3

4

5

12. Challenging/Pointing Out Discrepancies

Expresses observations of discrepancies (“You expect yourself to do when

facing the problem of but you do instead. When

this happens, you feel about yourself.”)

N

/

O

1

2

3

4

5

Total Score Qualified Ratings

Tape Review Pass

Approved to proceed to COUN 695

Feedback (only necessary if is given)

For more information regarding the validity and reliability of the items on this scale, the authors refer you to Eriksen, K &

McAuliffe, G. (2003). A measure of counselor competency. Counselor Education and Supervision, 43, p. 120-133.

20


Professional Counseling Performance Evaluation – R

Student:

N/O = Not observed but not required by the situation

1 = Not observed when required by the situation 2 = Demonstrated rarely

3 = Demonstrated inconsistently 4 = Demonstrated consistently

5 = Demonstrated consistently and to a level of expertise normally indicative of one beyond this level of training/expertise

Student ID:

Semester/Year: Mid-Sem End-Sem

Course Number:

Evaluator:

Counseling Skills and Abilities N 1 2 3 4 5

1. Demonstrates the ability to establish a therapeutic, working relationship

2. Demonstrates therapeutic communication skills including:

A. Immediacy – recognizes the here and now

B. Timing – responds at the optimal moment

C. Intentionality – responds appropriately and with a clear therapeutic purpose

D. Self-disclosure – skillful and carefully-considered for a specific therapeutic

purpose

3. Demonstrates empathic responses

A. Non-verbal communication – demonstrates effective use of head, eyes, hands,

feet, posture, voice, attire, etc.

B. Responding to content – reflects the primary elements of the client’s story

C. Understands context – understands the uniqueness of the story elements and

their underlying meanings

D. Congruence – genuineness; external behavior consistent with internal affect

E. Responds to feelings – acknowledges & responds to client affect

therapeutically

4. Uses appropriate procedures for assessing risk of suicide or harm to self/others

5. Uses appropriate procedures for managing risk of suicide or harm to

self/others

6. Uses appropriate procedures in screening for substance abuse/dependency

7. Collaborates with the client to establish clear therapeutic goals

8. Regularly check on client’s progress toward goals

9. Matches appropriate interventions to presenting clinical profiles in a theoretically

consistent manner

10. Demonstrates multicultural competencies

11. Demonstrates analysis and resolution of ethical dilemmas

12. Keeps appropriate client records with accuracy and confidentiality

13. Maintains a current list of community resources and facilitates client access to

those resources as appropriate

21


Student: Evaluator: Sem/Year: MidTerm Final

14. Sets and maintains appropriate boundaries in the professional relationship

(meeting time and place, session time limits, etc.)

15. Demonstrates skill in collecting and using the results of assessments for

treatment planning or referral. (See Below)

A. Intake interviews

B. A mental status exam

C. A biopsychosocial history

D. A mental health history

E. An education/work/career history

16. Properly assesses the traumatic effects of crises and disasters and treats or refers

trauma clients as appropriate

17. Uses current research and program evaluation data to shape and improve her/his

practice as a counselor

18. Selects assessment instruments that are appropriate for clients’ demographics

and presenting profiles and the student’s training and experience

Professional Responsibility N 1 2 3 4 5

19. Behaves ethically so as to promote confidence in the counseling profession

20. Promotes wellness and mental health through prevention, education, and/or

advocacy activities

21. Relates to peers, professors, supervisors, and others according to professional

standards

22. Advocates for services and resources appropriate for her/his client’s individual

needs

23. Demonstrates sensitivity to real and ascribed power differences between

themselves and clients, and does not exploit or mislead clients or others during

or after professional relationships

24. Demonstrates application of legal requirements relevant to counseling training

and practice

Competence N 1 2 3 4 5

25. Demonstrates basic cognitive, affective, sensory, and motor capacities to

respond therapeutically to clients

26. Recognizes the boundaries of her/his particular competencies and limits

her/himself to providing only those services and applying those techniques for

which she/he is qualified by education, training, and experience

27. Takes responsibility for compensating for her/his deficiencies

28. Assures client welfare when encountering the boundaries of her/his expertise

Maturity N 1 2 3 4 5

29. Demonstrates appropriate self-control (such as anger control, impulse control)

in interpersonal relationships with faculty, supervisors, peers, and clients

30. Demonstrates honesty, fairness, and respect for others 31. Demonstrates an awareness of his/her own belief systems, values, needs, and

limitations and the effect of these on her/his work

32. Receives, integrates, and utilizes feedback from peers, teachers, and supervisors

22


33. Is appropriately self-assured, confident, and trusting in his/her abilities

Student: Evaluator: Sem/Year: MidTerm Final

34. Follows professionally recognized conflict resolution process, seeking to

informally address the issue first with the individual(s) with whom the conflict

exists

Integrity N 1 2 3 4 5

35. Refrains from making statements which are false, misleading or deceptive

36. Avoids improper and potentially harmful dual relationships

37. Demonstrates respect for the fundamental rights, dignity, and worth of all

38. Respects the rights of individuals to privacy, confidentiality, and choices

regarding self-determination and autonomy

39. Respects cultural, individual, and role differences

Comments:

23


Multicultural Awareness, Knowledge, and Skills Survey –

Counselor Edition-Revised (MAKSS-CE-R)

Student Name:

Semester/Year:

Student ID:

Please indicate one that best describes you 1 very

limited 2

limited 3

good 4

excellent

1. How would you rate your ability to effectively consult with another

mental health professional concerning the mental health needs of a

client whose cultural background is significantly different from your

own? (C.D2; S.D1, F1)

2. How would you rate your ability to accurately assess the mental

health needs of men? (C.D2; S.D1, F1)

3. How would you rate your ability to accurately assess the mental health needs of women? (C.D2; S.D1, F1)

4. How well would you rate your ability to accurately assess the mental health needs of lesbian women? (C.D2; S.D1, F1)

5. How well would you rate your ability to accurately assess the mental health needs of gay men? (C.D2; S.D1, F1)

6. How well would you rate your ability to accurately assess the mental health needs of older adults? (C.D2; S.D1, F1)

7. How well would you rate your ability to accurately assess the mental

health needs of persons who come from very poor socioeconomic

backgrounds? (C.D2; S.D1, F1)

8. How would you rate your ability to identify the strengths and weaknesses of psychological tests regarding their use w/persons from

different cultural/racial/ethnic backgrounds? (C.H1)

9. How would you rate your ability to accurately assess the mental

health needs of individuals with disabilities? (C.D2; S.D1, F1)

10. How well do you effectively secure information and resources to

better serve culturally different clients? (C.D2; S.D1, F1)

11. At the present time, how would you rate your understanding of the

following term? “ethnicity” (C.D2; S.D1, F1)


following term? “culture” (C.D2; S.D1, F1)


following term? “multicultural” (C.D2; S.D1, F1)


following term? “prejudice” (C.D2; S.D1, F1)

15. At the present time, how would you rate your understanding of the following term? “racism” (C.D2; S.D1, F1)

Please indicate one that best describes you

1 very

limited 2

limited 3

good 4

excellent 16. At the present time, how would you rate your understanding of the

following term? “transcultural” (C.D2; S.D1, F1)


following term? “pluralism” (C.D2; S.D1, F1)

Student Name: Student ID: Sem/Yr:

24



following term? “mainstreaming” (C.D2; S.D1, F1)


following term? “cultural encapsulation” (C.D2; S.D1, F1)


following term? “contact hypothesis”

21. At this time in your life, how would you rate yourself in terms of understanding how your cultural background has influenced the way you think and act?

22. At this point in your life, how would you rate your understanding of

the impact of the way you think and act when interacting with persons

of different cultural backgrounds?

23. How well do you think you could distinguish “intentional” from

“accidental” communication signals in a multicultural counseling

situation?

Please indicate one that best describes your opinion 1 very

limited 2

limited 3

good 4

excellent 24. Promoting a client’s sense of psychological independence is usually a safe goal to strive for in most counseling situations.

25. Even in multicultural counseling situations, basic implicit

concepts such as “fairness” and “health” are not difficult to

understand. (C.F3)

26. In general, counseling services should be directed toward assisting clients to adjust to stressful environmental situations.

27. While a person’s natural support system (i.e., family, friends,

etc.) plays an important role during a period of personal crisis,

formal counseling services tend to result in more constructive

outcomes.

28. The human service professions, especially counseling and

clinical psychology, have failed to meet the mental health needs

of ethnic minorities.

29. The effectiveness and legitimacy of the counseling profession would be enhanced if counselors consciously supported universal definitions of normality. (C.F3)

30. Racial and ethnic persons are underrepresented in clinical and counseling psychology.

31. In counseling, clients from different ethnic/cultural

backgrounds should be given the same treatment that White

mainstream clients receive. (C.D5)

32. The criteria of self-awareness, self-fulfillment, and self-

discovery are important measures in most counseling sessions.

33. The difficulty with the concept of “integration” is its implicit bias in favor of the dominant culture. (C.D5)

25


Career Adapt-Abilities Inventory USA

Version

Student: Student ID # Course Completed:

Directions: Different people use different strength to build their careers. No one is good at everything, each of us emphasize some strengths more

than others. Please circle your rating of how strongly you have developed each of the following abilities using the scale below.

5 4 3 2 1

Please indicate one that best describes you Strongest Very Strong Strong

Somewhat Not strong strong

1. Planning important things before I start 5 4 3 2 1 2. Thinking about what my future will be like 5 4 3 2 1 3. Realizing that today’s choices shape my future 5 4 3 2 1 4. Expecting the future to be good 5 4 3 2 1 5. Preparing for the future 5 4 3 2 1 6. Becoming aware of the educational and vocational choices that I must make 5 4 3 2 1 7. Planning how to achieve my goals 5 4 3 2 1 8. Keeping upbeat 5 4 3 2 1 9. Considering the consequences of my decisions 5 4 3 2 1 10. Anticipating changes I must make 5 4 3 2 1 11. Concerned about my career 5 4 3 2 1 12. Making decisions by myself 5 4 3 2 1

13. Thinking before I act 5 4 3 2 1 14. Taking responsibility for my actions 5 4 3 2 1 15. Being persistent and patient 5 4 3 2 1 16. Sticking up for my beliefs 5 4 3 2 1 17. Counting on myself 5 4 3 2 1 18. Directing my future 5 4 3 2 1 19. Learning how to make better decisions 5 4 3 2 1 20. Doing what’s right for me 5 4 3 2 1 21. Doing what’s best for my family 5 4 3 2 1 22. Finding the strength to keep going 5 4 3 2 1 23. Taking charge of my future 5 4 3 2 1 24. Exploring my surroundings 5 4 3 2 1

25. Looking for opportunities to grow as a person 5 4 3 2 1 26. Imagining what my future will be like 5 4 3 2 1 27. Investigating options before making a choice 5 4 3 2 1 28. Observing different ways of doing things 5 4 3 2 1 29. Probing deeply into questions I have 5 4 3 2 1 30. Searching for information about choices that I must make 5 4 3 2 1 31. Becoming curious about new opportunities 5 4 3 2 1 32. Considering my alternatives 5 4 3 2 1 33. Seeking feedback about my plans 5 4 3 2 1 34. Questioning myself 5 4 3 2 1 35. Performing tasks efficiently 5 4 3 2 1 36. Learning from my mistakes 5 4 3 2 1 37. Being dependable—doing what I say I will do 5 4 3 2 1 38. Feeling pride in a job well done 5 4 3 2 1 39. Having self-confidence 5 4 3 2 1

40. Being conscientious and doing things well 5 4 3 2 1 41. Learning new skills 5 4 3 2 1 42. Working up to my ability 5 4 3 2 1 43. Overcoming obstacles 5 4 3 2 1 44. Solving problems 5 4 3 2 1 45. Doing challenging things 5 4 3 2 1

26


Evaluation of Site Supervisor


Counselor Education

Candidate Name: Student ID:

Site: Evaluation Date:

Site Supervisor:

Evaluation Period: From To

Circle the number which best represents how you, the student counselor, feel about the supervision received. After the form

is completed, the supervisor may suggest a meeting to discuss the supervision desired.

P o o r A d e q u a t e G o o d

Gives time and energy in observing, tape processing, and case conferences 1 2 3 4 5 6

Accepts and respects me as a person 1 2 3 4 5 6

Recognizes and encourages further development of my strengths and capabilities 1 2 3 4 5 6

Gives me useful feedback when I do something well 1 2 3 4 5 6

Provides me the freedom to develop flexible and effective counseling styles 1 2 3 4 5 6

Encourages and listens to my ideas and suggestions for developing my

counseling skills 1 2 3 4 5 6

Provides suggestions for developing my counseling skills 1 2 3 4 5 6

Helps me to understand the implications and dynamics of the counseling

approaches I use 1 2 3 4 5 6

Is spontaneous and flexible in the supervisory sessions 1 2 3 4 5 6

Helps me to define and achieve specific concrete goals for myself during the

practicum experience 1 2 3 4 5 6

Gives me useful feedback when I do something wrong 1 2 3 4 5 6

Allows me to discuss problems I encounter in my practicum setting 1 2 3 4 5 6

Provides an adequate amount of attention to both me and my clients 1 2 3 4 5 6

Focuses on both verbal and nonverbal behavior in me and my clients 1 2 3 4 5 6

Helps me define and maintain ethical behavior in counseling and case

management 1 2 3 4 5 6

Encourages me to engage in ethical behavior 1 2 3 4 5 6

27


P o o r A d e q u a t e G o o d

Maintains confidentiality in material discussed in supervisory sessions 1 2 3 4 5 6

Deals with both content and affect when supervising 1 2 3 4 5 6

Focuses on the implications, consequences, and contingencies of specific

behaviors in counseling and supervision 1 2 3 4 5 6

Helps me organize relevant case data and in planning goals and strategies with

my clients 1 2 3 4 5 6

Helps me to formulate a theoretically sound rationale of human behavior 1 2 3 4 5 6

Offers resource information when I request or need it 1 2 3 4 5 6

Helps me develop increased skill in critiquing and gaining insight from my

counseling tapes 1 2 3 4 5 6

Allows and encourages me to evaluate myself 1 2 3 4 5 6

Explains his/her criteria for evaluation clearly and in behavioral terms 1 2 3 4 5 6

Applies his/her criteria fairly in evaluating my counseling 1 2 3 4 5 6

ADD I T I O NA L C O M M E N T S AND /O R S U G G E ST I O N S

Practicum/Internship Student Date

My signature indicates that I have read the above report and have discussed the content with my supervisee. It does not

necessarily indicate that I agree with the report in part or in whole.

Site Supervisor Date

Used with permission of Accelerated Development Press (1995)

28


Evaluation of Site


Counselor Education


Site: Site Supervisor:

Evaluation Date:

Evaluation Period: From To

1 = Very Unsatisfied 2 = Moderately Unsatisfied 3 = Moderately Satisfied 4 = Very Satisfied

Rate the statements below concerning your site and experiences using the following rating scale:

Amount of supervision

Quality and usefulness of on-site supervision

Usefulness and helpfulness of faculty liaison

Relevance to career goals

Exposure to and communication of school/agency goals

Exposure to and communication of school/agency policies

Exposure to information about community resources

Rate all applicable experiences that you had at the site:

Report writing

Intake interviewing

Administration and interpretation of tests

Staff presentation/case conferences

Individual counseling

Group counseling

Family/couples counseling

Classroom guidance lessons

Psychoeducational activities

Consultation

Career counseling

Child/adolescent counseling

Play therapy

Other

COMMENTS: Include any comments or suggestions for improvement in the experiences you have rated moderately to very

unsatisfied. You may use the back of this form for additional space.

29


Practicum/Internship

Site Visitation Form

Site Name: Date:


Course: COUN 693 695 Semester: Fall Spring

Site Supervisor: The supervisor:

a. conducts supervision sessions with intern

b. conducts one-one weekly supervision

c. views video recordings of sessions

d. completes written evaluations

e. is able to provide adequate space for counseling

yes

yes

yes

yes

yes

no

no

no

no

no

Comments:

Comments:

Comments:

Comments:

Comments:

f. other yes no Comments:

The supervisor recommends the following:

The supervisor assesses the counseling student as progressing on a 1-10 scale (progress rated as: 1-not at

all, 10-very well, and 5-on schedule): 1 2 3 4 5 6 7 8 9 10

The supervisor would like assistance with:

Site Supervisor/Date Practicum/Internship Instructor/Date

counselor education program department of leadership and...

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