ࡱ> BD  !"#$%&'()*+,-./0123456789:;<=>?@AERoot Entry FpFXCWorkbook~SummaryInformation(DocumentSummaryInformation8 1nȀ\pDaniel R. Huron Ba==`J-8X@"1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Arial1Calibri1 Calibri1Calibri14Calibri1 Calibri1Calibri1Calibri1,8Calibri18Calibri18Calibri1>141<Calibri1?Calibri1*h8 Calibri Light1Calibri1 Calibri"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)                                                                      ff + ) , *     P  P        `            a>     @ @ (0@ @   (@ @  (@ @    ( (8@ @ ( * (p@ @  `@ @ (0  `  @ (p   ||Pdrs}-} 00\);_(*}-} 00\);_(*}-} 00\);_(*}-} 00\);_(*}A} 00\);_(*ef;_(@_) }A} 00\);_(*ef ;_(@_) }A} 00\);_(*L;_(@_) }A} 00\);_(*L;_(@_) }-} 00\);_(*}A} 00\);_(*L;_(@_) }A} 00\);_(*L;_(@_) }A} 00\);_(*L ;_(@_) }A} 00\);_(*23;_(@_) }A} 00\);_(*23;_(@_) }-} 00\);_(*}-} 00\);_(*}A}  00\);_(*23;_(@_) }-}! 00\);_(*}A}" 00\);_(*;_(@_) }A}# 00\);_(*;_(@_) }A}$ 00\);_(*;_(@_) }A}% 00\);_(*;_(@_) }A}& 00\);_(*;_(@_) }A}' 00\);_(* ;_(@_) }A}( 00\);_(*;_(@_) }}) }00\);_(*;_(@_)    }}* 00\);_(*;_(@_) ??? ??? ??? ???}-}/ 00\);_(*}A}0 a00\);_(*;_(@_) }A}1 00\);_(*;_(@_) }A}2 00\);_(*?;_(@_) }A}3 00\);_(*23;_(@_) }-}4 00\);_(*}}5 ??v00\);_(*̙;_(@_)    }A}6 }00\);_(*;_(@_) }A}7 e00\);_(*;_(@_) }x}800\);_(*;_(  }}9 ???00\);_(*;_(??? ???  ??? ???}-}; 00\);_(*}U}< 00\);_(*;_( }-}= 00\);_(* 20% - Accent1A 20% - Accent1 % 20% - Accent2A" 20% - Accent2 % 20% - Accent3A& 20% - Accent3 % 20% - Accent4A* 20% - Accent4 % 20% - Accent5M. 20% - Accent5 ef % 20% - Accent6M2 20% - Accent6  ef % 40% - Accent1M 40% - Accent1 L % 40% - Accent2M# 40% - Accent2 L渷 % 40% - Accent3A' 40% - Accent3 % 40% - Accent4M+ 40% - Accent4 L % 40% - Accent5M/ 40% - Accent5 L % 40% - Accent6M3 40% - Accent6  Lմ % 60% - Accent1M 60% - Accent1 23 % 60% - Accent2M$ 60% - Accent2 23ږ % 60% - Accent3A( 60% - Accent3 % 60% - Accent4A, 60% - Accent4 % 60% - Accent5M0 60% - Accent5 23 %! 60% - Accent6A4 60% - Accent6 % "Accent1AAccent1 O % #Accent2A!Accent2 PM % $Accent3A%Accent3 Y % %Accent4A)Accent4 d % &Accent5A-Accent5 K % 'Accent6A1Accent6  F %(Bad9Bad  %) Calculation Calculation  }% * Check Cell Check Cell  %????????? ???+ Comma,( Comma [0]-&Currency.. Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}% 5InputuInput ̙ ??v% 6 Linked CellK Linked Cell }% 7NeutralANeutral  e%"Normal 8Noteb Note   9OutputwOutput  ???%????????? ???:$Percent ;Title1Title I}% <TotalMTotal %OO= Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight168dq:Fc-2NWgFSWc-2NWgFSW̙̙3f3fff3f3f33333f33333\`ZSheet1{Sheet29}Sheet3I Not ApplicableNot Satisfactory Below Average%Average/ Commensurate with experience Above AverageI. PROFESSIONALISMHDisplays awareness of normal growth and development and client strengthsRating&Mean Score for Professionalism Section/II. REFLECTIVE PRACTICE/ SELF ASSESSMENT & CAREGReflects on practice and mindfully recognizes impact of self on others*Mean Score for Reflective Practice SectionIII. RELATIONSHIPSTForms and maintains productive and respectful relationships with peers or colleagues$Mean Score for Relationships Section#IV. INDIVIDUAL & CULTURAL DIVERSITYTUnderstands one's own cultural identity and personal attitudes toward diverse others Mean Score for Diversity SectionV. ETHICAL & LEGAL STANDARDSPDemonstrates knowledge and awareness of appropriate ethical codes and state laws%Mean Score for Ethics & Legal SectionVI. ASSESSMENTCSelects appropriate assessment measures for cases at practice site.!Mean Score for Assessment SectionVII. INTERVENTION#Mean Score for Intervention SectionVIII. SUPERVISIONdDemonstrates knowledge of interventions and explanations for their use in practice based on evidencekDemonstrates knowledge of the supervision process including one's own roles and responsibilities as trainee"Mean Score for Supervision SectionIX. OTHER AREAS OF COMPETENCYcA. Scientific Knowledge and Methods: Values and applies scientific methods to professional practice"Mean Score for Other Areas Section!TOTAL MEAN SCORE FOR ALL SECTIONSMName of Supervisee/ Student: ________________________________________________ONames of Supervisor/ Instructor: ______________________________________________4Semester of Supervision/ Practicum: ________________LName of Agency/ Class: _____________________________________________________bEVALUATION OF PRACTICUM STUDENT COMPETENCIES Counseling Psychology Program - ɫ1Summary of Supervisee/ Student's Growth Areas: cSignature of Supervisor/ Instructor: _________________________________________ Date: ______________.Summary of Supervisee/ Studen'ts Strengths: aSignature of Supervisee/ Student: __________________________________________ Date: ______________ Leave Blank+Displays professional demeanor and language=Displays compassion and respect in interpersonal interactions<Demonstrates integrity by adhering to professional standards'Shows appropriate respect for authority3Demonstrates effort to effectively resolve conflict'Completes case documentation accurately2Understands impact of therapy relationship on self8Understands own impact on client in therapy relationship1Maintains appropriate therapist-client boundaries7Is willing to admit mistakes with minimal defensiveness8Uses persons other than supervisor for skill development0Provides helpful feedback and critique to others0Is sensitive to the needs and strengths of peers4Is willing to be assertive with supervisor and peersNDemonstrates awareness f clinical competencies and identifies areas for growthKCritiques and analyzes own interview/ sessions accurately and appropriately:Recognizes own limitations in treating a particular client8Takes appropriate care of self and is aware of own needs[Forms and maintains productive and respectful relationships with supervisors or instructorsnDemonstrates cooperative discourse (e.g. refrains from interrupting, does not dominate, contributes actively)1Conveys counseling atmosphere of trust and safety%Demonstrates acceptance of the client+Expresses warmth and caring with the client0Shows a non-judgmental orientation toward clientSExhibits appropriate verbal regulation of emotion (i.e. expression and containment)VExhibits appropriate nonverbal regulation of emotion (i.e. expression and containment)(Communicates clearly using verbal skills.Nonverbal communication matches verbal content)Communicates clearly using written skills;Awareness of and sensitivity to clients' nonverbal behaviorNUnderstands clients' feelngs and communicates this understanding to the client?Recognizes the way culture shapes others' identity and behaviorZUtilizes language that demonstrates sensitivity to culture, gender, and sexual orientation^Directly addresses issues of difference between therapist and clients along salient dimensionsETherapeutically processes issues of cultural difference and diversitywAsks questions or offers suggestions that help clients think about how contextual issues may impact presenting concerns6Identifies potential ethical concerns and legal issues?Adapts behavior in accordance with ethical codes and state lawsIIdentifies areas of client functioning where further assessment is neededEProvides appropriate feedback to clients based on assessment measuresoApplies concepts of normal/ abnormal behavior to case formulation and diagnosis within a developmental contextoApplies concepts of normal/ abnormal behavior to case formulation and diagnosis within the context of diversity8Writes assessment reports and progress notes effectivelyMTies together seemingly discrete and isolated components of client's behavior<Generates hypotheses concerning client behavior and dynamicsSProvides rationale for conceptualization based on psychological theory and research=Provides rationale for conceptualization based on client data4Attends to systemic issues in case conceptualizationvFormulates and conceptualizes cases and plans interventions utilizing at least one consistent theoretical orientationIEvaluates treatment progress and modifies treatment planning as indicatedIs able to track client work)Acts purposefully and with intentionality5Uses appropriate and therapeutic open-ended questions$Can paraphrase and summarize contentAccurately reflects feeling-Encourages client to be specific and concrete7Does not talk over or interrupt clients inappropriately)Clarifies client content when appropriate4Handles silence and uses it effectively in treatmentEstablishes appropriate goals'Explores resolution of similar problems%Able to separate process from content:Encourages client to accept responsibility in relationshipUDemonstrates the ability to effectively implement therapeutic treatment interventionsQImplements interventions one at a time and stays with interventions once intiated(Exercises therapeutic control in sessionWorks with depth of affect)Confronts appropriately and in the moment/Demonstrates appropriate use of self in session$Uses therapeutic process effectivelyRecognizes client resistance7Handles client resistance appropriately and effectivelyqIs able to comfortably discuss sensitive issues with clients (e.g. sexuality, transference/ countertransference)8Provides crisis management interventions, as appropriate7Develops and tests hypotheses using systemic principles/Makes contact and attends to all family members5Helps family/ couple establish appropriate boundariesEAttends to covert family/ couple conflicts, alliances, and coalitions0Attends to systemic interactions in interventionVUses supervision process to reflect on areas of strength and those needing improvement;Demonstrate willingness to admit errors and accept feedback2Willing to be observed and evaluated by supervisor4Integrates feedback from supervisor into performanceUB1. Interdisciplinary Systems: Appreciates expertise and professional roles of otherszB2. Interdisciplinary Systems: Makes appropriate referrals and works effectively with professionals from other specialtiesRC. Consultation: Able to provide consultation in the form of professional guidancekD. Teaching: Able to provide psychoeducation and outreach to support developmental or preventative efforts.E. Management-Administration: Functions effectively within professional settings by complying with policies and participating in management structureBF. Advocacy: Assists clients in development of self-advocacy planslIn your opinion, has this student successfully completed this semester of this pra<(cticum experience? YES/ NO0*APA Accreditation Standard II.B.3.d, IR C-14 D.iTo meet new APA accreditation standards (SOA)*, please list at least one date that you directly observed k(in person or via video) a session lead by this student this semester: Date:________________________+ ,(.l/13{5 '7k w9 ?;=:@~VBCoEr `С-;c=1gN$BRvZH MNl4 p:̉ CbÝ V*ڒ! cyg$wS.QD[@o¶Vi'tJCFZe_(3xL!C8;kNLՈ\1,5'r!VO. L.fNIfaZ^^3ੵ9حw Wk՚.{vms[R?+N [+fqd;+NPhz  r%dٱ Z_SLyZ_r12h<#SB0cA b( \pQԶ_i~5x ʐPLuOAkP#b1N/o?}veI}Nq E|__| фH\ssXNbcHt{T!tU9f>\P=0>c03E=3?x9r c=W%£Y'*K=:)2VSًcéIB JPpɧ 7$#:v i!tLg ډs!tyN|*G8aՀ`EXLGqԟ)}2O[Ic`OLr#1"gͺ]QB+il.e h7ab}lB" M,KU'h8S8!$I=,kP [7i҅mUcM8m mͫSD 8ǐ~gB%\bp+m^ܚ3M.8fYsԷ:EYT1|n+ʕj\\*lOtBN\ ep5j]x i sVik}wN#$(,'*-AY=_zJ+2U1Wf1$l9pGspb(u&9 ry#Gdi{޸f~&bFX#]R gkӄMZkkF01 JXAMT~ ꈟ"la㇠iV iacm1iU6GGXxZλlm&eM;Ӌw"~ ?? ? >#~ ?@ ? >$~ ?@ @ >%~ ?@ ? 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