Contract for Supervision of Psychotherapy

Kirk Honda, MA, LMFT

 

This agreement has been created to address the legal, ethical, practical, and clinical issues of the supervisory relationship.  This agreement is intended to articulate and clarify the mutual responsibilities of the parties involved and the procedures and standards for effective supervision.

Qualifications

I have been a licensed marriage and family therapist in Washington State since 1999. My license number is LF00001679. Licensure indicates that a practitioner has met basic education, competency, and supervision standards. If more information is needed, contact the Department of Health, PO Box 47890, Olympia, Washington 98504-7890, (360) 236-4030.

In 1997, I obtained a masters in psychology with a specialty in couple and family therapy from Antioch University Seattle. I am currently pursuing a doctorate in psychology from Antioch University Seattle. I have been practicing as a psychotherapist since 1996, and I have been in private practice in Seattle since 1998.

I have also been faculty in the Couple and Family Therapy Specialization at Antioch University Seattle since 1998. I have been supervising clinicians in their work with clients since 1999 and an AAMFT approved supervisor. I am a clinical member of the American Association for Marriage and Family Therapy.

Supervisee Responsibilities

To obtain client signed informed disclosure and consent of:

  • My contact information
  • That I am bound by the same confidentiality laws and ethics
  • The supervisee is in supervision and will be discussing clinical information      with me

To abide by the current rules and regulations of the Washington Department of Health and other relevant professional licensing entities

To abide by the national code of ethics for his or her profession (e.g., AAMFT)

To not practice outside one’s competence

To abide by the relevant professional standards of care

To adhere to the policies of the employers of the supervisor and supervisee

To immediately inform supervisor of any problems (email or phone text are the quickest way to inform me)

To take reasonable means to protect client confidentiality when using means of communication such as postal mail, telephone, video, and email

To obtain and maintain professional liability insurance coverage

To prepare appropriately for supervision sessions

To submit clinical documentation for review by the supervisor when requested

To be open to feedback in a non-defensive manner

To implement the recommendations made by the supervisor

To complete readings and other educational assignments made by the supervisor

To participate in personal counseling outside of the supervisory process when it appears that personal issues may be undermining the supervisee's clinical effectiveness and professional growth

To be on time to supervision meetings

To provide a minimum of 48-hours-notice when rescheduling or cancelling an appointment or you may be charged the full fee

To talk with me about any complaints you have about my supervision, so that I can respond to your concerns

(If you believe that I have been unwilling to listen and respond, or that I have behaved unethically, you can complain about my behavior to the Department of Health, PO Box 47890, Olympia, Washington 98504-7890, (360) 236-4030.)

To initiate meetings as often as necessary to meet the goals of supervision, to meet his or her training needs, to provide high levels of care to the clients involved, and to address other clinical needs that may arise

To call the Crisis Clinic at (206) 461-3222 or 911 in an emergency

To pay a prorated fee if I spend more than 10 minutes outside of face-to-face supervision

Supervisor Responsibilities

To foster an atmosphere of trust, support, encouragement, and mutual respect that is conducive to the professional growth of all participants in the supervision experience

To abide by the American Association for Marriage & Family Therapy Code of Ethics

To abide by the current licensing rules and regulations of the Washington Department of Health

To adhere to the policies of employers of the supervisor and supervisee

To consider the client’s best interests

To review case material via case presentation, direct observation, co-therapy, video or audio recording

To provide feedback regarding the supervisee’s work with clients

To provide readings and other educational assignments as needed

To collaborate with the supervisee in evaluating the supervisory process on an ongoing, informal basis

To be available to the supervisee between supervision sessions for brief clarifications as needed

To assist the supervisee in exploring interpersonal and intrapsychic issues which appear to impact on the supervisee's clinical work

To recommend personal counseling for the supervisee should the supervisee be unable to resolve personal issues which are affecting her/his therapeutic effectiveness and professional development

To have someone cover my supervision if I am on vacation or otherwise unavailable

To end the supervisory relationship if the supervisee has a significantly overdue balance, the supervisee is non-compliant with recommendations, or the supervisee is not consistently showing up for appointments 

To keep confidential records of the dates and times of supervision meetings, the cases involved, and the supervision content