Member Association of the Psychotherapy and Counselling Federation of Australia Inc. (PACFA)
SUPERVISOR’S REPORT
This form should be used by QCA Provisional members applying for Clinical Membership.
(It is strongly recommended that this form be completed as part of closure when changing supervisors and kept as evidence when applying for membership upgrade.)
Once Provisional members have completed the required supervision of an additional 75 hours post-training supervision linked to 750 client contact hours post-training over a minimum of 2 years (a total requirement of 950 client contact hours linked to 125 supervision hours) they will be eligible to apply for Clinical membership.
Supervision logs should be provided to your supervisor as evidence for the hours noted below, but they should not be submitted in place of this form.
If you have more than one Supervisor, please use multiple copies of this page.
To be completed by the applicant’s Supervisor:
Please ensure that you have read the Supervision Guidelines on the QCA website before completing this form.
(Link to Supervision Guidelines)
Post-Training Supervision: Supervision is a formal, collaborative process in which case material from the supervisee’s own practice experience is reflected upon. It is not the same as administrative or management supervision, nor is it the same as psychotherapy or counselling of the supervisee. QCA does not accept supervision in dual relationship situations.
If you are reporting on both group and individual supervision experiences with the same Supervisee please consider both these contexts in the following report.
Supervisor’s Name: ......
Supervisor’s Address: ......
Phone: ...... Email......
Supervisor’s Qualifications: ......
Applicant/Supervisee’s Name: ......
Supervision was:Individual: Yes / NoSession Duration (minutes): ......
Group: Yes / NoSession Duration (minutes): ......
Number in the Group: ...... (maximum of 6 people)
If Supervision included both Individual and Group formats, please indicate the percentage of each (minimum of 50% Individual and a maximum of 50% Group)
Individual: ...... Group: ......
This report relates to the period from ...... /...... /20...... to ...... /...... /20......
Total Client Contact hours in this period: ......
(Note: See Supervision Guidelines for information on the percentage of telephone and/or e-counselling client hours that can be counted.)
Total Supervision hours in this period: ......
Supervisor’s Comments (attach extra page as needed):
Summary Statement of Supervisor:
I have read the QCA Supervision Guidelines.
The details in this Report accurately describe our supervision arrangements. The applicant has demonstrated a capacity to work autonomously, and has met the requirements for QCA Clinical membership. I endorse this application.
Supervisor’s Signature: ......
Date: ......
V3.02.2017