Sample Clinical Supervision Contract


Sample Clinical Supervision Contract – Free Download

This sample clinical supervision contract is free and customizable. Much of this sample clinical supervision pdf download is based on understanding your role as a supervisor or your role as a supervisee.

So sign up now for downloadable sample of a great LPC supervision contract.

So where do you begin? Thankfully, I’ve done a lot of the work for you. Here are key elements that should be included in a clinical supervision contract.  I also offer a comprehensive ethics workshop on supervision documentation.

How is Clinical Supervision for LPC in Georgia defined?

First, the definition of LPC supervision varies widely from state to state. The definition of Supervisor in Georgia Composite board rules are, ” …direct clinical review, for the purposes of teaching…purpose of supervision is to promote the development of the practitioner’s clinical skills.” The paragraph also discusses what types of direct clinical review are acceptable. Read the full definition here at 135-05-.01 “Definitions”, paragraph 4. Please note the policies change without notice.

Important Board Policies

Georgia’s Composite Board has also implemented several policies not included in board rules that are important to read and understand. More detail of supervisor/supervisee responsibilities can be found directly on the APC forms.

5 Basics of a Solid Clinical Supervision Contract

The document will open in a new browser window. Continue reading below. Some supervisors choose to include other key elements in supervision in the contract such as their various models and approaches to clinical supervision.

General Agreement

The agreement should convey confidence, competence and decisiveness. It should be direct. Finally, it should convey a supportive supervisory relationship and importantly, a relationship of mutual trust. First, this sample clinical supervision contract addresses:1) The professional responsibilities of the supervisee.2) The respective professional roles of supervisor and supervisee.

Board Law and Rules

1) The supervisee must thoroughly understand board rules including diagnose and testing rules.2) The supervisor will assist with understanding GA composite board rules in all manners possible.3) Finally, the honus is on the supervisee to know the board rules.

Specific Tasks Required in Clinical Supervision

1) Evaluation2) Supervisor Intervention. In addition, supervisors should seek ethics CE training in managing boundaries with supervisees/ students. 3) Duty to warn.


This section does not address notes and documentation of supervision, but important documents you will want to have in their file. 1) Malpractice Insurance2) A complete copy of the APC application.3) Supervisee forms previously submitted with their LAPC/APC license application. 4) The application for supervision. Prior to what you can expect in the supervision interview, you will want the supervisee to complete a specially designed application for supervision.

Termination of Supervision

Note the sample clinical supervision contract also includes how supervision can be terminated.

Writing a Killer Supervision Contract

A good example of a clinical supervision contract should make clear respective roles. For example, it is the supervisee’s job to be teachable. In addition, the supervisor should make clear the supervisee’s responsibilities for maintaining their license. Third, the supervisor should have a clear understanding of the supervisee’s past and current work and supervision experience. And finally, how to avoid financial disputes with the supervisee.

Clinical Supervisor is Incompetent and Unethical

Ethics Demystified: Clinical Supervisor Incompetent Unethical

So you say your clinical supervisor is incompetent?

Let’s learn to distinguish when a clinical supervisor is incompetent versus poor quality versus unethical. They may be one or all three. Some supervisor relationships can turn catastrophic.

But for sure, let’s learn what you can do about it. But be sure to read Guidelines for APCs from the Supervisors’ Perspective.

The relationship between a psychotherapy clinical supervisor and their supervisee is complicated. Clinical supervisors who provide distance or telesupervision face other challenges. Supervision is not for the faint of heart. One needs to work fearlessly and with confidence and conviction.

It has similarities to a client and therapist relationship. You may be a student in a graduate program. Perhaps it is an employer and employee relationship. Each has specific responsibilities. Very importantly, it is a professional peer relationship.

In any case, if you think your clinical supervisor is incompetent you’re clearly frustrated with with them.

Poor Quality Supervision

We encounter poor quality in everything we buy. Whether it is goods or services. Poor quality at a restaurant or from an online marketplace. Low quality clinical supervision whether provided by a social worker, psychologist or professional counselor.

In some instances what we perceive as poor quality clinical supervision may not be to someone else. So poor quality may not mean your clinical supervisor is incompetent. In addition, high quality supervision can be subjective.

However, when there is consensus of poor quality it probably just is. But what determines quality clinical supervision?

Clinical Supervision Training

There is quality supervisor training and inferior training. If you provide clinical supervision you should be trained properly. Training includes supervision CE continuing education workshops, masters or doctorate supervision coursework, one on one and group training in supervision of supervision and other.

In all situations, the training should meet an industry standard and be practical, logical and empirical. In many cases, a clinical supervisor is incompetent based on poor training. In short, clinical supervision training should be high quality.

A Competent and Experienced Therapist

Assuming our clinical supervisor is well trained, they also need to be experienced as a behavioral health clinician They should be a seasoned therapist with broad skills in treatment of mental illness and addictions. You will need someone to teach you these skills whether you are doing art therapy or working in a psychiatric hospital.

In other words, your therapy may not be deeply clinical. In most work settings, you WILL encounter suicidal and severe psychological disturbance. You need a clinical supervisor who has skill working with those problems.

A Supervisor Should Be Emotionally Mature

A clinical supervisor is held to a higher standard than your boss. In fact, your boss may be held to no standard at all. Perhaps held to a standard as an employee, but not as a boss. Managers are often provided little to no training.

A clinical supervisor needs to be a mentor. They need to know how to promote professional and personal growth. They need to be instructors and critics when needed. These are all skills required to provide counseling and psychotherapy.

Lastly, they should be receiving personal psychotherapy.

Incompetent or Unethical?

In brief, shortcomings in the above areas may suggest incompetence. Whereas not necessarily unethical but at it’s worst incompetent, inept and poor quality. Tragically, there are unethical supervisors.

+ MORE: Which Code of Ethics Should You Follow

Acting on Behalf of Another Against Your Best Interests

One encounters this most often when the clinical supervisor is also the boss. There is an inherent conflict with this arrangement. Mainly, in order for the supervisor to keep their job they must act on behalf of the mutual employer.

For example, you disclose to your clinical supervisor you refuse to comply with an employer policy of billing for services not rendered. Your supervisor reports your refusal and you are then fired. Therefore, the only way for you to resolve this conflict is to quit that job.

This does not represent high quality supervisory skills. In fact, there is an ethical violation: your supervisor has violated a confidence that has no bearing on your professional development. In fact, they have attempted to force you to something unethical. Even worse, they have pressed you to do something illegal.

Inappropriate Involvement With Your Off-Site Employer

For example, you inadvertently breached confidentiality. You have inflicted no harm. You ask your supervisor “John” for guidance. The supervisor believes it is their ethical responsibility to report the breach to your employer. They report and you are fired.

Perhaps an argument can be made for reporting to your employer. However, all other matters equal it is a violation of confidence and probably unethical. At the least, it is easy to understand why you might feel betrayed. An alternative solution might be your supervisor using this as a teaching opportunity. The breach was an accident and likely due to your inexperience.

We assume new and experienced therapists all make mistakes. The goal is first ‘do no harm’ and learn from the mistake.

As a side note, John has also put himself in a precarious position– his actions have directly caused termination of your employment. It’s easy to see this clinical supervisor is incompetent and unethical.

Appropriate involvement with an off-site employer can include confirming the worksite is consistent with that filed with the APC application and related matters. As a supervisee, you should provide your LPC clinical supervisor with a copy of the Directed Experience form completed by the Director.

Not Recommending For Licensure

John has supervised you for 12 months. It is time for you to submit your application for LPC licensing. You submit your application and it is denied because the supervisor checked the box that says, “I do not recommend for licensure”.

What happened? Why didn’t John notify you sooner? He told you he was concerned about the frequency of corrective action. However, it would have been best for John to notify you sooner that he did not intend to recommend you. It is probably an ethics concern because John accepted payment for supervision services for 12 months and was possibly aware before then of his intentions to not recommend.

Refusal to Complete Supervision Forms

Sometimes a supervisor will refuse to complete supervision licensing forms. The reasoning may be that the supervisee has an unpaid account balance. Or they do not want to recommend for licensure and refuse to complete the forms. The reason may also be they have formed opinions in their role as boss about the supervisees clinical skills.

Yet another reason, is this same boss / clinical supervisee has opinions about your job performance. Perhaps there is conflict with co-workers or deficiencies in completing agency paperwork.

Regarding an account balance, your supervisor would be wise to address it as a collection matter similar to unpaid patient accounts. In other words, this is not a matter for supervision, it is a fee dispute.

The others above are employer disputes and issues for the employer’s HR department to address. They may not directly reflect a supervisee’s competent and ethical practice.

Rude or Aggressive Behavior

There is a power differential between a supervisor and supervisee. It is unethical to abuse that power through aggressive, forceful or otherwise abusive behavior.

What You Can Do About It

Are Clinical Supervision Services, Services?

Yes they are. Like any service, we can choose to get it elsewhere. Anything we buy is a service and we pay –in some form– for clinical supervision. There is a cost of clinical supervision. That cost can be that an employer provides the supervision. Or we pay cash money for it. Ranging from $50.00 to $150.00 per session and higher.

Your Options

First, if you have exhausted all efforts to resolve the problem to no avail you can seek supervision elsewhere. If your supervisor refuses to complete your forms, you have several choices: do nothing and accept the license denial, attempt to resolve it with the supervisor, or rebut the supervisor’s refusal with the licensing board. Like all therapists, supervisors are fallible. If you want to justify your clinical supervisor is incompetent or unethical, make note of:

  • Can you defend it was an employer/employee dispute unrelated to your clinical competency?
  • Did the supervisor violate your confidence?
  • Was the conflict a result of your supervisor engaging in a dual relationship with your employer or other?

The Two Most Important Questions

There are two important questions to ask a supervisor during your interview:

• Have they ever refused to recommend for LPC licensure and if so, why.

• Have they filed a board complaint against a supervisee and why.

Determine whether you believe the supervisor had just reasons.

Lastly, request your supervision forms be completed immediately after you terminate with them. You can avoid problems that can result from attempting to get them signed later.

Clinical Supervision Training for LPC

Ethics Demystified: Clinical Supervision Training For LPC

Clinical Supervision Training for LPC Supervisors

Do you need to complete the clinical supervision training in Georgia? Here’s all you need to know about supervision training and why you are required to complete it.

“This workshop answered questions I’ve had about the industry for 20 years.” Richard Blankenship LPC, Capstone Counseling Services.

“I wish I had taken this workshop when I was initially licensed.” – Tamara Ashley LPC

“ Excellent information. This should be a required ethics workshop for all clinical staff and supervisors.” Ira Bennett, LCSW.

If you are an APC, read on because this greatly impacts you. The GA Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists passed a rule change effective “after 9/30/2018” that requires Supervisors to have either the CPCS or ACS credential. If you already know you need to complete supervision training, you can register now quickly and easily.  I am an NBCC approved CE provider ACEP # 6921. I hold both LPCAGA CPCS and NBCC ACS LPC supervision credentials.

Do I need the supervision training for LPCAGA CPCS or NBCC ACS?

If you are a Georgia supervisor, yes. First a good supervisory relationship begins with a solid free clinical supervision contract. The good news is supervision contracts submitted to the board prior to on or before 9/30/2018 lock you into the former requirements as long as you don’t change supervisors. You are not required to have a supervision credential to continue with your current supervisees or accept new supervisees provided the supervision contract is executed on or before 9/30/18. After 9/30/18,  supervision / supervisors must meet the new licensing board requirements: supervisors must hold either the LPCA of Georgia CPCS or National NBCC ACS credential. So complete the CPCS training in Georgia or training for the ACS. The training requirements for the CPCS credential and National ACS credential differ.

What if I only provide practicum and internship Supervision?

These is a long answer and short answer to this question. First, there are fundamental differences between a supervisor and practicum supervisor. A practicum supervisor does not execute a supervision contract that is submitted to the board. In that sense, they are not a Supervisor by rules definition. Rather, they complete a form attesting to number of practicum and internship hours completed and that they supervised their work. So, it follows that the nature of accountability differs. The practicum supervisor can either be the course instructor or the practicum site supervisor.

The practicum supervision is, in effect, a course requirement since it is part of the degree program. Still, currently the practicum supervisor must meet supervisor requirements. So you will need to complete the supervision training. But there are several issues that the board may encounter after the rule change becomes effective regarding both practicum supervisors, supervisors and future applicants.

Need to Renew Your CPCS?

Many Georgia LPC Supervisors have completed the clinical supervision training for LPC supervision for the CPCS in anticipation of the rule change subsequently raising the number to approximately 500, but out of state applicants’ Supervisors will not have the Georgia-specific CPCS credential (the board receives many applications from individuals relocating to Georgia who want to apply for GA licenses many of whom are currently fully licensed in their home state).

Will my clinical supervision transfer from another state if my supervisor does not have the CPCS or ACS?

It is not known how all license applications will be handled by the GA Composite Board.

First, if your LPC supervision was or is being provided by an NBCC Approved Clinical Supervisor, they are acceptable to Georgia’s Licensing Board provided they meet all other definitions of Supervisor.

Secondly, if you will be submitting an application for licensure by endorsement, the board will evaluate license equivalency (if your state’s licensing requirements are equivalent ) in a different manner.

If the board accepts a non- CPCS or ACS supervisor, it may need to allow in-state applicants to use non-credentialed supervisors as well. But the board has discretion to require the applicant to obtain a credentialed supervisor and start over with all of their supervision. 

Also, the other acceptable credential by Georgia’s Board is the national ACS. The majority of applicants after 9/30/2018 and at least in the future will not have the ACS credential. For example, as of this writing there are only 66 ACS credential holders in the state of Tennessee.

3) Again using Tennessee as an example, under the new rule the vast majority of Tennessee supervision forms submitted with a Georgia licensing application would be ineligible if they engaged with these supervisors after 9/30/18.

4) Applicants are in the same dilemma if they relocate from Florida. Florida has only 60 NBCC ACS and few CPCS  who are usually licensed in both GA and FL.


Supervisors: know this new rule. You can encounter conflict with your supervisees if you provide supervision that is not composite board-eligible.

Supervisees: If you have a supervisor on or before 9/30/18, don’t change supervisors before license eligible unless absolutely necessary.

Send an email to the board for clarification on whether they will accept out-of-state supervision provided by non-credentialed supervisors. However, they may not be able to provide an answer to this question.

Most importantly, read and understand the rules thoroughly before committing to a particular supervisor or work setting. Most important to know is “…year of post-masters directed experience under supervision in a work setting acceptable to the board.”

Continue to follow both the board policies and proposed rule changes at the Secretary of State Licensing Board Website.

clinical supervision training for lpc cpcs acs

Areas Served

I provide services to many areas in Georgia. Stay tuned for more information.