Sample Clinical Supervision Contract


Sample Clinical Supervision Contract – Free Download

This free sample clinical supervision agreement is a free template that is fully customizable. The template is designed to convey to your supervisee that having a license to practice psychotherapy is serious. As a supervisor, conveying that to your clinical supervisees protects you as well. Much of this sample clinical supervision pdf download is based on understanding your role as a supervisor their your role as a supervisee.

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.

5 Basics of a Solid Clinical Supervision Contract

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 as they are also licensed.

Specific Tasks Required in Clinical Supervision

1) Evaluation

2) Supervisor Intervention. In addition, supervisors should seek ethics continuing education 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 Insurance.

2) 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.

These are some of the most important elements of your supervision agreement– not an exhaustive list. It is wise to set the tone of the relationship and a clear understanding of roles before you engage the individual for supervision. 

You deserve a former licensing board president on your side.

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