To schedule supervision:
or call: 704-869-2047 ext. 700
LIVE SUPERVISION AND TELE-SUPERVISION AVAILABLE!
LPC Supervision Professional Disclosure Statement & Supervision Contract
between Supervisor: Erin B. Patterson, LPCS, NCC & Supervisee
This document is to inform you about my background and credentials, my approach to
supervision, and other important information.
Qualifications: I have a Master's of Arts, Education Specialist degree in Mental Health Counseling/Counselor Education from Gardner-Webb University in Boiling Springs, NC (2007). I am a Licensed Professional Counselor (license #7176) and a Licensed Professional Counselor Supervisor (license #S7176) in North Carolina. I hold a Professional Counselor License in the state of Michigan through the Michigan Department of Licensing and Regulatory Affairs (#6401016481). I also am a National Certified Counselor through the National Board for Certified Counselors (#295578). I have been actively providing counseling services since 2007.
Counseling Background: I have been providing counseling services since 2007 to adults, adolescents and children. I primarily utilize a combination of CBT and client-centered approaches. I have experience working with mood disorders, anxiety disorders, trauma, ADHD, and behavioral problems in children & teens. I have been trained in child-centered play therapy for children 12 & under. I have some experience using EMDR & Trauma-Focused CBT as treatments for trauma. I attempt to utilize
natural means when possible to help with symptom reduction in ADHD, depression, bipolar
disorder & anxiety. I have experience working with a variety of socio-economic statuses, ethnicities,
& sexual orientations.
Supervision Training and Experience: My supervision training includes continuing education units
in counseling supervision, including supervision models using developmental models and the
Discrimination Model. I have been providing clinical supervision in some capacity since 2008. My
supervision experience includes peer supervision within a large collaborative private practice
setting, administrative supervision for paraprofessionals in a clinical agency setting, and supervising
students in master's level counseling programs.
Models of Supervision: As, previously stated, I provide supervision based on the developmental &
discrimination models. The developmental approach to supervision suggests that each counselor
goes through different stages of development in their professional career. I recognize that
movement through these stages is not always linear and can be affected by changes in assignment,
setting, and population served. The discrimination model is based on supervisors’, often changing
roles, and four focus areas for counselors: (1) Counseling Performance Skills, (2) Cognitive
Counseling Skills, (3) Self-awareness, & (4) Professional Behaviors.
Role of the Supervisor: As a counselor, I use a collaborative, client-centered and strengths-based approach to promote supervision. Together we will explore and develop your own individual therapeutic style. Although therapeutic techniques may be important to learn, one of the most important skills to learn is the way you build and maintain relationships with your clients.
My responsibilities in the supervision work include monitoring client and counselor welfare, teaching counseling skills, and ensuring compliance with legal, ethical, and professional standards, as well as evaluating counselor performance through both formative & summative means. I am responsible to you (the supervisee), your clients & the counseling profession as a whole.
Objectives and Goals of Supervision:
1. To create a learning environment that matches the needs of the supervisee;
2. Facilitate professional development of supervisee;
3. Monitor and ensure client care and welfare;
4. Serve as a gate-keeper for the profession of counseling;
5. Evaluate performance and skills throughout supervision, culminating in one summative evaluation for advancement in educational program or career.
Methods and Modalities of Supervisee Training: Each supervisee is responsible to obtain written informed consent from each client for supervision of their case. In adherence to NC Administrative Code, each supervision session will include a review raw data from clinical work through a variety of methods, including but not limited to, audio tape review, video tape review, live observation, co-counseling, & review of case notes/process notes (21 NCAC 53 .0208).
Evaluation Procedures used in the Supervisory Relationship: We will work together to develop supervision goals that will give you direction in your professional work and in our supervision sessions. I will provide verbal and written feedback for each supervision session (formative evaluation) based on those mutually agreed upon goals. Supervision session notes will be provided to the supervisee prior to attending the next supervision session. Quarterly summative evaluation of overall counseling performance will include strengths, personal and/or professional limitations, areas for future improvement, and my analysis of your work. Clients are often the best assessors of the skills of the counselor; therefore, I will routinely seek input from the clients as to the outcome of treatment. We may also use:
1. Written competency tools;
2. Direct observation;
3. Counselor self-assessments;
4. Work samples, such as audio/video recordings; and/or
5. Peer assessments.
Confidentiality: The issues you discuss in supervision will be confidential with the following exceptions:
1. Your performance and conduct in this clinical experience will be described in general terms when I submit quarterly reports and verification of supervision forms to the NC Board of Licensed Professional Counselors and other credentialing boards or when consultation with another professional is necessary.
2. If I am asked to provide information about your clinical experience in the form of a recommendation for a job, licensure, or certification.
3. Disclosures made in triadic or group supervision cannot be absolutely guaranteed as confidential. I will take every measure to encourage confidentiality and act appropriately if confidentiality is not upheld.
Session Fees and Length of Session:
A minimum of one (1) hour of supervision will be provided for every 40 hours of clinical work you provide. Each supervision session will be at least one (1) hour.
Individual supervision is provided at a rate of $100 per hour. Dyad (2 supervises) supervision is offered at a $10 discount -- $90 for a 1 hour session. Group (3 – 5 supervisees) supervision rates are at a $20 discount -- $80 for a 2 hour session.
Supervisees that have completed a graduate school internship with me prior to graduation are eligible for supervision at the rate of $75 per hour if they are not on contract to provide services with Patterson Psych Group, PLLC. A discount of $25 will be applied to dyad and group supervision sessions for supervisees meeting this criteria.
Cash, debit cards or credit cards will be accepted at each supervision session. If you are doing distance supervision, an invoice will be e-mailed to you and should be paid online prior to your supervision appointment.
______ Please initial
I understand the fee I will be required to pay for each hour of supervision is:
 $100/hour  $75/hour
Supervisee’s Responsibilities in Supervision: It is important for you to take supervision seriously as this is an investment in your professional development. Therefore, supervisees will be required to:
1. Prepare for and attend sessions. This includes submitting a work sample (video/audio recording) and process notes at least 3 days before the scheduled supervision session. Forms for process notes will be provided to you during your first supervision session.
2. Complete homework & assignments from previous supervision sessions prior to the following supervision session. This includes tape critiques, additional reading of alternative techniques/interventions, etc.
3. Complete all documentation of counseling sessions within 24 hours of the conclusion of the session. I have forms that you can use to record session notes if your agency/site does not provide these for you.
4. Keep supervisor informed regarding all client issues & progress. Occasionally, you may need to contact me prior to our scheduled supervision. Feel free to call or text if you need immediate feedback or recommendations.
5. Maintain liability insurance at all times. A minimum of $1M single incident/$3M aggregate is required. Proof of insurance must be supplied no later than the first supervision session with me.
6. Schedule a minimum of 1 (one) hour of supervision per month after you complete your first direct hour of service provision, whether or not you have accumulated the minimum 40 hours of counseling work during that month time period. This requirement is because, as your supervisor, I assume vicarious liability of your services/clients. Much can happen in your clients’ lives in the span of 1 month and I need to be kept informed on a regular basis.
7. Scheduling your own supervisions with me as you are approaching the 40 hours. I have several supervisees at any given time, so I count on you to be responsible for contacting me to ensure that your supervision is on the calendar each month. I also tend to have a very full schedule and you will benefit if you contact me well before reaching the 40 hour minimum to get a session set up. According to the board, once you reach the 40 hours, you shall not provide one more minute of service until supervision happens.
8. Complete your supervision record at the time of supervision. I will maintain a form in your supervision chart on site. You are also to maintain your own forms to monitor your direct, indirect and supervision hours as they accumulate. Occasionally, there are issues that arise in calculating hours and it helps to have more than one set of records to review.
9. Submit reports from staff/supervisors, if you are providing counseling off-site.
10. Adhere to all legal, & ethical guidelines of the counseling profession. You are responsible for obtaining and maintaining an updated copy of all legal & ethical guidelines, including NBCC, ACA & NCBLPC Codes.
As your supervisor, I will communicate any issues that arise related to expectations that are not met and all communication will be documented and filed in your supervision file on site. The supervision contract will not be terminated without an attempt to resolve any issues that could potentially lead to termination. If your contract is terminated with me, I will inform you and submit required paperwork to the board, at which time, you will need to seek supervision elsewhere.
I understand that failure to adhere to any of the aforementioned expectations can be grounds for the supervision contract to be terminated.
Supervisor’s Responsibilities in Supervision: It is my commitment to you to assist you in developing professionally and achieving your professional goals. Understanding that supervision can cause a great deal of anxiety for supervisees, I believe that being transparent about what my responsibilities are to you will make our supervision experience more positive. Therefore, I will commit to:
Emergency Contact Information: In the event of an emergency you may call my cell phone at ...
Complaint Procedures: I abide by the NBCC, ACA, and NCBLPC Code of Ethics as well as the CCE's Standards for Ethical Practice of Clinical Supervision. Although supervisees are encouraged to discuss any concerns with me first, you may file a complaint against me with any of these organizations if you feel I am in violation of any of these codes of ethics.
North Carolina Board of Licensed Professional Counselors
P.O. Box 77819
Greensboro, NC 27417
Phone: 336-217-6007 Fax: 336-217-9450
Supervision Arrangements: Arrangements will be mutually agreed upon dates and times. While dates & times are subject to change, we are agreeing on the following schedule:
A minimum of 1 hour of supervision for every 40 hours of work completed, including direct and indirect hours. I suggest 1 hour of individual or 2 hours of group supervision every 30 hours to avoid having to receive extra supervision when nearing the end of your licensure process.
*Once the supervisee begins to provide services to clients, the supervisee will be required to attend a minimum of 1 hour of individual supervision per month, regardless of whether the minimum 40 hours have been reached within that month.
Acceptance of Terms: Our signature indicates that we agree to the aforementioned terms and will abide by these guidelines for the duration of the supervision contract.