Supervision Intake Form

Potential supervisees with Marie Bajada

ACA Clinical Supervisor. No 6226

First name

Last name

Date

Briefly tell me what you would like me to know about yourself personally and professionally- ( e.g Why you became a counsellor, personal & professional strengths, talents, weaknesses, hobbies).

Who did you train with, qualification and subjects?

What are the areas of counselling you want to specialise in?

How many hours of supervision have you had in your training?

Post-training supervision hours

What are your specific needs and how do you think I can support you?.

Important information -

If I become your supervisor you will need to sign with me, a SUPERVISORY CONTRACT, detailing mutual responsibilities and your ACA registration, insurance, quals, brief CV, cancellation policy. If at any time, you feel the supervisory alliance isn’t meeting your needs, I’d appreciate it if you speak to me first to see if it can be resolved.
It is essential that I am confident the services you offer align with your qualifications and training in speciality fields, and more importantly that you practice within your capabilities and skill set.
My role as your supervisor is not to teach you in specialist areas that require training including Art therapy. I can make suggestions, but ultimately it is your responsibility to seek out training that best meets your needs.
To register annually with ACA, 10 hrs of supervision is required, regardless of you having clients or not. Other associations such as ANZACATA/ PACFA have different requirements, you need to be familiar with and commit to these requirements to practise.
Supervision deals with many areas such as:

• Case studies
• Setting yourself up as a counsellor/ art therapist
• Areas around your business
• Being familiar with your association’s CPD/OPD, supervision/ insurance requirements
• Ethics/ boundaries/ conflict of interest
• Specific issues affecting your professional life as a counsellor and impacting how you practise