I will complete the section of the form for the supervisor will provide you

I will complete the section of the form for the

This preview shows page 65 - 67 out of 103 pages.

LPC Board "Registration of Supervision" form and include all attachments. I will complete the section of the form for the supervisor, will provide you with a copy of my "Declaration of Practice and Procedures," and will sign where necessary. You must then submit the form to the LPC Board for approval. 611. The supervision I provide for you will be individual supervision. You will meet with me one hour each week during the time you are completing your required 3,000 hours of supervised experience as a counselor intern. The hourly fee for my services is $_____, which has been set according to a fee schedule based on the income of you and your spouse or partner. This fee schedule will be reviewed annually and adjusted as appropriate. Fees are payable by check before each supervision session begins. In the event you must reschedule a session for some reason, you must notify me 24 hours in advance. If such notice is not received, you must pay the full fee for the missed session plus the fee for the current session prior to the next scheduled session. If you miss a session for circumstances Theodore P. Remley, Jr., JD, PhD, LPC, LMFT ∞ Our Lady of Holy Cross College ∞ New Orleans, Louisiana [email protected] Page 65
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beyond your control and were unable to contact me prior to missing the session, no fee will be charged. 612. Once our supervision relationship has been approved and you have been granted Intern status, our supervisory relationship will begin. Our professional relationship will be limited to the formal scheduled hours we have agreed to for your supervision. In the event situations occur in your role as counselor in which you need direction and advice, you should consult your immediate supervisor at the site where you are providing counseling services and follow his or her direction. My regular hourly fee for supervision must be paid by you for any telephone or face-to-face consultation requested by you outside our regularly scheduled supervision sessions. 613. My philosophy of supervision is that my role as your clinical supervisor is to assist you in practicing counseling in the most effective manner possible, given your choice of counseling theories, approaches, and interventions. I will review your work and give you my impressions of your strengths and weakness and will assist you in improving your skills as a counselor. In addition, I will evaluate your work on a continuing basis. 614. It is your responsibility to notify your administrative supervisor at the site or sites where you are collecting your hours of experience that you are receiving clinical supervision from me. You should explain the nature of our supervisory relationship. If your administrative supervisor wishes to consult with me regarding your work, ask him or her to contact me. 615. In order for me to supervise you, you must be able to audio-tape or video-tape one counseling session each week. You must follow any requirements your site or sites may impose regarding these tapes. At each meeting we have, you will provide me with a new tape. During the time the tape is in my possession, I shall ensure no one else has access to it. I will keep information revealed in the tape confidential.
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