Group/Individual Supervision Notes
Recco S. Richardson Consulting Inc.
Group/Individual Supervision Note
Participant’s Name:___________________________________________________________________
Date:______________ Session Time:______________ Session Time Out:_______________
Supervision Topic:_____________________________________________________________________
♦ Intervention:
( ) Education ( ) Supportive ( ) Clarification
( ) Confrontation ( ) Problem Solving ( ) Venting
( ) Exploration ( ) _____________ ( ) __________
♦ Emotional Response:
( ) Calm ( ) Anxious ( ) Sad
( ) Angry ( ) Hostile ( ) Happy
( ) Guilty ( ) Mourning ( ) Detached
♦ Behavioral Response:
( ) Good eye contact ( ) Good attention span ( ) Happy
( ) Poor attention span ( ) Reaching out ( ) Poor eye contact
( ) Hyperactive ( ) Withdrawn ( ) Inappropriate
♦ Cognitive Response:
( ) Insightful ( ) Denial ( ) Rationalizing
( ) Withholding ( ) Projecting blame ( ) Questioning
( ) Not identifying ( ) Not focused ( ) Displaying anger
( ) Unrealistic ( ) Realistic solutions ( ) Relates to material
Supervisor’s Input: _____________________________________________________________________________________
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Supervisor’s Signature Date