Welcome to my practice. I look forward to our work together in either a supervisory or consulting relationship. There is a distinction between these two terms; we will establish which type of relationship we have entered to be clear about the nature of our work together. If I am supervising your work, you are practicing under my license, and we share the responsibility for the work you do. If I am your consultant, I act in the capacity of an advisor only. You are not compelled to follow my suggestions and I am not legally held responsible for your work. The professional decisions you make as an advisee are solely your own.
I have been a licensed psychologist in Oregon since 1992 and earned my Diplomate in Clinical Psychology from the American Board of Professional Psychology in 1990. I have been supervising and consulting with a variety of mental health professionals since 1987. My theoretical orientation is psychodynamic and my professional experience includes therapy work and assessment in inpatient and outpatient settings: individual, couples and group work, public speaking engagements, workshop presentations, administrative and program development in academic settings. I work primarily with an adult populaion and do not consider myself trained to work with children or adolescents under 16. I am also not qualified to conduct neuropsychological testing, other than brief screening instruments.
Our supervision/consultant relationship and the work that takes place are considered confidential with the following exceptions:
If you work at an agency we will need to discuss communications with your supervisor at the agency. We will need to establish frequency and type of contact between myself and your supervisor, responsibilities of your agency, me and you for communication about professional activities and evaluations. All clients need to know you are in supervision (it is your choice whether to advise clients of retaining a consultant) and that they will be discussed confidentially. Please have clients sign permission to audio/video tape sessions after discussion with them and before you tape. This should be considered part of informed consent.
If you are working towards licensure or are presently licensed you are expected to abide by the Code of Ethics of your professional board. If I believe you are endangering clients by unethical practices, I will need to report those practices to the appropriate board.
If you are a student, evaluations will be shared with your school. We will also need to follow their requirements for standards and practice.
Expectations for Our Work Together
We will discuss and set goals for professional growth in supervision/consultation on an ongoing basis. You are expected to prepare for each session by thinking through these goals, your cases and deciding what case presentation and questions would be most pertinent for us to focus on.
We will have formal written evaluations every _________________. These will be shared with ____________________________. Your evaluation will be based upon the goals we are meeting and the ongoing feedback in each session. I expect you to evaluate how supervision and or consultation is meeting your needs and what I can do to change to better help you.
We will discuss suicide assessment, risks and procedures and duty to warn information to prepare you for a suicidal or violent client. This information is to assist your clients and support your professional knowledge and independent functioning if an emergency arises. You will be asked to sign that we reviewed this information.
You are expected to follow all ethical rules for informed consent and confidentiality for clients. We will review the forms you use for release of information with other professionals and to discuss when you have contacts with professionals about clients.
You are expected to maintain clear professional boundaries with clients. Throughout supervision/consultation we will focus on ethics and deepen your understanding of ethical practice. We will discuss professional boundaries and possibilities of dual relationships. This serves as notice I consider sexual relationships harmful to clients, unethical and prohibitive.
Feelings as they arise with and about clients are important information relevant to the therapeutic relationship. I expect these feelings to be discussed in supervision/consultation.
We will need to discuss all “out of office” contacts with clients. This includes telephone calls to your home by a client, telephone calls after work hours to or from your client, and any planned or unplanned meetings (i.e., at the grocery, social events, movies, school or professional functions, etc.)
We need to discuss any physical contact with your client, even if you consider this touching therapeutic.
We need to discuss any bartering arrangement you may consider with a client instead of a set fee. In addition, we need to discuss any acceptance or giving of gifts.
Information About You
Have you ever had a complaint of any kind filed against you by anyone, including but not limited to clients, colleagues or the lay public? This complaint may have been to a supervisor, administrator, licensing board or professional organization.
If yes, what was the outcome of the complaint? Were you disciplined? Please elaborate using an extra sheet if necessary.
Do you have malpractice insurance? Malpractice insurance is a requirement for supervision or consultation and coverage must be maintained throughout our work together. Please provide a copy of your current coverage including the name of the carrier, limits and dates of coverage. In the event you change insurers, have your insurance cancelled and/or have a claim made against your professional insurance, you must disclose these changes or events immediately. If our agreement lasts over time, I may request you provide me with an update of your professional liability coverage.
We have agreed to meet _________ for the dates beginning ________ through _______. My fee for each one hour session is _______. Please pay me at the time of our appointment, unless we make other arrangements.
This supervision/consultation relationship may be terminated by either party at any time. In such an event, we will document the termination agreement in writing.
I have read all the above exceptions to confidentiality and expectations. I have discussed this contract consisting of four pages and agree with all of its provisions. A copy of this contract has been provided to me.
I have read and understand the terms of this agreement. I am retaining Robin L. Shallcross, Ph.D., ABPP as a supervisor/consultant.
Supervisee_______________________________________ Date _______________
Consultant_______________________________________ Date _______________
________________________________________________ Date _______________
Robin L. Shallcross, Ph.D., ABPP
Diplomate in Clinical Psychology