Counseling Session Self-Evaluation Form for Triadic, Individual, and Group Supervision

Name: Nina Brashears Date: 9/29/17

Client Initials: CG Grade: 6th Session #: 1
Client Information
Type of referral (self, teacher, etc.): ​Self
Reason for referral: ​We have talked informally in the hallway when she was out of class “cooling off” and I helped with
a conflict resolution between her and another student. She brought in her recording permission form this week.

Has the ​client​ specified goals? What are they?

Focusing more and doing her work during her classes.

Systemic considerations:
Family: Mom, siblings, grandparents are important
Peers: she has been involved in some peer conflicts

If applicable, comment on any culture-relevant adaptations you made in your counseling approach with this client:
Meaning questions, empathetic listening, connecting to popular song

Is the client making progress as a result of counseling: If so, what is the basis (evidence or data) for your
conclusion, and how does the client’s progress relate to the counseling goals chosen by the client?
She has articulated a goal and currently rates herself a 9 out of 10. She is able to share steps she will need to take to
accomplish this goal. She also is aware of her own self-talk and could potentially use this to help reach her goals.

Counselor Information ​Basic skills (strengths and areas for improvement):

Paraphrasing/Summarizing Encouragers
Reflecting thoughts Cheerleading
Open/Closed questions
Meaning questions (but still could ask more such as what does school/education mean)

Areas of Focus/Growth
Silence
Reflecting feelings
SFBC: Missed question “How would you react to them?” / Identifying exceptions

Use of theory:
SFBC: Miracle question, Scaling, questioning, minefield
CBT: discussion about self-talk

List three questions you have for supervision:

1.) SFBC: Besides the two biggest missing components (in growth areas) what other changes or adaptations may
be needed?
2.) Follow-up: I will be following up next week, and from what I have observed and heard from teachers the 9 out
of 10 seems ambitious for her level of focus, etc.; is there another theoretical approach I should use beyond
SFBC follow-up?
3.) Growth Areas: When are opportunities to include more silence? I feel like there was a lack of feelings discussed,
are there times when I could have added it in? Also, were any of the questions too leading?