Supervision Disclosure for Individual Counseling
The Texas State University Counseling Center is a training site for masters, doctoral, and postdoctoral level clinicians. Doctoral level clinicians are enrolled in the Counseling Center’s doctoral internship in health service psychology which is accredited by the American Psychological Association.
With your consent, your clinician will be supervised by a licensed psychologist and your sessions may be recorded for supervision purposes. If your clinician is a practicum clinician, they may be supervised by a psychology intern, who is in turn supervised by a licensed psychologist. If your clinician is a postdoctoral resident, they are supervised but typically do not record sessions. Additional consent from you would be obtained if they need to record.
During your first session with your clinician, the name and contact information of the supervisor will be provided. Your clinician's supervisor has full responsibility for the work of your clinician and will meet on a regular basis to discuss the details and progress of their work with you.. Confidentiality, and the limits thereof, apply to both clinicians and supervisors.
If you have any questions about this supervisory relationship, we encourage you to speak to your clinician. Questions may also be directed to the Director of Training, Dr. Clare Duffy.
Signing this form acknowledges your informed consent for treatment by a clinician under supervision and your consent to have your sessions recorded for supervision purposes, if necessary. This consent supersedes the general informed consent regarding recording sessions. This form will become part of your clinical record. The audio, video, or digital recording of any session, however, is not part of your clinical record and will be deleted when it is no longer needed for supervision purposes.
My TXST ID and Date of Birth below indicate I have read, understand, and consent to the above.
If you do not consent, please exit this form and inform your therapist. They will reassign you to an appropriate clinician.