Clinical Supervision Template (NZBP)

**NZ Psychology Board – Professional Supervision Record Template** **Supervisee:** [supervisee's name] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Supervisor:** [supervisor's name] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Date:** [date of session] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Duration:** [session duration] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Location / Mode:** [location or mode] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank. Select from: in-person or online.) --- **1. Agenda** [agenda items] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. As per NZPB expectations: supervisee-led agenda, reflective, planned and emergent topics.) --- **2. Cultural Considerations / Te Tiriti o Waitangi Obligations** [cultural factors discussed] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. NZPB requires explicit attention to cultural competence and Treaty-aligned practice. Include cultural factors relevant to cases, clients, or practice discussed.) [Māori health models considered] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Note any Māori health models considered, such as Te Whare Tapa Whā or the Meihana Model.) [cultural positioning reflection] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include reflection on supervisee's own cultural positioning and its impact on practice.) [supervisor input on cultural practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include supervisor input on culturally safe and responsive practice.) --- **3. Wellbeing & Professional Self-Care (Pastoral Component)** **3.1 Physical and Emotional Wellbeing** [health issues affecting practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Aligned with NZPB requirement to monitor practitioner wellbeing and fitness to practise.) [emotional load and stress] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include emotional load, stress, and burnout risk.) [fitness to practise assessment] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include supervisor's assessment of fitness to practise.) [agreed strategies] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include agreed strategies such as pacing, self-care, and workload adjustments.) **3.2 Work–Life Balance / Personal Context** [personal factors impacting practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include personal factors impacting practice to the extent relevant.) [boundaries and professional functioning] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include reflection on boundaries and professional functioning.) --- **4. Core Competency Domains Addressed** **4.1 Professional & Ethical Practice** [ethical issues discussed] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. NZPB requires supervision to explicitly address competence areas. Include ethical dilemmas, decision-making, and Code of Ethics issues discussed.) [boundary and consent issues] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include boundary issues, dual roles, consent, confidentiality, and documentation.) [supervisor guidance on ethical practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) **4.2 Bicultural, Cultural & Diversity Practice** [bicultural and diversity practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Cross-reference with Section 2 above if cultural considerations were discussed there.) **4.3 Working with Clients (Assessment, Formulation, Intervention)** [cases discussed] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Do not include identifiable client details.) [presenting issues] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [risk or safety concerns] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [formulation approach] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [intervention strategies] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [progress and challenges] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [supervisor feedback on client work] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) **4.4 Communication & Professional Relationships** [collaboration with professionals] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include collaboration with other professionals, agencies, and whānau.) [communication challenges or successes] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) **4.5 Reflective Practice & Use of Supervision** [supervisee reflections] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include supervisee reflection on personal reactions, countertransference, and emotional responses.) [supervisor prompts and reflections] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [learning or insight gained] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) --- **5. Service Delivery & System-Level Issues** [service delivery issues] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include triage, waitlist management, and resource limitations, as NZ practice is often embedded in constrained systems.) [clinical prioritisation] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include clinical prioritisation and equity in access.) [policy and procedure implications] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) --- **6. Group Work / Specialist Practice Areas** [group work or specialist practice] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include group composition, suitability, risk, or dynamics, intervention pacing and structure, and supervisor guidance.) --- **7. Professional Development & Career Progression** [trainings and courses] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. As per NZPB's lifelong competence requirement. Include trainings, courses, or skill refreshers planned or completed.) [competence or recertification goals] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) [registration and career discussion] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include discussion around registration scope, Annual Practising Certificate, or career-related movement.) --- **8. Actions and Follow-Up** **Supervisee Actions:** [supervisee actions] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Supervisor Actions:** [supervisor actions] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) **Items Carried Forward to Next Session:** [items carried forward] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit placeholder, retain section heading and lead-in, and leave blank.) --- **9. Supervisor's Evaluation of Session** [supervisor evaluation] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Required for evidence of ongoing oversight and evaluative supervision. Include supervisor comments on supervisee's development, competence, and progress.) [practice concerns] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Include any concerns about practice if applicable.) [fitness to practise confirmation] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely.) --- **10. Summary Statement for NZPB Portfolio** [portfolio summary] (Only include if explicitly mentioned in transcript, contextual notes or clinical note; else omit section entirely. Provide a concise integrative summary synthesising pastoral and professional elements of the supervision session.)