Counseling Internship Manual 1

Montclair State University

Counselor Education Program

Counseling

PRACTICUM and INTERNSHIP

Manual

2017 – 2018

Updated Summer 2017

 Counseling Internship Manual 2

TABLE OF CONTENTS

Part I
Introduction to the Counseling Internship 5
Planning your internship experience 5
Definitions of terms used in this manual 6

Part II
Applying for and Enrolling in Practicum and Internship
and Finding an Internship Site 8
Prerequisites 8
Procedures for applying for Practicum 8
Procedures for applying for Internship I and II 9
Change in Internship Site 12
Change of Internship Site Supervisor 13
When Should You Begin and End on Site 13

Part III
Practicum and Internship Requirements 14
Number of hours to be completed 14
Internship duties 14
Work samples 15
Supervision 16
Evaluations 16

Part IV
Responsibilities 18
Internship student 18
On-Site supervisor 19
Internship course instructor 19
Clinical Coordinator 19
Counselor Education faculty 20

Part V
Program learning objectives 21
Curricular objectives 21
Counseling practice, knowledge, and skills 22
Becoming a professional counselor 24
Site and community skills 25

Part VI
Evaluation 27
Mid-Semester evaluation 27
Final evaluation 27
Guide for grade recommendations 27
 Counseling Internship Manual 3

APPENDICES

Appendix A: Practicum Approval for Orientation

Appendix B: Request for Internship Application
Appendix C: Orientation Agreements (Practicum: C-1 or Internship: C-2)
Appendix D: Placement Agreements (Practicum: D-1 or Internship: D-2)
Appendix E: Practicum / Internship Site Profile
Appendix F: Practicum Counseling Contract
Appendix G: Supervision Agreement/Consent to Permit Taping (Practicum G-1 or Internship G-2)
Appendix H: Affiliation Agreement *
Appendix I: Counseling Intern Evaluation by Site Supervisor
Appendix J: Counseling Intern Evaluation by Instructor
Appendix K: Counseling Internship Site Evaluation
Appendix L: Unsatisfactory Counseling Intern Work Performance Evaluation
Appendix M: Sample of Consent Form for Taping
Appendix N: Counseling Internship Log (Sample)
Appendix O: Internship Log Summary (Sample)
Appendix P: Intern’s Agreement to the Counseling Internship Manual
Appendix Q: Copy of the American Counseling Association’s Code of Ethics and Standards of
Practice
Appendix R: Copy of the Association for Counseling Education and Supervision’s Ethical
Guidelines for Counseling Supervisors
Appendix S: Audiotape Evaluation form (optional)

* Provided to individual students in community agency / hospital sites after an internship site is
confirmed
 Counseling Internship Manual 4

STUDENT’S NAME AND IDENTIFYING PRACTICUM / INTERNSHIP SITE

INFORMATION

Student Name:

For COUN 624, Practicum

Name of Practicum Site:
Name of on-site supervisor:
Supervisor’s work phone:
Supervisor’s e-mail:
Client population:

For COUN 654, Internship I (If same site, write “Same” for Name and leave rest blank)
Name of Internship Site:
Name of on-site supervisor:
Supervisor’s work phone:
Supervisor’s e-mail:
Client population:

For COUN 674, Internship II (If same site, write “Same” for Name and leave rest blank)
Name of Internship Site:
Name of on-site supervisor:
Supervisor’s work phone:
Supervisor’s e-mail:
Client population:
 Counseling Internship Manual 5
Part I

Introduction to Your Clinical Experience –

Counseling Practicum and Internship

Introduction

The clinical (practicum and internship) experience is the final step in your training as a
counseling student at Montclair State University. This is an opportunity to further enhance your
counseling, diagnostic, treatment planning, psychoeducational, administrative, and guidance skills.
You are undertaking a serious professional responsibility and working with diverse client populations
in school, community, addictions, and college student affairs settings. This experience is the
culmination of your theoretical and practical skills training, allowing the faculty to assess your ability
to fulfill the professional responsibilities and mastery of an entry-level counselor within your chosen
concentration.

You are not in this experience alone. During your practicum and internship, you will be
supervised by a qualified, on-site, appropriately certified/licensed counseling professional. This
person is a seasoned professional who will serve as your On-Site Supervisor and meet with you
minimally for 1 hour per week for individual supervision. Additionally, you will attend a weekly
practicum or internship class with an MSU professor serving as your Practicum or Internship
instructor. The class offers group supervision during which you receive feedback both from the
internship instructor and from fellow internship students.

During Practicum and Internship, you are required to adhere to “ethical practice” as described
by the American Counseling Association’s (ACA) 2014 Code of Ethics and Standard of Practice.
You can obtain a copy of the ACA ethical standards by visiting the ACA website at
www.counseling.org. You might make a copy of the ACA standards for your On-Site Supervisor.
Additionally, the Montclair State University’s counseling program follows the Practicum and
Internship standards as outlined by the Council for Accreditation of Counseling and Related
Educational Programs (CACREP). CACREP is the national accrediting organization for counselor
education programs, and this manual follows CACREP guidelines for the Internship experience.
Therefore, you are required to adhere to the guidelines provided in this manual throughout your
clinical training.

Planning your clinical experience

Preparing yourself for Practicum and/or Internship requires more than a belief that “I’ve
completed my course work and can now enroll for the class.” Review the items below as you’re
thinking about advancing to the clinical stage of your training. Completing an Internship, particularly
if you’re still working another job full or part-time, requires serious consideration of how you can 1)
complete the necessary hours; 2) complete those hours in a way that allows you to give your full
attention to your training; and 3) complete the hours and not feel overwhelmed that the stress
interferes with your training. The items below relate to some aspect of preparing yourself for
Practicum and/or Internship; read each one and check it as “completed” after you have given it
careful consideration and believe that you have prepared adequately for that item.

I’m confident that I have the requisite knowledge to work with clients
I’m confident that my counseling skills are developed enough to provide
professional counseling services to clients
 Counseling Internship Manual 6
I can work the requisite 8 – 12 hours (Practicum) or 18-20 hours (Internship) per week
on site into my current work, school, and personal schedule (requisite hours will double
if taken during the eight or ten week summer session)
I can begin to spend time interviewing with potential placement sites
I am prepared emotionally to deal with the additional responsibilities and
stress that often accompany an Internship experience

Definitions of terms used in this manual

Throughout this manual, certain terms related to the clinical experience are used repeatedly.
These terms are defined below, which will help you better understand the clinical requirements and
give you more information about the clinical experience itself.

1. Clinical Experience: the three semesters of practical training comprised of Practicum,

Internship I and Internship II.
2. Practicum: the first part of the clinical/practical training for counseling students in a
professional setting aligned with their counseling concentration. There is only one
exception where students may be permitted to do their practicum outside their chosen
concentration --- school concentration students choosing to do their Practicum in the
summer semester. While it is permissible for school students to do their practicum in the
summer, it is not recommended due to the limited number of schools possibilities during
the summer. The training requires one semester of 100 hours (minimally), during which
time students provide counseling, guidance, psycho-educational, and administrative
services similar to professional counselors working in that setting. This includes 40 hours
of direct client contact, and 60 hours of indirect work in the field at a placement site. Of
the 40 direct hours, you must accrue a minimum of 25 individual counseling hours and a
minimum of 8 group hours (if offered at your site). In the event group hours are not
available during practicum, students will be permitted to make up these 8 hours during
Internship. This is practical training whereby students implement the theoretical and
practical knowledge and skills learned in counseling courses in direct service to clients.
Students are expected to be involved in one-on-one counseling, group counseling, group
guidance (if applicable), diagnosis and treatment planning (if applicable), consultation,
intake interviews, programming responsibilities, case management (if applicable),
administrative responsibilities, and other job duties required by a professional counselor in
that setting.
3. Internship: the second part of the clinical/practical training for counseling students in a
professional setting aligned with their counseling concentration. There are no exceptions
– all internships MUST be concentration appropriate. This training requires two semesters
(Internship I and Internship II) of 300 hours (minimally) each semester, during which time
students provide counseling, guidance, psycho-educational, and administrative services
similar to professional counselors working in that setting. Each semester includes 120
hours of direct client contact, and 180 hours of indirect work in the field at a placement
site. This is practical training whereby students implement the theoretical and practical
knowledge and skills learned in counseling courses in direct service to clients. Students
are expected to be involved in one-on-one counseling, group counseling, group guidance
(if applicable), diagnosis and treatment planning (if applicable), consultation, intake
interviews, programming responsibilities, case management (if applicable), administrative
responsibilities, and other job duties required by a professional counselor in that setting.
4. Intern: an MSU student currently completing the clinical/practical training as a
professional counselor in an appropriate professional site
 Counseling Internship Manual 7
5. Practicum and/or Internship Site (or Site): the professional setting approved by the MSU
program for a student to complete a one semester Practicum and a two-semester Internship
(used interchangeably with placement or placement site), whereby students provide direct
one-on-one and group counseling and other services to clients within that setting. A site
must be approved by MSU as meeting all the requisites for a clinical experience as
outlined in the “Practicum and Internship Requirements” section of this manual.
6. Supervision: a triadic experience between an Intern, Site Supervisor, and Practicum or
Internship instructor whereby the student receives guidance, feedback, and evaluation on
all aspects of the clinical experience
7. Site Supervisor or On-Site Supervisor: a designated counseling professional employed by
the Internship site, holding minimally a master’s degree in counseling or related field,
with a minimum of two completed years of experience in professional practice and
appropriate certification /licensure required to work in that specialty (e.g., certified school
counselor (for school concentration), LPC, LCSW or PhD (for mental health counseling)
or LCADC (for addictions counselor); this professional provides the direct, weekly, one-
on-one, site supervision (minimally for 1 hour/week) for the Intern’s counseling cases,
programming, and administrative responsibilities. This individual provides practical
training and assigns the work duties for the Intern at the site and works closely with the
Internship Instructor/Supervisor.
8. Practicum / Internship Instructor/Supervisor: an MSU professor providing weekly group
supervision for up to 10 students in a practicum or internship class; this person maintains
direct contact with the On-Site Supervisor, as well as the Intern. This individual is
ultimately responsible for providing feedback, evaluation, and assigning a course grade
for an intern’s clinical/practical training.
9. Site Manager: the individual who has administrative responsibility for the employees of
the organization or who has direct administrative responsibility for the employed
counselors. In a school setting this would be the Principal.
10. Direct Hours: the face-to-face (or via telephone, as in hotline counseling) counseling
services being offered to clients; examples include one-on-one or group counseling,
consultation, assessment, classroom guidance, workshops, and intake interviews.
11. Indirect Hours: all other services provided for the client population, Practicum or
Internship Site not involving direct contact with clients; examples include participating in
orientations, staffings, in-service training, preparing for workshops or guidance activities,
writing progress notes or treatment plans, receiving supervision, and being involved in
case management activities.
12. Practicum / Internship Evaluation: the formal written feedback provided by both the
Practicum or Internship Instructor and On-Site Supervisor at least twice per semester,
even though formal feedback can be provided verbally and documented in writing at any
time, as well as informal feedback during the training process.
13. Program: if capitalized, indicates the Counselor Education Program at Montclair State
University.
14. Clinical Coordinator: the MSU faculty member who handles all administrative aspects of
the Program’s Practicum and Internship experience.
 Counseling Internship Manual 8

Part II
Applying for and Enrolling in Practicum and/or Internship
and Finding an Appropriate Placement

Prerequisites:

The prerequisites to apply for COUN 624 – Practicum in Counseling are:

COUN 552 (Introduction to Counseling); COUN 577 (Counseling Theories); COUN 584 (Group
Counseling); COUN 588 (Counseling Techniques); COUN 595 (Multicultural Counseling); and
Department approval. Students must have a minimum GPA of 3.0 and must have earned a minimum
grade of B in COUN 584 and in COUN 588. It is the expectation of the counseling faculty that
students have completed the majority of the coursework for the degree, so that the Intern has as much
information and practice as possible before working with clients at a Clinical Placement Site. For
this reason it is REQUIRED that students complete a minimum of 24 credits in a 48 credit program
or a minimum of 30 credits in a 60 credit program before beginning Practicum.

The prerequisites to apply for COUN 654 – Internship in Counseling I, followed by COUN 674
– Internship in Counseling II are:
the successful completion of a minimum of 33 credits in a 48 credit program or a minimum of 42
credits in a 60 credit program including: COUN 552 (Introduction to Counseling); COUN 577
(Counseling Theories); COUN 584 (Group Counseling); COUN 588 (Counseling Techniques);
COUN 595 (Multicultural Counseling); COUN 624 (Counseling Practicum – having earned a grade
of “B” or better). In addition, School Counseling Students must have completed COUN 583
(counseling in Schools) and Community / Addictions Students must have completed COUN 604
(Clinical Diagnosis and Assessment), and Student Affairs / Higher Education students must have
completed one course in their concentration. For students entering COUN 674 (Internship II, a grade
of “B” or better must be earned in COUN 654 (Internship I). Students must earn a grade of “B” or
better in Internship II to successfully complete the counseling program.

Procedures for Applying for Practicum:

1. In order to be eligible to enroll in Practicum (COUN 624) a student must attend an orientation
session, but only the semester before the student plans on enrolling in COUN 624. During the
fall and spring semesters, the Clinical Coordinator will conduct an orientation for all students
planning to enroll in Practicum (COUN 624) for the semester following the orientation. This
orientation is usually within the first month of the semester. Notices regarding the date and
time of the Orientation Session will be posted on the counselor education program listserv and
in the Program’s suite, University Hall Rm. 3162.

2. Upon receiving the list-serve e-mail, students planning to begin Practicum must meet with
their advisor to obtain approval to attend a Practicum Orientation Session. Together with
your advisor you must complete the “Practicum Approval for Orientation” form, (Appendix
A). Once your advisor has signed this form you will need to provide it to the Clinical
Coordinator who will register you to attend a mandatory Orientation session.
 Counseling Internship Manual 9
3. Several days before your scheduled orientation, the Clinical Coordinator will notify you (by
MSU only e-mail) of the location of the Orientation Session. The Orientation will be an
information session providing the student with all necessary information and documentation
for securing an appropriate placement site as well as a forum to answer questions and
concerns.

Procedures for Applying for Internship I:

1. All students enrolling in Internship I (COUN 654) must complete a “Request for Internship
Application”, (Appendix B), and submit it to the Clinical Coordinator before they can be
registered for an Internship Orientation session. During the fall and spring semesters, the
Clinical Coordinator will conduct an orientation for all students planning to enroll in
Internship I (COUN 654) for the semester following the orientation. This orientation is
usually within the first month of the semester. Notices regarding the date and time of the
Orientation Session will be posted on the counselor education program listserv and in the
Program’s suite, University Hall Rm. 3162.
2. Attendance at an Internship orientation session is mandatory for beginning Internship I. The
counselor education faculty must approve each Master’s level student for Internship. Students
are notified of their approval for enrollment in COUN 654 by the Clinical Coordinator.

Procedures for Applying for Internship II:

1. Students enrolling in Internship II (COUN 674) do not need to attend another orientation.
However, if an Intern intends on changing sites, she/he must review the decision with the
Clinical Coordinator who will provide permission to change to a new Site; the Intern must
then file the appropriate placement paperwork. The new Internship Site must be approved by
the Clinical Coordinator.

Selecting a Practicum and/or Internship site:

Students are ultimately responsible for obtaining an approved Practicum and/or Internship Site.
However, the Clinical Coordinator will assist students as necessary with a referral to a previously
approved site if one is available. The Clinical Coordinator, with the advice from the Program faculty,
ultimately gives the final approval of whether or not a student can be successful in a chosen Site. The
Clinical Coordinator can, at any time, decide that a student does not have the knowledge and/or skill
to be approved for a particular Practicum and/or Internship Site. Practicum and Internship sites must
be within a reasonable driving distance to Montclair State University. Students are not permitted to
complete clinical experiences outside of the area, generally using 1 hour drive time as a gauge for
approved distances. Students who wish to complete their clinical experience out of state and within
this distance parameter must inform the Clinical Coordinator of their intentions prior to gaining site
approval.

In Choosing a Site Ask Yourself the Following

Have you discussed potential Internship Sites with your advisor? She/he may be able to
help you assess the suitability of any Site for your career development needs.
Does a proposed Site have an appropriate Site Supervisor who meets the qualifications
(see definition) for supervising an MSU counseling Intern?
 Counseling Internship Manual 10

Is the Site one that has already been approved by the MSU program?
If it hasn’t already been approved, can it offer an internship experience as outlined in the
Internship Requirements, Section III, of this manual?
What was your impression of the setting for a potential Internship when you interviewed
with the Site? Would you be satisfied there? Would it meet your own professional
development needs? Overall, is it a good fit?

If a student desires to do a Practicum or Internship in a Site not already approved, the Clinical
Coordinator must be informed and provided with the appropriate placement forms as soon as
possible. The Clinical Coordinator will contact the Site and confirm that the requirements for a
Practicum or Internship can be obtained at that Site. Ultimately, the Clinical Coordinator makes the
determination if the Site meets the requirements as an approved Site for an MSU internship.

Applying to the site to obtain an internship:

Students initiate the contact with their preferred placement sites and request an interview to discuss
the possibility of completing a practicum and/or Internship at that Site. Site Managers and/or Site
Supervisors have the authority to determine if the student is a suitable Intern for placement at the site.
If accepted by the Site Manager as an Intern, the student must turn in the Placement Agreement
(Appendix D), the Site Profile (Appendix E), the Practicum Contract (only if enrolling in Practicum)
(Appendix F) and the Orientation Agreement (Appendix C) and the Supervision Agreement/Consent
to Permit Taping (Appendix G) to the Clinical Coordinator for approval to complete an Internship at
the Site.

Complete Internship Documentation. This manual contains all the forms required and which must
be completed for students to receive a permit to enroll for COUN 624, 654, and 674 indicating that
the Internship Site is an approved setting. All required forms must be completed and submitted the
semester prior to beginning Internship, by the deadlines established by the Clinical Coordinator.
Placements will not be approved if paperwork is submitted after the deadline.

Registration and Permits: Clinical classes are by “permit only”. The forms specified above must be
completed, submitted to, and approved by the clinical coordinator in order to receive a permit to
register. Once a placement has been approved, the clinical coordinator will issue a permit for a
student to enroll in a clinical class.

Upon Choosing a Site have you completed the following?

______Orientation Agreement (Appendix C)

The student will review and sign one copy at the mandatory orientation meeting (Practicum and
Internship I). A second copy will be signed by both the student and the on-site supervisor verifying
that all requirements have been discussed with student and agreed to.
 Counseling Internship Manual 11
Placement Agreement (Appendix D)

The Site Manger, the Site Supervisor, the Student and the Clinical Coordinator must sign this
agreement, which indicates that the counselor education program faculty and the Site administrators
approve the student’s application to complete an Internship at the Site.

Internship Site Profile (Appendix E)

The Site Manager or Site Supervisor, must complete the Internship Site Profile. The Internship Site
Profile describes the types of counseling, guidance, programming and other services offered at the
site, as well as summarizes the Site Supervisor’s professional background.

______Supervision Agreement/Consent to Permit Taping (Appendix G)

The Site Manager and Site Supervisor, as well as intern sign verifying agreement to supervisor
requirements and consent to permit taping.

Practicum in Counseling Contract (for Practicum only) (Appendix F)

The Site Manager or Site Supervisor, the Intern and the Clinical Coordinator must sign this
agreement, which indicates the responsibilities and expectations of all parties.

Affiliation Agreement (Appendix H)

The Affiliation Agreement is an agreement between the Internship Site and the Counselor Education
Program at Montclair State University. If the Site has been approved in the previous academic year,
the Site Manager may have previously signed an Affiliation Agreement. If the Site has not been
previously been approved as a placement site for counseling interns by the Clinical Coordinator, then
the Site Manager must be willing to enter into an Affiliation Agreement prior to the student being
issued a permit. This agreement will be prepared by the clinical coordinator, after approval by MSU
legal department and provided to the site only upon completion and submission of all required
documentation (as stated above).

Professional Liability Insurance (must have policy in advance of the beginning of the
semester).

In addition to completing the forms listed above, Interns must obtain professional liability insurance
($1,000,000-$3,000,000 aggregate). This may be obtained through student membership in the
American Counseling Association (ACA). Membership in ACA and professional liability insurance
is a requirement for all Interns. Proof of professional liability insurance must be turned into the
Clinical Coordinator or the Internship Instructor no later then the first day of class. However, every
effort should be made to provide the Clinical Coordinator proof of professional insurance by the end
of the semester prior to enrollment in COUN 624.

*** Interns can not be on site without insurance. If a student Intern does not have liability
insurance at this time, the student will be withdrawn from COUN 624, 654 or 674.
 Counseling Internship Manual 12
Change in Internship Site
It is recommended that Interns complete at least two of their three semesters of clinical work at
the same Internship Site. Most Sites prefer to have an intern for all semesters in order to provide the
complete range of training experiences required as one becomes more experienced. No decision
should be made to change an Internship Site for COUN 654 or 674 without first consulting the On-
Site Supervisor, the Internship Instructor, and the Clinical Coordinator. An appropriate reason for
changing Sites (e.g., not able to get enough direct hours) must ultimately be presented to the Clinical
Coordinator. If an Intern does leave his/her Internship Site, then the Program faculty expects that the
Intern will engage in the appropriate termination process with clients and with the on-site personnel
prior to leaving the setting.

Change in Site Initiated by the Intern or Internship Instructor during the Semester:
If an Internship Site becomes problematic, the Intern or the Internship Instructor may desire to
change the placement. In this case, the following procedures must be followed:

1. The Intern, the instructor, and the Site Supervisor discuss the problem(s) and determine whether a
solution can occur within the existing placement. The Intern may be asked to continue with the
placement until the end of the semester, and an agreement may be made that a change of placement
will occur for the following semester.
2. If a solution is not found, and a change of placement is necessary during the semester, the request
for change of Internship must be completed in writing by the Intern and provided to both the
Internship Instructor and the Clinical Coordinator. The Intern must summarize the reasons for
wanting a change in Site, and the request must be signed by both the Intern and the Internship
Instructor. A summative evaluation in the form of the MSU Counseling Intern Evaluation (Appendix
J) must be completed by the current Site Supervisor and attached to the written request. Additionally,
an MSU Counseling Internship Site Evaluation (Appendix K) must be attached to the written request.
The Clinical Coordinator, with the Internship Instructor, will make a decision whether or not the
Intern should change to another Site during the semester. The Intern/student is not guaranteed another
placement during that semester or for any future semester.

3. The Intern and the Clinical Coordinator will then explore new placement options. The
Intern/student must follow all procedures outlined in this section of the manual to obtain a new
Internship Site.

4. The Clinical Coordinator reserves the right to confer with the Intern’s Site Supervisor at any time
during this process.

Withdrawal from placement at the desire of the Site Manger, Site Supervisor, or Counselor
Education Faculty:

When a Site Manager or Site Supervisor or the Program faculty decides to terminate a student’s
placement, the following procedures will be followed:

1. The Intern, the instructor, the Clinical Coordinator, and the Site Supervisor discuss the problem
and determine if the problem can be resolved, allowing the Intern to remain at her/his current Site. If
the Intern continues at the Site, an understanding may still be reached that the Intern will change to a
new Site for the next course. Then the Intern must follow all the procedures outlined in this section of
the manual, while finishing the current Internship.
 Counseling Internship Manual 13

2. If a solution is not found, the Intern may be terminated from her/his current Internship Site
immediately. The Site Supervisor, Site Manager, Instructor and Clinical Coordinator will provide the
intern a written summary of reasons for the termination on the MSU Unsatisfactory Counseling
Internship Work Performance Evaluation (see Appendix L) if unsatisfactory performance is
involved.

3. If the termination of placement is for unsatisfactory performance reasons, the Intern/student will be
allowed a hearing with the Counselor Education faculty (Remediation and Retention Committee). If
necessary, the Clinical Coordinator will confer with the Program faculty to devise a remediation plan
for the Intern/student. The Intern/student is not guaranteed another placement during that semester or
for any future semester. If the Intern is asked to leave the Site during the semester and this is due to
unsatisfactory performance, then the Intern receives an “F” for the course.

Change of Internship Site Supervisor

If a change in Site Supervisor occurs at any time during Internship, the Internship Instructor and
Clinical Coordinator must be consulted immediately, and the new supervisor must be approved as
meeting the requirements for an MSU Site Supervisor, and revised documentation provided to the
Clinical Coordinator. A professional not meeting the requirements for an MSU Site Supervisor is
cause for the Intern to be removed from the Site (at no fault of the Intern).

When Should You Begin and End On-Site

All required hours must be accrued within the semester and cannot be either rolled over from a prior
semester or accrued during a later semester. Students MUST begin the first week of the semester
and complete hours by the last week. IF needed, hours may be accrued during exam week but
completed and final log submitted the day their class would normally meet that week.

At all times students are on site they must be under the supervision of an MSU instructor and
enrolled in a clinical class.

Practicum students may NOT begin on site before the first week of class under any circumstance.
Internship I students may NOT begin on site before the first week of class, even if they are returning
to their Practicum site. Practicum and Internship are very different learning experiences.
Internship II students MAY begin on site up to two weeks prior to the beginning of the semester
ONLY IF THE FOLLOWING REQUIREMENTS ARE MET:
1) Student must be returning to the same site, same department as Internship I.
2) Student must have the same instructor for Internship II as they had for Internship I and
instructor must agree to provide supervision to student those additional weeks.
3) In the event Internship II instructor is not the same as Internship I, the new Internship II
instructor MUST consent to supervise student throughout the two weeks prior to the semester
and must provide e-mail verification to clinical coordinator BEFORE student returns to the
site.
Students are responsible for advising site supervisor(s) of these policies at the time of the
interview.
 Counseling Internship Manual 14

Part III
Practicum and Internship Requirements

The items below outline the expectations for completing an Internship for the Program.
Students can use this information as they are planning their Internships to decide if they are able to
complete the requirements at this time. Potential Site Supervisors can review this information to
determine what is expected of an Intern and decide if they can provide an Intern with the necessary
experience.

1. Number of hours to be completed:

Direct Hours Indirect Hours Total Hours

Practicum 40 60 100
Internship I 120 180 300
Internship II 120 180 300

TOTAL: 700

Check to Indicate Your Understanding

An adequate schedule will be developed with the Site Supervisor to complete

the 100 hours (Practicum) and 300 hours (each for Internships) in a timely manner
A copy of the schedule is given to the Internship Instructor; no changes
are made without the approval of the Site Supervisor and Internship Instructor
To meet the 100 hour Practicum requirement for one semester approximately 8-12
hours per week on site is necessary (on site hours doubled for 8 week summer semester)
To meet the 300 hour requirement for each Internship semester approximately 20-24
hours per week on site is necessary (on site hours doubled for 10 week summer semester)
All hours worked at the site are logged, and the Intern, Site Supervisor, and Internship
Instructor each sign the log
To indicate satisfactory progress, consistent accumulation of hours toward the indirect and
direct hours ratio must be reported.
Interns will work the agreed upon schedule throughout the semester, even if
completing the 100 (Practicum) or 300 hours (Internships) before the end of the semester
Upon completing the three semesters of Practicum and Internship, appropriate
termination with clients and site personnel must occur.

2. Internship Duties: Interns are ultimately expected to perform the duties of a regularly employed
counselor or college student affairs professional at their Internship Sites. A Site is considered
appropriate if it represents a typical setting within the Intern’s concentration, and it can provide
experiences required for completing an Internship. Interns are not permitted to staff a desk, file, or
engage in regular office administrative activities normally performed by clerical or
administrative staff members.
 Counseling Internship Manual 15

Check to Indicate Your Understanding of Practicum and Internship Duties

40 hours (Practicum) of Direct client service to include one-on-one counseling, group

counseling, intake interviews, guidance activities, consultation or other services to
address the needs of clients and their family members
60 hours (Practicum) of Indirect service which involves a variety of professional activities
such as record keeping, information and referral, staff meetings,
program development or other activities regularly performed by staff
120 hours (each Internship) of Direct client service to include one-on-one counseling,
group counseling, intake interviews, guidance activities, consultation or other services to
address the needs of clients and their family members
180 hours (each Internship) of Indirect service which involves a variety of professional
activities such as record keeping, information and referral, staff meetings, program
development or other activities regularly performed by staff
Become experienced in the use of professional resources such as assessment
instruments, technologies, print and non-print media, professional research in support of
work with clients
Maintain a weekly (and monthly summary) log of all hours worked; the Instructor must
ultimately approve all hours worked in consultation with the Site Supervisor
Maintain accurate documentation for individual clients, group counseling clients,
prevention activities (e.g., classroom guidance), keeping such documentation in a secure and
confidential location
Active involvement in supervision, helping to structure supervision sessions to request the
necessary feedback on all services provided to clients
Attend a weekly class for group supervision with the class Instructor
Attend a weekly individual supervision session with the On-Site Supervisor
Provide evidence of completing work samples described below

3. Work Samples: In order to evaluate an Intern’s progress, a variety of work samples are required to
be completed by the Intern and given to her/his supervisors. The work samples provided below
demonstrate that the Intern is completing the necessary requirements at the Site and allow supervisors
to provide formative constructive feedback. The Site Supervisor and/or Internship Instructor may
want other work samples or request that an Intern follow their specific format for certain work
samples (e.g., like log of activities).

Check to Indicate Your Understanding of Work Samples

Audio or videotapes (DVDs may be acceptable if approved by the Internship

Instructor): Permission to tape must be secured in writing from the client; if a
minor then parents or a legal guardian must give permission as well. (See
Appendix M for sample consent form.)
Weekly and Monthly logs: the weekly log is a summary of all activities
completed for the Internship for a one week period (See Appendix N for
sample weekly log form); the monthly log is completed once a month and
summarizes the Direct and Indirect hours completed weekly over an entire
month (See Appendix O for sample monthly log).
Progress notes: formal notes on individual or group counseling sessions; follow
 Counseling Internship Manual 16

the format suggested by the Site or the Internship Instructor and keep progress
notes in a secure location.
Treatment plans: maintained in client files for individual and group counseling
clients; follow the format suggested by the Site or the Internship Instructor and
keep in a secure location.
Guidance or workshop materials: evidence of classroom guidance or workshop
activities completed; for example, can be a complete package of outline and materials
presented.
Case studies: usually required for the Internship class involving a complete case
presentation on a client presented to the class
Other: either the Site Supervisor or the Internship Instructor may require other forms of
work samples in order to provide formative feedback

4. Supervision - Two forms of supervision are provided to an Intern during the Internship. Individual
supervision is one-on-one, face-to-face supervision provided by the Site Supervisor. If a Site has
more than one Intern, then the Site Supervisor may conduct the face-to-face supervision in a small
group format with no more than three Interns. Group supervision is provided by the Internship
Instructor, including up to 10 Interns in an Internship class. Overall, supervision is a triadic
relationship between the Intern, the Site Supervisor and the Internship Instructor. Unless otherwise
requested and agreed to by a supervisor within a supervision session, either supervisor may contact
the other supervisor to discuss any aspect of the Intern’s progress throughout the internship
experience. Supervision is recorded as Indirect Hours. The supervision described below is mandatory
throughout Internship. A third form of supervision (University Doctoral) may be provided between
Practicum and Doctoral Supervision classes.

Check to Indicate Your Understanding of Supervision

Individual, one-on-one supervision from Site Supervisor: Interns must

meet weekly with their Site Supervisors minimally for 1 hour per week for
one-on-one, face-to-face supervision; this must be documented on
the weekly log.
Group supervision provided by the Internship Instructor: Interns must
attend a weekly class with their Internship Instructors minimally for
one and one half hours per week; this must be documented on the
weekly log.
Other: Additional supervision can be required at any time as determined by the
Site Supervisor or the Internship Instructor.

5. Evaluations: Interns receive both formative and summative evaluations. Formative evaluation
occurs throughout the semester in both written and verbal formats, providing Interns with continuous
feedback on their knowledge and skills. The most structured form of formative feedback is the mid-
term evaluation. Summative evaluation occurs in both verbal and written formats during the final
evaluation. Evaluation is based on the Intern’s (a) implementation of knowledge and skills into
professional practice; (b) following the Internship requirements as detailed in this manual; and (c)
mastery of the Counselor Education Program’s learning objectives (described in Part V). (See
Appendix I for a sample of a Counseling Intern Evaluation Form). Interns receive copies of each
written evaluation and the evaluating supervisors must meet with them and discuss the results of the
evaluation.
 Counseling Internship Manual 17

Check to Indicate Your Understanding of the Evaluation Process

At mid-term, a structured, formative, written evaluation will occur. The On-Site Supervisor
and the Internship Instructor will both meet and discuss their evaluations
with the Intern.
Toward the end of the semester, a structured, summative, written evaluation will occur. The
On-Site Supervisor and the Internship Instructor will both meet and discuss their evaluations
with the Intern.
A structured, formal evaluation can occur any time during the semester when an Intern is
demonstrating unsatisfactory, unethical/illegal, or unprofessional performance in Internship
(see Appendix L for unsatisfactory performance documentation).
Interns must also evaluate their placement sites and supervisors on Appendix K, MSU
Counseling Internship Site Evaluation Form. This form is given to the Clinical
Coordinator and is due no later than the last day of the Internship class.
 Counseling Internship Manual 18
Part IV
Responsibilities

Internship is more than just another class; rather it is an on-the-job training experience during which
students function as professional counselors. In order to have a successful Internship experience,
certain responsibilities must be fulfilled by the student, as well as by the various professionals
involved. The first responsibility is for Interns, Internship Instructors, Site Supervisors, and Site
Managers to adhere to the following standards of practice.

• The 2014 American Counseling Association Code of Ethics.

• The 1993 Association for Counselor Education and Supervision’s Ethical Guidelines for
Counseling Supervisors.
• All legal statutes of the State of New Jersey governing counseling practice.

The responsibilities of the other professionals involved with Internship and the Intern her/himself are
described below.

Internship Student

The responsibilities of students in Internship are to:

Develop a work schedule with the Site Supervisor and work that schedule until the end of
the semester
Provide counseling/educational services to the client population while integrating
knowledge from previous courses into professional practice
Demonstrate successfully the skills and knowledge required of a professional within the
specified concentration and meeting the objectives for Internship listed in Section V
Complete appropriate documentation required by the Internship Site and by the Internship
class, including weekly documentation, weekly audio and/or videotapes
Participate in weekly supervision at the university (via Internship class), on site, and any
other supervision recommended during Internship
Take an active role in supervision by developing personal goals and helping structure
supervision sessions by sharing needs and concerns for continued professional
development
Follow all required ethical codes and legal statutes and the policies and procedures
outlined in this manual
Demonstrate regular progress in meeting Internship hours
Inform the Internship Instructor and Coordinator of any potential change in the
professional responsible for site supervision, in advance of the change

On-Site Supervisor Responsibilities

The responsibilities of On-Site Supervisors are to:

Help the Intern develop a work schedule that allows the Intern to meet the required
Internship hours, as well as meet the needs of the organization
Meet with the Intern formally at least once per week for an hour of individual
supervision, while consistently supervising the Intern’s work while at the Site
Assign professional duties that allow the Intern to meet the professional activities
required by the Internship class, as well as by the Site itself for professionals working
in the area of concentration.
 Counseling Internship Manual 19

Evaluate the Intern’s work formally through mid-term and final written evaluations
(sample evaluation form included as Appendix G); these forms will be supplied by the
Internship Instructor and the results of the evaluations must be discussed with the Intern and
turned into the Internship Instructor
Assist the Intern in completing all documentation in a professional and timely manner
______ Consult whenever necessary with the Internship Instructor regarding the Intern’s
progress (or lack thereof)
______ Document formally through the Counseling Internship Unsatisfactory Work
Performance Evaluation (Appendix L) at any time when an Intern is not meeting the
professional responsibilities of the Site or demonstrating unsatisfactory, unethical or
illegal performance in Internship; this can be done in consultation with the Internship
Instructor
Attend at least one site supervisor workshop or continuing education seminar related to
supervision each year

Internship Course Instructor

The Internship Instructor is directly involved with the Intern during a weekly class that meets for
group supervision, minimally for 2 hours. The Instructor is responsible for:

Meeting with a group of no more than 10 Interns per class once a week for group
supervision
Assuming the various roles involved in clinical supervision to help Interns develop
professional skills in individual and group counseling, diagnosis and treatment
planning, progress notes, psychoeducational work, and guidance activities
Following the course objectives as described in the syllabus and required by CACREP as
meeting the requirements for clinical instruction
Providing summative and formative feedback on all aspects of the Intern’s counseling
practice
Meeting with Interns individually, minimally for a mid-term and final evaluation (and
other times as necessary)
Following all ethical codes and legal statutes and assuring that Interns do the same
Serve as the Program liaison with the Site Supervisor and complete site visits when
necessary
Collecting and maintaining Site Supervisors’ mid-term and final evaluations on Interns
Assigning student grades while considering input from Site supervisors
Providing the Counseling Program with a final Internship folder on each Intern that
minimally includes: all logs, placement paperwork, mid-term and final evaluations, and
evidence of work completed like a case conference (optional)

Clinical Coordinator

The Clinical Coordinator functions as a manager for all aspects of the Internship experience,
interacting as necessary with students, faculty, and on-site professionals. The Coordinator is
responsible for:

Conducting a Practicum and/or Internship orientation for students applying for Internship
Providing final approval for a student to enroll in Practicum or Internship and giving the
permit to register for a clinical class.
 Counseling Internship Manual 20

Approving all potential Practicum and Internship sites according to the requirements of the
Program and CACREP guidelines.
Assisting in the development of policy and procedures related to the Internship
experience
Assuring that appropriate ethical codes and legal statutes are adhered to by everybody
involved with the Internship experience
Conducting appropriate supervisor training sessions
Resolving conflicts related to an Intern’s placement or counseling practice in
conjunction with faculty and On-Site professionals

Counseling Program Faculty

The Counseling Program Faculty may be asked to assist the Clinical Coordinator and the Internship
Instructor at various times during the Internship experience. Counseling Program Faculty are
responsible for:

Providing feedback related to a student’s “readiness” to enroll for the Internship class
Being available for student hearings in cases of grievance
Assisting in the development of remediation plans for Interns when necessary
Providing feedback on any aspect of the Internship experience
 Counseling Internship Manual 21
Part V
Program Learning Objectives

Internship is the final step in a student’s training as a professional counselor. It is a form of “on-the-
job” training during which the student must demonstrate: 1) knowledge related to the theoretical
courses taken, 2) skills learned related to the practice of counseling, and 3) multicultural competence
in helping clients from diverse backgrounds. This course allows students to integrate theory into
practice. The Internship experience is designed to reinforce students’ learning while remaining
accountable to:

A. Clients, by consistently monitoring that they’re receiving competent and

ethical service
B. Interns, by helping them develop the ability to work with clients and meet
personal goals
C. The counseling profession, by assuring that Interns are adequately
prepared for professional practice.
D. The Placement Site, by supporting the efforts of Site Supervisors to
help Interns implement training goals that meet the needs of the Site’s
clients and professional staff.

Curricular Objectives

The Master of Arts program in Counseling at MSU requires the CACREP guideline of 48 credits for
graduation from any concentration. The Internship is completed toward the end of the program, after
students complete most of the course work. The curricular objectives for the program include the
following:

1. knowledge of specific counseling theories and techniques;

2. knowledge of specific counseling, guidance, and programming skills and techniques in applied
settings;
3. understanding of the cultural context of relationships, issues, and trends in a multicultural,
international, and diverse society;
4. knowledge of individual, group, family and community strategies for working with diverse
populations and ethnic groups;
5. understanding of ethical practice as it relates to any community, school, or college setting;
6. knowledge of human growth and development, adjustment, social/cultural differences, and needs
of special populations;
7. knowledge and application of group counseling theory and techniques;
8. knowledge of research theory and methodology;
9. knowledge of individual appraisal theory, instrumentation, and test interpretation;
10. understanding of rights and responsibilities of both the counselor and client in the delivery of
counseling and related human services;
11. knowledge of mental health, DSM-V, and developmental issues/diagnosis and ability to
recommend effective treatment;
12. knowledge of the roles and responsibilities of the mental health counselor as a member of a
community agency and as a change agent for clients (FOR COMMUNITY COUNSELING
STUDENTS);
13. knowledge of the roles and responsibilities of the school counselor as a member of an educational
organization and as a change agent for students (FOR SCHOOL COUNSELING STUDENTS);
 Counseling Internship Manual 22
14. knowledge of the roles and responsibilities of the college student affairs specialist as a member of
an institution of higher education and as a change agent for students (FOR STUDENT
AFFAIRS/COUNSELING in HIGHER EDUCATION STUDENTS);
15. knowledge of the roles and responsibilities of the addictions counselor as a member of a
community drug and alcohol treatment facility and as a change agent for clients (FOR ADDICTIONS
COUNSELING STUDENTS).

The Counseling Program’s learning objectives for internship are organized into three major
interrelated areas:
• Counselor Practice, Knowledge, and Skills
• Becoming a Professional Counselor
• Site and Community Skills

A brief description of each objective is described below, followed by an overview of specific

competency-related skills. These skills are reflected in the initial evaluation (Appendix G) that is
completed by both On-Site Supervisors and Internship Instructors.

Counseling Practice, Knowledge, and Skills

Interns will demonstrate appropriate (to the concentration – i.e., community, school, college student
affairs, addictions) professional proficiency in the use of counseling, assessment and diagnosis,
guidance, and programming skills, to include intervention strategies with systems of varying size and
complexity. Multicultural counseling will be demonstrated for the diverse American populations of
any placement site, along with demonstrating multicultural awareness for the special needs of
international and immigrant clients. The emphasis is on direct and ethical counseling practice, using
various modalities of practice to implement the didactic and experiential training received while in
the Montclair State University Counselor Education Program. The competency-related skills will be
demonstrated by the ability to:

1) Use core counseling skills of empathy, active listening, appropriate questioning,

appropriate self-disclosure, respect, concreteness, genuineness, silence, cultural
sensitivity and immediacy within the counseling process.

The Intern is capable of using basic core counseling skills to communicate humanness, cultural
sensitivity, genuineness, and respect in helping clients express their feelings, experiences, and
reactions to various life situations. The Intern is able to help clients identify life issues and the
potential for growth, and through problem-solving capacities help clients make appropriate life
changes. The Intern is also able to distinguish personal feelings and opinions from a client’s and uses
self-disclosure appropriately only for the benefit and growth of a client.

2) Use advanced counseling skills such as advanced accurate empathy, confrontation, a

theoretical approach(s), and culturally appropriate counseling strategies and techniques
within the counseling process.

The Intern is capable of using advanced counseling skills and techniques within a theoretical
framework. The Intern uses advanced skills to demonstrate an understanding of what a client is
unconsciously expressing and experiencing, uses confrontation to challenge client discrepancies,
evasions, and resistances, and uses immediacy techniques to examine here-and-now relationship
issues. The Intern has the ability to identify key underlying issues with a client and helps a client
through the change process. The Intern demonstrates the ability to provide both individual and group
 Counseling Internship Manual 23
counseling and to select culturally appropriate counseling strategies and techniques that specifically
address a client’s life issues.

3) Engage in concrete service interventions appropriate to client needs, site function, and
assigned professional responsibilities.

The Intern is capable of providing concrete services to clients through case management,
psychoeducational programs, community referral, and consultation processes. The Intern provides
appropriate services to the family system of a client, respecting a client’s definition of family. The
Intern coordinates services for a client, matching client with needed community resources,
appropriate referrals, and professional follow-up. The Intern understands the role of advocacy in the
counselor/client relationship. The Intern understands her/his role in the case management process and
avoids dual therapeutic relationships as defined by the ACA Code of Ethics. The Intern provides
psychoeducational services, such as workshops, seminars, and guidance activities, when appropriate
to the placement site.

4) Provide counseling and concrete services within a culturally relevant framework.

The Intern is knowledgeable about the specific cultures, both American and International, within the
placement site. The Intern is aware of personal biases, prejudices, and stereotypes related to any
specific culture at the placement site and works with all clients fairly and respectfully. The Intern
practices within an accepting and nonjudgmental framework and uses methods and techniques
acceptable to the clients’ cultures. The Intern understands the counselor’s role in social justice,
advocacy and conflict resolution in dealing with oppression or prejudices about any culture at the
placement site. The Intern immediately seeks supervision with any difficulties related to practicing
within a culturally relevant framework.

5) Complete diagnosis, assessment and testing within the scope of practice typical at the
placement site.

The Intern is capable of completing a diagnosis using the DSM-IV-TR or a developmental assessment.
The Intern administers standardized tests in individual and group formats, including computer-
assisted instruments. The Intern understands the role of age, gender, sexual orientation, ethnicity,
language, disability, culture, spirituality, nationality, and other factors related to the assessment and
evaluation of individuals, groups, and specific populations. The Intern assesses for suicidal ideation
and drug and alcohol abuse at the level expected by the placement site and reports all findings to the
On-Site Supervisor and the Internship Instructor immediately. Using assessment results, the Intern
incorporates assessment/testing results into a client’s case conceptualization.

6) Formulate and implement a treatment plan to address a client’s life issues.

The Intern develops an appropriate treatment plan with a client, which includes writing the plan and
discussing a plan of action and rationale for it. The Intern carries out the steps of the plan in
collaboration with the client and monitors the plan with the client, exchanging feedback about the
process. The Intern maintains focus and continuity, revising assessments and contracts based on
changing needs, circumstance and perceptions. The Intern includes individual, group, family
counseling and concrete services in the plan as appropriate. The Intern practices only within the
scope of her/his training and abilities as required by the ACA Code of Ethics. The Intern consults with
both the On-Site supervisor and the MSU Internship Instructor if questioning her/his ability to work
with a client before any referral is made, in which case, appropriate referral procedures are followed.
 Counseling Internship Manual 24

7) Terminate and evaluate the counseling relationship.

The Intern follows the appropriate steps leading to successful termination, including, if appropriate,
transfer or referral. The Intern identifies and assesses the effects of termination on self and client. The
Intern evaluates the client’s movement toward planned goals for change, suggests next steps, and
consults, if appropriate and with the client’s consent, with the professional to whom the referral is
made.

Becoming a Professional Counselor

Interns will demonstrate awareness and a willingness to examine personal thoughts, beliefs, feelings,
and actions related to their growth as counselors and are active learners in achieving their own
personal goals. Both are necessary for autonomous practice. Students will demonstrate competence
in this area with ability to:

1) Apply the professional skills of self-observation and self-awareness.

The Intern identifies and assesses the effects of learning style, personal values, biases, and
feelings about work performance, especially regarding issues of human diversity. The Intern
consistently makes counseling interactions, case notes and treatment plans, case management
services, and psychoeducational activities observable and subject to feedback. The Intern is open to
examining and changing behaviors that interfere with successful work performance. The Intern
acknowledges when personal impairment of any type interferes with the completion of internship,
either self-identified or identified by another professional, and takes steps to either withdraw from
internship or, if appropriate, receive professional intervention while continuing with internship; such
decisions are made in collaboration with supervisors and counselor education faculty, even though
the ultimate decision rests with the counselor education faculty.

2) Attend regular supervision and use supervision feedback for effective change.

The Intern collaborates with both the On-Site Supervisor and the Internship Instructor in formulating
learning needs and interests. The Intern prepares work agendas, weekly contact logs, and case notes
and regularly shares them with supervisors. The Intern asks questions when in doubt about a
case/program and seeks other available learning resources, including professional staff, print and
nonprint media, web-based, professional literature and research. The Intern meets weekly with both
the On-Site Supervisor and the Internship Instructor to discuss assignments, cases, projects,
challenges, and problems and accepts constructive feedback on both strengths and weaknesses. The
Intern accepts feedback by fellow classmates/interns in the MSU internship class. The Intern
incorporates recommended appropriate changes in work performance to initial learning goals and
effect change in his/her own professional development.

3) Integrate theory from the Program into practice at the Internship Site.

The Intern integrates the knowledge and skills learned in the counselor education program into
ethical practice with clients, colleagues, community resources, and fellow students. The Intern
demonstrates knowledge of diversity issues during work with clients, during supervision, and during
 Counseling Internship Manual 25

classroom discussions. The Intern identifies ethical dilemmas in professional decision-making. The
Intern implements a theoretical approach to counseling.

4) Manage time and work demands professionally.

The Intern establishes a regular schedule of work hours at the site and arrives on time at the site and
for supervision and appropriately calls out and logs accurately when unable to report for work. The
Intern plans and organizes available time to manage the flow of work and prioritizes tasks in relation
to deadlines, site procedures, internship assignments, and client system needs. The Intern generates
reports, presentations, case notes, weekly logs, case summaries, and tapes professionally and on time.

Site and Community Skills

Interns will be able to demonstrate an awareness of how human and organizational behavior is
impacted by social class, age, gender, ability, sexual orientation, racial and ethnic differences,
nationality, as well as culture and personality. Interns will understand, assess, and discuss the
organizational and administrative policies and procedures of the Internship Site. Interns will
demonstrate awareness of how organizational structures, policies, and work cultures impact the
services to clients and employees. Competence will be displayed through the student’s ability to:

1) Describe the organizational structure, administrative procedures, services offered, and

responsibilities of employees.

The Intern understands the Internship Site’s organizational lines of authority and structure,
organization mission, and services offered to clients. The Intern completes administrative processes,
such as intake interviews and admissions procedures, performed at the site. The Intern works with
other staff members as necessary (e.g., assisting on projects) and understands the roles and functions
of other staff members. The Intern is involved in staff meetings and projects and attends in-service
training as required. The Intern functions as a member of work groups and demonstrates knowledge
and skills for conflict resolution in an organizational setting.

2) Describe the impact of selected policies, legislation, and organizational structure on site
services, clients, staff, and self.

The Intern follows the appropriate policies guiding the structure and activities of the Internship Site.
The Intern understands how legislation (e.g., state and district funding for guidance positions;
nonprofit funding) affects site services, clients, staff, and self. The intern identifies ways in which
gender, race, social class, age, ability, sexual orientation, nationality, and ethnicity impact the
organization and use of services. The Intern is aware of work climate issues and the impact on staff
productivity and morale.

3) Identify how the typical client’s community system plays a role in the client’s life and
use community resources in treatment planning.

The Intern is aware of critical aspects of the community which impact client functioning to include:
key organizations or institutions, significant social, cultural, religious members of the community,
family systems, and city, state, and national governmental human services providers. The Intern
makes appropriate referrals to other service sites or community resources as part of effective
treatment planning and case management. The Intern advocates on behalf of a client within the
 Counseling Internship Manual 26

community system and considers community systems in developing treatment plans. The Intern
serves as an expert witness, if required by the site or legally, and testifies within the limits of practice
and confidentiality as outlined by the ACA Code of Ethics and guidelines provided by the placement
site.

4) Serve as a change agent for both the Internship Site and the community.

The Intern serves as a viable member of the work group at the Internship Site. The Intern provides
feedback and recommends change if necessary with regard to client services, the organization, or the
community, in a professional and responsible manner. The Intern promotes social justice and
advocates on behalf of clients if appropriate and through the appropriate organizational procedures
(working first with the On-Site Supervisor and Internship Instructor). The Intern handles conflict
resolution within the organizational setting in a direct and professional manner.
 Counseling Internship Manual 27
Part VI
Evaluation

Evaluation is a process that occurs continually throughout the Internship experience. Formative
evaluation occurs at any time during Internship and can be in the form of verbal or written feedback
on an Intern’s work performance, work samples, or professionalism at the Internship Site or during
the Internship class. Feedback can come from fellow students, supervisors, or other professional staff
at the Internship Site. This feedback can be both informal and formal based on the purpose of the
evaluation process at that time.

Regularly scheduled supervision sessions with On-Site supervisors is the opportune time for
information evaluation to occur. Interns can receive feedback on their counseling kills, professional
practice, and overall professionalism. This type of evaluation should also occur each week during the
Internship class involving group supervision. Interns should use these supervision sessions to seek
feedback on how supervisors perceive their progress in the skills, professional practice, and overall
professionalism.

Formal evaluations can also occur at any time based on an Intern’s work performance. However,
minimally, two formal evaluations will be provided by supervisors, one at mid-term and a final
evaluation. These summative evaluations are in written form assessing the overall progress of the
Intern in achieving the objectives of Internship. Additionally, a plan for continued growth and
development can be devised from the evaluations. The Counseling Intern Evaluation form (Appendix
G) is usually used for the mid-term and final written evaluations.

The Counseling Intern Unsatisfactory Performance Evaluation (Appendix L) can be used at any time
during the Internship when an Intern demonstrates unsatisfactory, unethical or illegal performance in
internship. The evaluation form will be completed by a supervisor, shared with the Intern, given to
the Clinical Coordinator, and eventually shared with the Counseling Program faculty.

Mid-Semester Evaluation: A formal written evaluation using the Counseling Intern Evaluation form
(Appendix I and J). Both the On-Site Supervisor and Internship Instructor complete an evaluation
form on an Intern. Supervisors should use this opportunity to summarize the strengths of the Intern,
the progress made to date, and the areas the Intern yet needs to develop. Personal individual
supervision sessions should occur during which the summary of the evaluation is shared with the
Intern. Students are asked to inform On-Site Supervisors of the due date the mid-semester evaluation
is due.

Final Evaluation: The final evaluation follows the same procedures as the mid-term evaluation, even
though the Internship Instructor can develop a different evaluation form. The Internship Instructor
should receive all evaluations no later than the last class period before final exam week on the
University calendar. Again, students are asked to inform their On-Site Supervisors of the due date of
the final evaluation.

Guide for Grade Recommendations: Ultimately, the Internship Instructor is responsible for
assigning a final grade for the Internship class, even though On-Site Supervisors can provide input
into the assignment of a final grade. The grade is based on work performance, professional behavior,
and demonstrated competencies in the professional practice of counseling. All grades that might
indicate dismissal from the Program must go through the Department Chair after the Program
Faculty. Grades are assigned according to the following guidelines:
 Counseling Internship Manual 28

A = demonstrates superior performance of the professional practice of counseling and

professionalism, as well as superior knowledge related to the practice of counseling

B = demonstrates satisfactory performance of the professional practice of counseling and

professionalism, as well as satisfactory knowledge related to the practice of counseling

C = unsatisfactory performance. The student cannot continue to Internship I (COUN654) or

Internship II (COUN 674) or complete the program (if grade is earned in Internship II), and
remediation must occur before moving on in the program.

F = lacks the ability to demonstrate counseling skills and/or professionalism or there is evidence of
unethical or illegal practices or other problems that prohibit effective counseling practice to occur.
The student may be dismissed from the counseling program.

In order to continue from Practicum (COUN624) to Internship I (COUN 654) to Internship II (COUN
674), an Intern must receive a grade of “B” or above. In order to successfully complete the program,
an Intern must receive a grade of “B” or above in Internship II (COUN 674).

Unsatisfactory performance: Evaluation is a part of the Site Supervisor and Internship Instructor’s
responsibilities. Unsatisfactory performance should be noted early on and appropriate intervention
should occur. If the unsatisfactory performance persists, then the Supervisor should document this
using the Counseling Intern Unsatisfactory Performance Evaluation (Appendix L). Once it is
documented in written form, then the Supervisor should share this with the Internship Instructor (or
vice versa) and a meeting should be arranged with the Intern. The report must be dated and signed by
the Supervisor and the Intern. The Intern’s signature indicates awareness of the Supervisor’s
evaluation; it does not indicate agreement or approval of such. In the case of differences of opinion
that cannot be resolved, the Intern should write an addendum, ask the Supervisor to read and sign it,
and then attach it to the evaluation. The Internship Instructor is responsible for contacting the
Internship Coordinator with regard to an unsatisfactory evaluation report, so that appropriate
remediation or resolution of the situation can occur. If the Intern does not improve her/his inadequate
performance during an agreed upon timeframe, then the Intern can be removed from the site, and a
grade appropriate to the inadequate performance can be assigned.

Unethical or illegal performance of counseling services is sufficient cause to administratively

withdraw a student from an Internship Site and to deny the student further enrollment in the
Counselor Education program.

The following reasons are examples of when an Intern might be demonstrating unsatisfactory,
unethical or illegal performance. Other reasons may be determined by the site supervisor or course
instructor.

Failure to follow appropriate ethical codes or legal statutes

Failure to follow the administrative guidelines or expectations of counselors working at the
Internship Site
Failure to demonstrate satisfactory counseling skills, thus failing to demonstrate the
ability to help clients rather than harm them
Failure to attend or resisting supervision or failing to follow supervisory feedback
 Counseling Internship Manual 29

Failure to demonstrate professionalism (e.g., arriving late and keeping clients waiting;
poor or inadequate documentation of cases or treatment plans; poor record keeping)
Failure to provide work samples for supervisors to evaluate
Failure to maintain ethical boundaries between personal and professional roles
Failure to maintain appropriate hours at the Site, keeping an appropriate ratio of direct to
indirect counseling services.

If an Intern’s work suggests that a final grade of C might be assigned, the supervisors should
address the following steps (whenever possible):

Inform the Intern as early as possible that her/his work is occurring at the unsatisfactory
level
Outline the unsatisfactory work as clearly as possible
Document this in written form, meet with the Intern and share the areas of deficiency, and
have the Intern sign the document indicating that she/he understands the deficiencies
Develop a remediation plan in conjunction with all supervisors and the Intern to help the
Intern work on the areas of deficiency
Provide an adequate time frame for the Intern to implement the remediation plan and
begin working at a satisfactory or above level
Provide as much supervision and resources as necessary to help the Intern achieve
success and reach a satisfactory level of work performance

If a grade of C is assigned for Practicum or Internship:

For Practicum (COUN 624):

A remediation plan (in the form of an independent study) can be devised to basically
repeat the content and experience of the Internship course, during the semester following the
assignment of the C (unless the Counseling Program faculty determines that the student
should not continue with Internship or in the counseling program).
A grade of B or higher must be earned for the remediation plan in order for the student to
continue in the Counselor Education program.
Hours accumulated during the remediation plan will be considered as part of the Practicum
experience, regardless of the number of hours already accumulated.
An Intern who earns a C for the remediation work (synonymous to a second enrollment in
Pacticum) will be reviewed by the Counseling Program faculty to determine if she/he should
continue in the program.

For Internship I (COUN 654):

The same procedures apply as those for Practicum.

For Internship II (COUN 674):

The same procedures apply as those for Internship I.
 Counseling Internship Manual 30

If an Intern’s work performance is at the final grade of C or F level at any time during the
semester, the supervisors should address the following steps:

The Intern should be assigned administrative work only and clients should be referred to
other counselors.
A decision can be made by the Site Manager, Site Supervisor, or the Clinical
Coordinator that the Intern be removed from the Internship Site.
If the reason for the evaluation is due to “lack of ability to demonstrate counseling skills
and/or professionalism,” then a decision should be made by the supervisors if remediation at
that time in the semester is possible; if not, the Intern will be removed from the Site and will
repeat the course the next semester.
If the reason for the evaluation is due to unethical or illegal practice on the part of the
Intern, then a hearing must be conducted by the Counselor Education faculty to determine
if a violation did occur and the extent of the violation; if a determination is made that a
violation has occurred, the Intern will be removed from the Site.

If a grade of F is assigned for Internship:

If a student receives an F in Internship due to lack of skill or professionalism, the Counseling

Program faculty, with the input of the On-Site Supervisor and the Internship Instructor, will
determine if the student can repeat the Internship.
If a student receives an F in Internship due to unethical or illegal practice and after a
hearing it is determined that a violation did occur, then the student may be dismissed
from the Counselor Education program.
 Counseling Internship Manual 31
APPENDIX A
MONTCLAIR STATE UNIVERSITY COUNSELING PROGRAM
COUN 624: PRACTICUM APPROVAL FOR ORIENTATION

Name of Student: ____________________________________ Student ID#: ____________________________

Name of Advisor: ___________________________ Student e-mail: (MSU ONLY) ______________________

Intended Semester for Practicum: _________________ I will attend orientation on:_____________________

Must Complete Grid #1

IF NOT ALREADY TAKEN -
PRE-REQUISITES FOR GRADE
SEMESTER TAKEN SEMESTER TO FULLFILL
PRACTICUM RECEIVED REQUIREMENT
COUN 552 (Intro. to Counseling)

COUN 577 (Counseling Theories)

COUN 584 (Group Counseling)

(with “B” or better)
COUN 588 (Counseling Tech.)
(with “B” or better)
COUN 595
(Multicultural Counseling)

Must Complete Grid #2

PRE-REQUISITES FOR IF NOT ALREADY TAKEN -
GRADE
INTERNSHIP I SEMESTER TAKEN SEMESTER TO FULLFILL
RECEIVED REQUIREMENT
(with a “B” or better)
COUN 583 (Counseling in Schools I)
SCHOOL COUNSELING STUDENTS
COUN 604 (Clinical Diagnosis & Asses)
COMMUNITY COUN. STUDENTS
COMPLETION OF ONE SPECIALTY COURSE
STUDENT AFFAIRS and ADDICTIONS
(Provide Course Name)

* IF A PERMIT IS ISSUED FOR PRACTICUM OR INTERNSHIP DURING A TERM A PREREQUISITE IS BEING COMPLETED, IT IS
THE STUDENT’S RESPONSIBILITY TO NOTIFY BOTH THEIR ADVISOR AND THE CLINICAL COORDINATOR IF THE
REQUIRED GRADE IS NOT RECEIVED. STUDENTS CANNOT TAKE PRACTICUM OR INTERNSHIP IF THEY DO NOT RECEIVE
THE REQUIRED GRADE IN ALL PREREQUISITES. FAILURE TO ACHIEVE THE REQUIRED GRADE AND/OR MAKE THE
PROPER NOTIFICATIONS WILL RESULT IN PERMITS BEING RESCINDED. *

Student Signature Date

Advisor Signature Date

It is REQUIRED that students complete a MINIMUM of 24 credits in a 48 credit program, and 30 credits in a 60
credit program prior to beginning Practicum. Ultimate enrollment in COUN 624, Practicum in Counseling, requires
department approval, which must be given by the Clinical Coordinator. This “advisor approval form” only provides
permission to attend the Practicum Orientation. Final approval to enroll in a Practicum class is provided by the Clinical
Coordinator after several other steps occur, which will be explained at the Practicum Orientation.

__________________
Clinical Coordinator Signature Date
 Counseling Internship Manual 32

APPENDIX B

Montclair State University

Counseling Program

REQUEST FOR INTERNSHIP APPLICATION

It is REQUIRED that students complete a minimum of 33 credits in a 48 credit

program, and 42 credits in a 60 credit program prior to beginning Internship I.
Please make sure you meet this requirement before submitting this Application.

Name:_____________________________________ Date of Application: ________________

Local Address:________________________________________________________________

Permanent Address:____________________________________________________________

Home Phone:____________________________ Cell Phone: ______________________

Email:_______________________________________________________________________

Term of Internship I: ___________________________________________________________

Semester Year
Anticipated Term of Internship II: ________________________________________________
Semester Year

1. Date attending Internship Orientation____________________________________________

2. Academic Preparation:
No. of credits completed in the Counselor Education Program (including this semester): ____

3. Relevant Prior Work Experience (If no experience in working in human services,

schools, or health agencies write none):

4. Two population groups with which you would like to gain experience:

5. Have you already made any contacts for Internship?

My signature indicates I have read and will conform to the policies and procedures of the Montclair
State University Counselor Education Program Internship Manual.

____________________________________________ ________________________
Signature Date
 Counseling Internship Manual 33

APPENDIX C-1

MONTCLAIR STATE UNIVERSITY

Clinical Practicum

ORIENTATION Agreement
Each item below provides additional information for your path toward completing your clinical
experience (Practicum and Internship) at MSU. The items are “requirements” not “preferences or
options.” They will also provide you with accurate information to discuss with potential site
supervisors.

1. Attending the Clinical orientation is your first step toward being approved for a
____________ Practicum. Ultimately, the faculty must agree that you are ready in terms of
your knowledge, skills, and ability to counsel and provide guidance activities with clients in a
community mental health agency, school, college, or addictions center.

2. PRE-REQUISITES: you cannot go into Practicum without having successfully completed a

minimum of 24-27 credits (in a 48 credit program) or 30-33 credits (in a 60 credit program)
including COUN 552, Introduction to Counseling, COUN 577, Counseling Theories, COUN
588, (with a B or better) Counseling Techniques, COUN 595, Multicultural Counseling and
COUN 584, (with a B or better) Group Counseling.

3. Before Practicum begins, you must be a student member of the American Counseling
Association (ACA) and receive (it’s free now with membership) their insurance program at a
minimum of 1M – 3M annual aggregate; therefore you need to join ACA no later than
______________ and be enrolled in an insurance program no later than the beginning of the
semester. Nobody will begin Practicum until insurance is obtained and evidence of such is
submitted to the Clinical Coordinator.

4. You must have an approved placement site no later than ______________. We will not
approve people who do not have a placement site by this date. While you have a
responsibility to identify potential placement sites, the ultimate approval of the site for your
clinical work rests with the Clinical Coordinator. The following guidelines relate to
placement sites.
• An approved site is one that has already been used successfully by another MSU student.
Please check to make sure the site has not been taken off the list of “approved” sites.
• The Clinical Coordinator must approve any site that has not already been approved by MSU.
To be approved, a site must be able to guarantee that: 1) you will be able to do individual
counseling, group counseling, workshops and guidance activities (where appropriate), write
case notes, attend staff meetings, etc.; 2) receive one-on-one supervision at least once per
week for a minimum of an hour with a qualified supervisor; 3) on-site supervisor available to
 Counseling Internship Manual 34
consult with class instructor via telephone at least every other week during the semester; and
4) be able to audio and/or video tape sessions.

• The Clinical Coordinator, with the help of the faculty, will ultimately determine if a student is
prepared to work in a particular clinical site. The Clinical Coordinator reserves the right to
assign a site at any time for any student.

• For Practicum: You must be able to complete at least 100 contact hours for the semester.
Those hours include: 40 direct client contact involving one-on-one sessions with clients,
group counseling, and some other types of contact with clients, and 60 indirect client contact,
involving any other work at the site. Direct hours must include a minimum of 25 hours
individual counseling and a minimum of 8 hours group counseling. If the opportunity for
group work is not provided during Practicum, students must complete this requirement during
Internship. A student must be willing to commit approximately 8-10 hours per week at the
site for Practicum.

• Your supervisor must be appropriate to the specialization you are pursuing; they must hold a
Master’s degree AND be licensed / certified for a minimum of two full years, as follows: for
school counseling, supervisors must be a certified school counselor; for community
counseling, supervisors should either be a counselor (LPC), a psychologist (Ph.D.), or a social
worker (LCSW); for addictions, supervisors may have any of the credentials specified for
community counseling or be an LCADC, and for student affairs/higher education, supervisors
must have an appropriate master’s degree.

5. Each student will attend Practicum class throughout the duration of the semester. During this
class, students will discuss issues related to Practicum, present cases and samples of taped
sessions and review treatment plans. Missing any Practicum class is considered detrimental
to your development as a counselor. If you already know you will miss 1 or more classes, it is
better not to register for Practicum at this time. If you complete your 100 hours for the
semester, you must continue with your agreed upon hours with your site. Each student will
also meet with an assigned Doctoral student for 1 hour of individual supervision each week.

6. Unprofessional behavior will not be tolerated. This means that you must conduct yourself
like an employee while there (e.g., calling out ahead of time if you can’t come to work on a
particular day). You are expected to conduct yourself according to the ACA Code of Ethics
as well as your respective ethical codes (e.g., ASCA).

7. The Practicum instructor, along with the clinical coordinator, reserves the right at any time to
withdraw a student from a practicum or internship class (thus from the placement site) when
she/he thinks the student’s work may be doing “more harm than good” for the client
population. If this should occur, a remedial plan will be established for the student.
 Counseling Internship Manual 35
8. Your ultimate placement MUST be in your concentration in the counseling program. There is
only one exception where students may be permitted to do their practicum outside their
chosen concentration --- school concentration students choosing to do their Practicum in the
summer semester. While it is permissible for school students to do their practicum in the
summer, it is not recommended due to the limited number of schools possibilities during the
summer. Additionally, for community counselors, you should find some population (e.g.,
women) or specific “special population” issues (e.g., domestic violence; HIV/AIDS; Hospice)
that interest you enough potentially for future employment.

9. All community (including addictions) sites must have a “Memorandum of Understanding” in

place prior to approval being given. Some school and higher education sites may request this
as well. Please note that this is a long process that requires approval both by the
practicum/internship site as well as MSU.

10. Officially, the logging of practicum/internship hours begins the first day of class and ends the
date of the final exam (exceptions can only be made and approved in advance by the
practicum/internship instructor).

I, _____________________________________, understand and agree to the conditions stated above

in my application for COUN 624, Counseling Practicum.

______________________________________________ __________________________
Student Signature Date

I, ______________________________________, have reviewed the conditions stated above with the

student intern.

_______________________________________________ ___________________________
Site Supervisor Signature Date
 Counseling Internship Manual 36

APPENDIX C-2

MONTCLAIR STATE UNIVERSITY

Clinical Internship

ORIENTATION Agreement

Each item below provides additional information for your path toward completing your clinical
Internship experience at MSU. The items are “requirements” not “preferences or options.” They will
also provide you with accurate information to discuss with potential site supervisors.

1 Attending the Clinical orientation is your first step toward being approved for a
_____________ Internship. Ultimately, the faculty must agree that you are ready in terms of
your knowledge, skills, and ability to counsel and provide guidance activities with clients in a
community mental health agency, school, college, or addictions center.

2 PRE-REQUISITES: You cannot go into Internship I without having successfully completed

a minimum of 33 credits (in a 48 credit program) or 45 credits in a 60 credit program)
including - COUN 552, Introduction to Counseling, COUN 577, Counseling Theories, COUN
584. Group Counseling, COUN 588, Counseling Techniques, COUN 595, Multicultural
Counseling, COUN 624, Counseling Practicum (with a “B” or better). In addition, for school
counseling students, you cannot go into Internship I without having successfully completed
COUN 583, Counseling in Schools; for community counseling students, you cannot go into
Internship I without having successfully completed COUN 604, the DSM course.

3 Before Internship begins, you must be a student member of the American Counseling
Association (ACA) and receive (it’s free now with membership) their insurance program at a
minimum of 1M – 3M annual aggregate; therefore you need to join ACA no later than
____________ and be enrolled in an insurance program no later than the beginning of the
semester. Nobody will begin Internship until insurance is obtained and evidence of such is
submitted to the Clinical Coordinator.

4 You must have an approved placement site no later than ________________. We will not
approve people who do not have a placement site by this date. While you have a
responsibility to identify potential placement sites, the ultimate approval of the site for your
clinical work rests with the Clinical Coordinator. The following guidelines relate to
placement sites.
 Counseling Internship Manual 37

• An approved site is one that has already been used successfully by another MSU student and
which continues to meet all requirements. Please check to make sure the site has not been
taken off the list of “approved” sites.

• The Clinical Coordinator must approve any site that has not already been approved by MSU.
To be approved, a site must be able to guarantee that: 1) you will be able to do individual
counseling, group counseling, workshops and guidance activities (where appropriate), write
case notes, attend staff meetings, etc.; 2) receive one-on-one supervision at least once per
week for a minimum of an hour with a qualified supervisor; 3) on-site supervisor available to
consult with class instructor via telephone at least every other week during the semester; and
4) be able to audio and/or video tape sessions.

• The Clinical Coordinator, with the help of the faculty, will ultimately determine if a student is
prepared to work in a particular clinical site. The Clinical Coordinator reserves the right to
assign a site at any time for any student.

• For Internship: You must be able to complete at least 300 contact hours each semester
(within the parameters of the actual semester start and end), for two semesters. Those hours
include: 120 direct client contact and 180 indirect client contact.

• Your supervisor must be appropriate to the specialization you are pursuing; they must hold a
Master’s degree AND be licensed / certified for a minimum of two full years, as follows: for
school counseling, supervisors must be a certified school counselor; for community
counseling, supervisors should either be a counselor (LPC), a psychologist (Ph.D.), or a social
worker (LCSW); for addictions, supervisors may have any of the credentials specified for
community counseling or be an LCADC, and for student affairs/higher education, supervisors
must have an appropriate master’s degree.

5 Each student will attend an internship class for the two semesters of internship. During this
class, students will discuss issues related to internship, present cases and samples of taped
sessions, and review treatment plans. Missing any internship class is considered detrimental
to your development as a counselor. If you already know you will miss 1 or more classes, it is
better not to register at this time. If you complete your 300 hours before the end of the
semester (for either semester), you must continue with your agreed upon hours with your site.

6 Unprofessional behavior will not be tolerated. This means that you must conduct yourself
like an employee while there (e.g., calling out ahead of time if you can’t come to work on a
particular day). You are expected to conduct yourself according to the ACA Code of Ethics
as well as your respective ethical codes (e.g., ASCA).
 Counseling Internship Manual 38
7 The Internship instructor, along with the clinical coordinator, reserves the right at any time to
withdraw a student from an internship class (thus from the placement site) when she/he thinks
the student’s work may be doing “more harm than good” for the client population. If this
should occur, a remedial plan will be established for the student.

8 Your ultimate placement MUST be in your concentration in the counseling program.

Additionally, for community counselors, you should find some population (e.g., women) or
specific “special population” issues (e.g., domestic violence; HIV/AIDS; Hospice) that
interest you enough potentially for future employment.

9 All community (including addictions) sites must have a “Memorandum of Understanding” in

place prior to approval being given. Some school and higher education sites may request this
as well. Please note that this is a long process that requires approval both by the
practicum/internship site as well as MSU.

10 Officially, the logging of internship hours begins the first day of class and ends the date of the
final exam (exceptions can only be made and approved in advance by the internship
instructor).

I, _____________________________________, understand and agree to the conditions stated above

in my application for COUN 654, Internship in Counseling I and for COUN 674, Internship in
Counseling II.
______________________________________________ __________________________
Signature Date

*********************************************************************************

I, ______________________________________, have reviewed the conditions stated above with the

student intern.

_______________________________________________ ___________________________
Site Supervisor Signature Date
 Counseling Internship Manual 39

APPENDIX D-1

Montclair State University

Counseling Program

PRACTICUM PLACEMENT AGREEMENT

This form documents the fact that__________________________________________________

(name of student)

is approved to work as a Counseling Practicum Student at

_____________________________________________________________________________
(name of site)
for

_____________________________________________________________________________
(term of Practicum)

Each signature below indicates concurrence with the placement and acknowledges the need to
promptly inform the other signers if an early termination seems warranted.

APPROVED

______________________________________________ ___________________
Site Manager / Principal Date

______________________________________________ ___________________
Practicum Site Supervisor Date

Name of Site Supervisor__________________________________________________________

Work Address__________________________________________________________________

Work Phone (_____)_____________________________________________________________

E-Mail Address:________________________________________________________________

______________________________________________ _______________________
Student Date

______________________________________________ _______________________
MSU Clinical Coordinator Date
 Counseling Internship Manual 40

APPENDIX D-2

Montclair State University

Counseling Program

INTERNSHIP PLACEMENT AGREEMENT

This form documents the fact that__________________________________________________

(name of student)

is approved to work as a; Counseling I Intern or Counseling II Intern or Both at

_____________________________________________________________________________
(name of site)
for

_____________________________________________________________________________
( term(s) of Internship(s) )

Each signature below indicates concurrence with the placement and acknowledges the need to
promptly inform the other signers if an early termination seems warranted.

APPROVED

______________________________________________ ___________________
Site Manager / Principal Date

______________________________________________ ___________________
Intern’s Site Supervisor Date

Name of Site Supervisor__________________________________________________________

Work Address__________________________________________________________________

Work Phone (_____)_____________________________________________________________

E-Mail Address:________________________________________________________________

______________________________________________ _______________________
Student Date

______________________________________________ _______________________
MSU Clinical Coordinator Date
 Counseling Internship Manual 41

APPENDIX E

Montclair State University

Counseling Program

PRACTICUM and/or INTERNSHIP SITE PROFILE

Name of Intern:______________________________________________________________

I. AGENCY/SCHOOL (Descriptive brochures attached? _____)

A. Site Name: ____________________________Phone: ( )________________________

Address:________________________________________________________________

E-mail Address:__________________________________________________________

Hours of Operation:_______________________________________________________

Manager:________________________________________________________________

Contact Person:___________________________________________________________

B. Mission:_________________________________________________________________

________________________________________________________________________

C. Supplemental Information:

Stipend:_______ Stipulations:__________________

Transportation: Car Required: ___ Agency Car Available: ___Mileage Reimbursement:__

D. Primary Fields of Practice:

Family & Children’s Services:
_________ Adoption __________ Family Therapy
_________ Abuse & Neglect __________ Foster Care
_________ Delinquency __________ Geriatrics
_________ Developmental Disabilities __________ Mental Therapy
_________ Domestic Violence __________ School Services
_________ Public Welfare __________ Other:

Health Care Services:

_________ Clinic __________ Public Health
_________ Family Planning __________ Rehabilitation
_________ Hospital __________ Other:

Mental Health Services:

_________ Hospital/In-patient __________ Alcohol Abuse
_________ Crisis Intervention __________ Drug Abuse
_________ Community-based __________ Other:
 Counseling Internship Manual 42
Education:
_________ Elementary __________ Private School
_________ Middle __________ Public School
_________ High __________ Other:
_________ College/University

E. Special Populations Served:

F. Services:
_________ Residential __________ Crisis Intervention
_________ Inpatient __________ Brief Intervention
_________ Outpatient __________ Long-Term
_________ Case management __________ Telephone Only
_________ Home Based __________ Administration
_________ Policy Development __________ Other:

G. Primary Interventions:
_________ Casework/Case Management __________ Milleu Therapy
_________ Cognitive/Behavioral __________ Task-Oriented
_________ Family Therapy __________ Group Therapy
_________ Marital Therapy __________ Play Therapy
_________ Existential/Humanistic __________ Other:

H. Learning Experiences Available:

_________ Case Management/Casework __________ Research
_________ Intake __________ Use of computers
_________ Diagnosis/Assessment __________ Budget/analysis
_________ Intervention __________ Fundraising
_________ Psychosocial Studies __________ Staff Development
_________ Community organization __________ Legislative
_________ Community development __________ Program coordination
_________ Community education __________ Advocacy
_________ Marketing __________ In-service training
_________ Group work __________ Seminars
_________ Family/marital therapy __________ Conference
_________ Individual Counseling __________ Staffing/”rounds”
_________ Grant-writing __________ Consultation
_________ Policy analysis/development __________ Program evaluation
_________ Administration/planning __________ Multicultural
_________ Program development __________ Other:

II. DESIRED INTERN CHARACTERISTICS

A. Skills, Knowledge, Experience:

B. Personal Qualities:

C. Other:
 Counseling Internship Manual 43

III. PROFILE OF INTERN’S PROPOSED SITE SUPERVISOR

A. Supervisor Name:__________________________________________________

Agency:__________________________________________________________

Work Address:_____________________________________________________

Email Address:_____________________________________________________

Work Phone: ( )________________________________________________

B. Graduate Degree and Field of Study:

C. Pertinent Additional Training:

D. Professional Experience:

E. Supervisory Experience:

F. License/Certification:__________________________________________________________

Document Number:_________________________Specialty:___________________________

G. Primary Expertise:

______ Aging _______ Physical Health Services

______ Alcohol/Drug Addiction _______ Mental Health
______ Delinquency _______ School Social Work
______ Public Welfare _______ Children
______ Family Therapy _______ Adolescents
______ Child Welfare Services _______ Adults
_______ Other:

H. Theoretical Orientation:

I. Philosophy of Supervision:

_______________________________________________ ________________________
Site Supervisor’s Signature Date
 Counseling Internship Manual 1

III. PROFILE OF INTERN’S PROPOSED EMERGENCY ALTERNATE SITE SUPERVISOR

(Permitted to supervise intern only in emergency situations and not on a regular basis)

A. Supervisor Name:__________________________________________________

Agency:__________________________________________________________

Work Address:_____________________________________________________

Email Address:_____________________________________________________

Work Phone: ( )________________________________________________

B. Graduate Degree and Field of Study:

C. Pertinent Additional Training:

D. Professional Experience:

E. Supervisory Experience:

F. License/Certification:__________________________________________________________

Document Number:_________________________Specialty:___________________________

G. Primary Expertise:

______ Aging _______ Physical Health Services

______ Alcohol/Drug Addiction _______ Mental Health
______ Delinquency _______ School Social Work
______ Public Welfare _______ Children
______ Family Therapy _______ Adolescents
______ Child Welfare Services _______ Adults
_______ Other:

H. Theoretical Orientation:

I. Philosophy of Supervision:

_______________________________________________ ________________________
Site Supervisor’s Signature Date
 Counseling Internship Manual 2

APPENDIX F

MONTCLAIR STATE UNIVERSITY

DEPARTMENT OF COUNSELING AND EDUCATIONAL LEADERSHIP
COUNSELING PROGRAM

COUN 624, Practicum in Counseling Contract

Course Description: This is the second clinical core course in the graduate counseling program.
The course requirements include advanced counseling practice supervised by the professor;
further development of core counseling skills common to all theoretical approaches; and
demonstration of the understanding of the ACA Code of Ethics and Multicultural Competencies.
This course helps students further develop individual and group counseling skills.

DATE: ______________________

Student: ____________________________________________________________________

Site: _______________________________________________________________________

Site Supervisor: _______________________________________________________________

I. Student Responsibilities

a. Complete 100 hours at site; 40 Direct and 60 Indirect

b. Minimum of 25 hours of individual counseling
c. Minimum of 8 hours of group counseling (if offered at site)
d. 7 hours can be used to become oriented to the other types of direct service offered at the
site
e. Minimum of 5 counseling tapes of individual counseling
f. Complete individual and group supervision once per week each
g. Complete 60 hours of Indirect work at the site involving appropriate documentation being
used in the Practicum class and at site, as well as other administrative responsibilities
assigned by the site
h. Log all hours completed for Practicum weekly.

II. Site Responsibilities

a. Allow student to be on site 8-10 hours per week

b. Assign individual/group counseling clients and administrative work
c. Help students with client signing of consent forms for taping
d. Provide one-on-one supervision with student once per week (individual supervision can
be completed in a 2 students per 1 supervisor method)
e. Sign off on logs weekly
f. Assign other duties/responsibilities as needed
 Counseling Internship Manual 3

g. Interact minimally every other week with Practicum class instructor via phone or visit
h. Minimally complete a mid-term and final evaluation on the student

III. MSU Responsibilities

a. Provide necessary forms to complete Practicum

b. Provide instruction on individual/group counseling, particularly related to a theoretical
approach
c. Provide weekly group supervision with students
d. Provide individual supervision with students by doctoral student
e. Sign off on logs weekly
f. Interact minimally every other week with Practicum site supervisor via phone or site visit
g. Keep Practicum file on students with all appropriate paperwork (e.g., logs)
h. Minimally complete a mid-term and final evaluation for students

IV. Agreements Regarding Length of Hours of Practicum or Other Issues

a. Length of Practicum: __________________________ Semester

b. 8-10 hours per week on site; other out of office hours can count (e.g., preparing for a
topic group) if approved by site supervisor and Practicum instructor
c. Conferences for professional association meetings can be arranged and approved by site
as vacation time from site

Approvals:

___________________________________________ ______________________________
Site Supervisor Printed Name Date
___________________________________________
Site Supervisor Signature

__________________________________________ ______________________________
Student Signature Date

_________________________________________ _______________________________
Clinical Coordinator Signature Date
 Counseling Internship Manual 4

Appendix G-1
MONTCLAIR STATE UNIVERSITY
Clinical Practicum

SUPERVISION AGREEMENT
and
CONSENT TO PERMIT TAPING

To be an approved clinical Practicum placement, a site agrees to the following:

1) students will have the opportunity to provide individual, group counseling, workshops and guidance activities
(where appropriate), write case notes, attend staff meetings, etc.; Practicum students will complete at least 100
contact hours for the semester. These hours include: 40 direct client contact involving one-on-one sessions with
clients, group counseling and other types of contact with clients, and 60 indirect client contact, involving any
other work at the site which is counseling related. The 40 direct hours must include a minimum of 25
individual counseling hours and a minimum of 8 group counseling hours.

2) the Practicum site supervisor will provide one-on-one supervision at least once per week for a minimum of
an hour; supervisor will listen to and critique taped counseling sessions as part of weekly supervision;

3) the Practicum supervisor will be available to consult with class instructor via telephone or e-mail at least
every other week during the semester;

3) the Practicum supervisor will complete two formal, written, evaluations of student – one mid-term and one
final evaluation which will be provided by student;

4) Practicum students will be permitted to audio and/or video tape client sessions; the on-site supervisor will
assist student in getting clients to tape;

5) the on-site Practicum Supervisor is the individual whose signature appears on all submitted and approved
documentation and attests to holding the required credentials as specified in the Orientation Agreement.

6) the on-site Practicum Supervisor has been advised by the student that upon completion and submission of
paperwork to the MSU Clinical Coordinator, a “Supervisor Training Module” link will be provided. The on-
site supervisor(s) agrees to complete this on-line module before the practicum placement can be approved.

*****************************************************************************
By signing below, I am verifying that my chosen site is aware of the taping requirement and all other site
approval requirements for practicum, and has consented to all the above.

__________________________________________ _________________________
Student Signature of Acknowledgement Date

_________________________________________ _________________________
Site Manager/Principal Signature of Acknowledgement Date

_____________________________________________ _________________________
Site Supervisor Signature of Acknowledgement Date
 Counseling Internship Manual 5

Appendix G-2
MONTCLAIR STATE UNIVERSITY
Clinical Internship

SUPERVISION AGREEMENT
and
CONSENT TO PERMIT TAPING

To be an approved clinical Internship placement, a site agrees to the following:

1) students will have the opportunity to provide individual, group counseling, workshops and guidance activities
(where appropriate), write case notes, attend staff meetings, etc.; Internship students will complete at least 300
contact hours for the semester. These hours include: 120 direct client contact involving one-on-one sessions
with clients, group counseling and other types of contact with clients, and 180 indirect client contact, involving
any other work at the site which is counseling related. The 120 direct hours must include a minimum of 75
individual counseling hours and a minimum of 8 group counseling hours.

2) the Internship site supervisor will provide one-on-one supervision at least once per week for a minimum of
an hour; supervisor will listen to and critique taped counseling sessions as part of weekly supervision;

3) the Internship supervisor will be available to consult with class instructor via telephone or e-mail at the
beginning and end of the semester, and “as needed” throughout the semester.

3) the Internship supervisor will complete two formal, written, evaluations of student – one mid-term and one
final evaluation which will be provided by student;

4) Internship students will be permitted to audio and/or video tape client sessions; the on-site supervisor will
assist student in getting clients to tape;

5) the on-site Internship Supervisor is the individual whose signature appears on all submitted and approved
documentation and attests to holding the required credentials as specified in the Orientation Agreement.

6) the on-site Internship Supervisor has been advised by the student that upon completion and submission of
paperwork to the MSU Clinical Coordinator, a “Supervisor Training Module” link will be provided. The on-
site supervisor(s) agrees to complete this on-line module before the internship placement can be approved.

******************************************************************************
By signing below, I am verifying that my chosen site is aware of the taping requirement and all other site
approval requirements for internship, and has consented to all the above.

_________________________________________ _________________________
Student Signature of Acknowledgement Date

_________________________________________ _________________________
Site Manager/Principal Signature of Acknowledgement Date

_________________________________________ _________________________
Site Supervisor Signature of Acknowledgement Date
 Counseling Internship Manual 6

APPENDIX H

Montclair State University

Counseling Program

MEMORANDUM OF UNDERSTANDING

Memorandum of Understanding will be provided individually from the Internship Coordinator

of the Counseling Program. This is based on your area of concentration and is distributed upon
completion of the appropriate paper work for approval of an internship site.
 Counseling Internship Manual 7

APPENDIX I
Montclair  State  University  
Site  Supervisor’s  Evaluation    
 
Intern’s  Name:  _________________________      Supervisor’s  Name:    __________________________  
 
Date  of  Evaluation:        _________________          Midterm  Evaluation  ______Final  Evaluation  _________  
 
 Practicum
 Internship I
 Internship II

Rate  the  student’s  performance  on  the  five  global  dimensions  and  specific  items  using  the  following  5-­‐point  scale.    These  
evaluations  are  made  in  reference  to  the  expected  performance  given  the  student’s  developmental  level  (i.e.,  beginning,  
middle,  or  end  of  practicum  or  internship).  
 
Note:    You  are  rating  students  in  practicum  or  internship.  Practicum  is  the  first  field  experience  for  most  students;  if  the  
student  displayed  “skills  deficiencies”  at  the  start  of  practicum  or  internship,  please  specify  so.    If  this  forms  requests  
information  about  skills  not  observed  or  areas  not  covered  in  practicum/internship  rate  them  as  n/o  (not  observed).  
 
 
1                2                                3       4                    5  
       Not  Observed                Development   Meets  Developmental              Slightly  Above            Considerably  Above  
                                       Required                                          Expectations                                          Expectations                            Expectations  
                   
 
 
Section  A:    Attending  Skills  and  Relationship  Building  
 
_____    a. Non-­‐verbal:  Exhibited  appropriate,  effective  use  of  body  language,  vocal  tone,  facial  expressions,  and  
eye  contact  to  convey  warmth,  positive  regard,  and  acceptance.  Aware  of  client  non-­‐verbals.  
_____    b. Attending:  Demonstrated  interest,  focused  on  the  client,  encouraged  the  client  to  speak  through  the  
use  of  verbal  and  nonverbal  encouragers.  
_____    c. Active  Listening:  Demonstrated  the  ability  to  follow  the  client  with  understanding  in  all  aspects  of  
communication.  
_____    d. Respect  &  Warmth:    Demonstrated  through  open,  positive,  congruent  verbal  and  nonverbal  language.  
_____    e. Nonjudgmental  Attitude:  Demonstrated  neutrality  through  body  language  and  vocal  quality;  did  not  
attempt  to  impose  counselor  values  during  the  interview.  
_____    f. Authenticity,  Congruence:  Demonstrated  genuineness  and  flexibility  in  response  to  client.  
_____    g. Cultural  Competence:  Demonstrated  cultural  sensitivity  and  ability  to  attend  to  cultural  issues  in  the  
counseling  process.  
_____    h. Observation:  Paid  attention  to  verbal  and  nonverbal  behavior  of  client,  interactions  between  client  and  
counselor,  and  noted  discrepancies.  
_____    i. Use  of  Silence:  Allowed  appropriate  silences  and  demonstrated  the  ability  to  tolerate  silence  during  the  
session.  
_____    j. Positive  Assets:  Attended  to  and  noted  the  client’s  positive  assets  and  strengths.  
_____    k. Relationship  Building:  Demonstrated  the  ability  to  develop  a  working  alliance  and  rapport  with  client.  
 Counseling Internship Manual 8
_____    l. Opening:    Opened  sessions  smoothly  and  effectively.    
_____    m. Closing:  Allowed  appropriate  time  for  closing;  set  stage  for  next  session.  
 
_____                    Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Section  B:    Information  Gathering,  Questioning  Skills,  Case  Conceptualization  and  Counseling  Plans  
 
_____    a. Closed–Ended  Questioning:  Demonstrated  the  use  of  purposeful,  closed  questions  to  inquire  facts  or  
information  as  needed  but  did  not  overuse.  
_____    b. Open–Ended  Questioning:  Demonstrated  the  use  of  purposeful,  open  questions  to  keep  session  on  
track,  clarify,  or  to  encourage  further  communication  and  understanding  of  the  client’s  world.  
_____    c. Concreteness:  Sought  out  specific  information  and  examples.  
_____    d. Vocabulary:  Vocabulary  used  was  developmentally  and  culturally  appropriate  for  person  being  
counseled.  
_____    e. Assessment  Skills:  Demonstrates  ability  to  identify  themes  in  clients’  issues,  formulate  diagnostic  
impressions  (not  necessarily  using  the  DSM),  and  articulate  how  they  reached  these  impressions.  
_____    f. Counseling  Plans:  Develops  effective  counseling  plans,  based  on  diagnostic  impressions,  goals  agreed  on  
with  clients.  
_____    g. Case  Notes:  Case  notes  are  clearly  written  and  reflect  work  being  done.  
_____    h. Application  of  theory:  Demonstrates  knowledge  of  and  ability  to  apply  theory  to  practice  (case  
conceptualization  and  development  of  counseling  plans).  
_____    i. Application  of  Research/Professional  Literature:  Uses  information  from  professional  literature  in  the  
formation  of  case  conceptualization,  development  of  counseling  plans,  and  selection  of  interventions.  
_____    j. Cultural  Competence:  Demonstrates  ability  to  attend  to  cultural  issues  that  may  influence  the  client’s  
issues  and/or  resolution  of  those  issues  as  well  as  how  the  counselor’s  own  cultural  background  and  
worldview  may  influence  case  conceptualization  and  development  of  counseling  plans.  
_____    k. Advocacy  Competence:  Identifies  socio-­‐political  and  other  factors  (at  meso-­‐  and  macro-­‐  level)  that  may  
be  barriers  to  clients’  well-­‐being  or  growth  and  strategies  to  address  such  barriers  with  (and/or  on  
behalf  of)  clients  
   
_____       Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
 
Section  C:  Empathic  Skills  
 
_____    a. Paraphrasing/Reflection  of  Content:  Demonstrated  the  ability  to  briefly  reflect  the  essence  of  what  the  
client  has  said.  
_____    b. Reflecting  Feeling:  Demonstrated  and  communicated  empathy  by  reflecting  client  emotions,  explicit  
and  implicit.  
_____    c. Reflecting  Meaning:  Demonstrated  the  ability  to  facilitate  a  client’s  exploration  of  his/her  values  so  that  
the  client  gains  a  deeper  understanding  of  his/her  thoughts  and  feelings  which  underlie  his/her  
experience.  
_____    d. Summarizing:  Demonstrated  the  ability  to  integrate  and  reflect  the  content,  thoughts,  feelings,  and  
meaning  presented  by  a  client        
 
_____       Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Section  D:    Counselor  Attitudes  and  Behaviors  in  Supervision  
 Counseling Internship Manual 9
 
_____    a. Self-­‐Awareness:  Demonstrated  an  awareness  of  one’s  strengths,  challenges,  worldview,  values  and  
biases,  and  how  they  impact  working  with  a  client.  
_____    b. Comfort  Level:    Demonstrated  comfort  with  counseling  as  an  overall  process  of  helping.  
_____    c. Empathic  Response:  Demonstrated  an  understanding  of  the  client’s  world  as  evidenced  by  attending  
skills  and  accurate  reflections.    
_____    d. Preparation  for  Supervision:  Exhibited  readiness  for  supervision  as  evidenced  by  having  reviewed  
counseling  session  and  submitting  session  evaluations,  tapes,  and  paperwork  in  a  timely  manner.  
_____    e. Goals:  Demonstrated  ability  to  set  goals  based  on  a  realistic  evaluation  of  skills.  
_____    f. Effective  Use  of  Self-­‐Disclosure  in  Supervision:  Demonstrated  willingness  to  share  with  supervisor  one’s  
own  reactions  about  clients,  supervisor,  and  factors  in  one’s  own  life  that  may  influence  counseling  
effectiveness.  
_____    g. Use  of  Feedback/Growth:  Demonstrated  openness  to  feedback  and  willingness  to  implement  
supervisory  suggestions.  
 
_____      Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
   
Section  E:    Quality  of  Self-­‐Analysis  
 
_____    a. Transcription:  Conducted  a  thorough  analysis  of  the  clinical  session  utilizing  insightful  and  critical  
commentary,  identification  of  skills,  and  rephrasing  of  counselor’s  responses.  
_____    b. Contextualization  of  Session:    Included  a  background  overview  of  the  session  and  the  clinical  work  done  
with  this  client  to  date  including  number  of  sessions,  presenting  problem,  diagnosis,  family  
background,  and  history  of  the  problem.  
_____    c. Case  Conceptualization:    Analyzed  and  conceptualized  the  client’s  case  using  a  chosen  theory  and  
applied  the  theory  to  fully  understand  the  case  and  develop  appropriate  goals.    
_____    d. Self-­‐Critique:  Completed  the  self-­‐critique  form  AND  wrote  a  narrative  and  insightful  critical  analysis  of  
skills,  dynamics  of  session,  countertransference  issues,  and  overall  clinical  approach.  
_____    e. Treatment  Goals:  Included  a  treatment  plan  or  appropriate  set  of  goals  for  the  client.  
 
_____      Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Supervisor’s  Overall  Recommendations  for  Continued  Areas  of  Growth:      
 
 
 
 
Supervisor’s  Comments:  

_________________________________________   ____________________  
Supervisor’s  Signature           Date  
 
 
 
_________________________________________   ____________________  
 Counseling Internship Manual 10
Intern’s    Signature           Date  
 

APPENDIX J
Montclair  State  University  
Instuctor’s  Evaluation    
 
Intern’s  Name:  _________________________      Instructorr’s  Name:    __________________________  
 
Date  of  Evaluation:        _________________          Midterm  Evaluation  ______Final  Evaluation  _________  
 
 Practicum
 Internship I
 Internship II

Rate  the  student’s  performance  on  the  five  global  dimensions  and  specific  items  using  the  following  5-­‐point  scale.    These  
evaluations  are  made  in  reference  to  the  expected  performance  given  the  student’s  developmental  level  (i.e.,  beginning,  
middle,  or  end  of  practicum  or  internship).  
 
Note:    You  are  rating  students  in  practicum  or  internship.  Practicum  is  the  first  field  experience  for  most  students;  if  the  
student  displayed  “skills  deficiencies”  at  the  start  of  practicum  or  internship,  please  specify  so.    If  this  forms  requests  
information  about  skills  not  observed  or  areas  not  covered  in  practicum/internship  rate  them  as  n/o  (not  observed).  
 
 
1                2                                3       4                    5  
       Not  Observed                Development   Meets  Developmental              Slightly  Above            Considerably  Above  
                                       Required                                          Expectations                                          Expectations                            Expectations  
                   
 
Section  A:    Attending  Skills  and  Relationship  Building  
 
_____    n. Non-­‐verbal:  Exhibited  appropriate,  effective  use  of  body  language,  vocal  tone,  facial  expressions,  and  
eye  contact  to  convey  warmth,  positive  regard,  and  acceptance.  Aware  of  client  non-­‐verbals.  
_____    o. Attending:  Demonstrated  interest,  focused  on  the  client,  encouraged  the  client  to  speak  through  the  
use  of  verbal  and  nonverbal  encouragers.  
_____    p. Active  Listening:  Demonstrated  the  ability  to  follow  the  client  with  understanding  in  all  aspects  of  
communication.  
_____    q. Respect  &  Warmth:    Demonstrated  through  open,  positive,  congruent  verbal  and  nonverbal  language.  
_____    r. Nonjudgmental  Attitude:  Demonstrated  neutrality  through  body  language  and  vocal  quality;  did  not  
attempt  to  impose  counselor  values  during  the  interview.  
_____    s. Authenticity,  Congruence:  Demonstrated  genuineness  and  flexibility  in  response  to  client.  
_____    t. Cultural  Competence:  Demonstrated  cultural  sensitivity  and  ability  to  attend  to  cultural  issues  in  the  
counseling  process.  
_____    u. Observation:  Paid  attention  to  verbal  and  nonverbal  behavior  of  client,  interactions  between  client  and  
counselor,  and  noted  discrepancies.  
_____    v. Use  of  Silence:  Allowed  appropriate  silences  and  demonstrated  the  ability  to  tolerate  silence  during  the  
session.  
_____    w. Positive  Assets:  Attended  to  and  noted  the  client’s  positive  assets  and  strengths.  
_____    x. Relationship  Building:  Demonstrated  the  ability  to  develop  a  working  alliance  and  rapport  with  client.  
_____    y. Opening:    Opened  sessions  smoothly  and  effectively.    
 Counseling Internship Manual 11
_____    z. Closing:  Allowed  appropriate  time  for  closing;  set  stage  for  next  session.  
 
_____                    Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Section  B:    Information  Gathering,  Questioning  Skills,  Case  Conceptualization  and  Counseling  Plans  
 
_____    l. Closed–Ended  Questioning:  Demonstrated  the  use  of  purposeful,  closed  questions  to  inquire  facts  or  
information  as  needed  but  did  not  overuse.  
_____    m. Open–Ended  Questioning:  Demonstrated  the  use  of  purposeful,  open  questions  to  keep  session  on  
track,  clarify,  or  to  encourage  further  communication  and  understanding  of  the  client’s  world.  
_____    n. Concreteness:  Sought  out  specific  information  and  examples.  
_____    o. Vocabulary:  Vocabulary  used  was  developmentally  and  culturally  appropriate  for  person  being  
counseled.  
_____    p. Assessment  Skills:  Demonstrates  ability  to  identify  themes  in  clients’  issues,  formulate  diagnostic  
impressions  (not  necessarily  using  the  DSM),  and  articulate  how  they  reached  these  impressions.  
_____    q. Counseling  Plans:  Develops  effective  counseling  plans,  based  on  diagnostic  impressions,  goals  agreed  on  
with  clients.  
_____    r. Case  Notes:  Case  notes  are  clearly  written  and  reflect  work  being  done.  
_____    s. Application  of  theory:  Demonstrates  knowledge  of  and  ability  to  apply  theory  to  practice  (case  
conceptualization  and  development  of  counseling  plans).  
_____    t. Application  of  Research/Professional  Literature:  Uses  information  from  professional  literature  in  the  
formation  of  case  conceptualization,  development  of  counseling  plans,  and  selection  of  interventions.  
_____    u. Cultural  Competence:  Demonstrates  ability  to  attend  to  cultural  issues  that  may  influence  the  client’s  
issues  and/or  resolution  of  those  issues  as  well  as  how  the  counselor’s  own  cultural  background  and  
worldview  may  influence  case  conceptualization  and  development  of  counseling  plans.  
_____    v. Advocacy  Competence:  Identifies  socio-­‐political  and  other  factors  (at  meso-­‐  and  macro-­‐  level)  that  may  
be  barriers  to  clients’  well-­‐being  or  growth  and  strategies  to  address  such  barriers  with  (and/or  on  
behalf  of)  clients  
   
_____       Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Section  C:  Empathic  Skills  
 
_____    e. Paraphrasing/Reflection  of  Content:  Demonstrated  the  ability  to  briefly  reflect  the  essence  of  what  the  
client  has  said.  
_____    f. Reflecting  Feeling:  Demonstrated  and  communicated  empathy  by  reflecting  client  emotions,  explicit  
and  implicit.  
_____    g. Reflecting  Meaning:  Demonstrated  the  ability  to  facilitate  a  client’s  exploration  of  his/her  values  so  that  
the  client  gains  a  deeper  understanding  of  his/her  thoughts  and  feelings  which  underlie  his/her  
experience.  
_____    h. Summarizing:  Demonstrated  the  ability  to  integrate  and  reflect  the  content,  thoughts,  feelings,  and  
meaning  presented  by  a  client        
 
_____       Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Section  D:    Counselor  Attitudes  and  Behaviors  in  Supervision  
 
 Counseling Internship Manual 12
_____    h. Self-­‐Awareness:  Demonstrated  an  awareness  of  one’s  strengths,  challenges,  worldview,  values  and  
biases,  and  how  they  impact  working  with  a  client.  
_____    i. Comfort  Level:    Demonstrated  comfort  with  counseling  as  an  overall  process  of  helping.  
_____    j. Empathic  Response:  Demonstrated  an  understanding  of  the  client’s  world  as  evidenced  by  attending  
skills  and  accurate  reflections.    
_____    k. Preparation  for  Supervision:  Exhibited  readiness  for  supervision  as  evidenced  by  having  reviewed  
counseling  session  and  submitting  session  evaluations,  tapes,  and  paperwork  in  a  timely  manner.  
_____    l. Goals:  Demonstrated  ability  to  set  goals  based  on  a  realistic  evaluation  of  skills.  
_____    m. Effective  Use  of  Self-­‐Disclosure  in  Supervision:  Demonstrated  willingness  to  share  with  supervisor  one’s  
own  reactions  about  clients,  supervisor,  and  factors  in  one’s  own  life  that  may  influence  counseling  
effectiveness.  
_____    n. Use  of  Feedback/Growth:  Demonstrated  openness  to  feedback  and  willingness  to  implement  
supervisory  suggestions.  
 
_____      Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
   
Section  E:    Quality  of  Self-­‐Analysis  
 
_____    f. Transcription:  Conducted  a  thorough  analysis  of  the  clinical  session  utilizing  insightful  and  critical  
commentary,  identification  of  skills,  and  rephrasing  of  counselor’s  responses.  
_____    g. Contextualization  of  Session:    Included  a  background  overview  of  the  session  and  the  clinical  work  done  
with  this  client  to  date  including  number  of  sessions,  presenting  problem,  diagnosis,  family  
background,  and  history  of  the  problem.  
_____    h. Case  Conceptualization:    Analyzed  and  conceptualized  the  client’s  case  using  a  chosen  theory  and  
applied  the  theory  to  fully  understand  the  case  and  develop  appropriate  goals.    
_____    i. Self-­‐Critique:  Completed  the  self-­‐critique  form  AND  wrote  a  narrative  and  insightful  critical  analysis  of  
skills,  dynamics  of  session,  countertransference  issues,  and  overall  clinical  approach.  
_____    j. Treatment  Goals:  Included  a  treatment  plan  or  appropriate  set  of  goals  for  the  client.  
 
_____      Overall  Evaluation  (1  –  5;  using  the  scale  on  Page  1  of  this  evaluation)  
 
 
Instructor’s  Overall  Recommendations  for  Continued  Areas  of  Growth:      
 
 
 
 
Instructor’s  Comments:  

_________________________________________   ____________________  
Instructor’s  Signature           Date  
 
 
 
_________________________________________   ____________________  
Intern’s    Signature           Date  
 
 
 Counseling Internship Manual 13

APPENDIX K
Montclair State University
COUNSELING INTERNSHIP SITE EVALUATION

Intern’s Name____________________________________________________________

Name of Placement Site____________________________________________________

Name of Site Supervisor____________________________________________________

Period of Site Placement____________________________________________________

Please respond with a “Y” for “yes” or an “N” for “no” to the following statements regarding the placement
site:

__ There was a formal orientation or introduction to training at this site.

__ I received adequate introduction to the site’s policies and procedures and my duties at
this site.
__ I received adequate physical space to provide counseling with appropriate
confidentiality at this site.
__ I was regularly assigned clients at this site.
__ I had difficulty getting sufficient clients at this site to complete my direct hours
requirements.
__ I had difficulty getting opportunities to participate as a co-leader or a leader of
counseling groups at this site.
__ I had difficulty getting the necessary equipment and physical arrangements to video
tape at this site.
__ I was made a member of the regular staff at this site.
__ I was treated with professional respect by all staff members at this site.
__ I received adequate management and supervision at this site so I never felt unsupported
in my decision making.
__ This site provided me with adequate resources to continue my professional
development.
__ This site provided me opportunities to learn about applying various counseling theories
and techniques.
__ This site provided me opportunities to work with persons representing diversity in our
community.
__ I would recommend this site for other interns of the Montclair State
University Counselor Education Program

Other comments I would like to make about this site include:

____________________________________________ _____________
Signature of Student Date
 Counseling Internship Manual 14

APPENDIX L
Montclair State University
UNSATISFACTORY COUNSELING INTERN
WORK PERFORMANCE EVALUATION

Name of Intern:

Name of Supervisor:

Placement Site:

Date of Evaluation:

/ / 1st Notification
/ / 2nd Notification
/ / Final Notification
/ / No former notice provided, but situation serious enough to terminate internship

Cause: Please check the overall area(s) of unsatisfactory performance

/ / Counseling skills and/or knowledge
/ / Implementing a theoretical approach to counseling
/ / Professionalism (e.g., arriving late; doesn’t complete work in a timely manner)
/ / Poor documentation (e.g., inadequate progress notes or treatment plans)
/ / Supervision issues (e.g., missing supervision sessions; failing to attempt changes
recommended by supervisor)
/ / Ethical codes or legal statutes (is in violation of)
/ / Other (please explain):

Written summary of unsatisfactory performance: Please provide a brief written summary describing the
unsatisfactory performance area(s).

________________________________________________

______
Supervisor’s Signature Date

______
Student’s Signature Date

______
Internship Instructor’s Signature Date

______
Internship Coordinator’s Signature Date
 Counseling Internship Manual 15

APPENDIX M

Montclair State University

SAMPLE OF CONSENT FORM FOR TAPING

Selection of a specific tape permission form should be made in consultation with both your faculty supervisor
and your on-site supervisor. Ultimately, the agency or school with which you work must be in full agreement
with the taping process and the taping form.

CLIENT PERMISSION FORM

My signature below indicates that I understand counseling services are being rendered to me by
a master’s degree candidate under competent supervision, that sessions are being recorded for
counselor training purposes, and that all relationships with counselors and supervisory staff will
be kept confidential within the limits allowed by ethical guidelines for counselors. I understand
that failure to grant permission to record sessions will not affect my eligibility for services. I
also understand that I may withdraw this consent at any time.

Signature: Date:

PARENT OR GUARDIAN PERMISSION FORM

(If a client is a minor, parent or guardian needs to complete this section.)

My signature below indicates that I understand that counselor service is designed to help my
son/daughter as he/she makes vocational plans, education plans, and various other adjustments.
I further understand that the counseling service will be rendered by a master’s degree candidate
under competent supervision, that counseling sessions will be recorded for counselor training
purposes, and that all relationships with the counselors and the supervisory staff will be kept
confidential within the limits allowed by ethical guidelines for counselors. I understand that
failure to grant permission to record sessions will not affect my child’s eligibility for services. I
also understand that I may withdraw this consent at any time.

Signature: Date:
 Counseling Internship Manual 16

APPENDIX N
Montclair State University
COUNSELING WEEKLY LOG

Name of Intern: Course Name: _________________________

Week of: Semester: ____________________________

DATE DESCRIPTION DIRECT HRS INDIRECT. HRS.

WEEKLY TOTALS: __________ _________

CUMMULATIVE TOTALS: __________ _________

_________________________________ _________________________________
Intern’s Signature Date

_________________________________ _______________________________
Site Supervisor’s Signature Date

_________________________________ __________________________________
Instructor’s Signature Date
 Counseling Internship Manual 17

APPENDIX O
Montclair State University

COUNSELING MONTHLY SUMMERAY LOG

Name of Intern: __________

Name of Supervisor: __________

Placement Site: __________

Instructions: At the end of each month of Internship, the student will 1) fill in this form as a summary
of the month’s Internship activities, and 2) attach all weekly logs to this form. This form will be turned
into the Internship Instructor and maintained in the Intern’s permanent file with the University.

Internship Log Summary for Month of: ____

WEEK OF: # of DIRECT HOURS # of INDIRECT HOURS

Monthly Totals

Cumulative Totals:

____________
Intern’s Signature Date

____________
Internship Instructor’s Signature Date
 Counseling Internship Manual 18

APPENDIX P

Montclair State University

INTERN’S AGREEMENT TO THE COUNSELING INTERNSHIP MANUAL

My signature below is to indicate that I have obtained a copy of the Counseling Program Internship Manual for
the year _______________ and that I will adhere to the policies and procedures describe therein as I enroll in
the Counseling Practicum and Internship courses (COUN 624, COUN 654 and COUN 674) for the following
semesters:

Practicum _______________________, ___________

(academic term, year)

Internship I _______________________, ___________

(academic term, year)

Internship II _______________________, ___________

(academic term, year)

______________________________________________ ________________
Signature of Student/Intern Date
 Counseling Internship Manual 19

APPENDIX Q

Code of Ethics and Standards

Please visit the American Counseling Association (ACA) website to obtain a copy of the Code of Ethics.

Website: www.counseling.org
 Counseling Internship Manual 20

APPENDIX R

Ethical Guidelines for Counseling Supervisors

Please visit the ACA’s website to obtain a copy of the Association for Counseling Education and Supervision’s
Ethical Guidelines for Counseling Supervisors.

Website: www.counseling.org
 Counseling Internship Manual 21
APPENDIX S

Montclair State University

College of Education and Human Services
Department of Counseling and Educational Leadership

Audiotape/Videotape Evaluation

Student: ________________________Faculty Supervisor: ____________________________

Date: __________________________Evaluation Number (circle one): 1 2 3

RATING
SPECIFIC CRITERIA (poor to best) REMARKS
1. Opening: To the degree appropriate, was beginning of 1 2 3 4 5
sessions unstructured, friendly, and pleasant?

2. Rapport: Did counselor establish good rapport with the 1 2 3 4 5

counselee setting the stage for a productive session?

3. Interview Responsibility: If not assumed by the 1 2 3 4 5

counselee, did the counselor assume appropriate level of
responsibility for interview conduct?

4. Interaction: Were the counselee and counselor really 1 2 3 4 5

communicating in a meaningful manner?

5. Acceptance: Was the counselor accepting of counselee 1 2 3 4 5

emotion, and expressed thoughts?

6. Reflection of Feelings: Did counselor reflect and react 1 2 3 4 5

to feelings or did the interview remain on an intellectual
level?

7. Counselor Responses: Were counselor responses 1 2 3 4 5

appropriate in view of what the counselee was expressing,
or were responses concerned with trivia and minutia?

8. Value Management: Were attempts made to impose 1 2 3 4 5

counselor values during the interview?

9. Counseling Relationship: Was counselor-counselee 1 2 3 4 5

relationship conducive to productive counseling? Was a
counseling relationship established?

10. Closing: Was session closing counselor or counselee 1 2 3 4 5

initiated? Was time allowed for closing? Any follow-up or
further interview scheduling accomplished? Stage set for
next session?

11. Pacing: How well paced was the interview - not too 1 2 3 4 5
fast or slow moving?

12. Interventions: How well did the counselor employ 1 2 3 4 5

specific interventions appropriate for the type of client
problem and client functional level?
 Counseling Internship Manual 22
RATING
SPECIFIC CRITERIA (poor to best) REMARKS
13. Duration of Interview: Were interviews of appropriate 1 2 3 4 5
length based upon client characteristics and nature of issues
discussed?

14. Vocabulary Level: Was vocabulary used by the 1 2 3 4 5

counselor appropriate for the person being counseled?

15. Verbosity: Was the amount of talking by the counselor 1 2 3 4 5

appropriate? Consider such issues as being too wordy,
dominating the session, interrupting the client, or
overriding the counselee’s statements.

16. Silences: Were silences broken to meet counselor needs 1 2 3 4 5

or were they dealt with effectively?

17. Stage of Counseling: Were counselor interactions 1 2 3 4 5

appropriate for the stage of counseling?

18. Movement through Stages: Did the counselor move 1 2 3 4 5

appropriately from one stage of counseling to the next?

19. Growth as a Counselor: Accepts and responds to 1 2 3 4 5

feedback constructively?

20. Self-Evaluation: Self-critiques counseling sessions? 1 2 3 4 5

21. Consulting: Consults with professional staff as 1 2 3 4 5

appropriate?

22. Participation: Actively participates in supervisory 1 2 3 4 5

sessions?

23. Responsibility in Supervision: Attends regularly and 1 2 3 4 5

is on time for supervision sessions?

24. Preparedness: Has appropriate materials ready for 1 2 3 4 5

supervision sessions?

Comments for Counselor Assistance. Include any comments that might assist the counselor in areas not covered
by the preceding suggestions.

Supervisor’s Signature:__________________________________ Date:__________________