The following questions are a number of statements pertinent to consultation provided. Consider each statement with reference to your knowledge of the consultant being rated. Mark “Not enough data to assess” if there was no opportunity to observe the particular item. Rate the consultant based on how her/his consultation was experienced by you.

Once you submit the form, a copy will be emailed to you.

CAPP Consultant Evaluation by MIT

  • The email listed here will receive a copy of this form once it is submitted.
  • Semester and Year
  • ExcellentSatisfactoryUnsatisfactoryNot enough data to assess
    1. Values consultation and aids in establishing and maintaining the focus of consultation.
    2 .Appreciation of individual differences between consultant-MIT.
    3. Aids in setting goals for consultation.
    4. Demonstrates respect for the consultative frame (Keeps appointments on time, places high priority on uninterrupted consultation hours, provides notification when unable to keep scheduled consultation time).
    5. Establishes a climate of trust to maximize an honest and candid exchange of feelings and ideas re: treats MIT with respect, care, interest as a developing professional and demonstrates a willingness to hear and understand MIT concerns.
  • ExcellentSatisfactoryUnsatisfactoryNot enough data to assess
    1. Provides a good balance between feedback, support, & challenge.
    2. Helps to organize relevant case data in planning goals and strategies with patients.
    3. Conveys a sound conceptual grasp of patients and their problems and is able to explain clearly what she/he means when discussing cases or theory.
    4. Helps define and maintain ethical behavior in psychotherapy.
    5. Countertransference issues are explored in an educational and appropriate manner.
    6. Utilizes the process of consultation to teach/model principles of Self and Relational psychotherapy.
  • ExcellentSatisfactoryUnsatisfactoryNot enough data to assess
    1. Encourages independent thinking and action.
    2. Demonstrates a willingness to examine consultant/MIT relationship.
    3. Appropriately shares her/his own experiences as a psychotherapist.
  • Reset signature Signature locked. Reset to sign again
  • Reset signature Signature locked. Reset to sign again
Save and Continue Later