The following questions provide the format for performance evaluation in individual psychotherapy including the dimensions of diagnostic and conceptualizing skills, intervention and relationship skills, self-understanding, consultative relationship, and professional role functioning. Given that each MIT comes to the CAPP program with a unique background and prior level of training, the rating scale is designed to address the MIT’s areas of strength and need for growth relative to his or her particular clinical skills. Please respond based on your level of confidence in the MIT’s skills in a particular area.

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

CAPP MIT Evaluation by Consultant End of Program

  • The email listed here will receive a copy of this form once it is submitted.
  • Semester and Year
  • Area of strengthOn target - MIT demonstrates competency in this areaArea of growth - Review at next evaluation to consider closer supervision/corrective actionNot enough data to assess
    1. Recognizes the complexity of patient behavior and personality (i.e., aware of patient dynamics at a level beyond that of the specific problem situation).
    2. Integrates relevant data (assessment, observation, history, individual differences e.g., gender, culture, sexual orientation, lifestyle, disabilities) into meaningful and coherent conceptualizations which modifies as treatment progresses.
  • Area of strengthOn target - MIT demonstrates competency in this areaArea of growth - Review at next evaluation to consider closer supervision/corrective actionNot enough data to assess
    1. Makes effort to integrate and apply class material to clinical work.
    2. Manages and maintains the therapeutic frame effectively.
    3. Conveys feelings of warmth, acceptance and empathic understanding of patient's emotional world.
    4. Follows patient's shifts in topic and non-verbal cues.
    5. Recognizes unconscious meanings in the clinical situation.
    6. Remains available to exploring and repairing ruptures in treatment.
    7. Engages and tolerates the patient’s range of affects (both positive and negative).
    8. Appreciates and responds to diversity issues as they affect patient and therapist interactions. Including, but not limited to, cultural/ethnic differences, sexual orientation, gender role stereotypes, disabilities, religious affiliation, socio-economic status, other lifestyle/value differences and age differences.
  • Area of strengthOn target - MIT demonstrates competency in this areaArea of growth - Review at next evaluation to consider closer supervision/corrective actionNot enough data to assess
    1. Understands own emotional response to the patient (i.e., countertransference), across the spectrum of possible challenging reactions having to do with anger/hostility, sexual attraction, pt’s transference, idealization, shame etc.
    2. Recognizes impact of self on patient (i.e., nonverbal behaviors, presentation, differences, etc.).
  • Area of strengthOn target - MIT demonstrates competency in this areaArea of growth - Review at next evaluation to consider closer supervision/corrective actionNot enough data to assess
    1. Recognizes strengths as well as areas needing improvement and manages need for support and consultation.
    2. Demonstrates openness to self-examination during consultation and to consultant’s point of view.
    3. Responds to opportunities for personal development and professional growth.
    4. Shows initiative in preparing and planning for consultative sessions.
  • Reset signature Signature locked. Reset to sign again
  • Reset signature Signature locked. Reset to sign again
Save and Continue Later