Creating a Supervision Agreement

One of the most important supervision practices is for the dyad to collaboratively create a written agreement or contract that outlines both parties expectations. Supervision agreements must include information such as when the sessions will be, the cost, if any, how cancellations will be handled, and other such expectations. A good agreement will also include information about the supervisor’s teaching style or philosophy, how the supervisee should prepare for sessions, what information to bring, and how the supervisor will review the supervisee’s caseload. Below is a template to aid in creating a supervision agreement that new graduates can bring into a supervisor if the supervisor does not already use one. This template below is adaptable and contains the recommended topics (Milne, 2009; NASW, 2013; Sewall, 2019).

Based on the context, the supervisor should delineate power imbalances in the relationship. Supervisors who highlight how the supervisory relationship walks in between a student/teacher and a therapist/client can help supervisees feel comfortable discussing this dynamic as things arise. The Nebraska regulations (172 NAC 94) specify that supervisory relationships must be differentiated from therapeutic ones. While not required in Nebraska, it would greatly benefit supervisors and supervisees to attend multicultural training in the historical context of mental health, critical consciousness, bias, and privilege. Cultural awareness enriches the supervisory experience and helps the supervisor and supervisee maintain awareness of systemic oppression (Chernsky, 1986; Englebrecht, 2019). Regularly consult your professional code of ethics, state regulations, and agency policy.

Instructions for Supervision Agreement

The Supervision Agreement Form template below outlines written expectations for both participants by providing a collaborative space to document expectations relevant to individual circumstances. While a written supervision agreement form is not required in Nebraska, it can clarify the supervision process. This form is a starting point. Space is provided to individualize the agreement.

PLMHP Supervision Agreement Form


Today’s Date  ____________________

Supervisor   ______________________

Agency _____________________________

Supervisee   ____________________________________________



We will meet regularly on __________________day at __________(time). In Nebraska, the supervision requirement for LMHP is one hour per week. The supervision requirement for LIMHP is 2 hours of supervision per 15 hours of contact with clients diagnosed with major mental disorder. In addition, for a LIMHP license, the supervisee cannot accrue more than 45 hours of contact with clients with major mental disorder without having supervision.

This supervision format will be conducted in (circle) group | individual | both format; and (circle) in person | over zoom.  If over zoom, include a stable link here:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Cancellation policy: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Supervisor Introduction and Reflection

Introduce yourself below to the supervisee. Describe your experience, the modalities you practice, and any supervision philosophies or practices you would like the supervisee to know about. Reflect on what the supervisor will bring to the supervision session. Helpful details to include might be attitudes and philosophies about the supervision process, particular skills that can benefit the supervisee, teaching style, traits, and personality information. For an example see: Supervision Agreement


Supervisee Introduction and Reflection

Introduce yourself below. Describe your experience, your attitudes about supervision, how you learn best, your traits and personality information. Describe what you bring to supervision and what you want to get out of supervision. Sample Agreement with Supervisee Expectations (p3)


Structure of Supervision Sessions

Supervision is more successful when sessions are structured clearly and both participants know exactly what to expect. The content covered in supervision sessions will be unique, depending on the participants knowledge, desires, theoretical orientation and the content of the work the supervisee is doing. This section is to help guide you to create the structure (not content) of the supervisory sessions, such as when, where, record keeping, timing of evaluations and other regulatory concerns.

Date and time of sessions is:
How will client records be reviewed?
How will provisionally licensed hours be tracked and reviewed? How will supervisory sessions be documented?
How will ethics and relevant laws and regulations be incorporated into supervision? (required by regulation):
How often will the accompanying Goals and Competencies Worksheet:
Other considerations: will the sessions include board examination preparation, education, case consultations, or other multidisciplinary partners:

Discussion Points

Many view supervisors as the gatekeepers of clinical practice and control if the supervisee will obtain licensure. Open communication is critical. Discuss the following:

  • After supervision has concluded, what is the process for completing the state-mandated affidavit of hours?
  • Where will the supervisee’s clinical hours log sheet be located, and with what frequency will it be reviewed?
  • What is the arrangement for the supervisee’s affidavit of hours to be signed should either party leave their current employment?
  • Does the supervisor require that the supervisee arrange to complete the state-mandated affidavit of hours by a specific time after supervision is terminated?


This space is provided to include anything else you think is helpful, such as roles and responsibilities:




Agency or Practice _______________________________________________


Agency or Practice _______________________________________________



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Guidebook for Clinical Supervision in Nebraska Copyright © 2022 by Susan Reay is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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