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Makungu M. Akinyela, MFT, Ph.D. Licensed Marriage and Family Therapist AAMFT Approved Supervisor 2616 Old Wesley Chapel Road, Suite 103 Decatur, GA 30034 Phone (404) 288-7989


(678) 467-0178

This is an agreement for supervision between ___________________________ (supervisee) and Makungu M. Akinyela, Ph.D., for ongoing supervision of marriage and family therapy (MFT) practice. This supervision will be held (frequency)__________________________, on (days)__________________ for 60 to 90 minutes. Supervision will be held at (time) _________________. Supervision sessions will be conducted at the office of the supervisor in the case of presentation of raw data (audio/video) and at a site agreed upon by both supervisor and supervisee in the case of live supervision. The fee for supervision will be $__________. Fees will be paid in full if cancellations for supervision are not made 24 hours in advance. If supervisor is unable to make cancellations 24 hours in advance, the following supervision session will be provided free of charge. The guiding ethical code for therapy and supervision practice will be the code of ethics of the American Association of Marriage and Family Therapists (AAMFT). The supervisor will be responsible for supervisee receiving the AAMFT code of ethics. If the supervisee holds membership or plans to hold membership with any professional association other than AAMFT, supervisee will make that code of ethics available to supervisor prior to first session. Supervisee will be responsible for all informed consent, permission to record and release of confidentiality documents with clients. Supervision Relationship You should know that I am a licensed marriage and family therapist who has been in practice since 1989. I am a clinical member of the American Association of Marriage and Family Therapists (AAMFT) and an Approved Supervisor of AAMFT. My theoretical background is based in the multisystems approach to family therapy (Nancy Boyd-Franklin) and Symbolic-experiential therapy (Carl Whitiker). Postmodern approaches to therapy and an African centered philosophical perspective are the dominant metaphors shaping my clinical work for the past six years. Consequently my supervision style is shaped by these ideas. I focus on non-hierarchical collaboration with the supervisee, and an emphasis on the critical importance of social political context (ethnicity, class, color/caste, gender, sexuality, language and geography) to both the therapeutic and supervisory relationship. It will be important for the supervisee to reflect on and begin the work of defining your own approach to therapy theory and practice. Either you the supervisee or myself may initiate a renegotiation of this agreement at any time. In the event of a conflict of ideas about clinical work or assessment, you are encouraged to request an intervention by any other appropriate therapist of your choice.

Supervision Goals What will be your personal goals for this supervision? 1. Skill building: 2.

Personal development:


Defining and practicing from a Theoretical frame:

To help you more clearly define what you are seeking, please circle below the most appropriate work relationship for you to share with me. 1.

Supervision: You are a student or new therapist seeking certification or a therapist seeking clinical membership with AAMFT.


Consultation: You are an experienced, licensed or qualified professional seeking professional feedback on your work.


Training: You are a student or professional seeking theoretical, skill or technique training.

Clinical Issues Because in the supervisory relationship I (and my supervisor) will be ultimately responsible for your clinical work, you will need to provide me with a copy of your mal-practice insurance. I will also need to receive a copy of any policies and procedures for work as defined by your school, agency or licensing board. I will also need to have copies of all informed consent documents and releases of information, as well as audio/video tape releases from your clients. I will also need a copy of any documents you will use for keeping track of your hours. While we may never discuss all of your cases, I will need to be aware of your overall caseload. In the event of clinical emergencies with clients, who may be a danger to themselves or others, I will need to be informed immediately. Evaluation Process If you are a student, seeking certification/licensure or seeking clinical membership in AAMFT and need evaluation, we will review your work and your stated goals after your third presentation. Monthly reviews of your work based on your own goals and our discussions will be provided for you, including a final written narrative assessment at the termination of your supervision. _____________________________________ Supervisee’s Signature

_____________________ Date

Day time Phone: ________________________ Evening Phone: ______________________ Supervisee’s Address: ___________________________________________________________ City: ____________________ State: ___________________________ Zip: ________ _____________________________________ Supervisor’s Signature

_____________________ Date


Makungu M. Akinyela, MFT, Ph.D. Licensed Marriage and Family Therapist AAMFT Approved Supervisor 2616 Old Wesley Chapel Road, Suite 103 Deca...