Group Supervision Agreement
Thank you for joining Megan MacCutcheon’s supervision group. This is an Agreement between Megan MacCutcheon, LPC (Supervisor) and you (Resident), effective immediately. The purpose of this Agreement is to provide essential information about group supervision and give structure to the experience in order to ensure a common understanding of the group supervision process.
This is your terms of sale & Agreement. Please read it carefully before checking the agreement box above.
I. THE BASICS:
This is a legally binding Agreement by and between Megan MacCutcheon, LLC (“Megan,” “Supervisor,” “Company”) and the Resident (“Resident,” “You”).
1. You are securing one of a limited number of spaces offered in this round of group supervision.
2. The Price is $390 (US Dollars) for a package of four (4) 1.5 hour group supervision sessions (6 total hours of group supervision), payable in full in advance or in four installments of $115. PLEASE NOTE: This is not a monthly membership program with the option to cancel further monthly payments. The payment plan option is simply the opportunity to split your payment. You may use your four group sessions over a period of six months at any meeting noted on the schedule.
3. We make it easy to understand what it is like to do business with Megan MacCutcheon, LLC. Please check out the Policies (available via Website footer) before signing this Agreement. Those policies are incorporated by reference and are made a part of this Agreement even though they are not spelled out in this document.
4. This Agreement [and all referenced and incorporated forms and policies and the Credit Card Authorization] are the entire Agreement between us. These written documents supersede our prior discussions, emails, online or voice messages. By checking the agreement box, you agree that there is no information that you deem materially important that is not incorporated into this Agreement.
5Confidentiality: Resident and Megan MacCutcheon agree to hold any Confidential Information received from any participant in the group in the strictest of confidence. Information shared on calls and in video conferences, or any other means shall be maintained as confidential. Please note that as a Licensed Professional Counselor, Megan MacCutcheon is considered a mandated reporter and there are some exceptions to confidentiality in order to protect you and others. A full list of exceptions is provided in the Notice of Privacy Practices document Megan uses in her counseling practice. However, a brief list of such exceptions include danger to self or others, abuse of children and/or adults, orders of the court, social service referrals, and delinquent accounts.
II. THIS IS WHAT YOUR SUPERVISION GROUP INCLUDES:
1. Monthly Group Supervision Meetings. You will have six months to participate in four group supervision meetings, held on the first Monday of each month (unless otherwise noted in the schedule). Meetings will be from 10:00-11:30 AM via Zoom.
2. Group Supervision Provided by Megan MacCutcheon, LPC. Megan earned her Master of Education in Community Agency Counseling from George Mason University. She is a licensed professional counselor in the state of Virginia and an approved supervisor by the Virginia Board of Counseling. She also holds a certification in perinatal mental health and has done extensive training in trauma treatment. She has been in the field for over ten years and has worked in a variety of settings, including private practice, a community agency, and an in-patient hospital psychiatric unit. The primary focus of her private practice includes working with individuals facing issues with depression, anxiety, low self-esteem, perinatal mood and anxiety disorders, trauma, and life transitions. She utilize a mixture of modalities, mostly including Cognitive-Behavioral Therapy, EMDR, Internal Family Systems Model, Acceptance and Commitment Therapy, mindfulness, and a strengths-based approach. She frequently consults with colleagues and mentors and is active in several professional networks. She will provide Resident with appropriate referrals for additional consultation regarding any cases that are outside the scope of her expertise or practice.
III. ADDITIONAL TERMS OF GROUP SUPERVISION
1. Health Insurance Claims: Depending on their health insurance plan, some clients may be able to obtain out-of-network reimbursement for services provided by a Resident in Counseling. Clients may not, however, file insurance claims under the license of the Supervisor. (Details regarding assisting clients with Superbills to submit to insurance can be discussed in supervision.)
2. Liability Insurance Agreements: Malpractice/liability insurance will be obtained by the Resident and a copy of the policy (and annual renewals) will be provided to the Supervisor.
3. Purpose, Goals, and Objectives of Supervision: The purpose of supervision is to fulfill residency requirements for licensure and to promote development of Resident’s professional identity and competence, while ultimately ensuring the best possible care to clients. Please note that per the Virginia Board of Counseling, group supervision hours are equivalent to individual supervision hours; however, only half of the 200 required hours may be obtained in group supervision.
4. Context and Content of Supervision: The content of supervision will focus on the acquisition of knowledge, conceptualization, and skills within the defined scope of practice. The context will ensure understanding of ethics, codes, rules, regulations, standards, guidelines (including consent, confidentiality/privacy), and all relevant legislation. Supervision will also include the exploration of values, beliefs, interpersonal biases, and multicultural issues that may be sources of countertransference in the context of case material.
5. Rights & Responsibilities of Supervisor: Supervisor has the right to give constructive feedback and to bring up concerns and issues about the Resident’s work. Supervisor has the right to observe Resident’s work, to ask questions regarding work and caseload, and to consult with Resident's individual supervisor as deemed necessary.
Supervisor has the responsibility to model professionalism and to uphold ethical guidelines and professional standards while monitoring Resident’s performance and development. Supervisor agrees to create a supportive environment, give timely and helpful feedback, be available as needed, and deal with problems as they impact the Resident’s performance. Supervisor agrees to ensure group supervision sessions happen as agreed upon, to keep a record of the meetings, and to complete quarterly evaluation forms as required by the Virginia Board of Counseling.
6. Rights & Responsibilities of Resident: Resident has the right to time within the group and to the Supervisor’s attention, ideas, guidance, and feedback. Resident has the right to set part of the agenda, to ask questions, and to challenge ideas and guidance in a constructive way.
Resident has the responsibility to be prepared and on time for meetings and to be an active participant in the supervision process. Resident agrees to keep proper client documentation and to be prepared to discuss client cases with the aid of written case notes. Resident agrees to be open and receptive to feedback and suggestions.
Resident agrees to be truthful, open and honest, and to share mistakes with an understanding that they are a part of the learning process. Resident agrees to notify Supervisor immediately of any complaints against them.
Resident agrees to provide constructive feedback and to be respectful when interacting with other members of the group.
Resident attests to reading and intending to comply with the regulations set forth by the Virginia Board of Counseling. Resident has an understanding that clients and their care ultimately fall under the license and responsibility of the Supervisor and, therefore, agrees to uphold all ethical guidelines and professional standards. Resident agrees to consult Supervisor in cases of emergency or crisis. Resident agrees to inform the Supervisor of any changes regarding residency or work experience, including the disclosure of any additions to scope or location of practice. Resident understands that the Supervisor is obligated to immediately report to the Board any unethical practice performed by the Resident, in accordance with regulation 18VAC115-20-130 (Virginia Board of Counseling).
Resident agrees to inform clients in writing of his/her status as a Resident and to provide clients with Supervisor contact information. Resident agrees to utilize the title “Resident in Counseling” on all client documents and correspondence and will not directly bill clients for services. Resident agrees to follow rules of confidentiality and to avoid acting in ways that are injurious to clients, including adhering to professional codes regarding boundaries and the avoidance of dual relationships.
Resident understands that supervision may include the discussion of relevant personal topics but that it does not include therapy. Resident agrees to seek outside professional help to resolve any personal problems that may interfere with or negatively impact client care.
7. Procedural Considerations: Individual sessions will be scheduled as needed to discuss any concerns, issues of tension, conflict, or failure of either party to abide by the guidelines outlined in this Agreement. If concerns of either party are not resolved in a professional manner in supervision, outside consultation with another provider, professional organization, or the Virginia Board of Counseling will be obtained.
IV. THE FOLLOWING ARE *NOT* INCLUDED:
1. Ownership of Written Materials. As a participant, you will have one license to view written materials provided by Megan MacCutcheon LLC. You do not have ownership of this information, which is protected by federal copyright laws. You may not copy, re-engineer, distribute, or otherwise provide access to this information to any other person, for free or paid, without express written consent of Megan MacCutcheon, LLC, which it may withhold for any reason.
2. Trademark Usage. Megan MacCutcheon, LLC protects its names. You are not receiving permission to use trade and service marks of the Company.
3. Results Not Guaranteed. You are receiving a space in the supervision group, support and guidance, but not guaranteed results from participating in the group.
V. Additional Legal Terms:
1. There is a NO REFUNDS POLICY. By signing this Agreement, you acknowledge that no one has represented to you that refunds are available. Even if you cannot participate for any reason, you will continue to be billed and obligated to pay according to the schedule in Section I.2 of this Agreement through the end of the Term. Megan MacCutcheon, LLC considers this policy a material inducement to entering into this Agreement, and would not have done so unless this No Refunds policy were included. If you initiate a chargeback, Megan MacCutcheon, LLC may issue an additional $250 fee to you.
2. Disclaimer of Warranties. Participant understands the group supervision is offered on an “as-is, where-is” basis, without any implied or express warranty as to its performance or to the results that may be obtained by participating. This limited warranty is the only express warranty made to you and is provided in lieu of any other express warranties (if any) created by any documentation.
3. If we get sued due to something you did. You agree to indemnify, defend and hold harmless Megan MacCutcheon, LLC its affiliates, successors and assigns from and against any and all claims, damages, losses, liabilities, lawsuits, costs and expenses (including attorneys’ fees at all tribunal levels) arising out of or related to any activity, work, or other action taken or permitted to be taken by you where such liability arises from negligence on your part or the violation of this Agreement. This includes any liability arising from breach of confidentiality by any party.
4. Damages are limited under this Agreement. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, COMPANY WILL NOT BE LIABLE TO YOU FOR ANY INDIRECT, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING BUT NOT LIMITED TO DAMAGES FOR LOSS OF BUSINESS, LOSS OF OPPORTUNITY COST, LOSS OF PROFITS AND THE LIKE), WHETHER BASED ON BREACH OF CONTRACT, BREACH OF WARRANTY, TORT (INCLUDING NEGLIGENCE), OR OTHERWISE, EVEN IF COMPANY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND EVEN IF A REMEDY SET FORTH HEREIN IS FOUND TO HAVE FAILED OF ITS ESSENTIAL PURPOSE. DAMAGES, INCLUDING ATTORNEY’S FEES AND COSTS, ARE LIMITED TO THE AMOUNT PAID UNDER THIS AGREEMENT.
5. No Guarantee of Results; Risk of Loss. Results from the group supervision are greatly dependent upon individual decisions, abilities, and other factors outside Supervisor’s control, and the Supervisor makes no guarantees or warranties that information provided to you through the group will provide results.
6. Megan MacCutcheon, LLC can end your participation in the group. Supervisor may determine, in its sole discretion and without requiring disclosure of the reason, that the relationship under this Agreement must terminate.
7. Virginia law governs this Agreement and it will be enforced by either party in Virginia. This Agreement will be governed by Virginia law, without regard to its conflicts of law principles. Resident understands and agrees to submit to the personal jurisdiction and venue of this state and agrees that any legal proceeding commenced shall take place in Fairfax County, Virginia.
8. No Assignment; No oral waivers or modifications. This Agreement may not be assigned to any other party. Its requirements may not be waived or modified except in writing signed by the Supervisor.
9. Electronic Signatures and Other Documents. You agree that your electronic consent is valid and binding evidence of your assent to the terms of this Agreement.
10. No relationship. The parties hereto expressly understand and agree that they are not employers or employees, principals and agents, or partners or co-venturers in the performance of each and every part of this Agreement, and they remain solely responsible for all of their respective employees and agents.
List of Additional Terms:
- This agreement
- Privacy policies
I agree, to the best of my abilities, to uphold the guidelines specified in this group supervision Agreement and to manage the supervisory relationship and supervisory process according to the guidelines set forth by the Virginia Board of Counseling. This Agreement will remain in effect until the completion of Resident’s residency, or until notice is given by either party of intent to terminate the supervisory relationship.
I have read and understand the information contained in this document and agree to participate in group supervision according to these guidelines.
If you have questions about this Agreement, please email [email protected]