Counselor Interview Rating Form - North Carolina State University

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North Carolina State University
Counselor Education Program
Counselor Interview Rating Form
Masters Techniques of Counseling Class/ Practicum
(circle one)
Student Name: _______________________
Evaluator: ____________________________
Please rate the student on a scale of 1 to 5 in the following areas using this rating system:
1-Student does not meet expectations
2-Student is slightly below expectations
3-Student meets expectations
4-Student slightly exceeds expectations
5-Student exceeds expectations
Give ONLY ONE number for each skill
Note: You might not demonstrate each of the below skills in every tape so there may be skills
that will not be rated.
Counseling Process:
Skill
Rating
Examples/ Comments
Stage of the Session
Stage 1: Empathic
Developing rapport, greeting,
Relationship:
structuring the session
Initiating the Session
Stage 2: Story and
Attending Behavior (Visual,
Strengths/ Gathering
vocal , verbal tracking, body
Data
language, nonverbal matching)
Empathy
Open-ended Questions
Stage 3: Setting Goals
Appropriate Closed Questions
(Stages 1,2, and 3 use
Encouragers (“nodding, “uh
the skills from the
huh”; key word encouragers)
basic listening
sequence)
Paraphrasing
Reflection of feeling
Summarizing
43
North Carolina State University
Counselor Education Program
Counselor Interview Rating Form
Masters Techniques of Counseling Class/ Practicum
(circle one)
Student Name: _______________________
Evaluator: ____________________________
Please rate the student on a scale of 1 to 5 in the following areas using this rating system:
1-Student does not meet expectations
2-Student is slightly below expectations
3-Student meets expectations
4-Student slightly exceeds expectations
5-Student exceeds expectations
Give ONLY ONE number for each skill
Note: You might not demonstrate each of the below skills in every tape so there may be skills
that will not be rated.
Counseling Process:
Skill
Rating
Examples/ Comments
Stage of the Session
Stage 1: Empathic
Developing rapport, greeting,
Relationship:
structuring the session
Initiating the Session
Stage 2: Story and
Attending Behavior (Visual,
Strengths/ Gathering
vocal , verbal tracking, body
Data
language, nonverbal matching)
Empathy
Open-ended Questions
Stage 3: Setting Goals
Appropriate Closed Questions
(Stages 1,2, and 3 use
Encouragers (“nodding, “uh
the skills from the
huh”; key word encouragers)
basic listening
sequence)
Paraphrasing
Reflection of feeling
Summarizing
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Stage 4: Restory-
Focusing
Working
Empathic Confrontation
(While skills from the
basic listening
Reflection of Meaning
sequence are still being
used, new action
Interpretation/ Reframing
oriented skills are
introduced at this
Self Disclosure
stage.)
Feedback
Immediacy
Logical Consequences
Psycho-education (i.e. teaching
relaxation skills, assertiveness
training)
Instruction: Directives (i.e.
“I’d like us to try a role play
together. Would you be
willing to try it?”
Summarization of content and
Stage 5: Concluding
feeling
the session:
Generalizing and
Homework
Acting on New Stories
Follow-up and support
(looking ahead to the next
session and what to work on
until that time)
th
Rating form adapted from Ivey, Ivey, and Zalaquett Intentional Interviewing and Counseling (8
edition)

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