Clinician Competencies Survey

Hello! Thank you for taking time to complete this survey. The information gathered will be compiled to create brief profiles of each clinician in respect of your skills, experience, expertise, and preferences. These profiles will be used to assist the intake process & assignment of clients. It will also be a useful resource for staff to refer to for consultation & knowledge sharing purposes. The information gathered will be used for internal distribution only.
Please provide your name and credentials.*
What is the highest level of education you have completed, and the area of your degree?*
As part of your program, were you required to complete a supervised practicum placement and/or clinical internship?*
- Yes
- No
If yes, please briefly describe the nature and duration of this practicum and/or internship.
Are you currently a student?*
- Yes
- No
If yes, please indicate the level and area of your present program.
Please list any certifications you presently hold (ie. EMDR, ASSIST, CPR, NVCI, etc.)*
Are you presently a member in good standing with any professional associations, colleges, or societies?*
- Yes
- No
If yes, please check all that apply:
- Canadian Counselling and Psychotherapy Association
- Professional Association of Christian Counsellors and Psychotherapists
- Canadian Association for Marriage and Family Therapy
- Manitoba College of Social Workers
- Canadian Association of Social Workers
- College of Occupational Therapists of Manitoba
- Manitoba Society of Occupational Therapists
- Canadian Art Therapy Association
- International Expressive Arts Therapy Association
- Canadian Association for Music Therapy
- North American Drama Therapy Association
- Canadian Association for Sandplay Therapy
- Canadian Association for Spiritual Care
- Canadian Professional Counsellors Association
- Other
If you selected "Other", please specify:
Do you presently hold valid professional liability insurance?*
- Yes
- No
What title do you prefer to use as your professional designation?*
- Counsellor
- Mental Health Counsellor
- Therapist
- Couples Therapist
- Couple and Family Therapist
- Psychotherapist
- Social Worker
- Clinical Social Worker
- Occupational Therapist
- Other
If you selected "other", please specify:
Do you presently access supervision or clinical consultation outside of Aulneau?*
- Yes
- No
If yes, please check all that apply:
- Individual Supervision
- Group Supervision
- Individual Consultation
- Group Consultation
Is accessing supervision required for membership with your professional body?*
- Yes
- No
Do you presently have a continuing education/professional development plan as per your professional body's membership guidelines?*
- Yes
- No
If yes, please indicate the parameters of these requirements (ie. number of hours; eligible credits, etc.):
How many years have you been practicing counselling and/or psychotherapy since graduating from your educational/training program?*
- 0-2
- 3-5
- 6-10
- 11-15
- 16-20
- 20+
Please select all the services which you are presently able to provide.*
- Individual- Children (0-12)
- Individual- Adolescents (13-17)
- Individual- Adults (18+)
- Dyadic Caregiver/Child
- Couples
- Families
- MIG
- Play Therapy
- Verbal Psychotherapy
- Music & Expressive Arts Therapy
- Drama Therapy
- Occupational Therapy
- EMDR
- Groups
Of the aforementioned services/client populations, are there any you are presently undergoing training and/or supervision to increase your competency?*
- Yes
- No
If yes, please specify:
Please indicate the client populations you most enjoy and least enjoy working with. (Note: click the plus sign to add up to 3 choices each)*
Most Enjoy Least Enjoy
Please select all the presenting issues which you are presently competent to work with [without requiring supervision].*
- 2SLGBTQQIA Concerns
- Abuse (Emotional, Mental, Physical, Sexual, Spiritual)
- Addiction
- Anger
- Anxiety/ Anxiety Disorders
- Childhood Trauma
- Chronic Pain
- Defiant Behaviour (ODD; Aggression)
- Depression/ Depressive Disorders
- Developmental Difficulties
- Emotion Regulation
- Gender Identity
- Grief, Bereavement & Loss
- Intimate Partner Violence
- Mood Disorders
- Parenting Skills/ Attachment Concerns
- Personality Disorders
- Relationship Conflict
- Schizophrenia/ Psychotic Disorders
- Self-Esteem
- Self-Injury
- Separation/ Divorce
- Sexuality/ Sexual Identity
- Sexual Violence/ Sexual Assault
- Sleep Disturbances
- Social Skills
- Spectrum Disorders
- Spirituality
- Stage of Life Issues
- Stress & Overwhelm
- Suicidal Ideation
- Trauma (PTSD; C-PTSD)
- Other
If you selected "other", please specify:
Please indicate up to 5 presenting issues that you enjoy working with the most.*
Are there any client populations and/or presenting issues you would like to work with less?*
- Yes
- No
If yes, please specify:
What is your maximum case load capacity (ie. the number of open client files you have at any given time)?*
- Up to 10
- 11-20
- 21-30
- 31-40
- 41-50
- 50+
Please indicate the languages in which you can provide services.*
- English
- French
- German
- Urdu
- Hindi
- Arabic
- Other
If you selected "other", please specify:
Everyone has personal biases and values. Some are consciously known, and others are more subtle. What are some of the beliefs, values, personal attributes, or biases that you think might shape the therapeutic lens you work with?*

Most Enjoy	Least Enjoy