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Washington State Forms for the Supervision of Therapists and Counselors

Approved Supervisor
Licensed Mental Health Counselor

Supervisors and those seeking Supervisory Status:

The Washington State Department of Health (DOH) has a list of requirements all Licensed Mental Health Counselors must adhere to in order to offer supervisory services to licensed candidates.  Please refer to WAC 246-809-234 for complete requirements. Should you choose to supervise a licensed candidate, you must have a valid, current license for two years that is in good standing and without restrictions. You cannot be legally or blood-related ,  or cohabitate with,  the licensed candidate or candidate’s peer and you cannot have been a therapist of the licensed candidate within the last two years.

If you are an out-of-state counselor looking to become a Washington State Approved Supervisor, please refer to Washington State DOH for state reciprocity to ensure you meet Washington State requirements. 
Before you begin any supervision, you should provide that candidate with a declaration, to ensure that you have met the state requirements as outlined in WAC 246-809-234 and state that you do in fact qualify as a Washington State approved supervisor.  By stating the following, you are attesting that you have completed the requirements below.

I have obtained a minimum of 15 clock hours of training or more in clinical supervision through:

  • A supervision course
  • Continuing education credits on supervision
  • Supervision of supervision
  • Or any combination of these

And I have obtained 25 clock hours of experience in supervision of clinical practice; I attest that I will gain full knowledge of the supervisee’s practice activities including:

  • Practice setting
  • Record keeping
  • Financial management
  • Ethics of clinical practice
  • A backup plan for coverage

Declaration of Supervision—
must be completed by Supervisor and provided to license candidate prior to the commencement of supervision in accordance with WAC 246-809-234.

I, _______________________________ a licensed ___________________________
                      name of Supervisor                                    type of licensure
in the State of ________________________ with license number _________________

attest to ___________________________________________________,
name of Licensed Candidate
that I have read and met all the requirements in connection with WAC 246-809-234.

Signature of Supervisor
DOH 670-090 March 2011
Mental Health Credentialing, P.O. Box 47877 Olympia, WA 98504-7877, phone: 360.236.4700.

NOTE: The origin of this information comes directly from the Washington State Department of Health. For the most current version, go to .

Forms Used by the Supervising Counselor
(and given to each counselor being supervised)

Forms Used by the Counselor to Report
Hours of Supervision to the State of Washington

"Mental Health Counselor Associate Supervision and Experience Verification" Form. (one form for each supervisor)
"Marriage and Family Therapy Supervision and Experience Verification" form. (one form for each supervisor)
"Verification of Social Worker Supervised Postgraduate Experience" form. (one form for each supervisor)

Also see Counseling Washington's: List of Licensed Counselors Who Have Completed Their Clinical  Supervision Training in Washington State and are available for paid clinical supervision of private practice counselors working toward licensure.

Requirement for Washington State Approved Supervisors for Chemical Dependency Treatment Counselors and Counselor Trainees

I received an email from a counselor in Idaho who said he is negotiating for a job as a treatment supervisor in a Washington State Outpatient chemical dependency Treatment Facility and wanted to know what were the legal requirements to be an Approved Supervisor for chemical dependency counselors.

He further explained that that he was a Licensed Independent Clinical Social Worker with no Chemical Dependency credential.

Please Note: Again, I remind you that I am not a lawyer nor a state employee, but I have found the following information online that will help you understand Washington state requirements.

WAC 246-811-049


(1) An approved supervisor is a certified chemical dependency professional (CDP) or a person who meets or exceeds the requirements of a certified CDP in the state of Washington, and who would be eligible to take the examination required for certification.

(2) An approved supervisor has at least four thousand hours of experience in a state approved chemical dependency treatment agency in addition to the supervised experience hours required to become a CDP.

(3) Twenty-eight clock hours of recognized supervisory training may be substituted for one thousand hours of experience.

(4) An approved supervisor is not a blood or legal relative, significant other, cohabitant of the supervisee, or someone who has acted as the supervisee's primary counselor.

(5) A chemical dependency professional trainee (CDPT) must receive documentation of his or her approved supervisor's qualifications before training begins.

(6) An approved supervisor or other certified CDP must review and sign all CDPT clinical documentation.

(7) An approved supervisor is responsible for all patients assigned to the CDPT they supervise.

Best human source for information: The Division of Alcohol and Substance Abuse, Department of Social and Health Services, P.O. Box 45330, 612 Woodland Square Loop SE, Building C, Olympia, Washington, 98504-5330, (877) 301-4557 or the hotline at (800) 562-1240
"Addiction counseling competencies" means the knowledge, skills, and attitudes of
chemical dependency counselor professional practice as described in Technical Assistance
Publication No. 21, Center for Substance Abuse Treatment, Substance Abuse and Mental
Health Services Administration, U.S. Department of Health and Human Services 1998.

Rules governing facilities:
"Certification Requirements for Chemical Dependency Service Providers"

If any of these state links are broken--don't be surprised.  On the Washington State's website, URL addresses frequently are changed when the content is changed.  In that case (1.) please notify Counseling Washington about broken links so we can update them, and (2.) follow the directions below that were kindly furnished in May 2007, by Dawn Thompson, Program Representative, and Health Professions Quality Assurance Washington State Department of Health:
"The Approved Supervisor forms are located with the forms and applications that pertain to the correlating licensures....You can download these forms by going to click on Topics A-Z and choose the first letter of the licensure you need. Once you have that licensure pulled up there will be a site directory on the left hand side.  Click on 'forms and applications', then click on approved supervisor form, down load and print...."

With Counseling Washington's counselor locator service, counselors can be located by name, geographic area, or niche specialty.

The mental health and addictions counselors listed on these pages are:

(1.) Licensed Psychologists
(2.) Licensed Mental Health Counselors (LMHC),
(3.) Licensed Marriage and Family Therapists (LMFT),
(4.) Licensed Mental Health Counselor Associates (LMHCA),
(5.) Licensed Marriage and Family Therapist Associates (LMFTA),
(6.) Licensed Independent Clinical Social Workers (LICSW),
(7.) Licensed Social Work Associate-Advanced (LSWAA)
(8.) Licensed Social Work Associate—Independent Clinical (LSWAIC), and
(9.) Masters-level Certified Counselors (CC).

If the viewer has information that any professionals on this site are misrepresenting their qualifications, please let us know.

This document is Copyrighted© 2008 by, Floyd Else, Webmaster, and may not be reproduced, in whole or in part without crediting the author, source and site name. All rights reserved. 

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