Case Presentation Model 2019
A Model of Case Presentation for the Clinical Supervision of Psychotherapy
Date of presentation:
"Fabricated first name"
Referred by (source) on (date):
Client Description: Age Gender/Sexual Orientation Ethnicity Body type Spiritual life General appearance Present living & working situations: Mood Stressors
Presenting complaints: Issues presented by the client: Issues presented by the environment: (workplace; significant others; criminal justice system)
Previous counseling:
Precipitant:
Medications/amounts/frequency/beginning: Prescribing physician & phone:
Diagnosis:
Central/Historical facts: simple background information that contributes to this counseling event
Status of therapy to this point:
Process notes: some small portion of a session in which the two parties (therapist and client) statements-reactions-thoughts are described in sequence, typically written during or right after a meeting has concluded:
Therapist: "(approximated quotation)" Client: "(approximated quotation & reaction)" Therapist: "(approximated quotation& reaction)" Client: "(approximated quotation & reaction)" Therapist: "(approximated quotation & reaction)" etc.
CARLTON F. "PERK" CLARK, LCSW
PSYCHOTHERAPY & ORGANIZATIONAL DEVELOPMENT
5930 E PIMA ST STE 144 TUCSON, AZ 85712
VOICE: 520/519-8475
FAX: 520/519-8476
7/23/19 EMAIL: perk@
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