Systemic Case Conceptualization



Systemic Case ConceptualizationFor use with individual, couple, or family clientsDate: FORMTEXT ????? Clinician: FORMTEXT ?????Client/Case #: FORMTEXT ????? I. Introduction to Client & Significant Others List persons who will regularly participate in sessionsAdult(s) FORMDROPDOWN Age: FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Occupation: FORMTEXT ????? Other identifier: FORMTEXT ????? FORMDROPDOWN Age: FORMTEXT ????? FORMDROPDOWN FORMDROPDOWN Occupation: FORMTEXT ????? Other identifier: FORMTEXT ?????Child(ren) FORMDROPDOWN Age: FORMTEXT ????? FORMDROPDOWN Grade: FORMDROPDOWN School: FORMTEXT ????? Other identifier: FORMTEXT ????? FORMDROPDOWN Age: FORMTEXT ????? FORMDROPDOWN Grade: FORMDROPDOWN School: FORMTEXT ????? Other identifier: FORMTEXT ?????Others: FORMTEXT ?????II. Presenting Concern(s)Client’s Description(s) of Problem(s): FORMDROPDOWN : FORMTEXT ????? FORMDROPDOWN : FORMTEXT ????? FORMDROPDOWN : FORMTEXT ????? FORMDROPDOWN : FORMTEXT ?????Extended Family Description(s) of Problems: FORMTEXT ?????Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal system, etc.: FORMTEXT Name: FORMTEXT ????? FORMTEXT Name: FORMTEXT ?????III. Background Information Trauma/Abuse History (recent and past): FORMTEXT ?????Substance Use/Abuse (current and past; self, family of origin, significant others): FORMTEXT ?????Precipitating Events (recent life changes, first symptoms, stressors, etc.): FORMTEXT ?????Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.): FORMTEXT ?????IV. Client/Family Strengths and DiversityStrengths and ResourcesPersonal: FORMTEXT ?????Relational/Social: FORMTEXT ?????Spiritual: FORMTEXT ?????Diversity: Resources and LimitationsIdentify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background, socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc.Unique Resources: FORMTEXT ?????Potential Limitations: FORMTEXT ?????V. Family StructureFamily Life Cycle Stage (Check all that apply) FORMCHECKBOX Single adult FORMCHECKBOX Committed Couple FORMCHECKBOX Family with Young Children FORMCHECKBOX Family with Adolescent Children FORMCHECKBOX Divorce FORMCHECKBOX Blended Family FORMCHECKBOX Launching Children FORMCHECKBOX Later LifeDescribe struggles with mastering developmental tasks in one or more of these stages: FORMTEXT ?????Typical style for regulating closeness and distance in couple/family: FORMTEXT ?????Boundaries with/betweenPrimary couple FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ????? FORMDROPDOWN & Children FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ????? FORMDROPDOWN & Children FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ?????Siblings FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ?????Extended Family FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ?????Friends/Peers/Others FORMCHECKBOX Enmeshed FORMCHECKBOX Clear FORMCHECKBOX Disengaged FORMCHECKBOX NA Description/example: FORMTEXT ?????Triangles/Coalitions FORMCHECKBOX Cross-generational coalitions: Describe: FORMTEXT ????? FORMCHECKBOX Coalitions with family of origin: Describe: FORMTEXT ????? FORMCHECKBOX Other coalitions: FORMTEXT ?????Hierarchy between Parents and Children FORMCHECKBOX NA FORMDROPDOWN : FORMCHECKBOX Effective FORMCHECKBOX Insufficient (permissive) FORMCHECKBOX Excessive (authoritarian) FORMCHECKBOX Inconsistent FORMDROPDOWN : FORMCHECKBOX Effective FORMCHECKBOX Insufficient (permissive) FORMCHECKBOX Excessive (authoritarian) FORMCHECKBOX InconsistentDescription/Example to illustrate: FORMTEXT ?????Complementary Patterns between FORMTEXT ????? and FORMTEXT ?????: FORMCHECKBOX Pursuer/distance FORMCHECKBOX Over/under-functioner FORMCHECKBOX Emotional/logical FORMCHECKBOX Good/bad parent FORMCHECKBOX Other: FORMTEXT ????? Example of pattern: FORMTEXT ?????Satir Communication Stances: Describe most commonly used stance under stress. FORMDROPDOWN : FORMCHECKBOX Congruent FORMCHECKBOX Placator FORMCHECKBOX Blamer FORMCHECKBOX Superreasonable FORMCHECKBOX Irrelevant FORMDROPDOWN : FORMCHECKBOX Congruent FORMCHECKBOX Placator FORMCHECKBOX Blamer FORMCHECKBOX Superreasonable FORMCHECKBOX Irrelevant FORMDROPDOWN : FORMCHECKBOX Congruent FORMCHECKBOX Placator FORMCHECKBOX Blamer FORMCHECKBOX Superreasonable FORMCHECKBOX Irrelevant FORMDROPDOWN : FORMCHECKBOX Congruent FORMCHECKBOX Placator FORMCHECKBOX Blamer FORMCHECKBOX Superreasonable FORMCHECKBOX IrrelevantDescribe pattern: FORMTEXT ?????Gottman’s Divorce Indicators FORMCHECKBOX NA FORMDROPDOWN is Partner 1; FORMDROPDOWN is Partner 2Criticism FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ????? Defensiveness FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ????? Contempt FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ?????Stonewalling FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ?????Failed repair attempts FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ?????Not accept Influence FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ?????Harsh start up FORMCHECKBOX Partner 1 FORMCHECKBOX Partner 2: Describe: FORMTEXT ?????VI. Interactional Patterns Problem Interaction Pattern (A B): Start of tension: FORMTEXT ?????Conflict/symptom escalation: FORMTEXT ?????Return to “normal”/homeostasis: FORMTEXT ?????Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection, create independence/distance, establish influence, reestablish connection, or otherwise help create a sense of balance in the family? FORMTEXT ?????VII. Intergenerational & Attachment Patterns Construct a family genogram and include all relevant information including:Names, ages and birth/death datesRelational patternsOccupationsPsychiatric disorders and alcohol/substance abuseAbuse historyPersonality adjectivesGenogram should be attached to report. Summarize key findings below.Substance/Alcohol Abuse: FORMCHECKBOX NA FORMCHECKBOX History: FORMTEXT ?????Sexual/Physical/Emotional Abuse: FORMCHECKBOX NA FORMCHECKBOX History: FORMTEXT ?????Parent/Child Relations: FORMCHECKBOX NA FORMCHECKBOX History: FORMTEXT ?????Physical/Mental Disorders: FORMCHECKBOX NA FORMCHECKBOX History: FORMTEXT ?????History Related to Presenting Problem: FORMCHECKBOX NA FORMCHECKBOX History: FORMTEXT ?????Family strengths: Describe: FORMTEXT ?????Attachment Patterns: Describe most common attachment pattern for each FORMDROPDOWN : FORMCHECKBOX Secure FORMCHECKBOX Anxious FORMCHECKBOX Avoidant FORMCHECKBOX Anxious/Avoidant. Describe: FORMTEXT ????? FORMDROPDOWN : FORMCHECKBOX Secure FORMCHECKBOX Anxious FORMCHECKBOX Avoidant FORMCHECKBOX Anxious/Avoidant. Describe: FORMTEXT ????? FORMDROPDOWN : FORMCHECKBOX Secure FORMCHECKBOX Anxious FORMCHECKBOX Avoidant FORMCHECKBOX Anxious/Avoidant. Describe: FORMTEXT ????? FORMDROPDOWN : FORMCHECKBOX Secure FORMCHECKBOX Anxious FORMCHECKBOX Avoidant FORMCHECKBOX Anxious/Avoidant. Describe: FORMTEXT ?????VIII. Solution-Based AssessmentAttempted Solutions that DIDN’T work: 1. FORMTEXT ?????2. FORMTEXT ????? 3. FORMTEXT ?????Exceptions and Unique Outcomes (Solutions that DID work): Times, places, relationships, contexts, etc. when problem is less of a problem; behaviors that seem to make things even slightly better: 1. FORMTEXT ?????2. FORMTEXT ????? 3. FORMTEXT ?????Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the next day? (Describe in terms of doing X rather than not doing Y).1. FORMTEXT ?????2. FORMTEXT ????? 3. FORMTEXT ?????IX. Postmodern and Cultural Discourse ConceptualizationDominant Discourses informing definition of problem:Ethnic, Class and Religious Discourses: How do key cultural discourses inform what is perceived as a problem and the possible solutions? FORMTEXT ?????Gender and Sexuality Discourses: How do the gender/sexual discourses inform what is perceived as a problem and the possible solutions? FORMTEXT ?????Community, School, and Extended Family Discourses: How do other important community discourses inform what is perceived as a problem and the possible solutions? FORMTEXT ?????Identity Narratives: How has the problem shaped each client’s identity? FORMTEXT ?????Local or Preferred Discourses: What is the client’s preferred identity narrative and/or narrative about the problem? Are there local (alternative) discourses about the problem that are preferred? FORMTEXT ?????X. Client PerspectivesAreas of Agreement: Based on what the client(s) has(ve) said, what parts of the above assessment do they agree with or are likely to agree with? FORMTEXT ?????Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why? FORMTEXT ?????How do you plan to respectfully work with areas of potential disagreement? FORMTEXT ????? ................
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