Worksheet for Case Conceptualization

 

7.5 points per item x

20= 150 points.

Worksheet response place Complete info

provided

Incomplete info provided
Name:

 

     
1)   What are the reasons the patient came for treatment now?

 

The patient was referred to see a mental health provider because she was at the verge of losing her apartment due to her impulsive behavior towards her co-tenants    
2)   List one specific problem/issue identifies

the patient identifies

 

Post-traumatic stress disorder    
3)   List one goal the patient identifies

 

     
4)   How would the patient know if the treatment was successful?

 

If she is able to get along with people around her    
5)  When did the current symptoms start?

 

     
6)   Identify a key core belief      
7)   Identify a key dysfunctional assumption      
8)   Identify a

perpetuating factor of the key dysfunctional assumption

Speculate on what experiential contributors from the past might be driving the current symptoms.

     
9)   Identify a trigger, or modifier of the

key dysfunctional assumption

What other situations may be contributing to the problem now?

Is there a current crisis?

     
10) Identify any history of

vulnerability

     
11) Identify the

typical cycle of event, thought, mood, physiology and behavior

 

Beginning of cycle….

     
12) Mid cycle      
13) End of cycle      
14) Resources and strengths      
15) Create a hypothesis

about the case

     
Create a

treatment plan with 3 items:

 

16) Treatment plan Item I:

     

 

 

17) Treatment plan Item II:      
18) Treatment plan Item III:      
19) Identify what you learned from the exercise, make 3 points      
20) What went very well?

What could be improved?

     
Total points      

 


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