Worksheet for Case Conceptualization
| 7.5 points per item x
20= 150 points. |
Worksheet response place | Complete info
provided |
Incomplete info provided |
| Name:
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| 1) What are the reasons the patient came for treatment now?
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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
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Post-traumatic stress disorder | ||
| 3) List one goal the patient identifies
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| 4) How would the patient know if the treatment was successful?
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If she is able to get along with people around her | ||
| 5) When did the current symptoms start?
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| 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. |
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| 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? |
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| 10) Identify any history of
vulnerability |
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| 11) Identify the
typical cycle of event, thought, mood, physiology and behavior
Beginning of cycle…. |
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| 12) Mid cycle | |||
| 13) End of cycle | |||
| 14) Resources and strengths | |||
| 15) Create a hypothesis
about the case |
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| 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? |
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| Total points |
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