Assignment: Theoretical Systemic Case Conceptualization

Cross-Theoretical Systemic Case Conceptualization 3.0

For use with individual, couple, or family clients

Date:       Clinician:       Client/Case #:      

Introduction to Client & Significant Others

Identify significant persons in client’s relational/family life who will be mentioned in case conceptualization:

Adults/Parents: Select identifier/abbreviation for use in rest of case conceptualization

: Age:       Occupation:       Other:

: Age:       Occupation:       Other:

Children/Adult Children: Select identifier/abbreviation for use in rest of case conceptualization

: Age:      Grade: Other:

: Age:      Grade: Other:

: Age:      Grade: Other:

: Age:      Grade: Other:

Others: Identify all:

Presenting Concerns

Describe each significant person’s description of the problem:

:

:

:

:

Additional:

Broader System: Description of problem from extended family, referring party, school, legal system, etc.:

Extended Family:

Name:

Name:

Background Information

Trauma/Abuse History (recent and past):      

Substance Use/Abuse (current and past; self, family of origin, significant others):      

Precipitating Events (recent life changes, first symptoms, stressors, etc.):      

Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.):      

Client/Family Strengths and Social Location

Strengths and Resources:

Personal:      

Relational/Social:      

Spiritual:      

Based on the client’s social location—age, gender race, ethnicity, sexual orientation, gender identity, social class, religion, geographic region, language, family configuration, abilities, etc.–identify potential resources and challenges:

Unique Resources:

Potential Challenges:

Family Structure

Family Life Cycle Stage (Check all that apply):

|_| Single Adult

|_| Committed Couple

|_| Family with Young Children

|_| Family with Adolescent Children

|_| Divorce

|_| Blended Family

|_| Launching Children

|_| Later Life

Describe struggles with mastering developmental tasks in one or more of these stages:

Boundaries with/between:

Primary couple |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

& Children |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

& Children |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Siblings |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Extended Family |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Friends/Peers/Others |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Triangles/Coalitions:

|_| Cross-generational coalitions: Describe:

|_| Other coalitions:

Hierarchy between Parents and Children: |_| NA

: |_|Effective |_|Insufficient (permissive) |_| Excessive (authoritarian) |_| Inconsistent

: |_|Effective |_|Insufficient (permissive) |_| Excessive (authoritarian) |_| Inconsistent

Description/Example to illustrate hierarchy:      

Complementary Patterns between       and      :

|_| Pursuer/distancer

|_| Over/under-functioner

|_| Emotional/logical

|_| Good/bad parent

|_| Other:

Example of pattern:

Interactional Patterns

Primary Pathologizing Interpersonal Pattern (PIPs; A B): Describe dynamic of primary PIP:

|_| Pursuing/Distancing |_| Criticizing/Defending |_| Controlling/Resisting |_| Other:

Describe Start of Tension:

Describe Conflict/Symptom Escalation:

Describe Return to “Normal”/Homeostasis:

Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection, create independence/distance, establish influence, reestablish connection, or otherwise help organize the family?

Intergenerational & Attachment Patterns

Construct a family genogram and include all relevant information including:

· Names, ages and birth/death dates

· Relational patterns

· Occupations

· Psychiatric disorders and alcohol/substance abuse

· Abuse history

· Personality adjectives

Genogram should be attached to report. Summarize key findings below:

Substance/Alcohol Abuse: |_| NA |_| History:

Sexual/Physical/Emotional Abuse: |_| NA |_| History:

Parent/Child Relations: |_| NA |_| History:

Physical/Mental Disorders: |_| NA |_| History:

History Related to Presenting Problem: |_| NA |_| History:

Describe family strengths, such as the capacity to self-regulate and to effectively manage stress:

Describe typical attachment behavior when person does not feel secure in relationships; include Satir survival stances (placating, blaming, superreasonable, and irrelevant) used in description.

:: |_| Anxious |_| Avoidant |_| Anxious/Avoidant. Frequency: Describe:

:: |_| Anxious |_| Avoidant |_| Anxious/Avoidant. Frequency: Describe:

:: |_| Anxious |_| Avoidant |_| Anxious/Avoidant. Frequency: Describe:

:: |_| Anxious |_| Avoidant |_| Anxious/Avoidant. Frequency: Describe:

Additional:

Solution-Based Assessment

Attempted Solutions that DIDN’T work:

1.

2.

3.

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.

2.

3.

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.

2.

3.

Postmodern: Social Location and Dominant Discourses

Describe the client(s) overall social location (the groups a person belongs to based on diversity factors) and influential dominant discourses related to presenting concerns:

· Ethnic, Race, Class, Immigration Status, and Religious Discourses: How do key cultural discourses inform client identity(ies), what is perceived as the problem, and possible solutions (specify ethnicity, e.g. Italian American rather than White or Caucasian)?

· Gender and Sexuality Discourses : How do gender and sexuality discourses inform identity(ies), what is perceived as a problem and the possible solutions? Do these intersect with ethnicity and/or religion? 

· Community, School, Work and/or Extended Family Discourses : How do other important community discourses inform identity(ies), what is perceived as a problem and the possible solutions? 

· Identity Narratives : How has the problem shaped each significant person’s identity?

Client Perspectives (Optional)

Areas 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?      

Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why?      

How do you plan to respectfully work with areas of potential disagreement?      

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