I have a case study and I want someone help me to do 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 Locati
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