Systemic Case Conceptualization s1

Systemic Case Conceptualization

For use with individual, couple, or family clients

Date: Clinician: Client/Case #:

I. Introduction to Client & Significant Others

List persons who will regularly participate in sessions

Adult(s)

Select GenderNoneAdult Female Adult MaleAdult Female 2Adult Male 2 Age: Select EthnicityAfrican-AmericanAsian-AmereicanCaucasianEuropean AmericanHispanic/LatinoNative-AmericanMiddle Eastern AmericanMultiethnic/BiracialOther Select Relational StatusSingle heterosexualPartnered heterosexualMarried heterosexualSingle Gay/Lesbian/BisexualPartnered Gay/Lesbian/BisexualMarried Gay/Lesbian/BisexualSingle TransgenderedPartnered TransgenderedMarried Transgendered Occupation: Other identifier:

Select GenderNoneAdult Female Adult MaleAdult Female 2Adult Male 2 Age: Select EthnicityAfrican-AmericanAsian-AmereicanCaucasianEuropean AmericanHispanic/LatinoNative-AmericanMiddle Eastern AmericanMultiethnic/BiracialOther Select Relational StatusSingle heterosexualPartnered heterosexualMarried heterosexualSingle Gay/Lesbian/BisexualPartnered Gay/Lesbian/BisexualMarried Gay/Lesbian/BisexualSingle TransgenderedPartnered TransgenderedMarried Transgendered Occupation: Other identifier:

Child(ren)

Select GenderNoneChild FemaleChild MaleChild Female 2Child Male 2 Age: Select EthnicityAfrican-AmericanAsian-AmereicanCaucasianEuropean AmericanHispanic/LatinoNative-AmericanMiddle Eastern AmericanMultiethnic/BiracialOther Grade: Select GradeNot in SchoolPre-SchoolKindergarden1st2nd3rd4th5th6th7th8th9th10th11th12th School: Other identifier:

Select GenderNoneIdentified Patient: Child FemaleIdentified Patient: Child MaleChild FemaleChild MaleChild Female 2Child Male 2 Age: Select EthnicityAfrican-AmericanAsian-AmereicanCaucasianEuropean AmericanHispanic/LatinoNative-AmericanMiddle Eastern AmericanMultiethnic/BiracialOther Grade: Select GradeNot in SchoolPre-SchoolKindergarden1st2nd3rd4th5th6th7th8th9th10th11th12th School: Other identifier:

Others:

II. Presenting Concern(s)

Client’s Description(s) of Problem(s):

Select PersonNoneAdult Female Adult MaleAdult Female 2Adult Male 2:

Select PersonNoneAdult Female Adult MaleAdult Female 2Adult Male 2:

Select PersonNoneChild FemaleChild MaleChild Female 2Child Male 2:

Select PersonNoneChild FemaleChild MaleChild Female 2Child Male 2:

Extended Family Description(s) of Problems:

Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal system, etc.:

Name:

Name:

III. 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.):

IV. Client/Family Strengths and Diversity

Strengths and Resources

Personal:

Relational/Social:

Spiritual:

Diversity: Resources and Limitations

Identify 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:

Potential Limitations:

V. 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:

Typical style for regulating closeness and distance in couple/family:

Boundaries with/between

Primary couple Enmeshed Clear Disengaged NA Description/example:

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2 & Children Enmeshed Clear Disengaged NA Description/example:

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2 & Children Enmeshed Clear Disengaged NA Description/example:

Siblings Enmeshed Clear Disengaged NA Description/example:

Extended Family Enmeshed Clear Disengaged NA Description/example:

Friends/Peers/Others Enmeshed Clear Disengaged NA Description/example:

Triangles/Coalitions

Cross-generational coalitions: Describe:

Coalitions with family of origin: Describe:

Other coalitions:

Hierarchy between Parents and Children NA

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Effective Insufficient (permissive) Excessive (authoritarian) Inconsistent

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Effective Insufficient (permissive) Excessive (authoritarian) Inconsistent

Description/Example to illustrate:

Complementary Patterns between and :

Pursuer/distance

Over/under-functioner

Emotional/logical

Good/bad parent

Other:

Example of pattern:

Satir Communication Stances: Describe most commonly used stance under stress.

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Congruent Placator Blamer Superreasonable Irrelevant

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Congruent Placator Blamer Superreasonable Irrelevant

SelectNoneChild FemaleChild MaleChild Female 2Child Male 2: Congruent Placator Blamer Superreasonable Irrelevant

SelectNoneChild FemaleChild MaleChild Female 2Child Male 2: Congruent Placator Blamer Superreasonable Irrelevant

Describe pattern:

Gottman’s Divorce Indicators NA

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2 is Partner 1; SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2 is Partner 2

Criticism Partner 1 Partner 2: Describe:

Defensiveness Partner 1 Partner 2: Describe:

Contempt Partner 1 Partner 2: Describe:

Stonewalling Partner 1 Partner 2: Describe:

Failed repair attempts Partner 1 Partner 2: Describe:

Not accept Influence Partner 1 Partner 2: Describe:

Harsh start up Partner 1 Partner 2: Describe:

VI. Interactional Patterns

Problem Interaction Pattern (A D B):

Start of tension:

Conflict/symptom escalation:

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 create a sense of balance in the family?

VII. 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:

Family strengths: Describe:

Attachment Patterns: Describe most common attachment pattern for each

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Secure Anxious Avoidant Anxious/Avoidant. Describe:

SelectNoneAdult Female Adult MaleAdult Female 2Adult Male 2: Secure Anxious Avoidant Anxious/Avoidant. Describe:

SelectNoneChild FemaleChild MaleChild Female 2Child Male 2: Secure Anxious Avoidant Anxious/Avoidant. Describe:

SelectNoneChild FemaleChild MaleChild Female 2Child Male 2: Secure Anxious Avoidant Anxious/Avoidant. Describe:

VIII. 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.

IX. Postmodern and Cultural Discourse Conceptualization

Dominant 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?

§  Gender and Sexuality Discourses: How do the gender/sexual discourses inform what is perceived as a problem and the possible solutions?

§  Community, School, and Extended Family Discourses: How do other important community discourses inform what is perceived as a problem and the possible solutions?

Identity Narratives: How has the problem shaped each client’s identity?

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?

X. Client Perspectives

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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© 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org