Case Conceptualization Exercise Form

Client name: ______Age: ______
Occupation or educational status: ______
Family members: ______
______
Presenting problem(s)
Precipitants
Predisposing factors
Perpetuating factors
Issue and stage of change
Issue and stage of change
Client strengths
Individual abilities and personal qualities
Relational and systemic resources
Solutions
Considered (not attempted)
Attempted (unsuccessful, partially/temporarily successful)
Possible foci for intervention

Client name: ______Age: ______
Occupation or educational status: ______
Family members: ______
______Ethnicity: ______
Presenting problem(s)
What is the problem as described by the client and the referral source? This is the “B” in the A-B-C analysis (Cormier et al., 2013). Is the problem described differently by anyone else (e.g., referral source, parents, spouse)? In your problem exploration and problem definition interviews, elicit a “video with voice over” description of the problem as it manifests itself in the client’s experience. If you cannot “run the video” in your head, ask more open questions until you do. Your summary here should be similar to a summary you might offer in an interview.
Are there times when the problem is less frequent, less severe, not as problematic, or shorter in duration? Are these differences random or does the client do something to bring them about?
Is there a psychiatric diagnosis? Where did it originate? What is the client’s understanding of the diagnosis?
Does the current problem require crisis intervention or referral for psychiatric consultation?
Precipitants
This is the “A” in the A-B-C analysis. What are the precursors to the problem? What are the situations in which the problem occurs? Are some situations worse than others? What is the pattern or sequence of events leading up to the problem? Is anyone else involved? If so, could the other person do something that would make a difference?
Predisposing factors
What historical factors may be contributing to the problem pattern? Is there a history, either in the family, or in the client of:

trauma or abuse

immigration/geographical dislocation

substance abuse

mental illness

maladaptive parenting/high conflict post-divorce parenting

any other issues associated with future problems?

chronic health problems

a family life cycle transition

How does the client make sense of a difficult history? What has he/she done to overcome the negative effects of history? What is the history of individual and family coping/resilience? What are the positive and maladaptive aspects of coping? Does the client display any characteristic behavioural or emotional tendencies that may help or hinder?
Perpetuating factors
How is the problem maintained? The “C” in the A-B-C analysis suggests that the consequences perpetuate the problem. Is it an intrapersonal pattern (maladaptive belief, cognitive, or narrative; a script or role)? Or it is an interactional pattern? Who else is involved? Are there some attempted solutions that seem to be backfiring or ‘digging the client in deeper’?
Issues and stage of change/relationship pattern.
There may be more than one problem requiring clinical attention. What is your evaluation of the client’s ‘motivation’?
Client strengths
Individual abilities and personal qualities
What skills or personal qualities can be utilized? Could the ‘flip side’ of the problem be reframed as a strength?
Relational and systemic resources
Who or what is in the client’s social context that can be helpful? Who are the client’s practical and emotional supporters? What social connections does the client have, apart from the problem, that allow him/her to exercise competence? Who can provide support with the problem, or to ease the burden?
Solutions
Considered (not attempted)
What has the client thought about doing, but not done yet? If it seems like something the client is interested in or willing to do, is the timing right? Is there something that restrains the client from implementing the idea?
Attempted (unsuccessful, partially/temporarily successful)
What’s worked, even a little bit, for a short time? Is there some root of a potential intervention/solution there?
Possible foci for intervention
Based on your clear definition of the problem, your clear description of the problem pattern, and the client’s account of his/her history, what openings can you see for intervention? Can you distinguish:

An interactional pattern that could be interrupted?
An intrapersonal pattern – a problematic cognition, a script, or a narrative, that could be altered?
A skill that the client could learn?
A behaviour the client could do, but doesn’t? What gets in the way?
A problematic affect that interferes with the client’s life?
A dilemma or decision that must be solved or reframed?
A relationship that could be enhanced?
A partial solution or an exception to the problem on which you can build?

Other considerations:

How can you frame this in a way that will invite the client’s ‘buy-in’ based on the client’s theory of change and the client’s readiness level?
How does the client prioritize the concerns? For this client, which domain (affect, behaviour, cognition, sensation, interpersonal) is most amenable to intervention?
What ideas does the client have about how to intervene?
Is there a skill, talent, or ability you can utilize as a template for intervention?