Childhood Onset Disorders: Applying the T/C Model of Case Conceptualization

(* Areas that the counselor believes require more information)

Client: First Name:

Client Demographics:

Age

Gender

Relationship Status:

Spiritual/Religious Affiliation

Other

Presenting Problem: [No diagnostic nomenclature. No DSM-5 diagnosis. Provide a briefly stated presenting problem based on information conveyed by the client in the case study.]

Internal Personality Constructs and Behavior

Self-efficacy:

Self-esteem:

Attitudes/Values/Beliefs:

Attachment Style:

Biology/Physiology/Heredity:

Affect:

Cognition:

Hot Thoughts:

Behavior:

Symptomology:

Coping Skills and Strengths:

Readiness for Change:

Life Roles:

Environment

Relationships:

Culture:

Family Norms and Values:

Societal Influences:

Timeline

Past Influences:

Present Influences:

Future Goals: