COUC 521
Intake Report Part One: Initial Interview
Michael Blue
Department of Professional Counseling, Liberty University
COUC 521: Assessment Techniques In Counseling
Dr. Robert Moore
September 5, 2021
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COUC 521
Identifying Information
Gary Scott; 1725 Slough Avenue Carbondale, PA 18407; March 15, 1965; Male; Single;
Office Manager, paper distribution, (717)-555-0177, Tobias Flannigan, September 5, 2021
Reason for Referral
Mr. Gary Scott has been referred by the Pennsylvania Assembly of God General
Counsel Missions Board because he is a candidate to be a chaperone on a youth mission trip
to South America to build schools. Mr. Scott is coming in for an evaluation
Current Situation and Functioning
Mr. Gary Scott enjoys slow mornings where he is able to prepare his own breakfast.
Mr. Scott will get to the office early, around 6:30 am to get started on his day and then take
naps until everyone else arrives at 9:00. He will then attend an improv acting class in the
evenings and often end his days by watching a movie. Gary is able to take care of his daily
duties at home and in the office but described that he often misses social cues and often
offends the people that he works with.
Mr. Scott appears to demonstrate basic ADL skills, but with some areas of concern.
Mr. Scott showed proficiency in the following areas.
ambulating
continence
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toileting
housecleaning
Mr. Scott is lacking in the following ADL skills
Hygiene
ohe stated that he spends less than thirty seconds conducting oral hygiene.
Transportation
oMr. Scott has shown that he is able to transport himself to and from work.
However, he often gets distracted which led to him minorly injuring a
coworker in the parking lot.
shopping and meal preparation.
oHe described his eating habits as “not that bad,” but then went on to admit that
he often finds himself eating fast food instead of cooking for himself. He will
often run through the drive-through more than three times a day.
House Maintenance
oGary is competent in housecleaning but lacks the mechanical knowledge to
maintain his place of residence. However, he lives in an apartment and his
landlord is able to meet those needs.
General assessment of coping/character skills
stress management skills
oMr. Gary Scott places a high value on making those around him laugh and
often uses humor to cope with stress
oOther mechanisms of coping with stress involve compulsory spending
emotional regulation ability
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oMr. Scott could be described as emotionally monotone and is often described
as always trying to make a joke. However, he describes moments where he
will feel deeply sad.
problem-solving
oGary lacks problem-solving skills and has to ask for others to help him figure
out problems.
conflict resolution
ohe does not shy away from attempting to resolve conflict but has no real
knowledge of how to deconflict a situation, personal or professional.
Empathy
oMr. Scott is deeply empathetic. He sees his coworkers as his extended family
and has learned about their lives. He often feels the pain that his coworkers
will feel throughout their lives.
self-perceived strengths and weaknesses
Mr. Gary Scott sees himself as outgoing, loving, involved, and creative. He believes that his
greatest weakness is procrastination.
Relevant Medical History
There is no relevant medical history that would exclude Gary from going on this mission trip.
Psychiatric Treatment History
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Mr. Scott was mandated to attend six hours of counseling for an angry outburst that he had at
work.
Family History
Gary has no siblings. He grew up in a divorced home and was raised by his mother. As an
adolescent, his mother remarried, and Gary holds a deep resentment for his stepfather.
Social and Developmental History
Mr. Gary Scott has some cognitive milestones surrounding his parentage. He does not
remember the details surrounding his parents' divorce, but he recalled the feelings of loss and
uncertainty after his father left. Another cognitive milestone was his mother’s remarriage in
his preteen years. He recalled an emotional meltdown that he had during the wedding.
Relationally, Gary has not had any romantic relationships. He expressed that he has
been afraid of being rejected by women and that is what has held him back from pursuing
relationships. He becomes quickly attached to people that are friendly to him and has
described multiple individuals as being his “best friend.” He thinks of himself as part of his
peers’ families.
He has mixed reactions to authority. He likes to act autonomously but seeks the
attention and praise of those that are above him.
Educational and Occupational History
Gary’s highest level of education is high school. He attended his freshman year at
Penn State but ran out of money and dropped out after his first year. He worked at several odd
jobs for the next several years. He was trained as a salesperson by the former manager of the
office that he is currently managing. Mr. Scott has been for working for his current company
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since 1992. Gary has no military experience. His job performance has received mixed
reviews. He received a poor performance review from his direct superior, but his office has
continually produced better numbers than the other branches in his company. He has taken no
leaves of absence, nor has he been injured on the job.
Cultural Influences
Gary is not from a diverse population or region. Rather his cultural influence has come from
entertainment. He loves movies and TV shows from the 90s. He often personifies himself as a
character from one of these and expects similar outcomes in life, similar to those in the
storyline of the movie.
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