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Case Presentation Template
Student Name
School of Behavioral Sciences, XXXXX University
Author Note
Student Name
https://orcid.org/#####
I have no conflicts of interests to disclose.
Correspondence concerning this paper should be addressed to Student Name, 1971 University Blvd., City, State zip. Email: [email protected]
1
CASE PRESENTATION TEMPLATE 1
Case Presentation Template
Part 1 – Assessment and Diagnosis Identifying Information
Identifying Data
Date of Initial Assessment:
PSEUDO Name:
Age:
Gender:
Sexual Orientation:
Race/Ethnicity:
Marital Status:
Employment Status:
Reason for Referral/Presenting Problem
Text here
Source of Information: Text here
Background, Family Information, and Relevant History
Text here
Problem and Counseling History
Text here
Diagnostic Impression
Principal diagnosis:
Diagnosis 2 or z-code:
Diagnosis 3 or z-code:
Differential Diagnosis:
Discussion of Diagnostic Impression
Text here
Part 2 – Case Conceptualization: Inverted Pyramid Model (IPM)
STEP 1: IDENTIFY AND LIST CLIENT CONCERNS AND ANY OTHER PROBLEM AREAS
Text here
Text here
STEP 2: ORGANIZE CONCERNS INTO LOGICAL THEMATIC GROUPINGS
Theme Used
Text here
STEP 3: THEORETICAL INFERENCES:
ATTACH THEMATIC GROUPINGS TO INFERRED AREAS OF DIFFICULTY
Text here
STEP 4: NARROWED INFERENCES AND DEEPER DIFFICULTIES
Text here
Narrative of the Case Conceptualization
Text here
Part 3 – Treatment Planning/Integration/Counseling Theory
Treatment Plan
Objectives & Therapeutic Interventions |
Outcome Measures of Change |
Integration
Text here
Personal Model of Counseling
Text here
References
Provide all references here (at least five)
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