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    Case Write-Up - Beck Institute - Worksheet-Packet - 2020-18-23

    Uploaded by

    Carmen-Ioana Rotaru

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Case Write-Up - Beck Institute - Worksheet-Packet - 2020-18-23

    Uploaded by

    Carmen-Ioana Rotaru
    223 views6 pages

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    Case Write-up_Beck Institute_Worksheet-Packet_2020-18-23

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    223 views6 pages

    Case Write-Up - Beck Institute - Worksheet-Packet - 2020-18-23

    Uploaded by

    Carmen-Ioana Rotaru

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    17

    CASE WRITE-UP WORKSHEET


    For a click-and-fill version of this worksheet, please visit: beckinstitute.org/casewriteup.

    PART ONE: INTAKE INFORMATION

    IDENTIFYING INFORMATION AT INTAKE:

    Age:

    Gender Identity and Sexual Orientation:

    Cultural Heritage:

    Religious/Spiritual Orientation:

    Living Environment:

    Employment Status:

    Socioeconomic Status:

    CHIEF COMPLAINT, MAJOR SYMPTOMS, MENTAL STATUS AND DIAGNOSIS:


    Chief Complaint:

    Major Symptoms:

    Emotional:

    Cognitive:

    Behavioral:

    Physiological:

    Mental Status:

    Diagnosis (from the Diagnostic and Statistical Manual or International Classification of Disease):

    CURRENT PSYCHIATRIC MEDICATIONS, ADHERENCE AND SIDE EFFECTS; CONCURRENT


    TREATMENT:

    CURRENT SIGNIFICANT RELATIONSHIPS:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org
    18

    PART TWO: HISTORICAL INFORMATION

    BEST LIFETIME FUNCTIONING (INCLUDING STRENGTHS, ASSETS AND RESOURCES):

    HISTORY OF PRESENT ILLNESS:

    HISTORY OF PSYCHIATRIC, PSYCHOLOGICAL OR SUBSTANCE USE PROBLEMS AND IMPACT ON


    FUNCTIONING:

    HISTORY OF PSYCHIATRIC, PSYCHOLOGICAL OR SUBSTANCE ABUSE TREATMENT, TYPE, LEVEL OF


    CARE AND RESPONSE:

    PERSONAL, SOCIAL, EDUCATIONAL AND VOCATIONAL HISTORY:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org
    19

    MEDICAL HISTORY AND LIMITATIONS:

    CURRENT NON-PSYCHIATRIC MEDICATIONS, TREATMENT, ADHERENCE AND SIDE EFFECTS:

    PART THREE: THE COGNITIVE CONCEPTUALIZATION DIAGRAM

    See pages 3-6 of this worksheet packet.

    PART FOUR: THE CASE CONCEPTUALIZATION SUMMARY

    HISTORY OF CURRENT ILLNESS, PRECIPITANTS AND LIFE STRESSORS:

    MAINTAINING FACTORS:

    VALUES AND ASPIRATIONS:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org
    20

    NARRATIVE SUMMARY, INCORPORATING HISTORICAL INFORMATION, PRECIPITANTS, MAINTAINING


    FACTORS AND COGNITIVE CONCEPTUALIZATION DIAGRAM INFORMATION:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org
    21

    PART FIVE: TREATMENT PLAN

    OVERALL TREATMENT PLAN:

    PROBLEM LIST/CLIENT’S GOALS AND EVIDENCE-BASED INTERVENTIONS (INCLUDE UP TO FIVE):

    Problem/Goal #1:
    Interventions:

    Problem/Goal #2:
    Interventions:

    Problem/Goal #3:
    Interventions:

    Problem/Goal #4:
    Interventions:

    Problem/Goal #5:
    Interventions:

    PART SIX: COURSE OF TREATMENT AND OUTCOME

    THERAPEUTIC RELATIONSHIP:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org
    22

    NUMBER AND FREQUENCY OF TREATMENT SESSIONS, LENGTH OF TREATMENT:

    COURSE OF TREATMENT SUMMARY:

    MEASURES OF PROGRESS:

    OUTCOME OF TREATMENT:

    © 2018. Adapted from J. Beck (2020) Cognitive Behavior Therapy: Basics and Beyond, 3rd edition.

    Beck Institute for Cognitive Behavior Therapy • One Belmont Ave, Suite 700 • Bala Cynwyd, PA 19004 • beckinstitute.org

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