Material for training purposes

Clinical psychology
Manuela Beltran University

CASE FORMULATION

Date __/ ___ /___ Sent by Origin

BEHAVIOR DURING THE INTERVIEW

REASON FOR CONSULTATION

Description History of the problems and Level
events that triggered

PREVIOUS TREATMENTS

PRELIMINARY HYPOTHESES ON THE REASON FOR CONSULTATION

Reason for consultation Hypothesis Validation Strategies

1
 Material for training purposes
Clinical psychology
Manuela Beltran University

CONSULTANT INFORMATION
Full name Age Civil status
Profession Activities
Self Description
Who does he/she
live with?
Physical condition
and lifestyle
COUPLE INFORMATION
Full name Age Relationship
time
Profession Activities
Description
Relationship
INFORMATION ABOUT THE CHILDREN
Children Age Activity Institution Description and relationship

ENVIRONME ENVIRONMENTAL DIMENSION OR OPERATING CONTEXTS

NTAL
DIMENSION
OR
OPERATING
CONTEXTS
Physical
environment
Economic
conditions
Couple / sexual

Children

Parents

Labor /
Academic
Social

Leisure

FAMILY BACKGROUND

2
 Material for training purposes
Clinical psychology
Manuela Beltran University

Name Age Relation Description Relationship

description

Other influences
Relationship
between parents
SIGNIFICANT EVENTS IN PATIENT HISTORY
Age Events Processes

PURCHASE HYPOTHESIS
Reason for Acquisition hypothesis Mechanism Processes
consultation Proximal Distal

CLINICAL FORMULATION MATRIX

Basic process Secondary process Covariation R. Specific
Level 1 Level 2 Level 3 Level IV
Predisposition Maintenance Emotional Affective
factors factors

MECHANISMS COMMON TO THE REASONS OF CONSULTATION

Reason for Mechanism Common Process
consultation Mechanisms

FORMAT OF PRIORITIES OF INTERVENTION OBJECTIVES

Objectives Process Clinical activities Process

3
 Material for training purposes
Clinical psychology
Manuela Beltran University

INTERVENTION PLAN
Sesion No Date
Revision

Devellopment

Task

Observations

Next sesión objective

Sesion No Date
Revision

Devellopment

Task

Observations

Next sesión objective

4
 Material for training purposes
Clinical psychology
Manuela Beltran University