APPENDIX ‘F’

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CASE SUMMARY/SESSION REPORT FORM
COUNSELOR’S NAME:………………………………….REG.NO:………/…/………/……/…/……
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DATE: ……/………/………

Client Id No…/..…/….. Session No:… /…/…/…/…

Case category e.g HIV/AIDS, Marital, Drug& Alcohol abuse, others

(specify………………………………………………………………………….……)

Client’s details
Sex: Male/Female Educ.Level:
Age: …………… Yrs Occupation:
Marital status: Telephone No:

Creating rapport
…………………………………………………………………………………………………………………………
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Problem presented……………………………………………………………………………………………
………………………………………………………………………………………………...……………….

Actual problem identified ………………………………………………………………...…………………

…………………………………………………………………………………………………………………

Client’s negative thoughts associated with the presented problem

…………………………………………………………………………………………………………………
………………………………………………………………………………………...…………………….…

Client’s feelings associated with the problem

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………………………………………………………………….…………………………...…………………

Client’s behavior associated with the presented problem

……………………………………………………………………………………………….………………
…………………………………………………………………………………………………………………

Possible causes of the problem

…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

Counseling goal(s)

1. 2.

3. 4.

Options and issues discussed

Options Issues discussed - advantages and disadvantages
of each option (applicability)
A:

B:

C:
Best Option
Advantages
1. 1
2
3

Action plan and issues discussed

What to do? Guiding questions (when, where, how with
whom? Possible limitations identified and
solutions)
A:

B:

C:

Session Evaluation/outcomes
a) Successful (reasons) ……………………………………………………………...…………………
……………………………………………………………………………..…………………………

b) Un successful (reasons) …………………………………………………………………..

………………………………………………………………………………………………

c) Somehow successful (reasons)

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………………………………………………………………………………………………

Session ending (how?)

………………………………………………………………………………………………
……………..…………………………………………………………………………….…

Challenges faced and basic skills/techniques, qualities and knowledge applied

Challenges Skills/techniques, qualities and knowledge

applied
1. 1
2. 2
3 3

Areas well-done Areas that need improvement

Name of institution practicum supervisor:

Signature: Date: