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Case Presentation Template

Student Name

School of Behavioral Sciences, XXXXX University

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

Integration

Text here

Personal Model of Counseling

Text here

References

Provide all references here (at least five)

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