Counseling Case Conceptualization

Counselor: Tasha Andrews Client/Case #: CxxxGxxx

Date: 6/24/14

Symbols
AF=Adult Female; AM=Adult Male; CF=Child Female; CM=Child Male
Ex.=Example; Hx=History; NA=Not Applicable
I. Introduction to Client & Significant Others
AF AM CF CM Age:__16___ Ethnicity/Language: Black/English
Occupation/Grade in School: Student, High School Junior___
Relational/Family Status:
II. Presenting Concern(s)
Client Description of Problem(s): The client is a 16-year-old, Black, female who is a rising
junior in high school. The client has been diagnosed with Oppositional Defiant Disorder (ODD)
and mild Depression. Her presenting problems are mainly familial issues. She has had a
negative relationship with her mother for the past few years and was repeatedly kicked out of the
house. She has been in both foster care and a group home over the past two years. The client
just recently moved in with an aunt and is adjusting to her new living arrangement while trying
to deal with the emotional concerns of her negative relationship with her mother.
Significant Other/Family Description(s) of Problems:
No other descriptions available at
this time.
Broader System Problem Descriptions: Description of problem from referring party, teachers,
relatives, legal system, etc.:
_______:
_______:
III. Background Information
Trauma/Abuse History (recent and past):

Verbal abuse and physical abuse

Substance Use/Abuse (current and past; self, family of origin, significant others): Marijuana
Precipitating Events (recent life changes, first symptoms, stressors, etc.): Found out the man
she believed to be her father was not, has not had consistent communication with biological
father, mother recently married boyfriend who once abused the client.
Related Historical Background (family history, related issues, previous counseling,
medical/mental health history, etc.): The second born of 4 children, the only girl, with 3
brothers. Feels the mother treats her differently from her brothers. Mother was also the only
girl among her siblings growing up and had a negative relationship with her mother as reported
to the client by her uncles.
www.masteringcompetencies.com

IV. Client Strengths and Diversity

Client Strengths
Personal: Optimistic, open to change, willing to discuss concerns, very well-spoken, has a
good understanding of how to process her emotions and filter her thoughts
Relational/Social: Very personable and sociable, popular among peers, friendly and likes to
make others laugh
Spiritual: Has a basis of faith, relies on Higher Power, uses faith as a source of strength,
feels motivated to improve life so that she might inspire others, considers trials as a testing of
her faith from God
Diversity: Resources and Limitations
Identify potential resources and limitations available to clients based on their age, gender, sexual
orientation, cultural background, socio-economic status, religion, regional community, language,
family background, family configuration, abilities, etc.
Unique Resources: The client has a great sense of survival and determination to take care of
herself. She has experienced a lot of challenges and gained some confidence and belief in her
abilities to overcome.
Potential Limitations: The client reports that she can be overly aggressive when angered. She is
from a low-income home with few role models who have attained the educational and career
levels she wishes to achieve. She might also be limited by her lack of family support.
Taping Critique
What were your strength in the session (what did you do well)?
Good non-verbals, helped the client feel comfortable to be herself, promoted her strengths, had the right
balance of laymens terms and theoretical terms, met the client where she was, listened attentively.

What were your areas for improvement?

I dont think I took advantage of all the opportunities to dig deeper or hone in on the smaller details that
could have lead to greater discussion of her feelings, I had a hard time remembering how to incorporate
the cognitive-behavioral techniques that I studiedI believe this will be my greatest downfall. I think I
should have been more vocal; a good majority of my tape was the client talking. I know that that is the
expectation but she gave me so much information I feel like I should have interjected more to either
summarize, gain greater clarity, keep the clients focus on the topic at hand.
www.masteringcompetencies.com

*Questions or issues you would like to discuss during supervision?

I would like to discuss some of the clients behavioral concerns that led her to this point in life. With all
the things that she reports her mother used as excuses to remove her from the home, none of them seem to
line up with what Ive gathered from her personality in this session. She seems to be very respectful and
has presented her side of the altercations as if she has been harshly mistreated. I would like to get some
greater insight from my supervisor on the clients history.

*What if any were your multicultural concerns this week? If not, why not?
As discussed in my treatment plan, the client is of the same ethnicity, gender, and close in age range to the
clinician (practicum student) and has shown signs of great comfort during the initial phase. It has been
observed that the client uses a notable amount of slang and popular terms/phrases with the clinician. This
can be interpreted as a benefit for the therapeutic process since the client feels a cultural connection with
the clinician and can express herself freely without the pressure of trying to find jargon outside of her
normal means of communication.

*What if any were your ethical concerns this week? If not, why not?
No, there were no ethical concerns this week because my supervisor did a great job ensuring that all areas
were discussed and we were in compliance to conduct the recording with this client.

COMPLETE ONE OR MORE OF THE FOLLOWING SECTIONS (V-IX) BASED ON

THE THEORY(IES) YOU PLAN TO USE FOR YOUR TREATMENT PLAN
V. Psychodynamic Conceptualization
Psychodynamic Defense Mechanisms
Acting Out: Describe: Client shared that she would fight in school or not do her work
because she didnt care because she was hurt
Denial: Describe:
N/A
www.masteringcompetencies.com

 Displacement: Describe:

N/A

Help-rejecting complaining: Describe:

Humor: Describe: It appears the client uses humor to take the focus off of her problems,
she stated that she likes to make others feel good through humor even when she doesnt have
much to laugh about.
Passive Aggression: Describe: Client describes that she is easily angered and takes her
aggression from her negative familial relationships out on peers at school
Projection: Describe: Client describes her lack of trust and inevitable expectation of
disappointment in most relationships/friendships as a result of her projecting the outcome of
her relationship with her parents onto others
Projective Identification: Describe:
Rationalization: Describe:
She has rationalized that it is only a matter of time before
her aunt will, too, be ready for her to leave though she hasnt given any indication of such
Reaction Formation: Describe: Client is trying to move on with her life and not be in
relationship with her parents, reacting as if she doesnt care but does in actuality and desires
that love from them
Repression: Describe:
The client has repressed her feelings towards her father
Splitting: Describe:
Sublimation: Describe:
Suppression: Describe:
Other:
Object Relational Patterns
Describe relationship with early caregivers in past:
Spent a good portion of her life
thinking that her brothers father was her father, felt extremely distant from him only to find
out that he is not her biological father. Tried to form a relationship with her father, who is
also the father of one of her other brothers so she has always known him, but since he lives in
another city they have had very little interaction. Negative relationship with mother at the
start of teenage years. Had a good relationship with foster care guardian but was only there
for a short period of timerecalls that as soon as she was in a place with love and stability,
her mother took her out of foster care and made her come back home only to put her out
again.

www.masteringcompetencies.com

Was the attachment with the mother (or equivalent) primarily: Generally Secure
Anxious and Clingy Avoidant and Emotionally Distant Other:
Was the attachment with the father (or equivalent) primarily: : Generally Secure
Anxious and Clingy Avoidant and Emotionally Distant Other:
Describe present relationship with these caregivers:
Describe relational patterns with partner and other current relationships:

Ericksons Psychosocial Developmental Stage

Describe development at each stage up to current stage
Trust vs. Mistrust (Infant stage):
Autonomy vs. Shame and Doubt (Toddler stage):
Initiative vs. Guilt (Preschool age):
Industry vs. Inferiority (School age):
Identity vs. Role Confusion (Adolescence):
Intimacy vs. Isolation (Young adulthood):
Generativity vs. Stagnation (Adulthood):
Ego Integrity vs. Despair (Late Adulthood):
Adlerian Style of Life Theme
Control:
Superiority:
Pleasing:
Comfort:

www.masteringcompetencies.com

Basic Mistake Misperceptions:

VI. Humanistic-Existential Conceptualization

Expression of Authentic Self
Problems: Are problems perceived as internal or external (caused by others, circumstance,
etc.)? Predominantly internal Mixed Predominantly external
Agency and Responsibility: Is self or other discussed as agent of story? Does client take
clear responsibility for situation? Strong sense of agency and responsibility
Agency in some areas Little agency; frequently blames others/situation Often
feels victimized
Recognition and Expression of Feelings: Are feelings readily recognized, owned, and
experienced? Easily expresses feelings Identifies with prompting Difficulty
recognizing feelings
Here-and-Now Experiencing: Is the client able to experience full range of feelings as they
are happening in the present moment? Easily experiences emotions in present
moment Experiences some present emotions with assistance Difficulty with
present moment experiencing
Personal Constructs and Facades: Is the client able to recognize and go beyond roles? Is
identity rigid or tentatively held? Tentatively held; able to critique and question
Some awareness of facades and construction of identity Identity rigidly defined;
seems like fact
Complexity and Contradictions: Are internal contradictions owned and explored? Is client
able to fully engage the complexity of identity and life? Aware of and resolves
contradictions Some recognition of contradictions Unaware of internal
contradictions
Shoulds: Is client able to question socially imposed shoulds and oughts? Can client balance
desire to please others and desire to be authentic? Able to balance authenticity
with social obligation
Identifies tension between social expectations and personal desires Primarily
focuses on external shoulds
List shoulds:
Acceptance of Others: Is client able to accept others and modify expectations of others to be
more realistic?
Readily accepts others as they are Recognizes expectations of others are
unrealistic but still strong emotional reaction to expectations not being met
Difficulty accepting others as is; always wanting others to change to meet
expectations
Trust of Self: Is client able to trust self as process (rather than a stabile object)? Able to
trust and express authentic self Trust of self in certain contexts Difficulty
trusting self in most contexts
www.masteringcompetencies.com

Existential Analysis
Sources of Life Meaning (as described or demonstrated by client):

General Themes: Personal achievement/work Significant other Children

Family of origin Social cause/contributing to others Religion/spirituality
Other:
Satisfaction with and clarity on life direction:
Clear sense of meaning that creates resilience in difficult times
Current problems require making choices related to life direction
Minimally satisfied with current life direction; wants more from life
Has reflected little on life direction up to this point; living according to life plan
defined by someone/something else
Other:
Gestalt Contact Boundary Disturbances
Desensitization: Failing to notice problems
Introjection: Take in others views whole and unedited
Projection: Assign undesired parts of self to others
Retroflection: Direct action to self rather than other
Deflection: Avoid direct contact with another or self
Egotism: Not allowing outside to influence self
Confluence: Agree with another to extent that boundary blurred
Describe:

VII. Cognitive-Behavioral Conceptualization

Baseline of Symptomatic Behavior
Symptom #1 (behavioral description):
Frequency:
Duration:
Context(s):
Events Before:
Events After:
www.masteringcompetencies.com

Symptom #2 (behavioral description):

Frequency:
Duration:
Context(s):
Events Before:
Events After:
A-B-C Analysis of Irrational Beliefs
Activating Event (Problem):
Consequence (Mood, behavior, etc.):
Mediating Beliefs (Unhelpful beliefs about event that result in C):
1.
2.
3.
Becks Schema Analysis
Identify frequently used cognitive schemas:
Arbitrary inference:
Selective abstraction:
Overgeneralization:
Magnification/Minimization:
Personalization:
Absolutist/dichotomous thinking:
Mislabeling:
Mindreading:
www.masteringcompetencies.com

VIII. Family Systems Conceptualization

Family Life Cycle Stage
Single adult Marriage Family with Young Children Family with Adolescent Children
Launching Children Later Life
Describe struggles with mastering developmental tasks in one of these stages:

Typical style for regulating closeness and distance with others:

Boundaries with
Parents: Enmeshed Clear Disengaged NA: Diversity note:
Siblings: Enmeshed Clear Disengaged NA: Diversity note:
Significant Other: Enmeshed Clear Disengaged NA: Diversity note:
Children: Enmeshed Clear Disengaged NA: Diversity note:
Extended Family: Enmeshed Clear Disengaged NA: Diversity note:
Other:______: Enmeshed Clear Disengaged NA: Diversity note:
Triangles/Coalitions
Coalition in family of origin: Describe:
Coalitions related to significant other: Describe:
Other coalitions:
Hierarchy between Self and Parent/Child NA
With own children: Effective Rigid Permissive
With parents (for child or young adult): Effective Rigid Permissive
Complementary Patterns with
: Pursuer/distancer; Over/under functioner;
Emotional/logical; Good/bad parent; Other:__________; Ex:

www.masteringcompetencies.com

Intergenerational Patterns
Family strengths:
Substance/Alcohol Abuse: N/A; Hx:
Sexual/Physical/Emotional Abuse: N/A; Hx:
Parent/child relations: N/A; Hx:
Physical/Mental Disorders: N/A; Hx:
Historical incidents of presenting problem: N/A; Hx:
IX. Solution-Based and Cultural Discourse Conceptualization (Postmodern)
Solutions and Unique Outcomes
Attempted Solutions that DIDNT work:

Exceptions and Unique Outcomes (times, places, relationships, contexts, etc. when problem is
less of a problem; behaviors that seem to make things even slightly better):

Miracle Question Answer: If the problem were to be resolved overnight, what would client be
doing differently the next day? (Describe in terms of doing X rather than not doing Y).
1.
2.
3.
Narrative, Dominant Discourses, and Diversity
Dominant Discourses informing definition of problem:
Cultural, ethnic, SES, religious etc.:
Gender, sexual orientation, etc.:

www.masteringcompetencies.com

10

 Contextual, family and other social discourses:

Identity/Self Narratives: How has the problem shaped clients identity?:

Local or Preferred Discourses: What is the clients preferred identity narrative and/or narrative
about the problem? Are there local (alternative) discourses about the problem that are
preferred?:

www.masteringcompetencies.com

11