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Cognitive functioning |
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Does the client seem to be of normal intelligence? |
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Is the client oriented to person, place, and time? |
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Is there evidence of logical problem-solving thinking or capacities? |
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Does the client seem preoccupied by anything? |
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Is there evidence of delusional thinking? |
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If so, are delusions bizarre? |
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Is the client's thinking coherent and goal directed? |
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Does the client exhibit good judgment? |
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Does the client show any memory problems? |
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If so, are they immediate, recent, or remote? |
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Does the client report hearing or seeing things that others don't seem to hear or see? |
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Is there anything unusual about the client's manner of speaking? |
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Emotional functioning |
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What emotions does the client describe in relation to the presenting problem? |
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Do the client's emotions appear to be congruent with the client's thoughts? |
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How has the client been feeling the majority of time over the past year? |
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Has the client's emotional state created difficulties for the client recently? |
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Over the past year? |
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How stable are the client's emotions during the interview? |
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Does the client exhibit any blunting or flattening of affect? |
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Does the client seem unusually animated or expansive in his or her expression of emotions? |
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Physical functioning/Medical history |
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Does the client's level of energy or activity seem unusual (e.g., lethargy or hyperactivity)? |
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Does the client display any odd or peculiar motor behaviors (e.g., motor and/or vocal tics, mannerisms, or stereotypical movements)? |
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Does the client report any medical conditions or problems? |
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Has the client been examined by a physician during the past year? |
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Results of exam? |
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Does the client take any prescription medications for current ailments? |
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Does the client take any over-the-counter medications on a regular basis? |
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Has the client ever had any psychological or mental health-related treatment in the past (including inpatient, outpatient, and/or psychotropic medications)? If so, describe in detail. |
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Does the client present with any disabilities? |
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Substance use |
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Does the client use alcohol? If so, what kind? How often? |
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Does the client use any other substances? |
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Has the client experienced any social, occupational, or legal problems associated with his or her use of alcohol and/or other drugs? |
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Has anyone ever encouraged the client to stop or cut back his or her use of substances? |
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Has the client ever been treated for a drug or alcohol problem? |
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Relational Functioning |
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Family |
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Does the client reside with other family members? |
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What is the client's relationship with other family members? |
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Does the client's presenting problem involve other family members? |
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Is there any history of family problems? Have any family members had problems similar to the client's current situation? |
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Would family members be willing to participate in treatment if necessary? |
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Significant other |
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Does the client have a relationship with a significant other? |
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If so, what is the length of the relationship? The quality? |
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Does the client's presenting problem involve the significant other? |
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Would the significant other be willing to participate in treatment if necessary? |
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Social support system |
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Does the client have close friends and/or acquaintances? |
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What is the quality of these relationships? |
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Does the client feel that these are supportive relationships? |
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Are any members of the client's social support system involved in the presenting problem? |
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Occupational/School Functioning |
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Employment |
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Is the client employed? |
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Underemployed? |
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Unemployed? |
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If so, where is the client employed? |
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Full-time? |
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Part-time? |
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What is the client's occupation? |
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If the client is not employed, is he or she retired? |
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Does the client's presenting problem affect his or her job? |
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School |
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Is the client a student? |
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Full-time? |
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Part-time? |
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What is the client studying? |
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Does the client's presenting problem affect his or her studies? |
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Legal Problems |
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Does the client have current problems with the legal system? |
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If so, what types of problems? |
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Has the client had any history of problems with the legal system? |
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If so, what types of problems? |
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Has the client ever been convicted of a crime? |
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Diversity Issues |
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What is the client's ethnicity? |
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What is the client's nationality? |
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If relevant, immigration status? |
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How acculturated does the client appear to be? |
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Is English the client's first language? |
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Second? |
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Third? |
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What are some of the client's beliefs about mental health issues? |
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Does the client engage in any religious or spiritual practices? |
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Has the client discussed his or her sexual orientation? |
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Does the client utilize any cultural resources? |
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Does the client perceive barriers to accessing resources? |
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Client's Strengths and Resources |
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What do you perceive to be the client's strengths? |
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How can these strengths be utilized to assist the client in resolving the current issues? |
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What client resources could be utilized to enhance coping? |
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What agency resources could be utilized to intervene with the client? |
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