Posted: April 6th, 2017
Student Name: Case Name / #:
[Primary and contributing concerns for the client]
[What ethical, legal, cultural, or other key considerations need to be considered with this client when creating a treatment plan?]
Axis I: [be sure to provide full title and code]
Axis II:
Axis III:
Axis IV:
AXIS V: GAF =
Diagnostic Comments: [1 paragraph]
[Here, provide a brief—no more than 1 paragraph—comment on the justification for your diagnosis]
[How would your selected theoretical orientation explain the primary issues for this client, and thus which interventions / treatments would be best suited for this client?]
Presenting Issue #1:
Strengths:
Barriers:
Goals:
Interventions:
Modality / Duration:
Measure of Progress:
Presenting Issue #2:
Strengths:
Barriers:
Goals:
Interventions:
Modality / Duration:
Measure of Progress:
Presenting Issue #3:
Strengths:
Barriers:
Goals:
Interventions:
Modality / Duration:
Measure of Progress:
References from Empirically Supported Research
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