Case History

Name:
Age:
Sex:
Occupation:
Part I
1. Current complaints, onset and duration
2. Recurrent/sporadic/constant
(Recognize patterns or triggers)
3. Comorbid conditions
(Psychological or physical)
4. Sleep, appetite, mood
5. Difficulties faced while trying to achieve these goals
6. Behavioral patterns
7. Reinforcements
(Thoughts, behaviors, relationships, peers or other environmental factors that
may be reinforcing these patterns)
8. Coping mechanisms or techniques previously used
-Recognize healthy and unhealthy coping mechanisms
- Effectiveness of said techniques
- Why did they work?
- Healthy alternatives for unhealthy mechanisms
9. Protective factors
(Support system, skills, strengths, family, resources etc.)
10. Impact on other areas
(Self-esteem, interpersonal relationships, academics, career etc.)

Part II
1. Setting goals for the month
2. Splitting the goal into four areas (one for each week)
3. Behaviors to increase/ decrease
For example:
 - reduce: mindlessness, mood dependent behavior, impulsive behavior,
extreme emotions
- increase: accountability, consistency, other positive habits that the client
has been practicing or has benefitted from in the past
4. Describe what your regular day looks like.
- Use as a template for scheduling
- Incorporate activities
- Shift activities that require more effort to the time of the day when they
feel more alert and motivated
5. Assessments or Screening tools

Part III
1. Recommendations
- Maintain a realization list
- Make a to- do list before going to bed
- Establish morning/ night- time rituals
2. Concepts explained to the client
3. Links /posts shared
4. Podcasts, books or audio books
5. Personalized Affirmations