Case Study Project

Mock Counseling Intake Form on Walter White from the Breaking Bad Tv show. He will be diagnosed with: Antisocial Personality Disorder and Narcissistic Personality Disorder.

Complete the Mock Counseling Intake form and all questions about Walter White from the Breaking Bad Tv show.

Mock Counseling Intake Form:

Please describe the concerns you would like to discuss with a counselor:

How long have you had these concerns?

Please list the goals you wish to achieve in counseling. Consider the way you would like to feel, problems you wish to solve, and coping skills you would like to learn:

Please share any additional information you feel is important for your counselor to know:

What is the client's presenting concerns (impact of problem, severity, duration, symptoms, motivation to change, etc.)?

What is the client's overall life history (significant events such as divorce, loss of loved ones, major changes/adjustments, etc.)

What does the client's typical day look like (time wakes up, goes to sleep, work schedule, school schedule, etc.)?

How does the client do socially and with regard to their family (friends, family relationships and structure, peers, work relationships)?

Has the client ever been in legal trouble (for what, on probation, history of being incarcerated, etc.)?

What is the client's education history and goals (current major, learning disability, education goals, etc.)?

Is there a history of mental health problems in the client's family (whom, diagnoses, medications, treatment, etc.)?

Does the client currently use alcohol or non-prescribed drugs (type used, for how long, frequency, treatment, etc.)?

Has the client previously been involved in counseling or hospitalized (when, with whom, reason, duration, results, etc.)?

Is the client currently physically healthy (conditions or diagnoses, medication, reason, dosage, prescribing doctor, etc.)?

Has the client ever been abused in any way (by whom, type of abuse, was it reported, duration, etc.)?

Has the client ever attempted suicide (how many times, when, hospitalized, etc.)?

Is the client currently suicidal or homicidal (ideation, plan, lethality, intent, safety plan, assessment of hope, reasons to live, etc.)?

Are clinician actions or crisis plans needed? Yes No

What relevant cultural issues are there (age, gender, sexual orientation, spiritual/religious, ethnicity, and/or language issues, etc.)?

What does the client hope to accomplish in counseling?

DSM - V Diagnoses

CodeDiagnosis

Diagnostic Rational:

Treatment Goal #1:

Evidence-Based Treatment Strategy:

Treatment Goal #2:

Evidence-Based Treatment Strategy: