PATIENTS NAME:

DATE: February 28, 2014

SUMMARY FORMULATION:
In summary, the client has feelings of hostility towards the father due to him leaving the family when the client was still a child. This event has led her to feel
rejected and she showed signs of depression when the topic is about the clients. It is also seen in the test results for both MD5 and SRA Verbal Form that the
client shows below average grade that indicate she may have difficulties with her academic life specifically in the verbal and numerical aspect

MULTI-AXIAL DIAGNOSIS:
Axis I: V79.01
Axis II: V79.01
Displacement: Multiple Relationships
Axis III: Bleeding Bowel
Axis IV: Problem with Primary Support Group: Family Seperation
Father left the family when the client was still a child
Axis V: GAF: 92 (intake)
93 (current)

Level of Supervision: Medium

Expected Duration of Casework: 1 to 2 months


PROBLEM IDENTIFIED OBJECTIVES PLAN OF ACTION TIME FRAME EVALUATION INDICATORS
Abandonment Issue of Client
towards Parental Figure: Father

To reduce feeling of
hostility the client
towards the father
Client Centered Therapy:
Talk Therapy

1 month (six
sessions, 30 1
hour session)

Reduction of hostility
towards the father

To lessen feelings of
depression towards the
clients father
Gestalt Therapy:
Empty Chair Technique

1 month ( six
session, 30 min - 1
hour session)

Less of feeling of depression
and insecurity


To lessen feelings of
insecurity
Therapeutic Role-Playing

1 month (six
session, 30 1
hour session)
Able to find closure with the
issue and have better
output in life
To find a bit of closure
towards the issue


To help release negative
emotion


Prepared by: