Case Study Assignment Template
Client Concerns
| Symptoms | Behaviors | Stressors |
| (Examples) Sadness | Trouble sleeping | Parents’ divorce |
| Fatigue | ||
| No appetite | ||
| Hopelessness |
Client Concerns: Using a table as in the example above, identify and list the client’s symptoms and any other key issues/concerns noted. (Modify the chart size as needed.) For example, these may include biological, psychological, social, and/or spiritual problems. If symptoms/behaviors overlap, you only need to list them once.
Assessment
Give a short (3-5 sentences) overview of the assessment, what it would help you learn about the client, and why you chose it over other assessments.
Diagnostic Impression
Provide the primary diagnostic impression based upon the DSM-5. Include the ICD-10 code and full name of each diagnosis.
Signs and Symptoms
| DSM-5 Diagnostic Criteria: disorder name and code number | Client’s Signs/Reported Symptoms: |
| Criterion A: | |
| Criterion B: | |
| Criterion C: | |
| Criterion D: | |
| Criterion E: | |
| Criterion F: |
Other DSM-5 Conditions Considered
List other DSM-5 conditions you considered and the process you went through to decide they were not the correct diagnosis.
Developmental Theories and/or Systemic Factors
Discuss theories of normal and abnormal development and/or systemic and environmental factors that affect human development, functioning, and behavior.
Multicultural and/or Social Justice Considerations
Discuss multicultural or social justice considerations that went into your diagnostic thought process.
Treatment Recommendations
Key Issues for Treatment
- Top 2-3 symptoms/issues you believe are involved in the case study, in order of importance.
- X
- X
Recommendations for Individual Counseling
Identify two treatment recommendations for individual counseling based on the 2-3 key issues you identified. You will need to cite these recommendations using peer-reviewed journal articles, focusing on the treatments a counselor would provide. Medication or referral to another type of therapy may be a recommendation, but since these are case management, they do not count towards the two required recommendations and should not be the primary recommendations listed.
Specific Considerations
You will need to provide one paragraph (total) responding to the questions that correspond with case study.
- How do multiple diagnoses affect the decision-making process for diagnostic impressions and treatment planning?
- How do you decide what disorder you might address first, or do you address both simultaneously?
- How does a substance use disorder affect the process of diagnostic impressions and the order you make treatment recommendations?
Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.
