Clinical  Intake Report  Instructions

Regardless of its purpose,  no  psychological evaluation is  complete  without historical or background information about  an   examinee .  Historical information about  the  examinee  is absolutely necessary to  an  evaluator when  he/she  interpret s results from  psychological test s because  similar patterns of  test  scores could suggest different things about examinees wit h different life experiences.   Background information usually  is  gathered in an interview, but a biographical information sheet completed by the ex aminee also can be very useful.   Typically, information regarding the examinee’s family and social/relationship history, work experience, educational history, and medical and legal problems is gathered.  Additionally, the evaluator is interested in an examinee’s self-perceptions, significant life experiences, goals/aspirations  etc .   

For the current assignment, imagine that you are a therapist at a Chris tian Counseling C enter , and y ou are assigned a new client from whom you must collect historical information.

Step 1 : Conduct a  Clinical Interview . •  A  template for  a   comprehensive  Clinical Interview is provided in the Assignment Instructions folder  in  BlackBoard . •  U se the  Clinical Interview template to conduct  clinical interview on yourself or on a  willing and  generous  volunteer  who is  at least 18 years old ! •  You  DO   NOT   have  to complete the entire interview. ο  C omplete the following  4  required sections  of the Clinical Interview: 1.  Demographic Information 2.  Initial/General Impressions 3.  Reason for Coming/Presenting Concerns 4.  Initial Treatment Recommendations ***** ο  S elect  4 of the following optional sections  of the Clinical Interview to complete: 1.  Current and Recent Situation 2.  Previous Assessments/Counseling Experiences 3.  Birth and Developmental History 4.  Family of Origin/Family Constellation 5.  Early Recollections 6.  Marital and Family Data 7.  Medical History 8.  Education and Training 9.  Work Background/History 10.  Recreation, Interests and Pleasures 11.  Social Support, Communication Network, and Social Interests 12.  Self-Description 13.  Choices and Turning Points in Life 14.  Personal Goals and View of the Future •  Remember  that  any information you gather about the examinee must be kept  COMPLETELY CONFIDENTIAL!   In conducting this clinical interview, you are bound by the same ethical and professional standards of all mental health care providers (e.g., psychologists, licensed counselors, licensed clinical social workers etc.)

Step 2 : Write a  Clinical Intake Report . •  Based on the information that you gather in the clinical interview, write a Clinical Intake Report. •  Your report should include summaries of the 4 required sections of the clinical interview described above as well as summaries of the 4 optional sections that you selected.  •  *****IMPORTANT NOTE :  In the Initial Treatment Recommendations section of your clinical intake report, you are required to identify and describe  at least  ONE  Biblically-based treatment recommendation  given your examinee’s reason for coming/presenting concern(s).   Additonally , you must provide  at least  ONE  scriptural citation  that supports the use of the Biblically- based  intervention that you described. •  Include an APA-formatted Title Page to begin your report. •  Your completed report should be  typed, double-spaced, and 3 – 5  pages in length  (not including the title page) . •  Please DO NOT refer to  the  examinee by his/her full name  in your report .  Instead, refer to  the  examinee  by his/her title and first letter of last name.   ( For example, refer to Dr. William Jones as “Dr. J,” or refer to unmarried Samantha Murphy as “Ms. M.” ) •  W rite in the third  person (e.g., Dr. J. is a  a  42-year-old, married, white male…,  “ “ His greatest strengths are….” •  A template for a  Clinical Intake Report is  provide   in the Assignment Instructions f older in  BlackBoard .   B e sure to either use or refer to this template when putting together your final report. •  A sample completed  Clinical Intake Report also is provided in the Assignment Instructions folder in  BlackBoard .   ο  This  sample  document is a comprehensive report  and includes a summary of all of the typical, major elements of a full clinical interview. ο  Y our report will  NOT be as long as the sample!  Your report will  include only  8 sections —the  4 required sections  and  4 optional sections  that you chose .   ο  R efer to this sample report  only  as a guide for how to  approach your final report.

Be sure to carefully review the  g rading rubric posted in the Assignment Instructions folder so that you know exactly what is expe cted of you when completing this  assignment.