FISA DE EVALUARE SI CONSILIERE PSIHOLOGICA

Numele si prenumele clientului…………........................................................................... Varsta.................

Data nasterii................................ Sex.......................................... Nationalitate............................................

Domiciliu........................................................................................................................................................

Status marital.................................................................................................................................................

Copii..............................................................................................................................................................

Cu cine locuieste..........................................................................................................................................

Nivel de educatie...........................................................................................................................................

Motive neabsolvire ciclu educational la care era inscrisa persoana ........................................................................................................................................................................

Profesie.....................................................Loc de munca...............................................................................

De cat timp..............................................Schimbarea domeniului muncii......................................................

Perioade in care nu a putut merge la scoala sau serviciu.......................................................................................................................................................................

Tratament curent...........................................................................................................................................

Motivul prezentarii ........................................................................................................................................

Descrierea acurata a tabloului clinic, debutul si evolutia acestuia .............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Prezenta unor boli somatice sau psihice, internari anterioare ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Conditiile social-economice, informatii despre familie, situatii stresante...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

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Componenta psihică

Investigată

Interviu Teste psihologice pasibile a fi efectuate

Se noteaza cu X daca e efectuat

Factorul perceptiv Bender-Santucci

Benton etc.

Comportament

Memorie.

Rey- figură complexă,

Rey - verbal , Wechsler - Scala de Memoria Cifrelor etc.

Dispoziţie afectivăScale clinice/Chestionarele de distres, anxietate, depresie, emoţii pozitive etc.

PersonalitateMMPI, Optimism/pesimism, raţionalitate/iraţionalitate, probe proiective etc.

Depersonalizare

Derealizare

Obsesii Scale clinice

Compulsii Scale clinice

Atenţie Toulouse-Pieron, Praga etc.

Gândire şi inteligenţă

Matrici Progresive Raven, Scalele de inteligenţă Wechsler, Probele piagetiene, Probe de diagnostic formativ, Stilul cognitiv raţional/iraţional etc.

Orientarea

Conştiinţa bolii

Componentele psihologice investigate în cursul interviului clinic

Surprinderea dinamicii si consecintelor psiho-sociale. Evaluarea psihologica

detaliata a:

stării prezente a pacientului şi a modului în care acesta se adaptează la situaţiile

concrete......................................................................................................................

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problematicii comportamentelor simptomatice

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situaţiei somatice a pacientului

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dinamicii şi structurii personalităţii

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comportamentului interpersonal

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principiilor morale şi atitudinilor sociale

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mecanismelor defensive şi de coping precum şi a conflictelor şi dinamicii lor

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identităţii şi imaginii de sine

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determinanţilor sociali şi situaţiilor curente de viaţă

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problemelor de ecologie socială şi familială

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controlului şi autocontrolului comportamentului şi emoţiilor

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Stabilirea listei de probleme

Recomandari:

Concluzii:

Stadiul discutiei Finalizat

Nefinalizat

Data programarii pentru urmatoarea sedinta …………………………........................................…….si urmatoarea tema de discutie…………………………………….......................…………………………………………………………………………………………………............................………………….…………………………………………………………………………............................………………….…………………………………………………………………………………………….............................

Data Semnatura psiholog ............ Zagrean Camelia-Elena