Systemic Case Conceptualization
For use with individual, couple, or family clients
Date:
Clinician:
Client/Case #:
I. Introduction to Client & Significant Others
List persons who will regularly participate in sessions
Adult(s)
Select Gender Age:
Select Gender Age:
Select Ethnicity Select Relational Status Occupation:
Select Ethnicity Select Relational Status Occupation:
Child(ren)
Select Gender Age:
Select Gender Age:
Select Ethnicity Grade: Select Grade School:
Select Ethnicity Grade: Select Grade School:
Other identifier:
Other identifier:
Other identifier:
Other identifier:
Others:
II. Presenting Concern(s)
Client’s Description(s) of Problem(s):
Select Person:
Select Person:
Select Person:
Select Person:
Extended Family Description(s) of Problems:
Broader System Problem Descriptions: Description of problem from referring party, teachers, relatives, legal
system, etc.:
Name:
Name:
III. Background Information
Trauma/Abuse History (recent and past):
Substance Use/Abuse (current and past; self, family of origin, significant others):
Precipitating Events (recent life changes, first symptoms, stressors, etc.):
Related Historical Background (family history, related issues, previous counseling, medical/mental health history,
etc.):
IV. Client/Family Strengths and Diversity
Strengths and Resources
Personal:
Relational/Social:
Spiritual:
Diversity: Resources and Limitations
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© 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org
Identify potential resources and limitations available to clients based on their age, gender, sexual orientation, cultural background,
socio-economic status, religion, regional community, language, family background, family configuration, abilities, etc.
Unique Resources:
Potential Limitations:
V. Family Structure
Family Life Cycle Stage (Check all that apply)
Single adult
Committed Couple
Family with Young Children
Family with Adolescent Children
Divorce
Blended Family
Launching Children
Later Life
Describe struggles with mastering developmental tasks in one or more of these stages:
Typical style for regulating closeness and distance in couple/family:
Boundaries with/between
Primary couple
Select & Children
Select & Children
Siblings
Extended Family
Friends/Peers/Others
Enmeshed
Enmeshed
Enmeshed
Enmeshed
Enmeshed
Enmeshed
Clear
Clear
Clear
Clear
Clear
Clear
Disengaged
Disengaged
Disengaged
Disengaged
Disengaged
Disengaged
NA Description/example:
NA Description/example:
NA Description/example:
NA Description/example:
NA Description/example:
NA Description/example:
Triangles/Coalitions
Cross-generational coalitions: Describe:
Coalitions with family of origin: Describe:
Other coalitions:
Hierarchy between Parents and Children
NA
Select: Effective Insufficient (permissive)
Select: Effective Insufficient (permissive)
Description/Example to illustrate:
Complementary Patterns between
Pursuer/distance
Over/under-functioner
Emotional/logical
Good/bad parent
Other:
Example of pattern:
and
Excessive (authoritarian)
Excessive (authoritarian)
Inconsistent
Inconsistent
:
Satir Communication Stances: Describe most commonly used stance under stress.
Select:
Congruent
Placator
Blamer
Superreasonable
Irrelevant
Select:
Congruent
Placator
Blamer
Superreasonable
Irrelevant
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© 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org
Select:
Congruent
Select:
Congruent
Describe pattern:
Placator
Placator
Blamer
Blamer
Gottman’s Divorce Indicators
NA
Select is Partner 1; Select is Partner 2
Criticism
Partner 1
Defensiveness
Partner 1
Contempt
Partner 1
Stonewalling
Partner 1
Failed repair attempts
Partner 1
Not accept Influence
Partner 1
Harsh start up
Partner 1
Superreasonable
Superreasonable
Irrelevant
Irrelevant
Partner 2: Describe:
Partner 2: Describe:
Partner 2: Describe:
Partner 2: Describe:
Partner 2: Describe:
Partner 2: Describe:
Partner 2: Describe:
VI. Interactional Patterns
Problem Interaction Pattern (A  B):
Start of tension:
Conflict/symptom escalation:
Return to “normal”/homeostasis:
Hypothesized homeostatic function of presenting problem: How might the symptom serve to maintain connection,
create independence/distance, establish influence, reestablish connection, or otherwise help create a sense of
balance in the family?
VII. Intergenerational & Attachment Patterns
Construct a family genogram and include all relevant information including:
 Names, ages and birth/death dates
 Relational patterns
 Occupations
 Psychiatric disorders and alcohol/substance abuse
 Abuse history
 Personality adjectives
Genogram should be attached to report. Summarize key findings below.
Substance/Alcohol Abuse:
Sexual/Physical/Emotional Abuse:
Parent/Child Relations:
Physical/Mental Disorders:
History Related to Presenting Problem:
Family strengths:
Describe:
NA
NA
NA
NA
NA
History:
History:
History:
History:
History:
Attachment Patterns: Describe most common attachment pattern for each
Select:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Select:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Select:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
Select:
Secure
Anxious
Avoidant
Anxious/Avoidant. Describe:
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© 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org
VIII. Solution-Based Assessment
Attempted Solutions that DIDN’T work:
1.
2.
3.
Exceptions and Unique Outcomes (Solutions that DID work): Times, places, relationships, contexts, etc. when
problem is less of a problem; behaviors that seem to make things even slightly better:
1.
2.
3.
Miracle Question Answer: If the problem were to be resolved overnight, what would client be doing differently the
next day? (Describe in terms of doing X rather than not doing Y).
1.
2.
3.
IX. Postmodern and Cultural Discourse Conceptualization
Dominant Discourses informing definition of problem:

Ethnic, Class and Religious Discourses: How do key cultural discourses inform what is perceived as a problem
and the possible solutions?

Gender and Sexuality Discourses: How do the gender/sexual discourses inform what is perceived as a problem
and the possible solutions?

Community, School, and Extended Family Discourses: How do other important community discourses inform
what is perceived as a problem and the possible solutions?
Identity Narratives: How has the problem shaped each client’s identity?
Local or Preferred Discourses: What is the client’s preferred identity narrative and/or narrative about the problem?
Are there local (alternative) discourses about the problem that are preferred?
X. Client Perspectives
Areas of Agreement: Based on what the client(s) has(ve) said, what parts of the above assessment do they agree
with or are likely to agree with?
Areas of Disagreement: What parts do they disagree with or are likely to disagree with? Why?
How do you plan to respectfully work with areas of potential disagreement?
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© 2013. Diane R. Gehart, Ph.D. All rights reserved. www.mftcompetencies.org