Therapist's Guide to Clinical Intervention - Sigmund Freud

Effects of on Family/Support System:
Daily Activities that: A. support abstinence:
B. encourage usage:
History of Sexual/Physical Abuse (victim/abuser):
Sexual Orientation:
Education:
Vocational History:
Leisure/Social Interests:
Current Occupation:
Current Employer:
Impact of on Job Performance:
EAP? Yes_ No_ Name: Phone:
Socioeconomic/Financial Problems:
Legal: DWI: Yes_ No_ Court Ordered: Yes_ No_
Patient's Perceptions of Strengths and Weaknesses:
Preliminary Treatment Plan: List presenting problems based on initial assessment of the
client's physical, emotional, cognitive, and behavioral status.
Detox: Yes No Explain:
Rehab: Yes No Explain:
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