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Therapist's Guide to Clinical Intervention - Sigmund Freud

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ADULT PSYCHOSOCIAL<br />

IDENTIFYING INFORMATION (age, gender, ethnicity, marital status):<br />

Presenting Problem:<br />

Current Social Information:<br />

1. Describe the present living arrangements (include with whom you are living<br />

with, and a brief description of these relationships):<br />

2. How long have you been married/dating/living <strong>to</strong>gether? Describe this<br />

relationship (include occupation and age of significant other):<br />

3. How many children do you have? (name, sex, age):<br />

4. Are there any significant problems with any of these children? (describe):<br />

5. Give details of previous relationships/marriages:<br />

Adult Psycbosocial 463

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