Outline for Biopsychosocial Report of Sabina Spielrein

Date:

Age: ____ Gender: _____ F ___ M Race: _________ Marital status:

1. Current Family and Significant Relationships

(Include strengths, stressors, problems, recent changes, changes desired, and comments on family and relationship circumstances.)

2. Childhood/Adolescent History

(Include developmental milestones, past behavioral concerns, environment, abuse, school, social, and mental health)

3. Social Relationships

(Include strengths, stressors, problems, recent changes, changes desired, and comments on current circumstances.)

4. Cultural/Ethnic

(Include strengths, stressors, problems, recent changes, changes desired, and comments on current circumstances.)

5. Spiritual/Religious

(Include strengths, stressors, problems, recent changes, changes desired, and beliefs/practices to incorporate into therapy.)

6. Legal

(Include current and previous legal concerns and their impact on behavior, affect, and relationship.)

7. Education

(Include strengths, stressors, problems, recent changes, changes desired, and comments on current circumstances.)

8. Employment/Vocational

(Include strengths, stressors, problems, recent changes, changes desired, and comments on current circumstances.)

9. Military

(Include current impact on affect and behavior.)

10. Leisure/Recreational

(Include strengths, stressors, problems, recent changes, and changes desired.)

11. Medical/Physical Health

(Include