1(6)
Namn
Personnummer
Terapeut
Datum
Kort sammanfattning av sökorsak och aktuell situation ___________________________________________________________________________________________
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Kort bakgrund om studier/arbete, relationer, fritid, hälsa ___________________________________________________________________________________________
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Personliga styrkor, metaforer för starka sidor, lärorika erfarenheter och resurser i omgivningen ___________________________________________________________________________________________
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KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16 2(6)
A
Vilka är problemen?
Problembeskrivning ___________________________________________________________________________________________
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Problemlista (0-‐10) __________________________________________________________________________________/________
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Skattning av hur stora problemen är i patientens liv (1-‐10, fyll i ovan) Diagnoser:_________________________________________________________________________________
Mediciner: _________________________________________________________________________________
Psykometri:__________________________________________________________________
Utlösande faktorer (triggers) och modererande faktorer ___________________________________________________________________________________________
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Problemets historia – när började det, tidigare behandlingsförsök, egna lösningsförsök ___________________________________________________________________________________________
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Prioritering av problemen ___________________________________________________________________________________________
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KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16 3(6)
B
Varför går det inte över?
Onda cirklar t.ex. säkerhetsbeteenden, flykt-‐ och undvikanden, minskning av aktivitetsnivå, tankar/tolkningar, och/eller selektiv uppmärksamhet ___________________________________________________________________________________________
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Överskott Underskott Yttre Inre Funktionell analys (t.ex. SORK, ABC, kedjeanalys) __________________________________________________________________________________________
KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16 4(6)
C
Varför just jag?
Sårbarhetsfaktorer: Relevant barndomsdata och livserfarenheter som format sårbarheter ___________________________________________________________________________________________
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Grundantaganden ___________________________________________________________________________________________
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Livsregler ___________________________________________________________________________________________
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Automatiska tankar och inre respons i problemsituation ___________________________________________________________________________________________
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Kritiska livshändelser som föregått problemdebuten (Varför just nu?) ___________________________________________________________________________________________
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Motivationsanalys: positiva/negativa konsekvenser av att problemet blir löst, för-‐ och nackdelar med behandling, hinder och underlättande faktorer för att kunna arbeta med problemet ___________________________________________________________________________________________
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KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16 5(6)
Sårbarhet
Namn: Datum:
Grundföreställningar
Kritiska livshändelser
Problem (T+K+B+Kr)
Triggers
Vidmakthållande
Vidmakthållande
Vidmakthållande
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KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16 6(6)
D
Vad ska vi göra åt det?
Behandlingsmål övergripande ___________________________________________________________________________________________
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Delmål ___________________________________________________________________________________________
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Planerade behandlingsinterventioner ___________________________________________________________________________________________
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KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16