1(6) Namn Personnummer Terapeut Datum
1(6) Namn Personnummer Terapeut Datum Kort sammanfattning av sökorsak och aktuell situation ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Kort bakgrund om studier/arbete, relationer, fritid, hälsa ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Personliga styrkor, metaforer för starka sidor, lärorika erfarenheter och resurser i omgivningen ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________________________ 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 ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Problemlista (0-‐10) __________________________________________________________________________________/________ __________________________________________________________________________________/________ __________________________________________________________________________________/________ __________________________________________________________________________________/________ __________________________________________________________________________________/________ Skattning av hur stora problemen är i patientens liv (1-‐10, fyll i ovan) Diagnoser:_________________________________________________________________________________ Mediciner: _________________________________________________________________________________ Psykometri:__________________________________________________________________ Utlösande faktorer (triggers) och modererande faktorer ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Problemets historia – när började det, tidigare behandlingsförsök, egna lösningsförsök ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Prioritering av problemen ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________________________ 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 ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 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 ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Grundantaganden ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Livsregler ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Automatiska tankar och inre respons i problemsituation ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Kritiska livshändelser som föregått problemdebuten (Varför just nu?) ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Motivationsanalys: positiva/negativa konsekvenser av att problemet blir löst, för-‐ och nackdelar med behandling, hinder och underlättande faktorer för att kunna arbeta med problemet ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________________________ 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 __________________________________________________________________________________________ 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 ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Delmål ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Planerade behandlingsinterventioner ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ __________________________________________________________________________________________ KBT-‐baserad fallformulering Efter Westbrook et al. 2011 och Bengt E Westling 2013 Eva Marie Sjöberg, 2015-‐03-‐16
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