Terror in the Family

Section I: Demographic Information on the Family A. Adults in the Home: Name Age Status       B. Provide a brief description of each individual in the home           Section II: Presenting Problem and Background Information A. Provide a brief description of the presenting problem       B. Background Information   💕💕💕1) Recent Background (recent life changes, precipitating events, first symptoms, stressors, etc.):           💕💕💕2) Related Historical Background (family history, related issues, past abuse, trauma, previous counseling, medical/mental health history, etc.)         Section III: Systemic Assessment   💕💕A. Client/Relational Strengths (Each Family Member) 1) Personal/Individual 2) Relational/Social 3) Spiritual   💕B. Family Structure and Interaction Pattern 💕💕1) Couple Boundaries [ ] Clear [ ] Enmeshed [ ] Disengaged [ ] Other __________   Rules for closeness/distance: