A General information: Gender, age, class, grade, ethic, background, state of health, physical characteristics.

B client’s presenting problem
what problem / issue does black cloud present as needing change? does black cloud recognize a necessity for change? to what degree? what do you see as deeper problems, if any , the black cloud has not identified or verbalized ?

C Behavioral description
• what behaviors are engaged in black cloud that can actually be observed by others?
• what behaviors are specifically in need of change ?

D affective manifestation
• what feelings or emotional states does he report experiencing?
• what unspoken feeling or emotional states does he not verbalize or is not aware of? what needs are not being met?
• cognitive patters
• Describe the beliefs that black cloud seems to have in regards to each of following categories? self , people community : and world.
• what are his general thoughts patterns (rigid, scattered, focused, )
• is he internal or external locus of control ?
F interpersonal relationships
• How does he interact with others? Be specific
• What friends or social support systems does Black cloud have in his environment?•                                                                                                                   Howe does he cope with problems? {avoidance, directly }
G contributing factors :
• What personal history may be contributing to the problem?
• What traumatic experiences / event may be contributing to problem ?
• What specific family of origin issues may contributing to the problems?
• What general environment factors have combined to influence him both positively and negatively?
• What specific strengths can be identified?
• What are the multicultural issues that you foresee as possible barriers? {note: consider not only your personal worldview, but also “how might black cloud perceive you ?
H formal Assessment
What formal assessment would you recommend ?

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