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Clinical Formulation Cheat Sheet
Past and Current Mental Health Issues:
DSM-5 dx Past trauma Self-esteem, self-worth, and self-acceptance issues Current support system
Socioeconomic Status:
Income level Education Occupations Place of residence
Cultural Background:
Religiosity Race Ethnicity Cultural identity Family of origin culture: o Relationship models associated with primary care giver o Exposure to infidelity within the family system o Impact of family of origin on relationship worldview and adult attachments
Sexual Health and Identity:
Sexual Orientation
Any performance, desire, pain conditions
Menopause/Andropause
Hormone Therapy
Major Life Events (Positive or Negative):
Diagnosis of a major medical issue
Newborn
Promotion
Death of a family member or a major loss
Clinical Formulation Cheat Sheet
Past Relationships History:
How many long-term past relationships have you had?
How long did each relationship last?
How and why did these relationships end?
Were there any incidents of infidelity in these relationships?
If yes, how was the infidelity discovered, how was it handled, and how did it impact both parties?
Did any of these past relationships have any impact on the dyad’s current relationship struggle? Please describe the impact?
C urrent Relationship History:
What were their circumstances that led to starting the current relationship?
How and why did the relationship progress to the point of exclusivity?
What are some of the significant events and milestone in the current relationship and how did these evets impact the relationship?
Were there any significant events that impacted the clients level of satisfaction in the relationship?
How did the clients handle these issues? Did any of these issues contribute to the current infidelity behavior?
Relationship Dynamics:
How does the couple fare in the following areas:
Compatibility
Communication
Conflict resolution
Managing life stressors and adapting to change
Level of investment
Equality
