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Entrevista Psicológica para Adulto

Entrevista Psicológica para Adulto

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Published by: Psicologa Bernardita Soto Quilicura on Aug 27, 2011
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11/30/2015

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Entrevista Psicológica para Adulto/a

1. Datos de Identificación:
Nombre_________________________________________________________
Edad _______________________Cédula _____________________________
Estado Civil ______________
Escolaridad_______________Ocupacion______________________________Do
micilio________________________________________________________Telefo
no________________ Derivación _______________________________
ec!a ____________________Terapeuta______________________________
". Encuadre al entrevistado en donde se e#plica $ue primeramente se
reali%ar& un recorrido por su !istoria familiar ' las diferentes etapas dentro
del desarrollo de su vida.
(. )eno*rama
+. Observaciones
,- .ue/a inicial
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
0- 1or$ue a!ora ____________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
C- 2otivo de la consulta ______________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
D- 3istoria ' circunstancia actual del motivo de consulta 4dónde5 cu&ndo5
cómo5 con $uién- __________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
________________________________________
E- .ue de/a de !acer o $uisiera !acer ' no !ace como consecuencia del
problema ____________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
___________________________________________
- 6O78CIONE6 INTENT,D,6
1. 1or el paciente identificado _______________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
___________________________________________
". 1or los otros __________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________
(. E#itosas _____________________________________________
_______________________________________________________
_________________________________________________
6e mantuvieron____________________________________________________
________________________________________________________________
No se mantuvieron _________________________________________________
___________________________________________________________________
_____________________________________________________________
91or$ue fueron abandonadas: ______________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________
;. T<,T,2IENTO6 ,NTE<IO<E6 _______________________________
____________________________________________________________
________________________________________________________
,- .ue sirvió _______________________________________________
__________________________________________________________
__________________________________________________________
_________________________________________________
0- .ue no sirvió ____________________________________________
__________________________________________________________
__________________________________________________________
_________________________________________________
=. T<,T,2IENTO6 ,CT8,7E6 4 de cual$uier tipo $ue se consideren
pertinentes- ________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
__________________________________________________
7. ,CTIT8DE6 > O1INIONE6 I21O<T,NTE6 DE 7,6 1E<6ON,6
6I)NIIC,TI?,6 ___________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________
@. 1O6ICIONE6 > 7EN)8,AE DE7 CON687T,NTE .8E 18EDEN 6E<
8TI7E6 ___________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
B. 2OTI?,CION
,- 9.ué ob/etivos busca al consultar: ___________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
0- 9.ué espera $ue !a*a el terapeuta: _________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
___________________________________________
1C.DI,)NO6TICO _____________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
11.2ET, 2INI2, 1,CT,D, CON E7 CON687T,NTE > <E,CCION DE
E6TE _____________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
1".O0AETI?O6 DE7 TE<,1E8T,
Corto pla%o ________________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
2ediano pla%o ______________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
7ar*o pla%o ________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
__________________________________________________
1(.INTE<?ENCIONE6 DE ,D2I6O< > 1<I2E<, <E,CCION DE7
CON687T,TNTE
,- <eformulaciones _________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
0- 1rescripciones o su*erencias _______________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
C- Indicaciones de tipo de tratamiento ' sus ra%ones _______________
__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
1+.1<EDICCIONE6
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
1;.E6T<,TE)I,6 , 6E)8I<
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________
1=..8IENE6 6ON CIT,DO6 1,<, 7, 1<ODI2, 6E6ION
____________________________________________________________
________________________________________________________
1E.N82E<O DE 6E6IONE6 1<E?I6T,6 __________________________
1@.N82E<O6 DE 6E6IONE6 <E,7IF,D,6 ________________________
______________________________
1rofesional G irma

4. con quién) __________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ________________________________________ E) Que deja de hacer o quisiera hacer y no hace como consecuencia del problema ____________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ___________________________________________ F) SOLUCIONES INTENTADAS 1. cuándo. Por el paciente identificado _______________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ ___________________________________________ 2. Por los otros __________________________________________ _______________________________________________________ _______________________________________________________ ______________________________________________ . cómo. Observaciones A) Queja inicial __________________________________________________________ __________________________________________________________ __________________________________________________________ ______________________________________________ B) Porque ahora ____________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ______________________________________________ C) Motivo de la consulta ______________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ______________________________________________ D) Historia y circunstancia actual del motivo de consulta (dónde.

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