5/9/2018 Entrevista Psic ológic a pa ra Adulto - slide pdf.

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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 _______________________________
Fecha ____________________Terapeuta______________________________

2. Encuadre al entrevistado en donde se explica que primeramente se

realizará un recorrido por su historia familiar y las diferentes etapas dentro
del desarrollo de su vida.

3. Genograma

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4. Observaciones

A) Queja inicial
__________________________________________________________
__________________________________________________________

__________________________________________________________
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B) Porque ahora ____________________________________________

__________________________________________________________
__________________________________________________________
__________________________________________________________
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C) Motivo de la consulta ______________________________________

__________________________________________________________

__________________________________________________________
__________________________________________________________
______________________________________________

D) Historia y circunstancia actual del motivo de consulta (dónde, cuándo,

cómo, con quién) __________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

________________________________________
E) Que deja de hacer o quisiera hacer y no hace como consecuencia del
problema ____________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
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___________________________________________

F) SOLUCIONES INTENTADAS
1. Por el paciente identificado _______________________________
_______________________________________________________
_______________________________________________________
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___________________________________________
2. Por los otros __________________________________________
_______________________________________________________
_______________________________________________________
______________________________________________

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3. Exitosas _____________________________________________
_______________________________________________________
_________________________________________________
Se mantuvieron____________________________________________________
________________________________________________________________

No se mantuvieron _________________________________________________
___________________________________________________________________
_____________________________________________________________
¿Porque fueron abandonadas? ______________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________

5. TRATAMIENTOS ANTERIORES _______________________________

____________________________________________________________

________________________________________________________
A) Que sirvió _______________________________________________
__________________________________________________________
__________________________________________________________
_________________________________________________
B) Que no sirvió ____________________________________________
__________________________________________________________
__________________________________________________________
_________________________________________________

6. TRATAMIENTOS ACTUALES ( de cualquier tipo que se consideren

pertinentes) ________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
__________________________________________________
7. ACTITUDES Y OPINIONES IMPORTANTES DE LAS PERSONAS
SIGNIFICATIVAS ___________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________
8. POSICIONES Y LENGUAJE DEL CONSULTANTE QUE PUEDEN SER
UTILES ___________________________________________________
____________________________________________________________
____________________________________________________________

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____________________________________________________________
____________________________________________________

9. MOTIVACION

A) ¿Qué objetivos busca al consultar? ___________________________

__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________

B) ¿Qué espera que haga el terapeuta? _________________________

__________________________________________________________
__________________________________________________________
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___________________________________________
10.DIAGNOSTICO _____________________________________________
____________________________________________________________
____________________________________________________________
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11.META MINIMA PACTADA CON EL CONSULTANTE Y REACCION DE

ESTE _____________________________________________________
____________________________________________________________
____________________________________________________________

____________________________________________________________
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12.OBJETIVOS DEL TERAPEUTA

Corto plazo ________________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
Mediano plazo ______________________________________________
____________________________________________________________
____________________________________________________________
______________________________________________________
Largo plazo ________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
__________________________________________________

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13.INTERVENCIONES DE ADMISOR Y PRIMERA REACCION DEL

CONSULTATNTE
A) Reformulaciones _________________________________________
__________________________________________________________
__________________________________________________________

__________________________________________________________
______________________________________________

B) Prescripciones o sugerencias _______________________________

__________________________________________________________
__________________________________________________________
__________________________________________________________
______________________________________________
C) Indicaciones de tipo de tratamiento y sus razones _______________
__________________________________________________________
__________________________________________________________

__________________________________________________________
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14.PREDICCIONES
____________________________________________________________
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15.ESTRATEGIAS A SEGUIR
____________________________________________________________

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16.QUIENES SON CITADOS PARA LA PROXIMA SESION

____________________________________________________________
________________________________________________________

17.NUMERO DE SESIONES PREVISTAS __________________________

18.NUMEROS DE SESIONES REALIZADAS ________________________

______________________________

Profesional - Firma

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