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    This document contains a counseling session report for a child client. It includes sections on the child's subjective feelings and behavior, objective observations of their toy selection and play during the session, predominant themes in their play, any verbalizations from the child and therapist, limits set during play, an assessment of the child's activity level and inclusion of the therapist, the therapist's feelings and impressions, concepts of the child's progress, and recommendations for future sessions.

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    REPORT LONG FORM (1)

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    This document contains a counseling session report for a child client. It includes sections on the child's subjective feelings and behavior, objective observations of their toy selection and play during the session, predominant themes in their play, any verbalizations from the child and therapist, limits set during play, an assessment of the child's activity level and inclusion of the therapist, the therapist's feelings and impressions, concepts of the child's progress, and recommendations for future sessions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    25 views5 pages

    Report Long Form

    Uploaded by

    Emotion Jar
    This document contains a counseling session report for a child client. It includes sections on the child's subjective feelings and behavior, objective observations of their toy selection and play during the session, predominant themes in their play, any verbalizations from the child and therapist, limits set during play, an assessment of the child's activity level and inclusion of the therapist, the therapist's feelings and impressions, concepts of the child's progress, and recommendations for future sessions.

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    © All Rights Reserved
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    of 5

    Date: Counselor:

    Client name: Age:


    Session:
    Opening  Follow-up  Session no.:
    Specific Intervention Used:

    __________________________________________________________________________________

    I. Subjective:

    Overall child’s behaviour:

    Subjective (feelings and/or concerns of child):

    II. Objective:

    A. Toy selection:

    B. Play Behaviour

    i. Primary:

    Type of play

    Description

    ii. Secondary:

    Type of play

    Description
    C. Predominant themes
    Power and Aggression Themes
     Good Guy vs. Bad Guy
     Aggressor-Victim (Child as Aggressor or Victim)
     Generalized Aggression
     Dying/Death
     Demolishing
     Power Overcoming Weakness
     Seeking Power/Authority/Wisdom
    Family Relationship and Nurturance Themes
     Constancy
     Togetherness/Separation
     Nurturing Others
     Self-Nurturance
     Failed Nurturance
     Self-Neglect or Punishment
     Lack of Attachment/Detachment
     Parent/Caregiver-Child
     Regression
     Exits and Entrances to Family System
    Control and Safety Themes
     Danger
     Rescue
     Escape
     Fire/Disasters
     Burying or Drowning
     Broken/Sick/Hurt
     Fixing/Repairing/Doctoring
     Cleaning
     Messing
     Sorting
     Containing
     Protecting
     Controlling
     Refusal/Inaction
     Manipulation
    Exploration and Mastery Themes
     Sensory/Environment Exploration
     Mastery/Competence
     Cheating/Winning
     Creativity
    Interaction Themes
     Building Relationship With Adult
     General Positive Interactions
     General Negative Interactions
     Boredom
     Acceptance/Rejection
    Sexualized Play
     Sexual Activities
     Sexual Behaviors Directed at Adult
     Sexual Curiosity
    D. Significant Verbalization CH= Child initiated, TH= therapist initiated

    CH:

    TH:

    E. Limits Set In the blank to the left, indicate N of times limit set. In the blank to the right of the
    RATIONALE, indicate limit set. Also note if consequence and/or ultimate limit was set in response to
    broken limit. Describe process in the box at the right.

    _____________ Limit set

    III. Dynamics of Session: Rate Child’s Overall Play Behaviour, 1 for low and 5 for high

    LOW HIGH

    Child’s Activity Level (low) Child’s activity level(high)

    Intensity of Play (low) Intensity of play(high)

    Exclusion of Therapist Inclusion of therapist

    Destructive Constructive

    Messy/Chaotic/Disorganised Neat orderly

    IV. Assessment

    General Impressions/ Clinical Understanding:

    Specific impression/observation:
    V. Feelings reflected

    mad sad ashamed timid


    irritated sorrowful embarrassed bored
    frustrated teary angry satisfied
    annoyed scared proud gleeful
    enraged afraid jealous relieved
    outraged nervous confused guilty
    angry worried lonely depressed
    pissed off anxious powerful discouraged
    glad terrified shy distressed
    happy horrified distracted peaceful
    joyful concerned encouraged satisfied
    excited disappointed dissatisfied loved

    VI. Returning responsibility instances

    VII. Conceptualization of client and client’s progress:

    VIII. Plans/Recommendations Check all that apply.

     Family Session
     Parent consult
     Sibling(s) 1x
     Filial therapy
     Therapy for parents
     Medication evaluation
     Psychological testing
     Classroom Observation
     Professional Consult
     Request Records
     Recommend Parent resources
     Friend 1x
     School consult
     Other plans
     Play therapy

    Therapist’s Signature: ______________ Date: _________

    ** End of report**

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