Professional Documents
Culture Documents
Report Long Form
Report Long Form
__________________________________________________________________________________
I. Subjective:
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.
III. Dynamics of Session: Rate Child’s Overall Play Behaviour, 1 for low and 5 for high
LOW HIGH
Destructive Constructive
IV. Assessment
Specific impression/observation:
V. Feelings reflected
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
** End of report**