APPENDIX O: DIAGNOSTIC AND SUMMARY REPORT ON COUNSELING SESSIONS

Student Counselor:

Initials of Client:

Gender: Age:

Race/Ethnicity: _______________________ Sexual Orientation: __________________

Date of Session: Session Number (with this client):

Length of Session in Minutes:

Recording #:

Form of recording (Audio, DVD) _____________

Location of the recording on the recording device (Name of file) ___________________

Date that this report was written: ___________

Diagnosis (es) – include DSM 5 and ICD-10 codes and written descriptions:

Your focus in this session:

1. Presenting issues and treatment plan goals

2. Briefly describe what you think you did well in the session.

3. Briefly describe what you would do differently if you could repeat the session.

4. Outline your plans and/or expectations for the next session.

5. Briefly describe what happened to you in the session. (Reflect: How did you feel? Reactions to client, etc.)

6. What feedback would you like from the faculty supervisor?

This recording has an informed consent on file in the client record. _________ (student’s initials here)