anamneza dr[1]. grossmann

Dr. Grossmann (MD PhD)Medic Specialist in Psihoterapie şi Medicina Mediului

CHESTIONAR PENTRU PACIENŢI AFLATI SUB INDRUMARE PSIHOTERAPIE

Nume: Prenume: Data naşterii:Locul naşterii:

Stimate pacient (ă),

„Nimănui nu-i plac chestionarele”. Dar acest chestionar pentru pacienţi vă foloseşte, exclusiv, dumneavoastră şi nu este destinat unei cercetari ştiinţifice.

Este un sprijin în folosul sănătăţii dumneavoastră şi tratamentului dumneavoastră individual. Vă rog, de aceea, să citiţi fiecare punct al acestui chestionar şi să răspundeţi cu atenţie. Dacă nu ştiţi sau nu sunteţi sigur(ă), marcaţi punctul cu semnul întrebării „?”.

Luaţi-vă astăzi timpul necesar să completaţi chestionarul în linişte, fără a fi presaţi de obţinerea vreunei perfomanţe.

Mulţumesc pentru colaborare!

Dr Harry L Grossmann

Praxis Dr. GrossmannMedic Specialist in Medicină Generală, Psihoterapie şi Medicina Mediului

I Anamneză

Familie: bolile părinţilor sau ale altor membri ai familiei a)

Mama TataNume

Varsta

Data decesului (daca e cazul)Cauza decesului

b) Fraţi/ surori ____________________________________________________Vârsta:Sexul:Data decesului (daca e cazul):Boli cunoscute: -----_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Boli ale altor rude de sânge (gradul de rudenie): ____ _______________________________Boli neurologice sau boli psihice __________________________________________________________________________________________________________________Alte boli _________ __________________________________________________________________

Praxis Dr. GrossmannMedic specialist medicină generală, psihoterapie şi medicina mediului

c) Suferiti/ ati suferit de alte boli sau operaţii?

Daca da, va rog sa completati mai jos care sunt acestea si anul manifestarii fiecareia dintre ele: __________________________________________________________________________________________________________________________________________

Operaţii (de ex. apendicectomie în 1963


______________________________________________________________________________________________________________________________________________________

d) Ati suferit accidente si/sau accidente de muncă?Daca da, precizati cauza, anul accidentului si daca aveti vreun grad de invaliditate

______________________________________________________________________________________________________________________________________________________

e) Alte internări in spital, fără operaţii(precizati cauza internarii, anul)______________________________________________________________________________________________________________________________________________________

f) Alte boli: (de ex. hipertensiunea arterială, ficat, rinichi, plămâni, inimă)

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

g) Ati urmat tratamente de reabilitare in ambulator sau „intervenţii pe termen scurt”?Va rugam sa precizati:

Cauza Locul Anul Cine a facut decontarea

h) Ati facut investigaţii mai deosebite (de ex. CT (computer tomografie), cateterizare cardiacă, endoscopie gastrică, EEG (electroencefalogramă)?

Investigaţie luna/an Rezultat (dacă e cunoscut)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Cine a propus psihoterapia?______________________________________________________________________________________________________________________________________________________


Femei:

La ce varsta ati avut prima menstruatie? ____ ______________________________________Data ultimei menstruaţii: ______________________________________________________Ciclu menstrual neregulat sau alte acuze? ________________________________________Naşteri ____________________________________________________________________Avorturi spontane/ avorturi provocate:___________________________________________Complicaţii (dificulăţi) la naştere (de ex. operaţie cezariană): ____________________________________________________________________________________________________

Urmati vreun tratament hormonal? ______________________________________________ Daca da, de care? ____________________________________________________________Operaţii ginecologice? (Pelvis/sân):______________________________________________

Ultimul control periodic: ______________________________________________________ Rezultat_________________________

Bărbaţi:

Data ultimului control periodic: _________________________________________________ Rezultat: ___________________________________________________________________


1.Date generale:

Aveti pofta de mancare? _ __________________________________________________Ati avut creştere sau scăderi în greutate în ultimile 6 luni? _ _________________________Daca da, cate kg? ___________________________________________________________Cate lichide pe zi beti? _______________________________________________________Aveti vreo durere la urinare?nu___________________________________________________Mergi des la toaleta pe parcursul nopţii?nu __________________________________________

De cate ori si cauza:nu ____________________________________________________Aveti tulburări de somn?nu _____________________________________________________Câte ore dormiti noaptea?intre 6 si 8ore ___________________________________________________oreAveti dificultăţi de adormire sau de a rămâne adormit?nu ______________________________Daca da, mentionati cauzele: ___________________________________________________Tuse_nu ___________ Expectoraţie_nu_______Alergii_nu________________________________Cum vă alimentaţi? (vă rog marcaţi cu o cruciuliţă)

xechilibrat □ deficitar (de ex. neechilibrat „fast food” )□ bogat în grăsimi □ vegetarian

Cât alcool consumaţi pe zi/săptămână/lună?_ __________________________________Câte ţigări fumaţi pe zi?__ ______________________________________________De când nu mai fumaţi?___ __________________________________________

Activităţi sportive: ____________________________________________________________________________________________________________________________________________

Următoarele mi se potrivesc: (vă rog marcaţi cu o cruciuliţă) □ hipertesiune arterială cunoscută din ____ □ lipide sanguine mărite, cunoscute din ____ □ deficit de exerciţiu fizic

□ perioade de repaus deficitare □ consum regulat de analgetice/somnifere (precizati va rog tipul acestora) ____ ___________________________________________

Cum mă descurc cu stresul cotidian:


□ în situaţii de stres îmi pierd des stăpânirea de sine □ chiar în situaţii care ar necesita-o, am probleme si devin agresiv (ă) sau ______________________________________________________________________

2. Suferinte/ probleme actuale:

Ce acuze aveţi în acest moment? (atât corporale, cât şi sufleteşti)___________________________________________________________________________De când au apărut aceste acuze? ___________________________________________________________________________Cât de des apar acuzele? ___________________________________________________________________________Există situaţii în care acuzele se înrăutăţesc sau când se ameliorează ?___________________________________________________________________________(De ex. dureri de cap de 5 ani de aproximativ 1-2 ori pe săptămână mai puternice, de un an în situaţii de stres profesional)_________________________________________________________________________________in situatii de stress ma mai doare capul odata pe saptamana dupa care imi trece.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Aceste acuze vă limitează activitatea profesionale/ viaţa de familie/ timpul liber?Dacă da, descrieţi pe scurt aceste limitări.________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

În momentul debutului acuzelor, aţi avut evenimente stresante în viaţă?

____________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Cum vă explicaţi aceste acuze, care credeţi că este cauza lor?______________________________________________________________________________________________________________________________________________________


_______________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Aţi luat deja măsuri să vă modificaţi/îmbunătăţiţi starea de sănătate sau să vă amelioraţi acuzele?_________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Terapie actuală Ce fel de medicamente luaţi? (Doze/De când)

Medicament Dimineaţa Prânz Seara Din____x______ ________ _______ ____________ ____________________________ ________ _______ ____________ ____________________________ ________ _______ ____________ ____________________________ ________ _______ ____________ ____________________________ ________ _______ ____________ ____________________________ ________ _______ ____________ ____________________________ ________ _______ ____________ _________________

Ce fel de medicamente aţi luat mai demult, ca să diminuaţi acuzele? (doză/ în ce perioadă?)__________________________nu iau medicamente

Sunteţi la momentul actual în tratament psihoterapic? (vă rog marcaţi cu o cruciuliţă) □ Da x NuDe când?_________ Cât de des?_____________ Durata şedinţelor___________minute(de ex. din 1998, 1 dată pe săptămână, 50 minue)

Ati facut psihoterapie? Precizati tipul, anul, frecventa(de ex. terapie comportamentală din 1995, 25 de ore, aproximativ o dată pe săptămână, 50 de minute)_____________________________________________________________________________________________________________________________________________________

4. Biografia mea

Sunt născut(ă) în: __ _____________________________________________________


Am crescut în:_______ __________________________________________________________________________________________________________________________________________________________________________________________________________

Fraţi/surori: (vă rog precizaţi sexul, şi diferenţa de vârstă faţă de dumneavoastră, de ex. soră, -3 ani etc.)1.___ 2.____________________ ______ ani 3.____________________ ______ ani 4.____________________ ______ ani5.____________________ ______ ani 6.____________________ ______ ani7.____________________ ______ ani 8.____________________ ______ ani

Mama mea a avut la naşterea mea vârsta de ________ ani, de profesie ___________ ______________________________________________________

Tatăl meu a avut la naşterea mea vârsta de ___36______ ani, de profesie _____________ ______________________________________________________

Rezultate ale învestigaţiilor mamei de pe perioada sarcinii (în măsura în care se cunosc):__________________________

Marcati cu x, simptomele care vi se potrivesc si care au avut loc în copilărie:

□ Sperieturi nocturne □ Udarea patului □ Somnambulism □ Sugerea degetului (Pavor nocturn) (Enurezis)□ Roaderea unghiilor □ Bâlbâială □ Teamă x Copilărie fericită□ Copilărie nefericită □ Coşmaruri

simptome_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Situaţie generala de viaţă

□xnecasatorit(a) Partener de viaţă/ De când?______________ □căsătorit(ă) din ____________ până la _________________ din ____________ până la _________________□ văduv(ă) din ____________


□ divorţat(a) din ____________□ despărţit(a) din_____________

Cati copii aveti? ____x______________________________________ Care e vârsta lor?__x________________________________________

Partenerul/partenera de viaţă lucrează? _____sef service la o firma de masini______Care e profesia lui/ei? _____mecanic auto_______________________________________Cum este platit? □ cu ora x cu normă întreagă, Lucreaza in ture inverse? ___x__________________________________________________Este pensionar(ă)? _______x___________________________________________________

Locuinţa: (casă, apartament închiriat, câte camere)__2 case si un apartament___________________________________________________________________________________Câte persoane aveti in intretinere? __x____________________________________________Condiţii de locuit sunt bune/ suficiente/ nesatisfăcătoare/ deranjante prin?__________________________________sunt bune___________________________________________________________________________________________________________________________

Precizati care sunt activităţile dîn timpul liber şi eventualele hobby-uri :________________sport,muzica si citit _______________________________________________________________________________________________________________

Cand ati avut ultimul concediu (când şi unde)? ___de1 mai______________________Suprasolicitări personale la momentul actual (de ex. financiare, datorii, îngrijire, parteneriat, construcţia casei, etc.)? _______nu am_________________________________________________________________________________________________________________________________________________________________________________________________

6. Profesie

Vă rog să vă prezentaţi ruta profesională, începând cu terminarea şcolii (separat pe ani: terminarea şcolii/învăţătură/perfecţionare/ocupaţiile)

Dezvoltare profesională Anii (de la..................până la)________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________


Ocupaţia actuală:____ __________ din: ________________

Ocupaţia actuală (subliniaţi vă rog ceea ce se potriveşte) □ stau jos, □xîn picioare, □ în aer liber, □ în spaţiu închis, □ acasă, □ călătoresc

Vă rog să descrieţi concret munca: ______ ___________________________________________________________________________________________________________________Durata de muncă (subliniaţi vă rog ce se potriveşte)

x normă întreagă, □ jumătate de normă,□ în schimburi,□ la banda,□ munci ocazionale,□ muncă la domiciliu

Completări:____________________________________________________________Săptămânal_________ore Ore suplimentare?_______

Loc de muncă (subliniaţi vă rog ce se potriveşte)□ Luminos, □ lumină artificială□ întunecos □ zgomot□ praf, □ contact intens cu publicul

Completări: _________________________________________________________________

Drumul către serviciu: câte ore pe zi dus-întors la serviciu?___ ___________________

Gradul de mulţumire la locul de muncă (subliniaţi vă rog ce se potriveşte):□xbuna□ satisfăcătoare□ scăzută, □ absentă?

Completări: ___imi place colectivul cu care lucrez________________________

Preconizaţi să vă schimbaţi meseria? ____nu_________________________________________________________________________________________________________________

V-ati recalificat? __________nu_________________________________________________Sunteti somer la momentul actual?____nu___ de când?_____________________________La momentul actual în concediu de boală?____nu_____ de când?_____________________Din ce cauză?________________________________________________________________Câte săptămâni/luni aţi fost în concediu medical în ultimele 12 luni?____________________Ati cerut pensie? □ Nu □ Da de când? _________________Vi s-a acordat pensia? □ Nu □ Da de când? _________________


Vi s-a refuzat cererea de pensie □ Nu □ Da de când? _________________Au fost obiectii la cererea de pensionare? □ Nu □ Da de când? _________________Handicap sever? (gradul)_______ procente. Din ce cauză?____________________________Boli profesionale recunoscute:__________________________________________________

Sunteţi în legătură cu medicul de întreprindere (de ex. imbold către psihoterapie)? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Numiţi 5 temeri (frici) principale

Exemple

1._sa nu gresesc 2._sa nu dezamagesc pe cineva 3._frica de injectii 4.____________________________________________________________________________________________________________________________________________________5.____________________________________________________________________________________________________________________________________________________

7. Informaţii despre sexualitatea. Atitudinea părinţilor faţă de sexualitate(de ex. Dacă acasă la dumneavoastră vi s-a făcut educaţie sexuală sau aţi avut discuţii despre sexualitate?)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________b. La ce vârstă aţi aflat primele lucruri despre sexualitate?______________________ c. Când aţi fost pentru prima dată conştient/conştientă de pornirile sexuale?_____ d. Aţi avut vreodată sentimente de vinovăţie legate de sexualitate sau de masturbare. Dacă da, vă rog să descrieţi aceste sentimente in amanunt:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vă rog să ne informaţi despre detaliile esenţiale ale primei experienţe sexuale sau despre cele care au urmat___________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Viaţa sexuală actuală o consideraţi satisfăcătoare? (Dacă nu,vă rog completaţi)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vă rog să ne informaţi despre preferintele dumneavoastră heterosexuale (şi/sau homosexuale):__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Părinţii

Vă rog să descrieţi trăsăturile de caracter ale tatălui şi atitudinea sa faţă de dumneavoastră (mai demult şi la momentul actual): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vă rog să descrieţi trăsăturile de caracter ale mamei şi atitudinea sa faţă de dumneavoastră (mai demult şi la momentul actual):_________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________


________________________________________________________________________________________

Când aţi fost copil, cum aţi fost pedepsit(ă) de părinţi?___________________________________________________________________________

Încercaţi să prezentaţi (descrieţi) atmosfera casei parentale (căminul în care aţi crescut. Amintiţi cum s-au înţeles părinţii între ei şi cu copiii):

Aţi putut avea încredere în părinţii dumneavoastră?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dacă aţi avut un tată sau o mamă vitregă, ce vârstă aţi avut când părintele dumneavoastră s-a recăsătorit? (Cum aţi descrie relaţia cu cu mama sau tatăl vitreg?): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conturaţi, pe scurt, educaţia dumneavoastră religioasă?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dacă nu aţi fost crescut de părinţii dumneavoastră, cine v-a crescut şi la ce vârstă ? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. Altele

S-a amestecat cineva (părinţi, rude, prieteni) vreodată în căsnicia, profesia dumneavoatră?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Care sunt oamnenii cei mai importanţi din viaţa dumneavoastră?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Suferă vreun membru al familiei dumneavoastră de alcoolism, epilepsie sau de ceva are poate fi considerată boală psihică? (Descrieţi mai amănunţit aceste suferinţe):_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Prezentaţi vă rog toate experienţele care v-au produs teamă sau suferinţă şi pe care nu le-aţi amintit încă _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. AutodescriereVă rog completaţi următoarele:


Eu sunt _ _______________________________________________________________Eu mă simt __ _______________________________________________________Eu cred __in iubire_________________________________________________________Îmi doresc_sa fiu tot asa si in continuare______________________________

Vă rog să vă descrieţi în cuvinte cheie aşa cum v-aţi descrie singur:

De către dumneavoastră:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

De către soţul/soţia (partener/partenera de viaţă): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

De către cel mai bun prieten/ cea mai bună prietenă:___________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

De către cineva care nu vă place pe dumneavostră:_______ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11.Scopurile terapiei


Vă modelaţi terapia mai eficient, dacă reflectaţi la scopurile terapiei sau modificările pe care doriţi să le faceţi în ariile următoare, până la sfârşitul psihoterapiei:

Din punct de vedere sufletesc, vreau să ating (temeri, inhibiţii, depresii, etc.):_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Corporal vreau să ating:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Social vreau sa ating (familie, parteneriat, relaţia cu ceilalţi, etc.):_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Profesional vreau să ating (capacitate de lucru, scopuri profesionale, probleme profesionale):_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Referitor la mine însumi vreau să ating: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 12. Scurt tabel autobiografic cu suprasolocitările/experienţele emoţionale cele mai importante (despărţire, moarte, experienţe ale pierderii, casătorie, naşteri, etc.)


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13. Observaţii şi note

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II Anamneza familială

1. Condiţii de locuit în copilărie............................ ....................................................................Arie geografică: _____________________________________________________________Oraş: _________________________________________________________________Ati stat la casa sau la bloc? __ ____________________________________________Câte persoane ati fost în familie? ______________________________________________Ati avut cameră proprie? ____________________________________________________

Ati avut vreun sentiment de strâmtorare ? _______________________________Cand si unde v-ati mutat cu locuinta? ________________

2. MamaOcupatie : □ Casnică □ Activă în câmpul muncii


Din ce mediu provine mama? __ __________________________________Relaţia cu mama:

a) in timpul copilăriei timpurii a fost: □ severă□ distanta□ a stat mult acasa;

Cine pregătea mâncarea? _ ____________________________________________________Ati fost pedepsit(a) de mamă? ___________________________________________________Cum? ____ ______________________________________________

b) în perioada şcolară ________________________________________________________________________________________________________________________________

c) în adolescenţă ____ _________________________________________________________ ____________________________________________________________________

d) Actuală____________________________________________________________

3. TatălProfesie: ___ __________________________________________________________Din ce mediu provine tatăl? ___ ___________________________________________Educatie: ___ ______________________________________________________________Relatia cu tatal: a) in copilaria timpurie ____ _____________________________________________________________________________________________________________________________________________________________________________________________________ b) in perioada scolara ______________________________________________________________________________________

c) in adolescenta ______________________________________ _________________________________________________________________________________ _________________________________________________________________________________

d) actuala

Cum caracterizati relatia dintre parinti:a) a) mai demult: _____ __________________________________________b) _____________________________________________________________________________ b)actuala _______ __________________________________________________

4. Aveti frati/ surori? _____________________________________________________________Cum caracterizati relatia dvs cu fratii/surorile dvs:

a) in copilarie: ____ _______________________________________b) in adolescenta: __ _______________________________________________

_______________________________________________________________________________


c) azi: __ ________________________________________________________________________________________________________________________________________ 5. Alte rude care au avut un rol in educatia dvs: ____Ce rol au avut in educatie? ________ _____________________________________________________________________________________________________________________________

6. Perioada scolaraRelaţia cu ceilalţi şcolari ____ __________________________________________________________________________________________________________________________________Relaţia cu profesorii ______ _____________________________________________________________________________________________________________________________________Performanţe şcolare ______ _____________________________________________________________________________________________________________________________________Ce şcoli aţi frecventat ______________________________________________________________________________________________________________________________________________Alte perfecţionări _________________________________________________________________________________________________________________________________________________

7. Parteneriatea) Prietenul/ prietena:Descrieti prima relaţie din viata dvs (când? Cum s-a desfăşurat?)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Alte relaţii (când? cum s-au desfăşurat?)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Relaţia actuală (când? cum s-a desfăşurat)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Partenerul(a) de viata __________________________________________________________De când sunteţi împreună? _ ________________________________________________Cum ati devenit un cuplu? _________________________________________________________________________________________________________________________________________________________________Care sunt/ erau sentimente unul pentru celălalt

- La inceputul relatiei: __________________________________________________________________________________

- La momentul actual: ___ _________________________________


_______________________________________________________________________________

Cand au fost si care au fost situatiile de criza? __ ___________________________________________________________________________________________________________________________________________________________________________________________

d)Experienta despartirilor in viata dvs: ____ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Unele experienţe emoţionale importante _____ _______________________________________________________________________________________________________________________________________________________________________________________

8) Viata de familieDespărţiri în familie: ___ ____________________________________________________________________________________________________________________________________________________________________________________________________________________

Cazuri de deces ____ ______________________________________________________________________________________________________________________________________

Părăsirea familiei de către un părinte ______ ___________________________________________________________________________________________________________________________________________________________________________________________________

Mutarea din casa parentală __________________________________________________________________________________________________________________________________________

Certuri în familie _____ _________________________________________________________________________________________________________________________________________

Despărţirea de soţ/soţie __ _____________________________________________________________________________________________________________________________________

Pierderea locului de muncă ___ ___________________________________________________________________________________________________________________________________

Experienţe sexuale negative ____ _________________________________________________________________________________________________________________________________


Observaţii

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anamneza dr[1]. grossmann

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