Subheading for each section (you should have 12 section subheadings total)
Remember 1 PARAGRAPH = 4-6 SENTENCES.
Your report must include these sections (refer to the sample on page 321-326):
Demographic Information: Name, Address, Phone, Email, DOB, Age, Sex, Ethnicity, Name of Interviewer (yourself), Date of Interview.
Presenting Problem/Reason for Referral (Few sentences): You can say that this class was the reason for the referral.
Family Background (2 paragraphs)
Significant Medical/Counseling History (2 paragraphs)
Substance Use and Abuse (1 paragraph): Prescriiption medications/Daily vitamins, social drinking/abstaining from drinking, etc. Even if you have no history
of substance use/abuse, write it out in full sentences.
Educational and Vocational History (2 paragraphs)
Other Pertinent Information (1 paragraph)
Mental Status (2 paragraphs)
Assessment Results: you must take all three assessments and write about each of them.
Locus of Control (2 paragraphs): you will take the Locus of Control Download Locus of Control scale that is attached to this assignment page, score, and
interpret it. The first paragraph should explain the measure and what it looks at, the second paragraph should cover what you scored and your interpretation
of the score/what it means.
Big Five Inventory (7 paragraphs): you will take the Big Five Inventory (BFI) Download Big Five Inventory (BFI) assessment that is attached to this assignment
page, score, and interpret it. The first paragraph should explain what the Big Five Inventory is and the different factors and what they mean/show. Then you
must write 1 paragraph for each factor (Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism) for a total of 5 paragraphs based on
YOUR score and what that means (Ex. If you scored a 12 on Extroversion, that indicates that you are more on the introverted side). Finally you will write 1
paragraph over what you learned from your Big Five scores (Ex. Were you surprised to score low on Extroversion because you are often labeled as talkative
and outgoing, was this reflective of how you are more introverted when you are around new people and extroverted when you are in a group of friends?).
Focus2Career (2 pages, double-spaced): you will take the 5 assessments (Work Interest, Personality, Leisure, Values, and Skills). You should NOT describe
each of the assessments that you took on Focus2Career, instead you will write about the results, your interpretation of the results and what you learned (Ex.
The top 3 occupations in my results are all in the mental health field, since this is my goal and what I am currently in school for, these results reflect
accurately that I am on the right path towards what I want to do). These assessments will highlight careers and pathways for you, so you can go onto
onetonline.org (Links to an external site.) and search two of the occupations that you received from your results. Write about the education level required,
salary, if the field is growing, etc. You should also write about how you feel the results match what you want to do, new occupations that you didn’t know
about but maybe are now interested in, the amount of education that you are willing to go through for your career, etc. When you finish the Focus2Career
assessment you will have the option to save the results as a PDF. You must upload the results (your name must be on the results page) with this paper.
Diagnosis (Few sentences): Choose one based on substance use, mental health background, family history, etc., you can look up the DSM online and use the
Internet. (Please remember, this is not a TRUE diagnosis, just for the assessment you will need to choose one).
Summary and Conclusions (5 paragraphs)
Recommendations (1 paragraph): Write out 1 paragraph of recommendations based on the assessment and an overall “plan” for yourself moving forward
and include 3-4 bullet points of specific recommendations.
Your signature and printed name
Locus of Control Scale (Rotter)
1. a. Children get into trouble because their parents punish them too much. b. The trouble with most children nowadays is that their parents are too easy with
2. a. Many of the unhappy things in people’s lives are partly due to bad luck. b. People’s misfortunes result from the mistakes they make.
3. a. One of the major reasons why we have wars is because people don’t take enough interest in politics. b. There will always be wars, no matter how hard
people try to prevent them.
4. a. In the long run people get the respect they deserve in this world. b. Unfortunately, an individual’s worth often passes unrecognized no matter how hard
5. a. The idea that teachers are unfair to students is nonsense. b. Most students don’t realize the extent to which their grades are influenced by accidental
6. a. Without the right breaks one cannot be an effective leader. b. Capable people who fail to become leaders have not taken advantage of their
7. a. No matter how hard you try some people just don’t like you. b. People who can’t get others to like them don’t understand how to get along with others.
8. a. Heredity plays the major role in determining one’s personality. b. It is one’s experiences in life which determine what they’re like.
9. a. I have often found that what is going to happen will happen. b. Trusting to fate has never turned out as well for me as making a decision to take a
definite course of action.
10. a. In the case of the well prepared student there is rarely if ever such a thing as an unfair test. b. Many times exam questions tend to be so unrelated to
course work that studying in really useless.
11. a. Becoming a success is a matter of hard work, luck has little or nothing to do with it. b. Getting a good job depends mainly on being in the right place at
the right time.
12. a. The average citizen can have an influence in government decisions. b. This world is run by the few people in power, and there is not much the little guy13. a. When I make plans, I am almost certain that I can make them work. b. It is not always wise to plan too far ahead because many things turn out to be a
matter of good or bad fortune anyhow.
14. a. There are certain people who are just no good. b. There is some good in everybody.
15. a. In my case getting what I want has little or nothing to do with luck. b. Many times we might just as well decide what to do by flipping a coin.
16. a. Who gets to be the boss often depends on who was lucky enough to be in the right place first. b. Getting people to do the right thing depends upon
ability, luck has little or nothing to do with it.
17. a. As far as world affairs are concerned, most of us are the victims of forces we can neither understand, nor control. b. By taking an active part in political
and social affairs the people can control world events.
18. a. Most people don’t realize the extent to which their lives are controlled by accidental happenings. b. There really is no such thing as “luck.”
19. a. One should always be willing to admit mistakes. b. It is usually best to cover up one’s mistakes.
20. a. It is hard to know whether or not a person really likes you. b. How many friends you have depends upon how nice a person you are.
21. a. In the long run the bad things that happen to us are balanced by the good ones. b. Most misfortunes are the result of lack of ability, ignorance, laziness,
or all three.
22. a. With enough effort we can wipe out political corruption. b. It is difficult for people to have much control over the things politicians do in office.
23. a. Sometimes I can’t understand how teachers arrive at the grades they give. b. There is a direct connection between how hard 1 study and the grades I
24. a. A good leader expects people to decide for themselves what they should do. b. A good leader makes it clear to everybody what their jobs are.
25. a. Many times I feel that I have little influence over the things that happen to me. b. It is impossible for me to believe that chance or luck plays an
important role in my life.
26. a. People are lonely because they don’t try to be friendly. b. There’s not much use in trying too hard to please people, if they like you, they like you.
27. a. There is too much emphasis on athletics in high school. b. Team sports are an excellent way to build character.
28. a. What happens to me is my own doing. b. Sometimes I feel that I don’t have enough control over the direction my life is taking.
29. a. Most of the time I can’t understand why politicians behave the way they do. b. In the long run the people are responsible for bad government on a
national as well as on a local level.
Score one point for each of the following:
2.a, 3.b, 4.b, 5.b, 6.a, 7.a, 9.a, 10.b, 11.b, 12.b, 13.b, 15.b, 16.a, 17.a, 18.a, 20.a, 21.a, 22.b, 23.a, 25.a, 26.b, 28.b, 29.a.
Add all of the points you receive together.
A high score (Above 10) = External Locus of Control
A low score (10 or below) = Internal Locus of Control
Big Five Inventory (BFI) How I am in general
Here are a number of characteristics that may or may not apply to you. Please write a number next to each statement to indicate the extent to which you
agree or disagree with that statement.
1 2 3 4 5 Disagree Disagree Neither agree Agree Agree Strongly
I am someone who…
1. _____ Is talkative 2. _____ Tends to find fault with others 3. _____ Does a thorough job 4. _____ Is depressed, blue 5. _____ Is original, comes up with new
ideas 6. _____ Is reserved 7. _____ Is helpful and unselfish with others 8. _____ Can be somewhat careless 9. _____ Is relaxed, handles stress well. 10. _____ Is
curious about many different things 11. _____ Is full of energy 12. _____ Starts quarrels with others 13. _____ Is a reliable worker 14. _____ Can be tense
15. _____ Is ingenious, a deep thinker 16. _____ Generates a lot of enthusiasm 17. _____ Has a forgiving nature 18. _____ Tends to be disorganized 19. _____
Worries a lot 20. _____ Has an active imagination 21. _____ Tends to be quiet 22. _____ Is generally trusting 23. _____ Tends to be lazy 24. _____ Is emotionally
stable, not easily upset 25. _____ Is inventive 26. _____ Has an assertive personality 27. _____ Can be cold and aloof 28. _____ Perseveres until the task is
finished 29. _____ Can be moody 30. _____ Values artistic, aesthetic experiences 31. _____ Is sometimes shy, inhibited 32. _____ Is considerate and kind to
almost everyone 33. _____ Does things efficiently 34. _____ Remains calm in tense situations 35. _____ Prefers work that is routine 36. _____ Is outgoing,
37. _____ Is sometimes rude to others 38. _____ Makes plans and follows through with them 39. _____ Gets nervous easily 40. _____ Likes to reflect, play with
ideas 41. _____ Has few artistic interests 42. _____ Likes to cooperate with others 43. _____ Is easily distracted 44. _____ Is sophisticated in art, music, or
To score the BFI, you’ll first need to reverse-score all items with an “R”: To reverse-score, take your original score and change it based on this key:
1→5 2→4 3 → 3 4→2 5→1 (For example, for item 21R I put down 2, so my reverse score is 4. When calculating extraversion I will add my scores and use my
reverse-score for that item.) Average each subtest to receive your score Extraversion: 1 + 6R + 11 + 16 + 21R + 26 + 31R + 36 / 8 Agreeableness: 2R + 7 + 12R
+ 17 + 22 + 27R + 32 + 37R + 42 / 9 Conscientiousness: 3 + 8R + 13 + 18R + 23R + 28 + 33 + 38 + 43R / 9 Neuroticism: 4 + 9R + 14 + 19 + 24R + 29 + 34R +