List Of Client Concerns



Please mark all of the items below that apply.  In addition, please feel free to list any other concerns you may have that are not listed.

__Abuse – physical, mental, sexual, emotional

__Aggression, violence

__Alcohol use

__Anger, hostility, arguing, irritability

__Anxiety, nervousness

__Attention deficit, concentration, distractibility

__Career concerns



__Compulsions, obessions

__Custody of children

__Decision making, indecision, putting off decisions

__Delusions (false beliefs)


__Depression, low mood, sadness, crying

__Divorce, separation

__Drug use-prescription medications, street drugs

__Eating problems, overeating, undereating, forced vomiting


__Failure – fear of failure

__Fatigue, tiredness, low energy

__Fears, phobias

__Financial or money problems, debt, impulsive spending

__Friendships – lack of friendships


__Grieving, mourning, deaths, losses, divorce


__Headaches, other pains

__Health, illness, medical concerns, physical problems

__Inferiority feelings

__Interpersonal conflicts

__Impulsiveness, loss of control, outbursts


__Judgement problems, risk taking

__Legal matters, charges pending, suits


__Marriage conflict, distance/coldness, infidelity, remarriage

__Memory problems

__Menstrual problems, PMS, PMDD, menopause

__Mood swings

__Motivation, laziness

__Nervousness, tension

__Obsessions, compulsions, thoughts or actions that repeat themselves

__Oversensitivity, Feelings easily hurt

__Pain, chronic

__Panic or anxiety attacks

__Parenting issues, single parenting




__Relationship problems with family, friends, co-workers

__School problems (see also career concerns)



__Self neglect, poor self -care

__Sexual issues, dysfunctions

__Shyness, oversensitivity to criticism

__Sleep problems, too much, too little, nightmares, insomnia

__Smoking and tabaco use

__Spiritual, religious, moral, ethical issues

__Stress, inability to relax, tension

__Suspiciousness, distrust, jealousy issues

__Suicidal thoughts

__Temper problems, inability to control

__Thought disorganization, confusion

__Weight and diet issues

__Other concerns

Professional Seal for Sheila Kaminski