BRAGG’S REVISED LIFE STYLE ASSESSMENT FORM
NAME: _Ms. Abimbola ___________________________________________________
The Life Style is designed to depict an individual’s perceptions and convictions of the self, others, the world, and how one will respond
to the tasks of life. This data will reveal a consistent movement toward the goal of the individual, which becomes the case formulation
of the counselor or psychologist.
DIAGRAM OF THE FAMILY CONSTELLATION
The diagram of the family constellation should include a representation of each person residing in the household during the client’s
developmental years (from birth to age 7-8) and any other person whom the client describes as significant to him or her during the
ages of 0-7 (i.e. grandparents, aunts, uncles, cousins, god-parents etc.).
Use a large circle to represent persons who are female and large squares to denote males. Inside the shape, list the first name, age,
and five words (chosen by the client) to describe each individual. An asterisk (*) should appear beside the client’s name. The client’s
siblings should be listed beside the client in chronological order. Siblings who are older than the client should be placed to the clients
left while siblings who are younger than the client should appear to the client’s right. Also include the number of years older or younger
each sibling is from the client. Use a + symbol (to denote older than) and a – symbol (to denote younger than). For example, a sibling
who is 2 years younger than the client would appear to the right of the client and a -2 should appear beside that sibling’s name.
When constructing the diagram of the family constellation, the client is asked, “I’d like for you to tell me who lived in your home during
the time that you were between the ages of 0-7/8and, were there any other significant persons in your life during that time; I’d also like
for you to tell me five words to describe each person”. Allow the client to give you the order to which names are added to the
diagram. Extend upward for grandparents from the appropriate parental figure. For example, paternal grandparents would appear on a
line above the client’s father. Extend siblings by age (oldest) from left to right (youngest) on the line shown beneath the parents.
Draw the family constellation of this family.
Family of five
Father (Authoritarian, Hardworker)
Mother ( Hard worker, Caring)
Siblings of Abimbola
Victor (VI), Omobola (OM), Adimbola (AD)
RATING OF SIBLINGS
Using the initials of each sibling, rate the characteristic below from most to least. If the client is an only child,
they should rate self in terms of Good, Average, or Bad.
Intelligence – VI, OM, AD
Good at schoolwork- V, AD
Pleasing VI, AD
Cheerful – VI
Sociable (outgoing)- VI, AD
Sense of humor – VI
Critical of self- OM, AD
Critical of others- VI, AD
Sensitive/easily hurt- AD
Neat – OM
Responsible- OM, AD
Self-Centered – VI
Helpful- OM, AD
Polite – VI, AD
Easy going- VI, AD
Feminine- OM, AD
Caring- VI, AD
Got way with things- VI
Mischievous – VI
Hard worker –OM, AD
Friendly- VI, AD
Competitive – OM
Good listener- AD
Spiteful- VI, AD
Independent- OM, AD
Rebellious- OM, AD
Poor Temper- OM
Often Punished- VI, OM
Shy – AD
Kept you in check- VI
Lonely – OM
Loving – VI, AD
Generous – VI, OM, AD
Clumsy- VI, OM, AD
Excitement seeker- VI
ADDITIONAL SIBLING DESCRIPTIONS
1. Which sibling is/ and was most different from you, and how?
OM, she is completely different from me. She is not friendly; she is the first female child.
2. Which sibling is/was most like you, and how?
VI, first child male. He is very friendly, loving and look out for me
3. Which played together?
VI and AD
4. Which fought and argued?
OM & AD. We fought often because she is bossy
5. Describe any childhood fears?
AD, the fear of sleeping in my room by myself
6. Who took care of whom?
VI & AD takes care of OM during her asthma’s crisis
7. What did you like/care about most as a child?
Not being hungry of beaten
8. Who had an unusual achievement? Talent?
VI sport and creative Art
9. What was your role in the peer group?
Supportive and encourager
10. Who had a sickness (or surgery or accident)?
OM, she is an asthmatic patient
11. What were the family's most import values?
Obedience and respect
12. What grade school subjects did you like best?
Government & Literature
13. What grade school subjects did you like least?
14. What was your community/neighborhood like?
15. Where did your family live (house or apartment)?
16. How many people lived with you?
2 parents and 3 kids
17. Did you have your own room or did you share a room? If so, with whom did you share?
I have a room to myself
18. Did you feel your parents/family had enough, more than enough or very little of what they needed (money,
food, clothes, transportation)? Enough
SOCIAL DEVELOPMENT DATA (How a person sees themselves)
1. How would you describe your health as a child?
Good, expect when sick with malaria
2. Was that an advantage or disadvantage? How?
I will say it an advantage because I was able to build the humunity needed in my body to fight germs
4. Describe your physical appearance as compared to you same aged peers (average size, bigger,
smaller than others your age)?
Smaller than my peers
5. Was that an advantage or disadvantage? How?
Disadvantage because my peers thought we are not of the same age
PRE-SCHOOL /ELEMENTARY SCHOOL INFORMATION
1. Were you a good student (grades)?
2. What subjects were you best at? Worst at?
Best- Government and Literature
Worst - Math
3. Describe your behavior at school?
Good, well behaved student
CHILDHOOD MEANINGS GIVEN TO LIFE
Expectations, ideals, Meaningful Goals, Favorite Daydreams, Religious Convictions
1. What did you believe your parent(s) expected of you?
Respectful, obedience and to make them proud
2. Did you help around the house?
Yes, my sister I helped our mom with house chores
3. Were you helpful to in school?
Yes, I helped my teacher in class and my friends with tutorials
4. What did you parents want to grow up to be?
An independent woman, fearless & God fearing
5. Did you daydreams a lot? If so, what did you daydream about?
Yes, of being successful in my academics and make my parents proud
6. What were your favorites (as a child and now as an adult)?
WHAT WAS YOUR
As a Child?
What did you like about it?
I like that snow white over
come the evil queen by
Nelson Mandela He fought for freedom
The song gives hope and
TV The love of having a
family that support you
Be kind to people even if
they are not kind to you.
Be ready for the coming of
I like that the story
encourages one to follow
their dreams in spite of
any challenges they are
What do you like about it?
Martin Luther He fought for civil right
God will make a way Zach Williams
where there seems to be Chain Breaker
God will make no way
As an Adult?
He always act natural
Jeremiah 33 v 3
There is nothing God can
7. Describe any spiritual beliefs held as a child? As an adult?
Psalm 23, as a child I believe God is with me everywhere I go, and I still believe that an adult
8. Describe any religious beliefs held as a child? As an adult?
The believe in fasting and prayer as a child and as an adult
CHILDHOOD GENDER AND SEXUAL INFORMATION
(Describe physical development; include the source of the information, reaction to body changes, gender roles
feelings about sexual activity). *Remind the client they have a choice as to whether or not to answer any
question(s) at any point in time. Also, this information is strictly to be used to develop a therapeutic treatment
plan, and will be kept confidential within the treatment team.
1. When did you first notice your body was changing and developing? When you were becoming man/woman?
When I was in middle school
2. How old were you?
14 years old
3. If you are female, what age were you when you began your menstrual cycle?
If you are a male, at what age did you began to grow facial hair? At what age did your voice began to change
and at what age did you experience your first nocturnal emission?
4. Were you prepared for these changes? yes
My mom already explained the stages to me
5. Who talked to you about becoming a woman/man?
6. How did you feel about the changes that are/were happening with your body?
7. Do you or have you ever considered yourself to be a “tomboy” or “girlie girl”?
8. How do you feel about being a boy/girl?
9. Did you ever want to be a boy? If so, why?
No, I love to be a girl so I can do my hair and wear beautiful dresses
10. Did you ever want to be a girl? If so, why?
Yes, because I have a lot of dolls to play with
11. How do you feel about boys/ girls, relationships?
Strange because I attended only girls school for middle and high school
12. Are you currently in a relationship? Do you have a boyfriend/girlfriend?
Yes, I am married
13. Who talked to you about sex and relationships? Who do you talk to now about sex and relationships?
My mom. I talk my husband if anything is wrong
14. Have you ever had sexual relations? At what age? How did you feel about it?
I had sexual relationship with my husband. Age 26
15. Have you ever had a negative sexual experience? If so, with who?
16. What do you consider to be your sexual orientation?
Sexual relationship with opposite sex
CHILDHOOD SOCIAL RELATIONSHIPS
(Friends, gangs, availability of peers, role in peer group, relationships with adults)
1. Who were your friends growing up and what did you like about them?
Tolulope and Shade because thy were well behaved and smart
2. What was your role in your peer group (leader, follower, joker, etc.)?
Leader & Joker
3. What adults were you closest too? How did you know them (From where?)
My best friend big sister
4. Who do you consider to be your friends now? Who is your closest friend?
My family and husband’ best friend wife
5. What are they like? (What characteristics describe them?) What do you like to do together?
My family makes me happy. My husband’s best friend wife. We pray together
6. How do you know them?
Through my husband
7. What role do you play in your group of friends? Are you a leader/follower/joker?
Leader and Joker
8. What adults are you close to now? How do you know them?
My pastor’s wife, through church
ADDITIONAL PARENTAL DESCRIPTIONS
(List other significant adult parental figures)
Current Age: _67__________
Current Age: Passed___________
Age at Clients Birth: 27_____
Age at Clients Birth: 25_____
1. Did you live with them? When?
Yes, from childhood
Yes, from childhood
3. What were ways to win his/her praise?
4. What made him/her angry?
Poor grade & Disobedience
Poor grades & Disobedience
5. What were their expectations of the children?
Good Grades and Obedience
Good Grades & Obedience
7.Relationship to children
8. Sibling most like him/her? In what ways?
OM, because of her health
AD because she is the last born
9. Who was closest to him/her?
10. Who was the most distant?
11. Confided in whom?
12. Any Other important information?
2. What was most important to him/her?
6. Who was his/her favorite? Why?
ADDICTION AND TRAUMA
1. Has there been any history of substance abuse or addiction (gambling, sex, etc.) in the family?
2. If so, who, when, and what did they abuse? How do you feel about it?
VI, he started when our mom passed, in 2004 and I felt sad about it
3. Has there been a history of physical, sexual, verbal and/or emotional abuse (include domestic violence) in
your family? If so who and when? None
4. Have you ever experienced any form of abuse (physical sexual, and/or emotional)? If so, from who and
5. Describe any significant injury or physical trauma (hit by a car, serious fall from a tree, hit in the head, etc.).
I was sad for many years when my mom passed.
1. Is there a history of mental illness in your family? If so, who, and what type of mental health issues?
2. Has anyone in your family ever been hospitalized for mental health reasons?
3. Has anyone in your family ever received therapy or counseling? If so, when, where and for what?
4. Have you been ever hospitalized or received therapy?
5. Does anyone in your family currently take medications or attend counseling for a mental health issues?
6. Do you currently have a counselor or a therapist? If so, who is your therapist and where do they work (or)
what agency are they with? How long have you been seeing them? Do you feel like therapy has been
beneficial/ helpful? No
SIGNIFICANT LOSS OR CHANGES
Ask client if he/she has ever experienced any significant loss or changes such as death of a family member or
friend, a move, change of school, or loss of employment. Ask the client to describe when these changes were
experienced (ages birth to 7 years or more recent; include clients age at the time the change/loss was
experienced). Ask also how the family coped with the reported change or loss.
I experienced a significant change in my life and my family. I couldn’t concentrate on my studies in school
because my mom passed when I was a fresh man in school, but my advisor spoke with me about the situation
and that really helped me. My brother became alcohol addict but eventually be was able to over come it with the
support of his wife.
NATURE OF PARENTS RELATIONSHIP
Description, Division of Roles, Interpersonal Relationship, Conflicts/Agreements, Marriage--Happy or
Unhappy (This is how child perceived the parents relationship with one another, and with the client)
They have a happy marriage but occasional conflict
OTHER FAMILY INFORMATION
1. Describe the childhood (0-7) family climate, family values, socioeconomic status, ethnicity, spirituality?
The family was mostly great, shared, bonded, helped each other, respected elders. Kept up with homework and
2. Describe your current family climate, values, socioeconomic status, ethnicity, spirituality
Obedience, respectful, prayerful and independent
3. Describe any strengths and or challenges experienced by the client or the family system.
No problem, everyone is doing great. We all have our families and my daddy visit US every year.
ADDITIONAL PARENTAL FIGURES AND ADULT MODELS
Who/Relationship _My Uncle_____________
I spent some of my holiday with my uncle when
ever is around from US. He loves reading so his
house is another school for me
She is very nice and encourage me to be of good
Examples of questions that may be used to probe for early recollections:
• What is the first memory you can recall?
• What did your first day of school look like?
• What is your earliest memory of your family or your home when you were a small child?
• What did you like to play with as a child? Ex: favorite toy, blanket?
What is the first loss or change you can remember experiencing?
EARLY RECOLLECTION #1
AGE __6___E.R.__I remembered that I was very jealous when my uncle had a baby thinking they will
FEELINGS: __jealous_______________________________WHY? __I thought they all will not care about
me anymore. _____________________________________
EARLY RECOLLECTION #2
AGE__8___E.R.___I remembred when my sister had a crisis. She was rushed to the ER and I was very
FEELINGS: __Fearful_______________________________WHY?__because I thought I was going to
lose my sister_____________________________________
MOST IMPORTANT PART OF ER? ___When my sister couldn’t breath and we couldn’t find her
inhaler on time.____________________________________________________
EARLY RECOLLECTION #3
MOST IMPORTANT PART OF ER? _______________________________________________________
Purchase answer to see full