CONSULTORIO PSICOLGICO - UNMSM

DIBUJO DE LA FIGURA HUMANA DE KAREN MACHOVER

Nombre: ________________________________________________________ Edad: ___________ Sexo: M

Fecha: _____-_______-_________ Escolaridad ________________________ Entrevistador ______________________

Hora Inicio:

Hora Fin:

Latencia:

Tiempo total:

(Haga un dibujo de una persona) Observaciones y procedimiento

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Preguntas abreviadas:
(Hombre o mujer?) ________________________________________________________________________________
(Edad?) _________________________________________________________________________________________
(Dnde?) _________________________________________________________________________________________
(Haciendo?) ______________________________________________________________________________________
(Pensando?) ______________________________________________________________________________________
(A qu se dedica?) _________________________________________________________________________________
(Es saludable?) ____________________________________________________________________________________
(Es feliz?) ________________________________________________________________________________________
(Confa en las personas?) ____________________________________________________________________________
(Vive con? Cmo son? Cmo se llevan?) ______________________________________________________________
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(Ms afecto por?) _________________________________________________________________________________
(Menos afecto por?) _______________________________________________________________________________
(Lo que ms desea?) _______________________________________________________________________________
(Qu le gusta?) ____________________________________________________________________________________
(Qu le desagrada?) ________________________________________________________________________________
(Qu lo alegra?) ___________________________________________________________________________________
(Qu lo entristece?) ________________________________________________________________________________
(Qu lo enoja?) ___________________________________________________________________________________
(Qu lo preocupa?) ________________________________________________________________________________
(A qu le teme?) __________________________________________________________________________________
(Satisfecho?) _____________________________________________________________________________________
(Mejor parte?) ____________________________________________________________________________________
(Peor parte?) _____________________________________________________________________________________
(Qu cambiaras?) _________________________________________________________________________________
(A quin te recuerda?) ______________________________________________________________________________
(Quisieras ser como l?) _____________________________________________________________________________
(Le gustara que fuera su pareja o amigo/a?) ____________________________________________________________