Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the problem,? the

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Week (enter week #): (Enter assignment title)

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

Subjective:

CC (chief complaint):

HPI:

(include psychiatric ROS rule out)

Past Psychiatric History:

· General Statement:

· Caregivers (if applicable):

· Hospitalizations:

· Medication trials:

· Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

· Current Medications:

· Allergies:

· Reproductive Hx:

Objective:

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections:

Case Formulation and Treatment Plan:  

Assignment: Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.

View the Mother and Daughter: A Cultural Tale video in the Learning Resources and consider how you might assess the family in the case study.

The Assignment

Document the following for the family in the video, using the Comprehensive Evaluation Note Template:

Chief complaint

History of present illness

Past psychiatric history

Substance use history

Family psychiatric/substance use history

Psychosocial history/Developmental history

Medical history

Review of systems (ROS)

Physical assessment (if applicable)

Mental status exam

Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria

Case formulation and treatment plan

Include a psychotherapy genogram for the family

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I sometimes reflected on what they were saying to clarify or to expand the idea or how I understood it to give voice to other possibilities, but respecting the personal peace, and then, I ask I ask the family to come back to, in a classical way, to respond to those comments what strike them.

In the case that we watch, it seems that the family was dealing with sort of like two forms of trauma and/or three forms of trauma; one is, history of battering the domestic violence, child sexual abuse, a history of immigration that in some ways we lay it to that trauma getting away from it and basically the mother of five children deciding that they need to move out of the home, but in the process leaving one behind who is later on sexually, I mean, raped by the father. And then at the present moment mother dealing with a fairly traumatic illness that have her, very disable, unable to walk and to work. So, it's sort of like the interview trying to address these different forms of trauma and the way in which the young adults are trying to make sense of their bicultural life and how the whole family is trying to make sense of being bicultural and being immigrants. The session doesn't end with a need or incredible intervention of my part because I feel that this is the part of the therapist to try to decide, this is the family that's been working this therapist for year and half. Therefore, they have a relationship I feel that I need to respect and so those are the basic intercommons. So, tell me how is it that you came out with the idea of having this interview with me? Okay. I'm going to go back when Patti came in for the first time. She came in because they were chaos at her household.

Pt.’s History

She came to this country twelve years ago with her four children and one was left behind, her daughter who was 10 years old at that time, eight years old at that time, was left behind. Just two years back, finally they were able to get her visa and she brought her to United States. So ever since she came here chaos was created inside the household. She just felt that she needed the money more than coming to therapy and she refused the entire time and mom tried to she ask her, if she doesn't feel comfortable with me. She said she has had all appointments with other therapists at this clinic, still she refused to come in, but they kept on seeing Patti and the oldest daughter Sheela for about a year and a half now. Ever since then, we started working on the chaos in the household, what is it that creating chaos and I found out that Patti lives with traditional ways of living, their daughters are trying to detach herself from Patti and grow on their own and find their own individuality. So would ask where they have been working on and ever since then she had two surgeries.

Summary

I'm going to comment on some themes that had to with the interview per se with the family, the reflecting team for some conceptual ideas that I think that maybe important for people to know, and also to reflect on my own thinking as I was doing the interview and also about some of the things that I may have missed after having done the interview and having seen watch the video tape a couple of times. One of the things that I did not is in the case, in the Sandi's case is how difficult it is for the reflecting team to react personally sometimes, but unknowingly to a family but to react to the overall therapeutic system although I may have emphasized that I find that sometimes it's hard for therapists to think about the therapy system and not just the family. We are trying to observe the family and not to observe as interacting with the family and because it's so compelling sometimes the story of the client, but I find that it is helpful to think about the relationship between the therapist and the family and some of the isomorphisms that happened there to understand what is happening in the family. In this case, one of the things that we find is that trauma occurs, I mean, at various levels. On the one side, you have the survival story, which is also at the same time a traumatic story. That is the husband, the father and the husband in this family will seem to have been very abusive towards his wife and the mother and towards the children. And that isn't itself fairly traumatic.

And then the survival story is leaving him and coming to the United States. And then, the second peace of this traumatic story is for the children to come to terms and for the mother to come to terms with having left one of the children in the home country. The other peace of the trauma is in itself the story of survival becomes — could become story of trauma as this family come and immigrate the United States. In the interview, we didn't explore in detail the immigration story, we have enough time, because in some way, the conflict between the children and the mother, particularly one child and the mother, adult child takes over in terms of the interview, in terms of what becomes figure. And so, and then, as we — as that conversation moves along we're moving to knowing little bit about acknowledging the trauma of coming to terms with the illness for mother. One of the things I did, I do in first interview of course, is to know who is in the family and try to build a basic genogram and that's what I find myself doing in the first part of the interview. And also talking about how is it that they decide to come for a consultation. Conceptually a theme that I saw was interesting in this interview is the idea of leaving home, how is that this girl is struggling with independence, how mother is struggling with this independence. And how they are both in some ways struggling with the idea of dependence and independence and basically struggling with different notions of what it means to be independent or be dependent. And I would add that a lot of this course that is struggling with is that this course of how our society tends to see the kids leaving home, and tends to in some way, see independence as more important than dependence and work a lot around those polarities between dependents and independence rather think in terms of interdependence.

And particularly now that they have to negotiate how mother is going to taking care by the children since she is getting ill. One of the things that I didn't address in the interview is how the therapist define this process as detachment and I never addressed this idea of detachment, which is in itself, part of the process thinking about independence as separation rather than as joining. And it could have been, I think, I saw there was a last opportunity to talk about the therapist understanding of this process, since she understood it as detachment. One of the things that I also found myself doing a lot of was listening to the mother's situation to the facts and the daughter, while they were showing some of the tension that existed between the two of them. And at the same time, as the competition evolve, I do acknowledge the emotional climate and how is it that in particular, the daughter is feeling in the session and at certain moment, she is very upset and sad and angry. And I knowledge that and maybe I too have acknowledged a little bit more mother's emotional stands. One of the things that I didn't also address that that doesn't seem that the therapists could address later on is, how is that the daughter seems to know more about what's going on with the siblings and to really validate her concern for the family in that way that in someway, she is being very protective of her mother as she takes care of the siblings. Another concern of mine and I think that I might have done that during the interview, was to always bring forth the voices of those who are present and those who are being represented in this case how, she, the daughter will represent the voices of the siblings.

And another aspect of the interview includes how is it that I ask about social support and where is the family, what are the connections they have, and at the beginning, I ask about, is there is anybody else who immigrated with them and — or who is his close by as a relative. And at the end of the interview, I again suggest the possibility of thinking about social support, thinking of friends or other professionals or paraprofessionals who might provide support in particular around the new needs that mother, that the adult have right now in terms of the illness. The peace that was present in the session is this notion of agency. Although someone might have gone through a very traumatic period, I try to highlight the process of survival of overcoming that particular period and to think in terms of the future. And then think in terms of ambition and different kind of relationship and a couple of times in the interview I ask the mother and daughter to ambition how do they ambition in different kind of relationship. In the interviews, you can observe, and this is I think, basic in the collaborative approach, I often ask how — I mean, I check with the therapist and the clients around issues of how is this conversation moving, if this conversation were to continue this way, where will they go, and I ask the therapist to hypothesize what would happen if they were to continue talking in a particular way. During the reflecting theme, the basic conversation was around the dependence, independence and interdependence. And what I found very interesting is, how is it that the different place in the reflecting theme we're able to understand the immigrant experience and the big cultural aspects of this family.

And another piece that I saw that was important is to sort of like understand what it is to become more independent of your own parent while at the same time, coming to term with the notion that they would have — you would have to take care of your own parent, although this is in a very — at a early time, earlier than the usual. During the reflecting time, I thought to myself, I was reminded of how being close to the family coming from the same background, in this case, the therapist being also of some of from Iran may not necessarily ensure your success from a multi-cultural perspective. Although the relationship with the client maybe a very positive one and may not necessarily ensure the success and in that sense, the value of bringing the reflecting with very different voices. The peace that viewers may find interesting is, how I use words, in this case, the therapists, some are from Iran, I am also a non-English Irish speaker and how I use this an opportunity to play with words and to use humor with the family and the therapist, which I do often during the session. One of the questions I ask them and it will have different configuration with different families, I ask them who is more opinionated, who has a strong opinion, which in some way, is basically bringing — reflecting on something that could — we get them into trouble, something that will be seen as problematic, but at the same time, it maybe seen as validating. And when I ask who is more opinionated, a typical kind of secret questions I guess is, I'm basically, assuming that they are both opinionated that in a way they cheer some similarities, in fact, that with people are in conflict, often there's, because they are seeing themselves as two different.

And towards the end of the interview, I term on that I like her sense of humor and her daughter smile and I see how important it is to always validate both, any member, all the members of the family attending the session, so that the other one — so that the other one can feel okay about criticizing the other members of the family, but not having the therapist sort of like completely in coalition with that same statement. That is, if I can see and I can validate each members of the family, the other ones may also see that particular validation. Often in a consultation, I will mention that there's themes that can be talked in therapy later and I may say maybe we can, I could have same, maybe, we can think about this idea between now and then if I were to be alone as a therapist. Often in a consolidation, I may say, this is something that maybe helpful to talk about in the future in a therapy session. I may say something of that sort in a reflective way. Another aspect that I noticed in this session like in many other sessions is, how expectations about the others, are they ones that may — high expectations about another member of the family might bring a lot of conflict. In terms of assimilation and I — towards the end I term on that she'd always be concerned about the children. And that there might be other ways, in which you can get resources. I also try to reframe some of the difficulties using multi-cultural framework, for instance, by saying that there is some things that you might be thinking here, that here it could be conservative, but in home country couldn't because couldn't be considered very radical and very different. And I also try to help them to think about this different transitions they are going through, including — and this different traumas they are dealing with in the past, in the present and in the future.

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