Week 2: Family Assessment and Phases of Family Therapy
A family’s patterns of behavior influences [sic] the individual and therefore may need to be a part of the treatment plan. In marriage and family therapy, the unit of treatment isn’t just the person – even if only a single person is interviewed – it is the set of relationships in which the person is imbedded.
—American Association of Marriage and Family Therapy, “About Marriage and Family Therapists”
When issues arise within a family unit, the family often presents with one member identified as the “problem.” However, you will frequently find that the issue is not necessarily the “problem client,” but rather dysfunctional family patterns and relationships. To better understand such patterns and relationships and develop a family treatment plan, it is essential that the practitioner appropriately assess all family members. This requires you to have a strong foundation in family assessment and therapy.
This week, as you explore family assessment and therapy, you assess client families presenting for psychotherapy.
Learning Resources
Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
L’Abate, L. (2015). Highlights from 60 years of practice, research, and teaching in family therapy. American Journal of Family Therapy, 43(2), 180-196. doi:10.1080/01926187.2014.1002367
Mojta, C., Falconier, M. K., & Huebner, A. J. (2014). Fostering self-awareness in novice therapists using internal family systems therapy. American Journal of Family Therapy, 42(1), 67–78. doi:10.1080/01926187.2013.772870
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.
Chapter 2, “Basic Techniques of Family Therapy” (pp. 23-39)
Chapter 3, “The Fundamental Concepts of Family Therapy” (pp. 40-55)
Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207-215. doi:10.1111/famp.12025
Papero, D. V. (2014). Assisting the two-person system: An approach based on the Bowen theory. Australian & New Zealand Journal of Family Therapy, 35(4), 386-397. doi:10.1002/anzf.1079
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.
Chapter 12, “Family Therapy” (pp. 429–468)
Document: Group Therapy Progress Note
Required Media
Laureate Education (Producer). (2013a). Hernandez family> Sessions 1—6 [Video file]. Author: Baltimore, MD.
Note: The approximate length of this media piece is 52 minutes.
Psychotherapy.net (Producer). (2006). Tools and techniques for family therapy. [Video file]. Mill Valley, CA: Author.
The approximate length of this media piece is 52 minutes.
Assignment : Hernandez 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. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.
Learning Objectives
Students will:
Assess client families presenting for psychotherapy
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide on family assessment.
View the Hernandez Family: Sessions 1-6 videos, and consider how you might assess the family in the case study.
Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.
The Assignment
Address in a comprehensive client assessment of the Hernandez family the following:
Demographic information
Presenting problem
History or present illness
Past psychiatric history
Medical history
Substance use history
Developmental history
Family psychiatric history
Psychosocial history
History of abuse and/or trauma
Review of systems
Physical assessment
Mental status exam
Differential diagnosis
Case formulation
Treatment plan
Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment
By Day 7
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Hernandez Family Assessment
Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date
Hernandez Family Assessment
Introduction
The Hernandez family’s family assessment, both the wife and the husband, requires a comprehensive evaluation of their health condition. It comprises demographic information, presenting challenges, history of other illnesses, psychiatric history, and relevant medical history. The family assessment also evaluates the substance use history and developmental history. Other parts covered in the assessment include the mental status exam, differential diagnosis, review of the system and physical assessment. According to the assessment, the couple could be suffering from the post-traumatic disorder due to the punishment they received at a young age. A treatment plan is also part of the assessment for the condition identified in the diagnosis. The treatment plan will utilize cognitive behavior theory to help them change their way of thinking, thus altering their behavior. It is also important for them to learn better strategies for disciplining their children. The essay aims at evaluating the Hernandez family and developing a better understanding of their condition, and creating a treatment plan.
Demographic Information
The demographic information of the family shows it has four family members. They include Juan Hernandez, the husband, 27, Elena Hernandez, the wife, 25 and their sons Jan Jr. Alberto. The sons are eight and six years, respectively. They reside in Queens, New York. The wide is a baby sitter in a nearby home while the husband works in an airport in the baggage section. They complain of the budget falls that prompt Juan to work overtime.
Presenting Problem
The presenting problem is that the parents are punishing their children severely. One of the sons reported the issue to a social worker. They punish them by asking them to kneel while holding an encyclopedia in both hands. The parents believe it is the best way to discipline their children. The challenge seems to originate from the way they were raised. However, underlying issues could also be the cause of the problem.
History or Present Illness
The family has no history of major illness, both physical and mental. The children have also not been admitted to the hospital for any condition. However, the only problem is that they are punishing their children harshly. According to the social worker, the method of punishing the children is harsh, and thus an assessment is required.
Past Psychiatric History
The family has no history of psychiatric conditions. However, an additional assessment is required to determine if underlying mental issues could cause the punishment against their children. For example, the severe punishment at a young age could be a reason to punish their children. Other stressors, such as financial constraints, could also impact their psychiatric status, although it has not been diagnosed. A past psychiatric examination is unavailable to determine they have no mental condition.
Medical History
The Hernandez family has no significant history of illness or hospital admissions. For instance, they have no cardiovascular, respiratory, injuries, car accidents or bruises. They also have no skin condition. A comprehensive report of their condition and that of the extended family is not available. Therefore, no information is available on hereditary conditions. Hernandez’s family has no history of lifestyle diseases such as diabetes. However, further assessment may be required in the future to ascertain their health status.
Substance Abuse History
The family has no incidences of drug and substance abuse, including the sons. However, Juan and Elena occasionally take alcohol while hanging out with their peers.
Developmental History
The children and parents have hit their developmental milestones. No abnormalities in growth are recorded.
Family Psychiatric History
The family has no psychiatric history. However, based on their method of disciplining their children, there is a need for further assessment. They also strongly defend their style of parenting, which is also a warning sign of psychiatric conditions.
Psychosocial History
The family is heterosexual in nature. There is no information available if the children could be engaging or supporting homosexual relations.
History of Abuse/Trauma
Juan states that his father harshly disciplined him. He states that he would ask him to kneel while holding two encyclopedias in both hands. His mother was even worse since she would ask him to get more books. He believes similarly disciplining the children is the right way to go. The children have also been traumatized or abused by severe punishment. However, the parents do not appreciate that their style of punishment is a form of abuse.
Review of Systems (ROS)
Respiratory – The family has no background of chest pains, coughing or wheezing. They also have no paroxysmal nocturnal dyspnea or hemoptysis.
Cardiovascular – All family members have no history of dyspnea, edema, shortness of breath, palpitations, and discomfort.
Gastrointestinal – No history of diarrhea, anorexia, jaundice, vomiting, constipation, heartburn, or nausea.
Genitourinary System – No reported urinary incontinence cases, flank pain, dysfunctional urinary bleeding, or urinary flow changes.
Central Nervous System – The family has no dizziness, lack of consciousness or paresthesia.
Musculoskeletal System – The family has no back pain, joint swelling, myalgia or arthralgia.
Physical Assessment
A physical examination is not required at this stage since the focus is to evaluate the patient’s mental health condition due to their current behavior. However, the sons have not reported any physical injury as a result of the punishment.
Mental Status Exam
Juan and Elena Hernandez are well-groomed for the occasion. They are conscious of time and place and cooperative during the interview. Their speech is audible, and their normal rhythm rate shows no abnormalities. They are anxious about the outcomes and the need to come for various sessions. They try to remain calm throughout the interview. The couple’s long-term and short-term memory are intact. Their insight and judgment during the conversation show they are healthy. However, the only warning sign is that their past behavior could be a cause of underlying problems.
Differential Diagnosis
1. Post-traumatic disorder
2. Personality disorders
3. Psychosocial and environmental conditions
Case Formulation
Exposure to life stressors is one of the major reasons for the post-traumatic disorder (Shalev et al., 2017). According to the American Psychological Association (Help write my thesis – APA), people who experience trauma or stress for a long time are likely to depict lifestyle changes (Aalbers et al., 2017). For instance, punishing the children severely could be due to the financial constraints and the punishment from their parents. Juan admits that they learned the punishment from their parents. Other life stressors, such as trying to make ends meet (Bollens & Fox, 2019). Specifically, they indicate they are not available for all the parenting sessions since Juan has to work extra hours. Evidence from past literature shows that parent can vent their anger and frustration on their children (Manchaiahet al., 2020). The way they treat their children is an indicator of underlying mental challenges.
Treatment Plan
A treatment plan will involve group therapy for the couple. They should attend various sessions to explore their problem and present a solution. For instance, a therapist will use cognitive behavior theory to help change their thinking and emotional patterns (Edmondson & von Känel, 2017). The thinking and emotions will alter behavior and modeling better punishment methods (Haynes et al., 2016). Group therapy is effective since both parents support severe punishment. They also need to agree on the alternative measures of punishing their children without abusing them. It will also promote cohesion and limit the risk of conflict. The treatment plan is also goal-oriented, making it possible for the couple to achieve the goals they set together with a therapist (Sege et al., 2018).
Conclusion
Hernandez’s family demonstrates that they have an underlying issue due to their style of disciplining their children. The comprehensive family assessment covers various areas, including demographic information, history of illness, current presenting problem, medical history and developmental history. It also examines the history of drug and substance abuse, trauma and abuse, physical assessment, differential diagnosis, case formulation, and treatment plan. The diagnosis shows they could be suffering from the post-traumatic disorder. Therefore, they require treatment, including cognitive behavior therapy. The focus is to model their behavior by changing their patterns of thinking and emotions. The couple also needs to embrace the reality that their current punishment model is similar to a form of abuse. Therefore, they need to change to ensure they do not harm their children mentally, thus causing similar mental challenges in their families. They should attempt to find alternative methods of resolving their issues due to life stressors such as financial challenges.
References
Aalbers, D., & Teo, T. H. O. M. A. S. (2017). The American Psychological Association and the torture complex: A phenomenology of the banality and workings of bureaucracy. Journal für Psychologie, 25(1), 179-204.
Bollens, S. H., & Fox, R. A. (2019). Assessment of trauma symptoms in toddlers and preschoolers living in poverty. Child Maltreatment, 24(3), 275-285.
Edmondson, D., & von Känel, R. (2017). Post-traumatic stress disorder and cardiovascular disease. The Lancet Psychiatry, 4(4), 320-329.
Haynes, P. L., Kelly, M., Warner, L., Quan, S. F., Krakow, B., & Bootzin, R. R. (2016). Cognitive behavioral social rhythm group therapy for veterans with posttraumatic stress disorder, depression, and sleep disturbance: results from an open trial. Journal of Affective Disorders, 192, 234-243.
Manchaiah, V., Vlaescu, G., Varadaraj, S., Aronson, E. P., Fagelson, M. A., Munoz, M. F., … & Beukes, E. W. (2020). Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States. American Journal of Audiology, 1-15.
Sege, R. D., Siegel, B. S., ABUSE, C. O. C., & Committee On Psychosocial Aspects Of Child And Family Health. (2018). Effective discipline to raise healthy children. Pediatrics, 142(6).
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine, 376(25), 2459-2469.
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