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.
Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.
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
Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.
RUBRIC
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)
18 (18%) - 20 (20%) The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family's situation and culture.
• Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria
18 (18%) - 20 (20%) The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
• A psychotherapy genogram for the family
18 (18%) - 20 (20%) The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided.
Written Expression and Formatting - Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria.
5 (5%) - 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation
5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.delineate all required criteria.
Written Expression and Formatting - The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) - 5 (5%) Uses correct APA format with no errors.
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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:
Family Members
Patti- 40 years old
Sheela- 1st born 24 years
Sharleen- 23 years
Shirleen- 21 years (Left in Iran)
1st Son- 18 years
2nd Son- 15 years
CC (chief complaint): “Our household is full of chaos.”
HPI:
Patti, a 40-year-old Iranian female, comes for psychotherapy accompanied by Sharleen, her 23-year-old second-born daughter. Patti states that her household is full of chaos. The chaos began when her third-born daughter Shirleen joined the rest of the family in the US. Patti and her other four children immigrated to the US 12 years ago from Iran but left Shirleen with her father. Luckily, Patti managed to obtain a visa for Shirleen two years ago. Patti attributes the family chaos to when Shirleen mentioned that she was physically and sexually abused by her father back in Iran, and he would even abandon her in the house. Patti defines family chaos as unending fights, yelling, screaming, and cursing each other. Besides, Shirleen blames Patti for her adversities since she left Iran.
Patti states that the family chaos has been worsened by her daughters detaching from her because they think their mother is traditional. The daughters want to experience life independently and discover themselves. However, Patti feels that they should stay longer with her because she is disabled after a botched surgery. This has created increased tension and anxiety in the family. Patti states that she is hopeless and helpless and perceives that her children are beyond her control. She also states that she feels less in charge of the family with the children showing her that they do not need her any longer. Furthermore, Patti has been into heated arguments with her daughters because she wishes that they spend more time with her. Patti reports feeling depressed when her daughters fail to spend time with her. However, she denies experiencing delusions, hallucinations, obsessive thoughts, or suicidal ideations.
Past Psychiatric History:
- General Statement: Patti has a psychiatric history and referred to a psychiatrist.
- Caregivers (if applicable): None
- Hospitalizations: None
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: No history of Individual or Family psychotherapy.
Substance Current Use and History: The video does not provide information on current or past substance use. However, it can be obtained by asking if there is any family member with current or past use of alcohol, tobacco smoking, or use of illicit substances. The clinician should take the substance use history to identify clients’ risk of disorders associated with alcohol and drug substance use like depression and brief psychotic disorder (Grant & Chamberlain, 2020).
Family Psychiatric/Substance Use History: The video does not provide information on the family psychiatric and substance use history. The information can be obtained by inquiring about the presence of a relative with a history of alcoholism or substance abuse or a relative with a history of psychiatric disorder. The history is important in identifying hereditary risk factors for mental disorders in the family (Grant & Chamberlain, 2020).
Psychosocial History:
Patti was married with five children before moving to the US 12 years ago. She is currently living with her two sons, 18 and 15 years, and her three daughters have moved out. Patti was formerly a caregiver before she became disabled. The firstborn daughter, Sheela, is working and studying. The second-born, Sharleen, does promotional jobs and is currently working on getting a real estate license. The third born, Shirleen, is married and currently lives with her husband. The fourth-born son is in high school. The family has a cousin who also immigrated to the US but currently lives in LA.
Medical History: Patti had two lower limb surgeries, which left her disabled and in constant pain. Sheela had a medical problem during childhood.
- Current Medications: Patti was referred to a psychiatrist for pharmacotherapy due to depression symptoms.
- Allergies: Not provided. The information would be obtained by inquiring if there are family members with food, drug, or environmental allergy. Allergy information is vital when developing the treatment plan to avoid prescribing drugs that will cause an adverse drug reaction.
- Reproductive Hx: No history of gynecological/obstetric disorders.
Objective:
The video did not include a physical exam. Nonetheless, a head-to-toe exam is important to help identify underlying abnormalities that could cause Patti’s depressive symptoms like hypothyroidism.
Diagnostic results: No lab/imaging tests were ordered.
Assessment:
Mental Status Examination:
Appearance: Well-groomed and appropriately dressed for the weather and function.
Movement and Gait: Normal gait, posture, and coordination. Maintains eye contact and has positive facial expressions.
Mood: Nervous
Affect: Broad
Speech: Clear, but the rate and volume vary throughout the session.
Thought process: Coherent and logical.
Thought Content: No delusions, hallucinations, obsession, or suicidal thoughts/ideations.
Cognition: Oriented to person, place, and time.
Memory: Intact short-term and long-term memory.
Judgment: Good judgment.
Differential Diagnoses:
Major Depressive Disorder (MDD): MDD is a psychiatric mood disorder characterized by a depressed mood, diminished interest/pleasure, or both (Christensen et al., 2020). Patti exhibits symptoms consistent with the DSM V diagnostic criteria features of MDD, such as depressed mood, constant feelings of tearfulness, sadness, and emptiness, and feelings of hopelessness, worthlessness, and helplessness (APA, 2013).
Post-traumatic Stress Disorder (PTSD): PTSD occurs when a person is exposed to actual or threatened injury, abuse, or harm. This is by directly experiencing the trauma, witnessing, or finding out that trauma occurred to a loved one (Suomi et al., 2019). Shirleen has signs of PTSD after experiencing physical and sexual abuse from her father. The PTSD symptoms include irritable behavior, emotional distress, and reckless behavior (APA, 2013).
The other family members also exhibit PTSD symptoms attributed to learning about the traumatic events that occurred to Shirleen. Sharleen has avoidance symptoms and avoids conversations or thoughts connected with Shirleen’s traumatic event. Besides, Sharleen developed a negative emotional state. Patti’s PTSD symptoms include negative changes in mood and cognition (APA, 2013). Furthermore, Shirleen’s brother has refrained from talking with their father after learning he physically and sexually abused his sister.
Generalized Anxiety Disorder (GAD): GAD presents with unwarranted worry or anxiety about life events or activities (Slee et al., 2021). Patti demonstrates excessive worry about being left by her daughters with her disability. She is occupied with fear of living alone without her children watching her.
Reflections:
The assignment has enlightened me on the psychiatric disorders that can affect an entire family. I have learned that family members can develop PTSD symptoms if exposed to a traumatic event. Besides, family members can develop PTSD symptoms if they learn that a traumatic event occurred to one of them. Therefore, the therapist needs to address the problem through Family therapy to help the members jointly address the issue.
Case Formulation and Treatment Plan:
Patti and her children demonstrate PTSD symptoms associated with a traumatic event that occurred to one of her children. This is the possible cause of the chaos in the family. Patti also demonstrates depression symptoms.
Treatment will include Family Trauma-focused cognitive-behavioral therapy (TF-CBT) to help the family manage the PTSD symptoms (Suomi et al., 2019).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Christensen, M. C., Wong, C., & Baune, B. T. (2020). Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?. Frontiers in psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280
Grant, J. E., & Chamberlain, S. R. (2020). Family history of substance use disorders: Significance for mental health in young adults who gamble. Journal of behavioral addictions, 9(2), 289–297. https://doi.org/10.1556/2006.2020.00017
Slee, A., Nazareth, I., Freemantle, N., & Horsfall, L. (2021). Trends in generalized anxiety disorders and symptoms in primary care: UK population-based cohort study. The British journal of psychiatry: the journal of mental science, 218(3), 158–164. https://doi.org/10.1192/bjp.2020.159
Suomi, A., Evans, L., Rodgers, B., Taplin, S., & Cowlishaw, S. (2019). Couple and family therapies for post-traumatic stress disorder (PTSD). The Cochrane database of systematic reviews, 12(12), CD011257. https://doi.org/10.1002/14651858.CD011257.pub2