wk5Family Prac Assgn
See attached.
Family Psychotherapy Prac
Reword to prevent Matching
*Note. Don’t change the person names*
The Question
Part 1: Comprehensive Client Family Assessment
Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) 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
Part 2: Family Genogram
Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).
Practicum Experience Time Log and Journal Template
Student Name:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
Week 3 Journal Entry (Comprehensive Client Assessment)
HHHHHHHE
University
NRNP 6650 – Psychotherapy with Groups and Families
Instructor:
January, 2021.
This journal entry will discuss family group counseling of a client at Wales Counseling Center during the week 3 practicum experience. It will discuss detailed comprehensive client assessment, the differential diagnosis of the client formulated with legal and ethical considerations as it relates to the client, case formulation, treatment plan and finally the family genogram.
Divorce is one of the significant life events that disrupt the family life cycle as the family progresses, altering the original life path anticipated initially at the beginning of the marriage. According to Ramisch et al. (2020), mental health professionals consider divorce an ongoing process involving not just one court date. The family is going through marital challenges, communication breakdown, and are on the verge of considering divorce as an option; thus, they seek therapeutic intervention to salvage the marriage.
Demographic Information
Vincent is a 15-year-old Hispanic American adolescent boy accompanied by his father and mother to the therapist’s office. His mum Monica is a 38-year- old Hispanic American who works in the hospital as a case-manager, while his dad Arnold, a 45-year-old Hispanic American man, is a company’s construction project manager. They have a daughter (Bridget) who is eight years old.
Presenting problem
Vincent was informed about the divorce proposal the parents are considering. The information brought about a remarkable negative change in both behaviors and his school’s academic performance relating to the decline in grades. Vincent resorts to isolating himself at home, maintaining distance from his dad, exhibiting a lack of interest in activities, excessive worry/thinking, and displays frequent emotional outbursts and aggressive tendencies towards his younger sibling (8 years old sister). Lately, Vincent has been getting in fights in school. His parents are seeking psychotherapy to help him verbalize his feelings.
History of present illness
According to his parents, Vincent has always been a cheerful, playful, social butterfly. Parents have been married for more than 15 years. Vincent’s attitude started changing after witnessing initial fights between parents two years ago. There are other incidences Vincent witnessed his dad beating up his mom. Vincent verbalized mom did not report the incidents to the police department. The situation has worsened, and parents are considering divorce. Vincent reports that parents have a hard time informing the children about their decision to end the marriage. Vincent’s attitude became worse after finding out about the divorce proposal. The couple has been experiencing difficulties in their marriage for the past 3yrs and decides to end it. Vincent reports that since witnessing the initial fight two years ago, he has been keeping a distance from dad and has many anxieties, worries, and anger issues. Vincent has also been getting in fights in school, displaying frequent aggressive tendencies and emotional outbursts to his younger sister. Before the COVID-19 shutdown, Vincent has been refusing to attend school, impacting his scores and per.
Past psychiatric history
Vincent verbalizes occasional anxiety and anger in the last two years after witnessing his first episode of his dad beating up his mom.
Medical History
Vincent denied any medical history. Arnold has a medical history of chronic back pain relating to a motorcycle accident four years ago. Monica has no medical history. The paternal grandfather has diabetes.
Substance Use History
Vincent reports smoking cigarettes at 13 years old after witnessing the first episode of his parent fight. Vincent reports his friends encouraged him to try it whenever he is experiencing anxiety. Vincent said it has been working for him since it calms him down. Arnold indulges in alcohol and opioid abuse to calm his nerves and anxiety down.
Developmental History
Normal milestone, no history of a developmental abnormality.
Vincent is in 8th grade and plays basketball in school. Vincent also plays guitar and piano as a hobby.
Family Psychiatric History
Vincent has a history of anxiety disorder. The mother has depression that she is on medications. Arnold, his father, is an alcoholic, opioid abuse, and anxiety disorder. The maternal grandmother has depression. The great paternal grandparents are both dead, but the great paternal grandfather was an alcoholic when he was alive while the great paternal grandmother had an anxiety disorder. The great maternal grandmother has an anxiety disorder.
Psychosocial History
Vincent is in 8th grade and plays basketball in school. Vincent also plays guitar and piano as a hobby.
Due to the COVID-19 crisis and the resultant shutdown that happened, Vincent has been at home and chooses to continue with online class. Vincent’s dad is a construction company manager, and mum is working as a case manager in the hospital.
History of Abuse and Trauma
Emotional trauma due to witnessing several times his dad beating up his mom.
Review of Systems
HEENT:
Head: symmetry, no scar.no sign of injury, denied pain.
Eyes: sclerae is clear, has no visual problem.
Ears: no discharges, no hearing loss, denied pain in the ears.
Nose: no sneezing, no nasal discharge, no presence of abnormalities
Throat: denied any sore throat, no enlargement noted, denied difficulty swallow.
SKIN: good skin turgor. Vincent had facial acne and a scar in the right knee due to a fall last week.
CARDIOVASCULAR: no palpitation, S1, S2 heard.
RESPIRATORY: normal respiratory pattern. Chest is clear, with no shortness of breath.
GASTROINTESTINAL: low appetite; maintains normal daily bowel movement.
GENITOURINARY: No, abnormalities. Vincent denied pain with urination.
NEUROLOGICAL: Vincent is alert, well-oriented X4, able to answer all questions but in a low voice tone. Appears withdrawn but is actively participating in therapy.
MUSCULOSKELETAL: denied feeling of discomfort, able to move all extremities. Arnold has chronic back pain due to a motorcycle accident.
LYMPHATICS:
No enlarged nodes.
ENDOCRINOLOGIC:
denied any sign of hormonal imbalance
ALLERGIES: He denied any medication or food allergy
PSYCHIATRIC: Vincent has a history of anxiety disorder. Monica has a history of depression and is currently on medications. Arnold has an anxiety disorder and abuses alcohol and opioid.
Physical Assessment and Mental Status Exam
All family members are alert, well-oriented X4. Each member does not seem to be in any apparent distress. Vincent appears withdrawn at the beginning of therapy but was actively participating as expected. Vincent can answer all questions but in a low tone. Vincent denied suicidal or homicidal ideation. Each family member appears well-groomed and appropriately dressed, has a normal affect, and has good insight into the problem.
Primary Diagnosis: Separation Anxiety Disorder
According to DSM5, Vincent meets the three criteria requirements for establishing diagnoses of separation anxiety disorder. These requirements include recurrent excessive anxiety when anticipating or experiencing separation from home and prominent significant figures that the clients have established bonding or attachment. Persistent fear and objections to leaving the house to anywhere else or skip school sessions due to separation from significant figures; and finally, continuous, non-stop hesitancy and unwillingness to stay by themselves without the primary significant figures in the environment are consistence with a separation anxiety disorder (American Psychiatric Association, 2013).
Differential Diagnosis: Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) occurs in individuals who have witnessed traumatic or harmful events like physical injury/abuse, sexual violence, and or rape (American Psychiatric Association, 2013). The individual displays trauma by avoiding situations or individuals that remind them of the event. Symptoms include flashbacks, nightmares, detachment/estrangement from people (American Psychiatric Association, 2013). PTSD manifest by the client displaying evasive attitude and demeanor, negative character and disposition, and interference tendencies/inclinations due to traumatic experience (Stavropoulos, Bolourian & Blacher, 2018). According to Espinel and Shaw (2018), PTSD occurs when an individual experiences directly a significant threat to himself or someone remarkably close. The magnitude of the traumatic experience determines the vulnerability and the earnestness of the disorder (Espinel and Shaw, 2018).
Differential Diagnosis: Oppositional defiant disorder
According to DSM-5, children manifesting separation anxiety disorder can persistently display oppositional tendencies and behaviors when an attempt to forcefully separate them from their prominent attachment figures (APA, 2013). Diagnosis of ODD is common in uncooperative children and displays negativity, hostility to higher authorities, destructive and disobedient behaviors toward others (Linghiem et al., 2015).
Case Formulation:
Vincent is having difficulties handling the impending divorce from the parents. Family psychotherapy allows all to gain insight into the cause of the problem and strained relationship between parents, and probably salvage the marriage. Due to the excessive fighting and the dad beating on mom, Vincent isolates himself from dad, does not communicate feelings to the parents, has poor performance at school, and displays some emotional outbursts and aggressive behaviors to his sister. Participating in therapy has helped Vincent to divulge some of his feelings. Consistency in attending therapy sessions as scheduled and active participation by all will help the family.
Treatment Plan: Involves starting Vincent on cognitive behavioral therapy. CBT will help the client gain confidence in thoughts, actions, and positive coping strategies to handle and treat the separation anxiety disorder. Family therapy helps to resolve the problem at home that is causing emotional distress to the client. Cognitive Behavioral Therapy will help the client and family acquire problem-solving skills, assertiveness, controlling emotional outbursts, anger, and establishing strategic functioning family therapy (Ghosh, Ray & Basu, 2017). CBT is also highly effective in reducing PTSD symptoms (Tricola & Gill, 2018).
CBT in children last between six to twenty sessions, and the focus is on how adolescent thought process, emotions, and behaviors interconnect and affect each other. The therapist can utilize the CBT approach to intervene at various points in the cycle (Society of Clinical Child & Adolescent, 2017).
The Family Genogram
The Patient Sister
Father Mother
Grandparents (Both Maternal and paternal)
Great Grandparents (All Deceased).
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author.
Espinel, Z., & Shaw, J. A. (2018). PTSD in Children. Post-Traumatic Stress Disorder, 189-209.
Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight.
Psychology research and behavior management, 10, 353–367.
https://doi.org/10.2147/PRBM.S120582
Lindhiem, O., Bennett, C. B., Hipwell, A. E., & Pardini, D. A. (2015). Beyond Symptom Counts
for Diagnosing Oppositional Defiant Disorder and Conduct Disorder? Journal of abnormal child psychology, 43(7), 1379–1387.
https://doi.org/10.1007/s10802-015-0007-x
Ramisch, J.; MCvicker, M.; Sahin, Z. S. (2020). Helping Low-Conflict Divorced Parents
Establish Appropriate Boundaries Using a Variation of the Miracle Question: An Integration of Solution-Focused Therapy and Structural Family Therapy. Retrieved fromhttps://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=44460897&site=eds-live&scope=site
Stavropoulos, K. K. M., Bolourian, Y., & Blacher, J. (2018). Differential diagnosis of autism spectrum disorder and post-traumatic stress disorder: two clinical cases. Journal of clinical medicine, 7(4), 71.
Society of Clinical Child & Adolescent Psychology (2017). What is CBT. Retrieved from
Tricola, K., & Gill, A. (2018). Is trauma-focused cognitive behavioral therapy effective in decreasing posttraumatic stress disorder (PTSD) in children and adolescents? Evidence-Based Practice, 21(2), E16-E17.
Vincent Has Separation
Anxiety Disorder
DD: PTSD & ODD.
Bridget 8years
Monica 38 years
Depression
On medication
Arnold 45yrs
Anxiety Disorder
Abuse Alcohol & Opioid
Antonio
(Alive) DM
Maternal Grand Father
(Deceased)
Maternal Grand Mother (Alive)
Depression
Maria
(Deceased)
Lewis
Alcoholic
Madeline
(Depression)
Madeline
Anxiety
Jose
Alcohol
Deceased
© 2012 Laureate Education Inc.
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© 2014 Laureate Education, Inc.
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