Family Assessment and Psychotherapeutic Approaches Essay

Family Assessment and Psychotherapeutic Approaches Essay

 

Introduction

Different families have different family dynamics. This paper discusses the case of a 40-year-old Irani mother who immigrates to the United States with her children. Patti has five children: Sheela, age 24; Sharleen, age 23; Shireen, age 21; Armin Jr., age 18; and Sam, age 15. Shireen has recently been reunited with her family after her mother immigrated to America and left her in Iran with her father. Patti reports to the clinic because there has been chaos at home since her daughter rejoined the family after 10 years. The chaos began two weeks ago when Shireen started reporting how her father emotionally, physically, and sexually abused her. She blames her mother for this. She felt abandoned. The history also reveals that Patti has had surgery on both her feet. Patti lives at home with her two sons. Shireen got married secretly and moved out. The other daughters live on their own.  Patti has increasingly felt lonely and helpless. She wants her daughters to stay at home or visit more often. Her daughters feel that they want Patti to practice independence as they also have their lives to live.

Differential diagnosis

Post-traumatic stress disorder. (PTSD) is a mental disorder that occurs after someone close to them is exposed to an extremely threatening or horrifying event. An example would be physical trauma or sexual trauma in childhood. The patient may have a delayed presentation of symptoms. A diagnosis can be made in patients who have had an impaired function for one month. The criteria for diagnosis include persistent intrusive memories, recurrent distressing dreams, prolonged psychological distress, avoidance of reminders and stimuli, self-blame or blame of others, feelings of estrangement and detachment from others, persistent negative emotions such as anger and guilt, self-destructive behavior, and angry outbursts (Herringa, 2017). Both Patti and Shireen most likely have PTSD. They meet a number of the criteria required to diagnose this disorder. Patti was married to an abusive husband. She says she would step in between her husband and her children to protect them. When she left Shireen in Iran, she was worried that Shireen would have no one to protect her from the abuse. She is also concerned that her daughters may get married to an abusive husband. Ever since Shireen reported the trauma she endured at the hands of her father, the house has become an uncomfortable place. Patti feels guilty for what Shireen went through. Shireen blames her mother for all her trauma. Patti says that she enjoyed that quiet that came after Shireen left.

Adjustment disorder is an impaired emotional or behavioral response to change or a stressful event. The symptoms usually consist of stress that is out of proportion to the expected reaction. The reaction can also cause an impairment in daily functioning. The DSM-5 criteria for adjustment disorder include onset of behavioral symptoms within three months of an identifiable stressor. The distress is disproportionate to the stressor with cultural and contextual factors considered. The symptoms should cause impairment in daily functioning. The symptoms should also not meet the criteria for other mental disorders. The symptoms should not last for more than six months after the exposure to the stressor or resolution to a stressor (O’Donnell et al., 2019). The aftermath of Patti’s surgery is that she has chronic pain and is now disabled. This has affected her independence, and this causes stress and tension at home as she depends on her children more. She wants her daughters to stay at home or visit more often and be around more. Patti might be having an adjustment disorder. She has not come to terms with the fact that her daughters are grown and need to have their own lives. She demands too much of their time, and her daughters feel like Patti is overdependent. She also tries to impose the Iranian culture on her children. She doesn’t want to accept that the way of life in America might be different from the one she grew up in, which is Iran.

Acute stress disorder (ASD) is a disorder that is an acute stress reaction that occurs between three days and four weeks after a traumatic event. The risk factors for PTSD could also lead to ASD. Factors such as the female gender, history of traumatic events, assault, and rape are all risk factors. The DSM-5 criteria for ASD include exposure to a traumatic event, recurrent distressing memories of the traumatic event, and flashbacks of the traumatic events. Other criteria include a negative mood, dissociative symptoms, arousal symptoms, and avoidance symptoms. The difference between ASD and PTSD is the onset of symptoms (Bryant, 2018). Patti and Shireen are unlikely to be suffering from ASD based on the onset of symptoms for ASD.

Plan of Care

A treatment plan is meant to help a patient achieve their objectives. The treatment plan consists of Psychotherapy using cognitive behavioral therapy (CBT) to help with PTSD. This should focus on increasing knowledge of trauma psychology. Patients should be taught ways to identify and dispute thoughts that cause them to relieve the trauma (Schrader & Ross, 2021).

Family therapy is also necessary to help resolve the chaos and tension in the family. Patti and Sharleen should continue with family therapy. Family therapy would provide a platform for them to air their issues with a therapist acting as the moderator. Both parties can find a middle ground where they can both agree. The rest of the family members should also be encouraged to join the sessions. Shireen, who was sexually abused, should be educated on the importance of therapy. Her mother reports that she declines therapy and prefers that she is given the money used in therapy instead. Family therapy focuses on individual family members’ emotions and helps resolve them. Unresolved emotions can lead to frustrations in the family.

A multicultural framework should be employed when handling the cultural differences between Patti and her children.  Patti should understand that her children are more used to the American culture. Some practices that may be perceived as radical in Iran are considered conservative in America. Patti’s children feel suffocated. Patti should also be educated on the importance of letting her daughters live independent lives. Patti should be made aware of the different ways of living. She should understand that this is another country and that the children will eventually need to grow on their own. Patti should be made aware that there are other ways in which she might get resources.

Patti has chronic pain and should therefore have a prescription for analgesics. Patti should also be educated on the benefits of exercise on weight loss. She should be encouraged to exercise and observe a heart-healthy diet. A diet and nutrition specialist should be consulted to help formulate an appropriate diet.

 

Genogram

 

Patti’s husband physically abused Patty. She reports a history of battering and domestic violence. Patti and her husband are separated. Patti’s husband has remarried. Shireen was emotionally, physically, and sexually abused by her father. Ever since the abuse on Shireen came to light, Armin and Sam want nothing to do with their father. They are estranged. Sharleen and her mother have a tense relationship. Sharleen feels like her mother suffocates them.  She is torn between taking care of her mother and moving on with her life. She feels stuck. Patti has a distant relationship with Shireen.

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References

Bryant R. A. (2018). The Current Evidence for Acute Stress Disorder. Current Psychiatry Reports, 20(12), 111. https://doi.org/10.1007/s11920-018-0976-x

Herringa R. J. (2017). Trauma, PTSD, and the Developing Brain. Current Psychiatry Reports, 19(10), 69. https://doi.org/10.1007/s11920-017-0825-3

Mother and Daughter: A Cultural Tale. (2003). [Video/DVD] Masterswork Productions. https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment Disorder: Current Developments and Future Directions. International Journal Of Environmental Research And Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Schrader, C., & Ross, A. (2021). A Review of PTSD and Current Treatment Strategies. Missouri Medicine, 118(6), 546–551.

 

Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Formulate differential diagnoses for patients using DSM-5 criteria
Formulate plans of care for patients that incorporate family psychotherapy interventions
Develop psychotherapy genograms.
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

https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale?account_id=14872&usage_group_id=95102.