Select a client family that you have observed or counseled at your practicum site.
Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.
Part 1: Comprehensive Client Family Assessment
Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:
History or present illness
Past psychiatric history
Substance use history
Family psychiatric history
History of abuse and/or trauma
Review of systems
Mental status exam
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).
Running head: GROUP THERAPY PROGRESS NOTE 1
GROUP THERAPY PROGRESS NOTE 2
Group Therapy Progress Note
PRAC 6650: Psychotherapy with Groups and Families
Dr. Stephanie Smith
Group Therapy Progress Note
Group Therapy Progress Note
Client: ___ Jake___ and ___Jenna___ Date: __11/3/2020_____ Group name: ___ N/A__________ Minutes: ___50___ Group session # ___2___ Meeting attended is #:__12____ for this client. Number present in group ___6__ of _8____ scheduled Start time: __1000__ End time: ___1050_____
Assessment of client
1. Participation level: ☒ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
2. Participation quality: ❑ Expected ☒ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive
❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________
3. Mood: ❑ Normal ☒ Anxious ☒ Depressed ☐ Angry ❑ Euphoric ❑ Other: _______________
4. Affect: ❑ Normal ☒ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other_______________
5. Mental status: ❑ Normal ❑ Lack awareness ☒ Memory problems ☒Disoriented ❑ Confused
Disorganized ❑ Vigilant ☐ Delusions ☐ Hallucinations ❑ Other_________________
6. Suicide/violence risk: ❑ Almost none ☒ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
7. Change in stressors: ❑ Less severe/fewer ☒ Different stressors ☒ More/more severe ❑ Chronic
8. Change in coping ability/skills: ❑ No change ☒ Improved ❑ Less able ❑ Much less able
9. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ☒More severe ❑ Much worse
10. Other observations/evaluation: _____ Present and participating in group session _____
1. Daily Recording of getting out of bed before 0800 and plan the day
2. Focus on the present, use the past only to shape the future
Clients given handouts with information on how to best solve family conflict
Mental disorders may damage the ability of individuals to maintain their marital and social relationships. Marriage offers a variety of benefits such as general support and economic status maintenance. Divorce related to mental disorder affect the economic life of the couples as well as their social well-being of the children. Further, mental disorders increase the possibility of divorce as well as lowering the chances of marriage. Married couples with higher levels of stress, psychiatric disorders are more likely to divorce (Nichols and Tafuri, 2013). Consequently, the importance of couples experiencing some mental disorders to seek professionals help to avoid divorce cannot be undermined. The purpose of this assignment is to assess the two clients in a group therapy and outline the legal and ethical implications associated with the therapy.
History of the Presenting Case
The case family consisted of Jake, a 29-year old Caucasian and his wife Jenna a 26-year old also Caucasian. Both have lived together for 7 years with two children aged 6 and 4 in a small town in Missouri. However, Jake is an Army veteran who returned from his two-year tour of duty in Iraq 1 year ago. At the war zone, he worked as a communication specialist in charge of alerting the army convoy any potential danger. Upon his return to continental America, Jake received a medical discharge based on his physical and mental injuries. Also, the he had suffered from second-degree burns from spontaneous explosive device blast that instantly killed one of his best-friend.
In the session, Jake self-reported anxiety, insomnia, nightmares, flashbacks, and fear of social places. He reported flashbacks happened a few days ago when he was driving with wife to a grocery store. He stated he saw another car coming at a higher speed then theirs. Jake became diaphoretic and increased the driving speed drastically while screaming loud for the wife to take cover under the dashboard. In fear, Jenna also screamed out for her husband to stop the car. They did not understand the flashbacks were triggered by burning rubber, which was a reminder of the traumatic incident in Iran. Further, he reported the fear that he could face a divorce due to his declining condition. He said “he died long time ago” while in Iraq and has deep feeling of shame as he remembers how he accidentally killed an innocent child who would have been the same age as his old son. Besides, he has been experiencing frequent irritability, poor attention, and poor concentration.
Conversely Jenna, reported an intense fear because of the threats of her husband whom she describes as the reason to many issues in the family. Jenna has been undergoing emotional volatility, and insomnia, pervasive anxiety. Since, Jake returned from Iran, said she as lost some weight dealing with her husband’s violence behavior. Jenna said she warned the husband if he fails to seek help; she would take the children and leave him. She claimed her husband no longer marriage values they share before going to military. This makes her feel worthless, she said. She voiced concerns related to the conflict they have been having lately. she admitted at times she has been having suicidal thoughts.
Clinical Impression of the clients:
Jake appeared to be well-built, fit, walked stiffly and quickly. Even though the husband appeared orderly, his clothing masked signs of being fearful. Nevertheless, there was no evidence of delusion, hallucinations, and other psychosis symptoms (Mojta et al., 2014). Conversely, the wife, reported signs of anxiety such as sadness, irritation, agitation and rage.
Jake presented with complaints of not maintaining normal daily interactions with his family. He struggles with psychological, emotional, and social relations. His clinical presentation suggests he meets the DSM-5 criteria for post-traumatic stress disorder (PTSD). The DSM-5 manual list several criteria that the client must meet to be diagnosed with the PTSD. The criterion A outlines that the client must be involved in life threatening event, threated serious injury or sexual violation (American Psychiatric Association, 2013). According to the manual, the client must also have experienced or witnessed the event or experienced repeated exposure to distressing details of the event. Further, the client must experience at least one of the symptoms associated with the traumatic event such as recurring and involuntary memories of the traumatic event, dissociations such as flashbacks, repeated upsetting dreams related to the event, and strong body reactions such as increased heart rates and sweating (American Psychiatric Association, 2013).
Finally, the manual states, a client with PTSD exhibit at least two negative changes in moods such as irritability, negative emotional state such as rage and shame, and loss of interest in activities that once enjoyed. Jake meets the criteria for PTSD because of the re-experiences of flashbacks and nightmares, hyperarousal such as rage storms, avoidance, and irritability. Likewise, the client suffered grief from the loss of his friend and a child he killed accidentally during the mission. Nevertheless, it is important to rule out other conditions such as major depression disorder characterized by limited concentration and limited concentration as well as diminished interest in activities and insomnia. More than 1.8 million American soldiers are deployed in Iraq each year (Wheeler, 2014). Most of these soldiers are exposed to unpleasant experiences and trauma which can potentially lead to unstable family dynamics following one’s return from military operations. Despite their continued contribution to the community, many veterans commit suicide each year due to PTSD.
Conversely, Jenna presented with symptoms of major depression disorder (MDD). She voiced the complaints of insomnia, persistent anxiety, and feeling of worthlessness. According to DSM-5 criteria, the client experiencing MDD must present with at least five of the following symptoms; depressed moods, sleep disturbances, loss of energy, and feeling of worthlessness, significant weight change, and loss of interest in almost all activities (American Psychiatric Association, 2013). L’Abate (2015) stated, women who partners are away on military deployment are at great risk of developing mental condition. The review also, found that women whose spouses are in military experience increased anxiety and stress associated with isolations. The level of anxiety and depression on the women is worsened when their spouses return from the military operations with changed behaviors. That explains why the rate of military spouses tend to ask for divorce following their partners’ return from combat zone.
Legal and ethical Implications
Marriage therapists tend to face more ethical challenges than individually oriented therapists. The American Counselling Association (ACA) code of ethics the counsellors requires therapists to ensure they offer quality of care regardless of the diversity (Natwick, 2017). Legally, the counsellors or therapists must maintain the confidentiality of the clients’ information. ACA require a written informed consent and a verbal discussion of rights and responsibilities in counselling relationship (Natwick, 2017). The challenge is to isolate an individual from couple counselling. While it is critical to assess for family dynamics such as abuse and dependent disorders, the therapist can find themselves compromised by the promises made in good faith.
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
Natwick, J. (2017). Family ties: Tackling issues objectivity and boundaries in counseling. Counseling Today, 59(10), 16–18.
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
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.