Assessment, Diagnosis, and Treatment of a Family - Case Study Example

Assessment, Diagnosis, and Treatment of a Family In the case of Jones family, the first step for a therapist would be to gather information. In order to achieve this, the following assessment methods could be used:- CLINICAL INTERVEW: In our case these interviews could be done separately with the family members or if feasible, with the entire family unit. Such interviews, although highly important have certain limitations such as ‘resistance’ on the part of the individual to allow being treated or questioned. SYMPTOM QUESTIONNAIRES: These may be helpful in quickly assessing the symptoms along with their severity that the individual members of the family have. E.g. Beck Depression Inventory might help in indicating the level of depressive symptoms in the family members especially Shirley. Similarly, Child Behavior Checklist can be used to assess symptoms such as aggression and depression in Tracy and Ben. PERSONALITY INVENTORY: The Minnesotta Multiphase Inventory (MMPI) could be used for assessment of the personalities of the family members. BEHAVIORAL OBSERVATION: This is an effective tool in assessing the way individuals handle certain situations. Incorporating family systems model in the assessment:- Family systems model focuses on specific roles that every individual plays in the family unit to identify strengths and weaknesses. It helps in dealing with situations where dysfunctional relationship status results either due to a mental illness of one family member, or a recent stress/change that has happened or erratic ways of handling conflicts that so often arise. E.g. in the case of Jones Family, family systems model needs to be incorporated as the problem lies in communication between family members which can be assessed using communication theory, psycho-education, psychotherapy and relationship education. APPLICATION OF DSM IV-TR:- Applying the DSM IV-TR, we find that the family is having relational problems. Shirley appears to be having a mood disorder and therefore we might label it as ‘Relational problem related to a Mental Disorder’ having the code of V61.9. Based on the information given to us, it is thought that she qualifies for depressive illness as she is having trouble sleeping, complains of loss of interest and is irritable. If this diagnosis is made, it will impact the overall therapy as Shirley’s problem will have to be treated both pharmacologically and psychologically. Moreover, the family will have to be involved in order to help her through this difficult time. Also the information indicates that Ben and Tracy are exhibiting symptoms that may pertain to Parent-child relational problems having the code of V61.20.Ben is truant from school, withdrawn and is involved in substance abuse. Both children need special attention in order to address their psychological issues. Ben’s substance abuse must be adequately investigated and promptly treated. Improvement in Shirley’s attitude can bring a significant improvement in the behavior of children as cited in Journal of Child and family studies in an article by Abdul Khaleque. The GARF (Global Assessment of Relational Functioning) Scale shows a rough score of 21-40 which means that “relational unit is obviously and seriously dysfunctional, forms and time periods of satisfactory relating are rare”. SOCIO-CULTURAL FACTORS:- Assessment and diagnosis of a disturbed family unit is highly dependent on the involved social, cultural and personal backgrounds of the individuals. In the case of Jones Family, their being of African-American origin, the DSM IV-TR criteria might be ideally suited to them. Moreover, many questionnaires and personality inventories can be of extreme help as a lot of work has been done in these communities as opposed to Asian ones as suggested by the under utilization of psychiatric facilities based on DSM-IV in a study published in Psychiatric Services, VOL. 62, No. 10 Assessor’s personal background:- The assessors own socio-cultural background might affect the entire therapy procedure as it might lead to differences in perception, certain biases and culture clashes. E.g. in this case, I belong to an Asian Background which is quite different from African American culture and society. The perception of how a family unit ought to work differs greatly in both the cultures and this might cause problems as the assessor/therapist might find it quite difficult to isolate his own perceptions and to ensure that he understands the thought patterns of the individuals. Therefore, the use of standardized questionnaires might be helpful in overcoming such culture clashes as indicated by a recent study in Family Process, Volume 51, Issue 1, March 2012 about cultural adaptation of parenting interventions. ETHICAL ISSUES:- There are a number of ethical issues that can arise during the assessment and diagnostic phase of the Jones Family case. AAMFT (American Association for Marriage and Family Therapy) code of ethics stresses on Confidentiality of clients, however, while dealing with a family unit as a whole this might be difficult to accomplish owing to the fact that the therapist is dealing with more than one person at a time that are closely tied by relations while separated due to psychological problems or individual lives. When such a problem arises, the confidentiality of any client must only be breeched if there is a written waiver by the client. Moreover, it is important to disclose to the individual members about the extent of confidentiality that will be practiced and an agreement reached in written. NAADAC (National Association of Alcoholism and Drug Abuse Counselors) Code of Ethics stresses on Compliance with LAW. In the case of Jones Family, Ben’s use of marijuana might lead to an ethical dilemma. It is important to identify the source from where he gets such illegal substances and report them as well. However, this must be done with discretion and Ben’s young age must be kept in mind while dealing with him. TREATMENT OF THE FAMILY:- The Jones Family needs a comprehensive and effective treatment plan incorporating different methods and techniques. Key issues and concerns:- Shirley’s depressive condition. Ben’s inclination to substance abuse AND Tracy’s temper tantrums (reflecting a possibility of parent-child relational problem). Harold’s vulnerability to psychiatric illness due to financial stress. Bridging the gap between Shirley and her mother-in-law. Defining goals for the family:- To treat Shirley’s depressive symptoms in order to make her realize her role in the family unit and its importance. To develop sense of competency as a parent, spouse and an active member of the family unit. To treat Ben’s substance abuse before it gets out of hand. To establish adequate parental control at home. To help develop effective skills of communication by practice sessions for establishment of satisfactory relationships. To help family members realize the importance of helping each other out in difficult situations. To identify and alleviate the causes of Tracy’s temper outbursts and crying spells. To help Shirley and her mother-in-law in settling their issues and establishing a good, open and friendly relationship between them. TREATMENT PLAN WITH INTERVENTIONS AND TECHNIQUES USED:- To achieve the goals set above an effective treatment plan needs to be established and implemented. It must be evaluated after suitable intervals for efficacy and reviewed if the need arises. Following is the approach that can be followed for efficiently treating the family’s problems. 1. INDIVIDUAL THERAPY:- a. Pharmacological therapy: Shirley will need some anti-depressants in order to help her cope with her depressive episodes. b. Cognitive Behavior Therapy (CBT): This will help the family members learn effective problem solving techniques. These can help Harold cope with the stress of being unemployed. It can help in resolving the conflict between Shirley and her mother-in-law. c. Substance Abuse Treatment: Ben will benefit from this and will get over his habit of marijuana resulting in improvement of his other problems namely truancy and withdrawn attitude. FAMILY THERAPY:- This is said to be more cost-effective in treating substance abuse as opposed to individual therapy as mentioned in Journal of Family Therapy’s latest edition. It helps in making the family understand that all of them, not just one member, are responsible for the dysfunctional relationship status of the family. 2. GROUP THERAPY:- a. Parent Effectiveness Training (PET) b. Focused Relational Group Therapy MARKERS OF POSITIVE MOVEMENT IN SUBSEQUENT SESSIONS:- These must be identified in order to assess progress in the individuals as well as the entire family unit. For Jones Family, these markers may include:- Improvement in Shirley’s depressive symptoms helping her in interaction with her children in an improved an effective manner resulting in a better functioning family unit. It also may result in resolution of her conflicts with her mother-in-law as her irritability should be improved after a month or so of pharmacological management, CBT and group therapies. Ben’s improved attitude and his abstinence from further substance abuse, realization of its harmful effects and improved performance at studies after substance abuse treatment and CBT. Harold’s increased self confidence in coping with the situation the family is going through after Parent Effectiveness Training and positive effort towards finding employment rather than stressing about the loss of the previous one. Reduced frequency of Tracy’s tempers outbursts. Improvement in GARF scale of the family unit. References: Su Yeon Lee, B.A.; Silvia S. Martins, M.D., Ph.D.; Katherine M. Keyes. Ph.D., Mental Health Service Use by Persons of Asian Ancestry WithDSM-IV Mental Disorders in the United States. Psychiatric Services, VOL. 62, No. 10. Triston B. Morgan, D. Russell Crane,Adam M. Moore, Dennis L. Eggett. The cost of treating substance use disorders: individual versus family therapy. Journal of Family Therapy © 2012. Jose Ruben Parra Cardona, Melanie Domenech-Rodriguez. Culturally Adapting an Evidence-Based Parenting Intervention. Family Process, Volume 51, Issue 1, pages 56–72, March 2012. Abdul Khaleque, Perceived Parental Warmth, and Children’s Psychological, Adjustment, and Personality Dispositions: A Meta-analysis. JOURNAL OF CHILD AND FAMILY STUDIES, 2012. Read More