Family Genogram 6 Practicum – Assessing Client Families

FAMILY GENOGRAM 6 Practicum – Assessing Client Families March 17, 2020

Review the provided case study of a comprehensive client family assessment and genogram. The assignment involves analyzing the clinical presentation, family dynamics, history, and psychosocial factors of the client and his family. Based on this information, formulate a detailed case formulation, including the diagnosis, factors influencing the mental health issues, and relevant family and developmental history. Develop a comprehensive treatment plan addressing the client's current mental health concerns, incorporating pharmacological and therapeutic interventions, safety considerations, and goals for treatment duration and outcomes.

Construct a detailed and scholarly paper (~1000 words) that includes an introduction to the case, a thorough assessment of the family dynamics and individual factors, discussion of the differential diagnoses, and a well-structured treatment plan with objectives, medication management, therapy approaches, safety precautions, and expected outcomes. Support your analysis and proposed interventions with credible references from current psychiatric and family therapy literature, including APA-style citations.

Paper For Above instruction

Assessing family dynamics and individual mental health within a family system is crucial for comprehensive clinical intervention. This case involving SPC Li, a 27-year-old Asian American man, exemplifies the complex interplay of familial influences, personal history, and current psychosocial stressors impacting mental health. Through a detailed analysis of the case, including family structure, history, presenting problems, and therapeutic considerations, a holistic understanding can be developed to inform effective treatment planning.

Introduction and Case Overview

The case features SPC Li, a young male service member experiencing significant psychological distress following family changes, particularly the recent sustaining of his mother-in-law, Fei Hong, into the household. Li presents with symptoms consistent with adjustment disorder, notably depression, anxiety, and sleep disturbances. His wife, Feng Mian, seeks to maintain her marriage despite external pressures from her mother, who is exerting controlling and interfering behaviors. The familial context reveals historical psychiatric issues, notably anxiety in Li’s father and depression in his grandmother, which may serve as genetic predispositions influencing his current state.

Family Dynamics and Psychosocial Factors

The genogram and family history indicate a pattern of mental health issues that may contribute to the current family stress. The presence of a controlling mother-in-law and intergenerational psychiatric history suggest familial patterns that predispose the family to stress and maladaptive interactions. The couple’s reported mutual love and commitment highlight resilience, but external family interference exacerbates relational distress, culminating in Li’s depressive and anxious symptoms. The cultural context, including Asian family values emphasizing filial piety and respect for elders, further complicates boundaries and conflict resolution within the family system.

Clinical Assessment and Differential Diagnosis

Li’s clinical presentation aligns primarily with adjustment disorder with depressed mood (DSM-5: 309.0), stemming from external stressors involving familial interference and marital conflict. His symptoms include depression, anxiety, sleep disturbances, and concentration difficulties, which abate with stress reduction and therapy. The family’s high expressed emotion is a significant risk factor for sustained distress and possible escalation into more severe mood or anxiety disorders if untreated.

Consideration of other possible diagnoses, such as major depressive disorder or generalized anxiety disorder, is essential, but current evidence supports a situational adjustment disorder, given the recent onset following identifiable stressor—increased family interference. The presence of intergenerational psychiatric history suggests a possible genetic susceptibility for mood and anxiety disorders, reinforcing the importance of comprehensive treatment.

Interventions and Treatment Planning

The treatment plan integrates pharmacotherapy with psychotherapy, emphasizing cultural competence and family dynamics. Pharmacologically, Li will continue on fluoxetine 10 mg daily, an SSRI demonstrated to effectively treat depression and anxiety with a favorable side effect profile (Greiner et al., 2019). Regular medication reconciliation and psychoeducation on side effects, adherence, and avoiding alcohol or illicit substances are critical components.

Psychotherapeutic interventions include weekly individual therapy utilizing cognitive-behavioral therapy (CBT) techniques to address negative thought patterns, maladaptive beliefs about himself and family, and stress management strategies. Motivational interviewing (MI) will support adherence to medication and engagement in therapy. Family therapy sessions, conducted thrice weekly, will focus on improving communication, establishing boundaries, and addressing conflict with the mother-in-law. Incorporating cultural sensitivity, therapy aims to enhance family cohesion, reduce high expressed emotion, and improve the couple’s relational resilience.

Safety considerations involve continuous monitoring of suicidal ideation, homicidal thoughts, or adverse medication reactions. Li will be educated to seek emergency care if symptoms worsen or side effects become severe. Outpatient treatment remains appropriate, given the client’s current stability and safety profile. The overall goal is symptom remission, functionality restoration, and strengthened family relations within eight weeks.

Outcome Goals and Follow-up

The primary objectives include a 50% reduction in depressive and anxiety symptoms within eight weeks, increased family communication effectiveness, and enhanced emotional regulation. Follow-up appointments will be scheduled at four and eight weeks to assess medication efficacy, therapy progress, and the need for treatment adjustments. Long-term goals focus on relapse prevention, strengthening coping mechanisms, and fostering healthy family boundaries.

Conclusion

This case underscores the importance of integrating family history, cultural context, and systemic dynamics into mental health assessment and intervention. The combined pharmacological and therapeutic approach aims to alleviate Li’s symptoms, stabilize his family environment, and promote resilience and well-being. Developing a culturally responsive, multi-modal treatment plan enhances the likelihood of positive outcomes for clients navigating complex family relationships and mental health challenges.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• Greiner, T., Haack, B., Toto, S., Bleich, S., Grohmann, R., Faltraco, F., & Schneider, M. (2019). Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016. European Archives of Psychiatry and Clinical Neuroscience, 269(1), 1-11.
• Hardy, K. V., & Laszloffy, T. A. (2017). Key to training culturally competent family therapists. In Promoting Cultural Sensitivity in Supervision: A Manual for Practitioners (pp. 61-80).
• Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Boston, MA: Pearson.
• Saravanan, C., Alias, A., & Mohamad, M. (2017). The effects of brief individual cognitive behavioral therapy for depression and homesickness among international students in Malaysia. Journal of Affective Disorders, 220, 153-160.
• Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer.