Group 8 PRAC

THIS IS WEEK 3 WORK

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Client Comprehensive Assessment

ry

University

January 3, 2021

Family Psychotherapy

The assessment offers insight into a family group counseling session that transpired at my Counseling Center . It commences by detailing a client family assessment and proceeds to discuss differential diagnosis with consideration of legal and ethical issues, offers a treatment plan, and ultimately presents the family’s genogram that extends back at least three generations.

Part 1: Comprehensive Client Family Assessment

The death of a senior family member substantially disrupts a family’s social and economic well-being as initially envisaged in a marriage. Whereas the remaining senior figure assumes the responsibility of raising the younger members, they tend to miss the deceased, especially if they had formed a strong bond with him.

The Demographic Information

Vincent, a White American adolescent boy aged 14 years old, presents at the therapist’s clinic escorted by his guardians – mother and uncle. His uncle, Jamie, is 43 years old and works as a lawyer at a private law firm, while his mother is Caucasian and turns 39 in a fortnight. The Caucasian father, Arnold, deceased 2 years ago and left behind a family of three, which comprises of his wife, son, and a 9-year-old daughter (Bridget).

The Presenting Client Problem

The death of Vincent’s father occurred at important stage of his life. He is an adolescent and approaches a critical academic stage, which influences his decision making either positively or negatively. Arnold’s death resulted in noticeable changes in his son’s social behavior and academic performance as his grades in continuous assessment tests declined astonishingly. Since his father’s demise, Vincent has embraced seclusion where he often isolates himself from his peers, tutors, and family members both in school and at home. Further, he has worryingly lost interest in activities, suffered anorexia, is often lost in deep meditation, occasionally appears anxious, and exhibits spontaneous aggression against his peers and young sister. With an increase in rates of emotional outburst, the 14-year-old boy has initiated multiple fights against friends and classmates at school. Therefore, the guardians thought of therapy as an essential event that would make him express his feelings.

The history of client present illness

Throughout his life, Vincent’s mother remarked that her son has displayed a joyful, interactive, and playful character. Her marriage had lasted 12 years prior to Arnold’s severe illness and demise. She observes that the transformation in Vincent’s attitude began after he noticed his father’s worsening health condition. In a previous incidence, he had witnessed his dad collapse in the bathroom in the morning while he prepared to drive him to school. He confessed to have been horrified by the incidence beyond explanation. Although the dad had concealed information regarding his health, the children learnt about it later when his illness got him bed-ridden. Thus, his death worried Vincent, since they had formed a strong father-son relationship. He started keeping distance from people who believed his father was deceased and would never talk again. In most cases he felt angry, fearful, and bothered about his future without dad. His anger and emotional outbursts have lately resulted in a handful of fights and aggressive behavior against colleagues and sister, who feel life has to continue normally. Prior to the Corona virus disease outbreak, he had missed classes in school due to paranoia, which negatively affected his learning and performance in assessment tests.

Past client psychiatric history

He has experienced infrequent anxiety and irritability in the past 4 years after the episodic moment of his father’s collapse in the bathroom.

The medical history of client

Vincent’s mother denied that the son had never had any significant medical complication. The late father, Arnold, had been hypertensive and had a nasty accident at work whose impact affected his upper vertebral region. The mum, Monica, lacks a medical history whereas his paternal grandfather is diabetic.

The history of substance use

The patient reports secondhand smoking at 12 years in incidences where he would hang out with older youths who smoked cigarettes. Though the peers tried unsuccessfully to encourage Vincent to smoke, he hardly left their company during difficult moments when his father was critically ill. Their company would calm him down, but the situation changed when dad died. The father was an alcoholic and opioid consumer, substances which he claimed were assistive in offering him mental calmness.

The developmental history

The patient’s has had normal development with no abnormalities reported. He is presently in 7th grade and a skilled volleyball player. During his leisure time, he is fond of playing piano and guitar in church.

The family psychiatric history

Vincent’s extended family, which also comprises his late father, great maternal grandma, and the great paternal grandfather, has a history of anxiety disorder. Both his maternal grandma and actual mom have depression except that the latter is on medication. Despite the paternal great grandparents being deceased, the great grandpa was alcoholic.

The psychosocial history

The grade 7 pupil plays in the school volleyball team, is his home church’s pianist and guitarist, and also loves watching football. The corona virus disease pandemic led to shut downs that disrupted learning worldwide. Vincent has not been consistently attending online classes due to his condition. His father worked as a plant operator at an oil refining company in Texas while mum is a clerk in a construction company.

Client abuse and/or trauma history

He suffered emotional trauma following the incident involving his father’s collapse and loss of consciousness

Client review of systems

HEENT:

Head: balanced, no scars, ache, or any sign of physical injury

Eyes: sclerae is clear with no visual impairment

Ears: no hearing impairment, no agony or discharge

Nose: discharge, malformations, and sneezing were all absent

Throat: denied any pain or swallowing difficulty, throat neither sore nor enlarged

Skin: scar on the left knee and facial acne noticed (from a fall accident 3 days ago). However, good turgor reported.

Cardiovascular: presents with no palpitation; S1, S2 is clearly heard upon auscultation

Respiratory: normal breathing pattern, no obstruction

Gastrointestinal: poor appetite, normal bowel movement not well maintained

Genitourinary: no pain, lacks abnormality, no obstruction

Neurological: Patient is alert, well oriented, and responds shyly to questions but looks moderately withdrawn. Participates passively in therapy process.

Musculoskeletal: patient has no discomfort and can easily move all his limbs. Father had chronic upper vertebral pain due to an initial workplace accident

Lymphatics: lymph nodes appear normal – lack enlargement

Endocrinologic: no hormonal imbalance

Allergies: No food or medical allergies

Psychiatric: Patient and his father have a history of anxiety while the mother has suffered from depression

Physical assessment

Patient and the accompanying guardians are all alert and oriented X4. No individual appears to present any noticeable distress.

Examination of client Mental status

The patient initially appeared withdrawn but gradually participated albeit passively by answering queries shyly. Client did not endorse any thoughts or history of suicidal and homicidal ideations. Nonetheless, they are all groomed appropriately, show affect, and are aware of the problem being handled.

Primary Diagnosis: Separation Anxiety Disorder

With reference to DSM5, Vincent presents with at least three element requirement to be diagnosed as someone with separation anxiety disorder . These elements will include repeated excessive anxiety especially when going through separation from figures that are prominent with whom they have established bonding relationship with. Consistent objections to going out of the house to unknown destination and fear, and as well as not meeting up with school sessions as a result of separating for a figure that is significant to them; However, persistent and unreadiness to be by themselves without having in the environment, their main figure that is significant to them are common with the disorder of separation anxiety (APA 2013).

Differential diagnosis: Post Traumatic Stress Disorder (PTSD)

PTSD affects individuals who have initially been exposed to horrifying incidences such as physical harm, abuse, or violence (American Psychiatric Association, 2013). PTSD can be observed in client with behavior such as interference and negative character that could be due to past and presents traumatic events (Stavropoulos, Bolourian & Blacher, 2018). According to Espinel and Shaw (2018). Vincent is traumatized, hence, inclined to avoiding environments and people through whom he reminisces the horrifying incidence of his father’s collapse and later death. They make him develop bad experiences such as evocations, disinterest, and hallucinations, which the subsequently counteracts by exercising evasive attitude, aggression, and other forms of negative dispositions. Based on Espinel and Shaw’s (2018) observation, Vincent contracted PTSD when he experienced an explicit threat to a close family figure.

Oppositional Defiant Disorder (ODD)

With reference to DSM-5, individuals presenting with separation anxiety disorder tends to show tendency for oppositional trait and attitudes that could lead to them getting separated from close figure they are attach to (APA, 2013). ODD diagnosis is seen in children who are uncooperative and does presents with characteristics such as negativity, hostility, and the lack of cooperation. (Linghiem et al., 2015).

Case formulation

Vincent lives in denial following his father’s death because he finds truth and reality to be unbearable. He has developed a paranoid feeling where he believes that the world has turned against him to which he responds by enjoying isolation and concealing his feelings. This affects his school attendance and consequently performance while his aggressive behavior and emotional outbursts trigger multiple fights with colleagues and sibling. However, the therapy has counseling process has helped reveal some of his internal feelings yet regular visits and active participation will help change the behavior.

Treatment plan

Vincent will commence treatment by attending a cognitive behavioral therapy (CBT) program to regain self-assurance in reason, behavior, and coping mechanisms. Although the entire program intends to empower the family resolve the problem at home, CBT will provide the necessary skills, confidence, control and strategy to manage such issues as anger, outbursts, and aggression (Tricola & Gill, 2018). The program has always proved effective in improving adolescent emotions, thoughts and conduct as well as the reduction of PTSD symptoms.

Part 2: Family Genogram

Client Sister

Father Mother

Client grandparents: maternal and paternal)

Client great grandparents are 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.

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

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.

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 history of Separation Anxiety Disorder

ODD: PTSD &ODD.

Bridget 9 years

Monica 38 years

Depression

Takes medication

Arnold 44 years

Anxiety Disorder

Alcoholic & Opioid consumer

Maternal Grand Mother (Alive) with history of

Depression

Anxiety of

Gregg

(Alive) DM

Maternal Grand Father of Client

(Deceased)

Remy

(Deceased)

Cooper

Alcoholic

Anxiety

Martha

(Depression)

Rose

Anxiety

Stuart

Alcohol

Deceased