Genogram

March 17, 2020

Comprehensive Client Family Assessment

A comphrensive assessment and genogram. is a review of a cleints clinical manifestations, that are either physicological or psychological. A thorough clinical evaluation, includes a client’s medical history including the illnesses that have occurred in previous generations of the patient’s family. The Clinical assessment will provide a blueprint, for the genogram which is the graphical representation of the client’s relationships with his family. The genogram includes the psychiatric history of each of the members related to the client. The purpose of this comprehensive assessment is mapping the client, while in family therapy with his spouse and his in law

Demographic information: SPC Li twenty seven years-old Asian American living with wife of 12 months Feng Mian twenty five years of age. SPC Li mother in law Fei Hong fifty one-years old, moved in six months ago. The couple does not have any children.

Presenting problem: SPC Li Curtis reports expereicing difficulty sleeping, eating and concentrating since his mother in law moved in; he feels depressed and was anxious all the time. “my wife wants a divorce” His wife sits and looks at her husband. The mother in law has accused the SPC of “adultery” and wants her daughter to divorce the SPC. The SPC has admitted prior to his engagement he was dating and had a girlfriend, however aftger meeting his wife, he stopped dating and never interacted with any other females other than co workers. SPC met his wife through his parents, the wife is an immigrant from China. SPC is a communications specialist and linguist with the United State Army. SPC and wife both admits, they love each other and want to stay together, however the mother in law is interfering and causing friction in the couples relationship.

History or present illness: SPC Li started feeling depressed 5 months ago, after the mother announced she was staying indefinitely. He did not want to acknowledge the issue, and having trouble working, missed several formation, received a counselling statement regarding lateness and not meeting work deadlines. The problem worsens with threat of divorce from the mother in law, due to adultery. The mother is aggressive and quarrels with the SPC, daily about “anything and everything”. SPC reports difficulty with sleeping and feeling anxious all the time.

Past psychiatric history: SPC Li diagnosis with Adjustment Disorder with Depressed Mood . Mrs. Li denies any pscychaitric history

Medical history: neither reports any medical history

Medication: SPC Li is on Prozac 10mg daily by mouth.

Substance use history: SPC Li reports drinking a glass wine occasionally. Mrs Li drinks beer nightly, neither denies illicit or prescription drug use.

Developmental history: Both graduated from high school, no failures, Mrs. Li is attending community college.for nursimg. The husband E/4 in the US Army. SM is single, lives in off post housing. SM does not have any criminal or civil issues .

Family psychiatric history: SPC Li father has history of anxiety Mrs Li’s grandmother has history of depression.

Psychosocial history: denies any legal issues past or present. The couple met each through their parents who are childhood friends

History of abuse and/or trauma: The couple denies any physical or sexual abuse, neither reports neglect, Mrs Li did report her mother is often angry “for no reason”, since childhood.

Review of systems: SPC and wife speaks with fluent english, both agree, they want to stay married, mother is the primary barrier. General: Both are alert and oriented x 4 spheres

Review of Systems:

General: SM is alert and oriented x 4 spheres

HEENT: no problems

Skin: denies breaks intergrity

Cardiovascular: denies

Respiratory: denies.

GI: denies

Genitourinary: denies

Neurological: denies headaches.

Musculoskeletal: denies

Psychiatric: Anxiety

Allergies: No known medication/ food allergies

Physical Assessment:

General: Alert Ox3 both sitting on the sofas

General: Alert Ox3 both sitting on a sofa holding hands

Eyes: needs to be added.

HEENT: intact

Respiratory: needs to be added to

Cardiovascular: needs to be added to

Gastrointestinal: needs to be added to

Lymph Nodes: needs to be added to

Integumentary: skin warm moist intact

Musculoskeletal: Both have FULL ROM to all extremities

Speech: SPC Li speech becomes volume decreased when discussing his mother in law and “possible divorce” speaks concise and average volume regarding wife and his love for her. Mrs Li subdued during session.

Affect: SPC Li is depressed and anxious and Mrs Li depressed, congruent,

Range: full

Thought content: The couple denies suicidal ideation, homicidal ideation

Perceptions: The couple deny auditory/visual hallucination

Thought Process: The couple are logical, goal-directed and coherent

Attention and Concentration: The couple are focused on communicating, interacting with counsellors.

Judgment/Insight: The couple are attempting to find a solution and stay tohether as couple and eventually start a family. Clients have full insight

Visual/Abstract: needs to be added

Differential diagnosis:

Adjustment Disorder with Depressed Mood F43.23 (SPC Li) Mild features of depression in the situation of identifiable stressor, mother in law is interfering with the newlywed couples stability and controlling her daughter’s emotions

Relationship Distress With Spouse (V61.10 (Z63.0): A demonstration of distress or significant discontent in a marriage which occurs for various motives. The marital distress is purely based on difficulties within the relationship such as poor or ineffective communication, a lack of intimacy, financial difficulties, outside influences, sexual difficulties, or infidelity. Marital distress has powerful impacts on the partners, which can lead to sorrow, anxiety, a high level of hostility, fear, and depression. And, if it continues, it negatively impact one's physical health.The mother in law is interfering with the couple dynamics.

High Expressed Emotion Level Within Family (V61.8 (Z63.8): The couple has expressed emotions such as hostility, anger, resentment, bitterness, etc which is critical to the client well being. High expressed emotion is most likely to cause repression or depression.

Disruption of Family by Separation or Divorce/ Problems in relationship with in-laws (V61.03 (Z63.8): The couple is having problems initiated by the wifes mother, who feels the couple should divorce.

Case formulation: SPC Li is expereicning depression, anxiety and sleep difficulties, due to his mother in laws disdain and dislike for him. The mother in law is pressuring her daughter to divorce her husband without proof of aqdultery. Mrs Li is withdrawn and wants to remain married to her husband, however she feeling torn between her husband and mother. This is causing emotional and psychological instability in the family dynamic.

Treatment plan: SPC Li will continue on Fluxeotine 10mg a SSRI to assist with depression, anxiety and insomnia. The couple will remain in couple therapy three times weekly to help both interact and communicate properly for 6 weeks. Also SPC Li will attend individual therapy, with the use of CBT and Motivation Interviewing (MI) to monitor his medication and assist with depression. CBT will be applied during therapy sessions, to change negative thoughts and emotions related to his mother in law and her actions.

Safety Plan: The client, is NOT deemed an imminent threat to self or others. The client will be educated to seek emergency care if safety issues arise, including dangerous reactions to medications. SM will not admit to In-Patient and will have treatment on Outpatient Therapy.

Partial treatment of depression Goal: Full resolution of symptoms with 50% reduction in symptoms within 8 weeks of treatment Goal: Resolution of depression symptoms and restoration of function

1. SPC Li will continue with Fluoxetine 10 mg daily, reviewed risks, benefits, major/common side effects, and alternatives of below medication plan with client who verbalized understanding and agreement with plan. The client told to abstain from ETOH, drugs of abuse, and OTC remedies. If experiencing sedative effects from meds, client told not to drive or operate vehicles, including heavy machinery. (Greiner et al 2019).

2. SPC Li will attend Individual Therapy twice weekly, couple therapy three times weekly (Saravanan et al 2017) for 6 weeks.

3. SPC Li will follow up in 4 weeks for medication reconciliation and progress of treatment plan.

Part 2-Family Genogram

SPC Li father 55 has history of anxiety Mrs Li’s maternal grandmother 90 has history of depression.

SPC Li has two sisters 24 and 28, both married no children

Mrs Li has one brother single 21

SPC Li mother 52 has no history, maternal parents both 75 no history

SPC Li father’s parents, father smokes and alcoholic

Mrs Li’s father’s parents, grandfather alcoholic

The couples parents are living

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, 1-11.

Hardy, K. V., & Laszloffy, T. A. (2017). Key to training culturally competent family therapists. Promoting Cultural Sensitivity in Supervision: A Manual for Practitioners, 61, 9781315225791-8.

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, 108-116.

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer