Family Assessment and Psychotherapeutic Approaches
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
June 13, 2021
As providers, it is vital to be open-minded, if you are not aware or do not understand a person’s
culture, show your patients respect. Be engaged, respectful, and ask questions. Learn from your
patients, this helps develop a rapport. As providers we are obligated to provide optimal care, if
we feel a patient’s needs are out of our scope, the client should be referred to a provider that can
give them the help they need and deserve (Nichols & Davis, 2020).
The purpose of this paper is to provide documentation and a psychiatric comprehensive
assessment of a patient and family during a family therapy interview that highlights differences
in a multicultural family, respecting cultural norms and differences, and develop an
individualized treatment plan.
Keywords: Family therapy
Family Assessment and Psychotherapeutic Approaches
CC (chief complaint): “I like to learn to live on my own and not depend on the kids.”
HPI: A 40-year-old female (Patti) and her five children (Sheela age 24, Sharleen aged 23
and present today, Shireen age 21 recently reunited with family, Armin Jr. age 18, and Sam age
15), of Iranian descent, has been in individual and family therapy for the last 18 months. Patti
came to the clinic related to chaos in the home after her daughter was finally reunited with the
family after ten years. The family initially had rejoiced and celebrated, and after a few weeks,
Shireen began to tell her mother and siblings the emotional, physical, and sexual abuse at the
hands of her father. She blamed and felt abandoned by her mother. Patti needed necessary
surgery to both her feet after an injury, that has now left her disabled and with chronic pain. The
additional burden of surgery and disability has increased tension and stress in the home. Patti
lives with her two sons; her daughters live on their own. Shireen recently moved out, marrying
someone the family does not know, with little contact. Mother speaks and sees Sheela and
Sharleen daily. Patti has increasingly felt alone, depressed, hopeless, and helpless wanting her
daughters to stay and help her at her home. A psychiatric provider has been referred for a
Past Psychiatric History:
General Statement: Patti and her family began therapy 18 months ago after daughter
Shireen reunited with the family after 12 years of separation. Shireen shared significant abuse
she experienced, learning the trauma she went through brought on many emotions of the family
including blame, guilt, shame increasing stress on the family.
Hospitalizations: Patti denies any past psychiatric hospitalizations or history. The patient
has no history of substance abuse or residential treatment. Patti denies suicidal and homicidal
ideation, denies hallucinations. The patient has had two-foot surgeries secondary to arthritis,
hammer toe, and severe plantar fasciitis with no relief for over 2 years, patient in hospital
overnight after each surgery.
Zoloft 50 mg every morning for depression, with limited relief. Will feel helpless and
hopeless three to four days a week. The patient is tolerating the Zoloft and has recently been
increased to 100 mg daily.
Patti reports no adverse effects of Zoloft.
Naproxen 500 mg twice a day
Psychotherapy or Previous Psychiatric Diagnosis:
Patti has been receiving individual and participated in family therapy over the last 18
months. Shireen came once and has stopped attending and refuses to continue at this time. The
family has come to therapy together five times, to heal and move on together.
Patti had surgery in the last 6 months and is no longer able to work related to the
deteriorating condition of her feet that arthritis has caused. This has led to being unable to work
at home often alone. She is experiencing being independent and providing, what she has done for
so long. This has caused stress, increased anxiety, and depression for Patti.
Therapy over the last several months has also uncovered differences in the bicultural
situations. Patti is wanting the care provided to her as in the Iranian culture, where she is
dependent on her children. The children living in America for the last 12 years are more
Americanized and have adapted to the culture, with their own lives leaving less time for Patti.
Substance Current Use and History: Patti drinks 16 ounces of caffeinated beverages
daily. She denies smoking or drinking alcohol.
Family Psychiatric/Substance Use History: Patti denies any substance or alcohol
abuse. She is unaware of any of her family has any abused drugs or alcohol. Her husband drinks
large amounts daily, has not received treatment for alcoholism. Patti denies any psychiatric
history in herself or her family.
Psychosocial History: Patti was born in Luristan Iran, raised by her mother and father.
She had no siblings. At 14, her parents arranged for her to be married to Armin Ali, a 25-year-old
foreman of a prominent automobile company in Tehran. Patti moved to Tehran and had five
children with Armin. Patti gave birth to Sheela at the age of 16, Shareen at age 17, Shireen at age
19, Amir Jr at age 22, and Sam at age 25. Patti stayed at home working in the home and raising
the children while Amir worked and provided for the family.
When Sheela and Shareen were 11 and 12, it was discovered they had medical conditions
that needed treatment in the United States. Patti applied for visas to come to the United States.
She was able to take all her children but Shireen. Amir encouraged Patti to go, he would look
after Shireen and come to the United States later. Once Patti arrived, she was able to get the
needed medical treatment for her daughters and started making a home for her family She
believed Amir would later come with Shireen. After years went by, this did not occur, only letters
of how she needed to raise her children. Patti did not want to return to Iran. She struggled with
leaving Shireen behind and afraid for her other children if she returned. Patti had been abused
emotionally, physically, and sexually by Amir from the time they were married. Patti and her
four children made a home in the United States, Patti worked two jobs, but also made time to
attend school functions and volunteer at her children’s school. Patti continued to work at
bringing Shireen to the United States, it took several years. She was finally able to bring her,
Shireen was 18 when she arrived, and the family celebrated. After a few weeks, Shireen began to
share her trauma of emotional, physical, and sexual abuse by her father. Patty struggled to hear
the information, she was aware, as Amir would treat her the same way, she would tell him to beat
her and not her children. Shireen was angry and blamed her mother. Patti pursues help with
therapy to work through the guilt and shame of the trauma.
Medical History: Hammer toe, bilateral great toes, arthritis, plantar fasciitis
Zoloft 100 mg every morning for depression and anxiety
Naproxen 500 mg twice a day
Tramadol 100 mg twice a day as needed for severe pain.
No known drug allergies
No known seasonal allergies
No Known food allergies
Reproductive Hx: The patient is a Gravida 5 para 5. The patient denies any abortions or
miscarriages. The patient has been celibate for the last 12 years since arriving in the United
States. The patient denies any sexually transmitted infections, started menses at age 14. The
patient has menses every month without any significant issues or concerns.
ROS: Provided by a medical provider.
GENERAL: Alert and orientated x 4. No weight loss, fever, chills, weakness, or fatigue.
HEENT: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching. Incisions on bilateral great toes healed. The incision on
bilateral heels healed, with no redness or bruising.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. Regular rate
and rhythm, no murmurs, no rubs, no gallops. No palpitations or edema.
RESPIRATORY: No wheezes, rales, or rhonchi. No shortness of breath, cough, or
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal
pain. No guarding or rebound tenderness.
GENITOURINARY: No burning on urination, urgency, hesitancy, or odor.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia. No change in
bowel or bladder control.
Cranial Nerve 2: vision is grossly accurate.
Cranial Nerve 3,4,5,6: motor movements appear normal.
Cranial Nerve 7: facial muscles appear symmetrical.
Cranial Nerve 8: hearing is adequate for her age.
Cranial Nerve 9-12: swallows without difficulty.
MUSCULOSKELETAL: No muscle and back pain, chronic pain in bilateral feet.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria
Vital signs: B/P: 126/78, P: 88, Height: 63 inches, Weight: 225lbs, BMI: 39.9 (NIH.gov,
General: Alert and oriented to self, time, location, and situation.
Eye: extraocular movements are intact, normal conjunctiva. Vision: shortsighted, glasses
Ears: Symmetry. Normal hearing.
Neck: Symmetry. No swelling or palpable mass noted. Throat: Symmetry. Oral
mucosa is moist.
Neck: Full ROM. Carotids no bruit or JVD.
Chest/Lungs: Lungs are clear to auscultation. Respirations are non-labored.
Heart/Peripheral Vascular: Normal heart rate, regular rhythm, no edema noted.
Abdomen: Round and large. Bowel sounds present in all four quadrants. Negative
Genital/Rectal: No abnormalities. Menses started at 15 and are regular.
Musculoskeletal: Normal ROM. muscle weakness due to physical inactivity
Neurological: Cranel Nerves II-Xll grossly intact.
Skin: No clubbing or cyanosis.
Toes: Bilateral great toes, incisions healed.
CBC: within normal
Mental Status Examination: A 40-year-old Iranian female, appearing stated age. The
patient is alert and oriented to self, place, time, and situation. Patient cooperative, engaged in
conversation. Patient grooming clean, although shirt tight fitting. Speech is clear, Iranian accent
with average tone. During the interview, when upset or arguing with the daughter, her voice
becomes louder. Thought process goal-directed and logical. No noted flight of ideas,
hallucinations, or delusions noted. No abnormal motor activity noted. The patient’s mood is
depressed and anxious, affect blunted at times. The patient denies being suicidal or homicidal
currently. The patient’s short-term and long-term memory intact, good insight and judgment,
with good concentration. The patient has no legal history, arrests, and no pending charges. Eye
contact is fair throughout the interview.
Adjustment disorder with depressed mood – Patti’s children are growing up; she is
feeling alone. She states when she is lonely, she feels hopeless and helpless. She is wanting her
children to stay with her, having a difficult time adjusting to them not home as much. She has
also had recent surgeries in the last 4 months, and she is adjusting to not being as independent as
she was before with mobility and chronic pain issues. Patti is exhibiting feelings of sadness and
hopelessness in response to three identifiable stressors; recent surgeries and children moving out
of the home, and grief and guilt of past trauma her daughter experienced. The patient meets the
criteria as a primary diagnosis (APA, 2013).
Depressive disorders not due to another medical condition; grief, PTSD. Patti has
had depressive episodes prior to her surgeries, she has been in therapy for the last 18 months, she
has had traumatic events in her life including abuse, and loss. It is important to determine if the
medical condition is associated with depression. It is necessary to examine if an episode of
depression occurred prior to medical illness, the medical condition promotes depression, and if
the symptoms after the start of the medical condition stabilized (APA, 2013). A panel consisting
of psychiatric health professionals strongly recommends interventions for patients with post-
traumatic stress disorder to include cognitive behavioral therapy, cognitive therapy, and eye
movement desensitization and reprocessing (EMDR). Medications recommended include Prozac,
Paxil, Zoloft, and Effexor(“Summary of the Clinical Practice Guideline for the Treatment of
Posttraumatic Stress Disorder (PTSD) in Adults,” 2019).
Depressive Disorder Due to Another Medical Condition (chronic pain) – It is noted
that after Patti’s surgeries, she became more depressed, with feelings of hopelessness, and
needing her daughter increased(“Mother and Daughter: A Cultural Tale.”, directed by
Anonymous, 2003). Patti’s independence decreased, and she was no longer interested in
activities that impacted her mobility. According to recent studies, chronic pain has been
connected to family dynamic changes, causing family tension. As the family burden occurs, an
individual can become depressed and have increased difficulty managing their pain (Boone &
Kim, 2019). Patti does not meet the criteria listed for this diagnosis, she does find pleasure with
her children, friends, and three dogs. Relational dynamics, interactions, and symptoms causing
pain to influence an individual’s pain. People can be either positively or negatively affected
depending on the emotional support they are feeling. people with pain and their partners (Tankha
et al., 2020).
Case Formulation and Treatment Plan: include psychotherapeutic interventions that
take into consideration the family’s culture and current situation.
Order thyroid panel. The thyroid and hormones play a significant role within the brain
and how the brain functions. According to research, individuals that suffer from either
hypothyroid or hyperthyroid conditions, anywhere from 30-70% suffer from symptoms of
depression or anxiety (Erensoy, 2019).
Coordinate with community behavioral health agency for the patient to engage in services
including a psychiatric provider for medication management and peer specialist to engage
in activities including group and art therapy at the clinic.
Coordinate with a primary care provider for continuous management of medical
Referral to a pain specialist to evaluate treatment options for chronic pain of bilateral
Referral to physical therapy for increased mobility and prevent decompensation.
Referral to a nutritionist for assistance with weight management increase self-confidence
and promote community engagement.
Discussed the risks, benefits, side effects, alternatives of medications, and the target
symptoms with the patient. Side effects of Zoloft reviewed include weight gain, nausea,
vomiting, increased thirst, headache, weakness, increase in suicidal ideation, and
constipation(Drugs.com, 2020). Reviewed significance of not discontinuing any
medication without discussion with a provider, and to contact the provider with any
Strongly discouraged mixing of any medications. Discussed mixing medications
including over the counter, herbal supplements, alcohol, and illegal substances may be
detrimental. Discussed the importance of abstaining from alcohol and illegal substances,
as they may have a damaging influence on a patient’s mental health, depression, sleep
cycle, and physical health.
Scheduled appointment with a psychiatric provider in 3 days.
Scheduled appointment with a primary provider in 7 days.
Confirmed with a patient, she has phone numbers for her children, the crisis line,
emergency services, and to go to the closest emergency department if she starts having
feelings of self-harm, suicidal or homicidal thoughts.
The patient’s questions were answered. The patient verbally stated that she understands
the discussion and is in agreement with the treatment plan. Pt signed the treatment plan
This was an interesting case, with many layers, and many things that attributed to Patti’s
depression. Sandy, the therapist working with the family has worked with the family, doing well
throughout the last eighteen months. Although the family is currently stuck with moving
forward, I feel Sandy worked with the family with progress and moving forward. I liked the
approach of having a team to examine and bring forward other ideas and perspectives to help the
family heal and move forward. The family initially came in related to reuniting a family, as time
went on tensions of multicultural differences were also addressed. It is obvious that although the
family is having some struggles, they love and care for each other very much. The children want
their mothers to have a productive and independent life. It is important to address and respect the
family’s differences in their beliefs. An important goal for the family is to find a routine that
works for both mother and her adult children. It is important that both mother and children feel
supported, and both have their independence.
The articles I have attached are considered scholarly as evidence by, dated within the last
five years, peer-reviewed, and obtained from the Walden Library.
APA. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). [MBS Direct].
Retrieved from https://mbsdirect.vitalsource.com/#/books/9780890425572/
Boone, D., & Kim, S. Y. (2019). Family Strain, Depression, and Somatic Amplification in Adults
with Chronic Pain. International Journal of Behavioral Medicine, 26(4), 427–436.
Drugs.com. (2020). Interaction checker. Drug interaction report. Retrieved June 12, 2021, from
Erensoy, H. (2019). The association between anxiety and depression with 25(OH)D and thyroid-
stimulating hormone levels. Neurosciences (Riyadh, Saudi Arabia), 24(4), 290–295.
“Mother and Daughter: A Cultural Tale.”, directed by Anonymous. (2003). Masterswork
Productions [Video]. Alexander Street. https://video.alexanderstreet.com/watch/mother-
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
NIH.gov. (2020, October 26). Standard BMI calculator. National heart, lung and blood institute.
Summary of the clinical practice guideline for the treatment of posttraumatic stress disorder
(PTSD) in adults. (2019). American Psychologist, 74(5), 596–607.
Tankha, H., Cano, A., Corley, A., Dillaway, H., Lumley, M. A., & Clark, S. (2020). A novel
couple-based intervention for chronic pain and relationship distress: A pilot study. Couple
and Family Psychology: Research and Practice, 9(1), 13–32.