family therapy

Hernandez Family Assessment

Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues. As you examine the Hernandez Family: Sessions 1-6 videos in this week’s Learning Resources, consider how you might assess and treat the client family.

Learning Objectives

Students will:

· Assess client families presenting for psychotherapy

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide on family assessment.

· View the Hernandez Family: Sessions 1-6 videos, and consider how you might assess the family in the case study.

Note: For guidance on writing a comprehensive client assessment, refer to pages 137–142 of Wheeler (2014) in this week’s Learning Resources.

The Assignment

Address in a comprehensive client assessment of the Hernandez family the following:

· Demographic information

· Presenting problem

· History or present illness

· Past psychiatric history

· Medical history

· Substance use history

· Developmental history

· Family psychiatric history

· Psychosocial history

· History of abuse and/or trauma

· Review of systems

· Physical assessment

· Mental status exam

· Differential diagnosis

· Case formulation

· Treatment plan

Note: Any item you are unable to address from the video should be marked “needs to be added to” as you would in an actual comprehensive client assessment

Learning Resources

Required Readings

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

Chapter 12, “Family Therapy” (pp. 429–468)

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Chapter 3, “Basic Techniques of Family Therapy” (pp. 29–48)
Chapter 4, “The Fundamental Concepts of Family Therapy” (pp. 49–68)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: It is highly recommended that you use this resource as a reference guide throughout the course.

L’Abate, L. (2015). Highlights from 60 years of practice, research, and teaching in family therapy. American Journal of Family Therapy, 43(2), 180–196. doi:10.1080/01926187.2014.1002367

Mojta, C., Falconier, M. K., & Huebner, A. J. (2014). Fostering self-awareness in novice therapists using internal family systems therapy. American Journal of Family Therapy, 42(1), 67–78. doi:10.1080/01926187.2013.772870

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207–215. doi:10.1111/famp.12025

Papero, D. V. (2014). Assisting the two-person system: An approach based on the Bowen theory. Australian & New Zealand Journal of Family Therapy, 35(4), 386–397. doi:10.1002/anzf.1079.

Required Media

Laureate Education (Producer). (2013a). Hernandez family> Sessions 1—6 [Video file]. Author: Baltimore, MD.

N.B: PLEASE ATTACH WITH THIS ASSIGNMENT IS THE 6 VIDEO TRANSCRIPT DOWNLOADED IN PDF FORMAT FOR THIS ASSIGNMENT SINCE THE VIDEO AND THE AUDIO IS NOT AVAILABLE AT THIS TIME, AND A SAMPLE FORMAT FOR THE ASSIGNMENT.

Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript

Psychotherapy.net (Producer). (2006). Tools and techniques for family therapy. [Video file]. Mill Valley, CA: Author.

Hernandez Family Episode 1

Hernandez Family Episode 1 Program Transcript

JUAN HERNANDEZ: But we didn’t do anything wrong. That woman, that social worker, who came to our house, I told her, me and Elena, we decide what’s best for our boys, not her. Telling us we punish to hard. She doesn’t know anything about us.

ELENA HERNANDEZ: We give our sons a good life. We love them very much. It’s not fair what she said about Juan and me. We’re good parents.

FEMALE SPEAKER: Mrs. Hernandez, I understand how difficult this is for you–

JUAN HERNANDEZ: I don’t think you do. Everything that we do, we do for them, everything. We work hard. We take care of them. And when they don’t follow the rules, they get punished, strictly. The old fashioned way.

ELENA HERNANDEZ: Shh. Quiet. I told you.

JUAN HERNANDEZ: Sometimes I’m not strict enough with them. Look, I punish my sons the way I see fit. That’s the only way they are going to learn. That’s how we learned from our parents, right? Nobody took parenting classes. That’s ridiculous.

FEMALE SPEAKER: I understand you’re angry. And you’re raising your children the way you were brought up to do. But ACS has required that you do this.

JUAN HERNANDEZ: What if I don’t want to be required?

ELENA HERNANDEZ: I have a question.

FEMALE SPEAKER: Of course.

ELENA HERNANDEZ: If we go through with this, the things we talk about with you, will it be private?

JUAN HERNANDEZ: But we have not agreed to do this.

ELENA HERNANDEZ: I don’t want to be here either. But I don’t want to loose our children. Would it be private, what we talk about?

FEMALE SPEAKER: The information we share is between us. The only exception to that is if one of you says you’re going to hurt yourself or hurt someone else. In that case, I have to report it to the ACS worker. But everything else is strictly confidential.

Hernandez Family Episode 1

So how do you think we can work together to make this a positive experience for both of you?

JUAN HERNANDEZ: Parenting classes, really? What about the bills? I’m not going to be able to work overtime.

ELENA HERNANDEZ: If we do what we’re supposed to do, would it be OK with our family?

FEMALE SPEAKER: There are no guarantees. But here’s what I can say. We’ll all work together to create a plan based on what the ACS worker has required and recommended. Then it will be up to her what the outcome will be.

So shall we make a plan?

Hernandez Family Episode 1 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 2

Hernandez Family Episode 2 Program Transcript

FEMALE SPEAKER: It’s good to see all our parents again tonight. And I want to say thank you for being here these last few weeks. Today, we’re going to talk about child development, specifically the behavior of our children, and what are some realistic expectations we can have about how they behave, depending on how old they are.

Part of understanding human behavior is looking at where someone is in their life, as well at the impact of their environment, whether it’s school, home life, family, or friends.

MALE SPEAKER: What’s there to understand? I mean, come on. They’re kids. They shouldn’t be seen or heard, right?

FEMALE SPEAKER: We all want our children to behave. But throughout childhood, there are certain behaviors that come with certain ages that can be very challenging to deal with.

FEMALE SPEAKER: Tell me about it.

FEMALE SPEAKER: So let’s talk about some of your expectations about your children’s behavior.

MALE SPEAKER: Well, my son is nine. That age, I expect him to do his chores and listen to me. When I was nine, you better believe I was listening to my old man, or else, you know?

MALE SPEAKER: You’ve got that right. And I don’t understand why my son doesn’t listen to me when I tell them to do something. I mean, what if I didn’t listen and come to this class? We might lose our kids. How do I deal with this better? I mean, get him to listen and behave?

FEMALE SPEAKER: Well, Juan Junior is eight, and at that age, their attention can be really hard to not only gain, but–

Hernandez Family Episode 2 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 3

Hernandez Family Episode 3 Program Transcript

JUAN HERNANDEZ: Do you have any idea how hard it is for us to get to these classes?

ELENA HERNANDEZ: And there’s only one class a week. We don’t have a choice when to come.

FEMALE SPEAKER: That is why we offer the parenting class at night, to make it easier for working families to attend.

ELENA HERNANDEZ: That’s fine for some people, but that’s when Juan gets his overtime. He can’t do both. Every time we come here it costs us. We lose money. And the way things are, we can’t afford to lose a dime.

FEMALE SPEAKER: I understand that missing overtime is having a big impact on you financially. And I understand what you’re saying about the class only being offered one night a week. If we could offer it several times a week, that would probably be more helpful. But in the meantime–

JUAN HERNANDEZ: Look, let’s stop dancing around what’s really wrong here. We appreciate what you’re doing. You want to help parents do a better job with their kids. But we’re good parents. We love our kids. Yes, they get punished when they need to be punished, just Elena and I when we were growing up. But we don’t hit our boys. We don’t hurt them.

If anything, you hurt them by making us come here when I could be out there making extra money, money that the family needs. Do you hear me? This class this, whole policy is the real problem. That’s what needs to change, not us.

Hernandez Family Episode 3 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 4

Hernandez Family Episode 4 Program Transcript

FEMALE SPEAKER: So how’s your week going? What’s happening with that Hernandez family? That’s their name, right? You were having some challenges there?

FEMALE SPEAKER: They’ve missed four of their parenting classes, so far.

FEMALE SPEAKER: So they haven’t completed the parenting group?

FEMALE SPEAKER: I have to call the ACS worker and let her know. They’re probably going to have to take the classes over again, and that’s going to be tough. The father misses overtime to come to the classes, and they really rely on that money to make ends meet.

FEMALE SPEAKER: You have something else on your mind. Say it.

FEMALE SPEAKER: I should have discussed this with you earlier. I don’t know why I didn’t. But perhaps they weren’t the best candidates for this to begin with.

FEMALE SPEAKER: Because of their financial situation?

FEMALE SPEAKER: Yes, and something else. I remember the ACS worker. And when she talked about wanting Elena, she kept calling them Mexicans. It was really derogatory the way she said it.

FEMALE SPEAKER: So you’re saying she might have been biased into mandating that they take these classes?

FEMALE SPEAKER: Yes. The more I think about it, she never talked to me about trying to understand the way they’re raising their children. And that Mexican remark, it just really wasn’t respectful. It’s like she had already made up her mind about people from that culture, and now they’re paying the price for it.

Hernandez Family Episode 4 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 5

Hernandez Family Episode 5 Program Transcript

FEMALE SPEAKER: They’ve missed four of their parenting classes so far.

FEMALE SPEAKER: So they haven’t completed their parenting group?

FEMALE SPEAKER: I have to call the ACS worker and let her know. They’re probably going to have to take the classes over again, and that’s going to be tough. The classes caused the father to miss overtime at work, and they really rely on that money to make ends meet.

FEMALE SPEAKER: But they have to finish the program. They’re only allowed three missed classes. There’s another problem. You know the agency’s been conducting a study of our performance. Well, it lowers our completion numbers. Lower numbers put our funding at risk. Our bosses start questioning the credibility of what we’re trying to do here.

FEMALE SPEAKER: But I can’t give the Hernandez family the post test. They won’t be able to complete it.

FEMALE SPEAKER: No, that’s not why I brought this up. The agency needs data to determine how effective these parenting classes are. The more attrition we have when parents don’t finish the program, there’s no data. No data means no support for what we’re teaching or how it might benefit other populations.

FEMALE SPEAKER: Maybe we should account for the attrition then. Maybe there’s something we can learn from it?

Hernandez Family Episode 5 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

Hernandez Family Episode 6

Hernandez Family Episode 6 Program Transcript

FEMALE SPEAKER: So last week I showed you how to make a genogram, like this one. Now, the idea behind making a genogram is to help you draw a picture of your family history. And then we use that to discuss the relationships and connections among your relatives. OK? So Juan, why don’t you start off and talk about what you came up with.

JUAN HERNANDEZ: So we’re starting with my family. My father, Hector, he’s still alive. And he married my mother, Freda. And she passed away two years ago. And then there’s their children, myself– I’m the oldest– and then there’s my three sisters, Marie, Senta, and Rose.

FEMALE SPEAKER: Good. And Elena, what about your family?

ELENA HERNANDEZ: Well, here’s my father, Anthony. He met and married my mother, Sofia. They are both still alive. They had five children. Firstborn was my brother Daniel, then my brother Tomas, then my sisters Martina and Camila, and there’s me, the baby.

And then I met Juan, and we started our own family. And we have two beautiful sons that you met, one, Junior, who is eight, and Alberto, who is six.

FEMALE SPEAKER: Good. So for the last several weeks we’ve been talking a lot about how you discipline your sons at home. And both of you mentioned how your parents used to punish you when you were growing up. Juan, why don’t you talk about that and point to anybody on the genogram as you mention them?

JUAN HERNANDEZ: Sure. So my dad, when he was mad at me he would send me to get books from the encyclopedia. And he’d make me hold them out, straight out like this, until he told me to stop. It caused so much pain in my arms, I mean, my arms felt like they would break off.

And my mom, she did basically the same thing. Except when she was really mad, when would make me get more books than my dad. I hated those books so much. I never went near them on my own. To me, they only meant one thing, misery. And now, I guess I inherited that from them.

FEMALE SPEAKER: Elena, how about you?

ELENA HERNANDEZ: Yes, misery. That’s what it was like for me, too.

Hernandez Family Episode 6

Hernandez Family Episode 6 Additional Content Attribution

MUSIC: Music by Clean Cuts

Original Art and Photography Provided By: Brian Kline and Nico Danks

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