This paper is a psychological assessment of a client and her family done in November 14, 2011

Running head: PSYCHOLOGICAL ASSESSMENT

Psychological Assessment

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This paper is a psychological assessment of a client and her family done in November 14, 2011.

Part One: Study

Identifying Information

The client is a 46-year-old Japanese female who lives in Los Angeles downtown with her Latino husband aged 45 years. They have two daughters with ages of 13 years and 11 years. The client works as a part time baby sitter, and her husband works at a local bakery. They have been married for 16 years and both were born and raised in foreign countries before moving to the US more than 20 years ago.

Setting

They are enrolled in the Community Local Agency for family therapy follow up. The agency mostly serves communities of Chinese, Korean, Japanese and Latino backgrounds. It offers family therapy and social work services. This agency is funded by the accepted states, which are located in Los Angeles CA.

Reasons for Referral

A local school referred them to the agency, which suspected emotional child abuse in their youngest child. They were not aware of any constrain within the family. Their younger child is currently in therapy. The couple has trust and communication issues, which have lasted for 5 years with the cause still unknown. According to them, their two children do not want them to get a divorce. The problem is extremely serious to both of them. They would like to avoid the divorce for the sake of the children since no past problems had been identified.

Client has been in individual therapy for more than 7 years. She is currently on anti-depression medication (Zoloft) and medication for diabetes. They are trying to solve issues in order to improve their marriage. Their long-term goal is to provide a stable, healthy and safe environment for their children.

Description and Functioning of the Client

They are well groomed and decent. Their bodies are congruent to their heights, ages and weights. They have upright postures and apposite gaits with no obvious striking features, significant physical mannerisms, developmental delays and disabilities. They are not native English speakers. The Client is Japanese while her husband is a Latino who speaks Spanish. Therefore, they do not have a common language.

Both of them completed high school levels outside of the United States. The Client is extremely talkative and sometimes goes off track during conversations while the husband is quiet. She explains every single incident that happens between them and her stories tend to lack reputable organization. Currently, she is diagnosed with depression and diabetes, but periodically she goes for checkups with a physician. Therefore, she has the condition under control, and there is no relapse. Client’s husband has no history of medical and related psychological or emotional issues.

Physical Economical Environment

They live in an urban set up in Los Angeles CA. They are not indigenous to their neighborhood. The neighborhood consists of mixed economic classes. Generally, the area is a low-income region. The main source of income is the part time jobs that both are engaged in, apart from State and Federal support. The husband’s lifestyle has remained unknown. They currently live in a low-income housing, which is near a homeless shelter that makes it unsafe especially for the children who are at the risk of abuse, and disruptive behaviors. However, their house has a gate, and it is located in an accessible and convenient place for services such as education, healthcare and childcare.

Current Social Functioning

Family

Their family is composed of the wife, her husband and the two children. The wife’s origin is Japan and the husband originated from Mexico. They have been married for 16 years. The relationship between the family members is extremely poor. They have mistrust issues and improper communication links. The communication problem affects the children directly since the parents have limited ability to spoken English and argue quite often. However, the children understand the language, unlike their parents.

According to the client, she does not have any extended family in the US. She also claims that her husband’s extended family lives outside of California, but they are not that close. There is no report or evidence regarding the performance of the parents in taking up their role. Only the wife is responsible for communicating with the children and the school.

There is no evidence suggesting domestic violence, physical and sexual abuse within this family. The eldest of the two daughters is well, but the younger one suffers from Attention Deficit Hyperactivity Disorder (ADHD) and other behavioral issues.

Current Sexual Function

According to the client, the relationship with her husband has lacked intimacy for more than 2 years and currently she does not have any interest in an intimate relationship with him. The clients are parents, and they are not seriously committed to their relationship since they have some issues. There is no evidence indicating the daughters as being involved in any intimate relationships.

School

They do not have any issues with their children’s current school placement and are satisfied with the placement. However, they do not seem to be aware of any issue that pertains to the learning environment of their children such as disability, exceptional strength and intellectual gifts. The children have no vision or hearing problem, and there is no evidence showing that both children have sensory motor and sensory integration deficits.

There is no evidence of peer relationship, violence and bullying, emotional abuse, physical abuse, and sexual harassment in their children. The lack of peer influence is of concern as this may lead to the children not thriving within their age mates and developing social skills. They do, however, seem to have quality relationships with their teachers and are not involved with the advocate for child (IEP).

Recreational and Leisure Environment

They do not have a large or extensive social network. The Client has a few friends just near their home and others who live in the same housing building. It is unknown if they involved in league, sports, police activities, and community based theatre, swimming, gymnastics and horseback riding is unknown. The client’s favored recreational activity is surfing the internet, while that of the husband’s remains unknown.

Medical and Psychological History

The birth histories of both the wife and husband are unknown and have no birth problems. The wife is diabetic and suffers from depression. The husband’s medical condition is unknown. The wife is on anti-depressant drugs and diabetic pills. They cannot clearly identify the impact the medication she is on has on her current functioning as well as in her role as a mother. There is no psychiatric condition affecting the children apart from the ADHD the youngest daughter has. The case manager provided this information.

Legal Issues

The only legal issue that directly involves them is the suspected emotional child abuse, but it has not resulted in any criminal proceeding, civil litigation or committed crime. There is no evidence of juvenile contact with the legal authorities.

Personal and Family History relevant to Focus on Assignment:

The two children were born in Los Angeles, CA. they have appropriate developmental milestones. Any eating or sleeping disorder among them is unknown. The couple was married 16 years ago, and currently the client is seeking separation; a view not shared by the husband. Apart from the current problem, there are no other non-normative life events such as loss of job, victims of violence, accident, trauma, or medical illness. The husband was once a suspect of substance abuse, but he has been sober for more than three years. However, the wife has a financial issue, outside of the marriage, but she is hesitant to discuss it with her husband.

Non-Western Expectations for Child

The client and her husband are trying to understand her children’s developmental stages and secure a chance for a better future for their children through education. They have been trying to understand all the situations surrounding them, however, due to lack of communication, both seem to be frustrated with each other. The husband understands that both the wife and the youngest daughter need to be treated by professionals.

Part 2: Assessment for Parents

Psychological Functioning (Strength and Limitation)

There are no reports about their comprehensive emotional functioning. However, all of them seem to be fine and well despite the fact that the parents have communication issues. They seem to acknowledge the problems, and they have rigid assumptions that they make between them as parents. Despite the problem, they do not have any physical abuse, but they often argue in front of their children. The tension that comes about during these arguments tends to have a negative effect on impressionable children (Mandelstein, 2006).

The client remembers every single negative event about her husband’s behaviors, but the husband does not care about the previous unfavorable incidents. They are all avoiding the issue since they only notice each other’s unfavorable behaviors. They have denial, regression and projections as a defense mechanism to their problem (Cramer, 2002). They are all unable to compromise since each one of them is not willing to be in a concession.

Emotional Functioning

The couple has appropriate emotional expression towards the children, but it contrasts in respect to one another. At the beginning of the session, both did not show any emotional expressions. The wife has a more flat expression and does not want to use English, as this will disappoint her husband. The husband appears sad since he is not able to communicate with the wife in his way. Apparently, both are rigid and this particular reason makes communication exceedingly difficult.

Social and Behavioral Functioning

Both parents appear to be responsive in terms of their ability to form a relationship with their dependents, the daughters. Both of them seem to have outside friends. There are no clear distinct responsibilities between them since there is the lack of communication and trust. Communication may influence the relationship between marital satisfaction and stressful events by acting as a buffer (Vangelisti, 2004). The ability to perform the roles expected of them in school and religious setting is not known. The husband has been a suspect of alcohol abuse, but he claims not to have taken alcohol for more than three years.

Environmental Issues and Constrains Affecting the Situation

The family of creation, that is, the extended family is unknown. They have no evidence of domestic violence. The wife has some support and friends, but the husband’s social state is unknown. The cultural, agency and other economical constrains are also unknown.

Motivation and Commitment to Services

Their motivation is their own children. However, it does not appear that they have any progress despite both of them trying hard to commit to change. They are still pointing out each other’s behavior. This means that when they do realize that they need to change their own behaviors, then the first step to moving forward will have been attained (Borba, 2009).

Understanding of Clients Presenting Situation

In summary, I have met the clients seven times. What is motivating about them is that they come together to receive couples therapy. This indicates a remarkably positive attitude in both parties. However, during each session, they have both complained of each other’s unfavorable behaviors. During one of the sessions, the husband complained of having a headache, but he would continue while the client requested for a therapy session for the youngest daughter as couple therapy is not working. None of them has admitted to their own faults or discussed the prospect of reconciliation. They will continue having issues that will lead and deepen the prevailing trust issues due to the lack of communication skills (Wasserman, 2003). They should try to lean or use one common language within the family (Cramer, 2002). This will help them in coping with the situation.

From the interaction study and assessment, they both appear to be frustrated with each other and themselves. What triggers this kind of misunderstanding and mistrust that they have between them is due to improper communication (Pearson Assessment, 2009). The client seeks a separation so that she may be able to re-evaluate their relationship, but the husband disagrees claiming the wife will have too much free time and will not take care of the children. In the follow up session, the wife still stood her ground in terms of wanting a separation. Since arguing was producing no results, it was decided to let each speak in turn, and the other to listen.

Theoretical Explanation

From the study and assessment, three theories can be looked at that relate to their problem. One of them is the attachment theory developed by John Bowlby. It describes the dynamics of long lasting relationships among human beings (Exner and Erdberg, 2005). The most fundamental principle in this theory is that an infant or children need to develop some relationship and interaction with a primary care giver (it may be parents) for emotional or social development. Based on the quality of these early experiences, the internal, unconscious template is modeled in either a healthy and positive or an unhappy and negative manner.

The couple has also violated the key insight of role theory. This is because whenever a person is expected to act simultaneously in multiple roles with contradictory expectations, then the role conflict occurs (McGee et al, 2008). This is because the role theory considers normal activities that act out of the normal defined social categories. One of them is the division of labor, social norms and beliefs, which determines ones expectations. Since they have no common belief, norms or expectations, they will have trust issues and disagreements (Pearson Assessment, 2009).

Another theory is the conflict theory, which suggests that although conflict is natural and does exist in every family, it is supposed to help relationships grow and mature Use of renegotiations is the best way to solve the conflict (Howe, 2011). In this case, however, the arguments seem to be eating away at the marriage rather than allowing it to strengthen. It also states that over time couples may start questioning their traditional roles and will want more than is provided by the role. However, this does not mean they should abandon their primary roles as caregivers.

Part Three: Evidence Based Practice Search

Areas of Intervention

Various issues can be selected from the study and assessment of the couple. The first, main one is communication and trust issues. The main question posed was the cause of origin of mistrust. One could wonder if the mistrust is solely based on the lack of communication between the couple, or it is another underlying reason. Why is it easier to deny than to accept responsibility? Is separation and/or divorce the only option left in this particular case? The search procedure involved active participation from everyone in the family. Both individual and family sessions allowed for further insight into the problem (Mellenbergh, 2008).

The next area was dealing with the current health issues within the family. The Client has diabetes and suffers from depression. Although she is on medication, a medical background is necessary to validate if the condition is hereditary or caused by other external factors. The steps taken in regards to her youngest daughter’s condition have remained unknown. Focus should be on the advantages and disadvantages of using ADHD medication, what behavior changes are supposed to be created and how the whole family can deal with the ADHD child (Magwood, 2009).

Finally, the children are at risk in the midst of all the chaos that surrounds them. They are prone to abuse, failure to thrive, disruptive behaviors and trauma due to the broken family attachment that persists. The key question here was how to make the children feel that they are still part of the family. The other question was: are their social skills because of issues at home or school? (Achenbach and Rescorla, 2001). Social skills are necessary during tentative stages of growth as this contributes to the general outlook of one’s life and their wellbeing.

Part 4: Intervention Plan

Short Term Goals

The short-term goal includes the development of alliance between the couple, reducing the negative communication that exists, minimizing hopelessness, reducing the potentials of dropout from the family therapy program, development of family focus, and increase motivation for the expected change. The alliance and having positive communication will help the couple to develop mutual trust among them and be ready for a change. This can be achieved within the first two months.

Long Term Goals

Ensuring that the couple develops a long lasting cohesive family is the long-term goal. The couple is, therefore, to develop a common language for their communication. This is because proper communication promotes trust among family members. This will eliminate trust and communication issues. Both parents should be more involved in their children’s developmental stages both in school and at home. This will make them be more open to parents, teachers and other students.

The extended family also plays a key role in the growth of children as they give them a sense of identity (Zastrow and Kirst-Ashman, 2010). The bond between families strengthens and the children will learn about their various backgrounds. They can be invited over holidays, and the children can go visit them or make the relatives part of the family by sending them pictures of memorable events such as birthdays. This should be achieved within a period of six months. They should also be encouraged to learn more about the cultures as this will give them stability in their own future.

Description of the Interventions (Methodology)

For communication issues, I will use the narrative theory approach where we will first discuss immediate changes as well as long term behavioral changes that the couple need to make to achieve the short-term goals (Exner and Erdberg, 2005). After that, functional family therapy would be a suitable approach to this family. They will be required to develop and implement individual change plans. The focus will be to build rational skills such as communication among parents to resolve trust issues.

For the achievement of the long-term goals in terms of communication, a collaborative language system will be essential. The couple will be required to make meaning of their family experiences and about their issues (Cramer, 2002). They will drop their perceived issues through a truly transparent and creative dialogue. This will touch deep on their feelings to enhance emphatic capabilities among them.

In regards to the wife’s condition, it is imperative that she keeps taking her medication, as this will prove of benefit in the end. However, it is advisable to know whether the depression is due to emotional breakdown, stress or the family’s financial status. Several factors such as heredity, age, stress, hypertension and malnutrition related diabetes could cause diabetes. The entire family should undergo a thorough medical check in order to find out the risk factors.

The younger daughter’s ADHD problem can be solved by use of medication. However, every family member needs to accommodate the condition and the impulsiveness that comes with it. ADHD can make the child unpopular with teachers, other students and even within the family itself. They will also need to know what triggers the behavior and try averting the problem before it starts.

Therapy may also be helpful especially to the daughter afflicted by the condition as it helps them cope. For a long-term impact, cognitive, behavioral therapy may be applied. This theory uses the premise that the brain adopts change with learning, and it is through these changes that brain functioning is altered and reduces the symptoms of ADHD. Another intervention that may be of benefit is family therapy and education. Counseling, giving the daughter responsibilities and having a positive attitude will help develop self-esteem and nurture the child as well as help them meet their expectations (Bowman, 2000).

As earlier stated, the family lives in a low-income housing that is near a homeless shelter. Since they come from a broken family of sorts, they may take up behaviors they see around them such as alcohol and drug use. They are also at risk of physical or sexual abuse. The parents should make a plan on how to spend time with their daughters after school. Since both are dependent on part time jobs to meet their financial obligations, they should find someone to stay with the children when they are not around; a neighbor, friend or babysitter.

Furthermore, the lack of peer influence in the daughters’ lives should be looked into. There are various reasons as to why children may be anti-social such as alcoholism in the parents. Studies have shown that these children tend to have attention problems and impulsivity (Connor, 2004). Other investigations show that maternal depression may play a role in the anti-social behavior of children sometimes leading to aggression. An increase in the negative parent to child interaction due to the parent’s hostility or irritability is the cause of the behavior. This may also lead to a decreased level of parental supervision and monitoring resulting to a breakdown in the parental bond (Connor, 2004).

It is, therefore, important for the mother to play a role in the lives of both her daughters. This does not mean that the husband’s role does not matter since they are supposed to complement each other in the task of raising the children (Mandelstein, 2006). They should be involved in their schoolwork and even assisting in areas where they can. They should also try to invite children their daughters’ age for play dates or encourage their daughters to play within the neighborhood.

Part 5: Discussion and Analysis

During the individual therapy session, the use of questionnaires would have been used in case anyone of the clients felt uneasy. The use of questionnaires aims to get direct answers by asking specific obtrusive questions that measure personality traits (Mellenbergh, 2008). In each session, questions pertaining to the outlook on life and the steps that should be taken to help the family were asked. What was clear, especially from the children’s views, was that divorce was not an option to them. This was discussed with parents who did not want to traumatize the daughters, but none was ready to accept their mistakes. The client is still adamant on the issue of separation.

When performing the family session, care should be taken not to pick topics that may lead to an argument in front of the children. It should be made to feel like an area for sharing ideas and working to a common goal. Areas of discussion should revolve around the children. This is done so that the parents stop acting selfishly and see that there are other people in the equation. Upon realizing this, steps to build communication pathways should be initiated.

A language of choice should be chosen. Since the children are conversant in English, this can be a starting point. They can attend adult classes together giving them an opportunity to learn from one another. It can be assumed that one of them has picked some basic words or sentences from the other’s language since they have lived together for many years. Since learning a new language may take some time, patience is of the essence if whatever they will try to convey may not come out as expected.

The children case is a little tricky. They do have an attachment with their teachers, and this has to be transferred to the parents. The principle of the attachment theory comes into play here. At home, the children do not get enough attention and support, so they become attached to the teachers. This is not a grievous thing, but for their overall growth, they need a firm bond with their primary care givers. The youngest daughter needs the most attention from everyone in the family and at school so that she can develop her social skills.

Potential Limitation

Potential limitations posed by the couple include lack of motivation to facilitate change and negativity towards the entire process. The constant shifting of blame may hinder the therapy process leading to hopelessness in the clients affecting the targeted outcome. Some of the limitations posed by the agency may include low social support including both financial and material support to clients. Inadequate resources for follow up as well as services such as healthcare and training are also limitations. However, with the proper support from each other I believe the intervention plans, both short and long term, will be of considerable benefit in the healing and building process of the family.

There is a likelihood of separation due to the constant arguments. If this is the decision the parents will come up with, they will need to seek legal, professional help and discuss the details of child custody. The outcome of this was to be discussed in the next session.

References

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Connor, D. F. (2004). Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford Press.

Cramer, P. (2002). Defense Mechanism Manual, revised June 2002. United Kingdom: Williams College.Exner, J. E. and Erdberg, P. (2005). The Rorschach: A Comprehensive System: Advanced Interpretation (3rd ed., Vol 2). Hoboken, NJ: John Wiley & Sons.Howe, T. R. (2011). Marriages and Families in the 21st Century: A Bioecological Approach. West Sussex, UK: John Wiley & Sons.Magwood, R. (2009). How to Cope with and Beat ADHD: Powerful Steps to Take to Overcome Your ADHD. New York: CreateSpace.Mandelstein, P. (2006). Always Dad: Being a Great Father During & After Divorce. Berkeley, CA: Nolo.McGhee, R. L., Ehrler, D., and Buckhalt, J. (2008). Manual for the Five Factor Personality Inventory – Children. Australia: Austin Publishing.Mellenbergh, G. J. (2008). Surveys. In H. J. Ader, G.J Mellenbergh and D. J. Hand (Eds.), Advising on Research Methods: A Consultant’s Companion (pp 183- 209). Netherlands: Johannes van Kessel Publishing.

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Vangelisti, A. L. (2004). Handbook of family communication. New Jersey: Routledge.Wasserman, J. D. (2003). Nonverbal Assessment of Personality and Psychopathology. In R. S. McCallum (Eds.), Handbook of Nonverbal Assessment (pp 283- 309). New York: Springer.Zastrow, C. and Kirst-Ashman, K. K. (2009). Understanding Human Behavior and the Social Environment. (8th ed.). Belmont, CA: Cengage Learning.