An assessment starts when a therapist meets the client. The assessment is meant to help the therapist understand the defenses and challenges that arise when helping family members open to each other (Nichols & Tafuri, 2013). This paper provides a detailed assessment of the Hernandez family.
A 27-year-old Juan Hernandez is married to 25-year old Elena Hernandez. Together they have two boys, Juan Jr. aged eight years and Alberto, six years old. The conventional family is based in Queens, New York. The family is from a low social class, whereby Juan works in the airport luggage section while Elena is a babysitter for a neighborhood family. Also, Juan has to work overtime to meet the family’s financial needs.
A social worker has referred both parents for parenting therapy at the Administration of Child Services as they seem to have a harsh disciplinary approach for their two boys. The punishment involves the boys kneeling with their hands raised holding encyclopedias.
History or Present Illness
The family was fine until Juan Jr. reported to school staff that his parents punished him by making him kneel with their hands raised holding encyclopedias. After assessing the issue, a social worker noted that this approach was too harsh. Also, the Administration of Child Services' involvement authorized the parents to either attend parenting sessions or have their children taken away. However, the parents do not find the punishment as being harsh and even considered the intervention as unnecessary as their parents also raised them the same way.
Past Psychiatric History
Neither of the parents has had a psychiatric illness in the past even though they both admit that their parents punished them severely while young.
No medical history for both parents. More information is needed
Substance Use History
The family is against substance abuse and also has no history of substance use or abuse. More needs to be added.
Both parents reported normal development. The parents also reported both sons met their developmental milestones.
Family Psychiatric History
No cases of psychiatric illnesses. Further assessment is needed.
the clients have heterosexual marriage and live in the same house with their children. Juan Hernandez has to work full-time and overtime to meet the family's financial needs (Laureate Education, 2013). Further assessment is needed.
History of Abuse And/Or Trauma
Both parents report having received similar harsh disciplinary actions from their parents. When angry, Hernandez’s dad and mum would order him to get encyclopedias and hold them up on both hands until they would tell him to stop. The punishment caused a lot of harm that he felt like his hands will fall off. To Juan, books meant “misery.” Juan concedes that he might have inherited the act from his parents. Elena also reported to having some severe punishments from her parents. However, both parents deny any physical abuse.
Review of Systems
Clients deny any existing conditions relating to the cardiopulmonary, gastrointestinal, central nervous, and musculoskeletal systems. They also deny heat intolerance, night sweats, injury or trauma, body weakness, and body fatigue (Laureate Education 2013).Mental Status Examination
Both clients are well-groomed and look appropriate for their age, and in no acute distress.
Both of them are alert and well oriented to time, place, person, and situation. Also, they are accommodating and ready to engage in discussion. Moreover, they exhibit good abstraction with intact understanding and judgment (Laureate Education, 2013). However, Juan seems nervous about attending parenting sessions as he would be working overtime to cater for family finances. Elena is more patient and ready to cooperate if her privacy is guaranteed, and if the therapy sessions will stop her from losing her children.
Environmental and Psychosocial and problems – Financial hardships
Post-traumatic stress disorder
Stress and aggressive disorder
Prolonged exposure to intense psychological distress increases the chances for PSTD (American Psychiatric Association, 2013). In the case involving Juan and Elena Hernandez, they both report having “miserable” childhood characterized by severe punishments. At one point, Juan feels he might have inherited the behavior from his parents. Therefore, the main question before helping them would be “is the discipline action directed to their sons justified, or do the parents have stress/anger issues that play a part in their disciplinary approach? Coleman (2018) notes that in disciplining children, parents who are troubled with anger and stress could cross the line from discipline to abuse. One of the stressors could be the struggles to meet the family's financial needs, which forces Juan to work overtime.
Juan and Elena Hernandez were referred for parenting therapy sessions because a social worker thought they used harsh disciplinary methods for their children. The parents agree to the allegations as being true and give reasons why they did so. The ACS social worker was right that these parents needed to join parenting classes (Laureate Education, 2013). The classes would help them explore parenting methods and create awareness concerning other disciplinary methods that are not too harsh.
Family Group Therapy involves a structured methodology developed to reduce family conflicts, which accentuates family strengths. The style is crucial in ensuring that families overcome the actions that may result in rifts among members and concentrate on those actions that are good for all individuals, such as empowerment and commitment (Wheeler, 2014). The CBT approach will be incorporated into family therapy to address the parents’ behavior and impacts, such as the emotional and behavioral changes that might occur due to the harsh disciplinary actions (Wheeler, 2014). The CBT method will educate Juan and Elena on being responsible for their actions and the consequences.
Family therapy for the above clients should be an active and dynamic practice whereby the therapist examines any complaints and work towards settling them most efficiently rather than focusing only on information gathering. Family group therapy and CBT methods could help these clients adopt new and better disciplinary strategies.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author. https://doi.org/10.1176/appi.books.9780890425596
Coleman, P. (2018). What is the Difference Between Discipline and Abuse? It's all about what transpires at the moment. Retrieved from https://www.fatherly.com/parenting/what-is-the-difference-between-discipline-and-abuse/
Laureate Education (Producer). (2013). Hernandez family> Sessions 1—6 [Video file]. Author: Baltimore, MD.
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. https://doi.org/10.1111/famp.12025
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-toguide for evidence-based practice. New York, NY: Springe. ISBN: 978-0-8261-3625-1
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