How I've Spent My Summer Vacation: Part II

Same idea, different class, less intro... let's get to the point!

Interview & Treatment Plan of Family Y

I. Introduction to Client and Significant Others

AF: 50, lawyer, Caucasian

AM: 52, entrepreneur, Caucasian, alcoholic diagnosis

CM: 16, 11^th grade, athlete/honor student_(Twin A)

CM: 16 (IP), 11^th grade_(Twin B

II. Presenting Concern

AF: Blames husband for financial distress within the family, feels that she has to work extra hours so that her sons can afford the life that she had growing up.

AM: Upset that he made such a poor business decision after so many years of being responsible within his own company. Upset that he cannot support his family they way he’d like to and that wife has taken it upon herself to be the “bread winner.”

CM: (Twin A) Very supportive of mother and the decisions she has made to support family. Blames father for throwing business away and causing mom to have to work so much harder. Feels supported in both athletics and academically by mom, but not as much by dad.

CM: (Twin B) Admires all the hard work that dad put into his own business for so many years and understands that mistakes happen. He feels mom and brother should understand that as well and support dad as he picks up the pieces. Argues with mom over his desire to pursue art and not athletics or academics like his twin.

III. Background Information

About 9 months ago Dad lost his business that he had since graduating college in a bad business deal. Ever since that time, Mom has taken on extra cases at work to compensate for the loss of the dual income within the home. Out of frustration over not being the primary bread winner for the family Dad took up drinking excessively over 6 months ago. The two sons have their own outlets for dealing with the family stress. Twin A works hard at school and is a star athlete at his high school. He admires his mom for going out of her way to provide more income for the family, and feels Dad is lazy. Twin B doesn’t care too much for school and uses art as his outlet. He admires Dad for all the years he worked so hard and for the fact he is trying to start another business from scratch. Upset with Mom for spending so much time fighting with Dad and not being more supportive in his efforts to pick up the pieces.

IV. Systematic Assessment

Client/Relational Strengths

Personal/Individual: All four have a distinct way of viewing life and in how to achieve goals not only for themselves, but for the family as well. Parents are both highly intelligent and educated. Sons are their own individuals and taken from the examples their parents set and made their own path.

Relational/social: Parents both come from strong families of origin, and are encouraging of their boys in the futures they hope to pursue.

Spiritual: AF and AM both share strong desire to be more committed and involved in local church. Boys enjoyed the different activities and outings supported by the youth group.

Family Structure and Interaction Patterns

Couple Subsystem (to be assessed): Parents’

Couple Boundaries: Enmeshed & Other

Rules for closeness/distance: Frequently disagree on the choices the other has made for the family financially and in the area of work ethic. Avoid each other when argument becomes too heated and repeat pattern on daily basis. Wife places pressure on husband to conduct self in the same way as she in accordance to values/wishes.

Couple Problem Interaction Pattern:

Start of tension: AF informs AM that he needs to stop playing around with “making up” another business and find a “real job.”

Conflict/symptom escalation: AM gets upset that AF does not respect his desires/wishes in how he wants to support the family.

Return to “normal”/homeostasis: Ends by AM starting to drink and AF withdrawing from conversation to another room.

Communication Stances:

AF: Placator

AM: Blamer

Describe dynamic: AF focues on the needs of the family and how to maintain that financially. AM is focused on what is the best way to support his family based upon his desires (career-wise). AF picks up extra hours while AM struggles with what to do.

Divorce Indicators:

Criticism: AF/AM, Ex: Both critical in the approach to supporting family financially

Defensiveness: AM, Ex: AM very defensive in that he will approach his job search the way he wants to and feels is best for his family.

Contempt: NA

Stonewalling: AF/AM, Ex: Both tend to stonewall when AM begins drinking.

Failed repair attempts: Ex: Neither frequently extends repair attempt.

Not accept influence: AM, Ex: AM refusing to accept influence of AF at this point in relationship due to his sense of duty to be the primary provider for family doing what he desires professionally.

Harsh startup: AF, Ex: AF increasingly harsh in raising issues.

Hierarchy Between Children/Parents:

AF: Inconsistent

AM: Inconsistent

Ex: Both parents show an inconsistent style in that AF is more authoritative with Twin B and more permissive with Twin A, whereas AM is the opposite (authoritative with Twin A and permissive with Twin B). Both CMs would like to see parents support any decision they make towards their future, but find it hard to work through the disapproval when parents do not seem to understand their differences.

Triangles/Coalitions:

AF and CM (Twin A) against AM: Ex: In last few months, AF has grown closer to CM (twin A) in support of his desire to pursue an athletic scholarship for college over an academic scholarship, would like to pursue a career in professional sports, each angry that AM does not feel this is a productive or worthy career choice.

AM and CM (Twin B) against AF: Ex: In last few months, AM has grown closer to CM (twin B) in support of his desire to pursue art as a career choice and possibly open up an art gallery one day. AM admires CM tenacity and joy for the arts. Each angry that AF does not feel art is a “smart” career and stereotypes that artists are “druggies.”

Communication Stances:

AF: Placator

AM: Blamer

CM (Twin A): Superreasonable

CM (Twin B): Irrelevant

Ex: CM (twin A) follows the belief that as he pursues and does well in each area of his life he can distract from problems at home. CM (twin B) is focused on avoiding any and all tension and enjoys the escape that his artwork brings, has no desire to please anyone and is grateful to not have to try to please his father. AF is more focused on the financial needs of the family over emotional/mental needs. AM is more focused on his needs to provide for the family.

Hypothesis (Describe possible role or function of symptom in maintaining family homeostasis):

Both CM’s emotional and mental needs for the support of both parents during this time in their life has forced the family to address dynamics that were only mildly problematic in the past: AF’s obligation to be primary financial provider, AM’s depression/lack of availability in the evenings for family time, and the couple’s unresolved issues related to AM’s professional dilemma.

Substance/Alcohol abuse: Hx: AM’s paternal grandfather and father were alcoholics during bad business times/abuse associated with negative professional outcomes.

Sexual/physical/emotional abuse: NA

Parent/child relations: Hx: Parents on both sides have close relationships with children in which they share common interests which fulfill unmet needs in marriage.

Physical/mental disorders: NA

Historical incidents of presenting problem: Hx: AM was unable to connect with father growing up due to father’s desire to make it in the business world, often times leaving him unavailable. AM related mostly to mother emotionally and mentally. Sister had close relationship with father and was distant with mother.

Family Strengths: Strong work ethic, desire to make it on their own and not become dependent on society; professionals; highly intellectual.

Previous Solutions and Unique Outcomes

Solutions that DIDN’T work: The couple arguing about AM’s job situation and choice to pursue another business venture has not helped; parents have not provided a united front in supporting (equally) the desires/interests of twin CMs.

Solutions that DID work: AM’s desire to get back in the workforce and be the sole provider for his family. AF willing to step up professionally for a season to bring in more income to support family. AM’s support of CM’s (twin B) desire to pursue art and AF’s support of CM’s (twin A) desire to pursue sports.

How I've Spent My Summer Vacation: Part I

Okay, so as an adult you really don't have a "summer vacation" unless you are a teacher or rich enough to take of 3 months and not work... but alas that is not me and I've decided to share my summer homework with my readers so then they can be the judge of whether or not I'm truly ready to sit on the other side of the clipboard (meaning to be able to assess clients)... however you may feel, please keep your feelings to yourself (that would be greatly appreciated, unless of course you approve of my abilities)...

Mock Mental Health Evaluation

Client: CLIENT A Date of Evaluation: 7/26/09
DOB: 7/05/69 Date of Report: August 3, 2009

Age: 40

PURPOSE FOR EVALUATION: this mental health evaluation was requested by the Texas Department of Family and Protective Services (DFPS) as a part of the requirements for completing an application to adopt.

Client, is a 40-year-old, single, white female who has obtained the degree level of masters in education. She currently is on staff as a professor at Southern Methodist University and lives in the Dallas/Ft. Worth area.

The request for this evaluation was to evaluate the client’s level of emotional/environmental stress, depression, and anxiety as standard procedure in completing an application to adopt a child in the state of Texas.

ASSESSMENT PROCEDURES:

Basic Personality Inventory
Beck Depression Inventory - II

Beck Anxiety Inventory

Clinical Interview

This client participated in 2 hours of testing and a diagnostic interview. Tests were administered and interpreted by Cristyn Rohloff, MA, LPC.

BACKGROUND INFORMATION:

The client, a 40-year-old, single, white female, lives with alone in a home in Dallas, Texas.

Client graduated with her masters in education from Southern Methodist University in May of 1995. She has talked about wanting to adopt a child for about 5 years and 4 years ago begin the research process into what it would entail from her end. Client has never been married and has found the process a bit more difficult than she believes it to be for a married couple. Since graduating with her masters the client has taught at the high school level as an English teacher and nine years ago begin working at the collegiate level as an English professor for first-year students at Southern Methodist University (SMU). The client reports to have many friends and a supportive family circle. She appears to be quite independent and happy with the single life. She reports that she does not feel it necessary to become married in order to raise a child, she feels adequately prepared financially, emotionally, and mentally. Client denies any use of alcohol or drugs (either prescription or street drugs) except for the occasional drink at dinner when out with friends.

Client has a clean background/criminal history along with no reports of any misconduct in her professorship at SMU.

In regards to her emotional/environmental stress factors, it appears to be no more unusual than the standard professional. She appears to handle stress calmly and as reasonably as she knows how. At this stage of life she had hoped to be married so not as to raise a child alone, but her desire to have a child is great and she felt the need to step out and take a chance with the adoption process. Stated minor depressive episodes as a result of all the legalities in trying to adopt as a single parent.

During the testing phase of the session the client appeared somewhat anxious, but overall very cooperative as she understood it to be common procedure for those wanting to adopt within the state.

MENTAL STATUS EXAMINATION:

Results of mental status examination revealed a stable individual with minor depressive disorder working through the process of adoption in addition to other life commitments. She did not appear to have difficulty staying focused during the session. The client was appropriately dressed and groomed. Orientation was intact for person, time and place. Eye contact was appropriate and rapport was easily established. There was no abnormality of gait, posture or deportment. Speech functions were appropriate for rate, volume, and fluency. Vocabulary and grammar skills were suggestive of intellectual functioning within the above average range.

Client reports she has had no disturbance in her normal sleeping pattern. Appetite has remained normalized and reports no other disturbances in day-to-day functioning. She appears to be popular amongst her students at SMU and within her community of friends. She reports to be dependable and reliable for both her circle of friends as well as family. Has a tendency to neglect her own needs out of a desire to put the needs of others before her own.

The patient's attitude was open and cooperative. Her mood and affect were congruent. Memory functions were intact with respect to immediate and remote recall of events and factual information. Her thought process appeared intact, goal oriented, and well organized. Thought content revealed no evidence of delusions or hallucinations. At this time the client denies having homicidal ideations and reports to have a very positive outlook no matter how long the process of adoption takes. There was no evidence of perceptual disorder. Her insight into any stressors or struggles within her current situation appear to be normal.

Client A	40 y.o. white female
Consciousness	Alert
Orientation	x3
Attention/ Concentration	No apparent disturbances
Appearance	Consistent with stated age
Eye Contact	Good
Dress	Appropriate
Grooming	Good
Motor Functioning	No apparent disturbances
Gait	No apparent disturbances
Visual Perception	No Impaired vision
Speech	No apparent disturbances
Prosody*	No apparent disturbances
Auditory Comprehension	No apparent disturbances
Immediate Memory	No apparent disturbances
Recent Memory	No apparent disturbances
Remote Memory	No apparent disturbances
Estimated Intellectual Ability	Above Average
Executive functioning	No apparent disturbances
Affect	Appropriate
Mood	Calm/Happy
Interpersonal Behavior	Cooperative
Suicidal Ideation	Absent
Homicidal Ideation	Absent
Thought Content	Appropriate
Thought Processes	Reality Oriented
Delusions	None
Hallucinations	None
Judgment/ Reasoning	Good
Insight	Good

Note: x3 = oriented to person, place, & time.

*Prosody may reflect the emotional state of a speaker; the rhythm, stress, and intonation of speech

RESULTS OF EVALUATION:

The Beck Depression Inventory was administered to this client. Her score indicated that she would be placed in the minimal category of depression. The BDI-II also indicated that she is currently experiencing some environmental/situational stress that could be causing her minor depressive disorder.

The Beck Anxiety Inventory indicates that this client is also experiencing some mild anxiety. The anxiety appears to be generalized around this particular time of her life and what is going to happen next.

On The Basic Personality Inventory none of the validity indices are out of normal limits, indicating that the BPI was completed purposefully and that the results may be interpreted accordingly. The reliability index is in the normal range and indicates consistent responding throughout the BPI. The perseveration index indicates a normal pattern of responses. There were no omitted or incorrectly marked responses.

The BPI revealed that the client is well within average for her age group and professional group. There did not appear to be any major concerns in the results.

It appears that she sees herself in a positive aspect. She is not easily influenced by the opinions of others, but rather trusts her judgment in the decisions that she makes and feels very confident in her ability to hold a full-time professor role at SMU as well as healthfully raise a child as a single parent. She appears to have a plan and support group in helping to raise the child as she is working full-time. At this time she has no intention of introducing an additional person (i.e. boyfriend or husband) to the child’s life and feels confident that if the situation should arise she would be able to handle it accordingly and in the best interest of the child.

DIAGNOSIS:

AXIS I 311 Depressive Disorder, NOS

AXIS II None

AXIS III None

AXIS IV Stress from adoption process on top of demands from work with students

AXIS V 75 GAF: Current

RECOMMENDATIONS:

It is recommended that the client see a psychiatrist for possible medication for depression. This client would benefit from cognitive behavioral therapy as needed throughout the adoption process. Client should be encouraged as she continues through the application/interview process of adopting. Family therapy for client and adopted child upon completion of process would be encouraged. Parenting classes and/or a a support group for adopted parents is strongly recommended as this is the first child for the client and she has every intention of raising the child alone. This client has the potential to make a productive impact on the life of a child as well as her students at SMU.

Please let me know if any additional information is needed concerning the results of this evaluation.

Living in the Legacy he Left Behind...

For those of you who know me you know how much I admire, love, and cherish my family. I was raised in a wonderful home with awesome parents (who will celebrate 38 years of wedded bliss in September), 3 wonderful older siblings (even when the boys would put me in a headlock and my sister complained that I used her stuff without asking...what can I say, I wanted to be just like her), and a dog. But I don't think I share a lot regarding the history, the legacy that made a home for our family here in Dallas.

My grandfather (my dad's dad) was a remarkable, astonishing, loving, compassionate man. I truly believe that everything my dad exudes as a husband, father, & grandfather comes directly from the father who raised him (and definitely his mother as well). My grandfather moved to Texas to attend school at SMU and to work. He left behind my grandmother in Illinois. They were in love, but the time wasn't right for them to marry and he wanted to make a home for them first... so they dated via snail mail : ) It's a great story, I so can't do it justice, but my grandmother lights up a room when she shares it.

I had a break the other day and I was coming home from seeing a movie with a friend and decided to take a walk on the SMU campus. I know this campus very well as I spent 4 years of my education there. It brought overwhelming joy to imagine what it was like when my grandfather walked that campus as a student. I know for one thing... there was only one building (Dallas Hall), dirt roads, and a handful of trees. It's definitely grown since the late 1930s.

It was amazing the things I started to remember about my grandfather as I walked the campus this past weekend. I remembered his booming voice, his gentle spirit, how he would wrestle with us on the ground (just as my father does now with his grandkids), his passion for the Texas Rangers, his love and adoration for my grandmother... and most of all something I've never shared with anyone else (except for now with you dear readers). My grandfather grew gravely ill in the beginning of November 1997. He lived for 2 weeks longer than they expected in a hospital bed. During those two weeks I spent many evenings with my parents and grandmother in Granddaddy's hospital room. One night we watched "Wheel of Fortune" together, of course he was in a deep sleep, but I still shared that moment with him, I sat with him, I kept him company. I also told him that I would take care of myself, I promised him that I would get better for the rest of the family as I knew he was headed home to be with Jesus. I forgot about that promise until the other day. It's amazing what God reminds us of in times when we least expect it. It brought great joy to know that even though it took me 3 years, I did it... I kept my promise and I didn't do it alone. I've lost a lot of love in my life and I won't deny that I haven't wondered why He didn't take me home over 10 years ago while living a wreckless life of such disobedience, but with a gentle whisper (usually when I need it the most) I'm reminded of why I was given the strength to fight.

I'll see Granddaddy again in Heaven some day, but until then he's busy wrestling with Billy Jr. and that makes me happy. I thank God everyday for the legacy my grandfather built and left behind, I thank him that he set the bar for the man my father would become and my father in turn sets the bar for the man I hope to marry someday. I'm one blessed child of the King and if time and space would allow I would share more... I just hope Granddaddy knows how much I love him, I hope he is proud of the family my father raised, and I hope that I can continue make him proud by living out the legacy he left behind.

Sacrifice

Sacrifice - an act of giving up something valued for the sake of something else regarded as more important or worthy  (Dictionary definition courtesy of Apple MacBook)

Oh how I've been wrestling with the term "sacrifice" for the last several weeks.  I'm in the middle of my graduate studies and it's the summertime so it is an extra struggle these days to wrap my mind around the definition of what it is to "sacrifice."  But then I had a bit of an encounter today and I realized why I struggle so much with the term... it's because so many others don't understand and I can't seem to find the words for it to make sense.  I have a passion burning deep within me, but I keep it very protected because I find that I don't always have the words to explain so that others will understand.  I'm hoping that maybe this blog will be a start in what will eventually be some sort of understanding for others.  I realize that I can be quite the character sometimes, but it's mostly because I've walked so many crazy paths in my life thus far (27 years) that it only makes sense to be as random and joyful as I am.  Here's my point... we are all asked to make sacrifices at one point or another in our lives, right now is a season of many sacrifices for me and I've reached the point where it doesn't matter anymore if others understand or not, at least I'm obediently following the call that has been laid out before me.

We have soldiers who sacrifice their lives everyday so that we can have the choices and luxuries and lifestyle that we so choose in this country.  I can't say I "understand" the life of a soldier, but I do feel as though I'm out on the battle field right now.  The battle often times is within me, occasionally towards others, and more often than not against the enemy.  You see I'm sacrificing my free time, my play time, time with friends and family so I can become trained and prepared to help save the world.  It is a pretty big task laid out before me, but every time I sit down with my textbook and I'd rather be watching a movie or when I attend class and I'd rather be out playing with friends I remember that it took 3 long years for me to get where I am now. Before I was sacrificing God's call on my life for the life I wanted and it's no surprise to me that most of those desires/passions I was chasing at the time came crashing down around me.  Now, well now I'm sacrificing my "wants" to chase God's "wants" for my life and it brings so much peace and joy.  I'm finding that as I finally pursue the passion that God has planted within me, my trust that God will bring the deepest desires of my heart to pass grows stronger.  

Don't get me wrong, I still have my times of selfishness, but I praise God that He has healed me, He has forgiven me and He asks for nothing in return... but I choose to love Him because with Him I can do all things and with Him I can love with the great big love He has planted within me.  Sometimes the decisions I make don't make sense to others, but I've learned to stop caring so much.  I try to think of what I would want someone to do unto me should our roles be reversed.  That means I will continue to forgive by the grace of God no matter how many times someone hurts me or makes a mistake because were I to be in their shoes I would hope they would show me the same compassion.  

All this to say that if I have to sacrifice seeing the most recent movie in the theater, or sacrifice Happy Hour with the girls in order to obey then I will do it over and over again until the task laid out before me is complete.  I wish I could put into words all that I feel, and maybe I will be able to one day... but until then I keep it between me and the Lord until He so desires that I share it with the world.