Family Analysis and Case Conceptualization
Family Analysis and Case Conceptualization Family Analysis and Case Conceptualization
Background
Kathy, was referred by her primary care provider (PCP) for her depression, anxiety, and
anger which emerged 18 months earlier after her husband’s new job in the agricultural
industry brought the family to middle Tennessee from Jefferson City, Missouri. At the
time of the initial visit, Kathy was age 37, married 15 years to her husband Richard (40),
and the mother of three children—Rachel, age 8; Elizabeth, age 6; and William, age 2.
She acknowledged prior times of anxiety and depression—at age 5 when her parents
divorced, during stressful times at college, and after the birth of her second child—but
“never as bad” as this current episode.
Kathy reports that both her parents are still alive. They are Margaret (62) and John (65).
She expresses she is very close to her mother and calls her quite often. Her father John
and her do not communicate often due to recent family conflict. Her husband’s parents
are both deceased.
Her PCP had initiated antidepressant medication (a selective serotonin reuptake
inhibitor) with only partial symptom response. As part of your initial evaluation, you were
able to rule out bipolar disorder, confirm recurrent major depression, and change
medication to a different antidepressant medication (selective serotonin and
norepinephrine reuptake inhibitor). However, the medication adjustment alone would not
address the underlying issues fueling Kathy’s depression.
Kathy attributed the progressive worsening of her symptoms to her unhappiness since
relocating to middle Tennessee, missing her friends, her church, her life as the wife of a
university professor in agricultural sciences, her part-time work as a research assistant
for another faculty member, and her extensive support system. She bitterly resented her
husband’s new job for tearing her away from a lifestyle and close-knit community in
Missouri that she now idealized. She worried that her depression, anxiety, and anger
were affecting her relationship with her children and that she was a “bad mother.” She
struggled with guilt for being short-tempered with the children, feeling paralyzed by her
depression and unmotivated to unpack boxes and organize their new home, or make
any effort to build new relationships with neighbors or at her daughter’s elementary
school. She was withdrawn and resentful, verbalizing that the family would be “better off
without me.”
Questions:
Instructions: Review the above case. Construct your responses based on the Model you
have selected.
1. Complete a genogram demonstrating the emotional and relational connections of
the family in this case.
2. Describe how you would conduct the first session of therapy based on your
chosen model of therapy(Systemic (Bowen, Narrative, Solution Focused, Contextual)
Structural,Strategic, or Emotionally Focused (Couples therapy-new wave of Experiential Therapy)
. Include at least three questions you would ask, and
how you would establish the initial goals of therapy. Note: A complete response
demonstrates congruence between the clinical model and clinical choices in
questions and goal setting. Be specific in the actual question and proposed
answer.
3. Kathy returns for a follow up session. In this session, she mentions to you that
she sometimes wonders if she can “go on” or if she’s “made a terrible mistake” in
her life. What are your next steps? A complete answer includes specific
questions the therapist would ask the client with specific steps you would take
based on the responses.
4. Develop a Case Conceptualization using the Model you have selected.
5. Construct a session note from one of your therapy appointments with Kathy.Background
Kathy, was referred by her primary care provider (PCP) for her depression, anxiety, and
anger which emerged 18 months earlier after her husband’s new job in the agricultural
industry brought the family to middle Tennessee from Jefferson City, Missouri. At the
time of the initial visit, Kathy was age 37, married 15 years to her husband Richard (40),
and the mother of three children—Rachel, age 8; Elizabeth, age 6; and William, age 2.
She acknowledged prior times of anxiety and depression—at age 5 when her parents
divorced, during stressful times at college, and after the birth of her second child—but
“never as bad” as this current episode.
Kathy reports that both her parents are still alive. They are Margaret (62) and John (65).
She expresses she is very close to her mother and calls her quite often. Her father John
and her do not communicate often due to recent family conflict. Her husband’s parents
are both deceased.
Her PCP had initiated antidepressant medication (a selective serotonin reuptake
inhibitor) with only partial symptom response. As part of your initial evaluation, you were
able to rule out bipolar disorder, confirm recurrent major depression, and change
medication to a different antidepressant medication (selective serotonin and
norepinephrine reuptake inhibitor). However, the medication adjustment alone would not
address the underlying issues fueling Kathy’s depression.
Kathy attributed the progressive worsening of her symptoms to her unhappiness since
relocating to middle Tennessee, missing her friends, her church, her life as the wife of a
university professor in agricultural sciences, her part-time work as a research assistant
for another faculty member, and her extensive support system. She bitterly resented her
husband’s new job for tearing her away from a lifestyle and close-knit community in
Missouri that she now idealized. She worried that her depression, anxiety, and anger
were affecting her relationship with her children and that she was a “bad mother.” She
struggled with guilt for being short-tempered with the children, feeling paralyzed by her
depression and unmotivated to unpack boxes and organize their new home, or make
any effort to build new relationships with neighbors or at her daughter’s elementary
school. She was withdrawn and resentful, verbalizing that the family would be “better off
without me.”
Questions:
Instructions: Review the above case. Construct your responses based on the Model you
have selected.
1. Complete a genogram demonstrating the emotional and relational connections of
the family in this case.
2. Describe how you would conduct the first session of therapy based on your
chosen model of therapy. Include at least three questions you would ask, and
how you would establish the initial goals of therapy. Note: A complete response
demonstrates congruence between the clinical model and clinical choices in
questions and goal setting. Be specific in the actual question and proposed
answer.
3. Kathy returns for a follow up session. In this session, she mentions to you that
she sometimes wonders if she can “go on” or if she’s “made a terrible mistake” in
her life. What are your next steps? A complete answer includes specific
questions the therapist would ask the client with specific steps you would take
based on the responses.
4. Develop a Case Conceptualization using the Model you have selected.
5. Construct a session note from one of your therapy appointments with Kathy.
