Assessments and Screening in Family Therapy

Information-gathering strategies

Information-gathering is as crucial as the actual writing of the report. This is because the final report will only refer to the methods employed in the process of acquiring relevant information (Neukrug & Fawcett 2010). The choice of inappropriate instruments or carrying out a poor interview usually results in a report full of mistakes and bias. The key to ensuring the gathering of high-quality information is to consider the depth and breadth of the assessment procedures.

Breadth is concerned with the content of the issue at hand. It is realized through casting the net wide and should be founded upon the purpose of the assessment. On the other hand, depth is concerned with the intensity of the issue and also depends on the purpose of the assessment. Three methods are used in information gathering from the client. These are; structured interviews, unstructured interviews, and semi-structured interviews.

The semi-structured interview draws from the advantages of both the structured and the unstructured interviews and therefore it is the most comfortable of the three strategies of information gathering. According to Neukrug & Fawcett (2010), this interviewing technique uses prescribed items and therefore shortens the time required by the examiner to get relevant information. The flexibility of this interview style allows the interviewee to go beyond the boundaries of the preset questions during the interview process. This flexibility can have huge benefits to the clinician as it helps the client to open up new significant issues.

Flexibility is crucial as it allows the examiner to build a rapport between himself or herself and the client. When time is not a limiting factor, the semi-structured interview may be used to interview the clients and provide the much-needed breadth and depth. At the same time, it will allow the assessing clinician to attend to the process of relationship building.

Analysis of the case study

The assessment will be administered to Marceline because it seems that the problems in the family revolve around her. Furthermore, by coming to seek professional help from a therapist, she deserves to be helped. Marceline’s file should contain cumulative records from her employer and former high school. Her Autobiography and program are also a good source of client information and should be included in the file if there are available. In case there is a bibliographical inventory, this should also be in the file as it opens a window into the life of the client. Anecdotal information should also be included in the file as these side remarks and observations can offer important information about a client.

Tubbs & Moss (2005, p.226) defines ethics as, “the study of the general nature of morals and the specific moral choices to be made by a person”. The presented problems in the case study offer an avenue for discussing various ethical issues.

For example, Marceline is contemplating giving away her child Michael Jr. because she considers him to be hyperactive and uncontrollable. This situation stirs up ethical issues, compelling us to ask ourselves if it is morally right for Marceline to run away from her parental responsibilities by giving her child to her mother in law. This can be explained well by the consequential theories which assert that the morality of an action is only dependent on its consequences. The case of Marceline and her intention to give away her child brings out the case of ethical egoism which asserts that people act to promote their self-interest.

Marceline wants to promote her self interest (to be free of a child she considers troublesome, frustrating, and hateful). She does not consider that the child needs more parental care and that dumping him away to his grandmother is not a solution, but an escapism strategy. A better option would have been to seek professional help to assess what kind of help can be given to the child whether medical or social. If Marceline acts in the best interest of all, then according to the Act Utilitarianism type of consequential theory, her action will produce the greatest happiness for all.

Marceline is also confused about whether to go back to her husband and quit her current relationship with Leon. She should act in a way that will produce the greatest happiness for all people. She cannot continue lying to herself about her true feelings concerning the two men in her l life; Michael (husband and father to Michael Jr.) and Leon (current lover and roommate). If she continues to see Michael behind Leon’s back, the truth will come out eventually and this is going to explode into a huge confrontation that is going to cause discord and hurt to many people.

Because Leon has been laid off recently and is showing signs of threats and depression, this may aggravate the situation that may result from this kind of betrayal. Because Marceline is still legally married to Michael and has feelings for him, she should seek a way to end her current relationship in an open way that is not going to cause destructive ripple effects. Grace (M’s mother in law) is eager to see her son Michael back into the arms of Marceline. Grace is also a good grandmother to Michael Jr. and is involved in caring for him in her daycare service.

The best course of action for Marceline would be to solve her differences with her husband (Michael) and consider moving back to her matrimonial home. This is going to be very beneficial to all the involved people starting from Marceline to Michael Jr. Getting out of her current relationship that has started to show signs of threat and violence is good to all. Reconciling with Michael is going to be beneficial to the couple as it is obvious they have rediscovered their love for each other. Their child will also benefit from being raised in an atmosphere of love and care. It will be one happy family. Leon will not have to be betrayed behind his back and will not need to risk dealing with a jilted husband.

However, any tests that will be used on Marceline should be valid and reliable. Proper consent as stipulated by APA (2010) should be sought before administering the assessments. According to APA (2010), psychologists need to make use of appropriate assessment methods that are suitable for the person being tested in terms of preference to language and competence. The only exception is when the use of the alternative language has significant effects on the issues under assessment.

Although Marceline’s mother-in-law and her husband Michael are concerned about her welfare and that of her child Michael Jr., they cannot just come in and help. The APA (2010) code of ethics requires that psychologists maintain high confidentiality on the information of the clients they are assessing. Therefore, although Grace and Michael are on the phone during the Meeting between Marceline and her therapist, they cannot be allowed to contribute until approval is sought from the client. Before divulging the contents of the assessment to Michael and Grace, the therapist must seek Marceline’s consent.

The Minnesota Multiphasic Personality Inventory (MMPI) test which measures psychopathology will be used to assess Marceline. The MMPI is an objective personality test that is used to help in the diagnosis of emotional disorders (Neukrug & Fawcett 2010). According to Neukrug & Fawcett (2010), MMPI is the most commonly used tool for the diagnosis of personality disorders. This tool was initially the brainchild of Hathaway and McKinley in 1942. Several versions of this test have been introduced since the first one in 1942.

The MMP II version was introduced in 1989. Other versions include the MMPI-A, an adolescent version introduced in 1992, and a shorter version known as MMPI-2-RF which was unveiled in 2008. Both of these versions can be applicable in individual or group tests and need about 90 minutes to complete the 567 items. However, the MMPI-2-RF has 338 items that take about 45 minutes to be completed by paper-and-pencil and 30 minutes by the use of a computer.

Interpretation of the MMPIs is not as straightforward as its administration. According to Neukrug & Fawcett (2010), the interpretation process requires a person who understands complex psychometric, phonological, clinical well as professional sophistication and strong commitments to the ethics of the test user. There are six validity scales, ten clinical scales, and fifteen content scales in the MMPI-2. However, only three of the validity scales and the ten basic scales are commonly used.

In the interpretation of the MMPI, understanding the meaning of each scale is very crucial. The basic (clinical) scales are useful in the diagnosis and treatment planning. Decisions are based on patterns of responses instead of assessing individual scores on any one scale. Because the ten clinical scales can generate a wide range of patterns, computerized scoring is used to quicken the process and assist in diagnosis, interpretation, and treatment planning.

Apart from the MMPI test, other tests that are will come in handy in the diagnosis of personality or emotional disorders are Millon Clinical Multiaxial Inventory (MCMI). This is the test best known for measuring clinical disorders including personality disorders that fall under Axis II. The Millon test has 175 items that require a person to answer true or false. The items are meant for people who are 18 years and over. However, there is an adolescent version of the test which caters to those in the age bracket of 13 to 19 years. This version is called the Millon Adolescent Clinical Inventory (MACI). The third edition of the MCMI takes a shorter time (25 min) to administer as compared to the MMPI.

The MACI-III can be taken through the pen and paper approach or computer scoring when there is a need to quicken the scoring. The Millon test can also be score by use of optical scan scoring, hand scoring, or a mail-in scoring service. There are six major scales n the Millon test. These include; Clinical Personality Pattern Scales, Clinical Syndrome Scales, Modifying Indices, Validity Index, and Severe Personality Pathology Scales. The Millon is unique in the sense that it uses a method called Base Rate (BR) that can change a raw score to a more meaningful score that is mainly based on the psychiatric population.

During the testing and analysis of the Marceline case, there might be a need to refer her to a psychiatrist for possible medication such use of an antidepressant. The huge pressure she had to endure from all aspects of her life has left her emotionally wounded and in a state of depression. There might also be a need for counseling on the issue that concern marriage and parenthood. This may require the services of a marriage counselor and also a child psychologist. Apart from these specialized medical doctors, Marceline might also be referred to as anti-drug abuse crusaders or rehabilitation centers that can help her deal with her problems with drugs and alcohol. She will need to know and accept that doing drugs and alcohol is not a solution but a potential cause of more problems health-wise and financially.

Role of assessing and screening in the treatment process

The key to quick and effective treatment of any disease lies in the fast diagnosis of the problem at hand. An accurate and timely diagnosis will help reduce the time needed to treat a patient and consequently reduce the treatment cost. Also, accurate diagnosis helps to avoid the risk of treating the wrong disease with the right medicines and thus lowers the cost of treatment. When clients are quickly screened and accurately assessed, then it means that treatment will commence immediately.

This is very beneficial as it helps check the progress of the problem which if unchecked would have become worse and necessitated huge treatment costs. Because assessment is such an important determinant in the final cost of the treatment, a clinician must understand the correct way of administering as well as interpreting the results of various tests. The choice of the test to be used will determine the cost of treatment. Therefore, a test that has a high possibility of producing accurate results (reliable test) will be used to come up with an accurate diagnosis and thus ensure that the right treatment strategy is instituted.

The most fundamental thing that was acquired in doing the project in question number 2 was the skills of writing an assessment report. Apart from getting to know the standard structure that is recommended for the writing of the assessment report, I also learned that the report ought to be objective free of bias. It is good to write the report in a simple language that can be understood by all people including the ones who do not know basic psychology. As a practicing psychologist in the future writing professional assessment reports for my clients will be part of my job description. It will be a great advantage to have grasped the basics the report writing.

Importance of the concepts learned: how they can change life

Life is an interaction of people and their environment with the potential for conflicts, mental and emotional injuries. It is important to know how to assess or even notice the symptoms of common emotional disorders at an early stage. This will assist in instituting timely intervention. Because parenthood with its numerous challenges and responsibilities is beckoning, the analysis of the case study and the reference material used to analyze the case is very important as it helps in preparation against challenges common in that age bracket.

According to APA (2010), psychologists substantiate their findings through opinions contained in their reports, evaluation statements, and diagnostic statements. Therefore it is crucial to know how to write a good assessment report as you one may need to draw upon this information when called upon to substantiate a given opinion.

Another very important concept learned is the issue of confidentiality in dealing with assessment findings or results. According to the APA code of ethics, psychologists should maintain a high level of confidentiality about the results of an assessment. In the case that there is a need to divulge the data, consent should be sought from the client before results are released. Even in this eventuality, the identity of the client should not be exposed.

Knowing this concept will help me to conduct future assessments with the security of client information in mind. In the case of dealing with a person with questionable capacity to give consent, the psychologists must follow the laid down law or government regulations concerning such cases. This means that it is almost impossible to get consent from some clients and therefore it will be crucial to assess these people according to government laws. When there is a need to assess a child, consent should be sought from the parent or guardian.

Assessment Report

Demographic information

• Name: Marceline D.O.B: 10/4/1993.
• Address: 544 freedom corner Age: 19.
• Busy Life, Los Angels.
• Phone: 983-9985-4537 Sex: Female.
• E-mail address: [email protected] Ethnicity: African American.
• Date of Interview: April 1 Name of Interviewer: Fredric Tailor.

Presenting problem or Reason for Referral

This 19-year-old married but the separated female was referred by a neighbor because of high levels of stress. The client reports feeling confused and depressed and has even contemplated suicide in the past. She states that she feels confused about her marriage and is not sure whether she should stay with her current boyfriend Lion or go back to her husband Michael. An assessment was conducted to assist in determining diagnosis and the course of treatment.

Family Background

Marceline was raised in Los Angels. Her father married an African girl from South Africa at the time when he was working there as an expatriate. Marceline notes that her parents fled South Africa at the height of the call for independence in January 1993. Her mother was already pregnant when they come to America. Marceline was raised in an intact family but her parents died five years ago in a fatal car accident.

She states that her parents were “loving but strict” and notes that his father was ” in charge of the family and would often discipline me”. However, she describes both parents as loving and caring and sys that they”provided for all our family needs,” She reports that she currently lives with her boyfriend Leon in a one-room apartment and her child Michael Jr. Marceline notes that when she was 15 years old she met her husband Michael in High school and two years later married him after learning that she was pregnant with his child. She states that although her marriage was good during the first year, her husband Michael left her for another woman.

Marceline later moved in with her current boyfriend Michael and they had been working in the same Grocery but Leon was recently sacked while Marceline’s hours at the grocery were reduced. She notes that she is frustrated with her child Michael Jr. whom she describes as hyperactive.

Significant Medical /Counseling History

Marceline states that approximately one year ago after her husband Michel left her, she was so depressed that she went to a “shrink” to seek assistance. She also notes that the condition of her son has made her so frustrated and often has triggered depression.

Substance use and abuse

Although she considers herself a moderate drinker, Marceline notes that she has been drinking heavily since her working hours were reduced. Initially, she used to drink a little alcohol to calm the nerves but this has increased recently. Marceline also says that she usually uses “some other stuff now and then”.

Education and Vocational History

Marceline studied at Trinity school in Los Angels and because of her pregnancy, she did not proceed to college but rather decided to get married and thus eloped with her boyfriend. Marceline did not pursue college or vocational education and consequently has not been able to get employment in many establishments. However, she has been working in a local grocery shop together with her current boyfriend Leon. In a recent development, her work hours have been cut down and her boyfriend has lost his job completely. Marceline reports that she is not satisfied with her level of education or even her current employment. She does not have much of a life when it comes to leisure activities but only engages in moderate alcohol consumption.

Other Pertinent Information

This category addresses any important information that has not been noted elsewhere. Issues that may be included in this section could include changes in partner preference and even the financial problems the client may be having. For Marceline, we include the following information:

Marceline states that she is not happy with her current relationship with her boyfriend Leon who has become abusive and threatening especially after the recent job loss. She also states that her boyfriend is not receptive to the needs of her child (Michael Jr.) and that he is also drinking heavily. Another crucial issue is that Michael Jr. is hyperactive. Marceline reports that her son throws tantrums and tends to avoid people and he screams all the time.

Marceline reports that she is very frustrated with her son to the point that she is willing to give up her son and let her mother in law Grace who wants him to have her wish. Marceline is still angry that her husband Michael abandoned her after just one year of being married and moved in with another woman. However, she is confused that her husband is back and wants them to move back together. She even admits that she is seeing more of Michael in recent days when she takes her son to the daycare facility owned by her mother in law. The issue of finances is also a big problem in Marceline’s life at present. She states that they have been having problems with their rent and are getting rate in the payments. The recent cutback in her work hours has not helped matters.

The mental status Exam

Marceline is currently very unhappy with the state of affairs in her life. She does not like the fact that her job is threatened and that they reduced her number of hours in the job and consequently eroded her financial strength. Her love life is also in turmoil as her current boyfriend is not caring and has turned into a heavy drinker who goes to the extent of threatening her. During the interview, Marceline appeared anxious, often rubbing her hands together. She describes herself as feeling frustrated and depressed in recent days.

She appeared to be above average intellectually and her memory was intact. She seemed to have good judgment and appeared to welcome treatment. Marceline states that she periodically have suicidal thought but quickly adds that she deals with this problem through alcohol and other stuff.

Assessment results

These are the tests that were used to test Marceline:

• The Beck Depression Inventory
• The Kinetic Family Drawing
• The MMPI-II and
• Strong Interest Inventory

From the BDI-II score of 25, Marceline is clearly in the category of moderate range depression. The results also provided evidence of possible suicide indention. The MMPI Results concurs with these findings as they point toward a person with moderate to severe depression and mild anxiety that is generally confused about her world and feels inadequate about her role as a mother. The results suggest the need to assess possible suicidal indention.

On the KFD, Marceline placed her mother in law very high. Her mother in law continued to support her by accepting to stay with Michael Jr. despite being abandoned by Michael. On the strong, Marceline’s highest score on personality was Conventional. People possessing this trait are stable, conservative, and sociable. These kinds of people are good with persuasive skills and prefer business careers where their strong negotiation skills are put into practice. Marceline is actually in the grocery business and was able to maintain her job even when other people like her boyfriend were facing the sack.

Diagnosis

• DSM-IV-TR diagnosis (include another diagnosis such as medical, rehabilitation when, when important).
• Usually, note all five axes of DSM-IV-TR:

  • Axis I: 296.23 Major Depression, Single Episode, Moderate.
  • Axis II: V71.09 No diagnosis.
  • AXIS III: No medical conditions were diagnosed.
  • Axis IV: Not happy in her job, discontent with love life.
  • Axis V: GSF=52 (over the past year).

The diagnosis of Marceline shows a client who is experiencing a major depression (Axis I); shows no sign of any long-term personality symptom (Axis II); has no known general medical condition (Axis III); is discontent with love life and current job arrangements-psychological stressors (Axis IV), and has several serious symptoms such as occasional thoughts of suicide (Axis V).

Recommendations

1. One hour counseling session per week for depression, possible anxiety, discord in love life, and work-related stress.
2. Possible marital counseling with a particular focus on resolving the differences that led to their initial separation.
3. Referral to a psychiatrist for medication, possibly antidepressants.
4. Possible assessment of her son for ADD to help reduce client anxiety over her son.
5. Possible rehabilitation to stop alcohol and substance abuse.

Reference

APA. (2010). Ethical Principles of Psychologists and Code of Conduct American Psychological Association. Web.

Neukrug, E., & Fawcett, R. (2010). Essentials of Testing and Assessment: A Practical Guide for Counselors, Social Workers, and Psychologists. (2nd ed.). Belmont, CA: Cengage Learning.

Tubbs, S.L. & Moss, S. (2000) Human Communication. 10th Edition. NY, NY: McGraw-Hill Publishing.