Assessment

The second option is to include family members on a limited basis (i.e., one or two sessions) for assessment purposes. We often call this a "family meeting." This meeting may be the extent of the face-to-face contact with family members, or it may lead to more extensive treatment. Talking with a family member can be helpful with a great number of patients seen in individual therapy; therapists cannot always anticipate what they might learn by inviting a family member in for one meeting. An important goal of such a family meeting should be to help therapist, patient, and family to develop and refine an integrative case conceptualization. Family meetings can be especially helpful if aspects of the patient's presentation are inconsistent or confusing to the therapist.

The therapist might assess three areas: problems and strengths of the identified patient, of the family as a whole, and of one or more family members. First, family members can help the therapist to clarify certain aspects of their understanding of the depressed individual. Talking with a family member may help the therapist to understand to what extent the patient's perceptions of family relationships (or other issues) are distorted vs. to what extent they are based in reality. For example, a patient may complain that his spouse is easily overwhelmed when he talks about his depressed feelings. Including the spouse in an interview may allow the therapist to directly assess whether she is truly overwhelmed by the patient's feelings, or whether the patient is interpreting more ambiguous signals as signs that she is overwhelmed. Family members may also mention a problem to the therapist that the patient has not mentioned, perhaps because he/she does not see it as a problem (e.g., excessive drinking).

Second, if the patient has indicated that there may be significant family problems, or if the therapist has reason to suspect problems, then the therapist may want to meet family members to conduct a brief assessment of family functioning. This increases the therapist's understanding of the context in which the depressed individual experiences certain thoughts and feelings, and allows the therapist to develop further an integrative case conceptualization. We use the McMaster model of family functioning (Ryan, Epstein, Keitner, Miller, & Bishop, 2005), described earlier, as a guide to areas of functioning about which the therapist may want to inquire. Responses to this assessment may lead the therapist to recommend a more extensive family intervention.

Finally, if there is reason to believe that a family member is experiencing an untreated psychological problem (e.g., depression or alcohol abuses), the therapist may inquire about the family member's symptoms. The therapist might begin with a statement: "It's been my experience that when one member of a family is depressed, other family members sometimes feel stressed as well. Do you ever feel stressed? How do you cope with it?" This assessment could lead to recommendations for treatment for the family member.

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