Nurs 6650 Week 2 Assignment – History of Presenting Case

Nurs 6650 Week 2 Assignment – History of Presenting Case

Nurs 6650 Week 2 Assignment – History of Presenting Case

The family consisted of 40 -year-old John M, and his wife Mary M., who is 32 years old, and they have no children. The clients were seen in a mental crisis center. Initially, Mr. John had been voluntarily admitted to the unit due passive suicidal thoughts, depression, and alcohol dependence. Mr. John had been recently fired from his job due to showing at work drunk. Couple therapy was recommended to speed up his recovery and maintain sobriety.

In the session, Mr. John self-reported mood as depressed, and he acknowledged his drinking problem disrupting his life, and he was prepared to fully participate in the recovery for the sake of his well-being and his marriage. On the hand, his wife Mary, appeared anxious, and frustrated. She blamed the husband for all the misery of the family. She was much worried about their future as the husband had lost his job. However, she was willing to support him in recovery. Nurs 6650 Week 2 Assignment – History of Presenting Case.


6650 Week 2 Assignment – History of Presenting Case

Psychiatric History: Mr. John has battling depression for six years, and his PCP prescribed antidepressant (Zoloft) last year but he abruptly stopped taking them as he felt that the medication was affecting his sexuality. He did not follow up with his PCP. He self-medicates with alcohol. His wife reported history of anxiety and occasional panic attacks, she was taking fluoxetine 40mg daily. The medication was prescribed by PCP.

Psychiatric Hospitalization: It was the first time for Mr. John to hospitalized in mental facility.

His wife reported no history of psychiatric hospitalization.

Medical History: They both denied any medical history

Psychosocial History: They both said they smoked marijuana occasionally. The wife works as cashier in a local gas station. They live in a one- bedroom apartment. Nurs 6650 Week 2 Assignment – History of Presenting Case.

Differential Diagnosis:

Major Depression Disorder F 32

Mr. John presented with depressed mood and reported history of loss of interest in pleasurable activities, sleep disturbance and suicidal thoughts lasting more than 2 weeks. In addition, to meet the diagnostic criteria the symptoms had caused clinically significant distress or impairment in social, occupational, or other important areas of functioning( American Psychiatric Association, 2013)  Nurs 6650 Week 2 Assignment.

Alcohol Use disorder AUD

To be diagnosed with an AUD, individuals must meet certain diagnostic criteria. Some of these criteria include problems controlling intake of alcohol, continued use of alcohol despite problems resulting from drinking, development of a tolerance ( Grant& Saha, 2015).

Generalized Anxiety Disorder: Ms. Mary exhibited some of the signs of generalized anxiety. Diagnostic criteria symptoms include excessive anxiety and worry as well as restlessness, fatigue, irritability, tension, and sleep problems (Watson& Greenberg, 2017)

Ethical and Ethical Implications of Counselling the Couple

  Family members often experience resentment about past substance abuse and fear and distrust about the possible return of substance abuse in the future (O’ Farrell& Fals-Stewart, 2013)In the case of John and Mary, there is a higher probability that there will be uncertainty and distrust during the recovery. It may be unethical to tell directly his wife that her anxiety and blame towards her husband may demoralize him and impede the recovery. However, it may be beneficial as feelings experienced by the substance abuser and the family often lead to an atmosphere of tension and unhappiness in couple and family relationships( O’Farrell & Fals-Stewart, 2013).  Nurs 6650 Week 2 Assignment – History of Presenting Case

Nurs 6650 Week 2 Assignment – History of Presenting Case


American Psychiatric Association. (2013). Major Depressive Disorder. Retrieved from

Frisch, N. C., & Frisch, L. E. (2011). Psychiatric mental health nursing (4th ed.). Clifton Park, NY: Delmar Pub.

Grant, B., & Saha, T. (2015). Epidemiology of DSM-5 Alcohol Use Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. Jama Psychiatry72(8). Retrieved from

Nichols, M. (2013). The Essentials of Family Therapy (6th ed.). United States: Pearson Education.

O’Farrell, T. J., & Fals-Stewart, W. (2013). Behavioral Couples Therapy for Alcoholism and Other Drug Abuse. Alcoholism Treatment Quarterly26(1-2), 195-219. Retrieved from

Watson, J. C., & Greenberg, L. S. (2017). Emotion-focused therapy formulation of generalized anxiety disorder. American Psychology Association54(4), 17-40. Retrieved from Nurs 6650 Week 2 Assignment.

In this regard, therapists from all the three family therapy models agree that involving families in solutions finding often benefits clients; regardless of the problem origin, and whether the clients consider it a personal or family concern, family involvement is essential. However, all the three models have distinct views of systems that separate them from one another; for instance, the Structural Family Therapy, traditionally attributed to Salvador Minuchin, strives to address the challenges in functioning of the family unit (Colapinto, n.d). Structural Family therapy model is based on the Systems theory and it is characterized by certain salient features such as emphasis on structural change as the central focus of therapy; details of individual change and the concentration paid to the therapist as an dynamic representative in the procedure of reforming the family are secondary to structural change.

The family coupled with present conditions within the family is regarded as the fundamental contexts within which behaviour is first manifested, maintained and eventually transformed (Dorfman, 1998). During therapy, the structural therapist often aims at joining the family system in order to gain insight into the subtle rules that govern the functioning of family units, and to map the relationships between family members (Colapinto, n.d). In the end, the structural therapist aims to disrupt the dysfunctional relationships inherent within the family unit to invoke change and development of healthier patterns (Asen, 2002); according to Munich, Pathology rests in the family rather than in the individual member of the family unit. The Structural family therapy model is based on the primary assumption that the family structure is the framework for transactions that…

This essay stresses that narrative family therapists hold that individual identities are shaped by the accounts of personal lives as depicted in individual narratives, and as such, narrative therapists aim to help individuals to describe fully their rich stories. Nurs 6650 Week 2 Assignment – History of Presenting Case

This paper makes a conclusion that there are different views of systems in Structural, Milan Systemic and Narrative family therapy models; this is because the three family therapy models emanate from different schools of family therapy and they are based on different fundamental assumptions. For instance, whereas the structural therapist aims to disrupt the dysfunctional relationships inherent within the family unit to invoke change and development of healthier patterns, the Milan Systemic therapist aims to provide new information rather than attempting to set specific goals for change within the family unit.

Finally, Narrative therapists seek to separate individuals from their problems to allow for the formation and performance of their preferred identities. However, besides the differences in the systems of the three family therapy models, a common feature that is characteristic of all the three is also inherent; all the three models of family therapy agree on the fundamental role of the family in the process of seeking solutions to problems within the family system. Recognition of the importance of family involvement in the solution seeking process attests to the fact that healthy family interrelationships are essential for the ultimate reconstruction of the family system and sustenance of a healthier family.