Assignment: Family Assessment – Week 2

See complete instructions and review attachments. Use template to complete the assignment.
Assignment: Family Assessment
Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.
To prepare:
· Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.( See attachment)
· Be sure to review the resource on psychotherapy genograms. – See attachment
· View theMother and Daughter: A Cultural Talevideo in the Learning Resources and consider how you might assess the family in the case study. – See transcript – Attachment
The Assignment – Instructions
Document the following for the family in the video, using the Comprehensive Evaluation Note Template (attachment):
· Chief complaint
· History of present illness
· Past psychiatric history
· Substance use history
· Family psychiatric/substance use history
· Psychosocial history/Developmental history
· Medical history
· Review of systems (ROS)
· Physical assessment (if applicable)
· Mental status exam
· Differential diagnosis—Include a
minimum of three differential diagnoses
and include how you derived each diagnosis in accordance withDSM-5-TRdiagnostic criteria
· Case formulation and treatment plan
· Include a psychotherapy genogram for the family – See attachment for guidence
Note:For any item, you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.
** Minimum 3 references**
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template
the Rubric as your guide.It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· Read rating descriptions to see the grading standards!
In the Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
· Read rating descriptions to see the grading standards!
In the Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.
Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case
· Read rating descriptions to see the grading standards!
Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
demonstrate critical thinking beyond confidentiality and consent for treatment
!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why they are presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication, and referral reason. For example:
N.M. is a 34-year-old Asian male who presents for psychotherapeutic evaluation for anxiety. He is currently prescribed sertraline by (?) which he finds ineffective. His PCP referred him for evaluation and treatment.
P.H. is a 16-year-old Hispanic female who presents for psychotherapeutic evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her mental health provider for evaluation and treatment.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, the duration, the frequency, the severity, and the impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. You will complete a psychiatric ROS to rule out other psychiatric illnesses.
Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.
General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)
Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. (Or, you could document both.)
Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information (be sure to include a reader’s key to your genogram) or write up in narrative form.
Psychosocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.However, at a minimum, please include:
· Where patient was born, who raised the patient
· Number of brothers/sisters (what order is the patient within siblings)
· Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?
· Educational Level
· Hobbies
· Work History: currently working/profession, disabled, unemployed, retired?
· Legal history: past hx, any current issues?
· Trauma history: Any childhood or adult history of trauma?
· Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)
Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.
Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.
Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.
Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:oral, anal, vaginal, other, any sexual concerns
Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.
He is an 8yo African Americanmale who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation.Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Case Formulation and Treatment Plan.
Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions with psychotherapy, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.*see an example below—you will modify to your practice so there may be information excluded/included—what does your preceptor document?
Initiation of (what form/type) of individual, group, or family psychotherapy and frequency.
Documentation of any resources you provide for patient education or coping/relaxation skills, homework for next appointment.
Client has emergency numbers:Emergency Services 911, theClient’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)
Reviewed hospital records/therapist records for collaborative information; Reviewed PCP report (only if actually available)
Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (This relates to informed consent; you will need to assess their understanding and agreement.)
Follow up with PCP as needed and/or for:
Write out what psychotherapy testing or screening ordered/conducted, rationale for ordering
Any other community or provider referrals
Return to clinic:
Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care OR if one-time evaluation, say so and any other follow up plans.
References (move to begin on next page)
You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.
© 2021 Walden University
Page 1 of 3
Produced by
Andrews & Clark
Explorations, Inc.
copyright 2003
GONZALO BACIGALUPEWhen I’m asked to do a consultation, oneof the first things I ask is, what will be the most benefit for theclient and the therapist and in the case that you’re going to seeI’m basically asked to have a reflectingteam and what we did was first have an interview with thetherapist and the family and ask them what they will finduseful for the interview and basically to ask them about thehistory of the therapy and the history of what are the kinds of things thatthey have been working on. I ask the reflecting teamto come in and I instructed them to think of themselves as so let thegod mothers of the therapist, who in a way, put them, himself, or in this caseherself at risk in front of her peers andanother people. So, I wanted them, the reflecting team to address thetherapeutic system as a whole not just to address the family, Iwanted them to talk also about the therapist and to be protectiveof them. I also ask the reflecting team not tobe too much of clinician, but to really react on a morepersonal level around the family. I sometimes reflected on what they were sayingto clarify or to expand the idea or how I understood itto give voice to other possibilities, but respecting the personalpeace, and then, I ask I ask the family to come back to, in aclassical way, to respond to those comments what strike them.In the case that we watch, it seems that the familywas dealing with sort of like two forms of trauma and/orthree forms of trauma; one is, history of battering thedomestic violence, child sexual abuse, a history ofimmigration that in some ways we lay it to that traumagetting away from it and basically the mother of five childrendeciding that they need to move out of the home,but in the process leaving one behind who is later onsexually, I mean, raped by the father. And thenat the present moment mother dealing with afairly traumatic illness that have her, very disable, unableto walk and to work. So, it’s sort of like theinterview trying to address this different forms of traumaand the way in whichthe young adults are trying to make senseof their bicultural life andhow the whole family is trying to make sense of being biculturaland being immigrants. The sessiondoesn’t end with a need or incredible intervention ofmy part because I feel that this is the part of the therapistto try to decide, this is the family that’s been working this therapist for year and half. Therefore, theyhave a relationship I feel that I need to respect and sothose are the basicintercomments. So tell me how is it that you came out with theidea of having this interview withme?
SANDIOkay. I’m going to go backwhen Patti came in for the first time. She came in becausethey were chaos at herhousehold.
04:45Sandi – their therapist
SANDIShe came to this country twelve years agowith her four children and one was left behind, herdaughter who was 10 years old at that time, eight years old at that time, wasleft behind. Just two years back,finally they were able to get her visa and shebrought her to United States. So ever since she came herechaos was created inside thehousehold.
05:20GONZALO BACIGALUPESo I’m clear, Sharleen youare?
05:25SHARLEENHer daughter.
GONZALO BACIGALUPEHer daughter. And how old are you?
GONZALO BACIGALUPE23, andhow old are your siblings?
GONZALO BACIGALUPEAnd that’ssister or brother?
SHARLEENAnd then 21-year oldsister and 18-year old brotherand a 15-year oldbrother.
05:50GONZALO BACIGALUPEOkay, and which one is the one that stayed there.
GONZALO BACIGALUPE21.Okay. All right. Okay. Go ahead, sorry.
05:55SANDIAndI met with the entire family for twocouple of sessions and she really interested and wanted to be in therapy21, so.
06:10GONZALO BACIGALUPEWhat’s her name?
06:15Shireen – the 21 year old sister
emigrated from Iran 2 years ago
SANDIShejust felt that she needed the money more than coming to therapy andshe refused the entire time and mom tried toshe ask her, if she doesn’t feel comfortable with me.She said she has had all appointments with othertherapists at this clinic, still she refused to come in, but they kepton seeing Patti and the oldest daughterSheela for about a year and a half now.Ever since then, we started workingon the chaos in the household, what is it that creatingchaos and I found out that Pattilives with traditional ways of living,their daughters are trying to detachherself from Patti and grow on their own and find their own individuality.So would ask where they have been working onand every since then she had two surgeries.
07:30Patti had surgery on both feet.
SANDIEvery thing isstarted.
07:35GONZALO BACIGALUPEWho had two surgeries?
SANDIPatti had two surgerieson her feet.
07:40Surgery failed – she is disabled.
SANDIAnd that created more tension,anxiety in thefamily.
07:50She is in constant pain.
SANDISo — and I have been seeing herafter her surgery and she has been referred to a psychiatristfor medication because a lot of time she feelshopeless, helpless, she feels her children are out of control,she can’t be in charge, they no need her anymore.So those are themajor.
08:20GONZALO BACIGALUPEIf you were to describean accomplishment and you have accomplishment with the therapists during this time.Is there something that you will say, it’s an importantaccomplishment?
08:35SANDIAwareness of the difference betweenindividualist ways of living and collectivistic ways of livingand awareness that how theyto respect and understand the children are growingin this country and they are going to try to detach themselvesfrom Patti to be able to grow on their own.
09:00GONZALO BACIGALUPEWhat has been foryou this work with Sandi?
09:05PATTIShe helpedme to understand the kids grow up and left the house and they have beennot to depend on them so many times and try to live my lifealone and then to take care of my things, my problem in the lifeand respect them and give them theirfreedom.
09:30GONZALO BACIGALUPEDo you have a sense that that is sort word that has been accomplished that is more to bedone.
09:35PATTII think I need more to be done,I’m not done. No.
09:40GONZALO BACIGALUPEDo you have ofsense of what is that you would like to do?
09:45PATTIYeah, I’d like to learnto lead my life alone and depend on the kidsa lot because in our custom when the parents get old and especiallywhen they are in my situation they can’t walk or take care of theirself, the kids are alwaysthere for parents, but over here no, they have their own life. AndI expect them to be there all of the time for me and they can’t, matter of fact, Ihad a big argument with her last night about that, I had a very bad backfor few days I was done and last night, I called her and I said come and spend a night with me and she said no, Ican’t. I said, you should and you have to and we got into a bigargument.
10:30GONZALO BACIGALUPESo, you are on your own right now, you’re living in your own and each of the kidshave their own place or?
10:35PATTIThree of them, two of the boys lived with me 18 and15 years old, but the 15 years old was with her for three four days andI was with 18 years old a lot.I feel like they doesn’t do enough for me.
10:50SHARLEENShe makes her own plans for me, she expects me tolike to go with her and spend time with her because she is bored. I have too much to do, I can’tunwind your boredness, find something else to do, but I have plans, I’m 24and my world around me is happening and I need to be there, I accomplish things.I can’t sit down and like chitchat for a wholeday.
11:15PATTIAnd I feel I’m depressed I cannot move, I need them to comeand visit me, spend a night with me.
11:20SHARLEENI spend, I — out of the seven days, I sawher for six days, I make sure, I saw her for six days out of that week.I spent a day with a friend and I got some stuff done and she felt like I owe her something because Ididn’t spend that time with her. And she did a nice job raising us, she was a wonderfulmother, we all suffered through the good and the bad in the family like every family does,but we have all grown up, we can’t stay in the nestforever. I’m trying to experience life and my own good or bad, whether youapprove it or not, it’s my life.
11:55GONZALO BACIGALUPESharleen, is this something that you have had a discussion,the three of you, I mean this particular or this is not like?
12:00SHARLEENI think, I have mentioned to her, but she takes it personal, shedoesn’t hear me out.
12:05GONZALO BACIGALUPEIs this something that you have had conversationswith the family?
12:10SANDIOver and over, yes. Especially with theoldest daughter Sheela, she also, being the oldest,she feels that she has been the parentified child allher life, she has played a role of a man for — inher mother’s life and then the entire, I’ve seenher for about four times right, four, five times andshe used to cry the entire time in the session.
12:40GONZALO BACIGALUPEAnd I realize that you’re being verytouched by this, I mean this is not something that.
12:45SHARLEENYeah, it’s something that Istrive so hard to accomplish and as soon as I feel like I got her on the rightstep, there she goes falling depart again asking for like, I give herwhat I can and she keeps on asking for more and more and that’s not how my lifeworks.
13:05GONZALO BACIGALUPEWhat do you right now? Are you working, studying?
SHARLEENYeah, Iwork and I’m trying to get my license. I’m trying to get accomplish thingsfrom now.
13:15GONZALO BACIGALUPEWhat kind of work are you are doing right now?
SHARLEENI just — I find promotional jobsand then, I’m trying to get my real estatelicense.
13:25GONZALO BACIGALUPEAnd yoursister?
GONZALO BACIGALUPESheela, is she also on her own?
GONZALO BACIGALUPEShe is also working,studying? And the 18-year old, what is he doing?
13:35PATTIHe is astudent.
13:40GONZALO BACIGALUPEIn high school?
GONZALO BACIGALUPESo, he is finishing high school right now?
PATTIYes, thisyear.
13:45GONZALO BACIGALUPEAnd is he talking also about leaving home after finishing the high school orwhat are his plans?
13:50SHARLEENHe is not sure yet, depends on how the family situation isgoing, you know, everybody looks for happiness and peace of mind, depends likehow he feels around the home.
14:00GONZALO BACIGALUPEHow about the 15-year old?
PATTIIhave lots of problems with him, I don’t get long with him at all.
14:05SHARLEENShe has no patience.And she takes it out on other people.
14:10PATTIBecause Ican’t do anything, I walk fewer step and that’s it, I have a horrible painafter fewer step. And I have to sit and wait for them to come and give me a glassof water.
14:25SHARLEENWell, the thing is I want her not to wait for us, I want her to be on her own, I wanther to learn how to like, you know there is a — you know superman lost his both feetand he sits on a wheel chair, but he is still going on withlife.
14:40PATTIBut Superman has money, somebody take care of him all of the time.
SHARLEENYou have to learn how to ease your ownmind and not depend on other people. She is forty years old, ifshe was 60, poor dying lady, I would be more sympathetic, just 40 yearsold, there is much more for her to experience. It’s not time for her to start depending onher children yet. We’re only in our 20s, let me live life, let me experienceand do what you can, while you can. Give it yourbest.
15:10GONZALO BACIGALUPESharleen, how is that you decided to come today, I mean what’s it?
SHARLEENBecauseI was with her last week and they asked me to, they invited me to, so I thought maybeyou would like help as much as this is helping you.
15:20GONZALO BACIGALUPEDo you have a sense that you are sort of beingrepresentative of the other of your siblings that you are coming as a representative for all of themin some way?
15:30SHARLEENWe are all trying to get her to be more positive and feel likedo a little step at a day, but try your best to be better,to do a better in life. Every time I try to push her to be moreindependent and not as much like do that all stuff with her that she could do on herown, she keeps like she has a broken wing that she wants to buoy on us, after a while, it gets heavy.You just want it off because I want to breathe and I want to experience my life. I cannotlive like a 20-year old from Iran. I have different things to experience than to sitat home. And the thing is like I don’t feel like I canaccomplish with her when I’m at home because she is either watching TV or on the phone, whichis just like sad people around and I can’t hang out likethat.
16:20GONZALO BACIGALUPEBesides the — your five kids and yourself, is thereanybody else in the family here who immigrated with you guys or –?
16:25PATTII have acousin, but they live LA and I don’t even talk tothem.
16:35GONZALO BACIGALUPEAnd so, in a way, when youneed something, basically the only thing that you feel like you can go for yourkids? When you — we’re talking about chaos,there have been — there were some chaos about a year and half ago when we start through the work andcan you tell me little bit about what the chaos was about or what — how you definethat?
17:00SANDIOkay. I just want to mention something aboutbefore her surgery Patti has been a very independent womenas far as working hard, single mother, raising all herchildren and they are all proud of her in many ways.When they came she did not have the health problem as far as thepain in her feet, constant pain and feeling hopelessand helpless. They came for a different reason was for Shireen,because Shireen came form Iran and two weeks everything waswonderful, they all re-united, they enjoyed, celebratedfor two weeks, and then, she started telling him aboutthe stories that her father abused her sexually, physically andshe was abandoned in their house.So, that’s where the explosion, the chaos started.Before that —
18:05GONZALO BACIGALUPEWhen you say that the chaos started, what started to happen?
SANDIThey werefighting, constant fighting, screaming, yelling and cursingeach other. Before that, my understanding was thatkind of was a very peaceful way of living, am I correct inthis?
18:25GONZALO BACIGALUPEOkay. All right, so the tension has really sky rocketedafter Sheela came back, I mean, two weeks after one, and then, he came out of that — there’s beenthis –?
18:35PATTIAs she came back, she was blaming me, why did you left me back home with my dadthere, he did all of those things to me. And my husband usedto tell her, you was a rotten fruit and she didn’t take you, you are a rotten one.She took the good ones and left you behind for me.And she was blaming me for everything.
18:55GONZALO BACIGALUPEWhen you left, you had separated from yourhusband?
19:00PATTINo, we were living together my daughter had a medical problem, Sheelaand matter of fact, her, and they give me a medical visa to come here andSheela and Sharleen born here many years ago.And when I went to get a Visa, they told me two of them are Americancitizen, you have to take them, we cannot say no. And my boys werefour years old then 18 months old and Shireen was eight and they said, they decideShireen should be stayed home and make it sure I’ll will be go back. Butafter I came here, my daughter didn’t have any problem any more and they were find andI used to stay here and I decided to live here. And my husband waskeep telling me don’t come, don’t come, stay there, I will come some day and he never sent me anymoney, he never did anything for us at all except sending the letter 10 pagesevery single day, what to do, how to leave and how to raise the kidsand I throw them all in the trash because I didn’t had a time to read them and I didn’t hadtime to practice anything he said and I ignored everything until likesix, seven years later, he just wrote a letter, I want you to be back home, youare my wife, I order you to back home and I said, forget about you, I have my life here.And who wants to go back to that life. And I was thrown all of thetime to bring Shireen and I couldn’t until three years ago.Finally, she came and for couple of days, weeks everything was fine until shestarted talking about every problem she had back home andfor any little mistakes she made, my husband used to beat her up and keep her outsidethe house for all night and many, many things, the things he used to do to me.And I know what she talking about and what she had to gothrough, but I couldn’t do anything about it. I didn’t have the choice. When I camehere few week after, few months after I was here I called my dad and I said,I’m worried about Shireen, I afraid to beat her andI’m not there to protect them because I was all this over to protect the kids.Each time he wants to beat them, I was right ahead of them and say, beat me, don’t touchmy kids, do whatever you want with me. And my dad said youshould imagine your house was in the fire, you took four of them off the fire, you left onebehind, leave her behind and take care of those four you have and I thought about it, Ithought, he is very right, absolutely right, I should take care of the four I have over here.Why should I go back there. He would be — makeeverybody miserable. I didn’t have a very good life but like shesaid, we all worked together and take care of each other and like I was outall of the time and like Sheela said, she was father of the kid, take care of the kids,take care of the bank account, his groceries, everything. And I used to bea care giver and save it all this and Sheela and Sharleen would stay home and takecare of the kids, two younger brother and each other. And everything was okay untilShireen came. And then, after few months,for a couple of years, we had a problem until, thanks god, last May she got married with somebodybehind our back.
22:25GONZALO BACIGALUPEWho got married?
PATTIShireen,we were on the camping three when she ran away with one of my friend’s son and got married andshe moved out the house and my house is so quiet and I enjoythe life so much except I get so depressed because I feel hopeless and I have somuch pain and they can’t do anything about my pain, I’m always inpain.
22:50GONZALO BACIGALUPEAs you must have seen, when — do you work on how they make senseof what happen to Shireen, I mean, in Iran during the timethat she was alone, was that workout with the whole family, they were some sort ofa conversation in therapy?
23:05SANDIYes, I met, as Iremember, I met with all of them and they expressed their feelings andshouting, yelling, everything was going on in our session. And they wereexpressing, Shireen was constantly blaming the mother for allher pain and what happened to her to lead on and a mother tried toexplain her situation, the sisters also, brothers also.So, we had few sessions like that.
23:35GONZALO BACIGALUPEWhat wasyour sense of how it can — that there were some sort a resolution around that thatpeople were able to make sense that Patti and the kids were able to make senseof this or?
23:50SANDII was hoping for that, that was my really aim todiscover, explore their meanings of the situationand.
24:00PATTIThey got in fight, we couldn’t keep comingback, I couldn’t make them to go back as a family.
24:05GONZALO BACIGALUPEIs it still something that is very hard totalk about or not?
24:10PATTIAbout the rape you mean?
PATTIWhatdo you think?
24:15SHARLEENWell, I’m not very worried about, I mean, it’s affectingher life and I feel sorry for her, but I try not to think aboutit.
24:25GONZALO BACIGALUPEAnd do you have the sense that that’s what anybody else in thefamily tries to do that tries hard so they doesn’t affect?
24:30SHARLEENBecause we already didour crying over it and I’m over it, I’m ready to move onabout it.
24:40PATTIIt’s like when somebody die, you grieve for it.When I heard about it, I was crying and crying and crying for months and months, and then lateron, it’s something you can’t do any thing about this, something happened, what am I going to do about it.I tried to take her to counseling, I take her to Iranian psychologist, 200 dollars an hour.And she would then go back, then what can Ido. And I think I’mover with it, I feel sorry for her, but what can I do. My older sondoesn’t want to talk to this, his dad, nobody wants to contact him or have anyrelationship or any thing to —
25:20GONZALO BACIGALUPEHas he acknowledged that hedid rape her?
25:25PATTII told him once, and he will start cursing at me and I hang up. I said, Ipay a dollar fifty a minute, I don’t want to hear your cursing. I want to see what’s going on, whathappened and you tell me if it happened or not and will start cursing andI hang up. And after that, I never called back, and he is remarried, he marriedto Iris after Shireen came, during the three years, he got married twiceand he has moved on with hislife.
25:55GONZALO BACIGALUPEIs there any, I mean, is therea way in which you think, I mean you, Sharleenand maybe some of your siblings, but just from your perspective, isthere where you think about how the relationship with your mom should be, is it — doyou have a dream for how?
26:15SHARLEENYeah, I just wanted her to be more peaceful. I want her tolower her expectations and to accept a lot of things aboutlife.
26:25GONZALO BACIGALUPEWhat do you mean lower expectations, what?
SHARLEENNot to expect so much frompeople, not to — I think what she does is, she thinks of an idea and she reacts on it soso quick without she calming herself down before she like takes thereaction.
26:40GONZALO BACIGALUPEDo you have a sense that your mom thinks that you can do more thanwhat you can actually do?
26:45SHARLEENI have a sense that she is holding me back from doing all that I could be doingand as soon as I could get excited about her, every time I give her little bit of hope,there she goes back expecting more, and then, getting angry at. She has some thoughtsthen she is so hang up that these thoughts are like so true and she getsangry about them and she hold on to them, then she accuses people and all they areher thoughts in her mind. And I just ask her to leave them alone, let people be andeverything is going to — just then it’s going to take its course.
27:15GONZALO BACIGALUPEAm I trying to tell you, ifyou were to think about how your ambition, how you see it in the future, the relationhow do you see it? I mean, if you were to movein a way the direction that you want it to move, how many times do you see yourselfbeside in her or interacting with her?
27:35SHARLEENI speak to her everyday, I mean almost everyday.
27:40GONZALO BACIGALUPEBut again, I’m asking you more about —
SHARLEENLike in thefuture, yeah, I just want her to like be more calm aboutlike life so that I could like through her better. So that when I do spend time withher that I could enjoy it better instead of her frightening my other siblings or telling me about howso and so, this and that and this and that. I just want her to be more calmso we could just enjoy the moment when we hang out, rather than like.
28:05GONZALO BACIGALUPEWhat kinds of things do you enjoywith her in the moment?
28:10SHARLEENI try to tell her about my ideas, how she islike be more relaxed and not — you know same things.
28:15GONZALO BACIGALUPEPatti, how doyou ambition the relationship with your daughter?
28:20PATTII saw her on Sunday, Sunday nightand Sunday night, I went to visit my older daughter and she was aware that I tookthe dinner for them. And after I laid down fully at my daughter,older daughter house, I couldn’t get up, they pulled me and took me to the car and I came home.I didn’t see her until yesterday afternoon and I said, I have been done with my bag.I just want them to spend time with me. I’m lonely, I get depressed when I’m lonely.If she had a job, if she was working like the other people, I would understandshe is working everyday like my older daughter, she go to her school, she work, I understand she doesn’thave a time, but I know she has time and I expect her to come and spend the time. And Isaid, I gave you whatever you want, whatever I have in the house like furniture, thisand that, anything she said, mom can I have this? Sure, honey, doesn’t matter youor me, you can have it. And when I’m like that with you, I expect you to dosomething for me too.
29:20GONZALO BACIGALUPEPatti, I understand howalso you are feeling upset about this, aboutand I know that the question I’m asking is hard, I mean, how doambition the relationship with Sharleen? What will you like to happenin the future?
29:40PATTIBetween me and her? I want her tojust spend time with me whenever she can.
29:45GONZALO BACIGALUPEWhat kind of time for instance would you like to –?
PATTIShecome and stay at my house because she knows I cannot live with two boys and go to her house.She most of the time ask me to come and stay at my house, but when I go to her houseand I spend over there, I’m worried about 18 years old I have athome.
30:05GONZALO BACIGALUPEAnd do you have a sense of how many times,how many nights that you would like her to spend with you in your home?
30:10PATTIOnce a week is goodif she come and stay the day or night, once a week with me is fine, butwhen she come like one hour, half hour, she is for example, going to go see so and soto keep a board work, she will stop at my house to have a drink the water or say, hi mother, howare you?
30:30SHARLEENTwo, three hours?
PATTIThat’s not a visit for me, I wanted to come with me andspend the time with me and stay with me that day.
30:35SHARLEENWhen I go over there, she is either on the phone or she iswatching TV, I’m very, very uncomfortable in her house liketo where I cannot stand sitting down because she has two dogs around and I don’t like thosethings. I don’t like the hair on my body. When I touch an animal, I wash my hands before I eat.She has two dogs, there is dog here on the couch, dog here on the floor, dog here onthe chairs, there is dogs all around. I don’t want to eat anything because the dishes smell like dogs,I’m not comfortable. I don’t enjoy that, it’s not pleasant to me. Icould only do it so much at a time. I express that to her, you have dogs, I can’teat either your dishes. That’s my culture, that’s how I was brought up and I thoughtthat’s how she was brought up. So, she surprises me when she does these things, she makes the familyunhappy because nobody wants to see dogs, it smells like dogs in her house.
31:25PATTIHow come you don’tdo the other things, you grow up and have a cold chill like, that’s just the onlything you know.
31:35SHARLEENI don’t — I cannot stand it, I cannot stand it.
PATTIAnd they give me so much happiness, they make me so happy,I love them so much.
31:40SHARLEENI don’t like it.
PATTIAnd I never ever going to get rid ofthem.
31:45SHARLEENI don’t like it, don’t ask me to sleep in the pillow, it’s that the dogs stinks.
PATTIActually, you knowwe have a guest room, the dogs doesn’t in that room.
31:50SHARLEENI cannot sleep in motels, I cannot useother people’s bed, I cannot sleep with dogs, I cannot do these things.
31:55PATTIYou know that bedbrand new and you know the sheets and everything brand new in the guest room and you know that that door isclosed.
32:05SHARLEENI’m not enjoying it, I cannot eat breakfast, when I’m thirsty I can’t drink water there.
GONZALO BACIGALUPELet me ask you, is this the kind ofsometimes the — where the discussions go?
GONZALO BACIGAAnd if I wereto let you go over the discussion where will it end, one of you will leave the roomor –?
32:20SHARLEENI will start screaming.
PATTIScreaming, yeah.
SHARLEENAnd disrespecting and callingnames.
32:25PATTII do.
SHARLEENAt this stage, I don’t —
GONZALO BACIGALUPEAnd you would be like, I don’t want to see you, I don’t want to talk to youanymore.
32:30SHARLEENI’m trying to become a woman, I’m trying to became a lady.And when I go to her house, she treats me disrespectfully like that about her dogs, she would curseme out and I just feel, oh, what a mother.
32:40GONZALO BACIGALUPEWould you say both ofyou that you would like that not to happen that you will not get into this.
32:45PATTIOf courseI love them.
32:50GONZALO BACIGALUPEDo you sometimes dream with, been able to relateto each other without having to get into this.
32:55SHARLEENOf course, Ido.
33:00PATTII feel even we argue, we still love each other and I feellike, they are my kids, they will be still here for me if I needthem really. And they have been until sometimes lately.
33:10SHARLEENIjust want her to appreciate and not to expect and expect just like take whatpeople give you and just be happy.
33:20GONZALO BACIGALUPEWe’re going to stop a little bitnow.
33:25Reflecting Team Enters
ISAACI’m Isaac andI really resonated with Sharleen.I come from, well my parents emigratedhere.
33:40GONZALO BACIGALUPEWhere your parents came from?
ISAACKorea, and I wasborn in the States, but there are still this cultural tensionthat we experienced within our family. And so when she was talkingabout the difference of cultures and who she isand there was a little bit of disparity betweenher Iranian culture and the American cultures in her life and Iexperienced that in my life too. So, I really understood that and I thought, you knowwhat? I’m not the only one that went through that. And if I’m not the only one then she is not the onlyone either, so something that I guess happens in aculture of people when they immigrate intoanother country.
34:30GONZALO BACIGALUPEHow old were you when you immigrated?
ISAACI was born here.
GONZALO BACIGALUPEYou were bornhere, but still —
34:35ISAACMy parents, my parents moved here. When they werein their mid-20s, they moved here. And then I was born andshortly after they moved here. And so there was a been influencethere.
34:50GONZALO BACIGALUPEAll right, cool.
ROBERTAMy name is Roberta and these thingsreally struck out with me because I have seen Patti before. I have been onthe reflecting team. And I’m amazed at the difference in her, how much younger she looksand more vibrant than the last month I had seen her. So, I was very impressedby her change. Another thing that just really struck out from me waswhen Sharleen was talking about what she didn’t want to do, and then, Pattitalked about when her husband had sent her the letters and said, come homeand Patti didn’t want to go home and it was almost like it was the same conversation, only held with differentpeople. And I thought that was rather interesting that they are both having the samethings happen in their life at different times, but they both wanted their independence.And I saw that realistic out from me, so that was veryinteresting.
35:45GONZALO BACIGALUPEYeah, it’s interesting, I was — I don’t know if it’s the same you are saying, buthow can you have your independence, but at the same time, stillstay connected? It’s a hard one.
35:55ROBERTAAnd they are fighting tostay connected.
DOROTHYFirst of all, I’m really impressedwith Sandi, the therapist and working with this family and having the care and thelove that it concerns between all of them, including Sandias a therapist. And I reallyrelate it to Patti because I have six children and I watched them one leave one at a time and so I knowwhat that feels like.
36:25GONZALO BACIGALUPEWhat it feels like?
DOROTHYWell, it is — it feelslike a tragedy really each time. Thereis always, there’s something to deal with because it’s a grieving, you are letting go.You are letting go and I really relate it to her on that level,completely, but I didn’t have the kind of realtragedies to deal with that Patti has had to deal with, in addition tothis letting go, okay. She has had the, well, the disabilityto deal with in the pain, the constant pain that she deals withand also then the tragedy in her daughter’s life and what must come up fora mother in dealing with that. I mean, unavoidable in the situation, of course, but stillshe was dealing with that. At the same time, with all of this otheremotional stuff that I know about. So, I just have a lot of respectfor her and I noticed that she has done a goodjob with her children. How wise Sharleen isfor a age, very wise, so.
37:35GONZALO BACIGALUPEIn a way,Roberta?
GONZALO BACIGALUPEDorothy, in a way it is if it’sSharleen’s need for independence is in a way due toher mom’s wanting her to be independent toand sort of like I mean she has to get it from somewhere right?
AMBERYeahthat was a kind of a question I had. Well, what were Patti’s dreams for her children inmaking this enormous transition from Iran, right.
AMBERTothe States, this huge transition, I mean, there must have been a dream, some purpose that was bringingher over here, and I was really curious what her thoughts back, I guess, 20 yearsago or something like that. And I loved Sharleen’s metaphorof the birds, the wings feeling, really weighing her down rightnow.
38:30GONZALO BACIGALUPEAnd at the same the time, the wings are supposed to be as somewhatyou fly on. Yeah.
38:35AMBERYeah. And so at that kind tied into my thoughts about what were Patti’sdreams for her — duckling in a way. Ido not just kind of rambling thoughts about duckling is calling around and the infanttheir mom and their mind they follow her around forever even when they grow up, but they doeventually gained some distance more than theyhad.
39:00GONZALO BACIGALUPEMaybe one comment, so maybe you want to say something else, I mean, maybe there is a couple ofburning comments that people want to —
39:05ISAACI know thefamily really loves each other.Even if they argue, you see that there is a sense of careand compassion there for each other and I don’t think that.
39:20GONZALO BACIGALUPEAnd in that sense, it must be veryfrustrating to get into this stuff, it’s like.
39:25ISAACOh yeah, absolutely.
AMBERYeahPatti made that comment. Even when we are fighting, I know we love each other.
39:30ISAACI said they’regoing, you know, that’s exactly right, when she said that andeven though, Sharleen is — it seems like it’s littlebit tough love going on, on behalf — from Sharleen’s part of she representingall the kids, from kids towards their mom, and saying, mom, they love you, butwe want you to be able to function on your ownand I don’t know how that kind of fits in with everybody.
40:00GONZALO BACIGALUPEYeah.I was wondering what it is for a kid even if it’s an adult, Imean and clearly these are — kids were becoming adultsI mean, Sharleen put it very well. But it must be really hardto see your mom becoming a little bit, you know sometimes likea kid to, I mean, that they need to take care of so soon.
ROBERTAAndshe made that comment if she was older it would be different, but she is younger.And I don’t think they expected, I imagine she is tornwith wanting to live her own life and wanting to take care of her mom, I’m sure she is strugglingdeeply.
40:45GONZALO BACIGALUPEAny of you thinking as a therapist, putting yourself inSandi’s shoes and anything thatyou may think that Sandi is having to deal with or some dilemma that she may bestruggling with?
41:00ROBERTAWhat I felt for Sandi, because I think this must bevery difficult for her also to, because the families seemseven though they have said they have grown and they have made changes that they are almost stuck on thatand I imagine Sandi is probably having a hard time getting over thatstuckness, and so that’s what I see Sandi probably struggling with.It’s just being stuck and where do I go from here, where do I take the family fromhere?
41:30GONZALO BACIGALUPEI was wondering, I mean, and the reason I guess I had a self-interest in asking because I waswondering and wanted to check with you guys, I mean, since she’s also from IranI mean, people might think that she is more of an expert on this family. Andof course, there are things that have to do with being from Iran. Also, the things that probably have to dowith being an immigrant, but also there is some tragic things that have happened in this family andthat you know, so I wonder how she atsometimes might feel like not necessary knowing what to do andwhile at the same time, feeling very well connected with this family.
42:05AMBEROh I think sheis.
42:10ROBERTAShe shows she’s well connected with that.
DOROTHYOh yeah. And it must be very frustratingbecause how do you improve the quality of lifefor Patti, especially for the family in general, I mean, it must be very frustrating.I mean, what concrete steps do totake.
42:30GONZALO BACIGALUPEOkay. Alright. Thankyou.
42:35Family & Sandi Return
GONZALO BACIGALUPEI generally ask after this, we call thisis a reflecting team, if you had any reactions, any thoughtsor — and you don’t need to address everything that was — I mean,anything that strike you?
42:50SANDIFor me, I reallyfelt thatthey hit — they touched the right sensitive part asfar as being stuck, I’m always thinking okay, what else, whatcan I do to really — what can I, Icome with ideas of goal setting, achieving goals, andtrying to figure out what else can I do, so the familycan —
43:25GONZALO BACIGALUPEMove forward.
SANDIMove forward.
GONZALO BACIGALUPEPatti, did you, ofwhat, all what you heard, there was something that struck you something newor interesting or –?
43:35PATTINothing,they just talk about discipline on this — think you were asking me about Shireen, howdo I feel and I told you I have been grieved and it’s over, but I wasthinking about, it’s always in my head.I don’t think I never going to forget it. It’s alwaysin my head and sometimes I feel like, maybeif I was there, it wouldn’t happen and then I think aboutrest of them, what could have happened to the rest of them, maybe if I’d take them all, what would be happenedto all of them.So, I don’t know.
44:20GONZALO BACIGALUPEDo you move back and forth between that. Sharleenhow about you, anything that strike you as?
44:25SHARLEENOh pretty much everythingeverybody said was really interesting to hear about.
44:30GONZALO BACIGALUPEAnything in particularthat?
44:35SHARLEENI don’t think so.
GONZALO BACIGALUPEYou don’t think so.Is there amovement and this is something that it’s like youhave been working for a year and a half, you have been going throughsome very difficult stuff.Do you see yourselves andmaybe you can imagine your siblings thinking about this.Having other, so like very difficult conversationstherapy, I mean do you see yourselves having todeal with tough issues? Or will you say that this is the worstso to speak?
45:25PATTIThis is the worst. Just arguewith them because I love them and I don’t want to argue with them. I want them to havea good life and get married and move on with their life and I see them happy in theirlife.
45:40SHARLEENAnd sometimes she wants to choose our happinessfor us, and that’s not going to work out here.
45:45GONZALO BACIGALUPETell me how that works, I mean, you guys are —
SHARLEENShe wantsto like choose our friends or choose where I hang out or boyfriendsor husbands.
45:55GONZALO BACIGALUPEAnd she probably gave up already.
SHARLEENNo, no.That’s the thing.
46:00GONZALO BACIGALUPEYou really think that’s not the —
SHARLEENNo, that’s the thing, she hasn’t given up.
PATTII wassupposed to.
46:05GONZALO BACIGALUPEShe hasn’t given up?
PATTII was 14 when my parents chose my husband for me andI got married. And he was a nightmare, he was a man from hell, I think, sometimes.But I hate to say that especially in front of the boys, buthe was. But the thing is sometimes I think is not fair what happenedto me, I do it to them, but sometimes, I feel like if I don’t get involved they don’tknow what to do.
46:30SHARLEENShe doesn’t leave things alone like if the water is all calm, shehas to drop a rock. She doesn’t let things be.
46:35PATTII seethere are good looking guys, I keep telling them, look at him, he is cute, look at him, getclose to him or something like that, I want them to getmarried.
46:50GONZALO BACIGALUPEBut in a way you gave up the notion that you’re going to have to choose.
PATTINot theychoose, yes.
46:55GONZALO BACIGALUPEA boy I mean, for them?
PATTIChoose, yes, I don’t want to choose her husband.
SHARLEENSometimesI feel like she suffocates us with her opinionsand her thoughts and her beliefs.
47:05GONZALO BACIGALUPETell me about an opinion lately.
SHARLEENI mean, theyare nice, but.
47:10GONZALO BACIGALUPESome of the opinion that really —
SHARLEENThey make sense, but they make sense to you, not everybody has to go alongwith what you thing is the best way to do things. And she feels like, ifyou want to be a winner, you have to do it her way.
47:20GONZALO BACIGALUPEWho is the more opinionatedat home? I mean, she has a strong opinion, but whoelse?
47:30SHARLEENI think we all are that’s why we don’t get along. Everybody has an input.
GONZALO BACIGALUPEAnddo you have a strong opinion of how your mom should behave, do yousee –?
47:40SHARLEENYeah, I just wish she should be more calm, and what just she acts, so.
GONZALO BACIGALUPEIsthere any space in this, which I mean, you did say that before that you have the dream thatthings were, that you were more calm, so that you could relate with her in a different level.Is there some space for her not be so calm?
47:55SHARLEENImean, her house is what she creates for herself, to be calm or not be calm right.
48:00PATTISharleen, and mostof the time you guys come over there even with my bad fit dinner is ready, lunch isis ready.
PATTIWe sit, talk and have fun, but sometimes likewell, yesterday when I asked you to spend time with me you said, not it was an argument.
48:15SHARLEENI can’t, I hadplans.
48:20PATTIAnd most of the time they come over there and they have fun.
PATTIIt’snot always fun.
48:25SHARLEENOf course.
GONZALO BACIGALUPEAre you willing toallow for your kids to sometimes not to respond to your demandof what you want, I mean, is there sometimes some voice in you says,you know, maybe I know I will like that, but it doesn’t make sense again.
48:40PATTII do.You should have seen me before.
48:45GONZALO BACIGALUPETell me about that.
PATTINo, honest, I used to want them to be there allof the time, but not now.
48:50GONZALO BACIGALUPEI like your sense of humor actually.
PATTIThank you.No, honest I used to be to be want them to be there all of the time.
48:55GONZALO BACIGALUPEAh, ha. So, now you want themsometimes, not all the time.
49:00PATTILike when they moved out, the first one moved out, I want herto call every.
49:05GONZALO BACIGALUPEYou were crazy.
PATTIEvery hour, every hour, tell me what is going on, where is she going, what’sshe doing and everything. Now, I changed a lot. Thanksto Sandi, I give them lots of freedom and space and I let them to choose what theyshould do and give them lots of freedom, don’t I?
49:20GONZALO BACIGALUPEHave you been looking for boys forher.
49:25SHARLEENNobody remind hertoo.
49:30GONZALO BACIGALUPEWon’t you remind her to look for boys for you.
SHARLEENYeah, too much.
GONZALO BACIGALUPESosometimes, I mean, in a way you’re seeing the changes, but sometimes you get as obnoxiousabout it.
49:40SHARLEENNo, sometimes I just give up on her because I feel like, I don’t know how to get throughher.
49:45GONZALO BACIGALUPEPatti, let me switch a little a bit, because she said something that you probably guys cansort of like talk and addressing therapy. If you were nothaving this pain and you were not having this serious difficulty to walk,which is in a way sort of like a new member in the family, I mean, is a newsituation I guess for you, it was not there. How — whatwould you be doing?
50:10PATTII was working first of all.
GONZALO BACIGALUPEWhat were you doing?
PATTII wascaregiver and I have told you. And —
PATTII was a caregiver andI would be working 8, 12 hours a day and sometimes when I wasoff during the weekend I was shopping at the mall. When I go to a store I see, for example, meat are on saleI buy them all meats whatever it’s out there like, call her, I boughtyou meat, it’s awesome, it was all sometime I get it. Do things for them all.
50:35SHARLEENAnd that’s notright, because she is not letting us grow up and have responsibility, she wants to do things, these things for us andshe —
50:45PATTIWho said it is not right?
SHARLEENShe doesn’t understand.
PATTIEven if I don’t call and still you come and take it from the freezer.
SHARLEENMom, the thingI’m trying to — she cooks everyday as she delivers it to my sister’s food — house everyday.I tell her let her learn on her own, you do things for yourself, go for — don’tmeat stuff, go for a massage, go for this and that, clean your room if you are bored.Learn how to read and write if you are bored, do something else, stop involvingyour plans so much around your children, find other hobbies, find other things to entertain yourlife with.
51:15GONZALO BACIGALUPEWhat other things that she does for you or your siblingsyou will like her to continuedoing?
51:25SHARLEENBe the same mother that she has always been, but just not expect so much because she gives, andthen, she expects so much back in return, her expectations aretoo high.
51:35GONZALO BACIGALUPESo you will like her to continue cooking and doing the things?
SHARLEENOnce in a while.Once in — don’t make it like, it’s a family ritual every week. Letit — let us — treat us like we have grown up and are out and doingour own life because that’s how it actually is. It’s just too much sometimes.I feel like, if it wasn’t because of my involvement with — somuch of my energy involved with her, I would have probably take off to Europefor six months, work out there, do something, I would have a free mind to decide for myself, whatto do for like a summer time.
52:10GONZALO BACIGALUPEDo you have a sense that your mommay think that if she doesn’t do those things, that she would be thinking that she is sort of likeneglecting with you guys?
52:20SHARLEENYeah, she would feel like she has left us alone, that’s just her habit or howshe grew up, her mom probably that these things.
52:25GONZALO BACIGALUPEThe time I will report her tochild protector servants and doing the stuff.
52:30SHARLEENI don’t know about it, but she feels likeshe’s being the best mom.
52:35GONZALO BACIGALUPEAre you ever thought about reporting her for, I mean for —
SANDIForgreat mom.
52:40GONZALO BACIGALUPEFor actually, no, for letting them be their — do theirthings.
52:45SANDIOn their own.
GONZALO BACIGALUPEYeah. And have you thought about you could be reported, if you let them to be more independentor–?
52:50PATTINo, not.
GONZALO BACIGALUPEI mean I never thought that ina way, I mean, negligence can be different.
52:55PATTII’d tell they love that.
GONZALO BACIGALUPEI was wondering if whatit seems to bother you is not so much what she may do or what she mayexpect after she does it?
53:05SHARLEENI feel like I give her an inch and then she expects a mile.I give her like, I try to please her and please her let’s say, three days in a row, and she gets overexcited, thenshe thinks like it’s a shopping for everyday.
53:15GONZALO BACIGALUPEWhat are you thinking Patti when you hear that?I mean, you are not getting angry at this point, you were so like maybe she has apoint.
53:25PATTINo, I will call her and I leave her home, but no.
SHARLEENIt’s really that’s how she things then, then I try to —
PATTII swear to god, I will not call her.
SHARLEENSee,that’s —
53:30PATTII will not contact her and just leave her alone from now.
SHARLEENShe’s. I try to explain a point toher.
53:35PATTINo that’s not the point.,
SHARLEENThen she feels this way, I’m here to like, you know I feel.
PATTII will give you the space as muchas you want.
53:40SHARLEENThat’s how she feels and I feel like sometimes she’s like so in her zoombox that she’s not willing to like let them down.
53:45PATTIAs a mother, how old your kids getthen you see them like they are catching the fire, you want to grab them and not let themburn theirself.
53:55GONZALO BACIGALUPEYour kids are going to be your kids.
SHARLEENYeah, but you can’t interfere.
PATTIIt doesn’t matter how old they get, I wantto go take them, especially because I had that abuser husband, I don’t want shemarry somebody abuser.
54:05GONZALO BACIGALUPELet me — we are going to have to stop very soon and I was wonderingSandi, do you sometimes, in the sessions struggle with helping themto feed out how to negotiate these things.
54:15SANDII doconstantly.
54:20GONZALO BACIGALUPEAnd do you have a sense that thatis sort of like that the struggle is that you know the man for momto be more balanced, less the man they know orwhatever, or controlling or intuitive or whatever the waythe kids may see it, or the way Patti see it as, you know, this is the wayI understand being a mother and this is the way I do things and this is when I want to take care of them.How each put the other one in sort oflike a paradox, it’s like, love me, don’tlove me kind of thing, you know.
55:00SANDIRight, exactly.
GONZALO BACIGALUPEIt’s care for me, but don’t care for me.It’s how to find that.
GONZALO BACIGALUPEThat balance I guess.
SANDIExactly.I have been focusing on morenegotiation between them, and how they cancompromise as far as what makesPatti happy and what makes the children happy. As for one big issuewith Patti is the way they cloth also, the way theychoose their clothing, that is another big issue. She is nothappy with some of this stuff that you be talkedabout this before. So constantly I’m trying to balancebetween our way of living back home and our wayof living over here, and by negotiation andcompromise.
56:00PATTIIt’s mostly Shireen, the way she cloth, I don’t like it at all, I cannot evenstand to look at her. I will have to steal it and throw itinto trash can.
56:10GONZALO BACIGALUPEAlthough, you know here you — it’s interesting because in away here, you know in the stage you might seem like very conservative around it, but if you were to be Iranwith all of the kids, you’ll be considered sort of like the revolutionary and almost hang you for allowingyour kids to wear the clothing they are wearing right?
GONZALO BACIGALUPEAnd that’sthat although, I don’t know how — although you are here,you saw you feel like you are there in some way, I mean, you carry your culture aroundis about you.
56:40PATTIWhat do you suggest forme?
56:45GONZALO BACIGALUPEWhat do I suggest for you? I don’t know.
PATTILeave themalone.
56:50GONZALO BACIGALUPEYou cannot leave them alone. Right.But let me — I don’t think that you can leave them alone.
56:55PATTII’ll try it.
GONZALO BACIGALUPEBut at the same time, Ithink that you need to add another something that you need to do,I mean, I don’t think that you can leave them.
57:05SHARLEENYeah, find something to do.
SHARLEENFor real, find something todo.
57:10GONZALO BACIGALUPEI don’t think that you can leave them alone. I think that you’re still going to be concerned about them.I mean it’s impossible for you, what impress me and this is something that coming to termswith what is happening to you and your body, it’s not an easy task, Imean, definitely it’s — it must be really, really, really hard, and how to haveother people who can be a resource. I mean, you were having that conversation right now, howyou can have other people who can be resourcedto help you with that, I mean, that’s something that I think that should really be having conversation, the two ofyou.
GONZALO BACIGALUPEAbout what kinds of resources you can use besidesyou know, getting some help from your kids. I mean, because there are some things that your kids not able to doto help you with dealing with this pain and you know you were talking about yourweight and how to heal this and on and on.I mean, this is sort of like a new adjustment. And before you were dealing something to happenin the past that came to visit during the present, you were happy a year and a half, you have alwaysthat sort of suddenly you were faced with this very traumaticevent, series of events I, mean, what happened to you before you came here from what I understandwas very traumatic. And sort of like now you areface something that is very traumatic. I mean, how do you deal with thisexcruciating pain, difficulty, I mean, how can you be able to walk in your ownand having to — I mean, that’s — I find it very dramatic.It’s sort of like given up something, and you cannot just run away to another cultureto run away from this pain. I mean, and clearly, you’re going to have to join something tobe able to be aware, I mean, join, I don’t know exactly what, becausethat’s something that you probably know more about.
59:00SANDIWe’ve been exploring different optionsas far as resources. Patti came up and you came up with weight watchersidea. And she said, that’s some place I can joinand it makes me feel good and I said, okay, then you are benefitingso many ways, your health, your weight and also thepsychologically you are benefiting from that.
59:25GONZALO BACIGALUPEHope this was somehow helpful.And we don’t have more time. I’m reallyprivileged for having you coming to the interview with someone you do not knowanything about. I’m going to still thinking about this as I watch the video tape and I watchwhere we and I also would feel that there are things that maybe I didn’t ask, butthat you would have asked and I would just share them with you. Alright, because I think that you guyssaid so much and shared so much with us. Alright. So, thank you.
59:55SANDIThank you.
01:00:00SANDIThank you.
Family & Sandi Return
01:00:00GONZALO BACIGALUPEI’m goingto comment on some themes that hadto with the interview per se with the family, the reflectingteam for some conceptual ideas that I think that maybe important for people toknow, and also to reflect on my own thinkingas I was doing the interview and also about some of the things that I may have missedafter having done the interview and having seen watch the video tape a couple oftimes. One of the things that I did not is in the case,in the Sandi’s case ishow difficult it is for the reflecting teamto react personally sometimes, but unknowingly to a familybut to react to the overall therapeutic system although I may have emphasized thatI find that sometimes it’s hard for therapists to think about the therapysystem and not just the family. We are trying to observethe family and not to observe as interacting with the familyand because it’s so compelling sometimes the story of the client, butI find that it is helpful to think about the relationship between thetherapist and the family and some of the isomorphisms that happened there to understand what is happeningin the family. In this case, one of the things that wefind is that trauma occurs, I mean, at various levels. On theone side, you have the survival story, which is also at the same time a traumatic story.That is the husband, the father andthe husband in this family will seem to have been very abusivetowards his wife and the mother and towards the children.And that isn’t itself fairly traumatic. Andthen the survival story is leaving him and coming to the United States.And then, the second peace of this traumatic story isfor the children to come to terms and for the mother to come to terms with having leftone of the children in the home country.The other peace of the trauma is in itself the story of survivalbecomes — could become story of trauma as this family comeand immigrate the United States. In the interview, we didn’t explorein detail the immigration story, we have enough time, because in some way, theconflict between thechildren and the mother, particularly one child and the mother, adult childtakes over in terms of the interview, in terms of what becomes figure.And so, and then, as we — as that conversation moves alongwe’re moving to knowing little bit about acknowledging the traumaof coming to terms with the illness for mother.One of the things I did, I do in first interview of course, isto know who is in the family and try to build a basic genogram andthat’s what I find myself doing in the first part of the interview. And alsotalking about how is it that they decide to come for a consultation.Conceptually a theme that I saw was interesting in this interview is the idea of leaving home,how is that this girl is struggling withindependence, how mother is struggling with this independence. And howthey are both in some ways struggling with the idea of dependenceand independence and basically struggling with different notions of what itmeans to be independent or be dependent. And I would addthat a lot of this course that is struggling with is that this course ofhow our society tends to see the kidsleaving home, and tends to in some way, see independenceas more important than dependence and work a lot around those polaritiesbetween dependents and independence rather think in terms of interdependence.And particularly now that they have to negotiate howmother is going to taking care by the children since she is getting ill.One of the things that I didn’t address in the interview is how the therapist definethis process as detachment and I never addressedthis idea of detachment, which is in itself, part of the processthinking about independence as separation rather than as joining.And it could have been, I think, I saw there was a last opportunity to talk aboutthe therapist understanding of this process, since she understood it asdetachment. One of the things that Ialso found myself doing a lot of was listening to the mother’s situation to the factsand the daughter, while they were showing some of the tension that existedbetween the two of them. And at the sametime, as the competition evolve, I do acknowledge the emotional climateand how is it that in particular, the daughter is feelingin the session and at certain moment, she is very upset and sad and angry.And I knowledge that and maybe I too have acknowledged a little bit moremother’s emotional stands.One of the things that I didn’t alsoaddress that that doesn’t seem that the therapists could address later onis, how is that the daughter seems to know more about what’s going on with the siblings andto really validate her concern for the family in that waythat in someway, she is being very protective of her mother as she takescare of the siblings. Another concern of mine andI think that I might have done that during the interview, was toalways bring forth the voices of those who are present andthose who are being represented in this case how, she, thedaughter will represent the voices of the siblings.And another aspect of the interview includes how is it that I ask aboutsocial support and where is the family, what are the connectionsthey have, and at the beginning, I ask about, is there is anybody elsewho immigrated with them and — or who is his close by as arelative. And at the end of the interview, I again suggest the possibilityof thinking about social support, thinking of friends or other professionalsor paraprofessionals who might provide support in particular around the new needsthat mother, that the adult have right nowin terms of the illness. The peace that was present in the sessionis this notion of agency. Although someone might havegone through a very traumatic period, Itry to highlight the process of survival of overcomingthat particular period and to think in terms of the future.And then think in terms of ambition and different kind of relationshipand a couple of times in the interview I askthe mother and daughter to ambition how do they ambition in differentkind of relationship. In the interviews, you can observe, and this isI think, basic in the collaborative approach, I oftenask how — I mean, I check with the therapistand the clients around issues of how is this conversationmoving, if this conversation were to continuethis way, where will they go, and I ask the therapistto hypothesize what would happen if they were to continue talkingin a particular way. During the reflecting theme, thebasic conversation was around the dependence,independence and interdependence. And what I found veryinteresting is, how is it that the differentplace in the reflecting theme we’re able to understand the immigrant experience and the big culturalaspects of this family. Andanother piece that I saw that was important is to sort of like understandwhat it is tobecome more independent of your own parent while at the same time, coming to term with the notionthat they would have — you would have to take care of your own parent, although this is in a very — at aearly time, earlier than the usual. During the reflectingtime, I thought to myself, I was remindedof how being closeto the family coming from the same background,in this case, the therapist being also of some of from Iran may not necessarilyensure your success from a multi-cultural perspective.Although the relationship with the client maybe a very positive one and may not necessarilyensure the success andin that sense, the value of bringing the reflecting with very differentvoices. The peace that viewersmay find interesting is, how I use words, in this case, thetherapists, some are from Iran, I am also a non-EnglishIrish speaker and how I use this an opportunity to play with wordsand to use humor with the family and the therapist,which I do often during the session. Oneof the questions I ask them and it will havedifferent configuration with different families, I ask them who is more opinionated, whohas a strong opinion, which in some way, is basicallybringing — reflecting on something that could — we getthem into trouble, something that will be seen as problematic, but at the same time, it maybeseen as validating. Andwhen I ask who is more opinionated, a typical kind of secret questionsI guess is, I’m basically, assuming that they are bothopinionated that in a way they cheer some similarities, in fact, that with people are in conflict, oftenthere’s, because they are seeing themselves as two different. Andtowards the end of the interview, I term onthat I like her sense of humor and her daughter smileand I see how important it is to always validateboth, any member, all the members of the family attending thesession, so that the other one — so that the other onecan feel okay about criticizing the other members of the family, butnot having the therapist sort of like completely in coalitionwith that same statement. That is, if I can seeand I can validate each members of the family, the other ones may also seethat particular validation. Oftenin a consultation, I will mention that there’s themesthat can be talked in therapy later and I may saymaybe we can, I could have same, maybe, we can think about this idea betweennow and then if I were to be alone as a therapist.Often in a consolidation, I may say, this is something that maybehelpful to talk about in the future in a therapy session. I may say something of that sort in a reflectiveway. Another aspect that I noticed in this session like in many other sessions is, howexpectations about the others, are theyones that may — high expectations about another member of the family mightbring a lot of conflict. In terms of assimilation and I — towardsthe end I term on that she’d always be concernedabout the children. And that there might beother ways, in which you can get resources.I also try to reframesome of the difficulties using multi-cultural framework,for instance, by saying that there is some things that you might be thinking here, that hereit could be conservative, but in home country couldn’t because couldn’t be consideredvery radical and very different.And I also try to help themto think about this different transitions they are going through, including — andthis different traumas they are dealing with in the past, in the present and in the future.
01:15:45Visit our website
for monthly specials:
for info or catalogue, call:
800-476-1619 USA
NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Template
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
CC (chief complaint):
(include psychiatric ROS rule out)
Past Psychiatric History:
· General Statement:
· Caregivers (if applicable):
· Hospitalizations:
· Medication trials:
· Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
· Current Medications:
· Allergies:
· Reproductive Hx:
Diagnostic results:
Mental Status Examination:
Differential Diagnoses:
Case Formulation and Treatment Plan:
© 2021 Walden University
Page 1 of 3
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 1/10
Genograms for Psychotherapy
I. What is a Genogram?
II. How to Create a Genogram
a. Gender
b. Family Relationships
c. Emotional Relationships
d. Children
e. Lifespan
f. Additional Information
g. Putting it All Together
III. Using Genograms in Psychotherapy
a. Assessment
b. Individual Therapy
c. Family Therapy
d. Don’t Forget Strengths
IV. References
Every generation, families pass a piece of themselves to their kin. The things that are passed
down can be beautiful or valuable, like stories, culture, knowledge, and belongings. Or, they
can be mostly insigni�cant, like a cowlick and green eyes from one’s grandfather.
Other times, more insidious traits can be passed through generations. Sometimes there’s a
genetic predisposition to addiction or depression. Other times, unhealthy ways of thinking
and behaving are passed down socially, through example.
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 2/10
Genograms provide a way for us to examine these patterns. They bring a family’s strengths
and weaknesses out into the open. Genograms set the foundation for nurturing generational
strengths and overcoming weaknesses.
What is a Genogram?
A genogram is structurally similar to a family tree, but serves a very different purpose. A
genogram includes information about relationships and interactions between family
members, while a family tree only depicts lineage.
Imagine a genogram as a family tree with much more detail about how the family members
interact with one another. For example, a family tree might show us that “Emily and Kevin are
married”, while a genogram could tell us that “Emily and Ken are married, but they are
emotionally distant from one another”.
A genogram becomes most valuable when it includes information about several generations.
Patterns that are usually hard to decipher seem to jump out once they’ve been mapped on
paper. Maybe you’ve already noticed a trend of marital trouble in a family’s history, but a
genogram can highlight the pattern of aloofness and anger that’s at the root of those marital
Tip: It’s worth noting that genograms are written through the lens of their creator.
Everyone will interpret their family’s relationships at least a little bit differently, and
that’s OK. As a clinician, this bias must be taken into account when using genograms
during therapy.
How to Create a Genogram
Genograms use a combination of special rules and symbols to depict a lot of information
about families as succinctly as possible. Some of these rules and practices have been
standardized, and should be followed so future readers can understand your documentation.
Other rules and symbols used in genograms differ depending on who you ask, or what
reference you use. It isn’t a big deal what symbols you use, as long as you are consistent. This
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 3/10
will allow you to look at a genogram from any client—even those you don’t know as well—and
still glean useful information about their family.
We’ve also created a genograms symbol sheet for you to keep handy, and to share with
clients. We suggest including one of these printouts with any copies of genograms you share
with clients.
Tip: Try to include at least three generations when you create a genogram. You
can include more generations if they are relevant to treatment, but any less will
make the genogram signi�cantly less helpful.
Men are depicted by a square and women are depicted by a circle.
Family Relationships
Family relationships are depicted by two gender symbols connected by a line beneath them.
Men should always appear on the left, and women on the right.
Genogram Symbol Sheet
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 4/10
Descriptive symbols, which are placed on top of the family relationship line, give more detail
about the relationship’s status. Each of these symbols can be placed over any type of line (for
example, the “separated” symbol could be placed over the “committed relationship” line or the
“marriage” line).
Emotional Relationships
Emotional relationships are depicted with a line directly connecting two gender symbols
(different from family relationship connections, where the line is beneath them). These lines
can be used to connect any two people on the genogram.
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 5/10
Tip: Your genograms will be very complicated if you connect every person to
everyone else with emotional relationship lines. Try asking about each
relationship, but only mark areas that are noteworthy or relevant to treatment.
Children are placed beneath their parents, with a line stemming from the parents’ family
relationship line. Children should be listed from left to right, oldest to youngest.
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 6/10
Deaths are indicated with an “X” inside the person’s symbol. In some cases it may be
important to add extra information such as a person’s age, or dates related to birth and death.
Additional Information
You can use genograms to depict just about anything that you think might be relevant to
treatment. Feel free to create additional markers to �t your needs. For example, you might
use an asterisk to indicate “di�culty with anger”, or a squiggly line above a gender symbol to
indicate “alcohol addiction”.
Tip: Include a key whenever you use custom markers. Future you probably won’t
remember what the jumble of asterisks, squiggles, and diamonds mean.
Putting it All Together
Using the symbols and rules above, you should be able to construct a genogram that any
other clinician can pick up and understand. Here’s an example of completed genogram along
with some commentary.
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 7/10
Using Genograms in Psychotherapy
Genograms �t in naturally during the assessment portion of treatment. Not only can
genograms provide great information about your client, they can also inform you about family
history of mental illness, which can give insight into possible diagnoses.
During family therapy, a genogram can also be used as a way to measure progress.
Completing genograms at various points throughout treatment may help you and your clients
see when and where there have been improvements to relationships.
Tip: Creating a genogram doesn’t have to be a chore. Many people love to talk
about their family, and will jump at the opportunity to share a few stories. This is a
great opportunity to build rapport and get to know your client at the beginning of
Individual Therapy
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 8/10
All too often the importance of family is ignored during individual therapy, and genograms are
a great way to make sure that your client’s roots are not forgotten. In the same way that a
person’s ethnic or religious culture can shape their thoughts, feelings, and behaviors, so can
their family culture. For this reason, clients struggling with a wide range of issues can bene�t
from learning about their family.
Family Therapy
The use of genograms in family therapy can be tricky because family members may see their
relationships very differently from one another. However, these discrepancies can also be
very telling. Consider the following example:
Example: A family consisting of two parents (Kori and Jason) and their daughter
(Magnolia) come to your o�ce for family therapy. While creating genograms, you
notice that the parents both say Magnolia is distant, while Magnolia indicates that her
parents are very close to one another, but distant from her.
In this example, it could be hypothesized that Magnolia and her parents both feel excluded
from the other’s world. Magnolia may feel that her parents care more about one another, yet
the parents seem unaware of this. Kori and Jason might bene�t from seeing that their
daughter isn’t just trying to be di�cult. Instead, she might be afraid that her parents don’t
want her around.
Of course, these are just hypotheses. However, this example shows ways in which a
genogram can act as a starting point for further exploration, and as a tool for initiating
communication between family members.
Don’t Forget Strengths
It’s easy to get wrapped up in the negative traits that are passed down in families, so don’t
forget to spend some time on the strengths (especially during family therapy). If every
session is spent railing on how dysfunctional a family is, why should they believe things can
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 9/10
Sometimes, even the negative traits in a genogram can have a positive basis. Consider this
Example: Katy and her daughter Taylor both reveal through their genograms that
they have an anger-fueled relationship with one another, as did Katy and her own
mother. Now, Taylor is beginning to rebel.
After further exploration, Katy reveals that she rebelled against her own mother because
she couldn’t stand the constant lectures. However, Katy says she only lectures Taylor
because she wants to help her avoid the same mistakes she made.
In this example, despite some noticeable issues with anger, we also see strengths. Katy is
trying to help her daughter, although she seems to be going about it poorly. Her intentions
come from a place of love. Focusing only on the anger would be likely to cause further
division between Katy and Taylor.
Genograms are a great �t with many types of treatment, and many problem areas. Below,
we’ve included a few references used for this guide, and further reading if you would like to
continue learning about this subject.
1. McGoldrick, M., Gerson, R., & Petry, S. S. (2008). Genograms: Assessment and
intervention. WW Norton & Company.
2. Milewski-Hertlein, K. A. (2001). The use of a socially constructed genogram in
clinical practice. American Journal of Family Therapy, 29(1), 23-38.
3. Paradopoulos, L., Bor, R., & Stanion, P. (1997). Genograms in counselling practice: A
review (part 1). Counselling Psychology Quarterly, 10(1), 17-28.
6/8/22, 10:17 PM Genograms for Psychotherapy (Guide) | Therapist Aid 10/10
Disclaimer: The resources available on Therapist Aid do not replace therapy, and are intended to be used by quali�ed professionals.
Professionals who use the tools available on this website should not practice outside of their own areas of competency. These tools are
intended to supplement treatment, and are not a replacement for appropriate training.
Copyright Notice: Therapist Aid LLC is the owner of the copyright for this website and all original materials/works that are included.
Therapist Aid has the exclusive right to reproduce their original works, prepare derivative works, distribute copies of the works, and in
the case of videos/sound recordings perform or display the work publicly. Anyone who violates the exclusive rights of the copyright
owner is an infringer of the copyrights in violation of the US Copyright Act. For more information about how our resources may or may
not be used, see our help page.
Therapist Aid has obtained permission to post the copyright protected works of other professionals in the community and has
recognized the contributions from each author.
© 2012-2022 Therapist Aid LLC

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more