Family Psychiatric Assessment Using the Friedman Model

Introduction

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, focuses on patients' interpersonal relationships as a basis for diagnosing mental illnesses. Unlike most systemic diseases, psychiatric illness history-taking and mental status examination derive their foundation from the patient's family history, birth and developmental milestones, education history, social history, occupational history, and psychosexual history. This paper focuses on assessing a family within which one member was diagnosed with anxiety disorder, alongside multiple psychiatric illness risk factors present across the family system.

Conducting this family assessment provided an opportunity to utilize the assessment tools and theories relevant to psychiatric practice. The Friedman Family Assessment Model was applied to gather information about the family and to explore the interactions between family members and the healthcare provider or family therapist. The following information was obtained during the assessment process.

Family Form: The family form revealed a mixture of a stepfamily and a blended type. Mr. [Family Name] has two children from his previous marriage before his divorce, while Mrs. [Family Name] has one child from a prior relationship. Together, the couple has two additional children, for a total of five children in the household.

Family Assessment Form and Background

Cultural Background: The family is identified as Black-American or Black-Caucasian.

Religion: The family is Christian, from a Catholic denomination.

Social Class: The family is upper middle-working class.

Mr. [Family Name] is a 60-year-old male of African-American background who works with a textile company in Ohio. Mrs. [Family Name] is a 56-year-old female of African-American origin who works for an envelope manufacturing company, also in Ohio. The couple has been married for 30 years and together has a blended family comprising two daughters (aged 27 and 21) and three sons (aged 35, 25, and 19). All five children were born and raised in Franklin, Ohio.

Mrs. [Family Name] was married previously and was a single mother of one child before her current marriage. Mr. [Family Name] grew up in a stepfamily with a stepfather. Mrs. [Family Name]'s mother passed away when she was two years old; she was subsequently raised by her uncle and aunt, who later died in a car accident, leaving her on her own at the age of 22 while she was still in university.

The oldest son, aged 35, lives in New York, is married with two children, and works as a university lecturer. The elder daughter, aged 27, lives in North Carolina, recently completed her master's degree, and is in a relationship but not yet married. The three younger children — aged 25, 21, and 19 — are currently enrolled in college or university, are healthy, and are doing well academically. The family lives in a mid-sized house in Ohio, where they have resided for 21 years.

The genogram applied in this assessment proved very effective in analyzing family concerns. Its orientation was adopted from Bowen's Family Systems Theory, tracing multiple generations (Majhi et al., 2018). Mr. [Family Name] has been diagnosed with anxiety disorder and has a history of diabetes. Mrs. [Family Name] has a history of hypertension with no known psychiatric illness. The genogram provides a visual representation of the family system and is oriented to show the relationships and health histories across generations.

An interactive session was held with Mrs. [Family Name], in which she revealed several aspects and concerns regarding the family. The conversation was recorded as follows.

Genogram and Interpersonal Interaction

Psychiatrist: In general, tell me the issues you think concern your family.

Mrs. [Family Name]: First, I did not bond with my biological parents while growing up as a child. I have always felt that attachment guilt within me; sometimes, I have to choose sides in my current family. I have to do more for my children so they do not experience what I went through as a child. I am devoted to maintaining my family bond and providing the motherly attachment I did not receive while growing up.

Psychiatrist: Now that you have mentioned your childhood, would you please tell me more about it?

Mrs. [Family Name]: What exactly do you want to know about my childhood? Please be more specific.

Psychiatrist: Because our childhood history can greatly influence our adulthood, it would be significant to understand how you grew up.

Mrs. [Family Name]: Well, I lost my biological mother at the age of two. I was informed that she had succumbed to long-standing tuberculosis. I had to stay with my uncle and aunt while my elder brother stayed with another uncle, and my sister, the second-born, stayed with our father. Growing up with my aunt was stressful; she was a strict woman, and I often wished I had a mother.

Psychiatrist: I understand, and I am sorry for all you went through. Would you please tell me more about your aunt?

Mrs. [Family Name]: My aunt was a very strict person; I sometimes felt she treated me as if I did not belong to that family. I grew up alongside my four cousins. My uncle was so harsh that he drove my elder cousin to commit suicide. My aunt was another difficulty altogether; she constantly treated me with hatred and imposed heavy chores on me. When I became pregnant at university, she told me never to set foot in her house again — and I did not visit until they died in a car accident.

Psychiatrist: Do you feel the need to continue talking about your cousins and other siblings?

Mrs. [Family Name]: No, I do not particularly want to talk about my past because it hurts me a great deal. All I want to discuss is my current family.

Clients often do not fully recognize the impact of their past or childhood history on their present adult lives. Mrs. [Family Name] became defensive and withdrawn during this portion of the session; she did not want to address her past but preferred to focus on the present. It is therefore essential for therapists to help clients understand the connection between past experiences and present circumstances, as well as the potential implications for the future. The role of the therapist is to thoroughly explore the issues present across the family tree during assessment, identify psychiatric risk factors, and develop a corresponding treatment plan.