NursingReflective journalFamily therapy

Practicum journal: two clients, one family session

A practicum journal entry documenting a family therapy session with the supplied Group Therapy Progress Note, describing and diagnosing two clients from that session, and choosing between solution-focused and cognitive behavioural therapy for the family.

Aug 7, 2026Updated Aug 10, 2026

Editorial process

Last reviewed · August 7, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Why both clients must come from one session

One constraint decides everything that follows: *the two clients you select must have attended the same family session*. That is not an administrative detail — it is what makes the rest of the entry possible. Two clients from the same session share a system, an interaction you witnessed, and a set of dynamics you can describe from both sides. Two clients from different sessions give you two unrelated case notes and nothing to compare. It also constrains the therapy question at the end, because the brief asks which modality would be more effective *with this family*, singular. Choose the session first, then the two members of it whose material is richest, and the journal has a spine before you write a word. Choosing the session for the interaction you can still picture, rather than the one that was clinically most dramatic, is usually the better call for a reflective entry of this kind.

The documentation requirement is a form, not a narrative. You are asked to document the family session using the Group Therapy Progress Note supplied in the learning resources, which means completing its fields — participation level and quality, mood, affect, mental status, risk, changes in stressors, coping and symptoms, in-session procedures, homework — rather than writing an account and calling it documentation. Complete the form for the session, then write the reflective analysis separately. Submissions that merge the two produce something that is neither a usable progress note nor an analysis, and the progress note is the artefact a supervisor would actually read. Attaching the completed note as its own section, ahead of the reflection, also makes it obvious to a marker that the documentation element was answered rather than absorbed into the prose around it.

*Describe each client without violating HIPAA regulations* is a graded element and it fails in both directions. Too much detail — initials that are traceable, an unusual occupation, a named facility, a date of admission — breaches the requirement. Too little detail leaves a description that cannot support a diagnosis, which is the very next bullet. The workable position is to keep everything clinically relevant and remove everything identifying: age band rather than date of birth, the presenting problem, relevant history, current medications, and the family role. Say explicitly that identifying details have been altered or omitted, because stating the safeguard is part of demonstrating that you understand it. Two clients from the same family raise this problem twice over, because a detail that identifies one of them will usually identify the other as well.

The diagnosis bullet asks you to *explain and justify* using the DSM-5, and justification means mapping observed material onto criteria rather than naming a disorder. Say which criteria are met, what you observed that meets them, how long the presentation has lasted, and what functional impairment follows. Then say what you ruled out and why, because a differential is what turns a label into reasoning. This is also where the same-session constraint pays off: two clients from one family often present with related but distinct pictures, and explaining why the same family environment produces different diagnoses in two members is more interesting than two independent write-ups. Doing this for both clients also surfaces what the family shares, which is the material the modality decision at the end of the entry will rest on.

The modality question wants a decision, not a comparison. Solution-focused work is brief, future-oriented and builds on exceptions and existing strengths; cognitive behavioural work in families targets the beliefs and interaction patterns that maintain a problem and takes longer. Choose one *for this family*, and justify it from what you observed: the family's willingness to look forward, the presence or absence of a shared account of the problem, the number of sessions realistically available, whether a member's cognitions are clearly driving the pattern. Then give expected outcomes, which the brief asks for by name. Close on the legal and ethical implications for each client separately — confidentiality within family work is not the same problem for a minor as for an adult. Naming the specific provision you are relying on, rather than referring to confidentiality in general, is what keeps that final section from collapsing into a single shared paragraph.

Required element	The version that under-performs	What the journal entry needs
Client selection	Two clients from different sessions	Two members of one family session
Documentation	A narrative account of what happened	The progress note's fields completed
Client description	Either identifying detail or none at all	Clinically relevant, de-identified, with the safeguard stated
Diagnosis	A disorder named	Criteria mapped to observations, plus what was ruled out
Modality choice	A comparison of both approaches	One chosen for this family, justified from observation
Expected outcomes	Improvement	What would change, in whom, and by when
Legal and ethical	One paragraph covering both clients	The implications for each client, which differ

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Document a therapy session in a structured clinical record rather than a narrative.
02
De-identify a client description without stripping the material a diagnosis needs.
03
Justify a DSM-5 diagnosis by mapping observations onto criteria.
04
Select a therapeutic modality for a specific family and defend the choice.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

Practicum – Week 5 Journal Entry Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session. Then, address in your Practicum Journal the following: · Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session. (ALSO SEE ATTACHED Group Therapy Progress Note) · Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications. · Using the DSM-5, explain and justify your diagnosis for each client. · Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches. · Explain any legal and/or ethical implications related to counseling each client. · Support your approach with evidence-based literature. Resources for Aggressive and Oppositional-acting Children Practicum American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology & Psychiatry, 54(7), 707–723. doi:10.1111/jcpp.12058 Conoley, C., Graham, J., Neu, T., Craig, M., O’Pry, A., Cardin, S., & … Parker, R. (2003). Solution-focused family therapy with three aggressive and oppositional-acting children: An N=1 empirical study. Family Process, 42(3), 361–374. doi:10.1111/j.1545-5300.2003.00361.x de Castro, S., & Guterman, J. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital & Family Therapy, 34(1), 93–106. doi:10.111/j.1752-0606.2008.00055.x Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of Family Psychotherapy, 25(2), 132–144. doi:10.1080/08975353.2014.910023 Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship Therapy, 29(3), 366–367. doi:10.1080/14681994.2014.909024. Ramisch, J., McVicker, M., & Sahin, Z. (2009). Helping low-conflict divorced parents establish appropriate boundaries using a variation of the miracle question: An integration of solution-focused therapy and structural family therapy. Journal of Divorce & Remarriage, 50(7), 481–495. doi:10.1080/10502550902970587 Washington, K. T., Wittenberg-Lyles, E., Oliver, D. P., Baldwin, P. K., Tappana, J., Wright, J. H., & Demiris, G. (2014). Rethinking family caregiving: Tailoring cognitive-behavioral therapies to the hospice experience. Health & Social Work, 39(4), 244–250. doi:10.1093/hsw/hlu031 Group Therapy Progress Note American Psychological Association | Division 12 http://www.div12.org/ 1 Client: __________________________________________________ Date: ___________ Group name:________________________________________________ Minutes:________ Group session # ______ Meeting attended is #:______ for this client. Number present in group _____ of _____ scheduled Start time:________ End time: ________ Assessment of client 1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn 2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________ 3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________ 4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other:_______________ 5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________ 6. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt 7. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic 8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able 9. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse 10. Other observations/evaluations:________________________________________________________ In-session procedures:  _______________________________________________________________________________  _______________________________________________________________________________  _______________________________________________________________________________  _______________________________________________________________________________  __________ _____________________________________________________________________ Homework: 1. 2. 3. Other Comments: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Signatures Date

Everything the journal entry has to contain

01
Two clients selected from the same family therapy session.
02
The session documented on the Group Therapy Progress Note.
03
A description of each client, de-identified, with pertinent history and medications.
04
A DSM-5 diagnosis for each client, explained and justified.
05
A choice between solution-focused and cognitive behavioural therapy for this family.
06
Expected outcomes based on the chosen approach.
07
The legal and ethical implications of counselling each client.
08
Evidence-based literature supporting the approach.

From the progress note to the ethical implications

Choose the session, then the clients

One family session, two members whose material supports both a diagnosis and a comparison.

Complete the progress note

Participation, mood, affect, mental status, risk, changes and in-session procedures, as fields.

Describe each client safely and sufficiently

Presenting problem, relevant history, medications and family role, with identifiers removed.

Diagnose by mapping, not by naming

Criteria met, observations meeting them, duration, impairment, and what was excluded.

Choose the modality for this family

Solution-focused or cognitive behavioural, with the family features that decided it and expected outcomes.

Legal and ethical, client by client

Confidentiality within family work, consent, capacity and any reporting duty, for each client.

Evidence for a modality, not for a preference

Recommended databases

PubMed and PsycINFO
The DSM-5 itself
Professional association ethics codes
The week's assigned learning resources

Search sequence

1.
Read the criteria in the DSM-5 before writing the diagnosis, because justification means quoting what has to be met rather than recalling what the disorder is.
2.
Search for outcome evidence on each modality with children and families specifically, since the general adult literature will not support a claim about this family.
3.
Look for the limits of the evidence as well as its strength, because a modality choice is more convincing when it acknowledges what is not yet established.
4.
Check the ethics code for the specific provision on confidentiality in family and group settings, which is where the legal implications for two clients diverge.

Reviews of both modalities, and the privacy rule

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Practitioner Review: The effectiveness of solution focused brief therapy with children and families: a systematic and critical evaluation of the literature from 1990-2010
Journal of Child Psychology and Psychiatry, via PubMed · 2013
The systematic review the brief's own resource list points at, covering what solution-focused work achieves with children and families and where the evidence is weaker. Cite it for the strengths-based rationale, and for the honest limits that make a modality choice look considered rather than preferred.
02
Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta-analysis of randomized controlled trials
Journal of Psychiatric and Mental Health Nursing, via PubMed · 2019
Evidence for the other side of the choice, including the finding that effects were clear immediately after intervention but less established over the longer term. That distinction is directly usable in the expected outcomes element, which asks what would change and implies over what period.
03
Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis
Journal of the American Academy of Child and Adolescent Psychiatry, via PubMed · 2020
Comparative evidence across cognitive behavioural formats, including family-based delivery against treatment as usual and control conditions. Useful when the family member driving the presentation is a child, since it lets you argue for a specific delivery format rather than for the approach in general.
04
Summary of the HIPAA Security Rule
U.S. Department of Health and Human Services · 2024
The safeguards standard behind the instruction to describe clients without violating HIPAA. Read it for what identifiability actually means, since the practical question in a journal entry is which combination of details would let someone recognise a client rather than whether a name appears.

Before the practicum journal is submitted

Common mistakes

Selecting two clients who did not attend the same session.
Writing a narrative instead of completing the progress note's fields.
Including identifying details, or removing so much that the diagnosis is unsupported.
Naming a diagnosis without mapping criteria to observations.
Omitting the differential, so the diagnosis reads as a label.
Comparing the two modalities rather than choosing one for this family.
Leaving expected outcomes as a general statement of improvement.
Covering legal and ethical implications once for both clients when they differ.
Supporting the modality choice with a textbook rather than evidence.

Submission checklist

Both clients attended the same family session.
Every field of the progress note is completed.
The client descriptions are clinically sufficient and de-identified.
The de-identification is stated explicitly.
Each diagnosis cites criteria and the observations meeting them.
A differential appears for at least one client.
One modality is chosen and justified from what was observed.
Expected outcomes name what changes, in whom, and over what period.
Legal and ethical implications are addressed per client.
Evidence-based literature is cited for the chosen approach.

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