N480 Rick and Morty Family Assessment

The Smith Family Assessment Visual Report Jennifer Hall N480- Family Nursing Fall 2020

Introduction: The Smith family

The Smith Family is an extended family that lives in a house in a middle-class neighborhood outside of Seattle, Washington. Jerry Smith, the family patriarch is married to Beth Sanchez and the couple have two teenage children together, Summer and Morty.

Beth’s father Rick Sanchez also resides in the house, has converted the garage into his personal laboratory, and is continuously involving his grandchildren in his insane misadventures.

The Smith family has a toxic style of family communication commonly seen in families with substance abuse and subsequent psychological disorders.

Meet Rick Sanchez Rick Sanchez is a 70 year old genius scientist who went missing from his family’s life for 20 years before showing up on his daughter’s family’s doorstep, much to the disapproval of his son-in-law Jerry. He is divorced from Beth’s mother and spends his time creating inventions in the family garage, traveling the universe, and causing catastrophe in alternate dimensions. He is in Erikson’s ego integrity v despair stage of development and shows many signs of regret and despair as he is unhappy with the way his life turned out. His nihilistic and egocentric personality causes damage to his family and those around him however he uses his genius to emotionally and physically manipulate situations to avoid taking responsibility or dealing with the consequences of his actions. Although Rick’s reckless behavior consistently puts the wellbeing and lives of his family at risk he still shows that he cares about them such as when he sacrifices himself for Morty or expresses how proud he is of Beth.

Alcoholism Diagnostic criteria for alcohol addiction can be found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and states that when the use of a substance disrupts one's ability to fulfil responsibilities they have a substance abuse disorder. Alcoholism causes intense cravings and excess time spend trying to obtain and recovering from alcohol (Townsend, 2014).

Alcohol abuse not only leads to physical degradation such as malnutrition, hepatic dysfunction, and short and long-term cognitive impairment but also leads the breakdown of interpersonal relationships (Denham, Eggenberger, Young, and Krumwiede, 2015; Kaakinen, Duff-Gedaly, Hanson, and Coelho, 2015). Risk factors for substance abuse disorders include genetics, chronic stressors, past trauma, poor self-image, low frustration or pain tolerance, a lack of meaningful relationships, lack of life success, and risky behaviors (ATI, 2016).

Rick’s substance abuse is illustrated through his chronic use of drugs and alcohol to numb emotional pain associated with failed romantic relationships, guilt from abandoning his family, and the traumatic events he’s experienced traveling throughout the galaxy. He is rarely seen without green spillage on his mouth from alcohol consumption and vomit. He is often seen drinking from a flask, passed out from intoxication, and driving a spaceship full of empty bottles of alcohol.

Family dynamics and functions Morty Smith is the 14 year high school student and the grandson of Rick.

Like many adolescence going through puberty, he is awkward and lacks confidence in himself and therefore is easily manipulated. He is in Erikson’s fifth stage of development therefore he is dealing with the psychological crises of identity v role confusion. He is good-natured and is nice to all of his family member including the family dog Snuffles.

Morty does not have many friends and lacks the confidence to pursue romantic relationships. Morty’s only friend seems to be his grandpa Rick which is most likely why he continues to tolerate Rick’s egocentric and corrupt behavior although this puts a strain on his relationship with his father Jerry.

Summer Smith is a 17 year high school student and granddaughter of Rick.

Summer displays some narcissistic tendencies as she spends her free time on social media and expresses concern about being popular. Like her brother, she is also in Erikson’s fifth stage of psychosocial development and is able to successfully assert her individual identity apart from her family. She is very caring towards her family although she has shown slight sociopathic behavior when under stress. She can be very irritable often exploding in anger at her parents while expressing how terrible she thinks they are. She gets her intelligence from her mother Beth and grandpa Rick and often feels left out when Rick and Morty go on misadventures together. When her family members are feeling insecure she is usually the one to help them gain confidence.

Beth Smith (Sanchez) is the 35 year old successful horse surgeon and breadwinner of the family. Beth is in Erikson’s sixth stage of psychosocial development, intimacy v. isolation. She struggles to maintain intimacy in her marriage however allows her love for her husband to overcome her fear of abandonment. Beth is married to Jerry and often questions whether she’s settling for him although she truly loves him. She is very intelligent like her father Rick but has substance abuse problems like him as well. Due to abandonment issues she has from the absence of her father in childhood, Beth overlooks many of her father’s negative behaviors and defends him when Jerry ponts out any wrongdoing. She can be somewhat cold and distant with her family as her work can be demanding as she often turns to wine in times of loneliness.

Jerry Smith is a 35 year old failed advertising agent who married Beth after getting her pregnant at the high school prom. Jerry is in Erikson’s sixth stage of development and works to maintain intimacy with his wife. Jerry is a dedicated family man however his insecure and spineless nature puts him at odds with his father-in-law Rick. Rick’s constant undermining of Jerry threatens Jerry’s role as the patriarch of the family. This also causes problems in his marriage to Beth which has been unsteady since Rick came back into their lives. Jerry and Beth briefly separated but realized they really love each other and got back together.

Duvall’s developmental stage Evelyn Duvall explained family development in periods of eight developmental stages and recognized family goals during each of these stages. These stages are based on the stage of the family life cycle such as getting married, having children, and the different family dynamics as the parents and children grow and age (Kaakinen et. al., 2015). The Smith family is would be categorized in the fifth stage defined as ‘families with adolescence’ based on the age of their oldest child Summer. Family developmental tasks during this period focus on parents enabling their adolescent children to assert their individual identity, increase adolescent's family responsibilities, and begin thinking about future education and career development. Jerry and Beth provide their children with a low level of authority allowing them to make their own decisions and rarely provide structure or discipline. Jerry often attempts to discipline and set limits for his children but lacks the backbone to follow through when he is undermined by Rick.

The children do not participate in any family responsibilities such as cooking or cleaning however they are part of the power base in the family.

Communication strategies The Smith family has a high frequency of communication and are very open and honest to a fault when expressing their thoughts. The family often uses toxic styles of communication demonstrated through sarcasm, judgment, defensiveness, jumping to conclusions, stonewalling, and criticism. All family members eat breakfast and dinner together and discuss individual and family issues with concern for one another although they are often at odds.

Communication within the family often shows a lack of respect however when the family is threatened from an outside source they remain united and will make self-sacrifices for the good fo the family.

Rick’s communication style is pessimistic as he is always pointing out the negative in every situation. He often uses defense mechanisms as a way of coping with his depression as he views existence as haphazard and meaningless. His superiority complex is illustrated through non-verbal actions such as rolling his eyes, crossing his arms, and not giving focused attention to any concerns he feels is beneath him. Beth immulates some of these characteristics as she is often seen trying to hold herself together attempting to portray a persona of the person she believes she should be.

Culture/ religion The Smith family is of European (Jerry) and Spanish descent (Rick, Beth) living in the middle class suburbs in the northwestern U.S. The family does not participate in any religion and base most of their beliefs on scientific principles. Although Rick is a diehard atheist the rest of the family has some belief in a higher power. Beth idolizes her father and often questions her own beliefs however she ultimately holds on to the belief that there is meaning in the universe. Ironically, all of the family members including Rick have prayed when faced with the possibility of death.

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Family strengths The Smith family is has strong problem solving capabilities which is illustrated by Rick’s use of technology to resolve family issues. For example, Rick uses technology to bring his daughter and son-in-law to a futuristic place to engage in marriage counseling to save their failing marriage. Beth is very driven and has made numerous life sacrifices in order to become the successful surgeon she is. Jerry always has the best interest of the family at heart and is loyal to his family. Jerry strives for the admiration of his family which can be a motivator for positive change. Summer is an intelligent and very capable young woman so she can effectively assess each situation and fulfill the corresponding role. Morty is conscience of others and often questions the morality of situations. Morty demonstrates an interest in making decision based on the best interest of everyone rather than only himself.

Mm, there is no God Summer. You got to rip that Band-Aid off now.

You’ll thank me later,” -Rick

Family weaknesses The family dynamic is based around underlying tension between Jerry and Beth. Beth enables her father to display a lack of respect and boundaries for the existing family structure. Beth is also very needy as her father was emotionally unavailable for most of her life. Jerry is insecure and not very intelligent and is therefore intimidated by Rick’s involvement in his family’s life. Rick has no moral compass and believes that he is the most intelligent person in the galaxy, blinding him from ever addressing his many faults. Morty is insecure and afraid just like his dad. He is somewhat impressionable and never stands up to Rick even though he doesn’t agree with his actions. Summer is influenced by Rick as well and she takes on some of his narcissistic, egocentric, and aggressive traits. She is also very jealous of Rick and Morty’s relationship and will compromise her integrity to gain the acceptance and admiration of her grandpa Rick.

Family Assessment and Intervention Model Different theoretical perspectives are used in family healthcare to guide assessment, interventions, and plan of patient care. The Family Assessment and Intervention Model allows the family to be viewed as an ever changing unit under the influence of different environmental forces. The family works to stabilize itself by creating adaptable barriers to any stressors or other forces that may threaten the family system. The family may experience a threat when all defences have been infiltrated and the threat permeates the family core. Family health events stemming from physical or mental illness pose challenges the family’s capacity to cope and the ability of the family to adapt determines future stability. Changes in family dynamics in response to the threat are directed towards wellness or health promotion, family reaction, and restoration of family functioning (Kaakinen, 2015).

When applying this theoretical framework to the Smith family the nurse should first assess stressors and strengths, this may be done with the Family Systems Stressor-Strength Inventory (FS^3I). The family stressor in the Smith family is Rick’s cantankerous and risky behavior fueled by alcoholism which has lead to a shift in family dynamic. Specific stressors may include Rick continuously taking Morty out of school, putting Morty and Summer in dangerous situations, undermining Jerry’s authority, and emotionally manipulating Beth. Family strengths include Rick’s problem solving, Jerry’s family commitment, Beth’s endurance, Morty’s empathy, and Summer’s flexibility . The nurse may then interview family member in order to get a more focused picture of general stressors, perceived stressors and strength of each individual.

Assessment information is synthesized on a graph to more clearly illustrate the general family perception and from this the nurse will create a custom plan of care (Kaakinen, 2015).

Interventions Problem: Dysfunctional family process related to family history of substance abuse as evidenced

by Rick continues to consume excess amounts of alcohol despite negative consequences to his family and himself

Intervention #1: Provide cognitive behavior therapy to Rick’s interventions to help decrease depression and alcohol use among alcohol-dependent individuals, Rationale: A study by Thapinta et al, (2017) found that use of a Cognitive Behavior Therapy Self-Help Booklet decreased depression among alcohol-dependent individuals. The alcohol consumption levels of the experimental and control group were assessed and showed a decrease in alcohol consumption at seven days and one month after the intervention (Yaman,, & Yılmaz, 2020).

Intervention #2: Utilize motivational interviewing aimed at changing health related behavior of Rick. Rationale: A meta- analysis by Frost et al., (2018) found that motivational interviewing interventions had a beneficial effect on the outcomes related to frequency and/or volume of alcohol consumption for short term outcomes (Frost et al., 2018).

Intervention #3: Refer Rick to a peer support program for substance abuse such as Alcoholics Anonymous, Narcotics Anonymous, or Smart Recovery.

Rationale: In a study by Ferri et al., it was found that AA may help with retention and acceptance of substance abuse treatment (Guenzel & McChargue, 2019).

Outcomes

Outcome #1: By the end of the ďŹ rst therapy session Rick will be able to recognize a minimum of 3 maladaptive thought patterns and demonstrate understanding of adaptive methods of thinking.

Outcome #2: By the end of the family meeting Rick will identify a minimum of 3 motivational factors to prevent him from relapsing.

Outcome #3: Within 1 month, Rick will verbalize 5 coping strategies as learned in AA in order to prevent relapse.

References Assessment Technologies Institute. (2016). RN Mental health nursing: Content Mastery Series (10th ed.). Leawood KA: Assessment Technologies Institute, LLC. Denham, S., Eggenberger, S., Young, P. & Krumwiede, N. (2015) Family-Focused nursing care. F.A. Davis: Philadelphia. ISBN-13: 9780803629103 Frost, H., ⨯, P. C., Maxwell, M., Ronan E O’Carroll, Dombrowski, S. U., Williams, B., . . . ⨯, A. P. (2018). Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One, 13(10) doi:http://dx.doi.org/10.1371/journal.pone.0204890

Guenzel, N., & McChargue, D. (2019). Addiction Relapse Prevention. In StatPearls [Internet]. StatPearls Publishing.

Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health Care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. ISBN-13:9780803639218 Mangueira, S. D. O., & Lopes, M. V. D. O. (2016). Clinical validation of the nursing diagnosis of dysfunctional family processes related to alcoholism. Journal of advanced nursing, 72(10), 2401-2412.

Townsend, M. (2014). Psychiatric Mental Health Nursing 9th edition. Philadelphia: F. A. Davis Company. ISBN: 978-0-8036-4092-4 Yaman, Z., & Yılmaz, M. (2020). Nursing interventions applied to alcohol dependent individuals: A systematic review. Psikiyatride Guncel Yaklasimlar, 12(1), 100-116. doi:http://dx.doi.org/10.18863/pgy.524230

Image References [Untitled image of Rick and Morty logo]. Retrieved from https://www.logolynx.com/topic/rick+and+morty [Untitled image of the Smith family]. Retrieved from https://i.pinimg.com/originals/6a/4d/1f/6a4d1f30902da89ae924b75c88a7978c.jpg [Untitled image of Rick]. Retrieved from https://en.wikipedia.org/wiki/Rick_Sanchez_(Rick_and_Morty) [Untitled image of Morty]. Retrieved from https://rickandmorty.fandom.com/wiki/Morty_Smith [Untitled image of Summer]. Retrieved from https://ipdkverse.fandom.com/wiki/Summer_Smith_(69-1) [Untitled image of Beth]. Retrieved from https://ipdkverse.fandom.com/wiki/Beth_Smith_(69-1) [Untitled image of Jerry]. Retrieved from https://freepikpsd.com/jerry-smith-png-transparent-images/269025/ [Untitled image of Jerry, Morty, Rick and Summer]. Retrieved from https://www.inverse.com/article/37008-rick-and-morty-season-3-episode-10-finale-ending [Fig. 3-8. Family Assessment and Intervention Model (Kaakinen et al., 2015, p.92)] [Untitled image of Beth, Jerry, Rick, Morty and Summer]. Retrieved from https://www.digitalspy.com/tv/ustv/a827965/rick-morty-actor-drunk-season-3-filming/ [Untitled image of Rick and Morty]. Retrieved from https://www.kindpng.com/imgv/imoJih_rick-y-morty-png-transparent-png/