Mother and Daughter: A Cultural Tale video – NRNP-6645 Week 2: Assignment Family Assessment

Mother and Daughter: A Cultural Tale video – NRNP-6645 Week 2: Assignment Family Assessment

Family Assessment in Psychotherapy for an Iranian Immigrant Mother and Her Daughter

This is the case study of Patti, an Iranian immigrant mother of five whose living situation has deteriorated after all her grown children have left home. She has three daughters and two sons. Recently, she underwent two operations on her feet that were both failed procedures. They left her disabled and unable to walk or work. She is still reminiscing about her culture back in Iran and expecting that her children should be helping her at this time of need that she is not able to be independent. However, the children have adopted the American culture where children do not feel obliged to take care of their old or disabled parents at all. This has created conflict in the family and psychological trauma. Her husband remained in Iran with one of the daughters (Shireen) whom he sexually assaulted (raped) as was later to be revealed when Shireen joined her mother in the United States. The daughters are Sheela who is 24 years old (eldest), Sharleen who is 23 years old and accompanying the mother to the consultation with Dr. Gonzalo Bacigalupe, and Shireen who is now 21 years old and the one who was raped by her father back in Iran. The other two children are boys aged 15 and 8 years old and still in high school. The family has built a therapeutic relationship over the months with Sandi who has been their therapist for the last one and a half years. This paper is a comprehensive family assessment of Patti and her children through the comprehensive psychiatric evaluation model.

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Chief Complaint: Feeling lonely, hopeless, and helpless after being left alone by her children. Also, psychological trauma after learning that her husband raped one of her daughters while still in Iran.

History of Present Illness (HPI): The patient is an Iranian immigrant mother of five who presents with disability after failed surgeries and loneliness after her children abandoned her. She is also having psychological trauma related to the sexual assault of her daughter by her husband. She has no previous history of experiencing her current situation. The problems started when she underwent two foot surgeries that then failed then her daughter Shireen came with the story that her father had raped her. The symptoms are psychological and they are constant. They are characteristically stressing and are aggravated by being alone. Relief is achieved by having her children visiting her and staying with her. The timing of the symptoms is all day and she rates the severity of her situation at 7/10.    Mother and Daughter: A Cultural Tale video – NRNP-6645 Week 2: Assignment Family Assessment

Past Psychiatric History: The family does not have a significant psychiatric history.

Substance Use History: There is no significant substance use history in the family.

Psychosocial/ Developmental History: While in Iran, the social development of the children revolved around religion and conservatism. Liberal thought and expression was not tolerated. This was when the children were young. However, in the US the environment has been different. The children have become adults and adolescents who are independent and free.

Medical/ Surgical History: Patti has a history of two surgeries on her feet that both failed leaving her disabled and wheelchair-bound.

Review of Systems (ROS)

• GENERAL: Denies fatigue, fever, weight loss, chills, or malaise.
• HEENT: Denies double vision, blurring of vision, photophobia, or visual loss. Also denies otorrhea, hearing loss, sneezing, running nose, sore throat or difficulty in swallowing.
• SKIN: Denies pruritus and rashes on the skin.
• CARDIOVASCULAR: Denies chest pains, chest tightness, or palpitations.
• RESPIRATORY: Denies coughing, wheezing, and difficulty in breathing.
• GASTROINTESTINAL: Denies nausea, vomiting, or diarrhea. She does not suffer from abdominal pains or irregular bowel movements.
• GENITOURINARY: Denies urgency, frequency, and hesitancy. Also denies pdysuria and polyuria.
• NEUROLOGICAL: Negative for body weakness and numbness. Denies loss of bladder and bowel control.
• MUSCULOSKELETAL: Denies joint pains and muscle/ back pain.
• HEMATOLOGIC: Denies a history of blood or clotting disorders.
• LYMPHATICS: Denies swelling of glands or a history of splenectomy.
• ENDOCRINOLOGIC: Denies a history of heat and cold intolerance. Also refutes a history of excessive sweating, excessive thirst, and excessive drinking of water.

Mental Status Examination (MSE)

The patient is a middle-aged Iranian immigrant mother of five. She is alert and oriented to person, place, time, and event. Her grooming is appropriate for the season and time of the day. Her speech is clear, coherent, and goal-directed. She lacks any notable gestures, tics, or mannerisms. Self reported mood is “depressed” and affect is dysphoric. There is congruency between the mood and the affect. The patient denies any auditory or visual hallucinations as well as delusional or paranoid thought processes. She denies homicidal and suicidal ideation and her insight and judgment are unaffected. Diagnosis is major depressive disorder (MDD).

Differential Diagnosis

1. Major Depressive Disorder (MDD)

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, a diagnosis of MDD is made when five or more of the following symptoms are noted in a span of two weeks with at least one of them being depressed mood (Sadock et al., 2015; APA, 2013):

• Reduced interest in pleasurable activities
• A mood that is depressed for most of the day
• Disturbance in sleep patterns such as insomnia
• Weight loss that is significant
• Feelings of hopelessness and worthlessness
• Fatigue and malaise
• Reduced ability to think straight or decisively
• Thoughts about death and dying.

He patent in this case (the mother) has admitted that she feels hopeless and helpless as the children have left her alone.

2. Post-Traumatic Stress Disorder (PTSD)

The DSM-5 states that a diagnosis of PTSD is made when the person is haunted by thoughts and flashbacks of events that happened in the past and that were traumatic (Sadock et al., 2015; APA, 2013). This patient had one of her young daughters she left behind in Iran raped by her own husband. This has left her with psychological scars that can only qualify as PTSD.

3. Dysthymia

This disorder is close to MDD but also includes characteristics of dysthymic disorder as had been expressed in the DSM-4. Basically, the patient displays MD symptoms together with those of dysthymic disorder (Sadock et al., 2015; APA, 2013).

Case Formulation and Treatment Plan

The management of this patient and family will basically comprise of psychotherapy in its various forms. This will be as follows:

• Group psychotherapy for the mother and her children in which group curative factors such as altruism and catharsis will take effect (Wheeler, 2020; Corey, 2017, Yalom & Leszcz, 2005).
• Cognitive behavioral therapy (CBT) for the individual patent to reorient her thoughts (Wheeler, 2020; Corey, 2017, Yalom & Leszcz, 2005).

Genogram for the Family

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10^th ed. Cengage Learning.

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences/ clinical psychiatry, 11^th ed. Wolters Kluwer.

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, 3^rd ed. Springer Publishing Company, LLC.

Yalom, I.D., & Leszcz, M. (2005). The theory and practice of group psychotherapy, 5^th ed. New York, NY: Basic Books. Mother and Daughter: A Cultural Tale video – NRNP-6645 Week 2: Assignment Family Assessment