Family Assessment: Comprehensive Psychiatric Evaluation and Genogram for Mother and Daughter: A Cultural Tale

About the video and the family

Mother and Daughter: A Cultural Tale (Master’s Work Productions, 2003) is a 76-minute family therapy consultation led by Gonzalo Bacigalupe, with the family’s Iranian woman therapist present. The family is an Iranian immigrant mother and her 23-year-old daughter, who was raised largely in the United States and has become more Americanized. Their conflict centers on different cultural expectations: the daughter wants to fit in with her social circle, while her mother expects her to follow Iranian cultural norms. Specific points of conflict include the daughter’s dress, her choice to live apart from her mother while unmarried, and how much time she spends with family. In an epilogue, Bacigalupe explains his narrative and culturally informed approach (Bacigalupe, 2003).

Why family assessment matters here

In family therapy, the person brought to treatment is often labeled the identified patient (IP), here likely the daughter, whose behavior is seen as “the problem.” A systemic assessment asks a different question: what is happening in the relationships and context that maintains the distress? In this family, the conflict is less about one person’s pathology and more about an acculturation gap, in which children of immigrants often adopt the host culture’s values faster than their parents, creating intergenerational conflict over autonomy, dating, dress and family obligation (Berry, 1997). Assessing roles, rules, boundaries, communication and cultural meanings helps you avoid pathologizing normal acculturation stress.

Comprehensive psychiatric evaluation note: section-by-section guide

Chief complaint (CC)

Record the reason for the visit in each person’s own words, in quotation marks. In family work, include each member’s view, since they often differ.

Example: Mother: “[My daughter no longer respects our culture or our family.]” Daughter: “[My mother wants to control how I dress and live; I just want to live my own life.]”

History of present illness (HPI)

Summarize the onset, duration, triggers and course of the problem, and its impact on functioning. Cover the core conflicts shown in the video (dress, living separately while unmarried, time with family), how long they have been escalating, recent triggering events, how each person copes, and screen each person for mood, anxiety, sleep and safety.

Example structure: “The family presents for consultation with their therapist due to ongoing mother–daughter conflict related to differing cultural expectations. The daughter, a 23-year-old Iranian-American woman, [moved out of the family home X months ago], which her mother views as inappropriate for an unmarried woman in Iranian culture. Conflicts also involve the daughter’s clothing and the amount of time she spends with family. [Daughter reports feeling guilty, anxious and torn between two cultures; mother reports sadness, worry and loss.] [Both deny suicidal or homicidal ideation.]”

Past psychiatric history

For each family member: previous diagnoses, therapy (including how long they have seen the current therapist), hospitalizations, medications, suicide attempts or self-harm, and trauma history (for example, experiences related to immigration or political upheaval in Iran). Example: “[Mother and daughter are in ongoing family therapy with current therapist; no prior hospitalizations reported; no psychotropic medications reported.]”

Substance use history

Ask each member about alcohol, tobacco, cannabis and other substances, including amount, frequency and consequences. Note cultural or religious views about alcohol, which may themselves be a source of conflict. If not discussed in the video, write “not reported; to be assessed.”

Family psychiatric/substance use history

Document mental illness, suicide and substance use across at least three generations, including the father and extended family in Iran. Note family members who remain in Iran or are deceased, and any family history of depression or anxiety. This information also feeds the genogram.

Psychosocial and developmental history

This section is central for this family:

• Immigration story: when and why the family left Iran, the daughter’s age at migration, losses and support left behind.
• Family structure: father’s role and status, siblings, extended family, who lives where.
• Cultural and religious identity: the importance of family honor, collectivism, gender roles, modesty and marriage expectations in the mother’s framework; the daughter’s bicultural identity.
• Acculturation: language use, community ties, each person’s level of identification with Iranian and American cultures.
• Education and work: the daughter’s schooling or career; the mother’s work, social network and isolation.
• Developmental history: the daughter’s milestones, adolescence (when cultural conflicts often begin) and transition to adulthood.
• Strengths: mutual love and commitment, willingness to attend therapy together, cultural pride, resilience.

Medical history

List current medical conditions, medications, allergies, surgeries and reproductive history for each person, and note conditions that can cause psychiatric symptoms, such as thyroid disease or anemia. Example: “[No significant medical history reported for either; NKDA; last PCP visit unknown.]”

Review of systems (ROS)

Review symptoms by body system: general (sleep, appetite, energy, weight), HEENT, cardiovascular (palpitations), respiratory, GI (stress-related GI upset), musculoskeletal (tension), neurological (headaches) and psychiatric. Stress-related somatic complaints are common and should be noted.

Physical assessment (if applicable)

For a video-based family session, this is usually “not applicable/not performed; deferred to primary care,” with vital signs if available. Recommend baseline labs (CBC, TSH, CMP) if mood symptoms are significant.

Mental status exam (MSE)

Complete an MSE for each family member based on your observations of the video:

Differential diagnosis (minimum of three)

For each, state the DSM-5-TR criteria met or not met, and how you derived the diagnosis from the video evidence (American Psychiatric Association [APA], 2022). In family cases, Z-codes for relational and acculturation problems are often the most accurate focus of clinical attention.

Choose and justify the diagnoses that best fit what you observe; if criteria for a disorder are not met, explain why it was ruled out.

Case formulation

Use a systemic and cultural lens, for example the “4 Ps”:

• Predisposing: immigration and loss of extended family support; differing acculturation rates; strong collectivist and gender-role expectations in the mother’s culture of origin; [family history].
• Precipitating: the daughter’s move to live independently while unmarried; [recent events seen in the video].
• Perpetuating: polarized communication in which each defends her cultural position; the mother may experience the daughter’s choices as rejection and loss of honor, while the daughter experiences the mother’s expectations as control; possible isolation of the mother.
• Protective: strong mutual love and commitment; both willing to attend therapy; cultural pride; a therapist who shares the family’s cultural background.

From a narrative therapy perspective, used in the video’s consultation, the “problem” can be externalized as the conflict between two cultural stories rather than as a flaw in either woman, opening room for a new, shared family story that honors both (White & Epston, 1990).

Treatment plan

Psychotherapy genogram

A genogram is a multigenerational family diagram that uses standard symbols to show family structure, relationships, patterns and significant events (McGoldrick et al., 2020). For this family, include at least three generations: the maternal grandparents (likely in Iran), the mother and the father (status to be confirmed), and the daughter as the identified patient. Use relationship lines to show the close but conflictual mother–daughter bond, and note immigration, cultural identity and any losses.

Genogram tips: males are squares and females circles; the identified patient has a double outline; a deceased person has an X; a single slash on the marriage line means separation and a double slash means divorce; zigzag lines show conflict and multiple lines show closeness. Add a key and notes on immigration date, cultural or religious identity, and mental health or substance use history.

Related reading: cultural humility, depression and the DSM-5-TR and SOAP notes and care plans.

Conclusion

A comprehensive family assessment looks beyond the identified patient to the relationships, roles and cultural context that shape a family’s distress. In Mother and Daughter: A Cultural Tale, the conflict between an Iranian immigrant mother and her Americanized daughter reflects an acculturation gap rather than individual pathology. Careful documentation of each section of the comprehensive evaluation note, DSM-5-TR-based differential diagnoses including relational Z-codes, a culturally informed case formulation and a multigenerational genogram allow the PMHNP to design a treatment plan that honors both women’s cultural worlds and strengthens their relationship.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Bacigalupe, G. (2003). Mother and daughter: A cultural tale [Video]. Master’s Work Productions.

Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34. https://doi.org/10.1111/j.1464-0597.1997.tb01087.x

McGoldrick, M., Gerson, R., & Petry, S. (2020). Genograms: Assessment and treatment (4th ed.). W. W. Norton.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W. W. Norton.