View the Mother and Daughter: A Cultural Tale video in the L
View the Mother and Daughter: A Cultural Tale video in the Learning Resources and consider how you might assess the family in the case study. Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria. Case formulation and treatment plan, Include a psychotherapy genogram for the family. Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an example provided with detailed guidance and examples. For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning. Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria
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College of Nursing-PMHNP, Walden University
NRNP 6645: Psychopathology and Diagnostic Reasoning
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NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
CC (chief complaint):
HPI:
Past Psychiatric History:
· General Statement:
· Caregivers (if applicable):
· Hospitalizations:
· Medication trials:
· Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
· Current Medications:
· Allergies:
· Reproductive Hx:
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Physical exam: if applicable
Diagnostic results:
Assessment
Mental Status Examination:
Differential Diagnoses:
Case Formulation and Treatment Plan:
Reflections:
References
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Mother and Daughter: A Cultural Tale. . (2003).[Video/DVD] Masterswork Productions. https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale
TRANSCRIPT OF VIDEO FILE:
BEGIN TRANSCRIPT:
00:00:35
A MOTHER and A DAUGHTER:
00:00:35
A CULTURAL TALE
00:00:35
AN INTERVIEW WITH
00:00:35
GONZALO BACIGALUPE, PhD
00:00:35
Produced by
00:00:35
Andrews & Clark
00:00:35
Explorations, Inc.
00:00:35
copyright 2003
00:00:35
GONZALO BACIGALUPE When I'm asked to do a consultation, one of the first things I ask is, what will be the most benefit for the client and the therapist and in the case that you're going to see I'm basically asked to have a reflecting team and what we did was first have an interview with the therapist and the family and ask them what they will find useful for the interview and basically to ask them about the history of the therapy and the history of what are the kinds of things that they have been working on. I ask the reflecting team to come in and I instructed them to think of themselves as so let the god mothers of the therapist, who in a way, put them, himself, or in this case herself at risk in front of her peers and another people. So, I wanted them, the reflecting team to address the therapeutic system as a whole not just to address the family, I wanted them to talk also about the therapist and to be protective of them. I also ask the reflecting team not to be too much of clinician, but to really react on a more personal level around the family. I sometimes reflected on what they were saying to clarify or to expand the idea or how I understood it to give voice to other possibilities, but respecting the personal peace, and then, I ask I ask the family to come back to, in a classical way, to respond to those comments what strike them. In the case that we watch, it seems that the family was dealing with sort of like two forms of trauma and/or three forms of trauma; one is, history of battering the domestic violence, child sexual abuse, a history of immigration that in some ways we lay it to that trauma getting away from it and basically the mother of five children deciding that they need to move out of the home, but in the process leaving one behind who is later on sexually, I mean, raped by the father. And then at the present moment mother dealing with a fairly traumatic illness that have her, very disable, unable to walk and to work. So, it's sort of like the interview trying to address this different forms of trauma and the way in which the young adults are trying to make sense of their bicultural life and how the whole family is trying to make sense of being bicultural and being immigrants. The session doesn't end with a need or incredible intervention of my part because I feel that this is the part of the therapist to try to decide, this is the family that's been working this therapist for year and half. Therefore, they have a relationship I feel that I need to respect and so those are the basic intercomments. So tell me how is it that you came out with the idea of having this interview with me?
00:04:30
Sharleen
00:04:30
Patti
00:04:30
SANDI Okay. I'm going to go back when Patti came in for the first time. She came in because they were chaos at her household.
00:04:45
Sandi – their therapist
00:04:45
SANDI She came to this country twelve years ago with her four children and one was left behind, her daughter who was 10 years old at that time, eight years old at that time, was left behind. Just two years back, finally they were able to get her visa and she brought her to United States. So ever since she came here chaos was created inside the household.
00:05:20
GONZALO BACIGALUPE So I'm clear, Sharleen you are?
00:05:25
SHARLEEN Her daughter.
00:05:25
GONZALO BACIGALUPE Her daughter. And how old are you?
00:05:25
SHARLEEN I'm 23.
00:05:25
GONZALO BACIGALUPE 23, and how old are your siblings?
00:05:30
SHARLEEN 24.
00:05:30
GONZALO BACIGALUPE And that's sister or brother?
00:05:35
PATTI Sister.
00:05:35
SHARLEEN And then 21-year old sister and 18-year old brother and a 15-year old brother.
00:05:50
GONZALO BACIGALUPE Okay, and which one is the one that stayed there.
00:05:50
SHARLEEN 21.
00:05:50
SANDI 21.
00:05:50
GONZALO BACIGALUPE 21. Okay. All right. Okay. Go ahead, sorry.
00:05:55
SANDI And I met with the entire family for two couple of sessions and she really interested and wanted to be in therapy 21, so.
00:06:10
GONZALO BACIGALUPE What's her name?
00:06:10
SANDI Shireen.
00:06:15
Shireen – the 21 year old sister
00:06:15
emigrated from Iran 2 years ago
00:06:15
GONZALO BACIGALUPE Okay.
00:06:15
SANDI She just felt that she needed the money more than coming to therapy and she refused the entire time and mom tried to she ask her, if she doesn't feel comfortable with me. She said she has had all appointments with other therapists at this clinic, still she refused to come in, but they kept on seeing Patti and the oldest daughter Sheela for about a year and a half now. Ever since then, we started working on the chaos in the household, what is it that creating chaos and I found out that Patti lives with traditional ways of living, their daughters are trying to detach herself from Patti and grow on their own and find their own individuality. So would ask where they have been working on and every since then she had two surgeries.
00:07:30
Patti had surgery on both feet.
00:07:30
SANDI Every thing is started.
00:07:35
GONZALO BACIGALUPE Who had two surgeries?
00:07:35
SANDI Patti had two surgeries on her feet.
00:07:40
Surgery failed – she is disabled.
00:07:40
SANDI And that created more tension, anxiety in the family.
00:07:50
She is in constant pain.
00:07:50
SANDI So — and I have been seeing her after her surgery and she has been referred to a psychiatrist for medication because a lot of time she feels hopeless, helpless, she feels her children are out of control, she can't be in charge, they no need her anymore. So those are the major.
00:08:20
GONZALO BACIGALUPE If you were to describe an accomplishment and you have accomplishment with the therapists during this time. Is there something that you will say, it's an important accomplishment?
00:08:35
SANDI Awareness of the difference between individualist ways of living and collectivistic ways of living and awareness that how they to respect and understand the children are growing in this country and they are going to try to detach themselves from Patti to be able to grow on their own.
00:09:00
GONZALO BACIGALUPE What has been for you this work with Sandi?
00:09:05
PATTI She helped me to understand the kids grow up and left the house and they have been not to depend on them so many times and try to live my life alone and then to take care of my things, my problem in the life and respect them and give them their freedom.
00:09:30
GONZALO BACIGALUPE Do you have a sense that that is sort word that has been accomplished that is more to be done.
00:09:35
PATTI I think I need more to be done, I'm not done. No.
00:09:40
GONZALO BACIGALUPE Do you have of sense of what is that you would like to do?
00:09:45
PATTI Yeah, I'd like to learn to lead my life alone and depend on the kids a lot because in our custom when the parents get old and especially when they are in my situation they can't walk or take care of theirself, the kids are always there for parents, but over here no, they have their own life. And I expect them to be there all of the time for me and they can't, matter of fact, I had a big argument with her last night about that, I had a very bad back for few days I was done and last night, I called her and I said come and spend a night with me and she said no, I can't. I said, you should and you have to and we got into a big argument.
00:10:30
GONZALO BACIGALUPE So, you are on your own right now, you're living in your own and each of the kids have their own place or?
00:10:35
PATTI Three of them, two of the boys lived with me 18 and 15 years old, but the 15 years old was with her for three four days and I was with 18 years old a lot. I feel like they doesn't do enough for me.
00:10:50
SHARLEEN She makes her own plans for me, she expects me to like to go with her and spend time with her because she is bored. I have too much to do, I can't unwind your boredness, find something else to do, but I have plans, I'm 24 and my world around me is happening and I need to be there, I accomplish things. I can't sit down and like chitchat for a whole day.
00:11:15
PATTI And I feel I'm depressed I cannot move, I need them to come and visit me, spend a night with me.
00:11:20
SHARLEEN I spend, I — out of the seven days, I saw her for six days, I make sure, I saw her for six days out of that week. I spent a day with a friend and I got some stuff done and she felt like I owe her something because I didn't spend that time with her. And she did a nice job raising us, she was a wonderful mother, we all suffered through the good and the bad in the family like every family does, but we have all grown up, we can't stay in the nest forever. I'm trying to experience life and my own good or bad, whether you approve it or not, it's my life.
00:11:55
GONZALO BACIGALUPE Sharleen, is this something that you have had a discussion, the three of you, I mean this particular or this is not like?
00:12:00
SHARLEEN I think, I have mentioned to her, but she takes it personal, she doesn't hear me out.
00:12:05
GONZALO BACIGALUPE Is this something that you have had conversations with the family?
00:12:10
SANDI Over and over, yes. Especially with the oldest daughter Sheela, she also, being the oldest, she feels that she has been the parentified child all her life, she has played a role of a man for — in her mother's life and then the entire, I've seen her for about four times right, four, five times and she used to cry the entire time in the session.
00:12:40
GONZALO BACIGALUPE And I realize that you're being very touched by this, I mean this is not something that.
00:12:45
SHARLEEN Yeah, it's something that I strive so hard to accomplish and as soon as I feel like I got her on the right step, there she goes falling depart again asking for like, I give her what I can and she keeps on asking for more and more and that's not how my life works.
00:13:05
GONZALO BACIGALUPE What do you right now? Are you working, studying?
00:13:05
SHARLEEN Yeah, I work and I'm trying to get my license. I'm trying to get accomplish things from now.
00:13:15
GONZALO BACIGALUPE What kind of work are you are doing right now?
00:13:15
SHARLEEN I just — I find promotional jobs and then, I'm trying to get my real estate license.
00:13:25
GONZALO BACIGALUPE And your sister?
00:13:30
SHARLEEN Sheela?
00:13:30
GONZALO BACIGALUPE Sheela, is she also on her own?
00:13:30
SHARLEEN Yeah.
00:13:30
GONZALO BACIGALUPE She is also working, studying? And the 18-year old, what is he doing?
00:13:35
PATTI He is a student.
00:13:40
GONZALO BACIGALUPE In high school?
00:13:40
PATTI Yes.
00:13:40
GONZALO BACIGALUPE So, he is finishing high school right now?
00:13:40
PATTI Yes, this year.
00:13:45
GONZALO BACIGALUPE And is he talking also about leaving home after finishing the high school or what are his plans?
00:13:50
SHARLEEN He is not sure yet, depends on how the family situation is going, you know, everybody looks for happiness and peace of mind, depends like how he feels around the home.
00:14:00
GONZALO BACIGALUPE How about the 15-year old?
00:14:00
PATTI I have lots of problems with him, I don't get long with him at all.
00:14:05
SHARLEEN She has no patience. And she takes it out on other people.
00:14:10
PATTI Because I can't do anything, I walk fewer step and that's it, I have a horrible pain after fewer step. And I have to sit and wait for them to come and give me a glass of water.
00:14:25
SHARLEEN Well, the thing is I want her not to wait for us, I want her to be on her own, I want her to learn how to like, you know there is a — you know superman lost his both feet and he sits on a wheel chair, but he is still going on with life.
00:14:40
PATTI But Superman has money, somebody take care of him all of the time.
00:14:40
SHARLEEN You have to learn how to ease your own mind and not depend on other people. She is forty years old, if she was 60, poor dying lady, I would be more sympathetic, just 40 years old, there is much more for her to experience. It's not time for her to start depending on her children yet. We're only in our 20s, let me live life, let me experience and do what you can, while you can. Give it your best.
00:15:10
GONZALO BACIGALUPE Sharleen, how is that you decided to come today, I mean what's it?
00:15:10
SHARLEEN Because I was with her last week and they asked me to, they invited me to, so I thought maybe you would like help as much as this is helping you.
00:15:20
GONZALO BACIGALUPE Do you have a sense that you are sort of being representative of the other of your siblings that you are coming as a representative for all of them in some way?
00:15:30
SHARLEEN We are all trying to get her to be more positive and feel like do a little step at a day, but try your best to be better, to do a better in life. Every time I try to push her to be more independent and not as much like do that all stuff with her that she could do on her own, she keeps like she has a broken wing that she wants to buoy on us, after a while, it gets heavy. You just want it off because I want to breathe and I want to experience my life. I cannot live like a 20-year old from Iran. I have different things to experience than to sit at home. And the thing is like I don't feel like I can accomplish with her when I'm at home because she is either watching TV or on the phone, which is just like sad people around and I can't hang out like that.
00:16:20
GONZALO BACIGALUPE Besides the — your five kids and yourself, is there anybody else in the family here who immigrated with you guys or –?
00:16:25
PATTI I have a cousin, but they live LA and I don't even talk to them.
00:16:35
GONZALO BACIGALUPE And so, in a way, when you need something, basically the only thing that you feel like you can go for your kids? When you — we're talking about chaos, there have been — there were some chaos about a year and half ago when we start through the work and can you tell me little bit about what the chaos was about or what — how you define that?
00:17:00
SANDI Okay. I just want to mention something about before her surgery Patti has been a very independent women as far as working hard, single mother, raising all her children and they are all proud of her in many ways. When they came she did not have the health problem as far as the pain in her feet, constant pain and feeling hopeless and helpless. They came for a different reason was for Shireen, because Shireen came form Iran and two weeks everything was wonderful, they all re-united, they enjoyed, celebrated for two weeks, and then, she started telling him about the stories that her father abused her sexually, physically and she was abandoned in their house. So, that's where the explosion, the chaos started. Before that —
00:18:05
GONZALO BACIGALUPE When you say that the chaos started, what started to happen?
00:18:05
SANDI They were fighting, constant fighting, screaming, yelling and cursing each other. Before that, my understanding was that kind of was a very peaceful way of living, am I correct in this?
00:18:25
GONZALO BACIGALUPE Okay. All right, so the tension has really sky rocketed after Sheela came back, I mean, two weeks after one, and then, he came out of that — there's been this –?
00:18:35
PATTI As she came back, she was blaming me, why did you left me back home with my dad there, he did all of those things to me. And my husband used to tell her, you was a rotten fruit and she didn't take you, you are a rotten one. She took the good ones and left you behind for me. And she was blaming me for everything.
00:18:55
GONZALO BACIGALUPE When you left, you had separated from your husband?
00:19:00
PATTI No, we were living together my daughter had a medical problem, Sheela and matter of fact, her, and they give me a medical visa to come here and Sheela and Sharleen born here many years ago. And when I went to get a Visa, they told me two of them are American citizen, you have to take them, we cannot say no. And my boys were four years old then 18 months old and Shireen was eight and they said, they decide Shireen should be stayed home and make it sure I'll will be go back. But after I came here, my daughter didn't have any problem any more and they were find and I used to stay here and I decided to live here. And my husband was keep telling me don't come, don't come, stay there, I will come some day and he never sent me any money, he never did anything for us at all except sending the letter 10 pages every single day, what to do, how to leave and how to raise the kids and I throw them all in the trash because I didn't had a time to read them and I didn't had time to practice anything he said and I ignored everything until like six, seven years later, he just wrote a letter, I want you to be back home, you are my wife, I order you to back home and I said, forget about you, I have my life here. And who wants to go back to that life. And I was thrown all of the time to bring Shireen and I couldn't until three years ago. Finally, she came and for couple of days, weeks everything was fine until she started talking about every problem she had back home and for any little mistakes she made, my husband used to beat her up and keep her outside the house for all night and many, many things, the things he used to do to me. And I know what she talking about and what she had to go through, but I couldn't do anything about it. I didn't have the choice. When I came here few week after, few months after I was here I called my dad and I said, I'm worried about Shireen, I afraid to beat her and I'm not there to protect them because I was all this over to protect the kids. Each time he wants to beat them, I was right ahead of them and say, beat me, don't touch my kids, do whatever you want with me. And my dad said you should imagine your house was in the fire, you took four of them off the fire, you left one behind, leave her behind and take care of those four you have and I thought about it, I thought, he is very right, absolutely right, I should take care of the four I have over here. Why should I go back there. He would be — make everybody miserable. I didn't have a very good life but like she said, we all worked together and take care of each other and like I was out all of the time and like Sheela said, she was father of the kid, take care of the kids, take care of the bank account, his groceries, everything. And I used to be a care giver and save it all this and Sheela and Sharleen would stay home and take care of the kids, two younger brother and each other. And everything was okay until Shireen came. And then, after few months, for a couple of years, we had a problem until, thanks god, last May she got married with somebody behind our back.
00:22:25
GONZALO BACIGALUPE Who got married?
00:22:25
PATTI Shireen, we were on the camping three when she ran away with one of my friend's son and got married and she moved out the house and my house is so quiet and I enjoy the life so much except I get so depressed because I feel hopeless and I have so much pain and they can't do anything about my pain, I'm always in pain.
00:22:50
GONZALO BACIGALUPE As you must have seen, when — do you work on how they make sense of what happen to Shireen, I mean, in Iran during the time that she was alone, was that workout with the whole family, they were some sort of a conversation in therapy?
00:23:05
SANDI Yes, I met, as I remember, I met with all of them and they expressed their feelings and shouting, yelling, everything was going on in our session. And they were expressing, Shireen was constantly blaming the mother for all her pain and what happened to her to lead on and a mother tried to explain her situation, the sisters also, brothers also. So, we had few sessions like that.
00:23:35
GONZALO BACIGALUPE What was your sense of how it can — that there were some sort a resolution around that that people were able to make sense that Patti and the kids were able to make sense of this or?
00:23:50
SANDI I was hoping for that, that was my really aim to discover, explore their meanings of the situation and.
00:24:00
PATTI They got in fight, we couldn't keep coming back, I couldn't make them to go back as a family.
00:24:05
GONZALO BACIGALUPE Is it still something that is very hard to talk about or not?
00:24:10
PATTI About the rape you mean?
00:24:10
GONZALO BACIGALUPE Yeah?
00:24:10
PATTI What do you think?
00:24:15
SHARLEEN Well, I'm not very worried about, I mean, it's affecting her life and I feel sorry for her, but I try not to think about it.
00:24:25
GONZALO BACIGALUPE And do you have the sense that that's what anybody else in the family tries to do that tries hard so they doesn't affect?
00:24:30
SHARLEEN Because we already did our crying over it and I'm over it, I'm ready to move on about it.
00:24:40
PATTI It's like when somebody die, you grieve for it. When I heard about it, I was crying and crying and crying for months and months, and then later on, it's something you can't do any thing about this, something happened, what am I going to do about it. I tried to take her to counseling, I take her to Iranian psychologist, 200 dollars an hour. And she would then go back, then what can I do. And I think I'm over with it, I feel sorry for her, but what can I do. My older son doesn't want to talk to this, his dad, nobody wants to contact him or have any relationship or any thing to —
00:25:20
GONZALO BACIGALUPE Has he acknowledged that he did rape her?
00:25:25
PATTI I told him once, and he will start cursing at me and I hang up. I said, I pay a dollar fifty a minute, I don't want to hear your cursing. I want to see what's going on, what happened and you tell me if it happened or not and will start cursing and I hang up. And after that, I never called back, and he is remarried, he married to Iris after Shireen came, during the three years, he got married twice and he has moved on with his life.
00:25:55
GONZALO BACIGALUPE Is there any, I mean, is there a way in which you think, I mean you, Sharleen and maybe some of your siblings, but just from your perspective, is there where you think about how the relationship with your mom should be, is it — do you have a dream for how?
00:26:15
SHARLEEN Yeah, I just wanted her to be more peaceful. I want her to lower her expectations and to accept a lot of things about life.
00:26:25
GONZALO BACIGALUPE What do you mean lower expectations, what?
00:26:25
SHARLEEN Not to expect so much from people, not to — I think what she does is, she thinks of an idea and she reacts on it so so quick without she calming herself down before she like takes the reaction.
00:26:40
GONZALO BACIGALUPE Do you have a sense that your mom thinks that you can do more than what you can actually do?
00:26:45
SHARLEEN I have a sense that she is holding me back from doing all that I could be doing and as soon as I could get excited about her, every time I
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