Intevnship 2

CLINICAL INTERNSHIP REPORT
SUBMITTED TO
Dr.Asghar Ali Shah
SUBMITTED BY
ABDULLAH
DEPARTMENT OF APPLIED PSYCHOLOGY
Advance Diploma in Clinical Psychology
Internship-ll
1
Table of Content.
S.No Page.No
1. Acknowledgement 3
2.Case#1 Social Anxiety Disorder 4
3.Case#2 Specific Learning Disorder 15
4.Case#3 Anxiety (Specific Phobia) 25
5.Case#4 Major Depressive Disorder 34
6.Case#5 Mania Bipolar I Disorder 42
7.Psychometric Scales 53
2
Acknowledgement
“All the world’s a stage and all the men and women merely players: they have
their exits and their entrances; one man in his time plays many parts, his acts being seven
ages.”
Praise to thy Lord who gave me strength and courage to overcome all the difficulties and
hardships and achieve my goal.
Like every person today I’m feeling proud after breathing the blow of a practical side, all this
would never have been possible without my parents who act as a shield to protect me from hard
attacks of life, supported me in achieving my goal. Thank you mother and my beloved father for
everything you people did for me and still doing, I love you so much.
I will like to dedicate this achievement to three persons who played an important role in
developing my professional skill. Thank you Dr.Asghar Ali shah Mam Ayesha & Mam Tayyeba
for continuously guiding and supporting me in every possible way to complete my cases.
My special thanks to my internship supervisor for his facilitating and encouraging attitude.
My sincere thankfulness and gratitude to friends and internship colleagues for their moral
support, encouragement and guidance, this was a big support for me throughout my placement.
Abdullah Sher Muhammad
3
Case # 1
Social Anxiety Disorder
4
Summary
Mr. U.S was 30 years old. He was the 3rd born child in the family of three
brothers and three sisters. His education was graduation. This was the patient’s first psychiatric
admission to this hospital. Now he has symptom of cannot speak in front of others low response
and confident feeling from last 15 days. Client has two previous similar episodes but both were
alternated with depressed symptoms. Client is clearly displaying symptoms of Social anxiety
disorder. .
5
BIO DATA
Name. U.SM
Age. 30 Years
Gender. Male
Religion. Islam.
Qualification. `Graduation.
Profession Assistant Oil Company..
Monthly Income. 30,000
Father Alive /Dead. Alive.
Fathers Profession. Gov. Employ.
Mother Alive/Dead. Alive.
Mother’s Profession. House Wife.
Birth Order 3rd Born
Number of Siblings. 6; 3 Sister, 3 Brother
Material Status. Single.
Family Structure. Nuclear
Socioeconomic Status. Middle Class
Language Known. Urdu /Punjabi
Referral Source. General OPD. Family.
6
Presenting Complaints:
Family History
The client’s father is 50 years old and a government employ. The temperament of his
father was good and relationship between father and client were also good. The father didn’t
have any psychological illness.
The client’s mother was 45 years old. She’s a housewife.
The parents of the client were first cousins .Their marriage was arranged marriage and
their relationship was normal. The mother didn’t have any psychological illness.
The client had six sibling’s, including him.
The client was born on 3rd number.
Pre-morbid Personality:
Pre-morbidly, client is reported during the present in an organization
in front of other he feel everyone notice me so during present the material he feels confused and
cannot continue his material .He was good in maintaining interpersonal relationships. Client had
positive stress coping as he used to share his problems with his siblings especially his brothers
and parents.
7
General Home Atmosphere
The general home atmosphere was good. Client had good relation with family.
Belonged to the middle class. The family system was nuclear and the authoritative figure was his
father.
Personal History
The client was born through normal delivery. The health of both, client and his mother
was quite satisfactory. The client did cry immediately after his birth. His family was happy to
have him. He didn’t suffer from any injuries or any accident and he achieved his milestones at
the appropriate age level. He wasn’t suffered from any neurotic traits in his childhood.
Education
The client had his graduation.
Occupational History
Client was an employee
Marital History
Client wasn’t married
Drug History
No drug history
History of present illness
. Clients father reported that client has experienced two previous episodes
similar behavior but both were alternated with periods of intense sadness and low mood. He
wants to live alone and never talk with any one.
8
Mental Status Examination (MSE)
Mr. U.S a young man of 30 years old, was physically in good
health. His hygienically condition was appropriate as he was wearing neat dress He had excellent
orientation of time place and person. He knew about his name ,present date and name of place
where he lived. There was no disturbance in his thought. He was hopeless about everything in
life.
Tests Administered:
• House tree person(HTP)
• Beck Anxiety Inventory (BAI)
Diagnostic Interpretation of Test Results:
one of projective test revealed that client has delusion
or grandiosity. He has high self-esteem along with strengthened ego functioning .Rating scales
indicates high level of social anxiety. Client scored 39 on BAI which shows severe anxiety.
Tentative Diagnosis
According to presenting complaints and the results of different test shows that he is suffering
from social Anxiety Disorder
Diagnostic Criteria 300.23 (F40.10)
Prognosis:
Client has good prognosis.
9
Management Plan
 Supportive therapy
 Cognitive behavioural therapy
 Family therapy
 Group Therapy
Short Terms Goal
 Supportive Therapy
 include setting specific tasks to complete in a short period of time, such as going grocery
shopping, or looking for a job that will help the patient gain independence,
 Assertiveness Training will be carried out to teach him effective ways of getting involved
in social situations and improve confidence level
Long Term Goals
Family Therapy would be conducted to ensure his family members are looking after the client
and motivate the client for social situations
The most favorable treatment for long-term relief from anxiety disorders is therapy--specifically
cognitive-behavioral therapy, or CBT. To teach that thought influences behavior, which in turn
influences action; by exploring the causes of a person's anxiety, it is possible to discern the steps
leading up to the episode and teach that person how to change his behavior once he recognizes
what is happening.
10
Case Formulation:
The trigger of the bio-psychosocial model refers to the body's physiological, adaptive responses
to fear. It also refers to genetic traits, and the brain functioning that we "inherit."
According to defense model anxiety is seen as protection against psychological state .In this
case Mr. U.S anxiety state also serves as a protective function .According to second model
anxiety reflects a disturbance in the reward systems of the brain .Research has indicate that
people with social anxiety disorder bipolar disorder themselves.
The client belongs to a middle class family. His father and mother both are
alive. Client has good and friendly relations with his parents. His mother is a house wife. He has
6 siblings (3 brother and 2 sisters) and two of them are married. Client is 3rd born child. He was
pampered by parents. He was attached to his mother. His family has good, loving and warm
attitude towards him. No family member has been reported as suffering from any psychological
problem. He was running his own work of generators was quite hopeful to get success in future.
Client’s current problem started 7-8 months before when he present in front of others. Since that
day client has gone without any sleep and has spent this time in a heightened state of activity
which he himself describes as out of control. Client attendant reported that client has experienced
two previous episodes similar behavior but both were alternated with periods of intense sadness
and low mood. He wants to live alone and never talk with any one.
11
Sessions:
Session-I
This session lasted for 30 minutes. In the first session, I had the bio data and history of the client.
And also started rapport building slowly. My client is 30 years old male, belonged to middle
class status. He had six siblings. He was third born child among his siblings. His education was
till graduation.
Session – II
In the second session, I had the presenting complaints and family history of the client
and also started rapport building slowly with the client.
The client had low confidence, periods of intense sadness and low mood. He wants to live alone
and never talk with any one. he had good relation with father and mother both as reported by the
father.
Session- III
This session lasted for 35 minutes. The main focus of this session was to establish rapport
with the client. Client was very enthusiastic and in good state. Mini Mental State Exam (MMSE)
was done in order to check his orientation and thought process. Personal information along with
a little history was also recorded.
Session-IV
This session lasted also for 35 minutes. During this session more detailed history starting from
childhood till was taken from client and attendant both. HTP was applied to know any social and
psychological problem. Therapists was applied BGT to check brain impairment of clients.
12
Session-V
This session lasted for 45 minutes. Through family Therapy, client’s family was
given insight about client’s illness, symptoms, duration and its effect on family. It was also
suggested to follow the treatment compliantly and regularly. For diagnostic support, Beck
depressive inventory and Beck Anxiety Inventory were applied during this session.
Session-VI
This session lasted for 40 minutes. Follow up sessions along with regular
treatment were suggested weekly. Cognitive behavioral therapy (CBT) was applied. At the start
of session the client feeling were explored and client how he is feeling and client reported that he
is feeling much better but he still feels little bit uncomfortable in social situation but less then
before. So “ABCDE” model was given to the client. Because it was essential for client to
identify the event that triggers the negative emotional belief. During this session assertive
training technique Positive visualization was given to him to practice assertiveness. At the end
therapist suggest him to continue this practice on daily bases because it provides him relief.
Session-VII
Person centered therapy (PCT) were used to provide insight about the illness and
its duration. Previous session’s feedback was given to the patient.
13
Session-VIII
After carried out feedback about the last session the technique of role playing was
given to client it give him courage to face how to manage the situation. . The role playing
technique was very affective for the client as this way than the client was given insight about his
problem how he reacts to the situation.
Session IX:
After carried out feedback about the last session Exposure Therapy was applied.
Problem solving technique was also used to change the areas of client person life that are
creating significant distress.
Session X:
The client was very happy about the previous session and reported that he feel
satisfied and have accomplished all the activities that were assigned to him. This was termination
session. Client was happy and satisfied. Also informed the client to have a normal routine
session again after a month or two months.
14
Case#2
Specific Learning Disorder
Dysgraphia or Writing Disorder
15
Summary
Ms. RM.F was 10 years old. She was student in 2nd class. She was the 3rd born child
in the family of 3 sisters and 1 brother. She has the symptoms like difficulties in use of writing
and she also had difficulty in conversation. Client mother reported she is depressed in this state
and spent mostly time alone and only play with her toy. She cannot write properly. She is shy to
speak in front of others .Client is clearly displayed the symptoms of childhood onset writing
disorder low intelligence
16
BIO DATA
Name. RM.F
Age. 10 Years
GENDER. Female.
Qualification. 2nd Class Student
Profession Student.
Monthly Income. Nil
Fathers Profession. Army Employ.
Birth Order. 3rd Born.
Number of Siblings. 4; 3 Sister, 1Brother
Religion ISLAM
Family Structure. Nuclear
Socioeconomic Status. Middle Class family.
Language Known. Urdu / Punjabi.
Referral Source. General OPD.
17
Family history
The client belongs to a middle class family. Her father and mother both are
alive. Client has good and friendly relations with her parents. Her mother is a house wife and her
family structure is nuclear .She has 4 siblings (1 brother and 3 sister) .Client is 3rd born child.
She was attached to her mother. Her family has good, loving and warm attitude towards her No
family member has been reported as suffering from any psychological problem.
The general home atmosphere was good. Client had good relation with family but she
was not good in maintaining interpersonal relationships. Belonged to the middle class. The
family system was nuclear and the authoritative figure was his father.
Personal History
The client was born through normal delivery. The health of both, client and her mother
was quite satisfactory. The client did cry immediately after his birth. Her family was happy to
have her.She didn’t suffer from any injuries or any accident and she achieved her milestones at
the appropriate age level. She wasn’t suffered from any neurotic traits in her childhood.
Education
The client was studying in class three .
18
Nil
Marital History
single
Drug History
No drug history
. Client’s current problem is that she is not cooperative and her behavior is
aggressive. She is 10 years old but her attitude is not like normal student , she does not pay
attention in her studies. Client mother and teacher reported she is feeling shy in front of other and
not responding to question as she also has low mood.
Pre-morbidly, client mother reported she is introverted and never talk and do
not attention to her studies especially , when she writes she is confused and never learn the
lesson. She was not good in maintaining interpersonal relationships. She wants to live alone and
she is attached with her mother.
19
Psychological Assessment:
Mental State Examination (MSE)
Miss RM.F a child of 10 years old. She was physically in good health. Her appearance was good
and she was wearing neat dress. She had low orientation of time, place and person. She was
hopeless about everything in life .She could not Spoke or Write properly
Tests Administered:
• Bendered Gestalt Test (BGT)
• Draw A Clock (DAC)
One of projective test reveals that client has introverted .MMSE that she has poor orientation
about things. Poor performance in written. On this administration of the Bender-Gestalt, the
client’s performance was as follows: The clients drawings were placed on the page in a
disorganized manner. Figure size was variable and use of space on the sheet was constricted.
Line quality was poor, with excessive movement and poor figure construction. Frequently, client
would complain that the figure was too hard to draw. She was encouraged to keep trying. The
protocol was significant for Simplification, Retrogression, Closure Difficulty, Motor
Incoordination, and Impotence. Such findings were consistent with the client’s low level of
functioning as found on formal ability testing.
20
Tentative Diagnosis
According to presenting complaints and the results of different test shows that she is suffering
from Dysgraphia Disorder
Diagnostic Criteria 315.2 (F81.81)
Prognosis:
Client has normal prognosis.
Management Plan
 Occupational therapy
 Family therapy
 Group Therapy
Short Terms Goal
 include setting specific tasks to complete in a short period of time, such as writing daily
two to three pages
 Use physical accommodations; include pencil grips, erasable pens, and paper with raised
lines, all of which help students with dysgraphia work on handwriting skills. Graph
paper, which provides visual guidance for spacing letters and numbers, is also useful.
Long Term Goals
and motivate the client and Teach typing. This is an absolutely life-saving strategy for any child
with dysgraphia. Invest in a well-regarded children’s typing program, such as Typing Instructor
for Kids.
21
Case Formulation:
The intelligence disorder is triggers of severe disorder appear quite similar to the triggers of
major disorder. IN this disorder child feel shy in front of other and can’t express her thought in
front of other. Child IQ level is low and not responding to answer the question. Ms. RM.F was
10 years old. She was student in 2nd class. She was the 3rd born child in the family of 3 sister
and 1 brother. She has the symptoms like difficulties in use of writing language limited sentence
structure and she also had difficulty in conversation with her friend. .Client mother reported she
is depressed in this state and spent most of time alone and only play with her toy. She cannot
express her feeling verbally or writing .She can’t, speak front of others .Client is clearly
displayed the symptoms of childhood onset writing disorder low intelligence.
Diagnostic Sessions
Session-I
This session lasted for 40 minutes. In the first session, I had the bio data and history of the client.
My client is 10 years old female, belonged to middle class status. She had four siblings and was
third born child among her siblings. She was studying in grade 2.
Session – II
In the second session, I had the presenting complaints and family history of the client
and also started rapport building slowly with the client.
The client was shy , had low mood and had problem in writing. She wants to live alone and
never talk with any one. She had good relation with mother more as reported by the father.
22
Session-III
This session lasted for 40 minutes. The main focus of this session was to establish
rapport with the client more. Started the session by taking history from the client and clients
parents. Client was highly elevated state. . Mini Mental State Exam (MMSE) was done but she
does not recognize the thing correctly.
Session-IV
This session lasted also for 40 minutes. During this session more detailed history starting from
childhood till was taken from client and attendant both. Intelligence test which show the client
low intelligent level Therapist recorded detailed history of client and inquired.
Session-V
This session lasted for 45 minutes. Through Family Therapy was given
insight about client’s illness symptoms duration and its effect on family .It was also suggested to
follow the treatment compliant regularly.
Session VI
This session last 40 minutes. Worked to improve the hand strength and fine motor
coordination needed to type and write by hand. Also worked to learn the correct arm position and
body posture for writing.
Session VII
This session last 40 minutes. In This session I , tried out pencil grips and other
tools that may make writing easier. I suggest her parents to have tools to help with
handwriting and graphic organizers to help with writing assignments. And try strategies for
self-regulation in writing.
23
Session VIII
This session last 30 minutes. In This session I gave some instructions to family
giving some home assignments to be completed by the client by the help of parents.
Session IX
This was terminating session. The results are positive. Client learnt different
techniques. Her Family also learned how to manage and how to help her.Parents were suggested
to have clients sessions again after a two months
24
Case#3
Anxiety (specific phobia)
25
Summary
Mr. S.M. was 30 years old. He was the 5th born child in the family. He has done
education till matric. Now he has the symptoms like, restlessness, terrified, scared, hear
pounding, sweating and fear of losing control when the client listen the news of death of
anybody. One of projective test revealed has client that immaturity and aggression and poor
inner control. Beck Anxiety inventory result indicated severe anxiety. The client suffered with
specific phobia severe without psychotic features.
26
BIO DATA
Name: S.M
Age: 30 Years
Gender: Male
Religion: Islam
Qualification: Matric
Profession Solider
Monthly income 25,000
Father Alive/Died Died
Father profession Had a private job
Mother Alive/died Alive
Mother’s Profession: House-wife
Birth Order: 5th born
Number of Siblings: 6;3 sisters, 3 brothers
Marital Status: Single
Family Structure: Nuclear
Socioeconomic Status: Middle Class
Language Known: Urdu
27
Family history
The client belongs to a middle class family. His father is no more and mother
is alive. Client has good and friendly relations with his parents. Her mother is a house wife and
her family structure is nuclear .He has 6 siblings.Client is 5th born child. He was attached to his
mother. His family has good, loving and warm attitude towards him. No family member has been
reported as suffering from any psychological problem.
Belonged to the middle class. The family system was nuclear and the authoritative figure was his
elder brother.
Personal History
The client was born through normal delivery. The health of both, client and his mother
was quite satisfactory. The client did cry immediately after his birth. His family was happy to
have him. He didn’t suffer from any injuries or any accident and he achieved his milestones at
the appropriate age level. He wasn’t suffered from any neurotic traits in his childhood.
Education
The client had his education till matric.
28
Soldier
Marital History
Single
Drug History
No drug history
. Client’s current problem is that he fear and lose control when the client listen
the news of death of anybody
Pre-morbidly, client is reported to be an extrovert person with many

friends. He was good in maintaining interpersonal relationships. Client had responsible and
moderate religious beliefs.
Mental State Examination

Mr. S.M, a man of adulthood of 30years, was physically in good
health. His hygienically condition was appropriate as he was wearing neat dress. He had good
orientation of time, place and person. He knew about his name, present date, and name of place
where he lived. There was no disturbance in his thoughts.
Tests Administered:
Human Figure Drawing (HFD)
29
Beck Anxiety Inventory (BAI)
One of projective test revealed has client that immaturity and aggression and poor inner control.
Beck Anxiety inventory result indicated severe anxiety. The client suffered with specific phobia
severe. Client scored 38 on BAI.
Tentative Diagnosis:
The client is sufferring from specific phobia. 300.29(F40.228)
Prognosis:
Management Plan
 Family therapy
 Terror management theory" (TMT)
Short Terms Goal
 include setting specific tasks to complete in a short period of time, such as going for
some ones condolence or having control on self-emotion that will help the patient gain
independence.
 Assertiveness Training will be carried out to teach him effective ways of getting exposure
to feared themes related to death.
30
Long Term Goals
and motivate the client for such situations
what is happening.
Case Formulation:
Mr. S.M. was 30 years old. He was the 5th born child in the family. His education
had done matric. This was the patient’s first psychiatric admission to the hospital. The client has
suffered from specific phobia. The client showing the symptoms of restlessness, Terrified,
scared, hear pounding, sweating and fear of losing control when the client listen the News of
death of anybody. The client showing these symptoms from one year after the death of father.
31
Sessions
Session-I
This session lasted for 40 minutes. The main focus of this session was to
establish rapport with the client. Started the session by taking presenting complaints from the
client it was an introductory session.
Session- ll
In the second session, I had the presenting complaints and family history of the client and also
started more rapport building slowly with the client. The client used to have fear when used to
hear death news of any one.
Session lll;
Mental State Exam (MMSE) was done in order to check his orientation and thought
process. Personal information along with a little history was also recorded in this session. The
session lasted 30 minutes.
Session-IV
This session lasted also for 30 minutes. During this session more detailed
history starting from childhood till was taken from client and attendant both. Human Figure
Drawing (HFD) .
Session- V:
Beck anxiety inventory (BAI) was applied in this session .
Client’s attendant reported about previous episodes of anxiety during this session. I
Recorded detailed history of client and inquired about the previous psychiatric episodes in depth.
Session-Vl:
In this session the instruction about CBT and Exposure Therapy was given to
client. The session remained 35 minutes.
32
Session- Vll
A different technique of Exposure therapy was applied in this session different

exercises was done by client and I said to him to repeat all these exercises at home.
Session -VIll
In This session CBT was applied, client learned how to change his behavior How to
cope the panic situation. The session lasted 40 minutes
Session -IX
It was terminating session it remained 25 minutes. Client gave positive results so

the therapeutic process was ended.
Gave some management plans that how to further cope with such situations and informed the
client to visit again after a month.
33
Case #4
Major Depressive Disorder
34
Summary
Mr. K.H. was 17 years old. He was the 5th born child in the family. He has 4 siblings (2 brother
and 2 sisters) and two of them are married His education had intermediate. One elder sister has
been reported as suffering from one psychological problem. Now he has the symptoms of low
mood, irritability, social withdrawal, unmanageable aggressive behavior due to his financial
issue. The client describes himself feeling something is wrong left ear and sound of noise in ear
and headache. Attendant reported that client having these symptoms from one years. These
symptoms become severe in last two week. One of projective test revealed has client that
insecurity feeling dependency and isolation. The client has tendency to develop hysteric and
manic episodes. Beck depression inventory (BDI) and Beck Anxiety Inventory (BAI) result
indicated severe depression and moderate anxiety.
35
BIO DATA
Name: K.H
Age: 17 Years
Gender: Male
Religion: Islam
Qualification: Matric
Profession Student
Monthly Income Nil
Father Alive/Died Alive
Father’s Profession Driver
Mother Alive/Died Alive
Mother’s Profession: House-wife
Birth Order: 3rd born
Number of Siblings: 4; 2 sisters, 2 brothers
Marital Status: Single
Family Structure: Nuclear
Socioeconomic Status: Lower Middle Class
Language Known: Urdu
Date of Assessment: 14 march 2016
Referral Source: BBH
36
Presenting complains
Family history
The client belongs to a middle class family. His father and mother both are alive.
Client has good and friendly relations with his parents. Her mother is a house wife and her
family structure is nuclear .He has 4 siblings. Client is 3rd born child. He was attached to his
brother more . His family has good, loving and warm attitude towards him. In family members
one elder sister was reported with some psychological problems she used to have some depress
mood according to the sisters report said by the brother.

friends. He was not that good in maintaining interpersonal relationships after the problem started
one year later. Client had responsible and moderate religious beliefs.
Mr. K.H, a man of adolescence of 17years, was physically in good health. His
hygienically condition was appropriate as he was wearing neat dress. He had good orientation of
time, place and person. He knew about his name, present date, and name of place where he lived.
There was no disturbance in his thoughts. He had one problem in thoughts due to financial issue.
37
Tests Administered:
 Mini-Mental State Examination (MMSE)

 House Tree Person(HTP)
 Beck Depression inventory (BDI)
 Beck Anxiety Inventory (BAI)

The client suffered with MDD .One of test’s results showed that client does not have any brain
organicity or impairment. His orientation and concentration level was good. One of projective
test revealed has client that insecurity feeling dependency and isolation. The client has tendency
to develop hysteric and manic episodes. Beck depression inventory (BDI) and Beck Anxiety
Inventory (BAI) result indicated severe depression as client scored (36) and moderate anxiety as
client scored (28) on BAI.
Tentative Diagnosis:
The client suffering from major depressive disorder. Moderate (p.188) single episodes
296.22(F32.1)
Prognosis:
Management Plan
 Family therapy
 Group therapy
38
Short Terms Goal
 include setting specific tasks to complete in a short period of time, such as to learn coping
skills or having control on self-emotion that will help the patient gain independence.
 Assertiveness Training will be carried out to teach him effective ways of problem
solving skills .
Long Term Goals
and motivate the client for such situations and not getting irritated from things.
learn to identify maladaptive, negative thoughts and how to replace them with more positive,
adaptive thoughts.
what is happening.
Case Formulation
Mr. K.H. was 17 years old. He was the 5th born child in the family. He has 4 siblings (2 brother
and 2 sisters) and two of them are married His education had intermediate. One elder sister has
been reported as suffering from one psychological problem. Now he has the symptoms of low
mood, irritability, social withdrawal, unmanageable aggressive behavior due to his financial
issue. The client describes himself feeling something is wrong left ear and sound of noise in ear
and headache. Attendant reported that client having these symptoms from one years. These
symptoms become severe in last two week.
39
Diagnostic Sessions
Session-I
This session lasted for 30 minutes. The main focus of this session was to establish rapport with
the client. This was an introductory session had the bio data from the client .
Session- ll
In the second session, I had the presenting complaints and family history of the client and also
started more rapport building slowly with the client. The client used to have low mood,
irritability, social withdrawal, unmanageable aggressive behavior due to his financial issue.
Session-lll
This session lasted also for 35 minutes. During this session more detailed history
starting from Childhood till was taken from client and from the parents and sibblings.
Session- IV
It was a 25 minutes session because clients attendant has some emergency at home so they wants
to leave early .Mini Mental State Exam (MMSE) was done in order to check his orientation and
thought process in this session..
Session -V
In this session though rapport building was established so I talked to client to tell
him briefly about therapies and tried to counseled him. I told him that it is mutual corporation
work so if you will co-operate with then will be able to get desirable results. So in this 40
minutes session we talked about therapies and guideline and I told him about different techniques
like de breathing and I council him to put his energy toward positive activities.
Session-Vl
In this session House Tree Person (HTP) was applied.
Client’s parents reported about previous depressive .Episodes during this session the subject
received a short, unclear instruction to draw a house, a tree, and the figure of a person. Once the
subject is done, they are asked to describe the pictures that they have done. I recorded detailed
history of client and inquired about the previous psychiatric episodes in depth. This session last
30 minuets’ gave him an assignment in this session
40
Session -VIl
In this session (BAI) and Beck depression inventory was applied on the client and
result was calculated. Home assignment was checked he did very well
Session VIlI
It was a counseling session. It remained 40 minutes. I tried to council him. in this

session different techniques of CT was applied.
1) Focus on automatic thoughts and depressogenic cognitive styles;
2) Focused on the way in which the person relates to others; and
3) The behavioral changes necessary to enable the individual to recover from the problem
situation.
Session- IX
It was terminating session, The Therapeutic process was ended. The desirable
goals were archived, Some management plans were given and also informed client to visit after 1
and half month.
41
Case # 5
Mania Bipolar I Disorder.
42
Summary
Ms A.Y. was 19 years old.. She was the 1nd born child in the family of 2
sisters and 3 brothers. Her education was matric. This was the patient’s first psychiatric
admission to the hospital. Now she has the symptoms like, hyper activity, exaggerated response,
overly confident and superiority feelings from last six days. One of projective test revealed that
client has delusion of grandiosity. She has high self-esteem along with strengthened ego
functioning. Rating scale’s result indicted moderate level of mania.
43
BIO DATA
Name. A.Y
Age. 19 Years
Gender. Female
Religion. Islam.
Qualification. Matric.
Profession Nil
Monthly Income. Nil
Fathers Profession. Driver.
Birth Order. 1st Born.
Number of Siblings. 5, 2 Sister, 3 Brother
Family Structure. Joint.
Socioeconomic Status. Lower Middle Class.
Language Known. Urdu /Pashto.
Referral Source. Father.
44
Family History
The client’s father is 47 years old a driver. The temperament of his father was good and
relationship between father and client were also good. The father didn’t have any psychological
illness.
The client’s mother was 41 years old. She’s a housewife.
The parents of the client were first cousins .Their marriage was arranged marriage and
their relationship was normal. The mother didn’t have any psychological illness.
The client had five sibling’s, including him.
The client was born on 1strd number.
Belonged to the Lower middle class. The family system was nuclear and the authoritative figure
was his father.
Personal History
The client was born through normal delivery. The health of both, client and her mother
was quite satisfactory. The client did cry immediately after his birth. Her family was happy to
have her.She didn’t suffer from any injuries or any accident and she achieved her milestones at
the appropriate age level. She wasn’t suffered from any neurotic traits in his childhood.
45
Education
The client had her education till matric .
Nil
Marital History
Client was engaged
Drug History
No drug history
. Client’s current problem started 8 days ago when she had an argument with her
mother in law. Since that day client has gone without any sleep and has spent this time in a
heightened state of activity’. Her behavior is characterized by strange and grandiose ideas that
often take on a supernatural tone. Client’s attendant reported that client has experienced two
previous episodes similar behavior but both were alternated with periods of intense sadness and
low mood. Her father also reported that when client is in depressed state, she does not properly
involve her house work and she restrict herself in a house.
46
friends. She was good in maintaining interpersonal relationships. Client had positive stress
coping as he used to share her problems with her sibling specially her mother.
Psychological Assessment
Mental State Examination (MSE)
M.S A.Y is a young girl of 19 years , was physically in good health. Her
hygienically condition was appropriate as she was wearing neat dress. There were no signs of
motor retardation and she entered room with a proper gate. She had good orientation of time,
place and person. She knew about hers name, present date, and name of place where she lived.
There was no disturbance in her thoughts. She had one problem in thoughts that she was too
positive about outcomes of things and was too motivated in every aspect of life. She was hopeful
about everything in life. She spoke at high rate, rhythm and volume. She had little insight about
her problem. The client has more religiosity thinking.
Tests Administered:
• House Tree Person (HTP)
• Young Mania Rating Scale (YMRS)
47
One of projective test revealed that client has delusion of grandiosity. She has high self-esteem
along with strengthened ego functioning. Rating scale’s result indicted moderate level of mania.
Client scored 22 on YMRS.
Tentative Diagnosis
Client is suffering from Mania Bipolar I Disorder Mild(p.154) 296.41(F31.11)
Prognosis:
Management Plan
 Family therapy
 Group Therapy
Short Terms Goal
 include setting specific tasks to complete in a short period of time, such as Be out of bed
by __:00 am.
 Finish one household chore.
 Assertiveness Training will be carried out to teach her effective ways of getting involved
in social situations and improve confidence level
48
Long Term Goals
and motivate the client for social situations
Get training or experience for a job.
Change a situation, e.g., find a new place to live.
Build a relationship with a friend or family member.
Cognitive therapy. involving learning to identify and modify the patterns of thinking that
accompany mood shifts.
Case Formulation:
Ms A.Y. was 19 years old.. She was the 1nd born child in the family of 2 sisters and 3 brothers.
Her education was matric. This was the patient’s first psychiatric admission to the hospital. Now
she has the symptoms like, hyper activity, exaggerated response, overly confident and superiority
feelings from last six days. One of projective test revealed that client has delusion of grandiosity.
She has high self-esteem along with strengthened ego functioning. Rating scale’s result indicted
moderate level of mania.
According to Manic defense Model, mania is seen as protection against painful psychological
state. In this case, Miss A.Y. Manic state also serves as a protective function.
49
Diagnostic Sessions:
Session 1
In the first session I had the bio data of the client as it was a introductive session. client
was showing hesitation and feeling uncomfortable at the start of the session. She felt alone and
quiet hopeless. I asked and discussed about her interest likes and dislikes. Personal information
along with a little history was also recorded. Client showed hesitant behavior. Rogers’s
technique approach was utilized in this session by giving warmth to the client in form of care,
respect. Unconditional positive regards was given to the client it’s helped to develop rapport with
the client and boosting up her courage when the rapport was developed with client then she was
relaxed and remains cooperative. The basic aim of this session was to establish rapport and
interview patient about his insight and symptoms with the help of MSE (Mental Status
Examination).
Session II
During this session more detailed information was taken by me. The focus of this session
was on past history of complaints and personal family, educational, occupational history. Her
attitude with her friends, siblings and parent’s class performance, History of problem, severity
level and duration of the problem was also discussed with them. This session is lasted for 40
minutes. As client at the start of session the client was unable to communicate well due to feeling
anxious and irritability but the implication of techniques of warmth, care and unconditional
positive regards helped the client to feel relaxed and feel comfortable during the session.
Session III
In this session had some discussions with the parents to know about her activities and
daily routine before and after the problem started with the client and had more detailed session
with client so that more rapport could be built.
50
Session IV
After carried out feedback about the last session I suggested to have HTP from the client.
.I recommend her to keep an activity scheduling log further recommend her to write down about
her thoughts that comes into her mind as home task to show me on the next session.
Session V
After carried out feedback about the last session assigned a task Wrote a self-Statements
to Counteract Negative Thoughts Client reported that this was hard to her, At the end client
reported that In the beginning, it was difficult to accept these replacement thoughts, but the more
she brought out these positive thoughts to counteract the negative ones, the stronger the
association was made and she felt relax. During this session also laughing therapy technique
clapping & warming up, just laugh and argument laughter was apply with client because it is an
excellent way to reduce stress in our lives.
Session VI
At the start of session the client feeling were explored and client reported that she is
feeling much better. So Talk therapy was also used in this session to discuss feelings, thoughts,
and behaviors that cause problems. Talk therapy was used to help understand and hopefully
master any problems that hurts client ability to function well in life and career.
Session VII
After carried out feedback about the last session CBT was applied for learning to
identify and modify the patterns of thinking that accompany mood shifts.. During this session,
horticultural therapy was given to client because it help him in reducing stress.
51
Session VIII
The client was very happy about the previous session and reported that she feel satisfied and
have accomplished all the activities that were assigned to her but anger is not controllable, Anger
management technique used with her to decrease the heightened emotional and physiological
arousal that associated with anger. Problem solving technique was also used to change the areas
of client person life that are creating significant distress. I asked her to elaborate desired changes,
the reason behind desired change, and the steps that she will take in order to achieve change in
future. After this technique application she reported easy to cope with problems.
Session IX
In this sessions we had the Monitoring your mood. It was done through a worksheet which is
kept up on a daily basis between sessions and then reviewed with therapist. client was asked to
rate her mood daily on a 0-to-10 scale, in which 0 represents “depressed,” 5 stands for “feeling
OK,” and 10 is equivalent to “highly irritable or elevated mood.” The purpose is to become more
aware of mood triggers and changes.
Session X
The last session was carried out with the client and the feelings of the client were explored the
client felt very relaxed and better about herself during the session. The Client was told to follow
up the session after a month . During this session CBT technique Learn to accept disappointment
was used by me. Did a family therapy, psycho educate her family about client situation and
asked if they are supportive it will boost their loved one's health and chances of recovery as well.
During this session therapist give her task to write down the advantage and disadvantage of their
particular behavior. This approach helped him to move away from negative thoughts and to
have control on thoughts and ideas.
52
PSYCHOMETRIC SCALES
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CLINICAL INTERNSHIP REPORT

Dr.Asghar Ali Shah

DEPARTMENT OF APPLIED PSYCHOLOGY

Advance Diploma in Clinical Psychology

2.Case#1 Social Anxiety Disorder 4

3.Case#2 Specific Learning Disorder 15

4.Case#3 Anxiety (Specific Phobia) 25

5.Case#4 Major Depressive Disorder 34

6.Case#5 Mania Bipolar I Disorder 42

Abdullah Sher Muhammad

Profession Assistant Oil Company..

Monthly Income. 30,000

Father Alive /Dead. Alive.

Fathers Profession. Gov. Employ.

Mother Alive/Dead. Alive.

Mother’s Profession. House Wife.

Birth Order 3rd Born

Number of Siblings. 6; 3 Sister, 3 Brother

Material Status. Single.

Family Structure. Nuclear

Socioeconomic Status. Middle Class

Language Known. Urdu /Punjabi

Referral Source. General OPD. Family.

The client’s mother was 45 years old. She’s a housewife.

The client had six sibling’s, including him.

The client was born on 3rd number.

Pre-morbidly, client is reported during the present in an organization

The client had his graduation.

Client was an employee

Client wasn’t married

History of present illness

wants to live alone and never talk with any one.

Mr. U.S a young man of 30 years old, was physically in good

• House tree person(HTP)

• Beck Anxiety Inventory (BAI)

Diagnostic Interpretation of Test Results:

one of projective test revealed that client has delusion

Diagnostic Criteria 300.23 (F40.10)

Client has good prognosis.

Short Terms Goal

Long Term Goals

people with social anxiety disorder bipolar disorder themselves.

a little history was also recorded.

its duration. Previous session’s feedback was given to the patient.

problem how he reacts to the situation.

creating significant distress.

session again after a month or two months.

Specific Learning Disorder

Dysgraphia or Writing Disorder

Qualification. 2nd Class Student

Monthly Income. Nil

Father Alive /Dead. Alive.

Fathers Profession. Army Employ.

Mother Alive/Dead. Alive.

Mother’s Profession. House Wife.

Birth Order. 3rd Born.

Number of Siblings. 4; 3 Sister, 1Brother

Material Status. Single.

Family Structure. Nuclear

Socioeconomic Status. Middle Class family.

Language Known. Urdu / Punjabi.

Referral Source. General OPD.

General Home Atmosphere