BLOCK PLACEMENT REPORT

Submitted to

Centre for Adult Continuing Education & Extension (CACEE)

University of Kerala, Thiruvananthapuram

in partial fulfillment of the requirements for the award of

Post Graduate Diploma in Counselling Psychology

By

VISHNU AJAY
Reg No :

CACEE UNIT
T. K. M. COLLEGE OF ARTS AND SCIENCE
KOLLAM

2023

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 CERTIFICATE

This is to certify that this Block placement report is a bonafied record of the work
carried out by Mr. VISHNU AJAY under my guidance and supervision and that no part of it
has been submitted for the award of any degree, diploma or other similar title of recognition.

Kollam, Supervising Teacher

15-06-2023. Dr. A. R.Unnikrishnan

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 DECLARATION

I, Vishnu Ajay, do hereby declare that this Block placement report is a bona fied record of the
work carried out by me and no part of it has been submitted for the award of any degree,
diploma or similar titles of recognition.

Kollam Vishnu Ajay

15-06-2023.

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 ACKNOWLEDGEMENTS

I would like to express my heartfelt gratitude to Dr. A. R. Unnikrishnan, our respectful

faculty and guide of Post Graduate Diploma in Counselling Psychology for his valuable
guidance and assistance given for the completion of Block Placement Report.

I express my sincere gratitude to other facilities namely Dr. S. Raju, Dr. Jayaraj B, and Dr.
Sajimon P. P. for their valuable assistance and suggestions which enhanced the level of my
knowledge and learning in counselling psychology.

I would like to extend my gratitude to Dr. Alfred V. Samuel, Dr. Anupama Priyankari,
psychologist Mr. Reny Patric and psychologist Mr. A. B. Sreekanth who belong to psychiatry
department in Holy Cross Hospital, Kottiyam for their kind cooperation and willingness to
share knowledge extended to me during the internship programme.

I express my sincere gratitude to our coordinator Prof. Shajitha S. and Mr. Sarath, non
teaching staff, continuing education unit T. K. M. College Kollam for providing the
necessary facilities for the completion of the programme.

Above all, I will always be grateful for the love, care and support provided by my classmates
during the course as well as the internship programme.

Kollam Vishnu Ajay

15-06-2023

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 TABLE OF CONTENTS
TITLE PAGE NO.

i. INTRODUCTION 6

ii CASE STUDIES

Case study – 1 7-9

Case study – 2 10 -13

Case study – 3 14 -16

Case study – 4 17 - 19

Case study – 5 20 - 22

iii. SUMMARY AND CONCLUSION 23

iv. APPENDIX 24 - 26

v. REFERENCES 27

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 INTRODUCTION

American Psychological Association defines counselling as "professional assistance in

coping with personal problems, including emotional, behavioral, vocational, marital,
educational, rehabilitation, and life-stage (e.g., retirement) problems." Our world has changed
a lot after the pandemic. Many people became aware of the need of professional assistance in
coping with certain mental conditions. Many faced mental health issues after the lockdown
and some were followed by the infection of covid-19. Psychological issues became so
common and solitude and prolonged days of secluded living significantly destabilized the
mental health of many. The stigma related to counselling had thus experienced a tremendous
wane compared to the past.

The significance of a counselor as a trained professional who can provide scientific help to
the client had been recognised by the society. So the need for counselling and counselors who
are able to make active and positive interventions in the society is at a high point. So the
programme organised by the CACEE is very helpful in moulding such trained professionals.

The programme is designed in such a way that the student has to undergo a hands on training
in relation to the block placement which will help to bring the theoretical knowledge to
application. It will also help in understanding the real life challenges in the field and ways to
overcome the hurdles. It will also be give opportunity to closely observe the client. Thus it
nurtures in the student qualities like unconditional positive regard and empathy

I consider it my privilege to do my internship at Holy Cross Hospital, Kottiyam which is a

well renowned presence in the field of social service. Its mental health wing has a legacy of
67 years. It has a well equipped and organised mental health department functioning under
the leadership of Dr. Alfred V. Samuel, MBBS, DPM, PGDGC as the senior consultant
psychiatrist and HOD. It has a row of experts including Mr. Reny Patric, M.Phil, M.A.
Psychology as consulting psychologist, Dr. Anupama Priyankari, MBBS, MD psychiatrist,
and Mr. A. B. Sreekanth M.A.Psychlogy.

During the internship I got an opportunity to interact with clients having psychological and
psychiatric problems. Witnessed various therapeutic interventions. The various cases that I
witnessed there gave me an insight on the soul of the counselling process and various
challenges and ways to overcome them. The below chapters will describe the various cases I
was part of at the centre.

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 CASE STUDY RECORD 1
1. Socio- Demographic Data

Name : A
Age/Date of Birth : 24 years
Gender : Female
Address : Ekambrakodu, Kollam
Religion/ Caste : Hindu
Education & qualification : Degree drop out
Domicile : Rural
Occupation : Nil
Socio- economic status : Middle class
Marital status : Unmarried
Patient stays : With parents
Position in family : Single child

2. Informant Details:

Name : R
Relationship : Mother - Reliable

3. Presenting complaints

Onset of illness : When she was studying in ninth standard

Course of illness : She joined a state syllabus school from an ICSE school
during tenth standard due to financial difficulty.
Course of symptoms : Continuous
Predisposing factors : Born and brought up in a highly religious environment,
possibly father performing religious rituals.
Precipitating factors : May be due to sudden change from comfortable
environment.

4. History of present illness: Few days prior to admission mother told her to a temple. There
she declared that she was the serpent goddess and imitated the possible actions of a snake and
spreading her shawl said that she was going to fly. Asked to pierce a nail on a tree and mother
repots she saw blood dripping down.

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5. History of past illness: Has a continuous history of complaints. Complaints that ghosts
visits her during night and jumps to her body from the ceiling fan above. Days that she is able
to hear music from an unknown source. She pulled down an shelf saying that the ghost had
instructed her to do so. Suspects that her neighbour had done some black magic that is the
reason for her present condition. Thinks that she is being continuously watched by the
neighbour. Verbally abuse the neighbour now and then. Tore away her books during
education. Reports insomnia and reduced appetite.

6. Family history: Had no history of reported mental illness in the family. Father is a priest
at the local temple. Mother is home maker. She is their single child. Over pampered. Mother
favours her in her matters.

7. PEDIGREE CHART

8. Personal history: Had normal milestone development through out all stages.

9. Mental Status Examination

Appearance and behavior : Look shabby and lack confidence. Partial

conscious and cooperative, irrelevant and
incoherent talk.
Psychomotor activity : Decreased
Rapport : Poor eye contact, rapport established
Speech and voice : Decreased
Mood and affect : Depressed mood, affect was sad.
Thought process : Disorganised thought process, delusions,
visual and auditory hallucinations
Thought content : About marriage, beauty, neighbour trying
to prevent her from getting married.
Perception : Thinks that she is able to see ghosts, others
are trying to attack her and influence her
life.
Cognitive function : Impaired
Orientation : Partially oriented
Attention and concentration : Unable to sustain concentration.
Memory : Partial

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 Intelligence : Average
Abstract ability and conceptual thinking: low
Insight : Low
Judgement : Impaired

10. Summary

A girl of 24 was admitted to the hospital with visible symptoms of delusion and
hallucinations. Disorganized and incoherent speaking, lack of concentration, suicidal
ideation, excessive tiredness, not interacting with family members, self harming thoughts,
causing harm to caregiver, visual and auditory hallucinations etc. She has been showing
psychotic symptoms for 4 years. On examination she is not oriented, less attention and
concentration, having disorganized thought process, delusions, visual and auditory
hallucinations, not maintaining eye contact and shows poor insight and judgement.

11. Provisional diagnosis: Schizophrenia

12. Plan of action :

 A combination of medication, and psychotherapy

 Cognitive Behavioral Therapy (CBT)
 Relaxation techniques

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 CASE STUDY RECORD 2
1. Socio- Demographic Data

Name : B
Age/Date of Birth : 32
Gender : Male
Address : Mevaram, Kollam
Religion/ Caste : Hindu
Education & qualification : B. Tech
Occupation : Works a junior artist in film industry.
Socio-economic status : Upper middle class
Marital status : Unmarried
Patient stays : With mother
Position in family : Second son

2. Informant Details:

Name : Self - Reliable

3. Presenting complaints

Onset of illness: His brother committed suicide 3 months back. He was the one who
tried to help him from another immediate attempt of suicide by trying to create an
accident. Since then his social interaction had decreased. Do not have much friends.
Now lacking interest in continuing with job.

Course of illness: He was sad after his brother's death. Stays at home locked in his
room. Trying to avoid social interaction and possible interaction with friends. Always
having a sad mood. Feeling guilty of not being able to save his brother. Thinks if he
had stayed with his brother this untoward incident wouldn't have happened.

Course of symptoms: Has a sad mood for more than 2 months. Locks himself in his
room. Low interaction with mother. Lack of interest in job. In a confusion if he should
have a career shift and move to middle east.

Predisposing factors: Father passed away a few years back. Brother was his only
companion. Less number of friends. Had a breakup the previous year.

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 Precipitating factors: Immediate and untimely death of brother.

4. History of present illness: Started after the death of his brother. Has guilt feeling about his
inaction. Informed that his brother's friend had informed about brother's suicidal ideation.
Has been in seclusion for nearly 3 months. Very concerned about mother who is alone.
Suspects she is having some suicidal tendancy.

5. History of past illness: Had depressive thoughts. But claimed to have overcome them.

6. Family history : Brother had symptoms of anti-social personality disorder. Father had
anti-social personality disorder and later tuned to an ascetic life. Father passed away a few
years back. The family was settled abroad. Brother had a divorce few years back. His sister-
in-law filed a complaint against brother and mother for domestic violence. Court made a
verdict to hand over the house as compensation to her. Brother was depressed due to this. So
he made a possible suicide attempt and was seriously injured and hospitalized, was not even
able to stand up. Helped him to recover and slowly was returning to normalcy. But all of a
sudden he committed suicide.

7. PEDIGREE CHART

8. Personal history

Completed B.Tech and was working as a junior artist in the film industry. Had a n affair and
she wanted to end the relationship. He moved away without any protest. Was into a short
term relationship. Waiting for the launch of the film Kaliyan in which he is playing a part. Is
dubious about the beginning of the shooting. Is very concerned if he should wait for it or to
migrate as his family members demand a change in his career to ease the pain of his brother's
death.

9. Mental Status Examination

Appearance and behavior : Conscious, dressesed in an old cloth, over

growth hair and beard, looks drowsy and
weak.
Psychomotor activity : Normal

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 Speech and voice : Normal
Mood and affect : Sad mood, depressed,
Thought process : Continuously shifts bac to his brother's
demise.
Thought content : About his brother's death and guilt abou it.
Perception : Normal
Cognitive function
Sensorium : Conscious and alert
Orientation : Normal
Attention and concentration : Average
Memory : Normal
Intelligence : Normal
Abstract ability and conceptual thinking : Normal
Insight : Impaired
Judgement : Moderate

10. Summary

A 32-year-old man with complaints of lack of sleep, low appetite, low food intake, persistent
negative thoughts, lack of interest in job and social interaction, and persistent thoughts about
his brother's death. He is in a state of confusion whether to wait for the project to begi pr go
abroad. Is concerned about mother's condition. Wants to move on in life

11. Provisional diagnosis

PTSD with depressive symptoms

12. Plan of action

Psyco education

Change on place of domicile advised

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 CASE STUDY RECORD 3
1. Socio- Demographic Data

Name : C

Age/Date of Birth : 15

Gender : Male

Address : Paravur

Religion/Caste : Islam

Education & qualification : 10th persuing

Domicile : Rural

Occupation : Nil

Socio- economic status : Middle class

Marital status : Unmarried

Patient stays : With parents and sister

Position in family : First child

2. Informant Details:

Name : F

Relationship : Mother - Reliable

3. Presenting complaints

Onset of illness : Since a few weeks the child is insessantly washing his hands.

Course of illness : Is very much concerned about cleanliness. He even empties the
handwash washing his hands. Throws away the toilet soap of it falls
on the floor. Throws away clothes outside as he think, those clothes
dried outside might be poluted by dog licking it. Is afraid of dogs.

Course of symptoms : Continuous

Predisposing factors : Nil

Precipitating factors : May be due to the stress he has to face as he is in 10th standard and
his parents are over enthusiastic about his studies.

4. History of present illness : Started a few weeks ago.

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5. History of past illness : Nil

6. Family history : No one have report history of mental illness. Father is abroad.
Mother is a home maker. Sister is studying in fourth standard.

7. PEDIGREE CHART

8. Personal history : Had normal birth and early development.

9. Mental Status Examination

Appearance and behavior : Normal

Psychomotor activity : Normal

Rapport : Rapport established
Speech and voice : Normal
Mood and affect : Normal
Thought process : Too obsessed with cleanliness.
Thought content : Too concerned about personal hygiene.
Perception : Impaired
Cognitive function : Average
Sensorium : Normal
Orientation : Impaired
Attention and concentration : Average
Memory : Normal
Intelligence : Normal
Abstract ability and conceptual thinking : Normal
Insight : Low
Judgement : Average

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10. Summary

A 15 year old boy with complaints of excessive personal hygiene and don'ts was brought to the out
patient facility by other. The child had an obsession for cleanliness and behaves oddly. The counsellor
at school recommended an immediate intervention. The child had a poor insight and his orientation
was impaired. He was hostile to any attempt to correct his irrational thoughts.

11. Provisional diagnosis: Obsessive Compulsive Disorder

12. Plan of action

 Psycho education to client and family

 Cognitive Behavioral Therapy (CBT)

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 CASE STUDY RECORD 4
1. Socio- Demographic Data

Name : D

Age/Date of Birth : 75 years

Gender : Female

Address : Kollam

Religion/ Caste : Christian

Education & qualification : Primary education

Domicile : Urban

Occupation : Home maker

Socio- economic status : Middle class

Marital status : Widow

Patient stays : With daughter

Position in family : First child

2. Informant Details

Name : J

Relationship : Daughter

3. Presenting complaints

Onset of illness : Two year back

Course of illness : Aggravated recently

Course of symptoms : Continuous

Predisposing factors : After seeing a pink stain on food(rice).

Precipitating factors : Others monitoring her.

4. History of present illness

For the last two years she believes that her daugh is performing some witchcraft against her. Suspects
ye priest in the church nearby. Suspects he is trying to harm her. There is alack of memory. Collets
motion in polyethene bags and throws them away carelessly. Suspects that the priest pluck coconut
from the courtyard at night. Says that she hear some sounds at night. Says that some one is throwing
things at her. Daughter report she continues to be so irritable after husband's death.

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5. History of past illness

15 years back consumed poison and was hospitalized.

6. Family history: No reported cases of mental illness in the family. Husband died a few years back.
Has four daughters. Patient lives with second daughter. All daughters are marriedand stays with
family. She and the informant live at their ancestral house.

7. PEDIGREE CHART

8. Personal history

Uneventful birthand early development. Was an efficient lady. Husband was paralised after an
accident. She ran the family alone.

9. Mental Status Examination

Appearance and behavior : Shabby and angry

Psychomotor activity : Retarded

Rapport : Established

Speech and voice : Irrelevant talk, paranoid ideas

Mood and affect : Irritable

Thought process : Disorganised and incoherent.

Perception : Have paranoid delusions and visual and auditory

hallucinations

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 Cognitive function

Sensorium : Conscious and alert

Orientation: Dis-orientated

Attention and concentration : Poor

Memory: Affected

Abstract ability and conceptual thinking : Poor

Insight : Poor

Judgement : Poor

10. Summary

A 75 year old widow with paranoid delusions and visual and auditory hallucinations, in high irritable
mood. Severe memory loss and lack of personal hygiene for one year. Insight and judgement impared
severely. She is not organised and no more remembers many

11. Provisional diagnosis

Dementia with psychotic features

12. Plan of action

Psycho education

Nursing care recommended

Medication

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CASE STUDY RECORD 5

1. Socio- Demographic Data

Name : E

Age/Date of Birth : 19 years

Gender : Male

Address : Panayam, Kollam

Religion/ Caste : Hindu

Education & qualification : B.A. Philosophy student

Domicile : Rural

Occupation : Nil

Socio- economic status : Middle class

Marital status : Unmarried

Patient stays : With parents

Position in family : First child

2. Informant Details:

Name : M&S

Relationship : Father and Mother

3. Presenting complaints

Onset of illness : Insidious

Course of illness : Increased talk than usual. Stays awake at night. Irritable mood and
violent behaviour.

Course of symptoms : Intermittent

Predisposing factors : When parents and grand mother deny his demand for money.

Precipitating factors : Grandmother denied him money to go to the gym.

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4. History of present illness

Grandmother who usually gave him money was not redy to give him money for the gym. This ended
up in a quarrel. There was a sudden change in his behaviour. He turned hostile towards the family.
Want to join the army and is continuously browsing about the army. He joined many social media
groups with such interest. He even chose friends with such interest and achievements.

5. History of past illness

Ran away from home at the age of 12 after an argument with his father. Dislikes parents, teachers or
elders advising him. Dislikes his uncle. Lack close friends and social contacts. Prime aim is to become
a soldier, but gets easily distracted.

6. Family history: No reported case of mental diseases in the family. Maternal grand father was an
army man.

7. PEDIGREE CHART

8. Personal history

Birth and early development uneventful. Always in a hostile mood towards family. Self- centred
attitude

9. Mental Status Examination

Appearance and behavior : Well dressed, groomed and well built. Frequently
become agressive

Psychomotor activity : Elevated

Rapport : Established

Speech and voice : Increased and full of irrational thoughts

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 Mood and affect : Euphoric

Thought process : Irrational

Thought content : Obsessed with the thought of becoming a soldier.

Cognitive function

Sensorium : Conscious and alert

Orientation : Oriented

Attention and concentration : Normal

Memory : Normal

Intelligence : Normal

Abstract ability and conceptual thinking : Poor

Insight : Poor

Judgement : Poor

10. Summary

A 19 year old boy was admitted with lack of sleep, irrational thoughts and hostile attitude towards
parents and relatives. Irrational ideas weekly related to action and staying awake at late night
browsing and interacting in social media with like minded people.

11. Provisional diagnosis

Bipolar Affective Disorder

12. Plan of action

Drug therapy

Psychotherapy

Family counselling

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 SUMMARY AND CONCLUSION

By doing the Post Graduate Diploma in Counselling course under Kerala University I got an
opportunity to understand the importance of counselling for maintaining a proper mental
health f the society. I studied the various causitive factors that led to various maladaptive
behaviours their signs and symptoms and different counselling techniques to overcome them.
The lectures, workshops and field visits as part of the carriculum helped me to understand
various psychological problems in depth, their prevalence in the society and the importance
of counselling techniques to improve the quality of life of the affected individual.

The block placement at the Department of Psychological Medicine , Holy Cross Hospital
Kottiyam helped me in handling clients with confidence. Through the art of counselling I
could enter into the clients world and see things from their perspective empethetically.
During the counselling session I could help them to became aware of their strength and
weakness and take appropriate corretive measures themselves for a better life.

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 APPENDIX

CASE STUDY RECORD

1. Socio- Demographic Data

 Name:
 Age/Date of Birth:
 Gender:
 Address:
 Religion/ Caste:
 Education & qualification:
 Domicile:
 Occupation:
 Socio- economic status:
 Marital status:
 Patient stays:
 Position in family:

2. Informant Details:

 Name:
 Relationship:

3. Presenting complaints

 Onset of illness:
 Course of illness:
 Course of symptoms:
 Predisposing factors:
 Precipitating factors:

4. History of present illness

5. History of past illness

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6. Family history:

7. PEDIGREE CHART

8. Personal history

9. Mental Status Examination

 Appearance and behaviour

 Psychomotor activity
 Rapport
 Speech and voice
 Mood and affect
 Thought process
 Thought content
 Perception
 Cognitive function
 Sensorium
 Orientation
 Attention and concentration
 Memory
 Intelligence
 Abstract ability and conceptual thinking
 Insight
 Judgement

10. Summary

11. Provisional diagnosis

12. Plan of action

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REFERENCES

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