Table of Contents

Topic Page no.

Weekly log…………………………………………………………………………………01

Case Report I (Depressive Disorder BDI)………………………………………………

Case Report II (Generalized Anxiety Disorder GAD)………………………………

Case Report III ()………………………………………………….... 21

Case Report IV ()………………………………………………………………… 29

Case Report V ()………………………………………….. …………. 37

References…………………………………………………………………………………45

Appendix ………………………………………………………………………………….50
 Department of Clinical Psychology
GIFT University, Gujranwala
Weekly Client Log (BSCP)
(To be signed off weekly by Clinical intern or On-site Clinical Supervisor and Head of the Department)

Name: Areej Irfan Batch: 2019-2024 Name of On-site Supervisor: Ayesha Tanveer
Name of Internship Site: Allama Iqbal memorial Hospital Name of Dept. Supervisor: Dr Um e Laila

Week # 1

Date Demopgraphics Presentation/Diagnosis Assessment/Observation Therapeutic Contact Time

Intervention

Tuesday F/S 32 Depression BDI Relaxation Technique 45min

19-10-23
 Case Reports
Major Depressive Disorder
 Summary

A 32-year-old woman was brought from the regular hospital room for a check-up and
help with her mental health. She was having problems like feeling tired, having trouble
sleeping and breathing, feeling very sad and hopeless, getting easily annoyed, having
tense muscles, and other symptoms like a fast heart rate, headaches, and not feeling
hungry.

We talked to her formally and informally to understand her situation. After checking,
she scored 30 on the Beck Depression Inventory, which shows she has severe
depression. To help her, we plan to use a relaxation technique.
Identifying Data

Name S.A
Father’s Name M.M

Date Of Birth 20-10-1991

Assessment Dates 19-10-2023

Age 32years

Gender female

Family system Nuclear

Birth order fourth order

Case No 1

Reason & Source for Referral

A person's case was brought to our attention from the regular hospital room, and they
were experiencing various issues like low blood pressure, low energy, trouble sleeping
and breathing, feeling helpless, being easily irritated, having tense muscles, feeling very
hopeless, restless, experiencing a fast heart rate, headaches, loss of appetite, tension,
and sweating.

Presenting Complaints

The complaints reported by client was Low blood pressure (kisi bt ki tension leti hun to
blood pressure low ho jata). Difficulty in Sleep (pareshani ki waaja sa raaton ko neend nahi ati).
Diffculty in breath (thanday paseenay aty hain aur saaans nahi liya jaata).

Table 1

Presenting Complaints and Duration of the Client’s Problems According to Psychologist

Duration Presenting Complaints
 ‫کسی بات کی ٹینشن لیتی ہوں‬
‫تو بلڈ پریشر لوو ہو جاتا‬
‫پریشانی کی وجہ سے راتوں‬
‫کونیند نہیں آتی‬
‫جب تک دوائی نہیں لیتی تب‬
‫تک آرام نہیں آتا‬
‫ٹھاندے پسینے آتے ہے اور‬
‫سانس نہیں لیا جاتا‬
Initial Observation

The client was sitting one the chair and continuously shaking her leg. She looked scared.
She was nervous and less responsive towards psychologist. Within and without session.
Developmental History of the Problem/ History of Present Illness

The client is a 32-year-old woman who had an arranged marriage and lives with her in-
laws. She described her relationship with her husband as troubled. Her illness began
about three years ago. According to her, her husband was controlling and didn't allow
her to make decisions or visit her mother's house or meet relatives without his
permission. She felt trapped, like being in a cage, and missed her family and relatives
greatly. She mentioned that her life was happier before her marriage.

After having children, she got busy with them, which helped her cope for a while. But as
time went on, she started to feel the strain, leading to tension, restlessness, and sleep
difficulties. Gradually, she developed symptoms like weakness, a racing heart,
headaches, loss of appetite, tension, low blood pressure, and cold sweats. Her illness
was causing her increasing worry.

She shared that her low blood pressure occurred when she missed her loved ones she
couldn't meet. She could talk to her mother-in-law about her concerns, but there was
little she could do to help. The client wanted to overcome this situation and return to a
normal life. She had been consulting a psychiatrist and using different medicines to
address her issues.
Background Information

Personal History

The client was a housewife from a middle-class family. After getting married, she didn't
have any hobbies or free time because she was very busy with her household
responsibilities.
Premorbid Personality

According to the client she was a healthy person physically and psychologically before the onset
of illness. She was social by nature. She enjoyed her life. She liked to attend friends and family
gathering.

Family History

The client comes from a lower-class family, and her father passed away three years ago.
He worked as a laborer and was known to be strict. The client's mother is 50 years old,
uneducated, and a homemaker. She is described as polite, friendly, and caring, but the
client feels unable to discuss her situation with her.

The client has eight siblings, consisting of five brothers and three sisters, with her being
the fourth in birth order. She has good relationships with her siblings.

In her in-laws' home, the atmosphere is positive, and she gets along well with her in-
laws, particularly her mother-in-law, whom she feels treats her like a daughter. However,
her husband's behavior has been affecting the home environment and the children.

To summarize, the client's family background is characterized by her father's occupation

as a laborer, her mother's caring nature, her eight siblings, positive relationships with
her in-laws, and challenges related to her husband's behavior.
.
Educational History

The client was uneducated because of her poor financial condition at that time
Social History

The client used to have a cheerful and friendly personality, and her relationships with
others were positive. She had a wide circle of friends. However, she now feels sad and
confined, which makes it difficult for her to fully enjoy the company of friends and
relatives. She desires a return to a social life where she can reconnect with her loved
ones.
Sexual History

Client hit the puberty at the age of 15, she gets all the information from her mother.
Occupational History

The Client husband work in a factory and earn good income to fulfills the need of his
family.
History of Psychiatry/ Medical Illness

According to the Client there is no such history of medical and psychiatry in her family.

Drug History

According to the Client there is no such history.

Marital History

According to the Client she had an arrange marriage. She had two children. One daughter
and one son. But not good relations with her husband.

Provisional Formulation

On the basis of above history, the client had not good relationship with her husband He
did not allow her to meet her relatives even her mother. As a result, she faces the problem of
Low blood pressure, tension, without taking medicine she cannot sleep.
Assessment

Informal Assessment

 Behavioral Observation.
 Clinical Interview.

Formal Assessment
  DSM-V Checklist for Major Depressive disorder
 Beck depression Inventory

Informal Assessment
Informal assessment in therapy means collecting information about a client's mental
health in a flexible way, not using strict tests. This can include watching how the client
acts, having casual talks, and asking the client about their feelings. The reason for
doing informal assessments is to get a deep and detailed understanding of what the
client is going through, which helps in deciding how to help them. Informal assessment
is helpful for clients who find formal tests hard or have trouble talking about their
feelings in a structured way. It can also make the relationship between the therapist and
client more open and trustworthy.
Behavioral Observation

Behavioral observation is when someone carefully watches and records a person's

actions. It's done in a structured way to collect accurate and trustworthy information
about a person's behavior and what influences it.

In the client's case, they were sitting in a chair, wearing traditional clothing that made
them seem older and frail. They appeared anxious, continuously shaking their leg, and
seemed fearful. They were not very responsive to the psychologist, finding it hard to
answer questions and not engaging much in the conversation.

Clinical Interview

A clinical interview is a conversation between a clinical psychologist and a client meant

to help the psychologist understand the client's issues and plan for treatment. It's a
crucial part of mental health assessment.

In the beginning of the session, the client only shared basic information like their name
and age and was quite reserved. They mentioned missing their mother and father a lot,
which was making them feel depressed and upset. They also talked about their
relationship with their husband.
Client’s Symptoms Pre-assessment Rating Scale (0-10)
Symptoms Ratings by Therapist Ratings by Client

(0-10) (0-10)
Loneliness 6 7
Low self-esteem 7 8

Formal Assessment

DSM V Checklists for Specific Disorder.

Table 2

DSM V Checklist for Major Depressive Disorder

Symptoms Yes/No
1. Depressed most of the day, nearly every Yes
day as indicated by subjective report (e.g.,
feels sad, empty, hopeless)
2. Markedly diminished interest or pleasure Yes
in all, or almost all, activities most of the
day, nearly every day.
3. Significant weight loss when not dieting Yes
or weight gain (e.g., change of more than
5% of body weight in a month), or
decrease or increase in appetite nearly
every day.
4. Fatigue or loss of energy nearly every day. Yes
5. Diminished ability to think or concentrate. Yes

Qualitative Interpretation.

Qualitative Interpretation. If the client is experiencing these symptoms at a mild level, it

could be a sign of mild depression. Mild depression affects a person's mood and daily
life, but it's not as severe as major depressive disorder. In mild depression, the
individual might feel sad or empty for part of the day, not necessarily most of the day.
They could have some loss of interest in activities but still find enjoyment in some
things. There might be changes in weight, fatigue, or difficulty concentrating, but these
changes wouldn't disrupt their daily life significantly. It's a good idea to seek help from
a mental health professional even for mild depression because it can still have a
negative impact on overall well-being, and professional treatment can be beneficial.
Beck Depression Inventory.
The Beck Depression Inventory (BDI) is a common questionnaire that people fill out themselves to
show if they have symptoms of depression. It was made by a psychologist named Aaron T. Beck,
who is known for his ideas about how thinking affects depression. The BDI has 21 questions that ask
about different signs of depression, like feeling sad, losing interest in things, changes in eating and
sleeping habits, and thinking about suicide. In clinics, it's used to check how depressed someone is,
see how their symptoms change, and help plan their treatment.

Quantitative Interpretation.

Table 3

Showed the result of client for BDI

Scale Raw Scores Level of Severity
Beck Depression 30 Severe

Inventory
Qualitative Interpretation.
The client takes score of 30 on the Beck Depression Inventory suggests Mild Depression. This
means that the person may have symptoms of depression, but it is affecting their daily life
significantly. However, the score should be considered alongside other evaluations, and seeking
support from a mental health professional for personalized treatment is recommended.
Case Formulation

Predisposing factors are conditions and activities that can increase the risk of
developing a disease in a person. This study looks at different types of spouse
abuse and how certain factors, like the woman's occupation compared to her
husband's, can increase the risk of abuse, especially the most severe kind.
Precipitating factors are things that trigger or contribute to the start of an
illness, disease, accident, or behavior. This study investigates sleep and fatigue
in people with severe occupational burnout, considering factors at work and
in real life that might have led to their burnout.

Perpetuating factors are conditions that maintain disabling symptoms in an

individual. The research here shows that how a spouse responds to a person's
pain can reinforce and continue their pain behavior, especially in close
relationships. This makes it harder to treat chronic pain.

Protective factors are characteristics that lower the chances of negative

outcomes or reduce the impact of risk factors. In the context of child abuse,
"protective mothers" are women who take steps to shield their children from
abuse. However, they sometimes face challenges under the Hague
Convention when trying to protect their children from abuse. This article
argues that the Hague Convention may not fully understand the role of abuse
in these situations, which can lead to misunderstandings and stereotypes of
protective mothers as mentally ill or malicious.
Case Conceptualization

Predisposing Precipitating Perpetuating Protective

 Low blood  Poor sleep  Chronic  Support of
pressure  Low energy illness/pain mother-in-law.
 muscles tension  Substance use  no relationship
 cold sweat  Stress parents
 fear of husband  hostile behavior  feeling
 no social life  fear of loss of imprisoned in a

relationships cage.

 fear of loss of
home
Diagnosis

According to DSM-V client fulfilling under the criteria or fulfilling the symptoms of Major
Depressive Disorder, and severe depression.
Relationship Distress with Spouse.
Client’s Prognosis

The favorable and unfavorable conditions for the client.

The Point in Favour

 Physical and therapeutic behavior

While against Point

 Physical Health

Proposed Management plan

The management plan was designed according to the complaints addressed by the client.

Relaxation Technique

Deep breathing is a simple and effective way to relax your mind and body. When we're
stressed or anxious, our breathing becomes fast and shallow, which can make us feel
more tense and anxious.

To practice deep breathing, find a quiet, comfortable spot where you won't be
disturbed. You can sit or lie down, whichever feels better for you. Then, follow these
steps:

 Inhale deeply through your nose for a slow count of four. Imagine you're filling
your lungs with fresh air and energy.
 Hold your breath for a count of four. Take a moment to feel the air in your lungs.
 Exhale slowly through your mouth for a count of four. Picture yourself releasing
all your tension and worries as you breathe out.
Limitations
 Time Shortage
 No separate rooms were given by the hospital for conducting session.
 Informants even the client were not responsive towards the therapist.
 Due to lack of time, assessment was not fully completed.
 Limited interaction that causes incomplete assessment/ lack of information and
assurance from guidance.
 There was no psychiatry ward, which is the basic reason of less psychological cases.
 As clients belonged to lower background so they don’t have psychological
awareness.

Intervention Strategies

Short-term Goals

● Encouraging the client to develop good relationship with her husband.

● Encouraging the client to talk to her husband about her daily life and make
communication.

Long-term Goals

● Helping the client establish a structured daily routine.

● Encouraging the client to reach out to family members for support and advice
can help them feel less isolated.

Recommendations

 There should be a psychiatry ward.

 Spread awareness by conducting seminars and workshops.
  There should be separate room for conducting sessions.

Session I

My client 32-year-old female was admitted to a general ward. A case report was filed for
psychological assessment and management, as the client reported the symptoms of
complaints of diffculty Low blood pressure, sleeping, feeling helplessness, irritability,
muscle tension, feeling hopelessness, Restlessness, heart pounding, headache, loss of
appetite, tension, cold sweat.
Session II
My client faces the symptoms of major depression, so I apply the test of BDI which
declares the result of 30 scores of severe depression.

References

Hornung, C. A., McCullough, B. C., & Sugimoto, T. (1981). Status relationships in marriage:
Risk factors in spouse abuse. Journal of Marriage and the Family, 675-692.

Ekstedt, M., Söderström, M., Åkerstedt, T., Nilsson, J., Søndergaard, H. P., & Aleksander, P.
(2006). Disturbed sleep and fatigue in occupational burnout. Scandinavian journal

work, environment & health, 121-131.

Kremer, E. F., Sieber, W., & Atkinson, J. H. (1985). Spousal perpetuation of chronic pain
behavior. International Journal of Family Therapy, 7(4), 258-270.

Salter, M. (2014). Getting Hagued: The impact of international law on child abduction by
protective mothers. Alternative Law Journal, 39(1), 19-23.