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Internship Report

Name: Petreamma Tukaram Mene

College/University: Vivekanand Education Society

Degree-Programme: MA Clinical Psychology

No of Internship days (30)

Internship From 31st July 203 To

CASE REPORT 03
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Sr.no Page No.

Index

01 Case History 03 - 07

02 Mental status Examination 08 - 09

03 Psychological Testing 10 - 21

22 - 24
04 Counseling session / Group therapy

05 Summary Of Internship 25

06 Learnings from Internship 26 - 28

07 References 29

08 Pictures of log sheet 30

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CASE REPORT 3

CASE HISTORY

Demographic Details:

● Name of the patient: KN

● Age: 31 years

● Date of Admission: 4th July 2023

● DOB: 30/05/1992

● Sex: Male

● Socioeconomic Status: Middle class

● Marital Status: Divorcee

● Education: 10th pass

● Occupation: unemployed

● Language Preference: Hindi/Marathi/Banjara

Informant Details:

Patient was brought by his father.

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Chief Complaints and their duration:

Reduced sleep, irritability, wandering/leaving house again and again, abusive if somebody annoys him (beech

beech me satak jata hu as stated by the patient), increased BP, threathing behavior, engrossed in a

particular thought continuously for a long time.

History of Presenting Concern:

Patient is having these issues since 10 -12 years but increased since 1 month due to recent divorce.

(a)Onset: Gradual

(b)Precipitating Factors: Divorce

(c)Course of the Illnesss: Continuous

(d) Associated Disturbances: Reduced sleep and withdrawal symptoms

Past History:

Patient was admitted and was taking psychiatric medication for 12 years from Samarth Hospital Jalgaon. Later

he was admitted to Thane mental hospital. This is his second time being admitted to Thane mental

hospital.
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Family History:

Personal History:

Birth and Development: Normal

Behavior during childhood: Normal and extrovert

Physical Illness during childhood: None

Education and Work History:

Patient has completed his 10th STD and ITI course. He started working in couple of places but was inconsistent

because of his illness.

Sexual History: was unstable due to his aggression issues and because of his extra marital affair.

Marital History: Patient got married 6 years ago. It was an arranged marriage.He also had an extramarital

affair because of which her wife aborted her child.

Social History:

He is an extrovert and enjoys being around people.He is also the helper patient in the ward.

Substance Abuse History:

Excessive tobacco,cigarette and alcohol consumption since 11th std.

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Suicidality/Homicidality:

Suicidal ideations and escaping tendencies were present in the month of August.

Premorbid Personality:

Normal

Attitude to others in social, family and sexual relationship :

Normal as mentioned by the patient until he used to have aggressive or irritability feelings after alcohol

consumption.

Attitude to self:

Well adjusted in all settings(as stated by the patient)

Moral and religious attitude:

Yes, pray everyday.

Mood:

Usually active and ready for a fresh start of life.

Leisure activities and interest:

Singing songs and dancing in the ward in free time(stated by the patient)

Fantasy life:

Want to work and earn and start a new life being single.
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Habits:

Appetite : Normal

Sleep: Reduced

Excretory Functions: Normal

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MENTAL STATUS EXAMINATION

General Behaviour:

Patient was cooperative and rapport was established. He was a helper patient and was quite active and he did all

his everyday activities independently.He was conscious and was in touch of her surroundings. Adequate

eye contact was maintained.

Psychomotor activity was normal.

Talk was spontaneous, tone was normal and was maintained.

Speech was relevant and coherent. Reaction time was appropriate and prosody of speech was maintained.

Thought: was normal. There was no presence of any thought disorder.

Mood was euthymic and affect were congruent.

Perception: There were no perceptual difficulties. No illusions or hallucinations were reported.

Cognitive Functions:

Attention and concentration: Attention and concentration was average. Client was oriented to time, place, and

person. Performance on memory task was sufficient.

Memory: Patient’s memory was intact.

General information: Patient could answer questions.

Intelligence: was average

Judgement: was fairly adequate.

Insight: was partially present.

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Diagnosis: Schizophrenia with Alcohol use disorder,BMD in Mania with Substance Abuse (As given by the

doctor)

Ongoing Treatment: Antipsychotic drugs

Summary of the case: The patient was very active. He shared his information openly which showed that

rapport was established .He also had partial insight towards his illness as he was taking medicines since

many years . The patient was good with MSE and attention concentration task , mathematical task , he

also read questions of MCMI and was pretty active during the test .

Differential Diagnosis: None

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PSYCHOLOGICAL TESTING

MCMI

Introduction:

The Millon Clinical Multiaxial Inventory (MCMI) is a psychological assessment tool designed to provide

information about an individual's personality structure and any potential psychological disorders or

clinical conditions they may be experiencing. It was developed by Theodore Millon, an American

psychologist, and is based on his theory of personality and psychopathology.

Purpose:

The MCMI is primarily used by mental health professionals, such as psychologists, psychiatrists, and

therapists, to aid in the diagnosis and treatment planning for individuals dealing with psychological

issues. It helps to identify specific personality styles, disorders, and clinical syndromes.

Theoretical Background:

The MCMI is based on Theodore Millon's personality theory, which suggests that personality is influenced by a

combination of biological, psychological, and social factors. It incorporates elements from various

psychological theories, including psychodynamic, cognitive-behavioral, and social learning theories.

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Structure:

The MCMI is divided into several scales, each assessing different aspects of an individual's personality and

psychological functioning. These scales are organized into three sections:

1. Base Scales: These scales measure the presence and severity of personality disorders and clinical

syndromes. They include scales like Depressive, Schizoid, Avoidant, and others.

2. Clinical Personality Patterns: These scales assess patterns of personality functioning, including the

presence of personality disorders. They provide information about the individual's overall personality

style.

3. Severe Clinical Syndromes: These scales focus on more severe psychological conditions, such as

psychosis or severe mood disorders.

Considerations:

It's important to note that the MCMI is just one tool among many in the field of psychological assessment. It

should be used as part of a comprehensive evaluation, considering other information about the

individual's history, behavior, and context.

Additionally, the MCMI should only be administered and interpreted by qualified professionals who are trained

in its use, as improper administration or interpretation can lead to inaccurate results.

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MCMI Table:

Scales Raw score

Base Rate sc Adjustmentnal Base rate s

e 1: Schizoid 8 66 55 55
prototypal items (x2) =
non prototypal items(x1) =
e (x1) =

e 2A: Avoidant 10 77 66 66
prototypal items(x2) =
non prototypal items(x1) =
e (x1) =

e 2B: Depressive 7 65 54 54
prototypal items (x2) =
non prototypal items(x1) =

e 3: Dependent 8 70 59 59
prototypal items (x2) =
non prototypal items (x1) =
e (x1) =

e 4: Histrionic 19 69 58 58
prototypal items(x2) =
e(x1) =

e 5: Narcissistic 15 67 56 56
prototypal items(x2) =
non prototypal items(x1) =
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e(x1) =

e 6A: Antisocial 15 85 74
prototypal items(x2) =
non prototypal items(x1) =
e(x1) =

e 6B: Sadistic (Aggressive) 18 80 69 69

prototypal items(x2) =
non prototypal items(x1) =

e 7: Compulsive 20 69 58 58
prototypal items(x2) =
e(x1) =

e 8A: Negativistic (Passive Aggressive) 16 81 70 70

prototypal items(x2) =
non prototypal items(x1) =

e 8B: Masochistic (Self-Defeating) 14 91 80 80

prototypal items(x2) =
non prototypal items(x1) =

e S: Schizotypal 7 67 61 61
prototypal items(x2) =
non prototypal items(x1) =

e C: Borderline 10 75 69 69
prototypal items (x2) =
non prototypal items (x1) =
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e P: Paranoid 17 81 75 75
prototypal items (x2) =
non prototypal items (x1) =

e A: Anxiety 7 81 75 75
prototypal items (x2) =
non prototypal items(x1) =

e H: Somatoform 6 64 58 58
prototypal items(x264) =
non prototypal items(x881) =

e N: Bipolar (Manic) 8 69 63 63
prototypal items(x2) =
non prototypal items (x1)=

e D: Dysthymia 7 64 58 58
prototypal items(x2) =
non prototypal items (x1) =

e B: Alcohol Dependence 8 88 82 82
prototypal items (x2) =
non prototypal items (x1) =
e (x1) =

e T: Drug Dependence 12 78 72 72
prototypal items (x2) =
non prototypal items(x1) =

e R: PTSD 10 77 71 71
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prototypal items (x2) =

non prototypal items (x1) =

e SS: Thought Disorder 8 67 61 61

prototypal items (x2) =
non prototypal items (x1) =

e CC: Major Depression 8 78 72 72

prototypal items (x2) =
non prototypal items (x1) =

e PP: Delusional Disorder 7 72 66 66

prototypal items (x2) =
non prototypal items (x1) =

e Y: Desirability 19 85 79 79
(x1) =
e (x1) =

e Z: Debasement 15 66 60 60
(x1) =

e X: Disclosure 150 85

V =No invalid questions were found

W = The inconsistency score was 4
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Reason for using the Test :

:MCMI-III was selected as psychological testing for the patient, to assess her personality trait and as per the

sessions taken, through clinical judgment, it was best thought to identify the major factors affecting her

depressive thoughts and mood as well as to understand the underlying factors that may be passive and

influencing the patient’s psychopathology. It was finally used as an assessment for differential diagnosis.

Result and Interpretation:

Patient’s score were the most elevated in Scale B Alcohol Dependence (82), Scale 8B Self-defeating (80),

Scale P Paranoid and Scale A Anxiety (75).

● For Alcohol dependence: is a chronic medical condition characterized by an inability to control or

stop drinking despite negative consequences. It's important to approach this issue with empathy

and understanding, as it can have a significant impact on a person's life and well-being.

● For Self-defeating: individuals who engage in behaviors that undermine their own well-being or

hinder their progress in therapy or treatment.They resist change,use negative self talk,aoid

therapy,are defensive,lack trust and many more which makes therapy though for them.

● For Paranoid- The patients are vigilantly mistrustful and often perceive that people are trying to

control or influence them in malevolent ways. They are characteristically abrasive, irritable,

hostile, and irascible, and may also become belligerent if provoked. Their thinking is rigid and

they can be argumentative. They may present with delusions of grandeur or persecution and/or

ideas of reference. They use projection as their main defense.

● For Anxiety- Patients experience restlessness, depression, physical symptoms like sweating

,feeling discomfort and a constant worry for the future .

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Treatment Plan:

1. Client reported that he felt a little better after speaking about her issues. The aim of the first session was to

establish rapport and trust. Empathizing with clients and a reflective listening of her narrative went a long

way in building the therapeutic relationship.

2. Client’s experiences were validated and space was given for him to share his feelings without any reproach.

A positive and supportive stance was taken towards the client.

3.Working on De Addiction can also be good as he mentioned how difficult iitt is for him tto avoid alcohol and

other drugs.

4. After working on testing on the client through Million Clinical Multiaxial Inventory- III, which will aid in

diagnosis and formulating further treatment plan accordingly.

As the patient was not in the counseling phase but was more reliant on medications because of the severity of

symptoms further counseling sessions didn’t take place.

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Pictures of response sheet and Scoring Sheet:

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Counseling Session :

Session Focus: Building on the established rapport and the patient's active engagement, this

counseling session aims to address the patient's partial insight into his illness (schizophrenia) and

continue exploring coping strategies for managing symptoms.

Session Goals:

● Reinforce medication adherence and discuss any medication-related concerns.

● Explore the patient's understanding of schizophrenia and its impact on his life.

● Provide psychoeducation about schizophrenia, emphasizing symptom management.

● Encourage active participation in therapy and coping strategies.

● Discuss the patient's goals for treatment and well-being.

Session Outline:

1. Rapport Building (5 minutes)

● Greet the patient warmly and express appreciation for their active participation.

● Create a safe and non-judgmental space for discussion.

2. Medication Review (10 minutes)

● Inquire about the patient's experiences with medication, including any side effects.

● Emphasize the importance of medication adherence.

● Address any concerns or questions regarding medications.

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3. Insight and Understanding (15 minutes)

● Explore the patient's understanding of his diagnosis (schizophrenia).

● Discuss how schizophrenia has affected his daily life, including relationships and

functioning.

● Validate his experiences and acknowledge his efforts in managing symptoms.

4. Psychoeducation (15 minutes)

● Provide information about schizophrenia, its causes, and the nature of auditory

hallucinations.

● Discuss common coping strategies for managing auditory hallucinations and stress.

● Offer resources and strategies for family members to better understand and support him.

5. Coping Strategies (15 minutes)

● Collaboratively develop coping strategies for managing auditory hallucinations and

related distress.

● Introduce relaxation techniques, mindfulness exercises, and grounding exercises.

● Encourage the patient to practice these techniques between sessions.

6. Goal Setting (10 minutes)

● Ask the patient about his goals for treatment and recovery.

● Help him set specific, achievable short-term and long-term goals.

● Discuss how achieving these goals can improve his overall well-being.
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7. Session Summary and Homework (5 minutes)

● Summarize key points from the session, including medication adherence, insights, coping

strategies, and goals.

● Assign homework, such as practicing relaxation techniques or keeping a symptom

journal.

● Confirm the date and time of the next session.

8. Closing (5 minutes)

● Express support and encouragement for the patient's efforts.

● Thank the patient for his active participation.

● Reiterate your availability for any questions or concerns between sessions.

Follow-Up: Monitor the patient's progress, medication adherence, and symptom management in

subsequent sessions. Adjust the treatment plan as needed to address emerging issues and goals.

Collaborate with other healthcare providers as necessary for holistic care.

Follow up was done twice but did not get much time to do more follow up with the patient.
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Summary Of Internship:

First day of the internship we got a short tour of all the wards. We were very excited to see the wards when it

was the time to get actually into it. It was a little scary. Around 24 Mse and case history was taken by me (male

and female both included). It was an nice experience as i was new to this clinical population it was little

difficult at start for taking mse and case history there was few days i just took half mse and case history and

went out because i was not feeling that much comfortable but later on i become well versed in taking mse and

case history it was like i have become professional in taking mse and case history we had a good supportive

psychiatrist and TA for guiding us nurses and maushi was also so cooperative and understanding. I have faced a

lot of challenges initially but later on I got well versed, language barriers were also there where I saw a lot of

people with different cultures merging together at one place and it was nice. The journey of seeing patients

from hopeless thoughts to hopeful thoughts and getting discharge gives a satisfaction that they are now living

the normal daily routine. Patients were a little attached and that made it a little overwhelming. I got to see

various types of patients from mild to severe. It was quite scary but I got to learn a lot and as time files we were

used to seeing the severe patients . social psy was very helpful, they help us to understand the overall

background of the patients at inpatient wards, With medical officer also we spent time observing them they

taught us new words which were there in the files, wherever we got stuck there was always nurses and doctor

were helping us to move further.OT sessions was very interesting we saw patient doing some work which is

there hobby or learning some new task to keep them engaged and to check their fine motor activity. OPD was

the favourite place for all of us where we can mostly see various types of outpatients. Surprisingly, there were a

lot of outpatients who are having their normal daily life with little psychotic symptoms. We also got some tricks

and ideas to take mse and case history while observing the doctors in opd.
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Learnings from Internship

During my clinical psychology internship at Regional Mental Hospital, I had the opportunity to gain valuable

insights, knowledge, and hands-on experience in the field of clinical psychology. This internship provided

a well-rounded education that combined theoretical learning with practical application, honing my skills

and deepening my understanding of various aspects of clinical psychology.

Objective from Internship:

My primary objective during this internship was to develop a comprehensive understanding of clinical

psychology and its practical applications. I aimed to enhance my skills in assessment, diagnosis, and

treatment while adhering to ethical guidelines. Throughout this internship, I gained the following key

learnings:

Theoretical and Experiential Understanding:

● Psychopathology: I deepened my understanding of various psychological disorders, including

mood disorders, anxiety disorders, personality disorders, and psychotic disorders. I learned to

recognize the nuances of each disorder and their diagnostic criteria.

● Assessment Techniques: I became proficient in using a range of assessment tools, such as

psychological tests, structured interviews, and clinical observation. This allowed me to gather

comprehensive information for accurate assessments.

● Therapeutic Approaches: I had the opportunity to observe and participate in therapeutic sessions

using different approaches, including cognitive-behavioral therapy (CBT), psychodynamic

therapy, and humanistic therapy. This exposure enriched my knowledge of evidence-based

treatments.
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● Crisis Intervention: I learned to handle crisis situations effectively, providing immediate support

and intervention to clients in distress. This experience helped me develop crisis management skills

and maintain composure in high-stress situations.

Assessment Techniques:

During my internship, I became proficient in various assessment techniques, including:

● Conducting clinical interviews to gather pertinent information about clients' history, symptoms,

and concerns.

● Administering and interpreting psychological tests and assessments, such as the Minnesota

Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI),

Millon-clinical-multiaxial-inventory(MCMI), Thematic appreation test (TAT), Rorschach Test

(ROR), House tree person (HTP)

● Using standardized assessment tools to measure specific symptoms, functional impairment, and

treatment progress.

● Collaborating with multidisciplinary teams to assess complex cases, gaining exposure to diverse

perspectives.

Treatment and Obtained Skills:

My internship provided me with hands-on experience in individual and group therapy sessions. I developed the

following skills:

● Creating personalised treatment plans tailored to each client's unique needs and goals.

● Implementing evidence-based interventions and therapeutic techniques.

● Monitoring client progress and adjusting treatment strategies accordingly.

● Practising empathetic listening and fostering a supportive therapeutic alliance.

● Promoting resilience and coping skills in clients to enhance their overall well-being.
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Ethical Learnings:

Ethical considerations were at the forefront of my internship experience. I learned to navigate complex ethical

dilemmas by:

● Adhering to the American Psychological Association (APA) Code of Ethics and maintaining

confidentiality and privacy.

● Obtaining informed consent and ensuring that clients fully understood their rights.

● Balancing the autonomy of clients with the duty to protect them from harm.

● Seeking supervision and consultation when faced with challenging ethical decisions.

Challenges Faced:

While my internship was a rewarding experience, it was not without its challenges. These challenges, such as

managing a diverse caseload and balancing the demands of clinical practice, provided opportunities for

personal and professional growth. I learned to navigate these challenges through effective time

management, self-care, and ongoing self-reflection.

Conclusion:

My clinical psychology internship at Regional Mental Hospital was a transformative experience that allowed

me to bridge the gap between theoretical knowledge and practical application. I gained a profound

understanding of psychopathology, honed my assessment and treatment skills, and developed a strong ethical

foundation for my future career as a clinical psychologist. This internship not only enriched my professional

growth but also reinforced my commitment to helping individuals achieve mental health and well-being

through evidence-based and ethical practices.

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Reference :

American Psychological Association. (n.d.). Millon Clinical Multiaxial Inventory (MCMI).

https://www.apa.org/pubs/tests/ancient/history#millon

Millon, T. (1983). Millon Clinical Multiaxial Inventory: A history. In J. N. Butcher & C. D. Spielberger (Eds.),

Advances in personality assessment (Vol. 2, pp. 113-136). Lawrence Erlbaum Associates.

Millon, T. (1977). MCMI: A self-report inventory for assessing affective, cognitive, and impulsive personality

styles. In J. D. Noshpitz & S. E. Kramer (Eds.), Advances in child psychiatry (pp. 249-276). Jason

Aronson.
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LOG SHEETS :