TRAINING AND PRACTICE

Submitted to the University of Kerala in Partial fulfilment of the requirement for the Degree of

Master of Science in Psychology

By
AMJITH S
Reg No. 60623144005

DEPARTMENT OF PSYCHOLOGY
UNIVERSITY COLLEGE, PALAYAM
THIRUVANTHAPURAM
JULY 2025
 CERTIFICATE

This is to certify that this is an authentic work carried out by AMJITH S to the University

of Kerala for the partial fulfilment of the requirements of the award of the degree of Master of

Science in Psychology and that no part of it has presented previously for any degree and

diploma.

Place: Thiruvananthapuram
Date:

Signature of the

Head of the Department

Signature of the supervisors

 DECLARATION

I, AMJITH S, hereby declare that this report is an authentic record of training and

practice carried by me and that it has not been previously presented for the award of any

degree or diploma.

Place: Thiruvananthapuram Amjith S

Date: Candidate code: 60623144005
 ACKNOWLEDGEMENT

I feel great pleasure in expressing my sincere gratitude to all those persons without whose

help and emotional support this work would not have reach its destination.

I acknowledge my sincere gratitude to Dr. Ashuthosh Acharya, Assistant professor & Head

Department of Sport psychology Lakshmibai National College of Physical Education (SAI-

LNCPE) , Thiruvanathapuram. I also acknowledge my sincere gratitude to Dr. Preethi,

Superintended, and Dr. Biji Vimala, Clinical Psychologist, Government Mental Health Centre,

Thiruvananthapuram. I express my deepest sense of gratitude to them for their profound

knowledge and valuable information at each stage of this Internship. Also like to thank all the

staff and Co-trainees.

I wish to thank Dr. Swapna Ramachandran, Associate Professor and Head of the Department of

Psychology, University College Thiruvananthapuram for providing me with the support and

necessary facilities available in the department. I wish to thank Smt. Kalarani K, Associate

Professor, Mr. Harikrishnan. A, Mrs. Hiya Roy, Ms. Arathi Sarma U, Assistant Professors,

Department of Psychology, University College, Thiruvananthapuram for their support and

guidance.

I express my gratitude and sincere thanks to all who had been a part of various activities and

services done as a part of this training. I express my gratitude towards my fellow classmates for

their support and encouragement.

 CONTENTS

[Link] TITLE PAGE NO

1 Introduction 7

2 Internship Report 9

3 Community Work Report 40

4 Active Training Report 46

5 Tour Report 51
TRAINING AND PRACTICE
 Introduction
The course, "Training and Practice in Clinical Settings," is meticulously designed as a
comprehensive theory-cum-practical program aimed at fostering the essential skills required for
aspiring clinical psychologists to thrive in their chosen specialization. This foundational course
recognizes that effective professional practice extends beyond theoretical knowledge,
demanding a robust set of practical competencies and a deep understanding of real-world
clinical dynamics.

The theoretical component of the course is structured to introduce students to the core tenets of
professional skills, equipping them with advanced problem-solving strategies necessary to
navigate the multifaceted challenges inherent in clinical psychology. Concurrently, the
practicum component provides invaluable opportunities for direct engagement with seasoned
professionals in the field. This exposure is vital for inculcating a strong sense of
professionalism, enabling students to acclimatize to the demands and intricacies of the
specialization. The culminating practical examination (ESA) at the end of the fourth semester
serves as a comprehensive assessment of the skills and knowledge acquired.

Prerequisites for this course ensure that students possess a foundational understanding of key
concepts, including: basic knowledge of psychopathological symptoms in both adulthood and
childhood; a working knowledge of psychological tests utilized in clinical settings; awareness
of fundamental counseling skills and strategies; the ability to execute a systematic interview;
and a foundational understanding of the psychologist's role as a trainer, the concept of primary
prevention, brief analyses of community (public health) and social action models of mental
health, Caplan’s preventive psychiatry, the ecological model, general systems theory, and
mental health promotion programs.

Upon successful completion of this course, learners are expected to demonstrate enhanced
competency across both cognitive and skills domains. Cognitively, they will be able to
understand the principles of psychological intervention and critically evaluate the scope and
limitations of diverse approaches to dispensing psychological services. In the skills domain, the
course is designed to empower learners to gain practical experience in professionalism, develop
significant employability potential within the field, effectively apply theoretical knowledge
acquired during their coursework, practice the skills and strategies employed by professionals,
and ultimately gain comprehensive practical exposure in clinical psychology. This holistic
approach ensures that students are not only academically proficient but also practically
prepared to meet the rigorous demands of clinical practice and contribute meaningfully to
community mental health initiatives.
 INTERNSHIP REPORT

An internship serves as a vital career-based learning opportunity, offering students practical

engagement within a professional environment and enabling the application of academic
knowledge to real-world scenarios. This structured work experience is invaluable for gaining
industry exposure and significantly enhancing one's professional Curriculum Vitae. Internships
function as essential job training, providing foundational understanding and practical
experience within a chosen field. A high-quality internship typically involves a substantial
work schedule with minimal administrative duties, a clear project description, and an
orientation to the organization's culture. It also fosters the development of learning goals,
provides regular feedback, and offers opportunities for professional networking and exposure to
senior management, while simultaneously expanding oral and written communication skills,
fostering cultural understanding, and enhancing interpersonal communication.

I completed two significant internships during April and May, reflected a mature and insightful
approach to Sport psychology, gaining comprehensive clinical experience in mental health and
neuropsychiatry settings. My initial internship was at the Lncpe College,
Thiruvanathapuram, during April, where I engaged in various therapeutic and observational
activities. This was followed by an internship at the Government Mental Health Centre,
Oolanpara, Trivandrum, throughout May.

Across these placements, my responsibilities included providing psychoeducation to patients

and their families, conducting detailed observation of patients, and assisting with mental status
examinations. I also had the opportunity to take seminars on relevant topics and diligently
perform assigned duties, contributing to the operational efficiency of both centers. Furthermore,
I gained invaluable insights by attending Electroconvulsive Therapy (ECT) sessions
administered to patients and actively participating in sessions involving aversion therapy,
broadening my understanding of diverse therapeutic modalities and patient care within a
clinical context. These experiences have significantly strengthened my practical skills in patient
assessment, intervention, and overall clinical practice.
CASE-3

Name: I.B

Age: 14 years

Sex: Male

Marital Status: Not married

Education: 9th Std

Socioeconomic Status: Middle class

Occupation: Unemployed

Religion: Hindu

Family Structure: Nuclear Family

Birth Order: 2

Location: Urban

Informant: Mother

INFORMATION: Reliable and adequate

PRESENTING CHIEF COMPLAINTS

Informant:

For 5 years,

 Has difficulty reading and writing

  Hyperactivity and inattention

 Poor academic performance

 Talks back when teacher reprimands him

HISTORY OF PRESENT ILLNESS

The client presented with difficulty sustaining attention and remaining seated during

class, particularly when the teacher is instructing. He frequently talks back when

reprimanded and engages in distracting behaviours such as playing with erasers, rubber

bands, and pencils instead of taking notes. He often talks during lessons and has recurrent

conflicts with both teachers and peers. Academically, he makes frequent careless mistakes,

especially in reading and writing, and shows confusion between similar letters, such as ‘d’

and ‘b’ as well as ‘◻’ and ‘◻’

At home, he is unable to sit through movies or cartoons and is easily distracted. He exhibits

demanding behavior and has anger outbursts when his demands are unmet. The child is

consistently restless and demonstrates fidgeting behavior. He was first evaluated at MCTT,

Trivandrum, following repeated complaints from school but was lost to follow-up. There is

no history of self-injurious behavior.

Mode of Onset: Gradual

Course: Continuous

Duration: 9 years

Predisposing factors: learning difficulties and temperamental issues

Perpetuating factors: lack of consistent treatment

NEGATIVE HISTORY

No history of head injury, mental retardation, epilepsy, seizure and substance abuse were

found.

TREATMENT HISTORY

The client underwent his first evaluation at MCTT, Trivandrum, following concerns

raised by school authorities. Last year, he attended counseling sessions during which he

received training for a duration of four months; however, the intervention was discontinued

after the child refused to continue. Currently, he is undergoing Cognitive Remediation

Therapy (CRT) at the Mental Health Centre, Peroorkada.

MEDICAL HISTORY

The client experienced a respiratory infection, including a reaction to penicillin, at the age

of four. Since then, he has had recurrent respiratory infections. Additionally, he has a

history of frequent physical injuries during play and an episode of poisoning.

PAST HISTORY

No positive psychiatric history was present.

 FAMILY HISTORY

The patient, DP, is a 14-year-old male currently residing with his mother, who is

employed as a nursing staff, and his elder sister, aged 15. His father works at the Indian

Overseas Bank in Trichy and visits the family every two weeks. There is a family history of

psychiatric illness, notably bipolar disorder in the maternal grandmother, and specific

learning disorders (SLD) as well as alcohol use reported among multiple third-degree

relatives. No history of suicide is reported within the family. Additionally, there is no

consanguinity reported.

(pneumonia)

(BPAD) (stomach cancer)

(14 years)

PERSONAL AND SOCIALHISTORY

Perinatal History:

The client was born following a full-term, planned, and wanted pregnancy. The prenatal

period was complicated by placental abruption, resulting in a lower segment cesarean section

(LSCS). At birth, his crying was delayed, and his birth weight was 2.6 kg. He also

experienced nutritional deficiencies during the early postnatal period.

Childhood History:

During childhood, the client exhibited significant difficulty in maintaining attention,

including trouble focusing on television programs and frequently becoming distracted by

objects he held in his hands. He often failed to follow parental instructions and showed

oppositional behavior, especially when his demands were unmet. He also had difficulty

reading sentences, suggesting early academic challenges. Physically, he would become so

absorbed in play that he often failed to notice or respond to injuries sustained during games.

Educational History:

The client began formal schooling at the age of 3 and is currently studying in the 9th

standard. His scholastic performance has been consistently below average throughout his

academic career. He has reported persistent difficulties with reading and writing.

Additionally, his relationships with teachers and peers have often been marked by conflicts.

Occupational History:

There are nil significant details provided.

Sexual History:

There are nil significant details provided.

Substance Use History:

 There is no significant history of substance abuse.

PREMORBID PERSONALITY (PMP)

● Attitude to Self: low frustration tolerance and poor emotional regulation

● Interpersonal Relationships: Frequent conflicts with friends and sister

● Use of Leisure Time: Plays football but does not follow the rules

● Predominant Mood: He mood was generally irritable

● Religious Beliefs and Moral Attitudes: he has adequate religious beliefs and holds

age- appropriate moral attitudes

● Habits: No specific habitual behaviors were reported.

MENTAL STATUS EXAMINATION (MSE)

General Appearance and Behaviour

The client’s personal hygiene and dressing are appropriate and adequate. Multiple

physical injuries are noted on his knees and elbows, reportedly due to frequent play. Eye

contact is maintained throughout the interaction, and rapport is adequate and easily

established. Reality contact is intact, and the client appears cooperative. No tics,

mannerisms, or catatonic features were observed.

Psychomotor activity

The client exhibited mild fidgeting behavior, particularly with his pencil, indicating

increased psychomotor activity.

Speech

The client’s speech demonstrates normal reaction time, tone, tempo, and volume. His

content was also relevant.

Mood: Irritatable

Affect : Appropriate

Thought

The client exhibited no thought disturbances.

Perception

No significant disturbance was observed.

Cognition

Orientation:

 Time: Intact

 Place: Intact

 Person: Intact
Attention and concentration:

Memory

 Immediate: Below average

 Recent: Below average

 Remote: Intact

Intelligence:

 General information: Adequate

 Comprehension: Below Average

 Arithmetic: Adequate

 Abstractibility: Below Average

Judgment

 Personal: Intact

 Social: Intact

 Test: Intact

Insight

Grade 2 level of Insight (Slight awareness of being sick and needing help but denying it

all at the same time.)

SUMMARY

I.B is a 14-year-old male student currently studying in the 9th standard from an urban

middle socioeconomic background. He lives in a nuclear family with his mother, father, and

a 15-year-old elder sister. The primary informant for this evaluation is his mother, who

provides reliable and adequate information.

The client has a history of academic difficulties spanning over five years, characterized by

hyperactivity, inattention, and poor scholastic performance, particularly in reading and

writing. He struggles with letter reversals (e.g., confusing ‘d’ and ‘b’, ‘◻’ and ‘◻’), careless

mistakes, and maintaining focus in both school and home settings. His behavior includes

frequent conflicts with teachers and peers and oppositional tendencies, such as talking back

when reprimanded. At home, he exhibits demanding behavior and anger outbursts when his

needs are unmet, and requires continuous parental prompting to complete daily activities and

self-care.

Perinatal history reveals complications with placental abruption leading to cesarean delivery

and early nutritional deficiencies. Childhood history indicates difficulties in attention,

oppositional behavior, and physical injuries sustained from hyperactive play. There is no

history of self-injurious behavior or substance abuse.

Family history is notable for bipolar disorder in a second-degree relative (maternal

grandmother) and multiple third-degree relatives with specific learning disorders and alcohol

use, though no suicidal history or consanguinity is reported.

Premorbid personality assessment highlights low frustration tolerance, poor emotional

regulation, frequent interpersonal conflicts, predominantly irritable mood, and adequate

religious and moral attitudes. The client enjoys football but struggles with adherence to rules.
Speech is normal in all aspects, with clear and relevant content. His mood is irritable with an

appropriate affect. Orientation is intact, though immediate and recent memory, attention,

concentration, comprehension, and abstract thinking are below average. Judgment is intact,

and insight is partial, showing some awareness of his condition alongside denial.

Currently, he is undergoing Cognitive Remediation Therapy (CRT) at the Mental Health

Centre, Peroorkada, following earlier counseling sessions which were discontinued due to his

reluctance.

PROVISION DIAGNOSIS:

F90.9 Attention-Deficit Hyperactivity Disorder, Unspecified Type

F81.3 Specific Developmental Disorders ( Mixed disorder of scholastic skills)

CASE-1

Name: S

Age: 17 years

Sex: Female

Marital Status: Single

Education: 12th Std

Occupation: Not working

Socioeconomic Status: Middle class

Religion: Hindu

Family Structure: Nuclear Family

Birth Order: 2

Location: Semi urban

Informant: Mother

Information: Reliable and adequate

PRESENTING CHIEF COMPLAINTS:

Client Informant

 She reported of intrusive thoughts (3  Reported that she had

months) recurrent sexual thoughts (3

 She complains of reduced sleep months)

and suicidal ideations (3 months)  Increased anxiety and fearful

thoughts (7 years)
  She reported of suicidal

ideations and sadness (3 months)

 Reduced sleep (3 months)

HISTORY OF PRESENT ILLNESS:

The client presented with a history of psychiatric symptoms beginning at the age of 8,

when she experienced her first manic episode. Symptoms at that time included reduced need

for sleep, increased talkativeness, irritability, and heightened suspiciousness. She was treated

for approximately one year, after which treatment was discontinued.

Following this, the client exhibited self-harming behaviors and made suicidal threats. Around

two years later, she began experiencing persistent intrusive thoughts, associated with

significant anxiety and fearfulness. These symptoms progressively intensified, with

increasing suspiciousness and emotional dysregulation, severely impairing her social

interactions and daily functioning.

The onset of her psychiatric symptoms coincided with a period of prolonged medical illness

involving kidney complications. She underwent multiple hospitalizations, surgeries, and tube

insertions, which contributed to the development of health-related anxiety. This anxiety

gradually generalized, leading to intrusive fears of being a burden on her family.

As a result of her worsening psychological state, the client discontinued her 10th-grade

education for six months to pursue treatment. At present, intrusive thoughts, anxiety, and

functional impairment continue to affect her daily life.

Mode of Onset: Gradual

Course: Continuous
Predisposing factors: Prolonged medical illness with kidney complications, multiple

hospitalizations and personality traits (heightened fearfulness)

Precipitating factors: Treatment discontinuation, and school interruption due to symptoms

Perpetuating factors: Fear of burdening family, academic disruption and lack of consistent

treatment.

NEGATIVE HISTORY

No history of head injury, mental retardation, epilepsy, seizure and substance abuse

were food.

TREATMENT HISTORY

The client’s prolonged medical condition involved multiple hospitalizations and

invasive treatments. The client was admitted to MHC, Peroorkada, for one month earlier

this year for psychiatric treatment.

MEDICAL HISTORY

The client has a history of a congenital fused kidney condition causing urinary

difficulties, for which she underwent surgery.

PAST HISTORY

The client experienced her first manic episode at 8 years old, presenting with symptoms of

increased talkativeness, irritability, and decreased need for sleep.

FAMILY HISTORY

The client belongs to a nuclear family consisting of her mother, father, and elder brother.

Her father is employed abroad, while her mother manages the household. The family

structure appears stable, with no history of consanguineous marriage. There is a history of

suicide among third-degree relatives. No specific familial stressors have been identified

as directly contributing to the client’s current condition.

(16 years)
PERSONAL AND SOCIAL HISTORY

Perinatal History

The client was born via lower segment caesarean section (LSCS) due to fetal distress. She

had a normal birth weight and completed the full gestational period. Following delivery, she

was admitted to the Neonatal Intensive Care Unit (NICU). There was no history of neonatal

convulsions or jaundice. However, the mother reported experiencing antenatal distress

during pregnancy. Although the APGAR score is unavailable, the birth cry was immediate,

and

developmental milestones were achieved on time.

Childhood History

The client's achieved age-appropriate motor, speech, and social milestones. There were no

significant health or behavioral issues. Feeding, sleep, and toilet training progressed

typically. She showed adequate social interaction and adjusted well to early structured

environments.

Play History

The client demonstrates a preference for creative and imaginative play. She enjoys drawing

and writing stories. She shows limited interest in social interaction with peers and tends to

engage more comfortably in activities done alone.

Educational History

The client began formal education at the age of 4 years. She continued her studies up to

10th standard, after which she discontinued schooling temporarily due to medical treatment.

She later resumed her education from the 11th standard onward.

Occupational history

There is no occupational history, as the client is currently a student and has not been

engaged in any form of employment.

Sexual history:

There is no history of sexual activity reported. The client has not been involved in any

romantic or sexual relationships.

Substance use history:

There is no history of substance use, including tobacco, alcohol, or other psychoactive

substances.

PREMORBID PERSONALITY (PMP)

Attitude to self: was always fearful and sad

Interpersonal relationships: She was introverted and maintained relationships but had

difficulty making new friends.

Use of leisure time: She spends her time drawing animals and writing stories or poems.

Predominant mood: His mood was generally sad

Religious beliefs and moral attitudes: She adhered to religious practices and visits temple

often.

Habits: The client exhibits a repetitive behavior of fidgeting with her fingers, particularly

when experiencing obsessional thoughts.

MENTAL STATUS EXAMINATION (MSE)

General Appearance and Behavior

The client was dressed appropriately. She was well groomed and did not frequently change

her posture. She maintained eye contact throughout the interaction and was cooperative. A

rapport could be established.

Psychomotor Activity

She was seen fidgeting her hands quite often.

Speech

She was spontaneous, fluent, and coherent. The rate, volume, and tone of speech are

within normal limits, and articulation is clear. The person communicates effectively, with

speech that is goal-directed and appropriate to the context, showing no signs of pressure,

latency, or unusual patterns.

Mood: Tired

Affect: Appropriate

Thought:

The client reported having repetitive, intrusive sexual thoughts.

Perception:

No significant disturbance was observed.

Cognition

 Time: Intact

 Place: Intact

 Person: Intact

Attention and concentration:

Memory

 Immediate: Intact

 Recent: Intact

 Remote: Intact
 Intelligence

 General Information: Adequate

 Comprehension: Adequate

 Arithmetic: Adequate

 Abstract Thinking: Adequate

Judgement

 Personal: Intact

 Social: Intact

 Test: Intact

Insight

Grade 6 level (True Emotional Insight)

SUMMARY

S is a 17-year-old female from a middle-class, semi-urban, nuclear family background,

currently studying in the 12th standard. She was referred based on a three-month history of

intrusive sexual thoughts, reduced sleep, sadness, and suicidal ideation, as reported both by

herself and her mother. Additionally, she has exhibited heightened anxiety and fearful

thoughts persisting over the past seven years. Her psychiatric history dates back to the age of

8, when she experienced her first manic episode characterized by reduced need for sleep,

increased talkativeness, irritability, and suspiciousness. She received psychiatric treatment for
a year, which was then discontinued prematurely. In the years that followed, she developed

self-harming behaviors, suicidal threats, and progressively worsening anxiety with

obsessive and intrusive thoughts, which led to emotional dysregulation and significant

impairment in her daily functioning and social interactions.

Her psychological symptoms were notably influenced by a prolonged medical history of a

congenital fused kidney condition, which required multiple hospitalizations, surgeries, and

invasive treatments. This prolonged physical illness contributed to the development of health-

related anxiety that eventually generalized into a persistent fear of being a burden on her

family. This fear, along with disrupted academic progress and inconsistent treatment, served

as major perpetuating factors for her ongoing distress. She had to discontinue her 10th-grade

education for six months due to her deteriorating mental health but later resumed schooling

from the 11th grade.

In terms of development, S had an unremarkable perinatal and childhood history, achieving

developmental milestones on time and showing age-appropriate behaviors. However, her

premorbid personality was marked by persistent fearfulness, sadness, and introversion. She

maintained relationships but had difficulty initiating new social connections and preferred

solitary, creative activities like drawing and writing stories. She adhered to religious

practices and exhibited repetitive behaviors such as finger fidgeting during episodes of

obsessive

thinking. There is no history of sexual activity, substance use, or occupational engagement.

Family history reveals no major stressors, though a third-degree relative had died by suicide.

The client appeared to be well-groomed, appropriately dressed, and cooperative. She

maintained eye contact and was able to establish rapport. Mild psychomotor agitation was

observed in the form of frequent hand fidgeting. Her speech was spontaneous, coherent,
fluent, and appropriate in rate and volume. She described her mood as "tired," and her affect

was appropriate to the context. Thought content was notable for persistent, intrusive sexual

thoughts. There were no perceptual disturbances. She was oriented to time, place, and person.

Attention, concentration, and memory (immediate, recent, and remote) were intact. Cognitive

functions such as general knowledge, comprehension, arithmetic, and abstract thinking were

assessed as adequate. Her judgment was intact across personal, social, and test domains.

Insight was assessed at Grade 6—true emotional insight—indicating a deep understanding of

her emotional state and recognition of her psychological difficulties and their implications.

PROVISIONAL DIAGNOSIS

F42.0 Obsessive compulsive disorder along with Cluster B personality traits