Internship

Clinical Cases Report

Table of Contents

Summary........................................................................................................................................3

General Overview of Organization..............................................................................................3

Description of Position..................................................................................................................3

Major Projects and Key Learning...............................................................................................4

Applicability to Degree and Program..........................................................................................4

Employment/Career Goals............................................................................................................4

Overall Perception of Internship and Organization...................................................................5

Case report 1....................................................................................................................................5

Case report 2....................................................................................................................................8

Case report 3..................................................................................................................................13

Case report 4..................................................................................................................................16

Case report 5..................................................................................................................................20

Clinical Cases Report

Summary

The internship at Fauji Foundation Hospital Rawalpindi spanned 6 weeks and 3 days.

Throughout this period, we acquired valuable experience by learning about new therapies,

techniques, and psychological tests, and by observing clients in a clinical setting. This report

includes a review of 5 case studies.

General Overview of Organization

Fauji Foundation Hospital (FFH) Rawalpindi, the largest hospital in the Fauji Foundation

network, was founded on March 6, 1959, by President General Muhammad Ayub Khan as a 50-bed

tuberculosis facility. It has since expanded into a major tertiary care centre and is affiliated with

Foundation University Medical College. Now an 811-bed hospital spanning 42 acres, FFH

Rawalpindi provides a wide range of medical treatments in nearly all major and minor specialties,

including Medicine, Surgery, Orthopaedics, Gynaecology, and more, along with comprehensive

diagnostic services.

Description of Position

During my internship in the Mental Health department under clinical psychologist Ms.

Farkhanda Jabeen, I spent my mornings attending lectures on new therapies, techniques, and

psychological tests, and delivering presentations. After 12:00 pm, I observed patients alongside

senior interns. In the first two weeks, my responsibilities included note-taking, patient observation,

taking patient histories, administering therapies and psychological tests, and identifying stressors.

Subsequently, I progressed to independently managing cases, applying psychological tests, and

conducting therapy sessions with the support of junior interns.

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Major Projects and Key Learning

After receiving comprehensive training from the clinical psychologist and senior interns, I

was able to apply my academic knowledge in a practical setting and acquire various new skills. I

became adept at administering psychological tests, including Raven’s SPM, Raven's CPM, Thematic

Apperception Test (TAT), and Beck Anxiety and Depression Inventories. I also gained experience in

therapeutic methods such as EMDR, CBT, TF-CBT, and Family-Focused Therapy. Additionally, I

learned about trauma bonding, research and report writing, and explored techniques like Art Therapy

and Metacognitive Training for Depression (D-MCT). I also became acquainted with Rational

Emotive Behavior Therapy (REBT) and several disorders, including Conduct Disorders and

Agoraphobia.

Applicability to Degree and Program

The knowledge and skills I acquired during my internship were directly applicable to my

clinical psychology degree. It helped me enhance my writing, teamwork, organization,

accountability, and problem-solving abilities. The internship offered valuable experience and

exposure, deepening my understanding of the field and showing me how to apply theoretical

concepts to real-life situations involving people in crisis.

Employment/Career Goals

During my internship, I discovered that my true passion lies in clinical psychology. The

hands-on experience deepened my understanding of the field and its role in analyzing human

behavior and addressing various challenges. I am motivated by clinical psychology’s mission to

enhance lives through interventions that alter thinking and behavior. As a future clinical

psychologist, I aspire to use psychological science to address complex issues, foster resilience, and

help individuals uncover their strengths for a more fulfilling life.

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Overall Perception of Internship and Organization

My internship was a great experience where I learned a lot about disorders, therapies, psychological

tests, and skills like history taking and rapport building. Ms. Farkhanda Jabeen provided excellent

guidance, and my senior interns helped me improve my skills in empathy, teamwork,

communication, and handling tough situations.

Case report 1

Identification Information

Name TR

Age 30

Gender Female

No. of Siblings 6

Marital Status Single

Children Nill

Occupation Nill

Father Occupation Retired from Army

Mother Occupation House Wife

Religion Islam

Birth Order 2nd child

Earning Members in Family Two brothers

Socio-economic Status Middle Class Family

Family System Joint

Residency Islamabad

Father Alive/Dead Alive

Mother Alive/dead Alive

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Head of the Family Father

Presenting Complaints

 Decreased sleep

 Suspiciousness and fearfulness

 Self-muttering

 Unprovoked laughter spells

 Odd behaviors

Above listed symptoms were noticed in the client for past one week.

Reasons for Referral

The patient was brought to the Outpatient Department (OPD), against her will, by her

family due to suspiciousness and having decreased sleep for past one week.

Psychological/Psychiatric History

The client, born at home in Chakwal, achieved her developmental milestones and started

school at age five, eventually completing her B.A. She grew up in a joint family with six siblings

and is the second child. Both her parents suffer from hypertension, and her mother also has diabetes.

Her elder sister had psychiatric treatment for six months and recovered. The client is described as

religious, honest, and generally well-adjusted, sharing her stresses with her siblings. However, she

occasionally becomes angry and suspicious due to her symptoms. Her first experience of

nervousness and shivering occurred the day before her engagement to her cousin, which was against

her will. She later broke off the engagement herself.

Psychological assessment

Informal Assessments

 Clinical interview
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 Behavioral observation

Formal Assessment

 Beck Anxiety Inventory

 Beck Depression Inventory

 Positive and Negative Syndrome Scale (PANSS)

Behavioral Observation

The client appeared well-groomed and appropriately dressed but exhibited a guarded

demeanor, indicative of a long-term psychotic state. Her psychomotor activity was normal, and she

was fully oriented, though she displayed suspicion, fear, and a tendency to isolate. Her speech was

coherent but centered on paranoid delusions, including fears of being harmed, poisoned, and

watched. She also experienced auditory hallucinations with voices discussing her behavior. Her

mood was low and anxious, with a blunted affect. Despite being cognitively alert, her thoughts were

dominated by persecutory delusions. She had insight into her mental illness but attributed her

experiences to external forces.

Beck Anxiety Inventory

Interpretation

This test used to assess the intensity of physical and cognitive anxiety symptoms of client

during the past week. Client scored 8 on BAI, which indicates that she is having mild anxiety.

Beck Depression inventory (BDI)

Interpretation

The Client got 18 scored after being analyzed through the test “Beck depression Inventory”

abbreviated as BDI, which indicates that she has mild depression.

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Positive and Negative Syndrome Scale (PANSS)

Interpretation

On PANSS, Client scored 85 which shows moderate severity.

Diagnosis

Schizophrenia 295.90 (F20.9)

Treatment

Cognitive Behavioral Therapy

CBT for psychosis (CBT-p) can help the client by reducing distress from her paranoid

thoughts, hallucinations, and suspiciousness. It can teach her to challenge and change her delusional

beliefs, like fears of being watched or poisoned, and manage her hallucinations more effectively.

CBT-p can also improve her daily functioning, help her cope with stress in healthier ways, and

strengthen her relationships. By providing her with better understanding and coping strategies, CBT-

p can enhance her insight into her condition and reduce her reliance on external explanations for her

symptoms.

Relaxation exercise would be helpful to reduce her tension. Help her to distract from those negative

thoughts which are disturbing for her. Relaxation techniques and anger management techniques

would be helpful to reduce her aggression.

Case report 2

Identification Information

Name ZK

Age 39

Gender Female

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No. of Siblings 4

Marital Status Widow

Children 3 daughters 1 son

Occupation Nill

Father Occupation Farmer

Mother Occupation Nill

Religion Islam

Birth Order Last child

Earning Members in Family Two brothers

Socio-economic Status Middle Class Family

Family System Joint

Residency Islamabad

Father Alive/Dead Dead

Mother Alive/dead Alive

Head of the Family Father

Presenting Complaints

 Decreased sleep for past one year

 Crying spells for past one year

 Anger issues for last seven months

 Forgetfulness for last seven months

Reasons for Referral

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The patient came on her own to the Outpatient Department (OPD) due to feeling of

hopelessness and difficulty to deal with the situations.

Psychological/Psychiatric History

The client, who achieved all developmental milestones on time, comes from a lower-middle-

class family and grew up in a strict household with three siblings. She left school after 8th grade due

to cultural restrictions on women's education and later married at 21. While she had a loving

relationship with her husband, her in-laws became unsupportive after the birth of her first daughter.

Their behavior worsened after her husband's death, forcing her to leave the house. Despite her

parents' emotional and financial support, they have limited resources, and the client now lives in Dar

ul Amaan with her eldest daughter, while her other children live in a hostel. Her younger son, who is

deaf, lives with his aunt. The client is under significant stress, especially due to financial challenges,

including her eldest daughter's college expenses. She has not received any prior therapy for her

symptoms.

Psychological assessment

Informal Assessments

 Clinical interview

 Behavioral observation

Formal Assessment

 House Tree Person – HTP

 Rotter’ s Incomplete Sentences Blank

 Beck Depression Inventory

Behavioral Observation

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The client appeared her age, was casually dressed with good hygiene, and was alert and

oriented. She had no issues with attention, memory, or perception. Her mood was depressed, marked

by feelings of hopelessness, but she showed no signs of psychosis or suicidal thoughts. She had a

fair understanding of her condition and displayed normal gait, posture, gestures, and facial

expressions. She maintained proper eye contact, was cooperative, motivated for treatment, and her

speech was appropriate and relevant.

House Tree Person (H-T-P)

General Interpretation

The HTP test revealed that the client has low ego strength, experiences tension and anxiety,

particularly regarding her home and children's future, and seeks control over her environment. She

feels helpless, faces external aggression, and has insecurities about the future. The test also indicated

poor adjustment, immaturity, and unrealistic goals, along with feelings of guilt and frustration. Her

drawings suggest a rejection of home life, rigid thinking, and a lack of emotional warmth, aligning

with her interview disclosures.

Rotter’ s Incomplete Sentences Blank

General Interpretation

The client's score of 139 on the Rotter's Incomplete Sentences Blank indicates social

maladjustment. Her responses reflect strong love for her children but also conflicts with others,

whom she perceives as cruel. She expressed concerns about her children's future and has

perfectionist tendencies in family relationships. The client feels socially inadequate and often blames

others for her failures. Despite these struggles, she has positive memories of school and believes

success comes through determination and education.

Beck Depression Inventory

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General Interpretation

Score on Beck Depression Inventory was 20 showed that client has moderate mood

disturbances. This score helped in confirmation of the diagnosis. The scores were consistent with

client’s complaints and interview information.

Diagnosis

296.31 (F33.0) Major Depressive Disorder Recurrent Episode, Mild

Treatment Plan

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) can help by addressing negative thinking patterns and

improving emotional regulation. Techniques such as cognitive restructuring can challenge and

change automatic negative thoughts, like hopelessness and guilt. Behavioral activation can

encourage engaging in pleasurable activities or self-care tasks, and sleep hygiene techniques can

help establish a regular sleep schedule and reduce ruminations before bed. Involving children in

meaningful activities and practicing relaxation techniques before sleep can also be beneficial.

Client-Centered Therapy

Client-Centered Therapy (CCT) focuses on creating a supportive and non-judgmental

environment where clients can freely express their thoughts and feelings. The therapist provides

unconditional positive regard, empathy, and genuineness, allowing clients to explore their

experiences at their own pace. Instead of directing or offering solutions, the therapist helps clients

find their own path to personal growth and self-acceptance. This approach helps clients work

through emotional pain, rebuild self-worth, and regain control over their lives, fostering

empowerment and resilience.

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Case report 3

Identification Information

Name MO

Age 23

Gender Female

No. of Siblings 2

Marital Status Single

Children Nill

Occupation Student

Father Occupation Lawyer

Mother Occupation Teacher

Religion Islam

Birth Order Last child

Earning Members in Family Parents

Socio-economic Status Middle Class Family

Family System Nuclear

Residency Islamabad

Father Alive/Dead Alive

Mother Alive/dead Alive

Head of the Family Mother

Presenting Complaints

 Feelings of sadness for past one year

 Feeling of loneliness for last six months

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 Constant Fatigue for last four months

Reasons for Referral

The patient was referred to the clinical psychologist for the psychological assessment and

devising a management plan.

Psychological/Psychiatric History

The client was born through normal delivery with no emotional or physical issues at birth and

achieved developmental milestones on time. She completed 13 years of formal education, starting

school at age five, and was previously an above-average student with positive relations with teachers

and peers. Recently, she has struggled with concentration, motivation, and a serious attitude towards

her studies. Coming from a supportive middle-class family, she is described as sensitive,

cooperative, and shy but inclusive. Her temperament changed drastically after a long-term

engagement was unexpectedly called off, leading to increased withdrawal, negative thoughts, and

signs of suicidal ideation, including two minor self-harm attempts in the past two months.

Psychological assessment

Informal Assessments

 Clinical interview

 Behavioral observation

Formal Assessment

 House Tree Person – HTP

 Beck’s Hopelessness Scale

 Beck Depression Inventory

Behavioral Observation

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The client appeared underweight and weak, dressed appropriately for the weather but seemed

subdued and fatigued. She sat stiffly, stared at the ground, and moved sluggishly. She responded to

questions when prompted, showing reluctance and unease in discussing her issues. Despite her

discomfort, she was alert, attentive, and had no memory impairments. She demonstrated insight into

her problems and had no delusions, hallucinations, or obsessional thoughts.

House Tree Person (H-T-P)

General Interpretation

The client's diagrams suggest an introverted personality with a strong tendency for

aggression and rigidity. She appears indecisive, has weak ego strength, and exhibits obsessive-

compulsive behaviors. Her feelings of inadequacy and poor interpersonal relations stem from her

reserved and closed-off nature. The client is shy, timid, and fears criticism, leaning towards fantasy

and struggling with reality. Overall, she displays a withdrawn personality with a strong need for

dependency and protection.

Beck’s Hopelessness Scale

General Interpretation

The BHS consists of total questions answered as True or False. The client answered 16 in the

scoring manner and so got a score of 16. This means she is at risk of suicide.

Beck Depression Inventory

General Interpretation

The client scored 55 on the Beck Depression Inventory, indicating extreme depression. This

severe level of depression suggests an urgent need for professional help to address the negative

effects of her unstable mental state.

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Diagnosis

Major Depressive Disorder (F33).

Treatment Plan

Dialectic Behavior Therapy

Dialectical Behavior Therapy (DBT) is ideal for the client, who is dealing with severe depression,

loneliness, and self-harm. DBT addresses mindfulness, distress tolerance, emotion regulation, and

interpersonal effectiveness. It can help her become more aware of her emotions, manage distress

without resorting to self-harm, improve her mood, and build better relationships. Through individual

therapy and family support, DBT will provide practical skills to manage her emotions and enhance

her overall well-being.

Case report 4

Identification Information

Name MI

Age 11

Gender Boy

No. of Siblings 2 (1 brother, 1 sister)

Occupation Student

Father Occupation Businessman

Mother Occupation Housewife

Religion Islam

Birth Order Last child

Socio-economic Status Middle Class Family

Family System Nuclear

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Residency Rawalpindi

Father Alive/Dead Alive

Mother Alive/dead Alive

Head of the Family Father

Presenting Complaints

According to mother:

 Feelings of sadness for last seven months

 Difficulty in understanding communication for last seven months

 Intense emotional reactions for last five months

 Frequent Verbal Disputes for last six months

Reasons for Referral

The client came to the OPD with behavioral issues, including refusing to sleep alone due to

recurring nightmares about separation. He also experiences excessive worry about being apart from

home or family, concerns for a family member's safety, fear of getting lost, and reluctance to go to

school.

Psychological/Psychiatric History

The client, born through normal delivery with no physical illness or emotional stress at birth,

achieved developmental milestones on time but had some delays in neck holding, sitting, crawling,

and babbling. He began formal education at age 3 but struggled with anxiety symptoms, leading to a

loss of interest in school and poor performance, resulting in not being promoted to 5th grade. He

comes from a supportive middle-class family with two siblings, and while he has a loving family, he

was very "clingy" during preschool, showing significant separation anxiety. He frequently

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experienced nightmares about his mother dying and exhibited fear, worry, trembling, sweating, and

crying whenever separated from her.

Psychological assessment

Informal Assessments

 Clinical interview

 Behavioral observation

Formal Assessment

 House Tree Person – HTP

 Beck Anxiety Inventory

Behavioral Observation

The 11-year-old client was neatly dressed, of average height, and bulky in appearance.

During the session, he leaned towards the therapist and initially resisted sharing information. He

maintained eye contact, and his gait was normal. His speech was appropriate in tone, volume, and

rate. His attention, concentration, memory, and judgment appeared intact, as observed during the

session. He was aware of the place, time, and day but seemed confused and anxious, rubbing his

hands and sitting on the edge of the chair due to discomfort.

House Tree Person (H-T-P)

General Interpretation

After a thorough examination of the diagrams drawn by the client it can be concluded that

the client seems to have suffered from the fear of lost loved one. Projective analysis showed the

insecure personality of the client. It also shows that client is not much social, shows weakness of

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the ego of client. Client may have limited skills, flight from reality, dependency, personal

problems, defensiveness, desire to be prominent and high need of nurturance.

Beck Anxiety Inventory

General Interpretation

The client scored 21 on BAI. Scoring of client falls in “severe anxiety”. The client is still

having some symptoms of anxiety, which needs to be sought out in order to gain full mental

stability.

Tentative Diagnosis

(309.21/F93.0) Separation Anxiety Disorder

Treatment

Anger spotlight technique

Anger spotlight technique was used to control anger by stopping, relaxing and letting go. It

was discussed with the client through verbal and pictorial demonstration. The client was shown a

worksheet of traffic light and he was guided when is angry, he is at red level and he must stop

himself at this level. The second level is the yellow light and he must relax himself at this level. The

third level was green light and he was told to let go of his anger at this level. Client practice it in

front of the therapist.

Behavior Management

Following techniques were used and discussed with the mother to manage the behavioral

problem of the client at home and school.

Reinforcement

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The concept of positive and negative reinforcement was taught to mother of the client in easy

language. He was taught how he can use the client’s reinforcers to increase the desirable behavior

and to decrease the problematic behaviors of the client. He was instructed that if the client behaves

in desirable way; he should be immediately reinforced so that desirable behavior can be

strengthened. On the other hand, if the client behaved in undesirable way, he was instructed to

remove things of client’s interest from his routine that day.

Behavioral contract

The behavioral contract took place between the therapist and the client. The client promised

the therapist to fulfill all the clauses of the contract and signed the contract. The clauses of the

contract comprised that the client will not argue with anyone, will not tease or annoy others, will not

verbally or physically hit others and will ignore if someone annoys him. He assured while signing

that he will keep in mind all the clauses of the contract.

Case report 5

Identification Information

Name FK

Age 25

Gender Female

No. of Siblings 5

Marital Status Single

Children Nill

Occupation Nill

Father Occupation Retired Soldier

Mother Occupation House Wife

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Religion Islam

Birth Order 3rd or the middle

Earning Members in Family 2

Socio-economic Status Middle Class Family

Family System Joint

Residency Jehlum

Father A live/Dead Alive

Mother Alive/dead Alive

Head of the Family Father

Presenting Complaints

 Spells of unresponsiveness for 2 years.

 Weeping spells for 2 months.

 Decreased interest in activities for 2 months.

 Irritability for 2 months.

 Minimal communication for the past 2 weeks (This was the duration at the time of the

session).

 Her sleep has been disturbed for the past 7 months.

Reasons for Referral

The patient was brought to the Outpatient Department (OPD) by her family because she

had been experiencing episodes of unresponsiveness for the past few weeks. She was then

referred to the psychiatry department, as she has been known to have intellectual disability since

childhood.

Psychological/Psychiatric History

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The client's personal history was verified through both her and her family's accounts. She did

not receive formal education and used to be friendly, enjoying her phone, TV, and favorite clothes

and bangles, but was not very religious. She grew up in a joint family with five siblings—three

sisters and two brothers. As the middle child, her eldest sister is married, her 27-year-old brother

lives in Dubai, her 25-year-old sister is unmarried, and her younger siblings include a 19-year-old

sister and an 18-year-old brother with an intellectual disability. The client and one of her cousins

also have intellectual disabilities. She is currently taking sleeping pills and medication for her spells.

Informal Assessments

 Clinical interview

 Behavioral observation

Formal Assessment

 Beck Depression Inventory

 Hospital Anxiety and Depression Scale (HADS)

 House Tree Person – HTP

Behavioral Observation

The client was well-groomed, dressed appropriately, and showed respect towards the

clinician. Her psychomotor activity was slow, indicating low energy, but she was alert and oriented

to person, place, and time. Her short-term memory was intact, though her long-term memory was

somewhat limited. She had adequate attention and concentration but displayed some restlessness.

Her speech was minimal but coherent and relevant. While her thought process and judgment could

not be fully assessed due to limited verbal interaction, her mood and affect were appropriate, and she

showed partial insight into her condition.

Beck Depression Inventory

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Interpretation

The client completed the Beck Depression Inventory (BDI) with a total score of 15,

indicating moderate depression. She showed high levels of wariness, frequent crying, and low

decision-making ability, assertiveness, and energy.

House Tree Person (H-T-P)

General Interpretation

The client appears preoccupied with belonging and nurturance, showing insecurity and

feelings of isolation, which may contribute to her social withdrawal. Her drawings suggest

dependency on others, emotional immaturity, and a fragmented sense of self, reflecting difficulties

in coping with life's demands. She seems to have a limited sense of self and an unstable

personality, leading to emotional instability and lack of confidence. Her mood is dysphoric, with

restlessness and a desire for significance. There are signs of immaturity, impulsiveness, and

difficulty facing real-life challenges, alongside possible regressed or infantile sexual concern.

Hospital Anxiety and Depression Scale (HADS)

Interpretation

The client scored 2 on the anxiety scale, which is normal, but scored 14 on the depression

scale, indicating an abnormal level of depression.

Tentative Diagnosis

293.83(F06.31) Depressive Disorder Due to Another Medical Condition

Treatment

Family Therapy

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Family therapy aims to rebuild trust and improve communication by addressing conflicts and

educating the family about the client’s condition. Psychoeducation helps family members

understand and empathize with the client. Ongoing collaboration with a psychiatrist and

psychologist supports the client’s medication and therapy, with regular sessions to monitor progress,

resolve conflicts, and reinforce strategies.

Reality-Based Therapy (WDEP System)

Reality-Based Therapy aims to help the client understand their behavior, assess its effectiveness, and

make positive changes. It involves exploring the client's goals, examining how current behaviors

(like nail-biting, sticking out her tongue, avoiding movement, and sitting idly) align with those

goals, and encouraging self-reflection on whether these behaviors are helpful or harmful. An

actionable plan with specific steps is then created to improve family interactions and manage

emotions effectively.

Stress Management Techniques

Stress management techniques aim to help the client develop strategies to manage and reduce stress.

The client learns to identify stressors and view them as opportunities for growth. Relaxation

methods like progressive muscle relaxation and deep breathing are introduced to help calm the mind

and body.

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