Case Presentation

Presented to;

Dr. Iffat Rohail

&

MS- 4th

Presented By;

Tabassum Javaid

Department of Psychology
 The following areas we will learn in our
Presentation … 
1. The Purpose of Case Presentation
2. Beginning the Presentation
a) Purpose of the presentation
b) Identifying data (ID)
c) Chief complaint (CC)
3. Focusing On The Main Points
a) History of Present Episode (HPE)
b) Personal History
c) Educational History
d) Social History
e) Marital History
4. Family History
5. Premorbid Personality
 Continue…
4. Psychometrics Assessment
5. Diagnoses
6. Case Conceptualization
7. Therapeutic Techniques of Therapies
8. Therapist/ client orientation dynamics
9. References
1). Beginning the Presentation
There are three components of beginning the presentation.
a) Agency Setting
This case was taken from CMH Rawalakot
b) Identifying Data

Name Miss. xyz

Age 54Years Old
Gender Male
Qualification M.A
No. of Siblings 5(3 Brothers, 2 Sisters)
Birth Order 5th Born
Marital Status Married
Spouse Age 50 Years Old
Spouse Qualification Intermediate
No. of Children Nil-
c). Chief Complaints

Duration of Present Problem:

when he was 12 year old
Severity of Present Problem
Excessively worried and irritating about his life when his aunt gave him
poison .

Following symptoms have been observed according to DSM-5:

1. Palpitations
2. Restlessness
3. Fatigue
4. Sweating
5. Insomnia
6. Muscular tension
7. Constipation

All the symptoms caused clinical significant distress in important areas of

functioning.
 c). Chief Complaints
Degree of Insight:
Client decided to seek treatment when he felt increased in symptoms.

Past psychiatric history:

The client did not have any psychiatric illness history in the family. Also
she did not have any kind of psychological issue before this.

Past medical history:

Client did not have any physical disease before this in her life. No
history of drug abuse, head trauma or injury was reported.
‫‪Client’s Verbatim‬‬

‫‪‬‬ ‫مجھے کچھ سمجھ نہیں آتا کہ میں کیا بولوں۔ شاید آپ‬
‫میری بات سمجھنے کی کوشش کریں۔ کیونکہ مجھے‬
‫کسی پر یقین نہیں ہے۔ لوگ جیسے عموماً نظر‬
‫آتےہیں ویسے نہیں ہوتے لوگ جلتے ہیں آپ کی‬
‫کامیابی سے اور ان کی مرضی ہوتی ہے کہ آپ کو‬
‫نقصان دیں کسی پر یقین کرنے کے لیے خود کو تیار‬
‫نہیں کر سکتا آسانی سے ہمارا معاشرہ ہر چیز ہر بات‬
‫کو معنی طور پر لیتا ہے‬
‫جس سے مجھے الجھن اور مسئلہ ہوتاہے ‪‬‬
 2). Focusing on the Main Points

Educational
History

History of
Social History Present Episode
(HPE)

Personal
Marital History
History
 History of Present Episode / Illness
Client reported that his problem become more severe at the age of 45
years when his female cousin also gave him poison. He reported that he
was a school owner, his relative especially his that cousin was jealous
with school. One day came with her husband in school and they also
give him poison in tea. His school was closed due to that poison,
because he cannot work properly. He reported the symptoms of the
poison, he falls in complete fear, & become too much aggressive, his
fear converted toward father he was very afraid with his father. His
sexual desires were too much prominent so he started establish
relationships with girls.
Continue…
Personal History
Including:

1. Developmental Milestone
2. Educational History
3. Marital History
Educational History
͏ The client started going to school at the age of 4 years.

͏ He went to the school which was close to his house.

͏ The client was friends with all his class fellows but two of them were
his best friends.

͏ Client had studied till M.A and before and after his marriage he was a
principle in school.

͏ Client want to continue her studies after divorce but her parents were
not allowing her.
Psychological Assessment

Psychological Assessment has been

at two levels:

1. Formal Assessment
2. Informal Assessment
Evaluative Techniques
2. Formal Assessment
Following tests and scales were used for the formal assessment to have clear idea of
the problem:
BAI he scored 28 which means
severe anxiety.
 Evaluative Techniques:
1. Beck Anxiety Inventory (BAI) BDI The client scored 18 on BDI
2. Beck Depression Inventory (BDI) which means mild depression.
3. House Tree Person (HTP)
4. Thematic Appreciation Test (TAT)
BGT The client scored 3 on BGT
5. Bender Gestalt Test (BGT)
6. Rotter Incomplete Sentence Blank (RISB) which means no brain
7. Standard Progressive Matrix Test (SPM) impairment.

RISB The client scored 135 on RISB.

Which shows she is socially
adjusted

SPM Intellectually Average

Grade III (40)
Diagnosis

301.0 (F60.0) Paranoid Personality Disorder

 Progression of Therapy
Session – 1

Time taken: 45 minutes

Goals:

 To build the rapport to facilitate the therapeutic process.

 To take history to get detailed information about the problem.

Techniques

 Rapport building
 History taking

Client’s Feedback:
The client felt good during the session.
Session - II

Time taken: 40 minutes

Goals:
 To conduct psychometric assessment

Techniques
Administration of psychometric tools
BDI
(She took 8 to 10 minutes to complete her test)
BAI
( She took 10 minutes to complete her test)
HTP
(Overall she took 20 minutes to complete her drawings)
Hoarding Disorder
Session - III

Time taken : 40 Minutes

Goals
To continue psychometric assessment
Psycho education of client

Techniques
Administration of Psychometric tools:
RISB
TAT
Continue..
 Session- IV

Time taken: 45 minutes

Goals :
 To continue psychometric assessment
 Relaxation training

Techniques :
Administration of Psychometric tools:
 BGT
 SPM
 Relaxation Training
According to DSM-5
Session - V
Time taken : 40 minutes
Progression of therapy

Goals:
͏ Identifying worries (listing down worries)
The home work task was given to client to write down all the worries that she faced.

͏ Cost and benefit analysis (pros and cons)

To psycho educate client that worries do not serve the function of preparation,
motivation and problem solving.

͏ Identification of control behaviors (verbal)

was also done through verbal strategies by asking the client about her behaviors when
she worried too much or felt irritable because of worrying. Initially, the client had to be
briefed about the purpose of control behaviors.

Client’s Feedback:
Client felt good after the session.
 Session - VI
Time taken: 40 minutes
Techniques:

 Suppression Experiments (paradoxical effects)

At first, the client was asked to close her eyes for 3 minutes and then try
NOT to think of a blue rabbit. She was then asked to open her eyes and
tell if she was successful in doing the job. The client reported that all the
time she was thinking of a blue rabbit although she had never even seen
one. The worries rebound in the same manner as the image of the blue
rabbit, whenever the client tries to control them. The more she wanted
to get rid of the thoughts (suppress the thoughts), the more they come
back in her mind.
Continue…

 Normalizing Worry (pathological & normal )

She was initially told that everyone in the world worries to some
extent. All individuals have worries related to their education, children
finances, home, job, relatives etc.
She was educated that worry can be helpful up to a certain point but
excessive worry leads to no positive outcomes, rather a continuously
stressed brain. The normalization helped in making the client
understand to create a balance in her worrying

Client’s Feedback:
Client felt better after the session.
Session - VII
Time taken: 1 hour
Techniques:
1. Challenging Uncontrollability Beliefs( ON or OFF)
She was asked about the times she could switch her worrying ON
or OFF. The client replied that she could not control her worrying
besides trying. She was then questioned about the times she
distracted herself or got herself busy in other mental activities. It
was those times when she could switch OFF her worrying thoughts.
2. Worry Time (specific)
She was asked to specify a certain time of day in which she will
worry about the problems and then find suitable solutions for them.
At the other times of day, when she worried about daily problems,
she was asked to postpone the worry until the worry time and then
utilize that time for constructive work. The controlled worry periods
also helped to loosen the client’s belief that worrying itself is
uncontrollable.
Session- VIII
 Time Taken: 1 hour 10 minutes
 Techniques
1. Sleep hygiene tips
2. Relapse Prevention
3. Termination
 Therapist/ client orientation dynamics

No transference or counter transference happened

during the sessions between the client and the
therapist.
References
Rowa, K., & Antony, M.M. (2008). Generalized anxiety disorder. In W. Craighead, D.Miklowitz, & L. Craighead

(Eds.).Psychopathology: History, diagnosis, and empirical foundations (pp. 78-115). New York, NY: Wiley

Wells, A. (2005). The Metacognitive Model of GAD: Assessment of meta-worry and relationship with DSM-IV

Generalized Anxiety Disorder.