Field Training Report

By:- Kinjel
Registration number:221902006
BSc Clinical Psychology
Semester lV

Faculty of Behavioral and Social Sciences

Under the supervision of:-

[Link] Dhingra ,Assistant professor
[Link] Singh Garaya,Assistant professor
 Preface
This report is produced as a part of the field training required for my BSc. In clinical
psychology, fourth semester [Link] report has been prepared in order to demonstrate the
knowledge and exposure that I have gained during the training. For the training and
completion of this report I interned at PARIVARTANAM Mental Health Clinic,Rohtak,
Haryana throughout the prescribed time of minimum 125 hours. I started my internship
from January 29th to March 25,2024 -136hrs . This report is presented as the culmination
of my practical experience and learning under the supervision of Ms. Komal at
“PARIVARTANAM Mental Health Clinic.”
 Declaration

I, Kinjel, student of BSc clinical psychology fourth semester department of clinical

psychology SGT university hereby. To clear that this field training report is an original piece
of my work by myself under the supervision of [Link] Dhingra ,assistant professor and
[Link] Singh Garaya,assistant professor , it has not been submitted previously
anywhere else for the award of any degree Diploma or equivalent course.
 Acknowledgement
This report would be incomplete until an appropriate acknowledgement of the debt to the
many people who made it possible is made. It gives me great pleasure to thank everyone who
has actively helped and supported this report in its current version.
First and foremost. I want to thank my supervisors [Link] Dhingra and [Link]
Singh Garaya for their ongoing support during skill training.
I will also like to thank [Link] for her unending mentoring and consistent support. I'd
like to express my heartfelt gratitude to them. I am entirely grateful to each of them for
instilling in me the will to work hard and the discipline to think clearly. Definitely, The
information I gained through this training session was lifetime experience and an opportunity
that will serve as the foundation for my future work.
I also like to thank [Link] of “PARIVARTANAM Mental Health Clinic” for being my
supervisor and providing me the opportunity to intern with her.
I also want to thank my parents for providing me with unconditional love and support
throughout my internship and hard times.
 Index
S. No. Title

1 Logsheet

2 About the host organization

3 About the supervisor

4 Weekly report

5 Introduction

6 Weekly report

7 Case record 1 Depression

8 Case record 2 Seasonal Depression

9 Case record 3 ADHD

10 Case record 4 Anxiety

11 Case record 5 OCD

12 Case record 6 Schizophrenia

13 Challenges faced
14 Key learnings
15 Summary
16 Reference
 Host organization
Rohtak ,Haryana the “PARIVARTANAM Mental Health Clinic”was established in 2022 by
R.C.I recognised clinical psychologist Ms. Komal . The clinic motto is “be the change” and
focuses on healing and providing genuine services to promote psychological well being
among the local population . It is one of the only private clinics In Rohtak, at the moment
with well qualified and trained professionals, providing various services,.Their services
including:-
1. Psychological assessment :- IQassessment , personality Neuro developmental
Disorder assessment, neurological assessment ,psycho-diagnostic assessment.

2. Psychological management:- Individual psychotherapy, family therapy, cognitive

behaviour therapy ,mindfulness based cognitive therapy support, psychotherapy,
interpersonal psychotherapy, directorial behavioural therapy, ABA for autism,
premarital counselling, anger management, grief counselling, motivation
enhancement therapy, relapse prevention therapy, relaxation exercises, interpersonal
conflict resolution problems solving and skill training.

3. Diagnosis and treatments of psychological illness :- Anxiety disorder,

depression,obsessive-compulsive disorder, behavioural problem in children and
adolescence, autism, ADHD,Adjustment problems, addicted disorder.

4. Training programs :- Internship program for undergraduate and postgraduate students

is well-designed to strengthen their professional competence and knowledge.
 Supervisor
[Link] is RCI licensed clinical psychologist based in Rohtak, Haryana. She completed
her bachelors and masters in psychology from Maharishi Dayanand University,Rohtak. She
finished her [Link] in clinical psychology from Pandit Bhagwat Dayal Sharma University Of
Health Sciences in 2021 and is currently pursuing her PhD in clinical psychology from Shri
Guru Gobind Singh Tricentenary University,Gurugram .She has also worked in a deaddiction
center as a clinical psychologist in Punjab, later she established her own clinic
“PARIVARTANAM Mental Health Clinic “in Rohtak and is currently practicing at her own
clinic and providing general and quality services in field of mental health.
 INTRODUCTION
The main objective of the internship course was to facilitate reflection on experiences
obtained in the internship and to enhance understanding of academic material by application
in the internship setting. Internship provided students the opportunity to test their interest in a
particular career before permanent commitments are made. The internship aimed at
developing a comprehensive understanding of how Clinical Psychology works as a field and
profession, starting from the basics and extending up to real time application. Attempted at
teaching how to understand the patient and reach a diagnosis and the various responsibilities
as a clinical psychologist. The course structure included orientation about the field and
requirements, theory lectures, discussions, various case observations analyzing cases and
developing a better overall understanding of root-level reality of psychological conditions.

Key factors
● One in every 8 people in the world live with a mental disorder
● Mental disorders involve significant disturbances in thinking, emotional regulation or
behaviour.
● There are many different types of mental disorders
● Effective Prevention and treatment options exist
● Most people do not have access to effective care

Mental health conditions are disturbances in a person's thinking, feeling or behaviour that
reflect a problem in mental function, they causes distress or disability in social ,work or
family activities. Just as the phrase “physical illness “is used to describe a range of physical
health problems, the term”Mental illnesses “ encompasses a variety of mental health
conditions.

Is mental illness genetic?What the research say:-

What is mental illness?

The American Psychiatric Association defines “mental illnesses as a health condition that
involves changing emotion, thinking or behaviour or a combination of these one. “ If left
untreated, mental illnesses can have a huge impact on daily living, including your ability to
work, care for family and relate and interact with others similar to having other medical
conditions like diabetes, or a heart attack. There is no shame in having mental illnesses and
support and treatment are available.

Mental illnesses signs and symptoms

Everyone experiences peaks and values in their mental health. A stressful experience, such as
loss of a loved one might temporarily diminish your psychological well-being. In general, in
order to meet the criteria for mental illness, your symptoms must cause significant distress or
interference with your social ,occupational or educational functioning and last for a defined
period of time of time.

Each disorder has its own set of symptoms that can vary greatly in [Link] common
signs of mental illness in adults and adolescence can include:
● Excessive fear or uneasiness: feeling afraid, anxious,Nervous or panicked
● Mood changes: deep sadness,enability to express joy in difference to situations,
Feelings of hopelessness , laughter at inappropriate times for no apparent reason or
thought of suicide.
● Problem thinking: inability to concentrate or problems with memory thoughts or
speech that are hard to explain
● Sleep or appetite changes :sleeping and eating dramatically more or less than usual
noticeable and rapid weight gain or loss
● Withdrawn :sitting and doing nothing for long period of time or dropping out of
previously enjoyed activities.

It is important to note that the presence of one or two of these signs alone does not mean that
you have a mental illness , but it does indicate that you may need further evaluation
If you are experiencing several of these symptoms at 1 time and preventing you from going
about your daily life,You should contact a physician or mental health professional.

Causes:-
There is no single cause of mental [Link], it's thought that they stem from a wide
range of factors sometimes in [Link] following are some factors that may influence
wheather Someone develops a mental illness or not
● Biology:- Brain chemistry plays a major role in Mental illnesses . Changes and
imbalance in neurotransmitters, The chemical messengers within the brain are often
associated with mental disorders.
● Environment :-exposure Children exposed to certain substances in urmay may be at
higher risk of developing mental illnesses. For Example, If your mother drank
alcohol, use drugs or was exposed to harmful chemicals or toxins, when she was
pregnant with you you may be at increased risk.
● Genetics:- experts have long recognised that many mental illnesses tend to run in
families. Suggesting a genetic component. For example-People who have a relative
with mental illnesses such as autism, bipolar disorder, major depression and
schizophrenia may be at higher risk of developing it.
● Life experiences:-the stressful life events you have experience may contribute to the
development of mental illnesses. For example, enduring traumatic events might cause
a condition like PTSD, while repeated changes in primary care given in childhood
may influence the development of an attachment disorder.
Diagnosis :-
Diagnosis of mental illnesses is a multi step process that may include more than one health
care provide ,often starting with your primary care physician.

Treatment :-
Most mental illnesses aren't considered curable, but they are definitely treatable. Treatment
for mental health disorder varies greatly depending on your individual diagnosis and the
severity of your symptoms and results can vary greatly on the individual level.
Some Mental illnesses respond well to [Link] conditions respond better to talk
[Link] research also supports the use of complimentary and alternative therapies for
certain [Link] , treatment plans will include a combination of treatment options and
will require some trial and anger before finding what works best for you.
 Weekly report
Week 1
Date -29 -30 January, 2024
Objective- During the period of first week, the primary objective of the internship was ice
breaking as we had our brief introduction and then moved towards the understanding of basic
concept as planned for the first week.
An idea about the field of psychology was given which included goals of psychology,
scientific nature of psychology and how it evolved in its present form. The rise of psychology
is a subject of choice for higher education was [Link] we taught about the various
fields of psychology , namely clinical psychology, counseling , neuropsychology ,
parapsychology , health development , industrial and educational psychologists.
Next topic was the field of clinical psychology, a sub-field that focuses on diagnosing,
treating and researching psychological disorders with the aim of alleviating human suffering
and promoting psychological well-being. The criteria and qualifications - bachelors, masters
and [Link] in clinical psychology needed to become a clinical psychologist was discussed.
After this, the difference between the roles and qualifications of a psychiatrist, MBBS & MD
in psychiatry and that of a clinical psychologist were elucidated. A psychiatrist is a doctor
with specialization in psychiatry with a license from the Medical Council of India (MCI) and
has the power to prescribe medicines for treatment. The clinical psychologist on the other
hand holds a Bsc/Ba, MSc/Ma and MPhil in clinical psychology and can only carry out
therapies and assessments for diagnosis and treatment of patients but can’t prescribe
medicines. The week ended with the discussion of the importance of hierarchy of treatment -
it is important to first visit a psychiatrist also to rule out any organicity (psychological
disorder developed due to neurological causes) and then consult the clinical psychologist for
proper assessment and diagnosis.
Later in the week, roles and responsibilities of a clinical psychologist were
[Link] of being hyper-vigilant with duties as a practitioner were taught. The
first week concluded with the introduction of ethics that are to be followed as a clinical
psychologist. Ethics Code of principles that include integrity, justice and respect for people’s
rights and dignity were elaborated.
This was followed by discussion of protocols and guidelines that are to be followed during a
session like taking and recording notes during or immediately after the session from the
participant’s verbalizations, ensuring safety of self and staff as well as the patient/client too.
Week -2
Date-5 -6 February 2024
In the second week we started with the briefing of the Diagnostic and Statistical Manual-5
(DSM-5) for the diagnosis and coding of various psychological disorders. American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) is a
classification of mental disorders with associated criteria designed to facilitate more reliable
diagnosis of these disorders. With successive editions over the past 60 years, it has become a
standard reference for clinical practice in the mental health field. Since a complete
description of the underlying pathological processes is not possible for most mental disorders,
it is important to emphasize that the current diagnostic criteria are the best available
description of how mental disorders are expressed and can be recognized by trained
clinicians. DSM is intended to serve asa practical, functional, and flexible guide for
organizing information that can aid in the accurate diagnosis and treatment of mental
disorders. It is a tool for clinicians, an essential educational resource for students and
practitioners, and a reference for researchers in the field.
We also discussed ICD - International Classification of Diseases, a book by the World
HealthOrganization (WHO) globally used as a diagnostic tool for epidemiology, health
management and clinical purposes. It was emphasized how the majority of clinical
psychologists and psychiatrists in India use ICD-10 as their reference for diagnosis purposes.
During this week we also studied about the definition of a mental disorder and common
psychological disorders - symptoms, prevalence, risk factors and comorbidities. These
included anxiety, depression, ADHD in children, OCD, schizophrenia, substance abuse
disorder, bipolar disorder. The meaning, triggers and differences between neurosis and
psychosis were discussed.
We then started with basics of case history taking , it's importance, reasons , needs . We also
talked about mental state [Link] The follow up work was to study the given
material about case history taking and MSE provided by the host.
Week 3
Date -12 -13 February 2024
In third week we discussed about mental state examination in details,we talked about the
questions to be asked,the tests to be done ,the skills and the conduction process in detail
Mental state examination is an important component of case [Link] is essential to record
the observations properly MSE has to be repeated for several times during the case history to
know the illness and to evaluate the symptoms and effectiveness of the treatment .
During a Mental Status Examination (MSE) in psychology, various tests and assessments can
be conducted to evaluate different aspects of a patient's cognitive, emotional, and
psychological functioning. Here are some common tests and evaluations used during MSE
case history taking:
● Appearance and Behavior:
Observation: Assess the patient's physical appearance, including grooming, dress, and
hygiene.
Behavioral Observation: Note any unusual behaviors, movements, or mannerisms.
● Speech:
Speech Assessment: Evaluate the patient's speech for rate, volume, fluency, and
coherence.
● Mood and Affect:
Self-Report Questionnaires: Use tools like the Beck Depression Inventory (BDI) or
the Hamilton Depression Rating Scale (HDRS) to assess mood.
● Observation: Observe the patient's affect (emotional expression) for appropriateness,
range, and stability.

● Thought Process and Content:

Thought Process Assessment: Evaluate the flow and organization of thoughts, noting
any disorganization, tangentiality, or circumstantiality.
Thought Content Assessment: Assess for delusions, obsessions, or preoccupations
through direct questioning.
● Perception:

Hallucination Assessment: Ask about auditory, visual, or other types of hallucinations

directly.
● Cognition:
Orientation: Assess orientation to time, place, person, and situation.
Mini-Mental State Examination (MMSE): A brief 30-point questionnaire testing
various cognitive functions, including arithmetic, memory, and orientation.
 Montreal Cognitive Assessment (MoCA): Another cognitive screening tool that
includes tasks related to attention, memory, language, and executive functions.
● Insight and Judgment:
Insight Assessment: Evaluate the patient's awareness and understanding of their
condition and situation.
Judgment Assessment: Assess the patient's ability to make sound decisions, often
through hypothetical scenarios.
● Memory:
Immediate Recall: Ask the patient to repeat a series of numbers or words.
Short-Term Memory: Ask about events of the day or recent past.
Long-Term Memory: Ask about past events or significant personal history.
● Attention and Concentration:
Digit Span Test: Assess attention by asking the patient to repeat sequences of numbers
forward and backward.
Serial Sevens or Threes: Have the patient subtract sevens or threes from 100.
● Executive Function:
Clock Drawing Test: Have the patient draw a clock showing a specific time, assessing
planning and spatial organization.
Trail Making Test: Evaluate cognitive flexibility and task-switching.
● Abstract Thinking:
Proverb Interpretation: Ask the patient to interpret common proverbs.
Similarities Test: Ask the patient how two objects or concepts are alike (e.g., "How
are an apple and an orange alike?").

These tests help clinicians gain a comprehensive understanding of the patient's mental state
and identify areas requiring further assessment or intervention. The combination of
observation, direct questioning, and specific tasks provides a holistic view of the patient's
psychological and cognitive functioning.
Week 4
Date- 19-20 February2024
In fourth week, I conducted my first case history taking on a patient with depression.I learnt
the basics of depression and how to take a case history.
Depression is a common and serious mood disorder that affects how a person feels, thinks,
and handles daily activities. It is characterized by persistent feelings of sadness, loss of
interest or pleasure in most activities, and a variety of emotional and physical problems.
Definition:
Depression, also known as major depressive disorder (MDD), is a medical condition that
significantly impacts one's mood and functioning. It involves more than just feeling sad or
going through a rough patch; it is a persistent condition that requires treatment.
Signs and Symptoms:
The signs and symptoms of depression can vary widely from person to person. For a
diagnosis of major depressive disorder, symptoms must be present most of the day, nearly
every day, for at least two weeks. Here are the common signs and symptoms:
[Link] Symptoms:Persistent Sadness,Loss of Interest or Pleasure,Feelings of
Worthlessness or Guilt,Hopelessness,Irritability,
[Link] Symptoms:Difficulty Concentrating,Indecisiveness,Thoughts of Death or Suicide
[Link] Symptoms:Changes in Appetite or Weight,Sleep Disturbances,
Fatigue,Psychomotor Agitation or Retardation
[Link] Symptoms:Withdrawal, Neglect of Responsibilities
Diagnosing Depression:
Diagnosis typically involves:
[Link] Interview: A thorough interview by a healthcare provider to discuss symptoms,
medical history, and family history.
[Link] Tools: Use of standardized screening tools like the Patient Health
Questionnaire-9 (PHQ-9) or the Beck Depression Inventory (BDI).
[Link] Examination: Sometimes, a physical exam and lab tests are conducted to rule out
other medical conditions that might cause similar symptoms.
Week 5
Date 26-27 February 2024
In fifth week of internship we talked more about how to conduct Mental state examination.
And also talked about counselling [Link] skills are essential tools for effectively
helping clients navigate their issues and improve their mental health. Here are some key
counseling skills:
● Active Listening:
Attending: Being fully present with the client, showing interest through body
language, eye contact, and nodding.
Paraphrasing: Restating the client's words in your own words to show understanding.
Reflecting: Mirroring the client’s feelings and content to validate their emotions.
Clarifying: Asking questions to ensure understanding and to clarify ambiguous
statements.
Summarizing: Providing a concise summary of what the client has said to reinforce
understanding and bring focus.
● Empathy:
Empathetic Understanding: Demonstrating a deep understanding of the client’s
emotions and perspective.
Nonjudgmental Attitude: Accepting the client without judgment or criticism.
● Communication Skills:
Open-Ended Questions: Encouraging clients to elaborate and explore their thoughts
and feelings.
Closed-Ended Questions: Used sparingly to gather specific information.
Probing Questions: Delving deeper into the client's issues and feelings.
Silence: Using silence strategically to give clients time to think and express
themselves.
● Building Rapport:
Genuineness: Being authentic and sincere with the client.
Respect: Valuing the client’s perspective and experiences.
Warmth: Creating a comfortable and welcoming environment.
● Goal Setting:
SMART Goals: Helping clients set Specific, Measurable, Achievable, Relevant, and
Time-bound goals.
Action Planning: Developing a step-by-step plan to achieve the goals.
● Problem-Solving:
 Identifying Problems: Helping clients articulate their issues clearly.
Generating Solutions: Brainstorming possible solutions with the client.
Evaluating Options: Weighing the pros and cons of different solutions.
● Reflective Practice:
Self-Awareness: Being aware of your own biases, emotions, and reactions.
Supervision: Seeking feedback and guidance from a supervisor to improve counseling
skills.
Continuous Learning: Engaging in ongoing education and training to enhance skills.
● Ethical Skills:
Confidentiality: Ensuring that client information is kept private and secure.
Informed Consent: Clearly explaining the counseling process, goals, and
confidentiality policies.
Professional Boundaries: Maintaining appropriate boundaries to avoid dual
relationships and conflicts of interest.
● Cognitive and Behavioral Techniques:
Cognitive Restructuring: Helping clients identify and change negative thought
patterns.
Behavioral Interventions: Assisting clients in changing maladaptive behaviors through
techniques like exposure therapy or behavioral activation.
These skills are fundamental for establishing a therapeutic relationship, understanding the
client's issues, and facilitating meaningful change. They are refined through practice,
supervision, and ongoing professional development.
Week 6
Date -4-5 March 2024
In the sixth week, we started by talking about anxiety and [Link] causes signs in
[Link] is a natural response to stress characterized by feelings of worry,
nervousness, or fear. It becomes a disorder when these feelings are excessive, persistent, and
interfere with daily activities. Anxiety disorders are among the most common mental health
conditions and include generalized anxiety disorder (GAD), panic disorder, social anxiety
disorder, and specific phobias.

Causes of Anxiety:
The exact cause of anxiety disorders is not fully understood, but a combination of factors is
believed to contribute, including:
1. Genetics: Family history of anxiety or other mental health disorders.
2. Brain Chemistry: Imbalances in neurotransmitters such as serotonin, dopamine, and
norepinephrine.
3. Environmental Factors: Stressful or traumatic events, such as abuse, death of a loved
one, or ongoing stress from work or relationships.
4. Medical Conditions: Chronic illnesses, pain, or other medical issues.
● Substance Use: Excessive use of caffeine, alcohol, or drugs, and withdrawal from
these substances.
● Personality: Certain personality types, such as those who are more prone to stress,
may be more susceptible.
Signs and Symptoms of Anxiety:
Anxiety manifests through a variety of physical, emotional, and cognitive symptoms. The
specific symptoms can vary depending on the type of anxiety disorder.
1. Emotional Symptoms:Excessive Worrying,Irritability, Restlessness,Fear
2. Cognitive Symptoms:Difficulty Concentrating,Racing Thoughts,Catastrophic
Thinking.
3. Physical Symptoms:
4. Increased Heart Rate:.SweatingTrembling or Shaking,Lightheadedness, Muscle
Tension,Gastrointestinal Issues,Sleep Disturbances.
5. Behavioral Symptoms:Avoidance,Compulsive Behaviors

Types of Anxiety Disorders:

Generalized Anxiety Disorder (GAD): Chronic anxiety, exaggerated worry, and tension, even
when there is little or nothing to provoke it.
Panic Disorder: Recurrent, unexpected panic attacks characterized by intense fear and
physical symptoms such as chest pain and heart palpitations.
Social Anxiety Disorder: Intense fear of social situations, leading to avoidance and distress.
Specific Phobias: Irrational fear and avoidance of a specific object, situation, or activity.
Separation Anxiety Disorder: Excessive fear or anxiety about separation from attachment
figures.
Agoraphobia: Fear and avoidance of places or situations that might cause panic or make one
feel trapped or helpless.
Week 7
Date -11-12 March 2024
In seventh week of our intention,we talked about OCD that is obsessive compulsory disorder
learned about its causes, signs and symptoms.
Obsessive-Compulsive Disorder (OCD) is a chronic mental health condition characterized by
persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). These
obsessions and compulsions can significantly interfere with daily functioning and cause
considerable distress.

Obsessions:
Obsessions are intrusive, irrational thoughts, urges, or images that repeatedly enter the mind.
They are often distressing and lead to anxiety.
Compulsions
Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety caused
by obsessions or to prevent a feared event or situation.
OCD symptoms can range from mild to severe and can vary over time. Key symptoms
include:
Obsessive Thoughts: Persistent, unwanted thoughts that cause significant anxiety.
Compulsive Behaviors: Repetitive actions performed in response to obsessive thoughts.
Avoidance: Avoiding situations that might trigger obsessions.
Distress and Impairment: Significant distress and interference with daily activities and
relationships.

The exact cause of OCD is not fully understood, but several factors may contribute,
including:Genetics, environmental factors, Brain Structure and Function.
Week 8
Date 18-19 March
In eighth week we talked about skills and ethics a counsellor should have In detail .
Counselors must possess a range of skills and adhere to a set of ethical principles to provide
effective and responsible support to their clients. Here is an overview of the essential skills
and ethical considerations for counselors:

Skills of a Counselor:
1. Active Listening
2. Empathy
3. Effective Communication
4. Building Rapport
5. Goal Setting
6. Problem-Solving
7. Reflective Practice
8. Ethical Skills
We also talked about types of counselling and treatments plans like CBT ,DBT in detail.
I also performed case history taking with a case of schizophrenia.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels,
and behaves. People with schizophrenia may seem like they have lost touch with reality,
which can be distressing for both them and their loved ones. The disorder is characterized by
a range of symptoms, which are generally categorized into positive, negative, and cognitive
symptoms.
The exact cause of schizophrenia is unknown, but it is believed to be a combination of
genetic, brain chemistry, and environmental factors. Risk factors include:Genetics,
environmental factors,Brain Structure and Function.
Week 9
Date -25 March 2024
Last week of internship,marked by the termination of my internship with [Link]
We discussed about what we did in our time period of internship , about any challenges i
faced and did a doubt sessions and feedback sessions .
We discussed about my overall performance in internship , what I can improve , about my
qualities.
We discussed the documentation process and terminated our internship program on 25 March
2024 .
 CASES OBSERVED
Total Cases observed :6

Case 1 :-
Name -Mr.A

Age-26

Gender- Male

Education- Graduate ([Link])

Marital Status- Unmarried

Socioeconomic status-Middle Socioeconomic status

Background- Urban

Informant- Father (got employee)

1)self
2)Father
3)Old records
● Informant has been living with parents through out the illness
● Nature of information: reliable and adequate

Chief Complaints-
According to the patient
1. “Mein udass Rehta hu”
2. “mein Acha nahi dikhta”
3. “future Acha nahi Hai “
According to the informant :-
1.”udass Rohtak hai”
2.”irritated Rohtak hai”

Onset- insidious

Course- continuous

Total duration of illness-3 years

Perception factors- not known

History of patient:-
Patient was apparently normal before 3 years [Link] he was studying in college, he was
conscious about his body image, especially his baldness and his extremely self-critical about
his skills and abilities,he has a very negative point of view towards his future .He also has
dysfunctioning relations with family because of his judgemental behaviour. He is not
currently on good terms with his family members. He could not cope up with the occupation
he was having and recently left it .

Negative history:-
● no history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
● no h/o TB,HTN, epilepsy, jaundice, seizure disorder,asthma or diabetes.

Family history:-
Patient's father is a government employee. Mother is a housewife. They are cooperative, but
the patient thinks that his behaviour is because of their upbringing in a certain way.
Genogram:-
Past history :- No significant past history.

● Attitude of family members towards illness:-

Family members think that he can be irritable because of some [Link] are willing to
take the treatment.

Personal history:-

1)Birth history-
● Full term normal delivery at hospital
● Birth cry cried immediately after birth
● Breastfed after birth for 1 year
● No history of postnatal illness
2)Developmental history :- milestones achieved normally according to the age .

3)School history:- average student , no history of class failure .

4)Occupation History:-left the job after 6 months (used to work in private sector), wanted to
try for govt job.

5) Sexual History:- Sexual knowledge acquired by friends from school.

6)Substance abuse history:- No history of substance abuse.

7)legal history:- no h/o legal misconduct or any court case in the past

Pre morbid personality:-

● Attitude towards self and others:-Low self esteem , respectful towards family and
teachers
● Interpersonal relationships:-no so good relations with the family member
● Attitude towards work and responsibilities:- he wouldn't take the responsibility and do
the work assigned to him.
● Religious beliefs:-he has faith in God and takes part in Religious activities.
● Leisure time:- he likes to watch TV and play with street dogs.
● Mood:Euthymic
Interference-well adjusted premorbid personality

Mental state examination:-

● General appearance and behaviour-thin male of stated age walked into the clinic
with a steady posture and set on the chair offered comfortably. He greeted after being
greeted, he was cooperative.
● Eye to eye contact -made and maintained
● Rapport -established
● Psychomotor activities- decreased
● Reaction time- decreased
● Speech- in response to questions comprehensible ,coherent and relevant. Normal rate,
low tone and volume
● Affect-
subjective-theek hai
objective -irritable
● Thoughts-form-no abnormality detected
stream- no abnormality detected
content-sadness
possession-no abnormality detected
● Perception- No hallucination behavior observed
● Insight-null
Diagnostic formulation- Mr. A is 26 years old. Male graduated and unmarried
,unemployed, belonging to Hindu nuclear family from Rohtak , presented with continuous
illness of 3 years with complaints of continuous dissatisfaction about his appearance and
abilities, sometimes acts very irritable with family members.

Diagnosis- On the basis of history taking and information given by informant, it is

administered an clinical observation is available past records , the patient is diagnosed with
depression (F32.1)
Overall impressions- Patient was showing no interest in socializing, lack of energy
,persistent feelings of sadness, hopelessness, or worthlessness and loss of interest, low mood
, difficulty while concentrating and careless . Patient had regular few crying episodes in
sessions suggesting an emotional unstable and dissocial personality.

Management issues-
● Treatment adherance
● Occupational rehabilitation
● Low self esteem

Management plan:-
● Pharmachotherapy
● Cognitive behavior therapy
● Psychoeducation about treatment
● Treatment adherence
● Life skills training
● Occupational rehabilitation
CASE 2
Name: Mr. R

Age: 40y

Gender: Male

Education: Graduate

Occupation: Employee in a private company

Socioeconomic status: Middle class

Marital status: Married

Children:2

Location of residence: Rohtak

Informant: Elder brother

Reliability: Reliable and Adequate

Chief complaints: According to the informant, the client showed no interest in socializing
with family and peers. He would sit alone in his room isolated with no light and would often
have crying spells at any time of the day without any particular reason. The client did not
enjoy playing with his children.

According to the client, he felt no motivation to go to work and do anything. Everything

seemed meaningless, even living sometimes. The client also reported disliking any kind of
noise around even if it was his own children playing.
History of present illness: The client was asymptomatic 4 weeks back but then developed
trouble in getting up for work in the morning. The problem intensified when he started
withdrawing from social interactions even with his own family and experienced persistent
sadness with crying spells and irritable mood after facing. The informant reported onset of
such symptoms whenever there was any change in client’s life: some minor financial loss,
even when the seasons changed.

Treatment History: The client had a history of similar problems from the past 10 years with
symptoms being triggered due to any stressor in life. The client did take medicines for the
same and showed decent recovery.

Negative History:
● no history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
● no h/o TB,HTN, epilepsy, jaundice, seizure disorder,asthma or diabetes.

Family History:-the Patient is married and has two [Link] family members are worried
about the [Link] are very religious and took him to a religious place for [Link]
were unsuccessful, their neighbour suggested that this might be a psychological problem
rather than [Link] they finally decided that they need psychological help and brought
him here and are willing to take treatment .
Genogram :-

Personal history:-
1)Birth history-
Full term normal delivery at hospital
Birth cry cried immediately after birth
Breastfed after birth for 2 years
No history of postnatal illness

2)Developmental history :- milestones achieved normally according to the age .

3)School history:- average student , no history of class failure .

4)Occupation History:-in same profession and company from last 15 years

5) Sexual History:- Sexual knowledge acquired by friends from school.

6)Substance abuse history:- no h/o substance abuse.

7)legal history:- no h/o legal misconduct or any court case in the past.

Premorbid personality: well registered.

MSE:
● General behavior, attitude and appearance : State age decently and
appropriately dressed man with combed hair and tidy appearance entered the
room with Slouched posture . Greeted before he was greeted and sat in the
chair after offered .
● Eye contact-Client was not maintaining eye contact with a monotonous.
● Rapport formation -established.
● Speech-slow rate of [Link] tone and volume
● Sad face expressions.
● Reaction time- decreased
● Cognition: normal, oriented to time, place and person
● Insight: null
Past history-no significant past history.
Mood and Affect: Patient showed signs of depressed mood with sad affect-congruent,
persistent feelings of sadness, hopelessness, or worthlessness,difficulty concentrating or
making decisions,irritability,and social withdrawal.
Diagnosis: On the basis of history taking and information given by informant, it is
administered an clinical observation is available past records , the patient is diagnosed with
Seasonal Depression(F33.9)

Management plan:
● Lifestyle changes with therapy and medicines
● Pharmacotherapy
● Cognitive behavior therapy
● Psychoeducation about treatment
● Treatment adherence
● Life skills training
● Occupational rehabilitation
CASE 3
Name: xyz

Age: 10y

Gender: Male

Education: 5th grade

Socioeconomic status: Middle

Location of residence: Rohtak

Informant: Maternal Grandparents

Reliability: Reliable and Adequate

Chief Complaints: According to the maternal grandparents the child is not able to focus on
what is being taught in the class and the academic performance is declining more than before.
The child is not able to learn according to his age and grade. He is facing difficulties in even
copying material from the blackboard.

History of Present Illness: The child has been facing learning difficulties from quite a young
age and has deteriorated after that. The Child is showing ignoring behaviour ,irritating
behaviour. Shows restlessness, cannot sit for a long time, not socializing much. The child is
not listening to his parents and [Link] does not want to play ,doesn't want to go to
school. Likes to sleep a lot ,and not study , does not complete any of the school homework
[Link] currently not having any friends at school , and fighting with teachers and is not
obeying rules of discipline.

Negative History:
● No history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
 ● No h/o TB,HTN, jaundice,,asthma or diabetes.

Family history:- From generations no one has showed these symptoms the family membera
are worried about the child's future , if he will be able to go wto school and get education
with this nature and IQ and cope with other children and make [Link] are worried that
he is getting distant from them and not showing any feelings and sharing things .After
noticing these symptoms for quite long time period they finally decided that he might need
some psychological help. The family members are willing to take the treatment .
Genogram:-

Personal history:-

1)Birth history-
Cesarean delivery at hospital
Birth cry cried immediately after birth
Breastfed after birth for 2 years
No history of postnatal illness

2)Developmental history :- milestones achieved a little delayed according to the age .

3)School history:- low IQ student , history of class failure-1

4) Sexual History:- No Sexual knowledge

5)Substance abuse history:- no h/o substance abuse.

6)legal history:- no h/o legal misconduct or any court case in the past.

MSE:
General behavior, attitude and appearance:- Stated age child entered the room was decent
and appropriately dressed in nature .He kept on checking things around [Link] was
continuously disturbing his grandparents while they were talking , was restless in nature and
irritated.
Eye contact-Made but not maintaining eye contact .
Rapport formation -Established
Speech- Increased rate tone and volume of speech.
Neutral face expressions.
Reaction time-delayed
Cognition: normal, oriented to time, place and person
Insight:null
Premorbid personality-well registered

Past history:-Seizures after birth with meningitis, Epilepsy with recurring seizures when
medication was halted.

Psychological Assessments:SFBT, ADHDT,MISIC, GDT, VMI

Diagnosis: On the basis of history taking and information given by informant, it is

administered an clinical observation is available past records , the patient is diagnosed with
borderline intellectual functioning with high levels of activity in ADHD.(F90.9)

Management plan:
● Therapy for ADHD management and medicines advised. Informants were advised to
contact special educators to deal with learning difficulties.
● Pharmacotherapy
● Cognitive behavior therapy
● Psychoeducation about treatment
● Treatment adherence
CASE 4
Name: Mr. J

Age: 51y

Gender: Male

Education: Post Graduate

Occupation: Haryana Civil Servant

Marital Status: married

Children: 2 kids

Location of residence: Rohtak

Socioeconomic status: upper

Informant: Self

Reliability: Not so reliable

Legal history: A case against the client for corruption was filed by his own sister tarnishing
his public image with news articles as well

Chief complaints: According to the informant, he is unable to work under pressure

especially on tasks with high responsibility and importance. The client reported getting
restless, choking sensation in throat and chest, wanting to run away even from the sight of
files. The client reported loss of interest in going to work and socializing with family and
peers.

History of present illness: The client reported having similar symptoms from the past 8
years ever since the case his sister filed against him. The client did take therapy and
medicines for anxiety before and showed signs of improvement but similar symptoms
reappeared once therapy and medicines were paused. He is too tired to work, always having
nightmares. Depressive thoughts. He is not able to communicate his [Link] feels like he
is lacking in his role of father He has no interest in socialising with anyone. He likes to stay at
home and not attend any social gatherings. Whenever he has depressive thoughts or past
memories, he feels like is suffocating .

Negative History:
● no history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
● no h/o TB,HTN, epilepsy, jaundice, seizure disorder,asthma or diabetes.

Family history :- There is no generational history of these symptoms in any family

[Link] family members are quite worried about the [Link] family members have
been noticing the signs for a quiet long period of time after the major traumatic incident
happened. They have been noticing the patient distancing himself,not communicating
enough, feeling depressive, not going out and socialising. They advised him to share his
thoughts and tried to communicate, but being unsuccessful ,they finally took advice of their
friend and talked him to take psychological help.

Genogram:-

Premorbid Personality: The client was social and active before joining this job with a
normal life.
Personal history:-

1)Birth history-
Cesarean birth
Birth cry cried immediately after birth
Breastfed after birth for 1 year
No history of postnatal illness
2)Developmental history :- milestones achieved normally according to the age .

3)School history:- average student , history of class failure -2

4)Occupation History:- has been serving as civil Servant from last 12 years

5) Sexual History:- Sexual knowledge acquired after marriage from friends.

6)Substance abuse history:- no h/o of substance abuse.

7)legal history:- just one court case in the past filled by his sister for corruption.

Psychological Assessments:
MSE:
General behavior, attitude and appearance :decently and appropriately dressed with
combed hair and tidy appearance overall.
Eye contact-Client was maintaining eye contact with a monotonous.
Rapport formation -Formed.
Speech-slow rate of speech.
Posture -Slouched posture.
Sad face expressions.
Reaction time-slow
Cognition: normal, oriented to time, place and person
Insight: null

Past history:no significant past history.

Predicted Diagnosis: As the informant was the client himself and was not giving reliable
information so the predicted diagnosis is anxiety due to Post-traumatic Stress Disorder
(PTSD).(F43.1)
Management plan: The client was advised to take relaxation therapy before starting therapy
for predicted [Link] that was advised therapies like pharmacotherapy,cognitive
behavioral therapy, exposure response prevention.
CASE 5
Name: Miss.A

Age: 23y

Gender: Female

Education: Pursuing masters

Marital status: unmarried

Location of residence: Rohtak

Socioeconomic status: middle

Informant: Parents

Reliability: reliable and consistent

Chief Complaints: According to the informants the client washes her hands repeatedly
during the day and ends up finishing a bar of soap everyday. Even her skin was damaged due
to the same.
This is causing a lot of adjustment issues and she is unable to function normally and even
study.
The client is often agitated due to repetitive washing of hands and self.
According to the client, she is unable to get the thoughts about keeping her hands and
surroundings with self clean calm in her head and feels like washing her hands for more time
everytime the thought troubles her. She reported feeling relieved after washing her hands or
self for some time until the thought again dominated. The client also stated the inability to
study and attend social gatherings due to her condition.

History of present illness: The problem started during the lockdown phase of COVID-19
when her neighborhood house was being constructed. The client started noticing some signs
that she was continuously washing her hands and was still not satisfied. She noticed that she
is washing her hands around 10 to 12 times a day. Then it started increasing to 30 times a day
she was quite worried about her problem. She started ignoring social gatherings and going
outside because of her problem. She was getting anxious feelings because of her problem.
Someone suggested her to visit a psychologist. She started having troublesome thoughts.

Personal history:-

1)Birth history-
Full turn normal delivery at hospital
Birth cry cried immediately after birth
Breastfed after birth for 1 year
No history of postnatal illness
2)Developmental history :- milestones achieved normally according to the age .

3)School history:- intelligent student , no history of class failure .

4)Occupation History:
5) Sexual History:- Sexual knowledge acquired by teachers from school.

6)Substance abuse history:- use of cigarette, ganja,cannabis and opioids.

7)legal history:- no h/o legal misconduct or any court case in the past
8)insight-null

Negative history:
● no history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
● no h/o TB,HTN, epilepsy, jaundice, seizure disorder,asthma or diabetes.

Family History:
The family was quite worried about the patient. They started noticing signs along with patient
near COVID-19, they were noticing how her daughter was not attending any social
gatherings anymore, how she was depressed and anxious all the time . they are willing to
support the patient and also pursued her for taking therapy .
Genogram:-
Premorbid personality: The client led a very normal and healthy life with no such behaviors
or tendencies.
Past history-no significant past history.

MSE:
General behavior, attitude and appearance :decently and appropriately dressed with
combed hair and tidy appearance overall.
Eye contact-Client was not maintaining eye contact with a monotonous.
Rapport formation -Formed.
Speech-normal rate of speech.
Posture -rigid posture.
Neutral face expressions.
Reaction time-normal
Cognition: normal, oriented to time, place and person
Insight:null

Diagnosis: Obsessive Compulsive Disorder (OCD)(F42)

Management plan:
● Pharmacotherapy
● Cognitive behavior therapy
● Psychoeducation about treatment
● Treatment adherence
Case 6
Name: Mr.M

Age: 18y

Gender: Male

Education: Undergraduate - [Link]

Marital Status: Unmarried

Location of residence: Rohtak

Socioeconomic status: Middle class

Informant: Mother

Reliability: Reliable and consistent

Chief Complaints: The mother reported that he is not sleeping and eating well. He sits alone
in the room most of the time, talks to himself and suspects family members of conspiring
against him. Mother reported that he often gets aggressive and angry with her and other
family members and accuses them of not helping save him from attackers. According to the
client there was no abnormality reported.

History of present illness: 2 months since the observation of initial symptoms, consulted a
psychiatrist as well who prescribed medicines to manage the symptoms. The client keep on
responding to voices which are not even pretty [Link] time in his room talking to air. He is
also aggressive in nature with his parents. He shows irritated behaviour , his is not social
anymore does not talk to anyone or goes out .He likes to say in his room .And sleep a little
more than normal.
Negative History:
● no history of head trauma
● No history of fever /convulsion/neck rigidity /vomiting
● No history of consciousness, negative moments of limbs/urinatory incontinence/
frothing in the mouth
● no h/o TB,HTN, epilepsy, jaundice, seizure disorder,asthma or diabetes.

Family history:- The family has been noticing these symptoms for a while now, they are
quite worried for their child .They also took him to a religious place , but were unsuccessful ,
someone suggested them to reach out to a psychologist they are willing to take any treatment
Genogram:-

Premorbid Personality: well adjusted

Personal history:-

1)Birth history-
Full term normal delivery at hospital
Birth cry cried immediately after birth
Breastfed after birth for 2 years
No history of postnatal illness

2)Developmental history :- milestones achieved normally according to the age .

3)School history:- average student , no history of class failure .

4)Occupation History:-unemployed

5) Sexual History:- Sexual knowledge acquired by friends from school.

6)Substance abuse history:- no h/o substance abuse.

7)legal history:- no h/o legal misconduct or any court case in the past.

MSE-
● General appearance and behavior: stated age man walked into the room with
General appearance being untidy. He hadn’t combed for two days. Overgrown and
dirty nails. Today he didn’t brush and bathe. He didn't greet even after being greeted

● Eye contact-He was staring at one place and constantly blinking.

● Cooperative- Client was not cooperative and was getting restless.

● Perception: Auditory hallucination present. Talking to people and voices that are not
present

● Cognition:not oriented to time, place and person

● Insight: poor
Past history-no significant past history.
Psychological Assessments conducted: Digit span test, draw a person test ,MISIC,MMPI,
Rorschach Inkblot Test

Diagnosis:- On the basis of history taking and information given by informant, it is

administered an clinical observation is available past records ,the client was diagnosed with
Schizophrenia .(F205)
Management plan:-
● The client was advised to start medicines as prescribed by the psychiatrist and take
therapies alongside.
● Pharmacotherapy
● Cognitive behavior therapy
● Psychoeducation about treatment
● Treatment adherence

Evaluation of management plan: The client started slowly gaining insight about his
condition and was becoming cooperative. His productivity also increased at home and he was
able to sleep peacefully for more hours. He was willingly showing up for sessions and
checkups.
 CHALLENGES FACED
During the semester break the biggest issue I faced was finding a RCI-licensed clinical
psychologist in Rohtak city. The city being comparatively small in size as compared to
Delhi/Gurgaon had very few genuine licensed psychologists, lesser patients and not much
diversity in psychopathology. Another major issue was protecting self from fake practitioners
offering internship programmes. Apart from this another issue I faced was with
understanding the local language terms used to describe the symptoms.
 ISSUES ADDRESSED
During the course of the internship issues related to clinical psychology were addressed and a
clear picture about the scope and nature of the job of a clinical psychologist was presented.
Apart from this discussions about the change in psychopathology and rise in comorbidities
were held.
The lack of proper training and negligence of teachers especially in primary schools leading
to the children with learning disabilities and symptoms of ADHD going unnoticed was
discussed.
The cultural differences and different family structures were discussed too.
 KEY LEARNINGS
[Link] of Psychology, Various fields, Clinical psychology - nature, scope, roles and
responsibilities of a clinical psychologist.
[Link] between roles of a psychiatrist and clinical psychologist, Hierarchy of
assessment. Overview of DSM, ICD and behavioral medicine.
3. Protocols of therapy sessions, Ethics and code of conduct.
4. Basics of prevalent disorders, History taking, MSE.
5. Overview of personality disorders.
6. Assessment methods and tools used for diagnosis.
7. Basics about therapies used for treatment.
 SUMMARY
The summer internship was completed under the guidance of Ms. Komal, at
PARIVARTANAM Mental Health Clinic, Rohtak. The duration of the internship was 132 hrs.
During the course of internship, we had studied various practical aspects of the field of
clinical psychology. We studied the role of clinical psychologist. We studied about Mental
status examination and some other psychological assessments commonly used for diagnosis
of disorders. In relation to the psychological disorders we looked at a few of the cases. An
overall view of cases was given and learned how clinical psychologists build rapport and
gather relevant points to conclude about the final [Link] was overall a holistic
experience for me which added to my personal development and a practical experience of the
field.
 REFERENCES
● American Psychological Association. (2004, August 5). The Truth About Lie Detectors(aka
Polygraph Tests).[Link] Retrieved from
[Link]
● Hufton, F., Petch, J., & Rege, S. (2022, June 24). Ten Point Guide to Mental
StateExamination (MSE) in Psychiatry. Psych Scene Hub.
[Link]
n-psychiatry/
● Khanal, S. (2018, March 29).Format for Psychiatric case work-up-Digital
[Link]://[Link]/format-for-psychiatric-case-work-up-824a1
ecce7a9
● Cherry, K. (2008, May 14). What Is the Rorschach Inkblot Test? Retrieved from-
[Link]:[Link]
95806
● The Editors of Encyclopaedia Britannica. (1998, July 20). Projective test |
Definition,Types,Examples,&[Link]://[Link]/scien
ce/projective-test
● Mendez, M. (2022). Overview of the Mental Status Examination. The Mental Status
ExaminationHandbook,41–50. [Link]
● Raypole, C. (2019, March 1). A Guide to Different Types of Therapy. Healthline.
[Link]