FIELD TRAINING REPORT

IN PARTIAL FULFILLMENT FOR THE REQUIREMENT OF THE

DEGREE OF MASTER OF ARTS IN APPLIED PSYCHOLOGY

Submitted
by

MANISHA SATI
(19MSY018)

M.A. Applied Psychology (Semester III)

Under the Supervision of

DR. NAVED IQBAL

Professor
Department of Psychology
Jamia Millia Islamia
New Delhi-11025

2019-2020
CERTIFICATE

This is to certify that Ms. Manisha Sati a student of M.A. Applied Psychology,
Department of Psychology, Jamia Millia Islamia has successfully completed her
summer internship at Mindglass Wellbeing Ltd.

The field training report, submitted in partial fulfillment of the Master of Arts
degree in Applied Psychology, is a record of her original work done under my
supervision and guidance.

Dr. Korsi Dorsene Kharshiing

Field Training Coordinator

Department of Psychology

Jamia Millia Islamia

New Delhi
ACKNOWLEDGEMENT

This summer field training was a great opportunity for me to find out my
standing in the field of psychology and my interest areas in a practical manner
through the actual field challenges. And this opportunity could not have been
possible without the help and facilitation of the department. So, I would like to
take the opportunity to thank the Department of Psychology, Jamia Millia
Islamia for providing me with the opportunity of this field training. I also extend
my utmost thank to Prof. Akbar Hussain Head of the Department and my
Supervisor for his precious advice, valuable guidance and constant
encouragement.

I would also like to extend my gratitude for the endless guidance and constant
encouragement to Dr. Suranjana , Dr Ashutosh and Dr. Archana and at the
Mindglass Wellbeing Ltd. for such a great experience.

Thank you all, I am greatly humbled and obliged and without your guidance and
support this field training would not have been possible.

Manisha Sati

M. A. Applied Psychology

Jamia Millia Islamia

New Delhi-110025
DECLARATION

I Manisha Sati a bonafide student of M.A. Applied Psychology, Jamia Millia

Islamia, hereby declare that I have undergone the internship program at
Mindglass Wellbeing Ltd. from 1st June 2020 to 3rd July 2020.

I also declare the present report is my original work. The contents of this report
has not been submitted to any other university or institute.

Signature of the student

Manisha Sati

M.A. Applied Psychology

Jamia Millia Islamia,
New Delhi
S. No. TOPICS PAGE NO.

1. Objective of Internship / Field Work

2. Description of the organization(s) / Institution(s)

3. Procedure of Internship

4. Tasks- related description and learning outcomes

5. Skills Imparted/ Case Studies/ Assignments

6. Lessons learned and overall experience from

internship
7. Challenges faced during internship

8. APPENDICES (Certificate and Log sheet)

CONTENTS
OBJECTIVE OF INTERNSHIP
The purpose of the internship is to expose students to the real work environment
experience pertinent to their area of interest. Other purpose of this internship is
to help students to judge their capability in particular career before permanent
commitments are made. It enables student to develop certain skills and
techniques used in their respective field of interest. It also provides students the
opportunity to gain insight into the psychological processes, developing issues
and relevant concerns related to their area of specialization. The aim of the
internship is to increase knowledge about assessment, diagnosis, intervention
and consultation up to professional practice standards.

Through this internship students will be able to learn about the ethics and values
of the profession and develop the capability to bear the ambiguities and conflict
inherent in the practice of social work. The internship also provides students
various opportunities to utilize their theoretical knowledge gained during
academic sessions. Students also developed an understanding of what kind of
skills and abilities are required for specialization in respective field. The
students will learn to identify, analyze and respond to critical social problems
and to understand the impact they have on clients. This internship thus provides
students opportunity to learn from the experts who are already working in that
field, which further helps students in understanding what would be their roles
and responsibility if they go ahead in that field. Moreover it enables students to
understand the client better- what are the different types of cases or nature of the
problem client face and different range of the problems faced by them and how
to deal with them.

Students of M.A Applied Psychology, III Semester were told to join online
internship according to their choice due to the Covid-19 in order to provide
practical knowledge in their area of specialization. I selected Mindglass
Wellbeing Ltd for my internship. There I go an opportunity to learn about basics
of making case histories, different types of clients, how to deal with them. It
also helped in refining my knowledge pertaining to various disorders, diagnosis
and their assessment. Besides these professional qualities this period helped in
developing some of personal qualities like cooperativeness and patience.
DESCRIPTION OF ORGANIZATION

Delhi – India based company “Mindglass well-being (P.) Ltd” is founded with
an aim to spread awareness on health and wellness, in 2019 December, and got
registered in Delhi- India, on 14th of January 2020. The organization is still
forming a team of multidisciplinary people, who’re loyal, driven, honest and
committed experts or ordinary citizens, who’re capable to work remotely, in
order to reduce the level of social stigma associated with mental health at
workplace and society in urban & rural locations.

The MindGlass runs a Psychological assessment intervention setup in Amritsar,

Punjab, India with the help of Kiran Foundation, a Non-profit drug
rehabilitation society, and soon they will be opening ten more psychological
intervention centres across India. They have chosen most populated cities to
open 30-40 more psychological centres in other cities. The organization has set
a psychometric facility centre for the institutions, NGO’s, private Clinics and
industries, where experts of psychological & allied disciplines provide reliable
and valid individuals as well as group assessment service, with aim to test the
aptitude, values, personality types, level of aspirations, motivation, conflicts,
leadership, and aptitude for employment selection, career decision, and other
purposes.

Mindglass has its separate departments to meet the unique need of different
organizational cultures, run by trained health & wellness supervisors. Team
Mindglass is skilled to handles multiple ‘Cost-Effective Programs’ in a limited
time. Today team Mindglass is successfully running multiple ‘Online
Counselling Session/ Training Facility’, ‘Therapy Sessions,’ ‘Psychotherapy
Sessions,’ ‘Cognitive Behaviour Therapy Sessions’ both for individuals and
groups, as it helps them to cut the cost of therapy or psychological assistance,
because their primary aim is ultimately to cut the cost of mental health services.
Another major focus of the organization is to train future leaders in psychology,
both locally and globally. With an aim to provide the service of a psychologist
feasible for everyone that are affordable. The organization is equipped with
tools, techniques, and materials which is useful for the current setup of society
and workplaces. Their professional psychologists are always available to serve a
variety of services in the domain of mental health and emotional well-being.
They have designed the wellness programs, which are modifiable and fit in
diverse settings including clinics, workplaces, schools, colleges, as well as
online. They are a team of professional psychologists, designing and delivering
workshops, based on positive psychology. Their team is helping employees’ and
students’ well-being in diverse settings, with the use of awareness and
psychological skills and workshops. They work for workplaces, schools etc
with a motive to boost awareness on health & wellness, removing barriers
related to mental health treatment seeking attitude and social stigma associated
with it. Team Mindglass is training future psychologists, with a novel 21st-
century approach and skills. Mindglass Well-being offer an opportunity to
young minds to guide their ideas, for the good cause of society, under our
guidance. They have trained approximately 500 psychology graduates, post
graduates, M.Phil. and PhD students in basics or Clinical Psychology and
counseling skills.
PROCEDURE OF INTERNSHIP
Due to corona virus outbreak, and lockdown imposed by the government,
movement was not allowed which caused a major hindrance in our summer
internship experience. Therefore the internship was done by virtual medium,
Students of MA Applied Psychology, III semester were told to join internship
pertaining to their interest of specialization. I joined Mindglass Wellbeing
organization because it offered internship on basics of clinical psychology
which involved case history illustrations, case discussions, detailed case history
taking, rapport building, negative history taking, mental status examination,
arriving at possible diagnosis, dual diagnosis discussions of various
psychological disorders including anxiety, stress disorders, mood disorders,
childhood disorders, substance use disorders, personality disorders, psychotic
disorder and psychological assessment and practical based assignment.

The internship started from 3rd June 2020 that continued till 2 nd July 2020 that is
for 30 days, where classes used to be on alternative days from 12 pm to 2 pm in
which one day was allotted for the class and the other day was for the
completion of assignment given by the Mindglass team which were based on
the topics covered on the previous day. The lectures were taken by three
facilitators – Ms. Suranjana Choudhary, Mr Ashutosh Tiwari and Mrs Archana
who taught different topics as per their areas of specialization. These lectures
were given in an online mode through PowerPoint presentations which were
detailed and informative with some real life case discussions and audio visual
clips and movies in between to make the topics more interesting and relatable.

Each lecture was followed by a Question and Answer session of 15-20 minutes
where students could ask questions related to topics covered to make the session
more interactive and participatory in nature. The assignment required critical
thinking and analysis. After every lecture, an activity was given based on what
was discussed in the lecture. These activities included – reading research
articles and critically evaluating them, case studies, psychological movie
reviews, reaching correct diagnosis based on a case description. Every
assignment was supposed to be submitted day before the next lecture and
required thorough reading and understanding of the topics and was supposed to
be written in our own words. There were no restrictions on the length of the
assignments, but the content was more important.
TASK RELATED DESCRIPTION AND LEARNING
OUTCOMES
The first day was orientation class in which Dr. Ashutosh, Dr .Suranjana and
Dr. Archana introduced them and briefed about Mindglass organization, they
also briefly talked about the things that they would teach and all the things they
would cover in this internship. Later all other participants of the internships too
introduced themselves and their institution, so the first day was all about
introduction session.

 From the 5 June onwards, proper classes begin, the first lecture class was on
“Clinical Interviewing and Case History” in which our facilitator first started
with the functions of case history such as-
1) Determining the nature of the client’s problem
2) Developing and maintaining a therapeutic relationship.
3) Communicating information and implementing a treatment plan.

 Later they touched upon the role of empathy in establishing rapport in which
they first defined empathy that it is the capacity or the ability to understand
and share what others are going through and how they feel, basically to put
‘ourselves in others shoes’. After that they taught how empathy is a way of
helping rapport and how one can show empathy. They state that the basic
premise of counseling is not to have same experience as client to understand
what they feel, we all are humans and we can to some extent understand. We
should be careful with our emotional reactions. For example, if client has
lost someone we shouldn’t say “oh my god” or its horrible etc instead we
should show compassion in our reactions without being carried away.

 After that they discussed in detail about the clinical interview, in which they
first talked about how to initiate the clinical interviewing that is by first
greeting the client, telling them about ourselves and ask about them, make
them seated. Asking opening questions after a formal interview, try to ask
client about the reason for coming like ‘what brings you here today’. These
questions should be open ended and should be followed by follow- up
questions. Try to assure in the beginning about the confidentiality, also we
should acknowledge and normalize client’s anxiety and fear about sharing,
client may feel ashamed and doubtful about seeking help and sharing, all
these needs to be done in initial stages. It is also necessary to take client’s
consent in this initial phase in case if client is not able to give their consent
like in case of schizophrenia or intellectual disability we take consent of
primary caregivers or who are accompanying them. The main phase of
clinical interview involves discovering in detail what troubles client, looking
at just the possibilities of what could be the problem, forming a hypothesis,
following up on vague or obscure replies, noting down points which client
isn’t willing to answer, asking them in later point, not pushing them and
allowing them to freely talk. With this information clinical interview ends
and case history taking begins.

 Case History and Format of Case study

Case history is basically a record of client’s life. This is always involves
client’s perspective and we don’t use much technical terms and try to include
client’s original words. The format of case study is as follows-

1) Identifying data- It includes a) demographic details like name, age sex etc b)
the source of the information and the reliability of source. c) Is it the first
episode or d) whether client came on their own or was referred or brought by
others.

2) Chief complaints- Why client came- usually consists of 2-3 sentences what
clients tell including their original words. Even if they are unable to speak,
this too should be recorded. For example, if person is having a schizophrenic
episode where whatever the client says is bizarre we have to note that as
well. The other person’s statement as a source of information (mother friend
etc) should also be recorded.

3) History of present illness- It is a detailed account of chief complaints which

includes a) it is a comprehensive and more detailed chronological picture of
events b) Starting with when was the onset, when was the first time – what
changed d) asking why now? Why are they facing problem now, why
seeking help now. e) In what ways their lives affected f) nature of
dysfunction g) current issues and psycho- physical symptoms like lost
weight etc.

4) Negative History- In this we rule out the symptoms on basis of history of

present illness. And also rule out others possible diagnosis or co morbid
conditions. It helps clarify diagnosis.
5) History of Past illness – Past episodes of some other health conditions or
existing one.

6) Family history- It includes brief family tree- writing about primary family-
parents, children and spouses. Who is the closest to the client, defining role
of each person in client’s upbringing and their current relations, any family
tradition relevant to client’s condition.

7) Personal History- It includes present emotional problem, a) Pre natal history

(whether full time or premature, normal or cesarean) b) Infancy & early
childhood (infant mother relation and significant milestones) c) Middle
childhood ( preschool & school experiences, social relationships, any
separation from caregivers) d) Adolescence ( onset of puberty, academic
achievement, work experience (if any) f) Young adulthood- (occupational
history and social activity).

8) Legal History- Probing questions whether client ever had legal case

9) Pre-morbid personality, dreams and values - How the person was before the
illness, social relations, intellectual activities, mood, character- major
character traits, habits, fantasies/dreams, any repetitive dream, recent
significant dreams troubling the client, any fantasies about future, client’s
opinions on social and moral values- money, play, work, parents etc client’s
priorities in life

 Mental Status Examination (MSE)

Mental Status Examination is a part of clinical assessment that is the sum
total of the examiner’s observations and impressions of the client and
impression of the client at the time of interview. While client’s history
remains stable, the client’s mental status can change from time to time. The
format of mental status examination is as follows-

A) General description
1) Appearance and behavior ( whether over-dressed, dressed not according
to occasion, level of cleanliness, do they underweight or overweight etc)
2) Overt Behavior (posture of the client, signs of anxiety and any agitated,
rigid and excessive psychomotor activity that is psychomotor agitation or
is there psychomotor retardation which is very slow body movements.
3) Attitude towards the client

B) Speech it describes the physical characteristics of the speech, basically

to see if there is any impairment in speech, it includes the following
 Volume ( amount of speech, speaking too much or too less)
 Rate ( the pace of speaking)
 Tone (pitch)
 Quantity and fluency
 Flight of ideas
 Pressured speech
 Rapid speech ( speaking continuously)
 Spontaneous (whether providing information themselves when asked)
or Non spontaneous

C) Mood and Affect- Mood is defined as sustained and pervasive emotion that
affects a human’s perception of the world. Statements about the client’s
mood must include depth, intensity, duration and fluctuations which need to
be recorded.
Affect on the other hand means how the client is currently feeling. It may or
may not be congruent with mood. The range of affect is known by whether
normal, blunted, constricted or flat.

D) Perception -It involves assessing the sensory system; whether any

perceptual disturbances such as hallucinations and delusions are present,
feelings of depersonalization or derealization.

E) Thought – There are two aspects of thought process (or form) and
content. Thought process is how a person puts together ideas and
associations whether they are rational, logical or not. It is assessed by
checking if the client is answering the question asked appropriately which
is checked by seeing if there is overabundance of thought or poverty of
thoughts. Formal thought process disorder that usually occur in
psychotic illness include the following-
 Circumstantiality- It involves over- inclusion of trivial or irrevelant
details that impede the sense of getting to the point.
 Clang association- In this thoughts are associated by the sound of words
rather than by their meaning ( example through rhyming)
 Derailment – A breakdown in both the logical connection between ideas
and overall sense of goal directedness.
 Word Salad – Incoherent or incomprehensible connections of thoughts.
 Flights of ideas- A succession of multiple associations so that thoughts
seem to move abruptly from idea to idea.
 Neologism- The invention of new words or phrases or the use of
conventional words in idiosyncratic ways.
 Perseveration- Repetition of out of context of words, phrases or ideas.
 Tangentiability- In response to a question, the client gives a reply that is
appropriate to the general topic without actually answering the question.
 Thought blocking- A sudden disruption of thought or a break in flow of
ideas.
Thought content on the other hand means what person is actually thinking
about current situation. Disturbances in the content of thought include
delusions, preoccupations, obsessions, phobias, plans, intentions, recurring
ideas about suicide or homicide, hypochodriacal symptoms and specific
antisocial urges.

F) Cognition and Higher Mental Functioning – this involves assessing

different aspects of cognition and higher mental processes such as
 Consciousness – disturbance of consciousness indicates impairment in brain
structure and have impaired awareness.
 Orientation – whether the person is aware of the time, place and the people
around them ∙ Memory – this involves testing recent memory, remote
memory (past information about life events) and immediate retention such
as using digit span tests. Client’s reaction to their impairments in memory
should also be recorded.
 Attention and Concentration – any impairment in the attention and
concentration of the client should be recorded which can be due to a
cognitive disorder, anxiety, mood disturbance etc. the abstract thinking
should also be assessed.
 Information and Intelligence – this involves assessing if client can perform
mental tasks. Intelligence refers to client’s vocabulary and general fund of
knowledge.

G) Impulsivity– it includes assessing if the client is capable of controlling his/

her sexual, aggressive or other impulses, their awareness of socially
appropriate behavior.

H) Judgement- this involves assessing the client’s Personal, Social and Test
Judgements. Personal judgements involve ability to form relatively realistic
future plans in relation to their life circumstances; social judgement involves
understanding implications of one’s own behavior on other people and test
judgement involves understanding what one would do in an imaginary
situation.

I) Insight – it refers to the client’s degree of awareness and understanding of

being ill. There are six grades of insight.
 Grade 1 – complete denial of illness
 Grade 2 – slight awareness of illness but denying it at the same time
 Grade 3 – awareness of being ill but attributing it to external factors
 Grade 4 – awareness that illness is caused by something unknown within
the client ∙ Grade 5 (intellectual insight) – awareness of being ill and that
it caused by one’s own irrational thoughts, feelings, yet one does not
apply this knowledge to current or future experiences
 Grade 6 (emotional insight) – awareness leads to significant changes in
future behavior

 THERAPEUTIC RELATIONSHIP
The next topic taught was the therapeutic relation between client and
therapist which is the crux of any psychotherapeutic process. Establishing
rapport is the primary and crucial step in making the client open up about
their problems. Three relational factors in the therapy process were also
discussed including
 Transference - the redirection of feelings about a significant person in
client’s life onto their therapist)
 Counter-transference - the redirection of a therapist’s feelings toward the
client. ∙ Resistance – it refers to client’s difficulty in therapy or avoidance
of issues.
 Under resistance, we studied different categories of factors that lead to
resistance such as Client Factors including cognitions about previous
therapy, secondary gains, fear of changing, lack of motivation, negative
attitude etc.; Therapist Factors such as lack of proper skills, poor
socialization to treatment model, lack of collaboration, therapeutic
narcissism, lack of experience and poor timing of intervention; Pathology
Factors including client rigidity, any medical problem, difficulty building
rapport, impulsivity, symptom profusion, substance abuse and
dependence.
 Neurotic, Stress related and Anxiety Disorders and Somatoform
Disorder:
The next topic discussed was pertaining to Anxiety and Stress related
disorder. The introduction about this was given in which they first,
discussed that neurotic, stress – related and somatoform disorders have
common historical association with the concept of neurosis and the
association of a substantial proportion of these disorders with
psychological causation and the mixture of symptoms especially anxiety
and depressive ones are common in these disorders. After that the
difference between fear, anxiety and the stress was made clear. Later the
following disorders were discussed in accordance with the ICD-10
guidelines.
 Phobic Anxiety Disorder (F40) – it is a disorder where anxiety is evoked
only or predominantly by specific well defined situations or objects that are
not currently dangerous. Under this disorder comes specific phobias such
as-

 Agoraphobia (F40.0) – it is the fear of open spaces such as where crowd is

present and from where immediate or easy escape would be very difficult.
The symptoms were discussed which can be quite similar to those of panic
attack such as rapid heart rate, excessive sweating, breathing difficulty,
chest pain, dizziness, stomach ache and fear of dying. Next the diagnostic
guidelines were discussed as per the ICD-10 and also a case example was
given for agoraphobia.
 Social Phobias (F40.1) – it is the fear of scrutiny or being judged by other
people in social settings, leading to avoiding these. The behavioral and
emotional signs and symptoms were discussed, followed by diagnostic
guidelines
 Specific Phobias (F40.2) – it is the fear of specific objects such as animals
or of particular situations such as height. The signs, symptoms and
diagnostic criteria was discussed and real life case of flying phobia was
discussed that is the fear of flying

 Panic Disorder (F41) – it is characterized by recurrent attacks of severe

anxiety. Under this topic, the features of a panic attack were explained and
later the diagnostic criterion of panic disorder was discussed. A detailed
case example for panic disorder was also shown to us.
 Generalized Anxiety Disorder (F41.1) – it is a free floating anxiety that is
persistent in nature. There is continuous worry and nervousness about
future. A case study on GAD was discussed.
 Mixed Anxiety and Depressive Disorder (F41.2) – there are symptoms of
both anxiety and depression and neither set of symptoms are separately
not sufficient to justify a diagnosis.

 Reaction to severe stress and adjustment disorder (F43) – an

exceptionally stressful life event producing an acute stress reaction. Under
this disorder the following subtypes were discussed
 Acute Stress Reaction (F43.0) – a transient disorder of significant severity
which develops in an individual in response to exceptional physical and/or
mental stress or traumatic experience.
 Post Traumatic Stress Disorder (F43.1) – a delayed and protracted response
to an extremely stressful or traumatic event, characterized by failure to
recover from that event
 Adjustment Disorder (F43.2) – characterized by distress and emotional
disturbance as result of any significant life change such as change of job,
break up etc.

 Somatoform Disorder (F45) - characterized by an extreme focus on

physical symptoms — such as pain or fatigue — that causes major
emotional distress and problems functioning. Under this disorder following
sub-types were discussed-
 Somatization disorder (F45.0) - The main feature are multiple, recurrent and
frequently changing physical symptoms of at least two years duration
 Undifferntiated Somatoform disorder (F45.1) - When somatoform
complaints are multiple, varying and persistent and does not fulfill clinical
picture of somatoform disorder, it is considered to be undifferentiated
somatoform disorder.
 Hypochondriacal disorder (F45.2) – It involves persistent preoccupation
with the possibility of one or more serious physical disorder.
 Somatoform autonomic dysfunction (F45.3) – It involves complaints of
physical dioder related to system or organ that is largely or completely
under autonomic control such as cardiovascular, gastrointestinal etc.
 Persistent somatoform pain disorder (F45.4) - The predominant complaint is
of persistent, severe and distressing pain.

 Obsessive Compulsive Disorder (F42):

After the completion of anxiety and stress related disorder, Obsessive
compulsive disorder was discussed, which is now a separate category of
disorder. It is defined by occurrence of unwanted and intrusive obsessive
thoughts or disturbing images and these intrusive thoughts are immediately
by compulsive behaviors that are performed to neutralize the anxiety
provoking obsessive thoughts. The facilitator then elaborated on what
―obsessions and ―compulsions are and how are they different.
Individuals with OCD often have depressive symptoms and individuals
suffering from recurrent depressive disorder may develop obsessional
thoughts. Then the diagnostic guidelines were discussed for OCD and the
diagnostic features for compulsions and obsessions were separately
discussed. The differential diagnosis between OCD and depressive disorder
was also highlighted. Three categories under OCD were explained to us :-

i) Predominantly obessional thoughts or ruminations (F42.0) – these

involve ideas, mental images or impulses to act that are distressing.
ii) Predominantly compulsive acts (F42.1) – most compulsive acts are
related to cleaning and repeated checking with underlying fear, usually
of danger either to or caused by client.
iii) Mixed Obsessional thoughts and acts (F42.2) – this involves elements
of both obsessional thinking and compulsive behavior. It should be used
when these 2 are equally prominent.

After that, the changes that have been made in the Obsessive Compulsive
disorder from DSM-IV to DSM V were put forth including removal from the
section of Anxiety disorders. Later, the different types of obsessions and
their respective compulsive acts were explained with examples. Two case
studies of OCD were discussed where in one case the client complained of
excessive checking, and in the second case, client complained of
repetitive and distressing thoughts of slapping her friends when they sat for
group study.
The treatment models of OCD were discussed next where broadly two
categories of treatment models were made clear – Biological and
Psychological models. Under psychological models is Cognitive and
Behavioral Models. Under biological model comes antidepressants
commonly SSRI (selective serotonin reuptake inhibitor) and anti anxiety
drugs such as minor tranquilizers (benzodiazepines). Cognitive Models
include Cognitive therapy for OCD that was developed by Salkoskis. It
is designed to help clients identify their automatic unrealistic thoughts and
change their interpretations of the meaning of these thoughts to reduce
anxiety. Under Behavioral model, the Exposure and Response (ritual)
Prevention therapy was discussed in detail which is based on learning
models. Exposure therapy involves making the client confront his/her fears
repeatedly until the fear subsides. This is the principle of “habituation.”
Response prevention involves helping clients refrain from the
compulsions (ritualistic behaviors), avoidance or escape behaviors. This is
based on operant conditioning. To make us better understand the disorder
and how ERP works, an audio clip of a client with OCD was played.
The audio clip included the chief complaints of the client regarding repeated
checking behavior and how ERP was carried out.
 Childhood Developmental Disorders:
After the completion of obsessive compulsive disorder they started teaching
Neurodevelopment with the help of diagrams and charts. Then they moved
on to neurodevelopment disorders, how are they caused and difference
between DSM IV and DSM V in neurodevelopment disorders such as two
new childhood disorders have been added in DSM V- Social
Communication disorder and Disruptive mood Dysregulation Disorder. The
disorders that were covered under NDD were as follows-
 Learning Disability – it interferes with the child’s ability to retain
information and to process and retrieve it when required. The specific
Learning disabilities that were majorly covered include: Dyslexia -
difficulty in reading writing and processing language; Dyscalculia -
difficulty in solving math problems, time and using money; Dysgraphia -
difficulty with handwriting and spelling; Dyspraxia - difficulty with fine
motor skills; Auditory processing disorders - difficulty hearing differences
between sounds and Visual Processing Disorder – difficulty in interpreting
visual information. Following this, the diagnostic criteria and symptoms of
specific LD were discussed and also some commonly held
misconceptions about LD were cleared. A working description of LD was
given followed by a video which showed famous personalities who suffered
from LD and how they coped up.
 Slow Learner – a child or student who has below average intelligence that
is IQ between 71 and 81. Hence they have ability to learn academic skills
but the rate and depth is below average.
 Autism Spectrum Disorder - Autism spectrum disorder (ASD) is a
complex developmental condition that involves persistent challenges in
social interaction, speech and nonverbal communication, and
restricted/repetitive behaviors. The main symptoms of ASD were depicted
through a short video of a child suffering from ASD.
 Intellectual disability - Intellectual disability involves problems with general
mental abilities that affect functioning in two areas: intellectual functioning
(such as learning, problem solving, judgement) adaptive functioning (such as
communication and independent living). A video of a real life case of Id was
shown to better understand its symptoms.
 Attention-deficit Hyperactivity Disorder - a disorder that makes it difficult
for a child to pay attention and control impulsive behaviors. It is
characterized by inattention, hyperactivity and impulsivity.

 Schizophrenia, Schizotypal and Delusional Disorders (F20-F29)

The topic of schizophrenia first began with its definition that it
is characterized by distortions in thinking and perceptions. Then the
symptoms of schizophrenia were discussed including positive symptoms
(delusions, hallucinations lose association or derailment and inappropriate
affect) negative symptoms (alogia, blunted affect, apathy, social
withdrawal) and Psychomotor symptoms (catatonic behavior). Then the
diagnostic guidelines were discussed as per ICD-10, following which,
different types of schizophrenia were explained with their important
features including
1. Paranoid Schizophrenia characterized mainly by delusions of
persecution, reference, exalted birth, bodily change etc. and hallucinatory
voices of threat of command from someone.
2. Hebephrenic Schizophrenia – here affective changes and other negative
symptoms are more prominent than delusions and hallucinations.
3. Catatonic Schizophrenia – marked by psychomotor disturbances that is
either excessive movement (hyperkinesis) or no movement at all
(stupor)
4. Residual Schizophrenia – a chronic stage in the development of a
schizophrenic disorder where there has been a progression from an early
to later stage characterized by long term, negative symptoms.

 Next the Schizotypal Personality Disorder was discussed which is marked

by inappropriate or constricted affect, eccentric behaviour and appearance,
odd beliefs and poor rapport. The diagnostic guidelines were listed down
and a case study was discussed.
 Persistent Delusional Disorders (F22) – it is characterized by a single or a
set of delusions that are usually persistent and something lifelong. The
diagnostic guidelines were explained along with different types of
delusions that occur in such clients. A case example for also discussed for
―Somatic delusional Disorder.
 Induced Delusional Disorder – a rare delusional disorder shared by 2 or
more people with close emotional links. The delusions are induced in the
other person(s) and usually disappear when people are separated.
 They also discussed in detail about a few articles on schizophrenia and
Schizotypal disorder that were given to us to read and evaluate as our
assignment. Later they talked about the case studies in those articles, the
symptoms that the individuals had, the other features about those disorders
and the treatment that was used, followed by question and answer session
related to the assignment. Then she continued with ―Acute and
Transient Psychotic Disorder where there are symptoms of schizophrenia
but the duration is short, usually less than a month.
 Schizoaffective Disorder – this is an episodic disorder with both affective
and schizophrenic symptoms within the same episode or within a few days
from each other. Under this the diagnostic guidelines were discussed and 2
major sub-categories were included – Schizoaffective disorder, Mania type
- F25.0 (symptoms of mania and schizophrenia) and Schizoaffective
disorder, Depressive type - F25.1(depressive plus schizophrenic
symptoms)

 Mood Disorders (F30 – F39)

This topic started with a general introduction of what mood disorders,
followed by difference between the two extremes of mood continuum –
mania and depression.

 Manic episode (F30) – it is characterized by elevated, expensive or irritable

mood, an increase in the quantity and speed of physical and mental activity.
The symptoms of mania were listed out such as extremely energized, rapid
speech, agitation, inflated self-esteem, risk taking etc. then mania without
psychotic symptoms and mania with psychotic symptoms were discussed. In
mania with psychotic symptoms, client may develop delusions from inflated
self esteem and grandiosity and also suspiciousness may develop. The
differential diagnosis with schizophrenia and with schizoaffective was
explained. A detailed case study on mania was also talked about.
 Hypomania (F30.0) – a lesser degree of mania with persistent elevation in
mood and increased energy and activity for several days. The diagnostic
guidelines were discussed ∙ Bipolar Affective Disorder – characterized by
repeated episodes, and severe mood swings. These mood swings take the
form of depression and mania or hypomania and may last for several months
at a time. then the different sub-categories of bipolar disorder along with
the diagnostic guidelines for each were discussed including – bipolar
affective disorder, (i) current episode hypomania, (ii) current episode mania
without psychotic symptoms, (iii) current episode mania with psychotic
symptoms, (iv) current episode mild or moderate depression, (v) current
episode severe depression without psychotic symptoms and (vi) current
episode severe depression with psychotic symptoms. A case study of bipolar
disorder was discussed where client’s current episode was of severe
depression without psychotic symptoms and episodes of hypomania in
between.
 Depressive Disorder - the individual usually suffers from low or depressed
mood, loss of interest and enjoyment, and reduced energy leading to
increased fatigability and diminished activity. Other common symptoms of
depression were listed out, followed by the three major levels of depressive
episodes – Mild, Moderate and Severe, depending on the severity
of symptoms and the duration. Severe depressive episode without and with
psychotic symptoms were also included. For each the differentiating features
and diagnostic guidelines were discussed. A detailed case study of Major
depressive disorder was also discussed with severe depressive episode.
 Recurrent Depressive disorder (F33) – it involves repeated episodes of
depression that are separated by time. It is subdivided into 2 types by
specifying first the type of the current episode and then the type that
predominates in all the episodes - recurrent depressive disorder, current
episode mild, current episode moderate and current episode severe
with psychotic symptoms.
 Cyclothymia – a persistent instability in mood involving numerous periods
of mild depression and mild elation (not so much that it meets criteria for
hypomania).
 Dysthymia – this is chronic or persistent depression that does not fulfill
criteria of recurrent depressive disorder. It is a very long standing
depression that usually begins early in life and lasts for several years and
usually there is mild depression.

 Personality disorders:
The topic of personality as usual began with describing what personality is
and the meaning of personality disorders, followed by some characteristics
that are common to all personality disorders. Each personality disorder (as
per ICD-10 classification) was discussed in detail including its characteristic
features, symptoms and diagnostic guidelines. For some Personality
Disorders case studies were also discussed for better understanding.
 Paranoid Personality disorder (F60.0) – characterized by high
suspiciousness and low trust and tendency to bear grudges persistently
 Schizoid Personality disorder (F60.1) – people with this personality
disorder do not usually enjoy activities that are pleasurable, are
emotionally cold and detached and have limited capacity to express
feelings, lack of friends and marked insensitivity to social norms.
 Dissocial Personality disorder (F60.2) – person find it difficult to follow
normal and required social norms, may commit crimes, lack empathy, are
sadistic and very low tolerance for frustration, are violent and aggressive.
 Emotionally Unstable Personality disorder (F60.3) – it is characterized by a
marked tendency to act impulsively without considering the consequences
along with affective instability. There are 2 variants of this PD – Impulsive
type, marked by emotional instability and lack of impulse control and
Borderline Type, where along with emotional instability, there is
disturbance in one’s own self image and internal preferences and chronic
feelings of emptiness. There is self harm, black and white thinking and
many unstable relationships. A case study on Borderline PD was discussed
 Histrionic Personality disorder (F60.4) – characterized by constant and
excessive attention seeking behavior, self dramatization, suggestibility and
are egocentric. Extremely concerned about what others think of themselves
and seek excitement and activities where they are centre of attention.
 Anankastic Personality Disorder (F60.5) – characterized by excessive
doubts and caution, preoccupation with details, rules and order, excessive
perfectionism, rigidity and stubbornness. It is different from OCD in the
sense that symptoms are less severe and here people don’t find anything
wrong with their thoughts and hence don’t try to get rid of them.
 Anxious Personality disorder (F60.6) – there is persistent feeling of tension
and apprehension all the time, such people usually avoid situations where
they have a feeling that things will go wrong and also avoid social
interactions; sensitive to criticism and rejection.
 Dependent personality disorder (F60.7) – such people are overly dependent
on others for taking their life decisions. They have problem in decision
making, seek suggestions and reassurance even for trivial matters, live on
others needs, suppressing their own, make no demands from others out of
the fear of being left alone and abandoned.
 Narcissistic Personality – though not mentioned in ICD-10, this disorder
was separately taught. It is characterized by no fixed sense of identity and
exaggerated self esteem, when in reality they have weak self esteem. Their
identity is defined by what others think of them and they seek popularity
and approval. There is antagonism, grandiosity and attention seeking.
 Other Specific personality disorders (F60.8) – this includes personality
disorders that don’t fit in any of the above categories.
 Mixed and other Personality disorders – it consists of problems where there
are symptoms of multiple personality disorders but none of them is enough
to meet criteria of one specific PD.

 Substance Abuse:
This topic started with the discussion of the assignment which was allotted
to us on substance abuse that is why it is appropriate to use the term
substance use instead of addict, and why it is called substance use disorder
and not addiction disorder. After 15 minutes discussion, the types of drugs
were explained including stimulants, hallucinogens, sedatives and narcotics,
followed by the causes of substance abuse including biological (neuro-
chemical imbalance, hereditary) psychological (mental disorders like
anxiety, depression etc.) and social or environmental causes (peer pressure,
family issues, problems at work, school, neighborhood etc.). The risk factors
of substance use (social-cultural, interpersonal and individual factors) and
the protective factors were listed out. Then the rehabilitation for substance
abuse was explained diagrammatically which included the basic
components of a comprehensive Drug addiction Treatment - (i) Assessment,
(ii) evidence based treatment, (iii) Substance Use Monitoring, (iv) Clinical
and Case management, (v) Recovery Support Programs and (vi) Continuing
Care. This was followed by Stages of change that was also explained
diagrammatically and that included pre-contemplation, contemplation,
action, maintenance and relapse. Then the 5 levels of addiction treatment
were discussed – early intervention services (level 0.50), outpatient services
(level 1), intensive outpatient hospitalization services (level 2),
residential/impatient services (level 3) and medically managed intensive
inpatient services (level 4). Next, we studied the techniques used with
family referred clients such as motivational interviewing, psycho-education
and cost benefit analysis and the principles of motivational interviewing.
 Psychological Assessment
The final topic that was taught to us was introduction to psychological
testing in clinical setting. First, the purpose of psychological testing in
clinical setting was explained that it can enable mental health professionals
to make diagnosis more reliably, validly and quickly than they can from
personal observations alone and later on assessment related to intellectual
functioning was discussed in the following test and their detailed
descriptions were given:-
 Seguin Form Board test - It is based on the single factor theory of
intelligence, measure speed and accuracy, and primarily used to assesses
visuo-motor skills.
 Binet- Kamath test- It is Indian adaption of the Stanford- Binet scale of
intelligence, it is an age scale where in the tests are grouped into age levels
extending from three years to superior level. It includes both verbal and
performance tests.
 Gessel’s Drawing test- It involves series of geometrical figures in increasing
order of complexity.
 Weschler’s Intelligence Scale for Children / MISIC – Malin’s Intelligence
Scale for Indian Children (MISIC) is an Indian adaptation of the Wechsler
Intelligence Scale for Children developed by Arthur J Malin.
After this, different personality assessments were described in detail by the
facilitators, those assessments are as follows:-
 Minnesota Multiphasic Personality Questionnaire (MMPI)- It is a
psychological test that assesses personality traits and psychopathology.
 16 Personality Factor Test (16PF) - It is a paper-pencil test which assesses
16 theoretically distinct personality dimensions.
 Sack’s Sentence Completion Test (SCT) – It is a 60 item test that asks
respondents to complete 60 sentence threads with the first things that comes
to mind.
 Thematic Apperception Test (TAT) – It is projective test, in which
participants are shown ambiguous black and white pictures.
 Rorschach inkblot test – It consists of 10 inkblot images, some of which are
black, white or gray and some of which are colored.
At last test for specific disorders was mentioned-
 Beck Depression Inventory (BDI)
 Beck Anxiety Inventory (BAI)
 Hospital Anxiety and Depression Scale (HADS)
 Yale- Brown Obsessive Compulsive Scale
 Connor’s Autism Rating Scale (CARS)
 Disruptive – Behavior Rating Scale (DBRS) etc.

LEARNING OUTCOMES
These tasks and lessons lead to the following learning outcomes-
 Learned how to take detailed Case History.
 Knowledge and deeper understanding of how to make Mental Status
Examination.
 Understanding the initial phase in counseling and the purposes of case
history and mental status examination.
 Better understanding of how to deal with different types of clients.
 In depth understanding of different mental disorders.
 Acquired knowledge about characteristic features, symptoms and
diagnostic guidelines as per ICD-10 for each disorder
 Improvement in Diagnostic Skills
 Gained ability to differentiate between different disorder and how to
arrive at a correct diagnosis by understanding the criteria for diagnosis.
 Innumerable case illustrations lead to practical understanding of various
disorders.
 Gained understanding on how to approach to difficult and reluctant
clients.
 Acquired better understanding of how clients with different disorders
behave in real life.
 Gained better understanding of psychological assessment.
 Understanding the purpose of psychological assessment in clinical
setting.

SKILL IMPARTED/ CASE STUDY/ ASSIGNMENT

On 4th June day after our orientation we got our first assignment in which we
were required to review an article “Emotion in Our lives” given by Robert
Plutchik, which basically talked about emotions in clinical work and we were
expected to write our views on the article as well our thoughts about the role of
emotions in mental health work.

Skill imparted: Reviewing, analyzing skills improved, gained deeper

understanding on roles of emotions

Our second assignment which was given on 6 th June was based on “Challenging
Situations in Initial Sessions” in this activity we were given different scenarios
in a clinical set up while working with a client and we were supposed to
imagine ourselves as a therapist/psychologist/counselor and accordingly answer
what would we do in such situations. The first scenario consisted of a ‘client
who is reluctant in sharing about their concerns and appears anxious and
fearful’. The second scenario was of a client who is disrespectful of the
therapist/counselor and scared that their confidentiality might be broken, and
their friends and family may get to know about their mental health condition. In
the third scenario there was a client who is unable to accept a mental health
diagnosis and says “I am not crazy”. The fourth scenario consisted of a client
who expresses that they cannot afford treatment for their mental health
condition. Hence there were four scenarios and we had to write what we would
say in such situations as a therapist/counselor.

Skill imparted: Acquired knowledge on how to deal with different types of

clients and situations. Gain insight on different scenarios in clinical setting.

The third assignment which was given on 8th June was about “Self Reflection
Activity as a Therapist” in which we basically had to reflect on our own
characteristics as a therapist. It consisted of different self reflecting questions
such as-
1) “What does being a therapist/counselor mean to me, personally? How
important is it for my identity.
2) What do I think my role should be in client’s life.
3) What are my personality characteristics which I feel will be my strength in
my work as a therapist/ counselor.
4) Are there any personality characteristics which I possess which could hinder
my work as a therapist/counselor.
5) Is there any specific kind of client I think I might find particularly easy to
work with.
6) Is there any particular kind of client whom I think I might find difficult to
work with.
7) Are there any personal experiences I have had as a person which I feel may
shape or impact my work in therapy.
8) How would I define success and failure in therapy?
9) What are some self care practices that therapists can follow for their own
mental wellbeing.

Skill imparted: Self reflective skills improved, gaining insight on how one
would behave when actually becomes a therapist and preparing for the possible
future challenges.

On 10th June we were given assignment regarding reviewing an article on

“Therapist Tactics for Uncovering Emotions” it was a chapter from a book
called Emotions in the Practice of Psychotherapy, by Robert Plutchik. In this
activity we were supposed to read the article and write about what we learnt
from the article and what could be the possible difficulties one face while
implementing some of the tactics etc.
Skill imparted: Learned different tactics for uncovering client’s emotions.

The fifth assignment was given on 12th June pertaining to movie analysis, the
movie that our facilitator selected for analysis was “Good Will Hunting”
because it depicted some aspects on counselling/therapy. Our facilitator
provided us worksheet that contained certain questions and we had to answer
accordingly based on our understanding of the movie. Those questions were-
i) The main character’s chief mental health/psychosocial adjustment related
concerns
ii) The potential causes of his mental health concerns
iii) The characteristics of the main character which may beneficial to
therapeutic goals/outcomes
iv) Any characteristics of the main character which may be challenging for
desired therapeutic goals/outcomes
v) Specific incidents of resistance in therapy, reasons for the same , depicted
in the movie
vi) Our reflections on the approaches utilized by the different therapists
towards the clients: what were some of the approaches which were
helpful/ not helpful and why?
vii) Our reflection on the depiction of counselling/therapy in the movie: what
are the aspects of therapy which are depicted accurately according to us?
viii) Our overall opinions on the movie, the story, the characters, and the
impression it had on us.

Skill imparted: Learned how to carefully focus on details and how to deal with
reluctant and difficult clients, what are the different approaches one can use
with difficult clients.

On 14th June we were given a simple assignment of reading three case studies
related to a) cognitive behavioural therapy for generalized anxiety disorder, b)
cognitive behavioural therapy for social anxiety disorder. c) Case study on exam
anxiety. It was given to us to help us get an idea about clinical picture (signs
and symptoms), mental status examination as well as treatment procedures used
in these conditions.
Skill imparted: Learned basics about cognitive behavioural therapy and
understand the difference between different kind of anxieties.

The seventh assignment that we were given on 16 th June was based on the
recording that we heard during our 15th June class session. The recording was
based on the conversation between a therapist and client seeking help for his
obsessive compulsive disorder. The assignment had different questions which
we needed to answer based on our understanding of the recording. We had to
share our thoughts on the following questions:

1) Client’s description of his symptoms: What specific features did us note

which are indicative of obsessive compulsive disorder? What were content
of his obsessions and compulsions? How did the client feel about his
symptoms?
2) What forms of questioning were used by the therapist? Were there any
specific types of questions utilized to elicit symptoms of OCD?
3) What was the Therapist’s overall approach towards the client.
4) What specific treatment techniques related to OCD were used or explained
by the therapist?
5) What was the level of insight the client demonstrated? What was his
approach towards the therapist?

Skill imparted: Thorough understanding of obsessive compulsive disorder, what

are possible difficulties faced with OCD clients. Also learned how to deal with
OCD clients and what the possible treatment plans for them.

On 18th June we were given assignment where we had to read four case studies
based on Neuro-Developmental disorders such as Attention Deficit
Hyperactivity Disorder, Autism Spectrum Disorder, Intellectual Disability and
Learning Disorder and make a provisional diagnosis on the basis of our
understanding of the cases. In addition we were required to write specific
symptoms from the case history which helped us in forming the provisional
diagnosis.

Skill imparted: Gained deeper understanding of ADHD, Autism, Intellectual

disability and Learning disability. Learned diagnostic criterion of these four
neuro-developmental disorders, gained confidence in making appropriate
diagnosis of these four neuro-developmental disorders.
On 20th June we were given assignment which was based on case studies of
Schizophrenia and Schizotypal personality disorder where questions related to
the cases had to be answered. In this activity we were given three cases and we
had to identify whether the client suffers from schizophrenia or schizotypal
personality disorder based on our understanding of the disorders. The questions
that were asked included the following:
i) How did the illness developed
ii) What were the signs and symptoms that they described meet the criterion
of ICD-10.
iii) Write about the subjective experience of the disorder to them. How did
they describe, what it’s like to go through it.
iv) What are the factors which helped them cope with their illness and
develop a high level of functioning. What were the challenges they faced
in treatment.

Skill Imparted: Acquired thorough understanding of schizophrenia, schizotypal

personality disorder, learned diagnostic criterion as per ICD- 10 of these two
disorders also learned the difference between the two disorders, improvement in
diagnostic skills for these two disorders.

On 22nd June we were given a simple assignment of reading a research article:

“The Challenges of Living with Bipolar Disorder: A qualitative study on
implications for health care and research”. It was a research done by Eva. F.
Maassen, Barbara J. Regeer et.al. We were given this research article to help us
get a better understanding of the bipolar disorder which was being taught us.

Skill imparted: Gained deeper understanding on bipolar disorder, reading skills

improved too.

On 24th June we were asked to read in advance about the substance use disorder
before our next lecture on the next day about substance use begin and were
expected to answer some basic questions like – why we use the term substance
use instead of addict?, why we call this problem as substance use problem rather
than calling it addiction disorder?, what is the difference between behavioural
addiction and substance use problem.
Skill imparted: Gained basic knowledge of substance use disorder

On 26th June we were given a case study related to substance use disorder and
had to answer the following questions based on our understanding of the
disorder-
i) List the signs and symptoms we have observed which meet the criteria of
ICD-10 or DSM.
ii) Write about the risk factors/causes due to which the client developed
substance use disorder.
iii) What treatment modalities were used that that helped the client?
iv) What are the further risk situations that the client should avoid and learn
to cope with, to maintain his recovery?
v) Was it a co-morbid disorder?
vi) What is our comment on the development of substance use disorder a)
does it develop due to depression or anxiety or the depression/anxiety
develops due to the substance use disorder.

Skill imparted: Learned about substance use disorder, diagnostic criteria of

substance use disorder according to ICD-10, and how to deal with the clients of
substance use disorder and also the possible treatment plans that can be used
with such clients.

On 28th June we were asked to read the case studies which involved four cases
related to personality disorders, we were supposed to answer the following
questions and come up with a provisional diagnosis for them based on our
understanding of the personality disorders –
1) Which personality disorder are the described symptoms suggesting?
2) Mention the specific signs and symptoms as per ICD-10 diagnostic criteria
which support our diagnosis.

Skill imparted: Thorough understanding of the personality disorders, learned

diagnostic criteria and symptoms of personality disorder according to ICD-10
and gained confidence in making diagnosis of the personality disorders

On 28th June we also had a workshop which was conducted by Ms. Anusuya
Datta who is a Delhi based clinical psychologist (RCI), the workshop topic was
“Looking after Yourself: Self- Care Practices among Therapists”. She basically
talked about how being a psychologist could impact our mental health,, well
being and relationships and what are the ways in which we can take care of our
mental health as a psychologist, which can protect us from the emotional impact
of our work. Case discussions and real life experiences were used to illustrate
this better.

Skill imparted: Learned about the possible difficulties faced by the therapist in
their daily life including “compassion fatigue” and how a personal trauma could
hinder the counselling process and what are the possible ways in which therapist
could cope with these difficulties like taking time for self, meditation and
practicing relaxation.

Our last assignment which was given on 30 th June consisted of a role play
activity in which we were divided into groups of two people. Each group was
assigned a disorder by the facilitator and the group had to prepare a role play on
a particular disorder in which one person was a client and the other person was
a therapist. In addition we were supposed to make a detailed report which
consists of case history and mental status examination of the client. In this
activity the person who played the role of a client had to come up with a
hypothetical case history for themselves based on what they know about the
specific disorder, also the person had to think how a person who does not have a
knowledge of psychology or mental illness, would describe their particular
condition/symptoms. The person who played the role of therapist had to ask
questions and try to elicit relevant symptoms, while also establishing rapport,
conveying empathy and being sensitive to the client’s situation. The next part of
the assignment was to write a report which included case history and mental
status examination which involved formulating possible causes of the client’s
concerns-biological factors, social factors, personality factors, and history of
trauma etc. We also had to write about a brief management plan that is how will
we approach the process of therapy with the client, what are the possible things
to explore initially, short term and long term goals, our overall approach, need
for medication etc.

I was assigned social anxiety disorder, in which I played the role of a client and
my partner played the role of a therapist, based on our understanding of the
disorder we then made a hypothetical case history, mental status examination
and management plans. The case history, MSE and management plans that we
made are as follows-

CASE HISTORY
Socio-demographic details
Name- Sakshi Mishra

Age- 23 years old

Gender- Female

Educational qualification- Bachelors in Biotechnology

Occupation- Not Any

Marital status- Not Any

Religion- Hindu
Socio-economic status- Middle Class

Income- 10 Lakhs per annum

Informant
Chief Informant- Client Herself

Reliability- Information is detailed and adequate

Chief Complaints
Feeling nervous, stammering, hands and feet becoming cold and sweaty, heart
beating really fast in front of strangers } since past six years.
Nightmares, disturbed sleep, nervousness, palpitation and disturbed daily
routine and decreased self confidence } since past 1 month

Onset- Insidious

Course- Continuous
Precipitating Factor - The client has to appear for her job interviews in the
coming month, the thought of which is very disturbing as this reminds her of
her nervousness and poor performance in other viva that she has given in the
past.
History of Present Illness

The client had been a shy and introvert person since her childhood, she
avoided much interaction with strangers as she was afraid that it would be
embarrassing for her as she would start stammering and once she become
comfortable and acquainted with the people her nervousness gradually goes
away. Until her 10th class she was an introvert person who would generally be
shy in front of strangers, but in her 11 th class she encountered one
incident which had a horrifying impact on her. In her 11 th class she had a
chemistry viva in which an external invigilator came to take their viva, when
it was her turn for the viva she was very nervous and visibly shaking, still she
managed to answer few questions looking down however invigilator asked her
to look up and then answer, it was this time which made her extremely
anxious and she literally froze and couldn’t answer any question after that,
her mind got completely blank and there were chills in her body. Even when
her internal teacher tried to support her and made few hand gestures to speak
up, she couldn’t answer anything as if she couldn’t hear what they were
saying. She cried a lot that day and couldn’t sleep whole night. She also
performed badly that year and her teachers and her parents especially
her father was really upset with her but she was unable to forget that
incident.
During her teenage life she would go to malls and restaurants or any party
only when her friends insisted her to accompany them, her friends many times
insisted her to make a boyfriend but she never got the courage to do so she
was afraid how his father would react and it might distract her from her
studies as her father is very strict about marks and academics. Moreover she
never got guts to talk to boys and talked to them only if it was urgent or
related to studies. She recalled that she was extremely shy in front of boys,
turn red, start experiencing palpitation and numbness of hands and feet. And
this continued even in her late adolescents and early adulthood therefore she
avoided much encounter with males and talked to them only if it was really
urgent.
After that incident she would generally avoid meeting any strangers because
of the fear that she would again make fool of her and people would ridicule
her for stuttering and she would be really embarrassed.
She was enrolled in college in 2014 and she managed to complete her
graduation with good grades, however she also recalled that she really
couldn’t manage to perform well in any of her college viva exams after that
incident.
She did not made lots of friends and was more comfortable with her fewer
and close school friends whom she recalled as always being supportive and
have accepted her the way she is.
But now she has a problem of facing her job interview, since 1 month she is
having nightmares, she wakes up in the middle of night and is not able to
sleep after that, she becomes terrorized just by the mere thought of giving
interview. She experiences immense palpitation and her hands and legs
become cold and sweaty as she thinks of any social situation like this. She has
a fear that if she goes to an interview her incident of 11 th class would be
repeated again and she will fail the interview miserably.
Negative History
• No H/O anxiety evoked by specific object.
• No H/O free floating anxiety.
• No H/O having repetitive and intrusive thoughts, images,
impulses or acts. • No H/O hearing voices or seeing images not
heard or seen by others. • No H/O head injury, seizure, high
grade fever.
History of Past Illness
No H/O past psychiatric illness.

No H/O significant medical illness.

Family History
The client belongs to a middle class, nuclear, Hindu family residing in Delhi
since 1995. The client’s father has been working in Krishibhawan for 20
years as a deputy director, he is perceived by the client as a discipline lover,
authoritarian and strict for academic performance. The client is afraid that if
she fails in her interview her father would be disappointed.
The client’s mother is a housewife though she had done masters in Hindi but
she didn’t do job for the sake of her children’s well-being. The client is more
close to her mother whom she recalls as funny and very supportive; she is
generally more comfortable around her mother and shares her feelings with
her mother. The client is the eldest sister and she has a younger sibling whom
she perceives as sharp, confident and intelligent and can give answer to
every question and he is also close to their father because of his traits. He is
currently in 12th standard and he had also taken science. The client is staying
with her family and because of her disturbed daily routine since past 1 month
her mother and her friends suggested her to seek counseling.
Educational History

The client started going to school by the age of 4 years. She attended regular,
English medium school. She joined KendriyaVidhalaya at the age of 6 when
her family shifted to Malviya Nagar, New Delhi. She stayed there till her
completion of 12thclass; she recalled that she was an average student till her 9 th
class after that she became serious towards her studies as her father used to
get disappointed with her grades. She was an introvert kind of a child and her
teachers used to like her because she was sincere, hardworking and
submissive kind of nature and never caused trouble during their classes. She
had fewer school friends whom she reported as supportive and understanding.
She did not have a major fight with them and whenever they fought they tried
to resolve it.
After completing 12th she gave entrance test for biotechnology in Jamia Milia
Islamia University and got admission there, one of her school friend also
accompanied her in JMI. She recalls her college life as good and largely
study oriented. She passed her college with good grades achieving 80 % in her
final semester though she is confident to about her knowledge but she does
not have the courage to face an interview. As soon as she completed her
bachelors she faced a pressure from her father to give job interviews.
Occupational History
Not any as she becomes extremely anxious just by the thought of giving
interviews and think that she will freeze again and make fool of her.
Sexual History
Not any she avoided encounter with males as it gives her chills and she started
stammering. Although her friend made her watch porn movie with them
during their night stay. She becomes extremely shy and anxious when
someone talks about sex.
History of Substance Abuse
No H/O of substance abuse though her friends insisted to one day during their
night stay to get drunk but she did not because of the fear that how her
parents would react and she finds drinking alcohol and smoking as wrong
acts.
Premorbid Personality
 Social Relations – The client was particularly close to her mother and
younger sibling than her father and had fewer friends with whom she was
very close and comfortable.
 Intellectual Activities, Hobbies and Interest- She had interests in music
and cycling. She used to sing and play guitar whenever she was stressed.
She also goes for cycling as she finds it calming and soothing.
 Mood- She is generally happy with her life though she becomes nervous
whenever she have to interact with new and more people.
 Character- She is a sensitive shy and vigilant person who is afraid of
making mistakes in life.
 Fantasy- Her dream is to work in one of the biggest firm of biotechnology
and make her father proud and becoming close to her father.
 Habits-She has habit of cycling daily she also reports she bites her hand’s
skin sometimes whenever she is anxious.

Mental Status Examination

General appearance and Behavior:

A young adult female of average built appeared well dressed and well groomed.
She entered the room while looking down at the floor and tried to maintain eye
contact for a few seconds while greeting the therapist and again started gazing at
the floor with quick eye movements. Rapport could be established after some
time as she was reluctant and did not speak much, answering with limited
words. She was restless as she kept on shaking her leg and held her water bottle
tightly close to her.

Psychomotor activity: The client appeared restless and kept on shaking her
legs, tapping them on the ground and held her water bottle tightly close to her.

Speech:
→ Rate: slow, dragged speech
→ Volume: adequate
→ Fluency: stammering initially
→ Reaction time: spontaneous
→ Tone: normal
→ Speech pressure: monotonous
→ Speech was coherent and relevant

Mood and Affect:

→ Quality-
 Subjective- “I feel nervous, I don’t know I have been like this…”
 Objective- Nervous, anxious, low mood
→ Range- restricted, flattened
→ Lability: Not present
→ Congruent and appropriate

Thought:
→ Flow and form: no abnormality detected
→ Content:
Worries about her job interviews
“I think I won’t be able to perform well for my job interviews, I think maybe
I’ll behave very weirdly in front of them, making a fool of myself. I think I will
be visibly shaking and my hands and feet will become cold, I will stammer and
won’t be able to maintain eye contact. It’s better if I avoid this interview.”

Worries about being evaluated

“I don’t go out because I think I’ll be nervous if I have to interact with new
people, what they will think about me.”

Perception: none (no hallucinations)

Orientation: oriented to time, place and person

Memory:
→ Immediate: Intact (digit span test: Forward 5 digits, Backward 4
digits) → Recent: Intact (recall of recent news articles)
→ Remote: Intact (recall of significant dates in life)

Impulsivity: not seen

General Information and Intelligence: Adequate

Attention and Concentration:

Adequate (serial subtraction of 7 from 100, naming the months of the year in
reverse order)

Abstract thinking: Present (similarities test, meaning of proverbs)

Judgement:
→ Personal
→ Social Intact
→ Test
Insight:

Grade IV (awareness of being sick, attributing it to something unknown

within oneself)

Diagnostic Formulation:
Client Sakshi, a 23 year old unmarried female, belonging to a middle socio-
economic status, Hindu, nuclear family, currently unemployed, presented with
chief complaints of feeling nervous, hands and feet becoming cold, heart
beating really fast when in front of strangers, from the past six years and
nightmares, disturbed sleep pattern, palpitations, disturbed daily routine and
decreased self-confidence, from the past one month. The illness had an
insidious onset with a continuous course. There is history of detachment from
father, who she perceived as very strict and demanding. Exploration of
premorbid personality revealed that she was a shy person, always careful about
what she is doing so that she doesn’t make a fool out of herself. She doesn’t
have many close friends and avoids going out with them too.
Mental Status Examination of the client reveals anxiety regarding her job
interviews, about disappointing her Father again and about her social
inadequacy, with Grade IV insight.

▪ Diagnosis: Social Anxiety Disorder

Management Plan

The management plan is formed keeping a client-centred approach at the fore

front. In the therapy initially, it is important to make the client feel less
nervous and anxious, showing empathy and positive regard to the client as she
already feels anxious when she has to interact with strangers. Once rapport
has been established the therapist can start using Cognitive Behavioral
Therapy which has been proved to be effective for treating anxiety disorders.

The therapist can begin with challenging the client’s irrational thoughts or
self-devaluating thoughts like “I know I will make a fool of myself”, “I will
be visibly shaking and I will start stammering” and “What will people think
about me”. Disputing these negative thoughts might be effective to reduce few
symptoms of anxiety. The therapist can use Decatastrophizing technique or
Socratic questioning to challenge the client’s negative thoughts.
The therapist can then proceed with short term goals of reducing the
symptoms of anxiety using Visual imagery. The client can be asked to
imagine the situation in which she is giving an interview and then gradually
work on her palpitations, increased heart rate and shaking by using relaxation
techniques. (In-vitro Systematic Desensitization).
The Client can be given small home work of practicing breathing exercises
which can again help her to bring her physical symptoms of anxiety under
control. This might help her to stay calm.

Avoidance can help keep the Client calm and can be helpful in the short term
and may prevent her from becoming more comfortable in social situations and
learning how to cope in the long term.
Therefore, in her therapy sessions later, the Client can be asked to face social
situations that she can handle and gradually work with her to deal with more
challenging situations, maybe going out with an outgoing friend for an hour
and once when she is comfortable with this stage, we may try introducing her
to a new person (maybe her friend’s friend) and so on. (In-vivo Systematic
Desensitization)

The therapist can also conduct small role plays during the sessions creating
an interview like set up and interviewing the Client.
These steps might help to build up her confidence and develop coping skills
whenever she is in social situations/settings.

Other techniques that can be helpful are:

 Assertiveness training: which focuses on “the way you act”, “the way you
feel” and “the way you think” and at the same time works on one’s ability to
communicate their thoughts, feelings and needs while simultaneously
considering the opinions and needs of others.
 Volunteering in doing something that she enjoys: such as cycling or
singing and playing guitar –anything that will give her an activity to focus on
while also being engaged with a small number of like-minded people.
 Social skills training: this involves role-playing, group therapy using
videotapes, videotaping and observing, mock interviews and other exercise
to work on situations that make her anxious in the real world. With more
practice, she will become more and more comfortable and this may lessen
the anxiety.
 If necessary anti-anxiety medications like benzodiazepines can also be used
to relieve the symptoms of social anxiety, however medication are not
helpful in the long term and is considered to be more helpful when used in
addition to psychotherapy.
Skill imparted: Gained confidence in making case history and mental status
examination of the client.

OVERALL EXPERIENCES AND LEARNING

The one month internship program which was based on basics of clinical
psychology had been an important and valuable experience for me.
Throughout this journey I learnt how to use theoretical knowledge pertaining
to clinical psychology in a practical way. I found this internship period to be
very interesting as I got practical situation based assignment which are faced
by clinician/counsellor/therapist on day to day basis.

This internship particularly helped me in getting deeper understanding of

clinical setting, what is the exact role of counsellor in client’s life, how to
form a meaningful relationship with a client, how to deal with difficult
clients, detailed case history taking of the client and how to make mental
status examination and so on. In this internship I got an opportunity to
deeply study about various disorders like Neurotic, Stress related,
Somatoform disorder, Anxiety, Obsessive compulsive disorder, Childhood
developmental disorders, Schizophrenia, Schizotypal, Delusional disorders,
Mood disorders, Personality disorders and about Substance Abuse. Here I
also learned about psychological assessment. The assignments were the most
interesting part of this internship because it required deeper understanding of
every topic that has been covered in the lecture which further strengthen my
understanding of the disorders and all other topics which were taught to us.
Since I have an inclination towards clinical psychology and was inquisitive
to know more about clinical psychology this internship helped me
understand the realistic picture of clinical setting, role and responsibilities
related to the field which will further help me in making my career plans for
the future and understanding my role in clinical setting.

Overall this internship will be a milestone experience for me. It taught me

about professionalism, sincerity, diagnosis of various disorders, assessment
etc. The knowledge and skills gained during this internship enhanced and
complemented my education which I obtained in my bachelors and masters.
I am sure that the lessons I have learned from this internship will be valuable
for me in the future.

CHALLENGES FACED DURING INTERNSHIP

The first and foremost challenge that was faced by almost every student was
that the internship was held in online mode due to Corona virus. Due to virtual
internship I lost the opportunity to develop key soft skills and competencies
needed in clinical setting. I also miss out the chance to understand professional
culture, work environment of clinical setting, subtle behavioural norms, ways of
communicating and interacting with people that is required in clinical set up.

It was difficult for me to adapt this new mode of learning, sitting next to the
laptop and sometimes mobile phones for attending two hour lecture was a huge
challenge, at the same time focusing in the long online lecture classes with full
attention was sometimes hard for me. Simultaneously making detailed notes and
listening what is being taught in an online class was also not easy and caused
problem in noting down each details during the initial internship classes. Many
times there was problem caused by the fluctuation of the internet sometimes
they were not audible, sometimes their presentation was visible causing
problem in learning process. During the initial days of internship there was
network issue from their end which disturbed the flow of learning as a result
many times they had to re- start with what they were teaching.
Due to the time limit and in order to cover many things within those thirty days,
they taught in hurry which sometimes resulted in overload of information and
loss of interest.

APPENDICES (CERTIFICATE AND LOG SHEET)

LOG SHEET OF FIELD TRAINING

M.A. Applied Psychology

Department of Psychology, Jamia Millia Islamia, New Delhi-110025

Name of the Student Intern: Manisha Sati

Period of Field Training: 30 days

Name of the Organization/Institution: Mindglass Wellbeing

S. No. Date Task/ Work Undertaken

1 3-06-2020 Orientation class – basic introduction about the program and
faculty

2 4-06-2020 Activity 1 – Reviewing an Article on “Emotions in Our Lives”

3 5-06-2020 Online Lecture on “Clinical Interviewing and Case History”

4 6-06-2020 Activity 2 – Assignment on “Challenging Situations in Initial

Sessions”

5 7-06-2020 Online Lecture on “Psychiatric Case History Format and MSE”

6 8-06-2020 Activity 3 – “Self Reflection Activity as Therapists”

7 9-06-2020 Online Lecture on MSE (contd.) and Therapeutic relationship

and Resistance

8 10-06-2020 Activity 4 – Reviewing an Article on “Therapist Tactics for

Uncovering Emotions”

9 11-062020 Online lecture on Therapeutic relationship and Resistance

(contd.) and Introduction to Neurotic, Stress-related and
Somatoform Disorder (only introduction)

10 12-06-2020 Activity 5 – Movie Analysis on “Good Will Hunting”

11 13-06-2020 Online Lecture on Neurotic, Stress-related and Somatoform

Disorder (contd.) in detail

12 14-06-2020 Activity 6 – Reading Case studies on –

1.Cognitive Behavioural Therapy for GAD

2.Cognitive Behavioural Therapy for Social Anxiety Disorder

3.Case study on exams anxiety

13 15-06-2020 Online lecture on Obsessive Compulsive Disorder

14 16-06-2020 Activity 7 – Assignment on treatment process of OCD where

questions related to a real case of OCD had to be answered

15 17-06-2020 Online Lecture on Childhood developmental Disorders

16 18-06-2020 Assignment on making provisional diagnosis for 4 Neuro-

developmental Disorder cases – ASD, ADHD, Learning
disability and Intellectual disability
17 19-06-2020 Online lecture on Schizophrenia, Schizotypal and Delusional
Disorders

18 20-06-2020 Assignment based on case studies of Schizophrenia and

Schizotypal disorder where questions related to the cases had to
be answered

19 21-06-2020 Online lecture on discussion of previous assignment and then

1. Schizophrenia, Schizotypal and Delusional Disorders with

major focus on Acute and Transient psychotic disorders

2.Mood Disorders – Diagnosis, Formulation and Treatment

planning

20 22-06-2020 Reading an article on – “The Challenges of Living with Bipolar

Disorder: A qualitative study on implications for health care
and research”

21 23-06-2020 Online lecture on – 1.Mood disorders (contd.) with main focus

on Major Depressive Disorder and 2. Personality Disorders

22 24-06-2020 Exploring basics of Substance Use and answering some basic

questions related to it

23 25-06-2020 Online Lecture on Substance Use Disorder (SUD)

24 26-06-2020 Assignment on Substance Use Disorder where questions related

to a real case of SUD had to be answered

25 27-06-2020 Online lecture on Personality Disorders (contd.)

26 28-06-2020 1.Assignment on making provisional diagnoses for 4

personality disorder cases describing their types.
2.A Workshop on – “Looking After yourself: Self care
practices among therapists

27 29-06-2020 Online session on detailed discussion of the previous

assignment on the provisional diagnosis of the 4 personality
disorders. Then a real life case was presented to us on how to
take Case history and MSE and arrive on correct diagnosis
based on these.

28 30-06-2020 An activity was assigned where students were divided in pairs.

The activity was divided in 2 parts

1.Role play on a particular disorder assigned to every group

pair

2.writing a detailed report consisting of case history, MSE,

possible causes and potential management plan based on the
role play (hypothetical)

29 1-07-2020 Online Lecture on Introduction to Psychological Testing in

Clinical Setting

30 2-07-2020 Last session where the last assignment made by students on role
play and report writing for different disorders were discussed in
detail and concluding remarks.

Signature of External Supervisor in Organization/Institution: