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Internship Report

Case 1: Stimulant Use Disorder (SUD)

Case 2: Major Depressive Disorder (MDD)

Submitted By: Wajeeha Iftikhar

Student ID: Bc230211961

Session: October 2024

Submission Date: 02. 12. 24

Submitted To:

Supervisor Name: Ms Shafaq Parvaiz

DEPARTMENT OF PSYCHOLOGY, VIRTUAL UNIVERSITY

OF PAKISTAN
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Dedication:

I really dedicate this report to my family and my internship psychologist especially as she
really guide me in report making and the in other practices related to internship. My
mentors and supervisors have provided me with incredible advice and insights that have
shaped my professional development, and I really appreciate them.

Acknowledgement:

In my internship report, my internship psychologist and instructor help in understand that

how to make report, formatting etc. My knowledge and skills have been much enhancing
by working in that organization and by their suggestions. I‘m really fortunate to have had
the chance to work with such an amazing personality.
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Case # 1

Executive Summary:

In Case 1, client name A.L, age 36, married and he was ICE user and his presenting
complaints involve right arm pain, foot finger pain, leg bone issue at childhood and his
drug history. He involved in drugs due bad companionship in college era. He admitted 3
times in rehab centers and relaps again and again in drugs due to his conflicts with wife
and father as there were trust issues between them according to him. His premorbid
personality was appropriate as normal person but a little bit aggressive from childhood.

He diagnosed as a stimulant use disorder patient after assessment and according to DSM-
5 by me in the supervision of senior psychologist as his problems start with use of drugs
(stimulant (Amphetamine))(2022-2024). He reported that there was pain in his right arm
from 10 to 15 days in withdrawal period but had no medical history or cause, so,
diagnosed as somatic delusions. After 4-5 sessions, he got many changes in his
psychological condition as group therapies, motivational therapy and cognitive
behavioral therapy given to him and he was also self motivated to change himself for his
family especially children.
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Background Information/ History:

A.L was 36 years old man. He was Graduate from Open University. His birth order was
02 and was three siblings. He was married and had 3 children, 1 daughter and 2 sons. His
occupation was Govt. employee as a Line man in WAPDA and monthly income 58,000
to 60,000 rounds about. His was a residential patient and date of admission was 23.10. 24
and informant was his brother in-law and his sister.

Main Reasons for Referral:

The client was referred to the internee Clinical psychologist by the psychologist for
psychological assessment and management of the problems of drug addiction.

Presenting Complaints:

As reported by the client he had:

Presenting complaints Duration (in weeks/months/years)

1. Mn 2002 se cigarette istamaal kr raha 2002 -2021 cigarette( phly saada cigarette
tha 2021 tk or phr 2022 mn ICE start ki phr churce wale cigarette lye)
thi.

2. Start mn main shayad out of control ho Admission k bd se jb bandha tha r abi tk h.

gya tha jb yahan pe le k aye the to inhon
ne mje chain se bandha tha jis ki waja se
mere paun ki choti finger pe zakham ho
gya r us mn pain hoti abi tk . wazu krte
feel hoti zyada.

3. Chote hote school time pe meri leg 2 se dhai saal rahi phr thk ho gai thi.
bone ka issue hua tha uski growth ruk gai
thi.

4. Meri right bazoo mn pain hoti h neck Yahan pe admission k dusre din se start hue
se hath k angoothe tk. Jb mn neck ko thi yani 24. 10. 2024 ko r abi tk h
upper krta un to zyada hoti h r subha k
time zyada feel hoti h.
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History of present Illness:

In my client’s history, the problem first started in 2002 when my client started smoking
and smoked his first tobacco cigarette in a friend's circle in college. My client started
smoking due to bad company of friends and his friends urged him to smoke and he also
wanted to do smoking. But there was no pressure on him or no any family issues in his
life. This was his own choice. He smoked from 2002 to 2021 start from tobacco cigarette
and then use chars cigarette and in 2023 he used ICE for the first time again in bad
company of friends but he realized that he involved in bad habits which disturb his family
matters and he took decision to take admission in Freedom treatment and Rehab centre to
get rid off this addiction. He was admitted there for 3 months and after this treatment he
completely left the drugs but then due to some conflicts with his wife, he again started to
use drugs(ICE). Then his family admitted him in a Rehab centre of Wazirabad and there
he lived for one month and half and got discharged from there due to the poor
environment of that Rehab centre. He used drugs again, again due to the conflicts with
wife and family as they didn’t trust my client that he was not involved in any drugs at that
time but taunted him all time that he took drugs still so in anger and stubbornness, he was
again involved in using drugs. So, near to my assessment, the family conflicts and their
taunting behavior with my client, trigger him (precipitating factor) and continuous
conflicts maintaining (perpetuating factor) this drug habit. Now for the third time his
family admitted him in the Freedom rehab centre and now my client is very motivated to
leave the drugs for forever.

Predisposing Factor:

His aggressive nature and his bad company of friends were his predisposing factors
which encouraged him to do smoking and drug addiction.

Precipitating Factor:

His family issues and the trust issues of family and society were his precipitating factors.

Perpetuating Factor:

Continuous family conflicts, continuous trust issues, irregular job, easy availability of the
drugs all were his maintaining factors.

Biopsychosocial Model: (4 p’s)

4 p’s Bio Psycho Social

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1. Predisposing Nill A bit aggressive from Bad company of

Factor childhood. friends.

2. Precipitating Nill Family conflicts Trust Issues of

Factor Family and society.

3. Perpetuating Nill Continuous family Continuous trust

Factor conflicts. issues.

Irregular job, easily

availability of
drugs.

4. Protecting Medication Self-Motivated/ His Family support and

Factor children are his friends support.
strength and he
decide to recover and
cope with his craving
of drugs.

Group therapy by
FTR centre,
Psychologist’s
individual sessions
and therapies
motivate him more.

Family History:

Father:

His father was alive and graduate retired employee of WAPDA as Line Superintendent.
His father was a sugar patient and no any psychiatric issue or any psychiatric history. His
father’s personality was humble but somehow aggressive in some matters but nature of
relationship with my client was very friendly but there were some conflicts between them
due to client’s drug addiction. His father’s relationship with wife was also good.

Mother:
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His mother was alive and she was also graduated and a housewife. She was also a sugar
patient and no any psychiatric issue. Her personality was so sweet and calm and had very
friendly relationship with my client. Her relationship with her husband was very good.

Siblings:

Client had 02 siblings and total number 03, 01 brother and two sisters and the client’s
birth order was 2nd. There was no any psychiatric or medical issue in client’s siblings.
Relationship with siblings was good and friendly

Overall family history: Overall, there are no any serious issues of medical or psychiatry.
And cooperative and friendly bonding of everyone with each other and with my client
before the ICE using history of my client.

Personal History: Birth (normal) No any problems faced by client’s mother during
pregnancy and after delivery.

Developmental Milestone (such as, speech, crawling, walking etc.): Appropriate as other
children.

Physical health/ Medical history (e.g. pneumonia, jaundice, hay fever etc.): No any
medical history

· Traumatic experiences (due to psychological problem, sexual assault etc.): Nill

· Schooling: My client schooling was normal as other children and he change his school
for higher schooling as there was not higher schooling available in his previous school
but he adjusted there easily.

·Adolescence (age of puberty, information regarding puberty, reaction towards puberty):

Client’s age of puberty was 17 and information about puberty given by his father and no
any severe or unusual reaction about it by client reported.

Marital History:

Client’s spouse was alive and her age was 33 and education was I.com and a housewife.
There was no physical or psychiatric problem or history of client’s spouse. Her
personality was calm and sweet but a little bit strict with children. Her relationship with
my client was very cooperative and understanding but some conflicts born between them
due to drug history of client especially after used of ICE.

Children:
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Client had 03 children, 02 sons (age05, 07 respectively) and 01 daughter (age08). Elder
son had breathing issue in prenatal stage and hospitalized (nursery). But no any other
medical and psychiatric problem. Relationship with client was very friendly and overall
home atmosphere was peaceful before client’s ICE history.

Occupational History:

Client start job at the age of 22 years with a private job and then got a change in
occupation and work as a Lineman in WAPDA. The reason of change in occupation was
to get Govt. job. Had friendly relationship with co-workers.

Premorbid Personality:

1. Social Interest:

The client was socially an active person before his drug history. He participated
actively in every field of life. Even in his schooling era, he eagerly participated in every
function, ceremonies etc.

2. Social Relationships:

Client’s social relationship was much managed and satisfacted as his relation with
his family, friends, and colleagues and with the society was very friendly, before the history of
drug induced psychosis.

3. Mood:

Client’s mood was jolly but he was a little bit aggressive from childhood which is
his predisposing factor, help him in addiction and in his drug induced psychosis. But overall his
mood was satisfactory before his drug history and after his psychosis.

4. Moral and religious values:

His moral and religious values was also appropriate as he had a good judgment in the moral
scenarios and decisions and this is his Protecting factors which helped him to cope with
triggering factors.
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5. Habits:

Client was fond of scatting, marshal art and gym. But after marriage, he skipped all these habits.

6. Reactions to Stress:

Client’s reaction to stress was always tensed as he had aggressive nature from his childhood and
he had not enough capacity to cope with the stress situations easily which formed his
predisposing factors and significant factors which provoked him towards drugs easily again and
again.

7. Drugs abuse/ smoking:

My client involved in smoking from his college life ( 2002-2021) as he got involve in the bad
companionship/company of friends. He started from tobacco cigarettes and then moved to charas
(cannabis) cigarette ( 5 cigarettes per day) and then shifted to ICE (amphetamine
/methamphetamine)(2022-2024), quantity of ICE was 5-7g per day in start but gradually
decrease to 1g in 3 days and root of use was nasal. He involved in drugs easily because he had
interest to take drugs (predisposing factors).

Assessment:

1. Informal assessment:

· Baseline Chart:
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Baseline chart for the substance induced disorder of client:

A baseline chart used for client’s assessment of his problems, triggering factors
and the craving chart used for this purpose and filled by client. The chart
mentioned in appendances.

· Subjective Ratings Of Presenting Complaints:

We set the subjective rating scale out of 10:

Session1 Sessio Sessio Sessio Sessio

Presenting Rating/In n2 n3 n4 n5
complaints tensity
9/10 7/10 5/10 3/10 3/10
1. Mn 2002
se cigarette
istamaal kr
raha tha
2021 tk or
phr 2022 mn
ICE start ki
thi.
8/10 6/10 3/10 3/10 Resol
2. mere paun ved
ki choti
finger pe
zakham ho
gya r us mn
pain hoti .
Life style Resol Resol Resol Resol
3. Chote hote modificat ved ved ved ved
school time ion/
pe meri leg medicatio
bone ka issue n
hua tha uski
growth ruk
gai thi.
10/10 9/10 7/10 5/10 3/10
4. Meri right
bazoo mn
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pain hoti h
neck se hath
k angoothe
tk.

· Symptom Rating Checklist according to DSM-5:

A symptom rating checklist according to DSM-5 was used to determine

the symptoms of stimulant use disorder. The chart attach in appendances.

Formal Assessment:

· Mental Status Examination:

1. Appearance:

Following points about the client’s appearance are as follows:

Sitting posture:

Client’s sitting posture was almost appropriate but during the session, somehow
grandiosity showed by his sitting posture.

Facial Features:

· Hair color: Black

· Styling and grooming: Wear cap on head, appropriate hygiene, well groomed

Height:

Height about 5.9 inches approx.

Weight:

75kg

Body Shape:

Slim healthy

Neatness:
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Hygiene, well groomed

Clothing/Dressing:

Appropriate dressing according to weather, season and situation.

Level of Eye Contact:

Level of eye contact was maintained during the session.

Eye Movement:

Appropriate

Degree of friendliness:

In first session, client was in elated mood and talk in very friendly manner but in the next
sessions, he talked in appropriate manner according to questions and showed lability
situationally.

Apparent Age:

His apparent age was matched with his chronological age.

Mannerism:

Cooperative.

2. Speech (Form and Content):

· Volume of Speech:

Low volume, fluent and rhythm was appropriate according to situation.

· Stammering/stuttering:

No stuttering.

3. Mood and Affect:

Euthymic mood overall and the mood affect was labile but situational.

4. Thought Process:
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Somehow flight of ideas was existed in his thought process.

5. Thought Content:

Client got somatic delusions as he claimed that he had pain in his right
arm but there was no any medical history or biological cause of that pain. His
delusions shaked a little bit but still exist. Furthermore, in his past, when he was
in psychosis due to SID, he attempted suicide and I observed his scars and cuts on
his left arm. He used paper cutter for suicide attempt. He was also a little bit
paranoid about his family conflicts and relations with father.

6. Delusions:

Client reported that he had pain in his right arm but there was no any medical
history and evidence of that pain.

7. Hallucination:

Client reported that he listened the voice of his mother everywhere when
he was intoxicated but he recovered from auditory hallucination.

8. Orientation:

Client was well oriented according to time, place and person.

9. Memory:

Client’s memory about remote, recent past and recent memory was appropriate.

10. General Information:

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Client gave appropriate answers of general information which I asked to him.

11. Insight:

A bit poor insight as he reported that he is completely fine but there were some
issues still exist.

2. Personality Assessment:

Personality assessment was done by the interview method and it was concluded that the
client had some personality traits like openness, extraversion and neuroticism, which helped him
to easily indulge in drug addiction.

Summary of Informal and Formal Psychological Assessment:

Informal Assessment:

For client’s informal assessment a baseline chart (Craving Chart) filled by client
to assess his triggering factors and his coping strategies for it. A subjective rating was
also performed in which the client rated his problems which really helped to assess his
problems severity.

Formal Assessment:

In formal assessment, MSE performed to assess his mental state and to check how
many problems were occurring by using drugs. And the personality assessment was also
done to find the personality traits of the client.

Interpretation of Assessment:

In the MSE, the client’s mental state was checked by asking questions about the
orientation, delusion, hallucination and by examining his appearance, behavior and
thoughts. The personality assessment was done by the interview method in which
different questions were asked to the client to find out his personality traits.

Diagnosis:

According to DSM-5, the client is diagnosed with Stimulant Use Disorder.

Disorder code: F15.20

Name of disorder: Stimulant Use Disorder

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Specifier:

Mild: Presence of 2-3 symptoms

F15.10 Amphetamine-type substance

Moderate: Presence of 4-5 symptoms

F15.20 Amphetamine-type substance

Severe: Presence of 6 or more symptoms

F15.20 Amphetamine-type substance

Prognosis:

Client developed psychosis when intoxicated and in withdrawals but now his psychosis
broke due to the medication and the therapies given to him and his problems managed
gradually. But still there is a need for medication.

Recovery: Satisfactory

Management and Treatment:

· Psychotherapy:

Psychotherapy proposed by psychologists like CBT (cognitive distortion, downward

arrow technique, conflict management, and vicious cycle), group therapy ( craving
management, psycho education, relaxation therapy), etc.

I gave motivational and support therapy to the client in sessions and apply different
tools like MSE and made an ASI file for his assessment. A baseline chart was also
used to assess his problems, triggering factors etc.

· Family Counseling:

There was a real need for family counseling as the client's precipitating factors are the
family conflicts which triggered him. So, a family meeting was arranged for
counseling and to try to resolve the conflicts between them.

Case formulation:
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The Behavioral model is fit for this substance use disorder patient as my client involved
in drug addiction by the observed behavior of his friends and the modeling furthermore, I
supposed the Biopsychosocial Model to relate and identify my client’s disorder as I took
help from the 4p’s predisposing; precipitating, perpetuating and the protecting factor
which are explained by bio, psycho and social factors of life. So, his biological factors in
first three p’s are nil but psychological and social factors were disturbed as in
predisposing factor, the psychological factor is a bit aggression from childhood, social
factor is his bad company of friends. Precipitating factor is family conflicts,
psychologically and trust issues of family and society, socially. Perpetuating factors are
continuous family conflicts psychologically and continuous trust issues, irregular job and
easy availability of drugs, socially. Protecting factors are medication biologically, self
motivation and therapies psychologically, and family, friends support socially.

Appendances:

The baseline chart, symptom rating scale, MSE is as follows:

Baseline chart:
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Symptom Rating Scale:

19
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Mental Status Examination:

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Case # 2 ( Major Depressive Disorder)

Executive Summary:

S.N is a female patient aged 31, showing the signs of MDD major depressive disorder.
She reported that she faced trouble in managing her life from the past 1 month as she
couldn’t sleep well, loss of appetite, loss of weight, depressed, low mood and took no
interest in any pleasurable activity of life; even she had some thoughts of suicide. This
occurred when she acknowledged her husband's second marriage as she had 03 daughters
but not the son so, her husband did the second marriage and after that he treated my client
badly and tortured her mentally.

According to DSM-5 Ms. S.N was diagnosed with MDD as she fulfilled all the criteria of
major depressive disorder. The cognitive behavioral therapy (CBT), counseling and other
motivational therapies proposed for her help and she learnt many coping strategies to face
her problems and how to deal with challenges. The psychiatrist prescribed her
antidepressants for her treatment as she needed the medication.

Background Information/ History:

The client's name was S.N and her age was 31. She graduated. Her birth order was 01
and had 05 siblings. She was married and had 03 children. She was a housewife. She
came to OPD on 10.11.24 and she was herself an informant.

Main reasons for referral:

The client was referred to the trainee/internee Clinical Psychologist by the Psychologist
for psychological assessment and management of the problem.

Presenting complaints:

As reported by the client he had:

Presenting Complaints Duration (in weeks,

months, years)

Har waqt udaas rehti hun. Ek maheena ho gya

Bhook nhi lagti. One month se hi

Weight km hone lga h. One month se

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Kisi kaam mn dill nhi lgta r One month se

dehan b nhi rehta kammon mn.

History of Present Illness:

Client’s problems start from one month when she acknowledged about her husband’s
second marriage as she had 3 daughters but not the son so her husband did second
marriage and my client couldn’t bear this incidence as she really loved her husband and it
was her love marriage with him and she couldn’t share her love with anyone else. Her
relationship with her husband was good before her 3rd delivery.

After her 3rd daughter birth, her husband taunted her for having no son. And her husband
got involved in an extra marital affair. This was her predisposing factor. When her
husband’s second marriage news reached to my client, her precipitating factor got
active and she indulge in depression, then her husband’s and her in-laws rude behavior
with her, cause her perpetuating factor and maintained her problems. But her decision
to visit to psychologist was her protecting factor with good coping strategies and her
medication was also her protecting factor.

Biopsychosocial model with 4 p’s:

1. Predisposing
factor Bio Psyc Soc
ho ial
Nill
Her Not
husb sup
and’ port
s ing
extra in-
marit law
al s
affai
r
2. Precipitating
factor Nill Her Tau
husb nts
and’ fro
s m
seco her
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nd in-
marr law
iage s
for
hav
ing
3
dau
ght
ers
3.
Perpetuating/m Nill Her Con
aintaining factor husb tinu
and’ ous
s me
rude ntal
beha ly
vior tort
with ures
her. fro
m
her
hus
ban
d’s
and
in-
law
s.
4. Protecting
factor Ant Visit Her
i- to mot
dep psyc her’
ress holo s
ants gist sup
me port
dici
nes
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Family History:

Father:

Client’s father was alive and uneducated. He was a retired guard of the government. bank
and he was a heart patient but not any psychological issue. He had a dominant personality
in his house and had an aggressive nature. The relationship between him and my client
was very good before her marriage but after her love marriage decision, her father got
offended with her. But her father’s relationship with the client's mother was very good.

Mother:

Client’s mother was alive and was a housewife. She had no physical or psychiatry issues.
Her personality was very calm and sweet and her relationship with my client was good
and cooperative. Her relationship with her husband was also very good.

Siblings:

Client had 5 siblings and her birth order was 1st. She had 02 brothers and 03 sisters. They
had no physical and psychiatric problems. Her sister’s relationship with her was very
cooperative but her brothers were offended with her for her love marriage.

Personal History:

Birth: Normal birth

Developmental Milestone (such as, speech, crawling, walking etc.): Client’s

developmental milestones were appropriate as other children.

Physical health/ Medical history (e.g. pneumonia, jaundice, hay fever etc.): No, any
medical history of my client existed.

Traumatic experiences (due to psychological problem, sexual assault etc.): Nil

Schooling: Client’s schooling was like other normal children and she was a brilliant
student and participated in extracurricular activities.

Adolescence: My client’s puberty period was appropriate and information about it got
from her mother.
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Marital History:

My client was married and her husband was alive. His age was 33 and qualification was
B.A, B.Ed. He was a Govt. officer of police. He had no medical or psychiatric problems.
His personality was dominant and the relationship with my client and her family was not
good but rude.

Children:

Client had 03 daughters of age 07, 05, 03 respectively. No physical or psychiatric

problem in her children and relationship with them was very good and humble. Overall
home atmosphere was disturbed after her husband’s second marriage.

Premorbid Personality:

o Social interest:

My client was a social person before her marriage but after marriage she
indulged in her house chores and her social interest became less.

o Social relationships:

Social relationships were very good before her marriage. Even after marriage,
she met everyone warmly and talked sweetly.

o Mood:

Client's mood was euthymic before her marriage but after marriage due her
in-laws rude behavior, her mood became agitated.

o Moral and religious values:

Client was very religious as she was a Muslim by religion and moral values
were also appropriate.

o Habits:

My client was fond of reading novels and digests.

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o Reactions to stress:

Client’s reaction towards stressful situations was negative. She was not very
strong to cope with sensitive situations.

o Smoking/ Drug abuse:

Nil

Assessment:

Client assessment done by different methods which are as follows:

Informal Assessment includes:

Baseline chart:

The scores of BDI scale include in the base line chart:

1-10 These ups and downs are considered as normal

11-16 Mild mood disturbances

17-20 Borderline clinical depression

21-30 Moderate depression

31-40 Severe depression

Over 40 Extreme depression

Subjective ratings of presenting complaints:

A subjective rating done by the client as she rates her presenting complaints. This
scale starts from 0-10 in which 0 indicates no problem but 10 indicates the
severity of the illness.

Problematic behavior Rating

Low/sad mood 10
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Loss of interest 8
Loss of sleep, appetite and 9, 8
weight respecti
vely.

Formal Assessment includes:

Mental Status Examination:

Diagnostic/Psychological Assessment:

Mental Status Examination:

Appearance:

Following points about the client’s appearance must be mentioned under this section:

Sitting posture:

Client’s sitting posture was inappropriate. She sat in low mood and looked sad and dull.

Facial Expressions:

Facial expressions were sad and dull.

Height:

5.5 approx.

Weight:

75kg

Clothing/Dressing:

Wore abaya and hijab.

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Level of Eye Contact:

Not appropriate.

Degree of friendliness:

My client was not much friendly.

Apparent Age:

My client’s apparent age was more than her chronological age.

Mannerism:

Appropriate.

Speech (Form and Content):

Volume of Speech: Low volume of speech.

Stammering/stuttering: Stuttering a little bit but situational.

Mood and Affect:

Client mood was sad and affect was agitated.

Thoughts:

Client’s thoughts were negative about her luck and world.

Thought Content:

Client had suicidal thoughts and she committed suicide once even.

Delusions:

She had no delusions.

Hallucination:

She had no hallucination.

Orientation:
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My client was well oriented about time, place, and person.

Memory:

Client’s memory was appropriate.

Remote memory: She known about her date of birth.

Recent Past Memory: She known about her yesterday's dinner.

Recent Memory: She was able to count from 20 to 01 backward.

General information/intelligence:

My client’s general knowledge was good as she was able to do sum to digits.

Insight:

She was well known about her problems and her illness.

2. Personality Assessment:

The personality assessment was done by interview method which showed the
different personality traits of the client such as the introvert personality, neuroticism
which helped her to easily get the depression state and couldn’t cope with the stressors.

Summary of Informal and Formal Psychological Assessment:

Informal Assessment:

In informal assessment, information collected by interviews and self-report tests.

Through the subjective rating scale, client’s problems and the degree of severity of
depressive symptoms were assessed. Client’s distress level and the overall symptoms of
major depressive disorder were assessed in informal assessment.

Formal assessment:

In formal assessment, the MSE was performed to check the mental state and
disturbances of the client. Furthermore, the Beck Depression Inventory BDI also
 32

performed for the client to determine the severity of MDD and it helped in examining a
number of areas such as mood, sleep, appetite and behavioral symptoms, and then
obtained the final score for the interpretation of MDD symptoms. Personality assessment
was also done by the interview method to find out her personality traits.

Interpretation of Assessments:

In the MSE, the client’s mental state was checked by asking questions about the
orientation, delusion, hallucination and by examining his appearance, behavior and
thoughts. In the BDI test, a sheet of BDI scale was given to the client and asked her to fill
it with great concentration and the result concluded by the given scale score as my client
fell into a severe depression.

Diagnosis:

According to DSM-5, the client is diagnosed with Major Depressive Disorder and
the code of MDD is F32.

Prognosis: Recovery (Satisfactory/Unsatisfactory):

Recovery was satisfactory.

Management and Treatment:

o Cognitive behavioral therapy

o Motivational therapy

o Supportive relationship

o Self help strategies

o Lifestyle modification

Case Formulation:

The cognitive psychology or school of thought is eligible to explain the case of

my client, how she thought about the relationships and the perception about it and love
for her husband as the cognitive psychology explains the thoughts and perception of a
person. A biopsychosocial model was supposed to endorse the reasons for manifestation
 33

of this disorder. As the 4p’s were used for this purpose. The biological factors were nil in
the first three factors. Her predisposing factors were her husband’s extra marital affair in
psychological factors and non-supportive in-laws in social factors. Her precipitating
factor was her husband’s second marriage, psychological factors and the taunts from her
in-laws for having 3 daughters, social factors which trigger her problems. The
perpetuating factor was her husband’s rude behavior with her, psychological factor and
the continuous mentally torture from her husband’s and in-laws, social factors, which
maintained her illness. The protecting factors were medication, biological factors, visit to
psychologist, psychological factor and her mother’s support of her social factor.

Appendances:

BDI and MSE performed for client’s major depressive disorder in the
psychological assessment which is as follows:

BDI Scale:
34
35
 36

MSE:
37
38