Summary

M.M was 30 years old male, who was referred to train clinical psychologist, with the present

complaints of OCD. He says that his 1st time experience of treatment for OCD. He was getting

treatment from three years. Due OCD created in his personality odd facts and thinking,

loneliness or isolation, drastic behavior, aggression, immoral social values, mood swings,

restlessness, strained inter-personal relations, excited speech. Informal assessment was done by

Clinical Interview, Behavioral Observation, Mental Status Examination (MSE), and Visual

Analogous Scale (VAS). Formal assessment was done , Rotter’s Incomplete Sentence Blank Test

(RISB). According to DSM-5, the client might be diagnosed with OCD. The management plan

was advised to manage his problem related to his issues. Different therapeutic techniques such as

Psych education, relaxation techniques, distraction techniques were advised this purpose.
Identifying data

Age 30 years

Sex Male

Education FA

Sibling 8 (5
sisters and 3 brothers)

Birth order 2nd last Child

Religion Islam

Occupation None

Marital Status Unmarried

Informant client himself

Residence Lahore

Date of test 25 February,

2020

Source Mother
 Total no. of session

Reason and source for Referral

The client came to the Civil hospital with the complaints of fear of getting

dirty, spending lot of time in washing and clothing, Aggressive behavior, Weakness,

Worry, repeating certain words, doing senseless things, Poor appetite, the client

was referred to the psychiatrist for the Purpose of Psychological assessment and

management of his problem.

Presenting complaints

According to patient

‫عالمات‬ ‫علامات‬

‫ایک سال سے‬ ‫مجھے لگتا ہے کہ میرے ہاتھ ہمیشہ گندے رہتے ہیں‬

‫ایک سال سے‬ ‫صابن سے بار بار ہاتھ دھوتا ہوں تولیے سے صاف‬

‫کرتا ہوں اور ماما سے پوچھتا ہوں کہ گندے تو نہیں‬

‫ڈیڑھ سال سے‬ ‫چیزوں کو استعمال سے پہلے بار بار صاف کرتا‬

‫ہوں‬

‫ڈیڑھ سال سے‬ ‫بالوں میں کنگھی گن گن کر کرتا ہوں‬

‫ڈیڑھ سال سے‬ ‫استعمال کرنے سے پہلے چیزوں کو گنتا ہوں‬

‫ایک سال سے‬ ‫جب بھی کوئی پاس سے گزر جائے تو لگتا ہے کہ‬

‫جراثیم لگ گئے ہیں‬

History of Present Illness

Client suffered from Obsessive Compulsive disorder. The client was born in

1992. He lived in Lahore. He was second last born. He was FA passed. He wanted to

continue his studied but could not continue his studies due to this problem and

financial problem.

All symptoms of the client were almost high in severity. His illness was

started before one year ago. According to the client he had this problem due to

death of his beloved caused by typhoid and also interpersonal conflict with family.

He performs every task repeatedly. His behavior becomes very strange towards. He

feels restlessness when he does every works repetitively. He also report the

complaints of repeated certain words, doing senseless things, fear of getting dirty,

Worry, poor appetite aggressive behavior, feeling of taking of cloth, spending lot of

time in hand washing. The client was too much disturbed. He thinks that if he will

not wash his hand again and again, he will be suffered in serious disease.

Client had symptoms of unhealthy personality. He didn’t have good

relationship with his parents. He also thinks that his parents do not love with him.

Because his brothers studied in good private colleges and he studied in Government

College. According to client he has three sister and two brothers. His elder brothers

and sisters are also qualified. His relationship with his siblings was good. None of

them any kind of physiological and disorder with his sibling. During studies client

had many friends and he was very talkative person. He was physically and

psychologically healthy person before disorder. He loved to watch T.V. dramas plays

and films [Link] wanted to visit different places. He was social and enjoy with his

friends. But after the present problem he was changed. He does not want to talk to
family members, and just want to meet friends. He had worried and thoughts about

his illness. His family was also worried about his illness.

The same factor as well as the financial issues was providing the base for the

continuity of disorder and other related symptoms in client. Client with his mother

came at Civil hospital for the first time for the cause of treatment. Before this he

visited many doctor or psychiatrist. Client had a positive attitude towards the

treatment. The client wanted to overcome his fear and illness and wanted to spend

a normal life. He had been consulting to the psychiatrist and use different

medicines.

Background Information

Background information contains the patient’s family history and his overall

home environment.

Family History

Client belonged to middle class family. According to client his father name

was M.S he was 60 years old. His father was worker in a factory. Client had bad

relationship with his father. According to client his father was not loving and caring.

Client father support his family even he is not financially very strong but client was

not satisfied with his father. There was not good relation between client and his

father

The client’s mother was 50 years old. She was housewife. She was not educated.

She was attached with all her children. And also had good relation with client. Client

was very attached with his mother. According to client his mother was very kind,

supportive and caring and she had very calm personality.

General home atmosphere.

 The client belonged to a middle class family. They lived in their own house in

Lahore. Total number of family was eight. They lived in joined family in the

childhood. And their grandparents died before the birth of the client. The family

environment was friendly. Parents were not educated and broadminded. But they

keenly desired that their off spring would have good education. That’s why

everyone chose different profession according to their interest even he is not

financially strong.

Personal History.

The client had a normal birth. His parents were really pleased at his birth. He

loved them very much. His childhood period was very memorable, free of bad

events and any physical problems. He really enjoyed his childhood because he lived

in happy family. He had different hobbies in childhood’ and spent a lot of time with

his friends. Client had no history of neurotic trait e.g. bed wetting, nail biting, and

thumb sucking. He had not severe illness in his childhood. And carried social and

friendly personality.

Educational History.

The client joined the school at the age of 4 and his school period was also

very good. He was intelligent student. He was very hard working student .and he

had very good attitude toward friends and teachers. According to client his teachers

was very supportive and helping. He had many friends and his friends were very

loving. He had very close and cooperative relationship with his friends and peers. At

school he participated in many plays with friends. He passed his matriculation in

Fist division. And take admission in FA. And cannot study more because he was not

able to concentrate on study.

Sexual History.

The client reported that he reached the puberty at the age of 14. He took

information about puberty from his father. He believed loved and related fantasies.

And had no sexual relationship.

Social History.

Client was very social because he had very good relationship with family,

sibling and peer. He liked to make friends. At school age he had many friends and

he loved to be with friends. But now he don’t like to make friends and lived

reserved.

Pre-Morbid Personality.

During studies client had many friends and he was very talkative person. He

was physically and psychologically healthy person before disorder. He loved to

watch T.V. dramas plays and films [Link] wanted to visit different places. He was

social and enjoy with his friends and family members. But after the present problem

he was changed. He does not want to talk to anybody, and don’t like to meet

friends.

Psychological Assessment

Psychological assessment is defined as a way of testing people about their

behavior, personality, and capabilities to draw conclusions using combinations of

techniques. Psychological assessment is the attempt of a skilled professional,

usually a psychologist, to use the techniques and tools of psychology to learn either

general or specific facts about another person, either to inform others of how they
function now, or to predict their behavior and functioning in the future. (Maloney &

Ward 1976).

The psychological assessment of the client was carried out at informal and

formal level.

Informal assessment

Informal assessment methods are subjective and there are many times when

they may be designed to meet the specific needs of a clinician. This is because it

gives the clinician an opportunity to measure certain individual performance with

casual techniques verses using methods that may require high participate

involvement. Once, these measures are obtained the clinician can then implement

performance objectivities that may improve the overall behavior that was observed.

Since, these methods are often developed to meet specific assessment needs, they

will also normally require less time, money and expertise than nationally developed

techniques (Neukrug, Fawcett, 2000).

Clinical interview

A clinical interview is a tool that helps physicians, psychologists and

researchers make an accurate diagnosis of a variety of mental illnesses, such as

depressive disorders (Kelly, 2017).

Behavioral Observation

The client wore neat and clean clothes. His nails were also clean and hairs

were comb mannerly. He was under-weight and was much slim and thin by general

appearance. His weight was 60 and his age was 30 and his height was 5.3 which

showed he is under-weight. His tone was very low. He was making continuous eye-

contact and he was cooperative. He answered any question effectively. His speech
was comprehensive and thoughts were organized. The content of the speech was

relevant and logical. He was stressed during interview according to her facial

expression.

Subjective ratings of symptoms

The Ratings of symptoms of the Client were taken from the client himself as

he had proper insight about his problem. The Ratings of symptoms of client’s

problem were taken from with the purpose of obtaining the severity of client’s

problematic behavior, and also to see that how much the client perceives her

problem. Ratings were taken through 0-10 scale, in which “0” means “no problem

at all”, and “10” means “severe problem”.

Visual Analogue (VAS)

A Visual Analogue Scale (VAS) is a measurement instrument that tries to

measure a characteristic or attitude that is believed to range across a continuum of

values and cannot easily be directly measured. For example, the amount of pain

that a patient feels ranges across a continuum from none to an extreme amount of

pain. From the patient's perspective this spectrum appears continuous ± their pain

does not take discrete jumps, as a categorization of none, mild, moderate and

severe would suggest. It was to capture this idea of an underlying continuum that

the VAS was devisedThe trainee clinical psychologist made these rating on a 0 to 10

point scale based on her findings in the initial sessions where 0 represented least

problematic and 10 marked the maximum problem. The rating are shown are shown

in the following table.

Table no. 2

Sr. No Symptoms Rating by clients

1 feeling of getting dirty 8

spending lot of time hand

2 9
washing

3 Worry 8

4 Repeating certain words 8

5 Doing senseless things 8

6 Aggressive behavior 9

7 Poor appetite 6

8 Feeling of taking cloth 9

9 Sadness 5

10 pain of body 5

Mental status examination

The mental status examination is a clinical assessment of the individual

which reflects both the individual’s subjective report and experience, and the

clinician’s observations and impressions at the time of the interview (Evans, 2002).

M.M was 30 years old and his appearance was good. He had a good

personality. His height was 5.3 and eye color was black. His general appearance

was normal, grooming and hygiene and he wore casual dress. His mood was

depressed, and his thought process was goal-directed and logical. His tone was low.
He shows flat and depressed affect. His tone of voice was normal and no pressure of

speech. When client was asking question, he answered normally. His attitude was

calm and cooperative. He was very curious about his interview but he became

bored after few minutes of interview. He behaved well. At the time of interview, he

was little tensed because when client was asked about her feeling and his life he

reported that he was very sad because of his health problem and it’s difficult for

him to forget this and wants to cry.

Client appropriateness was normal. When he was asked about his feelings

during sad and happy occasions and about himself, his responses were normal. His

thought process was good. He was worried about his condition and tensed about

the home environment which troubles his most. His abstract thinking was normal.

When he was asked to discriminate between two things e.g., apple and banana, car

and ship etc. He easily discriminated. His concentration ability was brilliant. When

he was asked to reverse counting, name of weeks and name of months. He did face

a bit difficulty in reversing the name of months in a year but he easily reversed the

name of weeks. Client was well oriented person. Because when she was asked

about his name, his doctor’s name and about the relation of client with informant he

answered correctly.

Formal assessment

Formal assessment methods are considered to be more objective. Formal

Psychological Assessment (FPA) tries to improve the assessment procedure by

providing a formal framework to build assessment tools. The FPA is a new

methodology potentially capable of maximizing the advantages of both semi-

structured interviews and self-report questionnaires by overcoming the limitations

of these tools and managing the problems of traditional assessment .The ability to

analyze clinical symptoms is important when evaluating the responses to a

questionnaire. FPA goes beyond the score of the patient and investigates the

diagnostic features implicated by the responses. The crucial issue that represents

the starting point of FPA is consideration of the information that can be collected

from a patient’s numeric score on a questionnaire. (Groth-Marnat) Formal

assessment involves the use of tools such as tests, Questionnaires, checklist and

rating scales. The purpose of evaluation is to determine the client’s personality and

the problems which impair the client’s normal functioning.

Obsessive compulsive test-Yale’s brown OCD scale (YBOCD)

The Yale’s brown obsessive-compulsive scale is a text to rate the severity of

obsessive compulsive disorder symptoms. The scale which was designed by Wayne

and his colleagues is used extensively in research and clinical practice to both

determine severity of OCD and to maintain improvement during treatment. This

scale which measures obsessions separately from compulsions, specially measures

the severity of symptoms of obsessive compulsive disorder without being biased

towards the type of content of obsessions or compulsions present.

Qualitative analysis

Table 1.2

Following table showing the result of the client on Y-BOCD

[Link] Symptoms Score

1 Time spent on obsessions 4

2 Interference from obsessions 3

3 Distress from obsessions 3

4 Resistance to obsessions 2

5 Control over obsessions 2

6 Time sent on compulsion 3

7 Interference from compulsion 2

8 Distress from compulsion 2

9 Resistance to compulsion 3

10 Control over compulsion 4

Total score = 28

Table 1.3

Following shows the age, raw score, range and result of the client scores

Age Raw Score Range Result

Mild (8-15)

Moderate (16-23)

30 years 28 Severe (24-31) Severe OCD

Extreme (32-40)

Quantitative analysis
Interpretation

The interpretation of Yale’s brown OCD scale is if the individual get the total score is

8-15= mild OCD, 16-23 = Moderate OCD, 24-31= SEVERE OCD and 32-40 =

Extreme OCD. The clients total score of Yale’s brown OCD scale was 28 which fall in

the category of severe OCD.

Personality Test

Personality test is used to access individual’s personality characteristics,

personality structure, his personality motives, emotions and desire and thus enable

the examiner to understand more subtle aspect of his personality

Following assessment techniques were used

Rotter Incomplete Sentence Blank (RISB)

A Sentence Completion Test or semi structured projective technique in which

the subject is asked to finish a sentence for which the first word or words are

supplied. RISB was developed by Julian Rotter and Benjamin Willerman in the early

1940s as a means of screening large groups of soldiers to evaluate adjustment and

fitness to return to duty and to obtain specific information for evaluation and

treatment. The original RISB was published in 1950, and the most recent revisions,

including separate forms for clients in high school, college and adulthood, were

published in 1992. Measuring both adjustment and maladjustment is a chief aim of

thee RISB, with the goal of identifying both the presence and the relative absence of

psychopathology. Therefore, the RISB is intended help guide an initial clinical

interview, formulate a diagnosis and arrive at a treatment plan, rather than provide

a comprehensive evaluation of the personality dynamic. (Rotter, J.B & Rafferty, J.E,

1950).
Quantitative Analysis:

Table 1.4

Table showing age raw score range categories and results

Type of items No. of responses Obtained scores

Positive

P1=2 3 2x3=6

P2=1 6 1x1=6

P3=0 3 0 x 3 =0

Neutral

N=3 3 3 x 3 =9

Conflict

C1=4 4 4 x 4 =16

C2=5 7 5 x 7 =35

C3=6 13 6 x 13 =78

Cut off Score=135 Obtained score= 150

Interpretation

The cut off score of RISB is 135 and client’s obtained score is 150 but the

client is maladjusted because this low score is due to missing of answers of some
statements which client did not respond. The missing answers indicate

maladjustment.

Qualitative analysis.

Familial attitude

The client shows conflicting attitude towards familial attitude. Items (4,

11, 29, and 35) show the conflicting attitude of the client. Item no. 4 At home, client

feels like as if he lives with his step mother. Item no.11. A mother, the client said is

good. In item no. 29 what pains me, the client said the way his family members

treats him. In item no. 35 my mother the client said that is good to me.

Social Attitude
The client social relationship was not good. He said in item number 10

but he was not comfortable with other people e. Before this problem he was very

social and had a lot of friends. But now he said he became anxious when people

questioned him about his worries so he did not felt calm with people.

Sexual Attitude

He had neutral neither good nor bad attitude toward sex. As he

described in item no 26his marriage was after 3 months.

General attitudes

The client showed more conflicting response towards the general

attitude. In item no. 2 the happiest times, for the client was when he was at work. In

item no. 3 I want to know, the client to know about the future. In item no. 6 at

bedtime, the client had trouble in sleeping. In item no. 7 Boys, the client said that

they can be good friends. In item no. 9 what annoys me, the client did not like

crowds and his home environment. In item no. 12 I feel that, he feels upset most all
the time. In item no. 16 Sports, the client liked to play tennis. In item no. 17 when I

was a child, the client was happier. In item no. 19 other people, the client said that

the annoy him, if others are good with him he also remains good with them. In item

no. 21 I failed, the client said that he failed at nothing. In itemno. 31 I am very, the

clients think that it is average. Item no. 34 I wish, the client wanted to be settled. In

item no. 36 I secretly, he has no secrets. In item no. 38 dancing, the client said that

it does not interest me. In item no. 40 most girls, the client said are fine.

Characteristic trait

The client showed more conflicting and less positive response towards

characteristics trait. In item no. 1 I like, the client liked games. In item no. 5 I regret,

the client said that he regrets about his past. In item no. 8 the best, client said that

the work he can do is the best. In item no. 13 my greatest fear, darkness was the

fear of the client. In item no. 14 in high school, the client said that he did alright in

school. In item no. 15 I can’t, he can’t keep from worrying about the future. In item

no. 18 my nerves, it was hard for client to control his nerves. In item no. 20 I suffer,

he suffered from physical pain. In item no. 22 Reading, it was a problem for him. In

item no. 23 my mind, the client said that he was confused. In item no. 25 I need, he

was in need of job to make everything better. In item no. 27 I am best when, when

he is alone. In item no. 28 sometimes, the client said that he wants everything to

get better. In item no. 30 I hate, he hates nothing. In item no. 32 I am very, he said

that he is restless. In item no. 39 my greatest worry is, the client said that he

worries about his future and wants everything to get better.

Summary

The client was obtained 150 score which was above the cut off score because

clients did not answer all the items of the test that shows his maladjustment toward

society. He has feelings of hopelessness and depression.

Trait assessment

Trait assessment of the client was done by using Obsessive

Compulsive test-Yale Brown OCD Scale (YBOCD)

Diagnosis

According to assessment results client might be with the problem of

330.3(F42), Obsessive- Compulsive Disorder

Prognosis

The client was 30 year old man. Females are affected at a higher rate than

males in adulthood, although males are more commonly affected in childhood. The

National Comorbidity Survey Replication reported the median onset was 19 years

(21 % of cases emerge by the age of 10), whereas the mean onset for OCD in adults

occurs between the ages of 22 and 35 years. Client prognosis did not seem to be

poor as client had proper insight of his problem. Smith and Pristach (2010) found

that patient with mental disorder who had poor insight their prognosis is not good

the poor insight poor treatment adherence and poor outcome.

Higher negative emotionality behavioral inhabitation in childhood or and

other stress full or traumatic events have been associated with an increased risk for

developing OCD. Some children may develop the sudden onset of obsessive-

compulsive symptom, which has been associated with different environmental

factors. Client had the stressful life event that interpersonal conflict of his family.
Stressful life events are well recognized as precipitants of obsessive compulsive

disorder, but the presence or absence of adverse life events near the onset of

episodes does not appear to provide a useful guide to prognosis or treatment

selection.

Case Formulation

The client was born in 1992. He lived in Lahore. He was second last born. He

did FA. He wanted to continue his studied but could not continue his studies due to

this problem and financial problem. His illness was started before six months ago.

According to the client he had this problem due to death of his beloved caused by

typhoid and he also interpersonal conflict with family. He feels restlessness when

he does every works repetitively. He also report the complaints of repeated certain

words, doing senseless things, fear of getting dirty, Worry, poor appetite aggressive

behavior, feeling of taking of cloth, spending lot of time in hand washing. Both

formal and informal assessments were carried out to assess the client. Case history,

clinical interview, MSE (mental status examination), and visual analogue test,

Obsessive Compulsive test-Yale Brown OCD Scale (YBOCD) and Rotter incomplete

sentence blank were administered to assess the functioning and personality of

client.

The predisposing factors mean factors that develop the tendency of illness in

client, biological factor, and family history, heritable factor of the disorder. OCD is

not caused by bad parenting and other family member. However, the way a family

reacts to a child can affect the symptoms associated with the disorder. Children

with OCD were also less confident in themselves, used less problem-solving, and

showed less warmth with their parents than children without. Stressful and

traumatic events have been associated with increased risk for developing OCD.
Some children may develop sudden onset of obsessive-compulsive symptoms,

which has been associated with different environmental factors, including various

infections agents and a post infectious syndrome. The precipitating factors are the

triggering events of the [Link] conflict death of his beloved,

financial problem are the precipitating factor of client obsessive compulsive

disorder.

The client’s mother was also suffering the obsessive compulsive disorder. She

has the symptoms of hands washing again and again. According to Taylor, (2010)

there is moderate genetic contribution to OCD, with estimates of heritability ranging

from 30 to 50 percent. At least 80 percent of intrusive or repeated thoughts from

time to time, an image get stuck in your head (Rachman, 1978). Intrusive thought

are so persistent that cause real distress or impairment. Behavioral models

emphasize operant conditioning of compulsions. The compulsions are reinforced

because they reduce anxiety (Meyer &Chesser, 1970). For example compulsive

hand wash would provide relief from anxiety associated obsessions about germs. In

pursuing this line of inquiry, it will become increasingly more important to evaluate

whether certain genetic variations predispose individuals to develop OCD under

different conditions of psychological stress. OCD, most times, highly interferes with

the life of the family, which is obliged to adapt to its symptoms, alter its routines,

and restrict the use of spaces and objects, which is a reason for constant conflicts.

The client home environment was not good. His relationship was good for his

sibling and his mother. He also thinks that his parents don’t love him. So his home

environment always tensed and disturbed. The client also developed this disorder in

early adulthood after stressful condition. When the death of his beloved cause by
typhoid he can also experience a large number of emotion and disturbance and

stressful events that death of his beloved. Stressful events are well recognized as

precipitants of major depressive episode.

Case Formulation Summary Table

Presenting Complaints
Assessment
 Feeling of getting dirty
 Behavioral
 spending lot of time hand Observation
washing  Clinical Interview
 Sadness  Mental Status
Examination
 Lack of sleep
 Visual Analogue
 Doing senseless things scale
 Low appetite  Yale Brown OCD
Scale (YBOCD)
 Repeating certain words  Rotter Incomplete
Sentence Blank
Client
(RISB)
Management plan

Short terms goals

1. Psycho education should be given to client to give her awareness about her

problem, causes and treatment.

2. Psycho dynamic intervention focuses on interpersonal conflict from the

patient past & present life and encouraged more adaptive ways of dealing

with others.

3. Educates the all client family members deal more effectively and contribute

to a better treatment plan for the client.

4. Client should be thought to monitor his own problematic behavior and to the

stimulus that trigger them.

5. Client should be thought to monitor his own problematic behavior and to the

stimulus that trigger them.

6. Client should be thought to monitor his own problematic behavior and to the

stimulus that trigger them.

7. Client should be taught to improve his self-esteem by using self-esteem

building exercise.

Long terms goals

1. Try to improve the interpersonal relations of the client

2. Try to develop healthy thinking pattern and increase his self-esteem that he

can utilize his potentials and work effectively.

3. Conduct regular follow up sessions for client and for his family to deal with his

problems effectively and train them how to use lapse prevention technique.
Therapeutic techniques

Cognitive behavioral therapy

CBT is often effective in treating persistent depressive disorder. Different

modalities have been shown to be beneficial. Empirically-based treatments, such as

cognitive-behavioral therapy, have been researched to show that through the

proper course of treatment, symptoms can dissipate over time. It can help to

identify negative beliefs and behaviors and replace them with healthy, positive

ones. Find better ways to cope and solve problems. Explore relationships and

experiences and develop positive interactions with others. Regain a sense of

satisfaction and control in life and help ease depression symptoms, such as

hopelessness and anger. Learn to set realistic goals for life. It may be helpful for

people diagnosed with dysthymia to develop better coping skills, search for the root

cause of symptoms, and work on changing faulty beliefs such as when patients

believe themselves to be worthless. (Segal, Williams, Teasdale, &Kabat-Zinn, 2001).

Psychotherapy
Psychodynamic therapy is more traditional. The client and therapist explore

behavior patterns and motivations that client may not be aware of which could

contribute to depression. The client may focus on any traumas from his/her

childhood. Psychotherapy is a general term for treating depression by talking about

your condition and related issues with a mental health professional. Psychotherapy

is also known as talk therapy or psychological therapy.

Different types of psychotherapy can be effective for depression, such as cognitive

behavioral therapy or interpersonal therapy. Your mental health professional may

also recommend other types of therapies. Psychotherapy can help you:

 Adjust to a crisis or other current difficulty

 Identify negative beliefs and behaviors and replace them with healthy, positive

ones

 Explore relationships and experiences, and develop positive interactions with

others

 Find better ways to cope and solve problems

 Identify issues that contribute to your depression and change behaviors that

make it worse

 Regain a sense of satisfaction and control in your life and help ease depression

symptoms, such as hopelessness and anger

 Learn to set realistic goals for your life

 Develop the ability to tolerate and accept distress using healthier behaviors.

Group therapy

Group therapy has been shown to be an effective modality for individuals

suffering from this disorder. A group can be more supportive an individual than any

one therapist can and help point out inconsistencies in the patient’s thinking and

behavior. It should be considered, if not initially, then later in treatment as the client

regains his or her own self-confidence and can interact in a social context. Issues of
self-esteem often accompany individuals who have dysthymic disorder, so care

must be employed not to place the person into a group situation (where failure may

be imminent) too soon (Segal, Williams, Teasdale, &Kabat-Zinn, 2001).

Family therapy
Focus on the caregiver appears to be an important component of behavioral

treatment, involving improvement in the caregiver's skills in communicating with

the patient and adapting to the disease. Caregivers are instrumental in increasing

the patient's engagement in pleasant activities. Both cognitive behavioral and

multi-component treatment approaches are effective in reducing depression in the

caregiver (Gallagher-Thompson & Coon, 2007)

Self-Help methods

Self-help methods for the treatment of this disorder are helpful to adjust to a

crisis or other current difficulty. Identify issues that contribute to depression and

change behaviors that make it worse. Patient can be encouraged to try out new

coping skills, assertiveness skills, cognitive restructuring, etc. within such a support

group. They can be an important part of expanding the individual’s skill set and

develop new, healthier social relationships. Through this treatment, issues such as

self-esteem, self-confidence, relationship issues/patterns, assertiveness skills,

cognitive restructuring, etc., can be worked through and strengthened (Segal,

Williams, Teasdale, &Kabat-Zinn, 2001).

Session Report
Session I Date:13th November, 2020
 The goal of this session was to develop rapport with the client, so that he

may feel comfortable while sharing his life events. Informed consent was obtained

by the client. In these sessions different questions were asked by the client related

to his likes dislikes, hobbies, personal interest, and daily routine. Personal and

familial history was also asked .it was assessed that client was very cooperative and

has insight of his problem; due to all these factors rapport was easily built.

Session II Date:14th

November, 2020

In the second session, different questions related to the clinical interview

were asked later on client’s appearance, motor behavior, thought content,

judgment, memory, thought processes was assessed with the help of MSE was

assessed.

Session III

Date:15thNovember, 2020

In this session RISB was used. Throughout these sessions with client was

given different therapies like a session of deep breathing and also ask him to note

his daily routine life that leads towards negative thought pattern and try to help

them by scheduling his activities. At the end, different sleep tips were given to the

client.