Case Reports 1

Participant’s Name: Mona AKHTAR

Participant ID: S2021146006
Supervisor
Ms. Musheeb Pervez
Department of Clinical Psychology
School of Professional Psychology
University of Management and Technology
 Summary of the Case

M.A was a boy with age of 9 years old. He was studying in three grade. Client was
referred by his teacher with the presenting complaints of didn’t well in studies, didn’t used to
stand from his seat and used to quite all day. There was total five number of session was
conducted with client. For the purpose of proper management, the assessment was done through
Behavioral Observation, Clinical Interview with Teacher, Client and his Elder sister, Subjective
Ratings, School Children Problem Scale (SCPS), Academic Assessment and Cognitive
Assessment Battery (CAB) including Digit Span and Paired Association Learning Test (PALT).
The management goals comprised rapport building, psychoeducation, study skill training,
Phoneme Awareness social skills training. The outcome of the 6 sessions were rapport was 70
percent built as well as there was 60 percent insight built regarding the disadvantages of using
excessive mobile phone.
Identifying Data

Name M.A
Age 9years
Gender Boy
Grade 3rd
School A.S
Total no. of session 6
Initial date seen 19-10-2022
Last date seen 24-11-2022
Source and Reason for Referral

The child has been referred by his teacher for the assessment and management of his
problems i.e. didn’t well in studies, didn’t stand from his seat and only talk to his friends, and
stay in his own world.

Presenting Problems

Table 1

Presenting Complaints and Duration by Client

Duration Presenting Complaints

1‫سال سے‬ ‫سبق یاد کرنے میں مشکل ہوتی ہے۔‬
Note. Presenting complaints were probed in the clinical interview

Table 2

Presenting Complaints and Duration by Teacher

Duration Presenting Complaints

8‫مہینوں سے‬ ‫پڑھائ میں اچھا نہیں۔‬
8‫مہینوں سے‬ ‫اپنی جگہ سے کھڑا نہں ہوتا اور صرف اپنے دوستوں سے‬
‫بات کرتا ہے۔‬
8‫مہینوں سے‬ ‫گم صم رہتا ہے۔‬
Note. Presenting complaints are discussed in detail in the clinical interview with teacher

Initial observation

The child was observed in different settings like classroom, session and playground. M.A
was a boy and his age was 9 years. He was a student of class three. Apparently client seemed to
be well kept. He wore proper, neat and clean uniform. The complexion of client was fair.
Client’s hygiene was well maintained but the teeth were not brushed. Client height and weight
was in accordance to his age. Client facial expression was different during session. Sometimes he
was giving flat expression and other time he had smile on his face. He was observed in the
session as well as in class and playground.

In the very first session, trainee came in the client’s classroom and asked his teacher to
bring him for the session. Client came with the trainee school counselor with curious facial
expressions. M.A was not maintaining eye contact, as the client used to establish but not
maintain. Client sitting posture was straight and his body movement was according appropriate.
Client was showing compliance towards trainee school counselor. His facial expression was flat
and sometimes confusing. Client used to communicate with low pitch, but whenever after asking
again something child used to increase little bit his voice. The talk with client was started with
introduction but in start it was observed that client was not interested in talking with trainee
school counselor. Client used to talk and answering the questions by seeing around.

Furthermore in classroom it was observed that client was sit in the corner of seat. He
didn’t used to leave his seat in the absence of teacher. He used communicate with his friends and
with low voice tone. The left over class was cheering loudly and doing mischieveness. In the
playground client had a smile on his face, he was running towards the swings and moving it for
his friends. After that game teacher give them some instructions and he went to classroom.

Overall it was observed client was lacking in eye-contact as well as socialization skills.

Developmental History of the Problem

 The source of this information was client as well as client’s sister whom was studying in
the same school. Client’s academic problem started when he left the tuition in the start of three
Class about 9 months ago. As client reported that from nursery class he was going to tuition. The
reason of leaving the tuition was the tuition teacher’s strictness. He reported that he used to beat
him. He forced his mother he didn’t want to go tuition. As client was last born child from his
siblings so he was pampered as well.

From last 9 months client used to studies in the home from his mother. His mother guided
him in his studies. Client didn’t pay attention in his studies in home. Client’s sister reported that
he used to spend all the time on mobile phone after school. Mother didn’t used to give him full
attention as he needed. Client also reported that he used to spend of his time by playing games
and watching cartoons. Through taking some it seemed that clients study related issue is due to
his excessive time and concentration that he given to mobile. His performance in class is also
affected, mostly his mind not present in class. It’s due to clients pampering, mother attitude
towards clients study is also neglected.

It seemed that last born child, pampered behavior of mother and neglected arritude
towards his studies, excessive time consuming on mobile phone are the some factors which
develop the problem related to studies and in his behavior.
Figure 1

Pictorial Representation of Developmental History of the Problem

last born child, it also affect on client

socialization skills i.e.
pampered attitude
initiative in talk, eye
towards child contact

study realted problem

left the tuition due to
started, lack of
teacher strictness. concentration

started studying in home spent more time on

by his mother, lack of mobile watching
attention towards study cartoons and playing
by mother and client. games
Background Information

Personal History

According to client and his sister, client got up in the morning at 6.30 O’ clock. Client ate
his breakfast as he liked to eat bread and egg in breakfast, then client get ready for school. His
elder sister helped him in getting ready for school. He always used to play game on mobile
before going to school. Client reached at school on time at 7.45, his father used to drop them in
the school. After school client used to change his uniform, took his lunch. Client reported he and
his elder brother used the same mobile phone. His elder brother also play games on mobile
phone. When his elder brother went for academy, he started watching cartoons and playing
games on mobile phone. Client also mentioned the game names i.e. free fire etc. client sister
reported that he gave only half hour to studies when my mother behave strictly and sit properly
with him.

Furthermore client liked are playing games on mobile phone watching cartoons. Client’s
favorite fruit is pineapple. His favorite vegetables are mix vegetables. M.A favorite color is
black. His favorite subject is math. Client reported that his hobby was running and paying games
on mobile phone. He wanted to become an engineer.

Family History

Clients belong to joint family system and a middle class family. There were 7 members
in the family i.e. grandmother, Grandfather, mother, father, clients elder sister and brother.

Client’s grandmother and grandfather with the age of approximately 75 years living with
them. Client reported that he had good relation with his grandparents. They used to love him so
much. Sometimes he used to go outside with his grandfather. His grandfather had a smart phone,
client used his phone it gave him more happiness.

Client’s father age was approximately 41 years. He was working as a government

employ. Client’s sister reported that his father had strict behavior regarding study. Sometimes he
used to scold the client, due to not taking interest in studies. Client reported that he had good
relation with his father but he used love more with his mother. Client’s mother is a housewife
with the age of 37 and her education is on F.A level. She used to teach the client. Client reported
that his mother love him more. Clients elder sister reported that her mother and father
relationship was also satisfactory. They never used to fight with each other.

Client has 2 siblings both are elders, 1 brother and 1 sister. Client brother was eldest one.
He was with age of 16 years and studying in the 1st year (pre-medical) in the P.C for boys. Client
reported that his elder brother loved him, but sometimes due to mobile they used to fight with
each other. Overall, they had satisfactory relationship. Moreover, client had elder sister with
second birth order. Her age is 14 years old and she was Studying in 8th class at A.S with client.
His elder sister reported that client never listened to her. Whenever she asked him to open his
books, clients deny her. Client reported that he didn’t like her sister because she always ask him
to study.

It seemed that overall home atmosphere was satisfied, client was pampered due to last
born.

Educational History

Before admitting in school client got the informal education in his home. His mother
taught him alphabets in English and Urdu. He reported that his elder sister also helped him in
writing by holding his hand. He also mentioned that he started writing in the tracing copies in the
home from his mother and sister. Client reported that his grandfather used to give him quranic
lesson daily from “Nourani Qaida”. M.A started schooling in the age of 4 years. Client started
his schooling from A.S. Client didn’t have any school change history from start to till. Client
reported that from playgroup he is studying in this school. According to client he liked the school
as well as his teachers in the school. He had also good friends in the school. Client reported that
he didn’t like so much school. Clients favorite subject is maths, he reported that he also liked
maths teacher. His teaching style was good. According to client he had also a game period at
every Tuesday in which he used to run in the ground with his friends. Moreover his game teacher
taught them exercise, played cricket with them etc.
Provisional Formulation

On the basis of available information, it was hypothesized that there are some
factors that contributed in clients current condition i.e. last born child, pampering in joint family,
excessive use of mobile phone, lack of interest in studies and quit from tuition. according to
information available, it seemed that client is last born he had a age gap from his elder sister and
brother. Clients elder brother is 14 years and sister is 13 years. Client was last born his age is 8
years it could be reason of client silent behavior as well as lack of socialization. Because he
reported that he never used to go outside from his home for any physical activity. He spent most
of his on mobile phone inside the house.

Assessment

Assessment is a procedure in which a clinician evaluates a person in terms of the

psychological, physical and social factors that have the most influence on the individual‘s
functioning (Halgin, 2010).

Following are some assessment modalities used:

 Behavioral Observation(Bakeman & Haynes, 2014)

 Clinical Interview
 Clinical Interview with Teacher
 Clinical Interview with Client
 Clinical Interview with Client’s Elder sister
 Subjective Rating of the problem
 Curriculum Based Assessment (CBA)
 Reading assessment
 Writing assessment
 Dictation
 Cognitive Assessment Battery (CAB) (Naeem & Mehmood, 2011).
o Digit Span
o Paired Association Learning (PALT)
o Logical memory
  School Children Problem Scale (SCPS) (Saleem & Mehmood, 2011).

Behavioral Observation

Behavioral observation is useful for the assessment of persons with limited verbal abilities, the

measurement of persons' behavior in their natural environments, and the measurement of

functional relations among contemporaneously occurring behaviors and environmental events. It

is particularly useful for measuring clinically important sequences of interactions between

persons and for examining how these sequences influence behavior and vary across contexts

(Bakeman & Haynes, 2014). The purpose of the behavioral observation was to assess the variety

of the dimensions of the behavior in both structured and unstructured manners. It was used to

assess the client’s behavior during the session and was done to assess the present level of

functioning and problematic behavior in order to formulate a comprehensive and effective

management plan.

The client was observed from the very initial session and it was observed that the client

had average weight and height in accordance with his age. The non-verbal communication was

appropriate as seemed that he established eye contact with the trainee school counselor but not

maintaining. The facial expressions were a lit bit confused as the trainee school counselor was a

stranger to him but after reciprocal communication, the client engaged with the trainee and

respond to her.

Overall it was observed client was lacking in eye-contact as well as socialization skills.

Clinical Interview

The clinical interview is a situation of mainly vocal communication, more or less

voluntarily integrated on the basis of expert customer deploying progressively in order to explain
the patterns of the characteristics of the patient's life, the patterns that you experience as
particularly problematic or especially valuable and in the revelation of which hopes to gain the
benefit is called clinical interview (Shoai, 2014). A clinical interview was conducted with the
client and as well as with the teacher of the client. The aim of conducting that interview was to
understand the background and current situation of the client and obtained detailed history of the
problems of the client. the clinical interview helped the trainee to identify the presenting
complaints and probe the history of the client and teacher for a clear picture of the case
formulation.. Clinical interview is important to fill the history gaps.

Clinical Interview with Client. A clinical Interview was conducted with the client in
which the trainee school counselor introduce herself as a counselor and engage the client to
introduce himself the client reported his likes and dislikes, favorite subjects and teachers, and a
brief introduction about himself and the trainee school counselor asked different questions about
his daily routine. Trainee counselor also disclosed her interest to develop a rapport it also
encourage client to share his information. Trainee school counselor asked client about the
problems he is facing in studies as well in his personal life. Client reported that
‫” "سبق یاد کرنے میں مشکل ہوتی ہے‬. Trainee counselor probed him about what did he meant by
“mushkil”. Client answered that he "‫"یاد نہیں ہوتا‬. Client reported that in all subjects he faced
difficulty, else Maths. client reported that he had no any problem in other domains of life.
Moreover, in clinical inter trainee counselor asked client about the questions of personal , family
and educational histories. During interview trainee used the techniques of summarizing and
paraphrasing techniques. Which was helpful in building rapport and it also increased client
interest level. Trainee also used active listening which was also very helpful in building
therapeutic relationship. Client was showing cooperative behavior during interview which
showed his willingness. Hence, clinical interview was very helpful , it helped the trainee to make
a clear picture of clients problems.

Clinical Interview with Teacher. A Detailed clinical interview was conducted with
clinical psychologist. The duration of the interview was 20 minutes in which trainee school
psychologist asked to inform about the presenting complaints of the client. Then trainee cleared
the ambiguity in the given presenting complaints by asking the psychologist to operationally
defined and used probing in the interview. The teacher used the verbatim “parhai me accha nai
ha” trainee counselor asked him to explain that what did mean by “accha” explain the definition
of acha nai. All the presenting complaints were probed in the clinical interview. The clinical
interview was well conducted with teacher it cleared the ambiguities of trainee counselor
regarding the presenting complaints. Teacher was showing cooperative behavior during clinical
interview. Teachers attitude towards trainee school counselor was concerned and she was
showing her willingness during interview.

Clinical interview with clients Elder sister. Client elder sister was also studying in the
same school. Trainee conducted an interview with her. The purpose of the in interview was to
cross check the information as provided by client and wanted to clear and fill the gaps of
histories. It was almost 20 minute interview in which trainee introduced her-self. And then told
her the purpose of conducted this interview. Client’s sister gave the information to the client that
was asking from her. She reported clients routine in detailed, his schedule as well. She was
showing cooperative behavior towards trainee.

Subjective Rating of the Problem

Any rating that a person gives that is based on their subjective reaction or opinion, their
feelings, desires, priorities, etc. While the rating is subjective, it is often measured on a Likert
scale, which allows for a quantitative measure that, when combined with ratings from multiple
people in the target audience, can provide an objective estimate of usability (Hongisto, Oliva &
Rekola, 2015).

The client was asked to rate his symptoms on a 10 point scale where 0 meant no symptoms, 5
meant average and 10 meant maximum severity of symptoms. The subjective rating was taken
from client as well as psychologist. It will be helpful for psychologist to check the differences in
pre rating assessment.

Table 4

Presenting Complaints and Subjective Rating by Client

Subjective Rating(0-10) Presenting Complaints

7 ‫سبق یاد کرنے میں مشکل ہوتی ہے‬

Note. 1= minimum, 5= average, 10= maximum

Table 5

Perceived Severity and Presenting Complaints Reported by teacher

Perceived Severity Presenting Complaints

7 ‫پڑھائ میں اچھا نہیں۔‬

7 ‫اپنی جگہ سے کھڑا نہں ہوتا اور صرف اپنے دوستوں‬

‫سے بات کرتا ہے۔‬

6 ‫گم صم رہتا ہے‬

Note. 1= minimum, 5= average, 10= maximum

A 0 on the rating scale indicated that there was no problem, a 5 indicated the normal or

average level of the problem and a 10-point indicated that there was a severe problem. The client

rated his difficulty in learning problem at 7. As well as the subjective rating was also conducted

by the client’s teacher. The subjective ratings of these problems will help in managing these

problems and help to rate the problems after the implementation

Curriculum Based Assessment (CBA)

Educational assessment or educational evaluation is the systematic process of

documenting and using empirical data on knowledge, skill, attitudes, and beliefs to refine
programs and improve student learning (Ostrander & Herman, 2015). The aim of the academic
assessment was to check his client current performance in all subjects. The main purpose of
conducting curriculum based assessment was to check the clients current perform,ance in the
class and assessed client in reading and writing. There was a presenting complaints by client
difficulty in learning, teacher reported didn’t well in studies, therefore there was need of
curriculum based assessment.
Checking of Books &Copies. The child was asked to bring her bag with him so that
trainee school counselor checked the copies and books. Client used to bring the bag with him
during session. He placed the bag on floor, trainee checked the bag. In the bag the books and
copies were placed separately. The binding of copies and books were in their good state. Trainee
counselor checked the notebooks in which classwork and homework were checked. There were
also mistakes in homework and classwork. Client scored below average in all subjects excepts
math. In Math client scored above average.
Urdu and English Reading Assessment. An assessment that examines a student's
decoding skills looks at a child's reading accuracy. One example of this type of measure is to
have a student read a passage of text as clearly and correctly as possible (Meisinger et.al, 2010).
The aim of the English and Urdu reading assessment was to assess the fluency and
recognition of letters and words. For the English reading, trainee asked the client to open your
favorite chapter. The students selected the paragraph that he was also read in class. The child
read the paragraph of three lines in which he found difficulty to pronounce words i.e. forget,
meaning, next, fight, accept, program, seen etc. Due to which client fluency also effected.
Client was unable to read the words through segmentation. He was tried to read through rote
method. In paragraph there were 20 words from which 10 words were correct but 10 words were
incorrect. Through English reading it cleared that client known the sounds of words he had
recognition but he didn’t used segmentation method to read the words .During assessment of
English client was a little bit confused. But client praised him during reading it also motivated
and reinforced the client.
The purpose of Urdu reading assessment was to assess the client fluency and recognition
of Urdu. The client was asked to select his favorite chapter and paragraph which he was also read
in class. During Urdu reading client facial expression was confused, but he was showing
motivation during reading the paragraph. . He seemed motivated to read the Urdu paragraph. The
Urdu paragraph consisted of 3 lines in which she made only two mistakes. As client find
difficulty in reading the Urdu words but he tried to read the words through segmentation. He had
the recognition of letter and sounds. In paragraph there were 22 words from which 12 words
were correct but 10 words were incorrect. Client had no fluency during Urdu reading; he used to
read the words through segmentation. From assessment it revealed that client had recognition of
letters and sounds, but client had lack of ability in segmented the letters, blending them with each
other etc.
Table 5
Clients Score on Reading Assesment of Urdu and English

Subject Total Words Incorrect Words Correct Words

English 20 10 10
Urdu 22 10 12

Urdu and English Writing Assessment. Writing assessment can also refer to
the activities and practices used to evaluate student writing and learning (Hout et al., 2012).
Written assessment of Urdu and English was done with the client to assess his
performance in Urdu and English writing. Client was written with the right hand. He was asked
to write a paragraph from her favorite chapter of Urdu and English. In Urdu she selected a
paragraph of 3 lines, he started writing the paragraph in Urdu. He used to see the words again
and again while writing. He was seem anxious while writing. Client was paying appropriate
excessive pressure on pencil while writing. He used to write most of the words below the line.
Dictation. Dictation is a technique where the learners receive some spoken input, hold
this in their memory for a short time, and then write what they heard( Nation, 1999). The purpose
of the dictation was to assess the child ability to recall the correct spelling of the words as well
she had the recognition of letters or not. The words of the dictation were taken from child
favorite chapter, from that paragraph which she read.
Moreover, trainee school counselor used to dictate the words and the client wrote them.
Where he didn’t understand what trainee speak he asked again to repeat the word. In urdu
dictation, Trainee school counselor dictate 10 words from which 5were wrong and 5 were
correct. Client was confusing while writing dictation. As he found difficulty in blending some
words.
Overall, it seemed that client had recognition of letters but he found difficulty in blending
words.
Table 6

Correct words Respond by client Errors

‫رہنمائ‬ ‫ہنائ‬ Omission
‫زریعہ‬ ‫زریا‬ Addition
‫زائع‬ ‫زایا‬ Addition
‫میل جول‬ ‫مل جل‬ Omission
‫جیب‬ ‫جاب‬ Addition
‫دل دادہ‬ ‫دل دادا‬ Addition

In English Dictation assessment trainee dictate 8 words from client’s favorite chapters. It
was from the paragraph that client read also. Client facial expression was calmed while English
dictation. The client was able to write 4 words correctly and the 4 words were wrong in which
su omission errors were find out. Through English dictation , it seemed that client had the
phoneme awareness as she had the recognition of letters as well as sound. Client was finding
difficulty in blending the the words properly
Table 6
Responses of Client on English Dictation

Words Responses of client Errors

About abot Omission
Next Net Omission
Forever Fover Omission
Seen sen Omission

.
Cognitive Assessment Battery (CAB)
The cognitive assessment battery (CAB) is based on different tests to identify the
learning abilities and disabilities of a child of 7 years and older. This test was administered to the
child to identify the learning difficulties of child as well as a neuropsychological tool to
understand the child’s current cognitive status, strengths, and weaknesses. The cognitive
assessment battery also identifies the brain function of the child (Naeem & Mehmood, 2011). In
this battery, different tests were mentioned that had different functions and all were based on the
child learning in different domains.

Digit Span.It is the measure of memory span which is the number of items, usually
words or numbers that a person retain or recall. It was an attention test to assess how many
numbers a person was able to retain. There was a forward and backward counting assessment.
Forward measures immediate memory and backword measures working memory
( Nugent,2013). It was also used to assess the client’s attention and concentration. The aim of
using this test was to assess the child’s attention, learning, and concentration problem which
become hindrances in remembering and encoding the lesson.

To perform this test all instructions were given to client. This test takes 10 to 15 minutes
to conduct.

Quantitative interpretation

Table 7

Clients Score on Digit Span Test

Forward digit score Backward digit score Total Score

6 4 10

Qualitative interpretation

First of all, clear instructions were given to the client so that he would understand how to
respond to the test. The school psychologist was psych educated the client that she will speak
some sequences of digits and the client had to repeat the sequence. There were two trials of the
test i.e. the forward sequence of digits and then the backward sequence of digits. The client
seemed to be excited as he liked the digits he responds well in the test. The outcome of this
assessment was that the client had the appropriate attention span and concentration. However,
the extraneous variables played their role in the learning of clients i.e. home environment
classroom environment and teacher learning strategies, etc.

In forward digit span the client didn’t faced difficulty to understand the instructions. By
giving example client responded on first item and understand it very well. When trainee asked
started the test and asked him forward digits score client took 2 to 3 second and recalls it. Client
was showing interest during the test. But by time when number of digits increases client took
more time 5 to 7 seconds to recall it. Client respond well in first 6 digit items but in seven digit
items client change the sequence and didn’t recall it in both trial. It showed that client had
average attention and concentration.

In backward digit span client didn’t understand the instruction easily. Then trainee school
counselor repeats it with more example and did a trial with client. After instructions and
understanding trainee started to ask the backward digits. Client find difficulty to recall it, he took
10 seconds in first two trial. In the third backward digit number client took 15 seconds to recall
it. When difficulty level increases in fourth backward digit number client took 20 seconds to
recall the both trials but client recall them wrong. During backward number of digits client
interest level was decreases.

Paired Associate Learning Test (PALT)

The paired associate method requires client to learn pair of items by forming an
association between them. It can be used to measure the verbal learning and verbal retention.
Paired associate learning test was a classic memory paradigm that was used to understand how
people encode and retrieve newly formed associations among stimuli. It was used to assess
verbal learning and verbal retention. It was also used to assess the child ability to associate
things to each other( Arndt, 2012). The rationale behind using this tool was to check is client
able to associate things it will be helpful for learning the new study skills.

Table 7
Clients Score on Paired Associate Learning Test

Category Trial 1 Trial 2 Trial 3

Easy 5 6 6
Difficult 4 6 8

Qualitative Interpretation

The paired associate learning test was administered to check the child’s learning through
association. He was maintaining eye contact all the time and his facial expression was full of
excitement. He was smiling all the time and he was sitting very comfortably on the chair. He
showed very voluntary behavior with trainee clinical psychologist. He was listening to all the
verbal instructions given by the trainee clinical psychologist very carefully. When the trainee
clinical psychologist started administering the test, the child was very excited and showed
willingness. In the test, the child was interested in both easy and difficult words. And when
trainee clinical psychologist repeating the words he was really enjoying the association between
words. He was answering all questions very confidently. Though child was finding a bit
difficulty in difficult words but gradually did very well after first trial and so on. Behavioral
observation of child was very helpful in qualitative analysis.

The child’s performance on the test reflected that he was trying his best to remember the
words. His performance in the test showed that he was very good in easy words but a bit weak in
difficult words. As her vocabulary was a bit weak thus he was finding difficulty in remembering
the association of difficult words but only in the first trial. As the teacher complained that he
didn’t learn his lessons sometimes. But as he performed better and better in successive trials, it
can be expected that in future it will be helpful in his academic learning and the teacher could get
insight from it that the child can perform better by learning tasks with successive trials and
forming association between them.

Summary of Assessment Results

 Through behavioral observation it seemed that client had lack of socialization skills as
well as lack of interest in studies. Through detailed assessment it seemed that client had average
concentration and attention but clients had the ability to associate the things.

Case formulation

M.A was 9 years old boy, he has been referred by his teacher for the assessment and
management of the presenting problems i.e. didn’t well in studies, didn’t stand from his seat and
only talk to his friends, and stay in his own world, difficulty in learning the lessons, didn’t
remember science long questions, didn’t remember islamiyat long questions. According to
available information, conceptualize the case and identified the four factors which contributed in
client current condition. Through identifying protective and risk factors psychologist could make
the prognosis either its favorable or unfavorable.

Clinical interview revealed that predisposing factor of client which makes him vulnerable
towards current situation client birth order as he was last child, difficult temperament.

The predisposing factor birth order make the client vulnerable towards current condition.
As the client was last born, he was pampered child so it could be a predictor of lack of school
performance as well as interest. As research also supported that they find that birth order affects
perceived academic performance for 8- to 14-year-olds. The effects of birth order persisted for
second children even when the sample was restricted to "intact" families in which children's
performance had not been affected by divorce or other family disruptions. (Jaun Pantano, 2014).

Another predisposing factor was temperament, as it was observed that client had difficult
temperament he didn’t like to communicate with everyone. As client teacher reported that he
didn’t used to communicate with everyone. As difficult temperament could be a predictor of
behavioral issues in later life. This study aimed to systematize the diverse and rather
controversial findings of empirical research on the relationship between the temperament and
academic achievement of school children, as well as to determine the average effect size between
these variables. ( Tomas ,2021)
 The precipitating factors that triggers the client problem are pampering from family, poor
conductive environment for learning at home and lack of motivation and excessive use of mobile
phone as well as lack of parental involvement.

One of the precipitating factor over protective behavior of client’s family. As client
belong to joint family. Client reported that his grandparents and parents used to love them a lot.
Researches also showed that parenting styles also effect on individual performance. Attachment
theory (Fisher, 1974) believes that a good parent-child relationship plays a fundamental role in
individual adaptation and development; conversely, a poor parent-child relationship may expose
it to more risks. Studies have shown that a good parent-child relationship is an essential factor in
promoting children’s healthy development, and parents are protective factors for children to
alleviate behavioral adaptation problems (Xie, 2020; Wang et al., 2018).

Furthermore the precipitating factors were lack of supervision from parents and excessive
mobile use. Parental involvement and genuine interest in an adolescent’s school life have a
significant influence on their academic performance and ability to focus and efficiently manage
homework (Brown & Iyengar, 2008). Parents should facilitate and encourage independent
problem-solving, choices, and self-determination in their adolescents if parents want them to be
independent and motivated in school. Wong (2008) analyzed the effects of parental involvement
and autonomy support in relation to the academic performance of adolescents. Proven through
multi-group analysis, statistics, and results from the participating adolescents, parental
involvement had a positive relationship with an adolescent’s successful academic performance.
Parents who actively participate and are interested in their child’s life will result in them having
greater academic performance in school (Jaiswal, 2018).Another precipitating factor was the
poor conductive environment for learning at home triggered the low academic performance.
Children educational activities at home are based on the physical environment of their home.
Home facilities of children enable and restrain them in practicing educational activities at home.
Class preparation and practice at home are fundamental for child, as a child spends only five and
six hours at school and the remaining time is spent at home which needs to be utilized properly
(Roemmich, Epstein, Raja, Yin, Robinson, & Winiewicz, 2006). There is evidence that a
supportive home environment enhances child’s confidence in his/herself, and enable them to be
sociable. This confidence helps students in developing their adjustment capabilities in different
environments which positively influences students’ educational performances. Students living in
non-supportive home environment struggle in every walk of life including educational life
(Parveen, 2012).

Further information revealed that perpetuating factors (maintaining factor) are the
inappropriate teaching strategies, lack of interest, lack of motivation.

Through assessment it revealed that client had lack of interest. Through observation it
revealed and researches also supported. The results of the research showed that academic interest
was proved to determine significantly the academic performance. However, the learning attitude
and learning quality did not contribute to the student’s academic performance. High academic
interest students possessed a bigger chance to have better academic performance. Meanwhile,
learning attitude and learning quality indicated otherwise, decrease the students’ academic
performance. Another perpetuating factor of the client was ineffective teaching strategies while
teaching the students. According to research, when students have more interest in what they are
being taught, it makes them want to learn more, and in return, obtain higher grades. Teaching
and learning are interrelated terms. The very effective and useful method in order to calculate
good teaching is the quantity of knowledge that the student has gained throughout the process.
Researches demonstrate that poor teaching strategy caused low academic performance as low
academic performance caused by ineffective teaching strategies (Barrech, 2022).

The protective factor that was observed while formulating the case of the child was
compliant behavior of the child that will help the child for maintaining good relationships with
the teacher to improve academic performance. As the findings of the study showed that
obedience to the rules at school improves your relationships with your teachers and demonstrates
that you care about your education. Showing you respect for the academic rules of the campus
like "no cheating" helps build trust with your teachers.
 Summary of Case Formulation
Presenting complaints

 Didn’t use to stand from his place and only

talk to his friends
 Didn’t well in studies
 Stay in his on world
 Difficulty in learning lessons

Assessment

 Behavioral Observation
 Clinical Interview
 Subjective Rating of the problem
 Cognitive Assessment Battery
 Curriculum Based Assessment (CBA)

Case formulation

Precipitating
Perpetuating
Factors
Factors
Predisposing Pampering from
Factors Inappropriate teaching Protective
family
strategies Factors
Birth order Quit tuition
Lack of interest Compliant behavior
Difficult
Use of excessive of client
Suspected problem

The detailed history and assessment of clients presenting problems didn’t well in studies,
didn’t use to communicate with his other fellows, stay in his own world, find difficulty in
learning . Through assessment and observation it revealed that client had lack of parental
involvement, lack of motivation, extra pampering which caused lack of interest in client.

Intervention Plan

On the basis of assessment results, these are the goals for the management of client’s
problem.

 Rapport Building in order to make the child at ease so that problem of the client would be

effectively formulated and managed.

 Psycho-education in order to increase client awareness the client about his problem.

 Psycho-education in order to increase insight about advantages and disadavantages of

using excessive mobile phone.

 Teacher’s counseling in order to psycho- educate him about current problems and the

contributed factors so that she would manage it effectively.

 Hygiene Management in order to increase client compliance to brush his teeth.

 Vertical decent and Storytelling in order to increase client interest in studies.

  Phoneme, and Segmentation awareness in order to manage reading and writing mistakes.

 Study skill training in order to teach the client to improve his study skills

 Social skills training in order to improve client social skills

Implementation of Therapeutic Strategies

Rapport Building

Rapport building is the most important step in the process of treatment plan. It refers to
the relationship between client and therapist. The better the relationship, the better are the
chances of therapy process being successful, in order to make the client follow the treatment plan
successfully, the therapist gain the trust of the client and provide them with unconditional
support (Fritscher, 2019).

The purpose of rapport building was to build a sense of connection with client, client feel
free to share his information. Rapport building plays a very crucial role in client- counselor
relationship. It made the session effective or productive. Trainee psychologist started the session
with greeting. Trainee makes sure about her self-management i.e. Session diary, proper setting
and provides the client conducting environment. Trainee used basic communication skills hold
her head up and maintained a good posture. For rapport building trainee school counselor used
active listening and calling clients name .

Effective Communication. Effective communication is a connection between people

that allows for the exchange of thoughts, feelings, and ideas, and leads to mutual
understanding( Watson., 2019). The trainee school counselor used the technique in order to build
a strong rapport building. The client became very satisfied with the effective communication of
the trainee school counselor.

Active Listening. Active listening is a pattern of listening that keeps you engaged with
the therapist. It is the process of listening attentively while someone else speaks, paraphrasing
and reflecting back what the client said, and withholding judgment and advice (Ahmad et
al.,2012). During session, trainee school counselor gave the client full attentiveness. Trainee
school counselor was non-judgmental. She used to listen the client attentively, which was very
helpful in building rapport. During session trainee paraphrased the client statement by calling his
name. It developed a sense of individuality and importance in client.
Calling clients name. In rapport building clients name play an effective role. When
trainee school counselor call client by his name, he used to listen the trainee very carefully. It
was very effective strategy to deal with client by calling his name. It develops a sense of
belongingness and trustworthy relationship.
Activities. For the purpose of rapport building these techniques were used
 Talking about games
 Coloring in drawing
 Maths activities
In initial session trainee school counselor used to done some interesting activities with
client so that it developed client interest in the session. After identifying reinforce, trainee used
to talk about games in the session which developed client interest in the session. Client also used
to color in the games drawings which he really liked and enjoyed to color in it. It was observed
in the session during coloring in the drawing of game client had a big smile on his face. Client
had also interest in math activities. Trainee used to give him some math activities which he really
liked. These activities helped in building rapport as well increasing client interest to take session.
(appendix)

Psycho-education

Psycho-education provides information to help people deal with a mental health

condition, such as how to manage symptoms and medication side-effects, and how to prevent
relapse. It also provides information on the recovery process, such as how to maintain a sense of
well-being and how to develop skills to manage stress and solve problems. (Baker, S. & Martens
2010).

Psycho-education

Psycho-education provides information to help people deal with a mental health

condition, such as how to manage symptoms and medication side-effects, and how to prevent
relapse. It also provides information on the recovery process, such as how to maintain a sense of
well-being and how to develop skills to manage stress and solve problems. (Baker, S. & Martens
2010).

Case conceptualization. Case conceptualizing help the therapist as well as client, to

understand the origin, current status and maintenance of the problem. Trainee school counselor
will used case conceptualization to develop insight in client how the factors involved in
maintaining his problems. How negatively they effect on client problem. It was done with the
client. It increased the client awareness how his excessive using of mobile phone effect on his
study. That’s why his interest level also decreased. Trainee counselor discussed with him the
maintaining factors that maintained his condition. According to client, it developed insight in
him when trainee told him the factor which maintained his condition. ( appendix)

Cost and benefit analysis. a cost-benefit analysis is a Cognitive Behavioural Therapy

(CBT) technique used by CBT therapists to help clients examine and manage thinking and
emotions in a natural process of problem-solving. We all reflect on the pros and cons of our
options when doing something new, e.g. going to a first date (or back for the second), accepting
a job offer, renting or buying, smoking, losing weight, going to a social event, moving to
London, finding a CBT therapist. The cost-benefit analysis helps CBT therapists identify
sticking points( James, 2018). The main rationale of using this technique with the client was to
increased client awareness by doing cost and benefit analysis. As client elder sister reported and
client reported by self that he used to play games and watching cartoon on mobile phone. In cost
and benefit analysis, trainee asked the client to think the advantages and disadvantages of using
excessive mobile phone and she will write on the worksheet. Then we will analyze which had
high percentage. Client reported only 2 to 3 advantages of using excessive mobile phone; there
were 7 disadvantages of using excessive mobile phone. It was ask by client who had high
weightage, client answered that disadvantages had high weightage. Client was psych educated
through cost and benefit analysis. It also developed insight in client about the excessive use of
mobile.

Psycho-Educate the Teacher. The trainee school counselor psycho educate the teacher
about client problems. Trainee counselor verbally psycho-educate her about the clients problem.
Trainee told the teacher about through reinforcing client desire behavior in class. it will be also
helpful for her. Teachers attitude towards client was very strict. Trrainee told her that strictness is
not the solution of the problem. Furthermore , there will be workshop conducting in the school
about effective teachning strategies. It will be more helpful for the teachers to deal with such
students.

Hygiene management

Good hygiene is critical for preventing the spread of infectious diseases and helping
children lead long, healthy lives. It also prevents them from missing school, resulting in better
learning outcomes ( Edward ,2014). The main rationale of using hygiene management
was to increase client awareness of about the importance of hygiene. Client didn’t use to teeth
his brush that’s why trainee worked with him on hygiene management.to able client to teeth his
brush on daily basis. For this purpose following techniques were used.

Cost and benefit analysis. a cost-benefit analysis is a Cognitive Behavioural Therapy

(CBT) technique used by CBT therapists to help clients examine and manage thinking and
emotions in a natural process of problem-solving. We all reflect on the pros and cons of our
options when doing something new, e.g. going to a first date (or back for the second), accepting
a job offer, renting or buying, smoking, losing weight, going to a social event, moving to
London, finding a CBT therapist. The cost-benefit analysis helps CBT therapists identify
sticking points( James, 2018). The main rationale of choosing cost and benefit analysis was to
develop insigh in client . what are the adsavantges and disadvanatges of not brushing the teeth. It
was done with client in which trainee asked him to told her the advanatges and disadvantges of
not brushing the teeth, she wil wrote on the worksheet. Then we will analyse through weiutage.
Client reported 5 to 6 disadvantges of not brushing the teeth. There was no adavantges reported
by client. After doing this worksheet client reported that it developed his insight, there was 100
percent disadvantges of not brushing the teeth. I will try my best to change this habit.

Pictorial Representation. There was a worksheet used in the session in which teeth
were made there was a lot of yellowish spots on the teeth. That was made by tyrainee. Trainee
used the toothbrush in which she attached the razor as a paste. Trainee asked the client in the
worksheet what did he see? He answered that there was teeth , but they are dirty. There was a lot
of yellowish spots which made them dirty. Then trainee asked him to take the brush and clean
them. Trainee did the activity with motivation and he used the verbatim “ me saaf kru ga inko
achy se”. client clean the teeth very well. trainee asked him , now what he see in the picture.
Client answered that now the teeth are neat and clean as well as looking beautiful. It was very
helpful activity in increasing client awareness and compliance towards brushing the teeth on
daily basis.( Appendix)

Brush Chart and Reinforcement. The action of strengthening or encouraging

something, the state of being reinforced ( Merriam, 2019). A chart of brushing was given to the
client. And asked her to mark the tick, when he brush his teeth. Chart was made according to 2
weeks. Trainee counselor used to reinforce the client behavior by pasting stars when client used
to brush. When client didn’t brush the teeth , trainee didn’t paste star on his brush chart. It was
very helpful for the trainee to change the client habit. In the chart there was 5 times when client
didn’t brush his teeth out of 2 weeks. (appendix)

Increase client interest in studies

Client reported that he had no interest in study as he feeling boring while studying. For
this purpose following technioques will be used

Vertical Decent. The Vertical Arrow / Downward Arrow / Vertical Descent technique
allows the therapist to access the beliefs underlying current thoughts or concerns. The veracity
and helpfulness of these underlying or core beliefs can then be explored and addressed (Leahy,
2003). Vertical decent will be used to find out the client core thought regarding his statement. It
will be done with the client in the next session.

Storytelling. Storytelling is the process of weaving language into a concrete narrative,

with the purpose of creating rich, believable experiences. to do this, storytellers tie together
character and plot, resulting in stories that act as metaphors for the human experience ( annes,
2014). The trainee will use storytelling technique in which he used the story of a person who
build his career through hard work and study. It will be encouraging for client.

Phoneme Awareness

Phonemic awareness is a subtype of phonological awareness in which listeners can hear,

identify, and manipulate phonemes, the smallest mental units of sound that help distinguish

meaning units (Suggate, 2016). It will be used with client to improve client reading and writing

skills. Client found difficulty in segmentation. It will be helpful for him. As well as blending will

also be used to blend 3 2 to 3 letters.

 Isolation

 Blending

 Segmentation

Study Skill Training

Students study skills refer to the strategies they use to learn. This includes everything

from memory techniques to better studying or test-taking strategies, such as the use of questions

before, during, or after instruction, which has been demonstrated to promote learning (Huffman

& Huffman, 2012). The following approaches will be employed with children to help them

improve their reading skills. The aim of using this skill will to improve the reading skills of the

client.
 Takes Note. Taking notes is a vital approach to academic achievement in any topic, but it

is especially crucial while learning to read and write English (Elliot et al., 2010).

Read Daily. The goal of a trainee school counselor will increase client’s reading

abilities. She gave the client some advice in this regard, such as spending at least 15 minutes a

day reading something from different books daily. Furthermore, the client will informed that

regular reading will increase not just his ability to read, but also his ability to write in English

and Urdu.

Limitations

 There was no distraction free session room for trainees; it distracted client as well as
psychologist.
 Trainee school counselor couldn’t conduct interview with parents due to their non-
availability.

Suggestions

 There should be distraction free rooms for sessions.

 There should be interview with parents to filled the history gaps.
 References

Barrech, S. (2022). The Impact of Instructional Teaching Methods and Resources on Student’s

Performance in Girls’ Secondary Schools, Chiltan Town, Quetta. PAKISTAN LANGUAGES and

HUMANITIES REVIEW, 6(II). https://doi.org/10.47205/plhr.2022(6-ii)64

Jaiswal, S. K. (2018). Influence of Parent’s Education on Parental Academic Involvement.

Journal of Advances and Scholarly Researches in Allied Education, 15(5), 114–119.

https://doi.org/10.29070/15/57555

parveen, D. (2012). Relationship Between Intelligence and Academic Achievement of Secondary

Level Students. Global Journal for Research Analysis, 3(3), 35–36.

https://doi.org/10.15373/22778160/mar2014/13

Pawlowska, D. K., Westerman, J. W., Bergman, S. M., & Huelsman, T. J. (2014). Student

personality, classroom environment, and student outcomes: A person–environment fit

analysis. Learning and Individual Differences, 36, 180–193.

https://doi.org/10.1016/j.lindif.2014.10.005

Sucgang, M. C., & Fabella, F. E. (2018). Relationship between the Academic Performance and

Birth Order of Grade 10 Students from Nuestra Seeora De Aranzazu Parochial School,
 Academic Year 2017-2018. SSRN Electronic Journal.

https://doi.org/10.2139/ssrn.3176933

Session Report

Session 1 19th Oct,2022

The initial session was about to introduced the school psychologist, ensuring
confidentiality, and telling the purpose of counseling sessions. It was a first session, trainee used
to introduced herself. Ask about client likes, dislikes. Trainee also used probed personal history
of client. As it was a very interactive session. At the end of the session trainee asked for the
feedback.

Session 2 3 Nov,2022

The session agenda was to check books and copies of client. For this purpose trainee
asked the client come with bag. Trainee checked books and notebooks in detailed. Furthermore
trainee work on apport building. Ask client about his family as well as educational history.

Session 3 8th Nov,2022

The agenda of this session was to administer two formal assessment digit span and paired
associate learning test. It wa only 25 minute session in whuich trainee used to done the test very
well. Trainee done the activity of cost and benefit of using excessive mobile phone.

Session 4 10th Nov,2022

 In which further histories were probed with the client. Trainee used to done some math
activities with client. Home work was also checked. It was almost 15 minutes session. Trainee
gave the brush chart to client. It was for 2 weeks.

Session 5 15 Nov,2022

In the fifth session trainee checked the chart of brushing teeth add the reinforce in the
chart. She did the activity on cost and benefit analysis for not brushing the teeth. In this session,
trainee asked the client to fill the remaining chart and also reinforce him . it was just 20 minutes
session. In the end trainee asked for feedback.

Session 6 24 Nov,2022

In this session trainee asked the client what he taught and what we did in the previous
session. Client also come with his brush chart. He mentioned he tick the days very honestly in
which he brush the teeth. It was jusrt 10 minute session.