Counselling Report 1

Case no: 1

(Inferiority complex and behavioural problem)

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Bio data:

Name XYZ

Age 19 year

Sex Male

Religion Islam

Address Pakpattan

Birth order 2nd

Siblings 2(brother)

Education Matric

Marital status single

Mother K.B

Mother living /dead living

Father M.B

Father living/dead living

Father occupation landlord

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Source of reference:

The client is self-referred for assessment and counselling

Reason for Consulting Psychological Assistance:

Behavioural problems create some other emotional and behavioural disturbances. He was

physically disabled. He was very depressed due to other people's comments and also

dominant inferiority complex due to his parents’ behaviour and feeling of frustration he

wants to overcome these feelings.

Presenting complaint:

(According to the client)

The client has some problems such as has lack of interest in his life. He has conflicted

relationships in his family. He feels lonely. He feels disturbed; he has also some physical

problems due to this illness that nobody likes. And he says this illness always makes hurdles

in his life but now he is very upset.

Personal history:

The client’s family told that the birth of the client was not normal and not achieved all his

developmental milestones at the appropriate age. He was not a responsible and hardworking

person. Due to his disabilities, he was not playing like other children .but he had no good

relationship with his friends and other society members because he did not want to attend

social gatherings and other family parties.

The client also found the difficulties to interact with people. He felt that he could not adjust to

people and could not bear other people’s comments. And this problem create many hurdles in
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his life and now he was much frustrated. In this place, he did not mix with people and did not

develop rapport with his age fellows.

He also told me that he loves his family members and other close friends but they did not

love me. Now the separation from family and cut off behaviour with other persons creates

many problems and these problems also affect his study. His interpersonal relations were

affected.

Family history:

His father is fifty years old and his mother is forty years old. He has two brothers .his elder

brother studies at a university and he is alone with his parents. His family belong to the

middle class .and he was not feeling comfortable even with his parents. Father clashes with

his child and mother, only his mother supports him.

Personal Medical History:

He has no medical history of illness.

Relevant Family Psychiatric and Medical History:

A client reported that his family did not have any type of psychiatric or medical history of

this problem.

Educational History:

He was not a brilliant student, but he was much interested in his studies. His physical

problem always make hurdles in his study. Over his entire academic career, his performance

was not satisfactory. He was a very hard-working student but no one provide guidelines for

him in his educational life.

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Psychosexual History:

He had a natural point of view.

Pre-morbid Personality:

He was living a happy life. He was a cheerful boy who had an attractive nature, a good sense

of humour, but everybody treats him as a special child but he was a normal child who only

need the attention and care of others .due to this perception about himself he was suffered

inferiority complex and felt loneliness.

Behaviour observation:

The Client’s behaviour during the session was not exposed and comfortable .he has not had

proper eye contact but he was very helpful during the session and sit with manners. the way

of taking is to confuse. His appearance was good. Well combed hair and well-dressed Looked

very sensitive. And sometimes he was weeping during the interview due to his father’s

behaviour. He was depressed and felt many anxious feelings.

Psychological Assessment:

In the current case psychological Assessment of the client included:

 Interview

 Mental status examination

 Slosson Drawing Coordination Test (SDCT)

 Beck Depression Inventory (BDI)

 Beck anxiety inventory (BAI)

 Human Figure Drawing (HFD)

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 Rooter’s Incomplete Sentence Blank (RISB)

Interview:

The counsellor made the interview to have a clear picture of the client’s problems. He

reported his misbehaviour with peers, father and siblings. He also reported his breakdown of

friendship, which led him toward an inferiority complex. He told me nobody loves me and

everybody ignores me. He told me that I am very depressed due to this problem and that

problem also creates hurdles in my study. i want to solve all tensions so that I live happily

like other people.

Mental state examination:

Appearance and behaviour:

His appearance was not good he wearer rough clothes and uncombed hair. He seemed too

restless and not so much talkative

2. Posture and Movement:

His posture and movement were normal.

3. Eye contact and Rapport:

He kept no normal eye contact.

4. Voice and Talk:

His volume and rhythm of voice were low.

Mood Subjectivity and Objectivity

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The client's mood was depressed, Client showed irritable mood and much disturbance in

emotions.

6. Illusion, Hallucination and Delusions:

He had no delusions and auditory hallucinations.

7. Cognitive Orientation:

His time place orientation was normal.

8. Insight:

The client has some awareness of the problem.

Slosson Drawing Coordination Test (SDCT)

This test is developed by Slosson Richard. It is designed to identify individuals with various

forms of brain dysfunction where eye-hand coordination is involved. In this test, the raw

score is the total number of minus drawings. The accuracy score is a percentage score for

errors at a certain age it is obtained from the table in the manual. The cut-off score is 85%.

Age 19 years

Errors 24

Accuracy Score 33%

Cut off 85%

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Tests quantitate interpretation:

Qualitative interpretation:

The eye-hand coordination of the subject does not seem to be intact.

Beck Depression Inventory-II (BDI)

BDI was developed by Gregory k Brown, Aron T. Beck and Robert E. Steer. It is 21 items

self-report instrument for measuring the severity of depression in adults and adolescents aged

13 years and old. It requires 5 to 10 min to complete. Each item is scored by summing the

ratings of 21 items. Each item is rated on a 4 point scale ranging from 0 to 3. The maximum

score is 63.

Tests quantitate interpretation

Patient’s age 19 years

Total Score 28

Range 20-28

Category Moderate

Time Taken 20 minutes

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Qualitative interpretation:

The score of BDI reveals that the patient seems to be suffering from a moderate level of

depression.

Beck anxiety inventory (BAI)

This test was developed by Aron T. Beck and Robert E. Steer. It contains 21 items. It requires

5 to 10 min to complete. The total score is the sum of the ratings given by the examinee for

21 symptoms. Each symptom is rated on 4 point scale ranging from 0 to 3. The maximum

score is 63.

Tests quantitate interpretation:

Patient’s age 19 years

Total Score 29

Range 19-29

Category Moderate

Time Taken 15 minutes

Qualitative interpretation:
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The score of BAI reveals that the patient seems to be suffered from moderate level of

anxiety.

Rotter Incomplete Blank Sentence (RISB)

The rotter incomplete sentence blank is a semi structured projective psychological test

developed by Julian Rotter in 1950. It comes in three forms, for different age groups, and

comprises 40 incomplete sentences; usually only 1-2 words long such as “I regret ….”The

subject is asked to complete the sentence. As in other projective device it is assumed that the

subject reflects its own wishes, desires, fears and attitudes in the sentences he makes.

Tests quantitate interpretation:

Types of No. of Categories of No. of Responses Value Total

Responses Responses Responses in a Category

C 25 C3 8 6 48

C C2 9 5 45

C C1 8 4 32

N 8 N 8 3 24

P 7 P1 2 2 4

P P2 2 1 2

P P3 3 0 0

Cut off Scores = 135

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Total Scores = 161

Qualitative interpretation:

The result of RISB indicates that the client seems to be maladjusted as his score is greater

than the cut-off score.

Familial Attitudes

The client's attitude toward his family is conflicted showed these items: item no.4 ‘‘at

home….I am not happy ’’item no: 11… ‘‘a mother…. helpful’’ item no: 35 ‘‘my

father…….always beat me’’

Social and Sexual Attitudes

Client social relation was not god and he also show a conflicted attitude in these items: item

no: 3 ‘‘I want to know ……why people irritate me? ’Item no: 7 boys….bad’ ’Item no: 9

‘‘what annoys me….when people taunt me’’ item no: 10 ‘‘people….. Hurt me’’ item no: 29

‘‘what pains me……when people say me disable’’

General Attitudes

The client's general attitude is shown in the following items:

Item no: 2 ‘‘the happiest time…..childhood’’ item no: 12 ‘‘I feel……weakness’’

Human figure drawings (HFD)

Florence Good Enough in 1926 established human figure drawing. The test aims to measure

the intelligence of children by drawing. There is no time limit to the HFD test. HFD non-

verbal test of intelligence was intended for children aged 2 to 13 and required children to

draw a picture of a human. The (HFD) test defined the manual that the children draw ‘the

whole person at the request of the examiner in his/her presence. The paint is important for

HFD and should always be the product of an interpersonal situation. The HFD presents the

graphic form of communication between the child and the psychologist and such differs from
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spontaneous drawings children may make when they are alone with friends. The instruction

given to the child is significant and may influence the results obtained. Human figure

drawings have become one of the most widely used techniques of a psychologist working

with children but the purpose to which the drawing is put very greatly to main approaches to

the interpretation of (HFD)exist today. Used as a developmental test of mental maturity.

Qualitative interpretation:

The client's figure showed instability and poor coordination impulsivity. Also show extreme

insecurity, withdrawal and depression.

Case Formulation:

The information that was gathered from the interview and test results reveals that the client

has behavioural problems due to her cognitive biases and irrational beliefs. Test BDI

indicates the client's moderate level of depression and BAI also indicate a moderate level of

anxiety. His conflicted nature is the major problem to make any cooperation with his family.

His problems were based on misinterpretations and communication gaps with his family. He

was worried about his future relations with his family.

Prognosis:

The client’s prognosis is satisfactory because he wanted to resolve his problems and want to

bring a change in his life without any negotiation with his family.

Recommendations:

1. Client centre Therapy

2. Rational Emotive Behavioural Therapy

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3. Family Counselling

4. Social Skills Training

Session summary:

1st session:-

In the first session, I met with the client and introduced myself and asked his name. I started

to develop rapport with the client. I asked the client about his daily routine work in the 1 st

session. He was confused and gave response very slowly. Even not have eye contact and

move his eyes in other directions. His behaviour was very disturbed due to his problems.

2nd session:-

In the second session, I asked about his family members and his friends. His liking and

disliking e.g his favourite actor or actress and his favourite activity etc. The behaviour he

presented was helpful and a little bit open. I took whole bio data about his family history and

background. Now he seemed to be relaxed with me because he told me everything that way

he feels in a better way and develop some eye contact then I encouraged him to solve all

problems.

3rd session:

Today I asked him about his problems in detail and administered the psychological test (BDI)

he quickly gave the answers after encouragement now he confident to solve his problems. I

applied rational emotive behavioural therapy to modify the client irrational thoughts and

cognitive distortion. Then I used the coping self-statement technique.

4th session:
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In this session, I administered the other test (SDCT) and (BAI). He easily responded to it. In

this session, I applied the techniques of role play and I have played the role of the client's

father and then trained the client regarding social skills and boldness. After that, the client

said to me he was much more confident to solve his problems

5th session:

In the last session, I administered the other test RISB. The client responded with full attention

and asked me more about his problems and then I applied the forceful self-dialogue

technique. Throughout the sessions, I have fully tried to show empathy to the client. In the

end, the client was happy and interested to be freshening their mind so that he can solve his

problems.
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