Case Summary ??????

Biodata/Demographic data

Name: M.F

Age: 25

Gender: Male

Education: BS. Computer Sciences (Bahria University, Islamabad)

No. of Siblings: 2

Birth Order: 2nd

Marital Status: Single

Socio-economic Status: Upper Middle Class

Occupation: Work with a private International based company

Informant: The cClient Mr. M.F himself

Reason and Source of Referral

The reason behind the Client's referral was looking for a psychologist's help in order

to recover. And the main reason was the client's sister (S.Q), this is because her sister is very

much protective and caring about his brother's health and always supported her in every

difficult time that’s why she eagerly wants his brother to come to normal life as soon as

possible so that everything gets better. And the client also wanted to get better as he is sick of

his life and wants to have a normal life like others and wants to forget everything which is
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distressing or upsetting him.The client was referred to the trainee clinical psychologist for the

purpose of assessment, diagnosis and devising a management plan. The purpose behind was

to fulfill an academic degree requirement.

Presenting complaints

As the client (M.F) came to the hospital for practitioners help, at that time he was

having the following complaints (complaints are in his verbatim);

Following complaints were reported by the client:

"Me chahta tha kay me teek ho jao". (Duration)

"Meri wajah se meri behen KO kafi mislay hotay thay, WO shadi shuda ha or iski wajah se

WO apnay susral par dhyan nahi de pati thii WO har waqt meri wajah se pareshan rehti thii".

"Me ab is zindagi se tang tang agay tha".

"Mein har waqt bemar rehta thaa or bss tabyat bohat kharab rehti thii".

"Meri behen hi meri sab se Bari wajah ha yahan anay kii".

Background History

Background history consists of detailed family history, personal history, educational

history, sexual history, occupational history, social history, past medical history, and pre-

morbid history

Family History
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The Client Mr. M.F is 25 years old adult and iswas living with heris mother and sister.

Heris mother wais a 47 years old lady. She is a housewife. and she is the only parent who

takes care of his son. The client's mother iwas areported to be usually loving and caring

mother however, sometimes she gotets veryextremely strict because she haswas the single

parent and got disturbed due to the increased responsibilities to be fulfilled alone. to take

care of her children and the house without husband's help and cooperation, whereas t The

client's father was 52 years old mechanical engineer in USA. He was reported to be least

concerned about the upbringing of his children but he only sends asent a handsome amount

of money every month every monthwithout delay. The client's father is 52 years old man. He

is not in Pakistan, he is in the USA and working as a mechanical engineer in a private firm.

He visits Pakistan not often. According to the client last time when his father visited Pakistan

when he was in 10th grade. The client reported that he was very attached to his father but his

father did not visit Pakistan often. Due to his father’s least interest and less time for the

children, the client started developing aggressive and hatred feelings towards him. from the

time he started visiting Pakistan seldom, now he is having aggressive and hatred feelings

towards his father. Now coming towards herThe client had only a sister. so sShe wais

reported to be very nice, cooperative, understanding, and a loving sister. as reported by the

client. The client said thatAs per the client, his her sister always supported herim in every

situation and always stood besideands for him. She iswas married and a mother ofhas onea

daughter. The client is having shared a very lively and caring relationship with hiser niece.

General Home Atmosphere

Personal History
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At this time the client was in the withdrawal phase, which means that he was stable

enough to answer all those dark questions from the past and was mentally stable now. It

means that he was currently in a recovering phase of the treatment. The client claimed that he

started using cigarettes when he was in his second semester and for the first time when he got

breakup with his girlfriend. From that time he was addicted to that habit and whenever he is

having some troubling kind of situation with her girlfriend the intensity of smoking increases

from having five cigarettes to one full packet in one day. Then he started Cannabis back in

2018 when his girlfriend got married to someone else. From that day he started cannabis use

by his friend's recommendation. The client never had any counseling session regarding any

issue, nor have been engaged in any form of treatment or intervention other than the recent

one. According to the client, heThe client was born through normal delivery. His mother had

no emotional stress during his birth. He had no physical illness at the time of birth. He had

achieved his developmental milestones at an adequate age level. As per the client, According

to the client, he was a very naughty, caring, and helpful person. Along with his lively and

cooperative nature, he was also an introvert personality. He reported that As per the client

the golden period of my life. The client’s reported that before his illness whenever he had any

problem he never shared it with anyone and always kepteeps it to himself and triesd to deal

with it. Before the illness, the client had normal daily functioning and his attitudes towards

others were always friendly unless someone didoes something bad worse to him as reported

by the client.

Educational History

The Client started his schooling at the age of 4 years. He was overall an average

student and good in his studies. He participated in every extra-curricular activities in school.
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Client relationships with his peers were friendly and he was an obedient student with his

teachers. his relation with his teachers was cooperative. He passed matriculation with really

good average marks. aAfterwards that he got admission in Punjab Ccollege where he

completeddid his FSC. For further higher studies, he and after that, he got admission in

Bahria University, Islamabadin the University. The client was good in his studies and

havingshared a healthy a and friendly relationship with his classmates and teachers. The

Client’s parents had always been very motivating and supportiveed towards him. They , and

never forced him to opt for a particular degree or never imposed their own wishes onto him

of their wish.

Sexual History

The client reached puberty at the age of 13 years. His reaction was quite positive. He

had an emotional attachment to one of his class fellows. The relationship lasted for three

years when his girlfriend was married to her cousin. his lover. She was his class fellow and

had a relationship with her for 3 years. He wanted to marry her but the girl got married to her

cousin. Currently, the client reported that he had a strong feeling of guilt associated with his

past love affair,. hHe stated that it was his life's biggest mistake.

Occupational History

The Client M.F isis the client reported that currently he was working in a private

company in Islamabad, and nowadays he is working from home because of the Covid

situation. He stated that all his work is computer-based so all the time he is in front of his

computer. He had to work on computer. He statedfurther added that he iswas now satisfied

with his job but he along with his co-workers had suffered a lot and also his co-workers due
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to his drug addiction. He said reported that he usesd to skipremain absent from his job for

many days when he was on drugs and because of thatwhich resulted into weakening of his

position weakens in the office.

Premorbid Personality

Social History

Before he became an addict, he was an outgoing personality who preferred the time spent

with his friends. The client M.F doesn’t He reported that he did not socialize much when he

was on drugs but sinceas he iwas recovering from that phase, now he had started visiting

some of his close friends again. Those were the and those friends whom he knew are the

ones who will always motivated and encourage him to leave drugs. and all. At the time when

he was in university, he was having a lot of friends and always go to restaurants and trips

with them which indicates that he was a pretty socializing person. Premorbid Personality

Before the onset of his illness, the client was living a healthy life. He had a good

relationship with his family and friends. He like social gathering as well. He was active and

energetic and spent his leisure time with his sister and friends but sometimes Sometimes, he

became hyper and aggressive by losing his temperament. He also reported that he had a shy

personality and felt uncomfortable talking to strangers. On inquiring about about his hobby,

so he reported listening to music.

Medical history
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He isdid not havinge any medical history. As stated by tThe client reported that once

in his childhood he fell from a seesaw in his childhood and got stitches in his head. There is a

history of medical illness in his family.In addition, The client'shis mother iswas reported to

be a Sugar patient diabetic for almost 6 years.

Drug History

The client started taking cigarettes when he was 20 years old and started cannabis at

the age of 24 years. when he was at the end of 23 one and a half years back. At that time he

took After taking drugs the whole all dayday, he would feelfelt dizzy, feel and sleepy.

Moreover, he reported to consume more food than his usual routine, and either eate all the

time or sometimes doesn'tstopped eating for consecutive two days. Furthermore, he reported

that he got and disconnected from the family and worldly daily situationsactivities. This was

his first hospital admission which he got consulted and in touch with regarding hisfor the

treatment of his drug addiction.

Premorbid Personality

Before the onset of his illness, the client was living a healthy life. He had a good

relationship with his family and friends. He like social gathering as well. He was active and

energetic and spent his leisure time with his sister and friends but sometimes he used to be

hyper and aggressive in small talks. He was a caring & loving kind of person since childhood.

He was a shy person also and feel uncomfortable when talking to a stranger. He was very

helpful in nature. He make many friends when he entered university. When I asked the client

about his hobby so he stated that he likes listening to music.

History of Present Illness

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Psychological Assessment

The assessment has two ways:was carried out both formally and informally.

 Informal Assessment
 Formal Assessment

Informal Assessment

The informal assessment can bewas carried out through using behavioral observation,

and his overall mental status examination.

Behavioral Observation

In behavioral observation it Apparently, he was clearneat and clean. His cooperative

and polite nature was evident of his general attitude. and evident that the client's behavior

was very cooperative and polite. He was a tall, heightenedd person individual with a normal

weight. Heis was dressed was appropriately according to the place and weather conditions.

Apparently, his mood His was in looked stable mood and his talk was and the content of his

speech was relevant to the questions asked. His level of consciousnesse was alert. He was

very and attentive and also concentrates on the questions which the therapist asked to him

during the whole interview. HeThe client’s memory was intact and his general knowledge

was adequate with had no impairment in memory. His general knowledge was normal. He
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reported insight regarding his problem. and he wanted to get to normal life. He has nodid

not report any delusions, hallucinations and nor any obsessional thoughts.

The rapport was builtestablished so easily. and the therapist finds no difficulty in

establishing and maintaining it. Hise maintained the eye contact was appropriate. And lastly,

heand communicated very welladequately with the therapist. While asking the client about

his clinical interview he was compliant to answer all questions. A semi-structured clinical

interview was carried out with the Client. The Interview was conducted to identify the

Client's problem, history of present illness, background history, personal history,

occupational history, sexual history, family history, and educational history.

Formal Assessment

In the formal assessment, the following psychological tests were used:

 Drug Abuse Screening Test (DAST-10)

 Post-traumatic Stress Disorder (PCL-C)

 Beck's Depression Inventory (BDI)

 House Tree Person (HTP)

a) Drug Abuse Screening Test (DAST-10)

Quantitative assessment: The DAST-10 consists of total 10 questions .in which were

all answered by the client. The client got 7 "yes's" and 3 "no's" overall. It means that he

scored 7 out of 10. This means that he was having a substantial level of symptoms according

to DAST.
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Scores Range Severity Level

7 6-8 Substantial level/Intensive assessment

Qualitative assessment: On DAST the number of yes responses indicated over the

past 12 months that the client was using the drugs other than those required for medical

reasons,. He was useing more than one drug at a time, and abuse drugs

continouslycontinuously. due to which family complaints about the client’s involvement with

drugs. He never neglected his family.

b) Post-traumatic Stress Disorder (PCL-C)

PTSD has been used in order to check that whether still, the client iwas having all

those symptomsany symptoms related to trauma, which he was having by due to which he

started using cannabis drug. So this screening was basically to cross-check the client's current

feelings, mainly the after treatment feelings.

Quantitative Assessment. The PTSD checklist of the Civilian version consists of

total of 17 items, all the items were answered by the client Iin an appropriate manner. He got

a a score of 29 score out of 85. Thiswhich indicates that the client iwas having mild PTSD

symptoms., which can be sought out through relaxation techniques by the practitioner.

Scores Range Severity Level

29 28-29 Mild level

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Qualitative Assessment. The qualitative assessment or analysis showsed that the

client wais having little to mild symptoms of PTSD. This indicates that he iwas in his

withdrawal or recovery phase, which ultimately playeds a significant role in his mental health

and his mental stability. The responses showed that he iswas having a few experiences from

the past regarding in the form of his memories, thoughts, or images. He doesn’t act in a

stressful way if something happens suddenly nor he cut off himself from others. Also, he is

having less difficulty concentrating and having fewer angry outbursts, and not having any

sleep disturbances. The score also indicateds that he avoided thinking about or talking about a

stressful experience from the past, which unwantedly remindsed him about the stressful life

events.

c) Beck's Depression Inventory (BDI)

Quantitative Assessment. The Client got 20 scores after being analyzed through the

test “Beck Depression Inventory” abbreviated as BDI. Scoring of client falls in "Borderline

clinical depression" that is score laying between the range 17-20 of the test total score.

Scores Range Severity Level

20 17-20 Borderline clinical depression

Qualitative Assessment. The Client scored 20 ion BDI, which indicatesd that he is

having fell in the category of borderline clinical depression. The client M.F. is still having

some symptoms of borderline depression, which needs to be sought out in order to gain full

mental stability and so that he can fully recover and come to his normal life. Still, theThe
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symptoms awere less of drug abuse, which automatically indicatesd that he iwas in his

withdrawal phase and slowly and gradually caome back to life.

d) House Tree Person (HTP)

Qualitative Interpretation. The overall drawings depicts that, all of them are in the

center so it shows rigidity and some planning ability. High placement is the sign of unrealistic

striving, fantasizing, and frustration. While more emphasis on shading depicts anxiety, while

mild distortion also shows anxiety and poor adjustment power. Circles and triangles in the

drawings represent vaginal symbols. As we can depict that the mood was happy so self-

esteem was high. Cartoon figures show internalized hostility, while thin lines and light

drawing are the signs of aggression and anxiety. Drawing the house first depicts that the

client is concerned with a sense of belonging, nurturance, and bodily needs.

 House Interpretation

The relatively normal size of the house and details reflect the nurturing places, while

the details are excessive so it depicts obsessive-compulsive trends. Shapes like triangles and

circles and other objects shows vaginal symptoms. Small size of door shows indecision,

shyness, withdrawn inadequacy over even hostility. There are more emphasis on the

foundation of the house which depicts security feelings. Missing chimneys is a sign of

passivity, lack of psychological warmth in a person’s home life. Extra details are more which

shows overwhelming family life. Thin lines are a sign of anxiety and need for protection.

There are no pathways so it shows that the client is not social or shares feelings with others.

There is a fence around the house that depicts insecurity and suggests defensiveness.
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 Tree Interpretation:

Drawing tree is concerned with person’s sense of growth, vitality and development. It

also shows relationship with environment and family members. As the tree is like fantasy

type drawn so it shows unrealistic thoughts and distorted perception of the world. Lacking

details in the drawing is the sign of withdrawal the shape of tree is one dimensional so it is

shattering and disintegration experience of self. The crown of the tree is cloud like so it

depicts fantasy while its flat appearance depicts environmental pressure and denial. Instable

personality is there because there are no roots. While broad and long trunk is the sign of

dependency and regression. Also large and vertical emphases tells us about more ego strength

and poor reality concerns. In the drawing there is more emphases on the bark which

represents anxiety and depression.

 Person Interpretation:

The subject drawn younger figure which shows emotional fixation at that age. Full

face figure is the sign of social accessibility. Central drawing is the cause of security,

emotional and self-centeredness. Minimal shading is the sign of relative freedom from

anxiety. The facial features are little bit bizarre which is the sign of psychosis. There is more

emphases on clothes which shows excessive need for social approval and lack of depth. As in

the drawing it is clearly seen that the head is large which, the sign of regression and

grandiosity is. While it’s disproportionate structure is the sign of impulsivity. The hands are

drawn so it shows productivity. As the fingers of the hands are jointed so it is the sign of guilt

and aggressive feelings. The wrist is away from the body represents channelization towards

others. As the fingers are less than five is the sign of helplessness and dependency. And they
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are in shape of petals which shows immaturity. Expansion of arms depicts desire to be

prominent. While the openness of the arms are again the sign of aggression. Legs are also

drawn thin so it also represents sense of insecurity. While narrow stance is the sign of rigidity

and tension. The lower drawing of the person shows depression and feeling of inadequacy,

whereas it’s centered drawing shows emotional and self-centeredness. As the eyes are

distorted so it is the sign of distorted self-image. The eyes are small and with no pupil so it

shows introversion, self-absorption, voyeuristic tendency and a typical of schizophrenics. The

facial expressions are dummy type so it shows poor interpersonal relations. Ears are absent

and it is the sign of self-criticism or can’t bear criticism. Distorted nose tells us about weak

ego power. Neck is also drawn which shows rational control and impulsivity, whereas it’s

long and thick so it depicts inhibition and repression. As the hairs are given much attention so

it represents narcissism and positive homosexual tendency.

Overall Analysis

By having deep analysis and deep clinical observation of the subject, there awere

some personality traits clearly visible in the subject. One of the main personality trait

observed was that the subject iwas suffering from anxiety and depression disorder, but awith

milder intensity mild one whichthat can be cured. It can be cured by full family attention as

theThe subject wais very close to heris family sotherefore, by full support of the family

members he wouldill caome out of the difficult conditions. Some scars of aggression werare

also found. It wasis also observedrevealed that the subject wais showing immature behaviors

in some parts of his life especially in making decision making strategies. And theThe subject

iwas mainly concerned with sense of belonging, nurturance and bodily needs.

Precipitating, Maintaining, Factors for Drug use

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Precipitating factors are basically all those factors that are immediate triggers for drug

addicts, such as feelings of anger or depression or stress, being exposed to drugs, and

experiencing withdrawal symptoms. So the precipitating factors for the client M.F. were

feelings of stress and depression. He always feel irritable and having trouble and relationship

problem with sister and mother. He also reported that for days and days he wouldn't talk to

his father, just because he was extremely frustrated and stressed out and don’t know what to

do in the particular situation.

Motivating factors to leave drugs

One of the foremost motivating factor for the client to leave drugs was his sister and

his mother. We he got to know that this drug abuse is killing him and ruining his life without

any reason so he start looking into his life and realized that what he is doing is not good.

After that he also realized that his mother and sister are also suffering just because of him and

they can't see him like this so he decided to take his life seriously and have visit to the doctor.

Risk factors for relapse

Problem solving skills are very important to know to the client in order to overcome

and effectively manage problems in his life for relapse prevention. Also Relapse prevention

will be taught to the client in order to develop insight to manage the life hurdle after recovery

and not get distracted by any of his peers.

Diagnosis

The Client M.F. has been diagnosed earlier with 292.0 (F12.288) Cannabis

withdrawal Disorder. But now he is having minor symptoms of that and now he is in his
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withdrawal phase and practitioners are trying their best that he could not go to that relapse

phase. He is also having some symptoms of PTSD and BDI so suitable interventions would

be needed in order to cope with the issue.

292.0 (F12.288) Cannabis withdrawal Disorder

------------------ Major depressive Disorder, mild intensity

------------------ Post traumatic stress disorder …….

Prognosis

A prognosis is the "forecast" that doctors use for a patient's recovery from an accident

or disease. This is based on the individual's progress toward recovery and the statistical

probability of recovery based on past incidents of the same disease or accident. The prognosis

of the client M.F. problem seemed to be favorable due to the presence of many supportive

factors for the treatment. And that supportive factors are his family support system. He had

an insight regarding his problems and his drug abuse. He also had an emotional support from

his sister and mother which encouraged him to seek treatment and to come to better life

which is waiting ahead.

Case Formulation

Management Plan

References

Appendices
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