Counselling LL Report (By Ashar729)

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Case Report No. 1

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Summary
F.M was 22 years old single man, he reported that he had low motivation, aggression,
loss of interest, and sleep decreased. His problem was started 2 year back due to the death of
his brother and child which were close to him. Client lived in nuclear family system. Father and
mother were not educated. The father was dead and the mother was alive. The mother was a
housewife. He had good relationships with his parents. Client had were 6 siblings, 3 sisters and
3 brothers and the client was 1st in birth order and all other siblings of were younger than him.
Client was very close of him. He had good relationships with his siblings. The client was
educated, he did Metric. His performance in school was good. He had good relationships with
his friends and teachers. He was a factory worker. He had not fair relationships with his
colleagues. So that's why he quit the job. Now he was jobless. Psychological Tests used for
assessments the Slosson Drawing Coordinaton Test, Standard Progressive Matrix, Depression
Anxiety and Stress Scale, Rotter Incomplete Sentence Blank, Human Figure Drawing and Mental
Status Examination. The result of SDCT showed that client had dysfunctioning of brain. The eye
and hand coordination was not good. The result of SPM Test indicated that client had Definitely
below average in Intellectually capacity. The results of DASS test showed Mild Depression,
Normal Anxiety and Mild Stress levels in the client. The total scores were 112 and cut off scores
135 that's showed the client was social adjustable. The results of HFD showed that the client
had passive avoident, depression withdrawal and emotional disturbance. He also had
immaturity and critical malfunctioning. Mental Status Examination the client's mood was low
when explord about the low mood he said ( main job ke bary main bohat preshan hon). His
speech tone and volume of voice was high. He didn't maintained eye contact. His thinking was
negative he said ( mjhy future k bary me koi achii umeed nzar nahi aati)The perception of client
was normal there were absence of delusions and hallucinations. His cognition and memory
were appropriate. His orientation was good. He had insight about his problem. According to the
symptoms and according the history of problem of client, he had job related issues. The client
prognosis was good because he had insight about his problem. The treatment approachs were
Deep Breathing, Progressive Muscles Relaxation , Family Counseling, Psycho Education and
Cognitive Behavioral Therapy ( CBT).
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Identify Data
Client Name : F.M
Age : 22
Gender : Male
Marital status : Single
Education : Matric
Session Date : 22-05-2023
No. of session : 4
Source and Reasons for Referral
The client came own self to the counselor for solution of his problems which he faced at
work place.
Presenting Complaints
Table 1
Presenting Complaints Reported By Client
Duration Problem
‫دو سال‬ ‫کوئی کام نہ ملنے کی وجہ سے بہت پریشان رہتا ہوں‬
‫ایک سال‬ ‫بہت زیادہ غصّہ آتا ہے‬
‫ایک سال‬ ‫چڑچڑا پن محسوس ہوتا ہے‬
‫دو سال‬ ‫مستقبل کے بارے میں بہت پریشانی رہتی ہے‬
Initial Observation
The two types of observation one is the non participante observation and other is
participant observation.
In the non participante observation the client was walking around in the ward. He had an
odd behavior. He was coming here and there for no reason. he got very angry at his mother's
prohibition and started speaking in a loud voice.
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In the participant observation the client was wearing clothes that were clean and
appropriate for the season. The volume of the voice was very normal, the answered to every
question relevant to the content. The session time was hardly one hour. During the session, the
client's eye contact was maintained at all, he was answering everything easily and attention was
good. The client had insight about his problem. He was accepting his problem and was saying
that he wanted to change his behavior because sometimes he reacted in anger. That's why he
came to the counselor to get counselling.
Developmental History of Problem
According to the client, this problem started about two years ago. Ever since he started
working, he was facing some kind of problem. The client stated that he had done B.com. Before
he did not get any job, still he felt very anxious and worried about the future. Because the
financial condition of the house was not very good and he was also the eldest son in the house.
Due to which he often got to hear things. He said that he used to spend most of his time
outside with his friends. Whenever he came home, he was often angry. This attitude of his
became a part of his personality. Then a year ago, I got a job as a supervisor in a factory. But
she could not last long. Because he was a man with an angry personality. Talking angrily to
everyone or often did his own thing at work. Due to all these reasons, he was fired from that
job.
This was another troublesome phase for the client. During this time he started to feel
more and more irritable. Now again the family members had adopted the same attitude
towards him as before and he also lived in the same state of anger and anxiety and rarely came
home. But the purpose of the client's coming here was to ease all his worries and improve
himself to lead a peaceful life.
Background Information :
In background information included personal history, family history, marital history,

educational history, occupational history and family psychiatry history / medical illness.
Personal History
The client was educated, he did Matric. He was unmarried man. It had been two days since
he came to the hospital, so he did not have any special activity. His hobbies were playing
games with friends and spend his more time outside of home with friends.
Family History
Client lived in nuclear family system. Father and mother were not educated. The father was
dead and the mother was alive. The mother was a housewife. He had good relationships with
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his parents. Client had were 6 siblings, 3 sisters and 3 brothers and the client was 1st in birth
order and all other siblings of were younger than him. Client was very close of him. He had
good relationships with his siblings.
Educational History
The client was educated. He had passed Matric. His performance in school was good. He
had good relationships with his friends and teachers.
Occupational History
He was a factory worker. He had not fair relationships with his colleagues. So that's why he
quit the job. Now he was jobless.
Family Psychiatry History / Medical illness
There was non significance of psychiatry history and medical illness in his family.
Assessments / Psychological Tests
 Slosson Drawing Coordinaton Test (SDCT)

 Standard Progressive Matrix (SPM)
 Depression Anxiety and Stress Scale (DASS)
 Rotter Incomplete Sentence Blank (RISB)
 Human Figure Drawing (HFD)
Slosson Drawing Coordinaton Test (SDCT)
The Slosson Drawing Coordination Test An individually or group administered screening

instrument for the diagnosis of perceptual disability or brain damage manifest in hand-eye
incoordination.
Purpose of designed to identify the client with brain dysfunction or perceptual disorders
involving hand and eye coordination.
Instructions
You will be given 2 pages. There will be 12 geometry shapes on it. You have to make three
shapes of each geometry shape in the same way three times. Remember that you cannot use
eraser and you have to try your best to complete 12 shapes.
Quantitative Analysis
Age 22
6
Error 8
Accuracy 77%
Qualitative Analysis
The result of SDCT showed that client had dysfunctioning of brain. The eye and hand
coordination was not good.
Standard Progressive Matrix (SPM)
The Standard Progressive Matrices (SPM) is a group or individually administered test that
nonverbally assesses intelligence in children and adults through abstract reasoning tasks.
The purpose of used SPM test for client to gain insights into his cognitive abilities, such as his
capacity for logical reasoning, problem-solving skills, pattern recognition, and the ability to infer
relationships between visual stimuli of the client.
Instructions
In each test item, the subject is asked to identify the missing element that completes a pattern.
Many patterns are presented in the form of a 6×6, 4×4, 3×3, or 2×2 matrix, giving the test its
name. The task comprises a series of geometrical figures with a missing piece. Participants are
instructed to select the missing piece among 6 to 8 alternatives. The SPM consists of 5 item-sets
that increase in difficulty both within and between sets.
Total Scores 24
Discrepancies 0
Percentile 10th
Grade -lV
Grade level Definitely below average in

Intellectually capacity
The result of SPM Test indicated that client had Definitely below average in Intellectually
capacity.
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Depression Anxiety and Stress Scale (DASS)
The Depression, Anxiety, and Stress Scale (DASS) is a set of three self-report scales
designed to measure the negative emotional states of depression, anxiety and stress. The DASS
21 is a 21 item self report questionnaire designed to measure the severity of a range of
symptoms common to Depression Anxiety and Stress.
The purpose of the used of DASS was to isolate and identify aspects of emotional
disturbance, for example, to assess the degree of severity of the core symptoms of depression,
anxiety, or stress of the client.
Instructions
You will be given a questionnaire that will have 21 questions. First have to understand
each question well then have to choose one of the four options given in front of each question.
Total Scores Categories
Depression 12 Mild
Anxiety 6 Normal
Stress 16 Mild
The results of DASS test showed Mild Depression, Normal Anxiety and Mild Stress levels in
the client. It indicated that client was experiencing emotional disturbance.
Rotter Incomplete Sentence Blank (RISB)
The Rotter Incomplete Sentence Blank (RISB) isThe Rotter Incomplete Sentences Blank
(RISB) is the most frequently used sentence completion test of personality and socioemotional
functioning. A performance-based test, the RISB is used to screen for adjustment problems, to
facilitate case conceptualization and diagnosis, and to monitor treatment
The purpose to used on client to explore the needs, inner conflicts, fantasies, attitudes,
aspirations, adjustment difficulties, and sexual abuse in the client.
Instructions
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You have to complete 40 incomplete sentences. For that you will be given a word and you
have to make a related sentence from it. There is no limit to the length of the sentence, there's
freedom of responses you can say as much as you want.
Types of Categories No of Responses in Values Total

Responses Responses Categories
C C1 3 4 12
C2 6 5 30
C3 4 6 24
N N 9 3 27
P P1 5 2 10
P2 5 1 5
P3 4 0 0
O 0 5 0 0
Total 112
The total scores were 112 and cut off scores 135 that's showed the client was social
adjustable.
Familiar Attitude. In item no 1 ,3 . I like ( me game khelo or jeto), ( Me Janna chahta Hun k me
Kon Hun ) these statements showed the client had Familiar attitude.
Social and Sexual Attitude. Item no. 26 , 11, 10 Marriage ( Mubarak he ho janii chahiy),
Mother ( ko apny bachon se Pyar hota he) , People ( log wahi achy hain Jo dosron ke kaam aty
hen) these statements showed the client had social sexual attitude.
General Attitude. Item no. 8 , 32‫ ۔‬A man ( admi ko admi ka khyal hona chahiye) I (me bohat ba
himat hona chahta Hun ta k har mushkil aasan ho jaye) these statements showed the client had
general attitude.
Human Figure Drawing Test (HFD)

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HFD test (Human Figure Drawing) is an Human Figure Drawing test is a projective test and
abbreviated test which was developed with the aim to evaluate various psychological states,
especially assessing the psychic status including psychiatric illness and personality state. This
test used to assess the personality state and cognitive function of the client.
Instructions
Draw a complete person with a pencil on A4 paper. There was no specific time limit, but
participants usually finished within 10 min.
The results of HFD showed that the client had passive avoident, depression withdrawal
and emotional disturbance. He also had immaturity and critical malfunctioning.
Mental Status Examination
The mental status examination (MSE) is a structured assessment of the patient's behavioral
and cognitive functioning. The purpose of used to identify, diagnose, and monitor signs and
symptoms of mental illness of client. Each part of the mental status examination is designed to
look at a different area of mental function to thoroughly capture the objective and subjective
aspects of mental illness.
The client was 22 years old. His dress was appropriate. The client's mood was low when
explord about the low mood he said ( main job ke bary main bohat preshan hon). His speech
tone and volume of voice was high. He didn't maintained eye contact. His thinking was negative
he said ( mjhy future k bary me koi achii umeed nzar nahi aati)The perception of client was
normal there were absence of delusions and hallucinations. His cognition and memory were
appropriate. His orientation was good. He had insight about his problem.
Case Formulation
F.M had presenting complaints of sadness, hopeless about future, irritation and
aggression. The problem started 2 years back and his introverted personality might be the
predisposing factor of his problem. He said that he had interest in study that's why he left the
study after metric education. He had no close friends but he was close with his one brother. He
didn't shared his problems with anyone. This was showed ,he was introverted person. The
research evidence (Soenens et al. 2012).(Kuppens et al. 2013) and (Beato et al. 2016). These
studies have generally identified the parenting style that might be the factor of the client
problem.
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The precipitating factors was that he was an jobless person. This was the most life changing
event for him. The perpetuating factor was that he was financial poor . He faced economical
issues. According to the researches(Staring et al., 2009)&(Osatuke et al.2008)Poor insight is a
manifestation of the mental illness. The protective factor was that his supportive family
environment. The intimate relationships involve supporting, sharing, and caring for each other
within the family unit, and it includes couples, children, other kin, and family friends (Poole,
2011).
Tentative Diagnosis
According to the symptoms and the history of problem client had job related issues and
financial poor.
Prognosis
The client prognosis was good because he had insight about his problem.
Tentative Treatment / Management Plan
Case No 1
Gender Male
Symptoms Sadness, fear and hopeless about future, irritation and

aggression.
Diagnosis Job related issues and financial poor.
Targeted Symptoms Sadness, hopeless about future, irritation and aggression.
Treatment goals for  Rapport building and confidentiality

Targeted Symptoms  Improve the hopelessness about future.
 To work on aggression and irritation.
 Find out the factors that contribute the problem.
Treatment Approachs  Motivation Enhancement Therapy

 Psycho Education
 Cognitive Behavioral Therapy ( CBT)
Session 1:
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In the first session the counselor introduce himself with client. In a stated the client feel
hesitated or confused and not feel a comfortable with counselor. Then talk to him and build a
rapport with him and tell him the session was 45 minutes after that take biodata for client.
Session 2:
In a second session the client tells his compliant and feel about a school. Counselor asked about
his family member. And taking all the history from him. When all the history was taken, then
tell to he client for test assessment procedure.
Session 3:
In a third session administered the all the tests on client. In a starting he feel comfortable but in
the last when he feels a RISB he feels a tired. But at the end he completes all the 5 tests. He
asked about the results also. Psycho educate him. Motivation Enhancement Therapy also apply
on him.
Session 4:
In a fourth and last session the client was feeling better I suggest some plan with him. Tell him
about the daily activity. Give him direction how to cope with problem.The most work for them
her was an outing. The client feels happy and fresh.
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Appendices
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Case Report No. 2

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Summary
M.A was years old female, she reported that she had loss of interest, low mood, sleep
disturbance, low appetite, worthlessness. Problem was started 2 years back when her baby was
died after the birth of 10 days and after the few months she got divorced. Client lived in nuclear
family system. Father and mother were educated. They both were alive. Mother was a
housewife and father was a clerk. She had fair relationships with her parents. The client had 4
siblings, 2 brothers and 2 sisters. Her birth order was 2nd. She has good relationships with her
siblings. Family environment is good and supportive. The client was educated. She had passed
middle. Her performance in school was excellent. She had good relationships with her friends
and teachers. The client's mother had medical illness. She was suffering from diabetes and was
admitted to the hospital for treatment some months ago. These psychological tests used for
assessments the Slosson Drawing Coordinaton Test, Standard Progressive Matrix, Depression
Anxiety and Stress Scale, Rotter Incomplete Sentence Blank, Human Figure Drawing and Mental
Status Examination. The result of SDCT there was no dysfunctioning of brain. The eye and hand
coordination was good. The result of SPM Test indicated that the client had intellectual capacity
fall within definitely below average in Intellectually capacity. The results of DASS test showed
Moderate Depression, Severe Anxiety and Moderate Stress levels in the client. The total scores
were 116 and cut off scores 135 that's showed the client was social adjustable/ adaptive. The
results of HFD showed that the client had impulsivity, instability and poor coordination. She
also had the immature behavior, poor impulsive control and helplessness sense of insecurity.
She was emotional disturbed. The client was 33 years old. Her dress was appropriate. The client
told that his mood was low when explord about the low mood she said ( me apny bachon se
milna chahtii hun, me bs unhen ak dfa dekh lo). Her speech tone and volume of voice was low
and she was finding it difficult to speak. She didn't maintained eye contact. Her thinking was
positive she said ( me chahtii hun k me apny ghar walon k Sath rahun). The perception of client
was normal there were absence of delusions and hallucinations. Her cognition and memory
were appropriate. Her attention was not focused. Her orientation was good. She had insight
about her problem(me jaldii thek ho kr apny ghar walon k Sath rehna chahti hun). In the case
formulation the predisposing factor was introverted personality. The precipitating factor was
death of baby and divorced her.The perpetuating factor the client was financial poor. The
precipitating factor fear about going to school. The protective factor was that his family
support. According to the symptoms and duration client had Depression Anxiety Disorder. The
client prognosis was good because he had insight about his problem and had supportive family
environment. .The Treatment Approachs Deep Breathing, Progressive Muscles Relaxation,
Family Counseling and Cognitive Behavioral Therapy(CBT).
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Identify Data
Client Name : M.A
Age : 33
Gender : Female
Marital status : Married
Education : Middle
Session Date: 27-04-2023
No. of session : 4
The client's mental problem had worsened due to which her mother brought him to the
counselor for counseling.
Table 1
Duration Problem
‫دو ماہ‬ ‫کسی کام کو دل نہیں کرتا‬
‫دو ماہ‬ ‫بھوک نہیں لگتی۔‬
‫دو سال‬ ‫میرا اپنے بچوں سے ملنے کا دل کرتا ہے‬
Initial Observation
The two types observation one is the non participante observation and other is participant
observation.
In the non participante observation was done in the hospital ward where client was
admitted.The client was lying in bed and feeling very uncomfortable. Due to which she was
unsuccessful in trying to sleep.
In the participant observation the client's age was 33 years old, normal in height and
weight. The clothes were fully appropriate according to season and looked clean.The volume of
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the voice was low. She was not paying attention to what was asked. Her attention was not
focused. The duration of the session was about the one and half hour, during which she was
feeling very uncomfortable. She was not maintain eye contact while talking. Her behavior was
cooperative but sometimes show resistance. Her mood was low, feeling restless and lack of
interest. She had insight about her problem and wanted someone to help her. That's why her
parents to came the hospital for treatment.
The client's problem started 2 years ago. Then the client gave birth to a daughter who died
after 10 days. The client's state of mind was greatly affected by his death. which caused the
client to have depression at the time. After treatment, the condition got better. But the client's
in-laws got fed up with his mental problem and divorced him. After that, she became more
depressed. The client also had 2 sons who were kept by her husband after the divorce. Due to
all these reasons, the client's condition continued to deteriorate day by day.Then after regular
treatment and continuous medication she got better. She was doing well without medication
for about 2 years. But now the same problem started again for some time.
The client and his mother came to the hospital to get the client treated.

Personal History
The client was educated. During the problem she had no interest in any activity. It had
been 4 days since he came to the hospital. She used to sleep for a long time. In the problematic
condition she had no interest in any activity.
Family History
Client lived in nuclear family system. Father and mother were educated. They both were
alive. Mother was a housewife and father was a clerk. She had fair relationships with her
parents. The client had 4 siblings, 2 brothers and 2 sisters. Her birth order was 2nd. She has
good relationships with her siblings. Family environment is good and supportive.
Educational history
The client was educated. She had passed middle. The performance in school was average
student. She had good relationships with her friends and teachers. She had no interest in
studies and she also had the financial issues that's why she left the study.
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The client's mother had medical illness. She was suffering from diabetes and was admitted
to the hospital for treatment some months ago. Her uncle had the psychiatry history.


incoordination.
Instructions
Age 33
Error 6
Accuracy 83%
The result of SDCT there was little dysfunctioning of brain. The eye and hand coordination
was not properly good.

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The purpose of used SPM test for client to gain insights into his cognitive abilities, such as
his capacity for logical reasoning, problem-solving skills, pattern recognition, and the ability to
infer relationships between visual stimuli of the client.
Instructions
In each test item, the subject is asked to identify the missing element that completes a
pattern. Many patterns are presented in the form of a 6×6, 4×4, 3×3, or 2×2 matrix, giving the
test its name. The task comprises a series of geometrical figures with a missing piece.
Participants are instructed to select the missing piece among 6 to 8 alternatives. The SPM
consists of 5 item-sets that increase in difficulty both within and between sets.
Analysis
Total Scores 19
Discrepancies 0
Percentile 5th
Grade V
Grade level Intellectually defictive
The result of SPM Test indicated that the client had intellectual capacity fall Intellectually
defictive capacity.
Instructions
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You will be given a questionnaire that will have 21 questions. First you have to understand
each question well then have to choose one of the four options given in front of each question.
Depression 20 Moderate
Anxiety 16 Severe
Stress 20 Moderate
The results of DASS test showed Moderate Depression, Severe Anxiety and Moderate
Stress levels in the client. It indicated that client was experiencing emotional disturbance.
Instructions
freedom of responses you can say as much as you want.
Instructions
have to make a related sentence from it. There is no limit to the length of the sentence and
have freedom of responses.

20
C C3 2 6 12
C2 9 5 45
C1 10 4 40
N N 1 3 3
P P1 2 2 4
P2 12 1 12
P3 0 0 0
O 0 8 0 0
Total 116
adjustable / adaptive.
Familiar Attitude. In item no 5 ,9 and 13 I regret ( main bemar kiun hui) iMy Fear (meri bemari
he ) I feel bad( khuda k alawa kisi or pr yaqeen rakhna) these statements showed the client had
Familiar attitude.
Social and Sexual Attitude. Item no 8 ,19 and 40 ‫۔‬Man (ak dosry ke bagair kuch nhi he)، Other
People (apny bary me acha sochty hen), Female (achi hoti hain) according to these statements
showed the client had social and sexal attitude.
General Attitude. Item no 22 and 31 . This place (hospital hai) , Study ( achi baat hai) according
to these statements showed the client had general attitude.
Human Figure Drawing (HFD)
Instructions
21
The results of HFD showed that the client had impulsivity, instability and poor coordination. She
also had the immature behavior, poor impulsive control and helplessness sense of insecurity.
She was emotional disturbed.
The mental status examination (MSE) is a structured assessment of the patient's

behavioral and cognitive functioning. The purpose of used to identify, diagnose, and monitor
signs and symptoms of mental illness of client. Each part of the mental status examination is
designed to look at a different area of mental function to thoroughly capture the objective and
subjective aspects of mental illness.
The client was 33 years old. Her dress was appropriate. The client told that his mood was
low when explord about the low mood she said ( me apny bachon se milna chahtii hun, me bs
unhen ak dfa dekh lo). Her speech tone and volume of voice was low and she was finding it
difficult to speak. She didn't maintained eye contact. Her thinking was positive she said ( me
chahtii hun k me apny ghar walon k Sath rahun). The perception of client was normal there
were absence of delusions and hallucinations. Her cognition and memory were appropriate.
Her attention was not focused. Her orientation was good. She had insight about her
problem(me jaldii thek ho kr apny ghar walon k Sath rehna chahti hun).
Case Formulation
had presenting complaints of low mood, sleep disturbance and low appetite.The problem
started 2 years back and his family psychiatry history might be the predisposing factor of his
problem. Some
The precipitating factor fail in baby death and divorced. The perpetuating factor of his
problem was authoritative parenting style.Research suggests that having at least one
authoritative parent can make a big difference (Fuentes et.al 2021) and (Alcaide et.al 2023).
The protective factor was that his family support. The intimate relationships involve supporting,
sharing, and caring for each other within the family unit, and it includes couples, children, other
kin, and family friends (Poole, 2011).
Tentative Diagnosis
According to the history of client problem and after the psychological assessments client
had Emotional Disturbance problem.
Prognosis
22
The client prognosis was good because she had insight about her problem and her family was a
support for her.
Case No 2
Gender Female
Symptoms Low mood, sleep disturbance and low appetite.
Diagnosis Emotional Disturbance
Targeted Symptoms Low mood, sleep disturbance and low appetite.
Treatment goals for  Rapport building and confidentiality.

Targeted Symptoms  To work on sleep disturbance
 Improve sleep and low appetit.
Treatment Approachs  Deep Breathing

 Family Counseling
 Cognitive Behavioral Therapy (CBT)
Session 1:
Session 2:
In a second session the client tells her compliant and feel about a school. Counselor asked
about her family member. And taking all the history from her. When all the history was taken,
then tell to the client for test assessment procedure.
Session 3:
the last when she feels a RISB she feels a tired. But at the end she completes all the 5 tests.
Psycho educate her. Deep Breathing and Progressive Muscles Relaxation also apply on her.
23
Session 4:
In a fourth and last session the client was feeling better I suggest some plan with him. Tell her
about the daily activity. Give her direction how to cope with problem.The most work for her.
She went to every weekend for outing. The client feels happy and fresh.
24
Appendices
25
Case Report No. 3

26
Summary
S.S was 24 years old single man, he reported that he had irritation, unstable interpersonal
relationships and difficult to control anger. The problem started 6 months back. In psychological
assessments these tests were used the Slosson Drawing Coordinaton Test, Standard Progressive
Matrix, Depression Anxiety and Stress Scale, Rotter Incomplete Sentence Blank, Human Figure
Drawing and Mental Status Examination. The result of SDCT test client had no dysfunctioning
of brain. His eye and hand coordination was also good. The result of SPM Test indicated that
the client had intellectual capacity fall within Definitely below average in intellectual capacity.
The scores of DASS test showed Depression was Severe, Anxiety and Normal were Moderate
levels in the client. It indicated that client was experiencing emotional disturbance. The total
scores of RISB were 108 and cut off scores 135 that's showed the client was social adjusted.The
HFD show that the client had fear and depression. He had resistance, anxiety, refusal to
communication with others. HFD revealed that conflict, social withdraw and insecurity
complaints.Mental Status Examination showed that the his dress was appropriate. The client
told that his mood was low when explord about the low mood he said (main ziadah logon ki
wajah se irritate hota hun). His speech tone and volume of voice was active. He maintained eye
contact. His thinking was negative he said (main Chahta Hun ke main Akela hi rahon or main
khud ko takaleef deny ya zakhmi krny ya cut wagera lgany k Baad skoon or khushii mehsoos
krta Hun). The perception of client was normal there were absence of delusion and
hallucinations. Attention was also focused. His cognition and memory were appropriate. His
orientation was good. He had insight about his problem. His social isolation from family might
be the predisposing factor of his problem. The precipitating factor marriage and fear about
future.The perpetuating factor of his problem was conflicted environment. The protective
factor was that he had insight about his problem. According to the symptoms and the history of
problem client had social avoidance. The client prognosis was good because she had insight
about his problem and had supportive family environment. The Treatment Approachs Deep
Breathing, Progressive Muscles Relaxation, Motivation Enhancement Therapy, Family
Counseling and Cognitive Behavioral Therapy (cognitive restructuring )
27
Identify Data
Client Name : S.S
Age : 24
Gender : Male
Marital status : Single
Education : F.A
No. of sessions : 4
According to the client, he he reported that he had irritation, unstable interpersonal

relationships and difficult to control anger. So he came to the counselor for the
Table 1
Duration Problem
‫بچپن سے ہی‬ ‫میں اکیال رہنا چاہتا ہوں‬
‫چھ ماہ‬ ‫جو لوگ مجھے جانتے ہیں اُن سے دور رہنا اور نئے‬
‫لوگوں سے نہیں ملنا چاہتا‬
‫چھ ماہ‬ ‫چڑچڑا پن محسوس ہوتا ہے‬
‫چھ ماہ‬ ‫غصہ آتا ہے‬
Initial Observation
There are two types of observation one is the non participante observation and other is
In the non participante observation the client was sitting in a low mood. And seem as he
feel irritation.
28
The participant observation included many things, client's age was 24 years old. The
clothes were appropriate and looked clean.The volume of the voice was active and normal. He
was answering what was being asked, meaning it was relevant content. The duration of the
session was about the one and half hour, during which he sit as was feeling comfortable. He
was trying to maintain eye contact while talking. But after the one session he maintained eye
contact. His behavior was cooperative but sometimes show resistance. His mood was low,
feeling empty and showed lack of interest. He had insight about his problem. But don't want
someone care him. His parents came the hospital for his treatment.
This problem of the client started from last 6 months. The problem started when the
client's marriage was discussed. The client did not want to get married. The reason for this was
his conflicted family environment. According to him, marriage was a failure. Because he had
found many people close to him in his life to fail him. First of all, his parents, who often used to
quarrel over things. Due to which the client was mentally disturbed since childhood. Due to the
quarrel between the parents, the relationship with the children was difficult. Since childhood,
he stayed away from his parents and never shared anything. This was the reason why the client
liked more solitude. He often felt capable of harming and hurting himself. For 6 months now, he
had started to become more withdrawn and self harming. But the family was not aware of this,
so no treatment or better suggestion was given to him till now. 2 weeks ago the client had also
attempted suicide. The client wanted to kill himself by using poison. When the family saw his
serious condition, they brought him to the hospital for treatment.

Personal History
The client was educated, he did F.A. It had been a week since he came to the hospital. He
had no activity. He used to sleep for a long time.
Family History
Client lived in nuclear family system. Father and mother were not educated. They both
were alive. He had not good relationships with parents. According to the client, there were 5
siblings, two sisters and three brothers and the client was 1st in birth order. He has good
relationships with his siblings. Family environment was most of the time conflicted but
supportive.
29
Educational history
The client was educated. He did F.A. His performance was good in school. He had good
relationships with his friends and teachers.
He worked as a factory worker. He had good relationships with the colleagues.
There was no psychiatry history but had medical illness in client family. His father was a
patient of high blood pressure.


incoordination.
Instructions
Age 24
Error 5
Accuracy 86%
30
The result of SDCT test client had no dysfunctioning of brain. His eye and hand
coordination was also good.
The purpose of used SPM test for client to gain insights into his cognitive abilities, such as
his capacity for logical reasoning, problem-solving skills, pattern recognition, and the ability to
infer relationships between visual stimuli of the client.
Instructions
In each test item, the subject is asked to identify the missing element that completes a pattern.
Many patterns are presented in the form of a 6×6, 4×4, 3×3, or 2×2 matrix, giving the test its
name. The task comprises a series of geometrical figures with a missing piece. Participants are
instructed to select the missing piece among 6 to 8 alternatives. The SPM consists of 5 item-sets
that increase in difficulty both within and between sets.
Total Scores 26
Discrepancies 0
Percentile 10th
Grade lV-
Grade level Definitely below average in

intellectual capacity
The result of SPM Test indicated that the client had intellectual capacity fall within
Definitely below average in intellectual capacity.

31
Instructions
each question well then you have to choose one of the four options given in front of each
question.
Depression 22 Severe
Anxiety 12 Moderate
Stress 22 Moderate
The scores of DASS test showed Depression was Severe, Anxiety and Normal were
Moderate levels in the client. It indicated that client was experiencing emotional disturbance.
Instructions
32
freedom of responses.

C C1 4 3 12
C2 10 5 50
C3 5 6 30
N N 4 3 12
P P1 5 2 10
P2 4 1 4
P3 2 0 0
O 0 3 0 0
Total 108
adjusted.
Familiar Attitude. In item no 11, 26. A mother( dosry bachon k bary me ziadah sochti he),
Marriage ( nhii krna Chahta eska koi faidah nhii) according to these statements showed the
client had Familiar attitude.
Social and Sexual Attitude. Item no. 7, 4, 10 and 40. A man (ko mashry me ahmiyat deni
chahiye), People ( logon se dour rehna acha lgta he ) Women.(achi hoti hen) according to
these statements showed the client had Social Sexual Attitude.
General Attitude. Item no 28 and 35 . Sometimes (sb kuch acha lgta Hy). It's difficult ( kuch bhi
nhii) according to mthese statements showed the client had general attitude.
Human Figure Drawing (HFD)

33
Instructions
The HFD show that the client had fear and depression. He had resistance, anxiety, refusal
to communication with others. HFD revealed that conflict, social withdraw and insecurity
complaints.

The client was 24 years old. His dress was appropriate. The client told that his mood was
low when explord about the low mood he said (main ziadah logon ki wajah se irritate hota hun).
His speech tone and volume of voice was active. He maintained eye contact. His thinking was
negative he said (main Chahta Hun ke main Akela hi rahon or main khud ko nuqsan ya zakhmi
krny ya cut wagera lgany k Baad skoon or khushii mehsoos krta Hun). The perception of client
was normal there were absence of delusion and hallucinations. Attention was also focused. His
cognition and memory were appropriate. His orientation was good. He had insight about his
problem.
Case Formulation
S.S had presenting complaints of self harm, irritation, suicidal attempt, unstable
interpersonal relationships and difficult to control anger.. The problem started 6 months back
and his social isolation from family might be the predisposing factor of his problem .He had no
close friends and didn't shared his problems with his family. This was showed ,he was
introverted person. Social isolation is a significant threat to the health and well-being of older
adults (Klinenberg, 2016) that is associated with an increased risk of mortality. Being socially
34
isolated is also linked to poorer mental health (Cornwell & Waite, 2009)and (Coyle & Dugan,
2012).
The precipitating factor marriage and fear about future.The perpetuating factor of his problem
was conflicted environment. The protective factor was that he had insight about his problem.
Tentative Diagnosis
According to the history of problem client had social avoidance.
Prognosis
The client prognosis was good because she had insight about his problem and had supportive
family environment.
Case No 3
Gender Male
Symptoms Irritation, avoid from the people's Unstable interpersonal

relationships and Difficult to control anger.
Diagnosis Socially avoidance
Targeted Symptoms Irritation, unstable interpersonal relationships, irritation and

feeling of emptiness.
Treatment goals for  Rapport building and confidentiality.

Targeted Symptoms  To work on client socialization
 Improve interpersonal relationships.
 To work on irritation and anger. .
Treatment Approachs  Deep Breathing

 Progressive Muscles Relaxation
 Family Counseling
 Cognitive Behavioral Therapy (CBT)
Session 1:
35
Session 2:
tell to the client for test assessment procedure.
Session 3:
asked about the results also. Psycho educate him. Deep Breathing and Progressive Muscles
Relaxation also apply on him.
Session 4:
about the daily activity. Give him direction how to cope with problem.The most work for him.
The client feels happy and fresh.
36
Appendices
37
Case Report No. 4

38
Summary
U.H was 30 years old married man, he reported that he had body pain, sleep disturbance,
low appetite, aggression and chances of relapse. His problem was started 5 years back with the
help of friends company and the reason was relationship issues. Psychological Assessments the
Slosson Drawing Coordination Test, Standard Progressive Matrix, Depression Anxiety and Stress
Scale, Rotter Incomplete Sentence Blank Test, Human Figure Drawing and Mental Status
Examination. The result of SDCT showed that the dysfunctioning of brain. The client had eye
and hand coordination was low. The result of SPM Test that client had intellectual capacities fall
withi intellectually defective. DASS test results showed Severe depression, Extermely severe
anxiety and moderate stress levels in the client. It indicates that client's had emotional
disturbances. The total scores of RISB 100 and cut off scores 135 that's showed the client was
socially adjusted. Human Figure Drawing Test (HFD) showed that the client had impulsivity,
instability, poor coordination and guilty feeling. According to the history and HFD also showed
that he had aggressive impulsive, emotional disturbance and conflicted. The Mental Status
Examination showed that client told that lo mood was low when asked about the low mood he
said (kash mery Ghar waly Meri baat maan lety or main nashah nah krta). His speech tone and
volume of voice was normal and maintained eye contact. His thinking was positive he said (ab
me ne nashah chorny ka Socha Hy to me behtr ho jaon gha). The perception of client was
normal there were absence of Delusion and hallucinations. His cognition and memory were
appropriate. Attention was not properly focused. His orientation was good. He has insight
about his problem. In the case formulation his authoritarian parenting style might be the
predisposing factor of his problem. The precipitating factors was the friends company and
relationship issues. He was involved in drug addiction for the feeling of relaxed. The
perpetuating factor of his problem was his friends company. The protective factor was that he
had insight and want to leave the drug. According to the symptoms and history of problem the
client had chances of relapse. The client's prognosis was good . Because he want to quit drug
and had insight about his problem.The Treatment Approachs were Deep breathing, Progressive
Muscles Relaxation, Family counseling, Motivation Enhancement Therapy and Cognitive
Behavioral Therapy (Daily activity chart) .
39
Identify Data
Client Name : U.H
Age : 30
Gender : Male
Marital status : Married
Education : Matric
No. of sessions : 4
Source and Reasons for Refferal
The client himself has come with his brother. The client said that he has been using drugs for 5
years and wants to quit. He has come to the hospital for complete treatment.
Table 1
Duration Problem
‫پندرہ دن‬ ‫جسم میں بہت درد محسوس ہوتا ہے‬
‫پندرہ دن‬ ‫بہت زیادہ غصّہ آتا ہے‬
‫پندرہ دن‬ ‫چڑچڑاپن محسوس ہوتا ہے‬
‫پندرہ دن‬ ‫کسی کام کو دل نہیں کرتا‬
‫پندرہ دن‬ ‫دوبارہ نشہ کرنے کا دل کرتا ہے‬
Initial Observation
There are two types of observation one is the non participante observation and other is
In the non participante observation the client was in the ward of hospital. The client was
sitting on the bed. He was feeling restless and was changing the pose repeatedly.
In the participant observation the client's age was 30 years old. The clothes were
appropriate but did not look clean. The volume of the voice was the normal and he was
40
answering what was being asked, meaning it was relevant content. He was trying to pay
attention to the matter or answer the questions asked. The duration of the session was about
the one and a half hours, during which he would try to sit as he was feeling very uncomfortable.
He tried to maintain eye contact while talking. His behavior was cooperative. His mood was
low, feeling restless and interest was also low. He had insight about his problem, that's why he
came to the hospital for treatment with his brother.
According to the client, he had come to the hospital for treatment and to quit addiction. He
said that he was using opium since 4 years ago. There was no specific reason to start the
addiction. Where he worked, some people used to get drunk. The client said that he was very
tired one day due to which he was feeling fever and body ache. His friends said that take this
drug and you will be fine. client then took the opium. He said that after using the drug I really
got better. Then I became addicted to this drug for the same relief. 3 months ago I quit opium.
Started taking symbro tablets to fulfill his habit. Now I am tired of all this. And want to leave.
That is why I have come to the hospital to get complete treatment.

educational history , occupational history and family psychiatry history.
Personal History
The client was educated. He got married 4 years ago. He was a carpenter. It had been two
days since he came to the hospital, so he did not have any special activity. He fondly kept cattle
and would take care of them.
Family History
Client lived in joint family system. Father and mother were not educated. The father was
died in an accident. The mother was alive. She was a housewife. He had fair relationship with
parents. According to the client, there are 5 siblings, three sisters and 2 brothers and the client
was third in birth order. He has good relationships with his siblings. Two earning members in his
family.
Marital Status
The client was married 4 years ago. The relationship with wife was fair in past but now a days
he has aggressive behavior with his wife. He had a son 2 years old. The relationship with child
was good.
41
The client worked in a work in company. The relationship with colleagues was fair.
Family Psychiatry History / Medical Illness
There is no psychiatry history in family but had the medical history. His mother was the
heart patient.
 Slosson Drawing Coordination Test (SDCT)

 Depression Anxiety Stress Scale (DAAS)
Slosson Drawing Coordination Test (SDCT)

incoordination.
Instructions
Age 33
Errors 3
Accuracy 92%
The result of SDCT showed that the dysfunctioning of brain. The client had eye and hand
coordination was low.
42
Standard Progressive Matrix Test
The purpose of used SPM test for client to gain insights into his cognitive abilities, such as his
capacity for logical reasoning, problem-solving skills, pattern recognition, and the ability to infer
relationships between visual stimuli of the client.
Instructions
In each test item, the subject is asked to identify the missing element that completes a
pattern. Many patterns are presented in the form of a 6×6, 4×4, 3×3, or 2×2 matrix, giving the
test its name. The task comprises a series of geometrical figures with a missing piece.
Participants are instructed to select the missing piece among 6 to 8 alternatives. The SPM
consists of 5 item-sets that increase in difficulty both within and between sets.
Total Scores 20
Discrepancies 2
Percentile 5th
Grade V
Grade level Intellectually Defective
The result of SPM Test that client had intellectual capacities fall within intellectually
defective.
Depression, Anxiety and Stress Scale (DASS)
43
Instructions
each question well then you have to choose one of the four options given in front of each
question.
Quantitative analysis.
Depression 18 Moderate
Anxiety 18 Severe
Stress 20 Moderate
DASS test results showed Severe depression, Extermely severe anxiety and moderate stress
levels in the client. It indicates that client's had emotional disturbances.
functioning. A performance based test, the RISB is used to screen for adjustment problems, to
Instructions
have to make a related sentence from it. There is no limit to the length of the sentence, have
freedom of responses.
Types of Responses Categories of No of Responses in Values Total

Responses
Categories
C C1 7 4 28
44
C2 8 5 40
C3 2 6 12
N N 3 3 18
P P1 3 2 6
P2 5 1 5
P3 8 0 0
O 2 0 0
Total 100
The total scores of RISB 100 and cut off scores 135 that's showed the client was socially
adjusted.
Familial Attitude . Item no 11 and 25. A mother (Acha slook krti hy) , I need (apny masaly k alaj
ki) according to these statements showed the familiar attitude if client.
Social and Sexual Attitude. In Item no 8, 10 and 26 . A man ( bachon ki achi tarbiyat bhi krta
hy), People (dosry logon se koi Matlab nhi he) & Marriage (marzi se ho jaye to koi maslah nhii
hota ) according to these statements showed the social and sexal attitude of client.
General Attitude. In Item no 3.. I feel bad ( jb koi ghalat kaam krta Hun), In School (teacher
taleem dety hain) according to these statements showed the general attitude of client.
Human Figure Drawing
Instructions
45
Human Figure Drawing Test (HFD) showed that the client had impulsivity, instability, poor
coordination and guilty feeling. According to the history and HFD also showed that he had
aggressive impulsive, emotional disturbance and conflicted.

The client was 30 years old. His dress was appropriate. The client told that his mood was
low when asked about the low mood he said (kash mery Ghar waly Meri baat maan lety or main
nashah nah krta). His speech tone and volume of voice was normal and maintained eye contact.
His thinking was positive he said (ab me ne nashah chorny ka Socha Hy to me behtr ho jaon
gha). The perception of client was normal there were absence of Delusion and hallucinations.
His cognition and memory were appropriate. Attention was not properly focused. His
orientation was good. He has insight about his problem.
Case Formulation
F.H had presenting complaints of body pain, aggression, decrease sleep, low mood and
chances of relapes. The problem started 5 years back and his authoritarian parenting style
might be the predisposing factor of his problem. He said that he liked to live with friends and
have no interest in study that's why he left the study after the middle. This was showed he was
extroverted person. The research evidence (Rueda C. et.al .2015). The precipitating factors was
the friends company and relationship issues. He was involved in drug addiction for the feeling
of relaxed. According to the researches (DeLay et al., 2013) &( Bukowski, Velaszquez, &
Brendgen, 2008). The perpetuating factor of his problem was his friends company. The
protective factor was that he had insight and want to leave the drug. His children was the
protective factor for him. According to researches (Kipping R.R .et.al.2012).
Tentative Diagnosis
According to the symptoms and history of problem client had Chances of relaps.
Prognosis
The client's prognosis was good. Because he want to quit drug and had insight about his
problem.
46
Case No 4
Gender Male
Symptoms Body pain, aggression, decrease sleep, low mood and chances of
relapes.
Diagnosis Drug addicted and chances of relapse.
Targeted Symptoms Sleep disturbed and disturb appetit and aggression.
Treatment goals for  Rapport building and confidentiality

target Symptoms  Improve sleep, appetit and body pain.
 Work on aggression.
Treatment Approachs  Deep breathing

 Progressive Muscles Relaxation
 Family counseling
 Motivation Enhancement Therapy
 Cognitive Behavioral Therapy (Daily activity chart)
Session 1:
Session 2:
tell to the client for test assessment procedure.
Session 3:
47
asked about the results also. Psycho educate him. Deep Breathing and Progressive Muscles
Relaxation also apply on him.
Session 4:
about the daily activity. Give him direction how to cope with problem.The most work for him.
The client feels happy and fresh.
48
Appendices

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1

Case Report No. 1

Client Name : F.M

Marital status : Single

Session Date : 22-05-2023

Source and Reasons for Referral

Presenting Complaints Reported By Client

‫ایک سال‬ ‫بہت زیادہ غصّہ آتا ہے‬

‫ایک سال‬ ‫چڑچڑا پن محسوس ہوتا ہے‬

‫دو سال‬ ‫مستقبل کے بارے میں بہت پریشانی رہتی ہے‬

Developmental History of Problem

In background information included personal history, family history, marital history,

Family Psychiatry History / Medical illness

Assessments / Psychological Tests

 Slosson Drawing Coordinaton Test (SDCT)

Slosson Drawing Coordinaton Test (SDCT)

The Slosson Drawing Coordination Test An individually or group administered screening

Standard Progressive Matrix (SPM)

Grade level Definitely below average in

Depression Anxiety and Stress Scale (DASS)

Total Scores Categories

Rotter Incomplete Sentence Blank (RISB)

Types of Categories No of Responses in Values Total

Human Figure Drawing Test (HFD)

Mental Status Examination

Tentative Treatment / Management Plan

Symptoms Sadness, fear and hopeless about future, irritation and

Diagnosis Job related issues and financial poor.

Targeted Symptoms Sadness, hopeless about future, irritation and aggression.

Treatment goals for  Rapport building and confidentiality

Treatment Approachs  Motivation Enhancement Therapy

Case Report No. 2

Client Name : M.A

Marital status : Married

Session Date: 27-04-2023

Source and Reasons for Referral

Presenting Complaints Reported By Client

‫دو ماہ‬ ‫کسی کام کو دل نہیں کرتا‬

‫دو ماہ‬ ‫بھوک نہیں لگتی۔‬

‫دو سال‬ ‫میرا اپنے بچوں سے ملنے کا دل کرتا ہے‬

Developmental History of Problem

In background information included personal history, family history, marital history,

Family Psychiatry History / Medical illness

Assessments / Psychological Tests

 Slosson Drawing Coordinaton Test (SDCT)

Slosson Drawing Coordinaton Test (SDCT)

The Slosson Drawing Coordination Test An individually or group administered screening

Standard Progressive Matrix (SPM)

Grade level Intellectually defictive

Depression Anxiety and Stress Scale (DASS)

Total Scores Categories

Rotter Incomplete Sentence Blank (RISB)

Types of Categories No of Responses in Values Total

Human Figure Drawing (HFD)

Mental Status Examination

The mental status examination (MSE) is a structured assessment of the patient's

Tentative Treatment / Management Plan