Case work – 9

NAME: Ms. X

AGE: 23

SEX: Female

CHIEF COMPLAINTS: Loneliness

HISTORY OF PRESENTING ILLNESS: The client is feeling lonely because of her best friend's behaviour
for the last 2 months. Without any reason she stopped talking to the client.

PAST MEDICAL HISTORY: The client does not have any medical history or complications.

PERSONAL HISTORY:

• Birth history was found to be Normal

• Language and motor developmental milestone were achieved appropriately.

• Sleep patterns were normal

FAMILY HISTORY: The client is the youngest daughter of her parents. She has two elder brothers.
Her father is a barber and mother is a housewife. She has good relations with all the family
members.

SOCIAL HISTORY: The client is introvert by nature. The client has a very small group of friends of her
school and college. She likes to go out with them.

MENTAL STATUS EXAMINATION

APPEARANCE AND BEHAVIOUR: Neatly dressed and well groomed. The client maintained adequate
eye contact throughout the session. Rapport was well established. The client was comfortable when
speaking. She was very cooperative, attentive, and willing to talk.

PSYCHOMOTOR ACTIVITY: Appropriate motor activity

SPEECH: Normal.

MOOD AND AFFECT: Appropriate

COGNITIVE FUNCTIONS: Normal

ATTENTION AND CONCENTRATION: Normal

ORIENTATION: well oriented

MEMORY ASSESSMENT immediate retention and recall, Recent memory and Remote memory were
observed to be fair.

INTELLIGENCE: Age appropriate

ABSTRACTING ABILITY: Age appropriate

JUDGEMENT: Age appropriate

INSIGHT: Aware of her problems

 COGNITIVE BEHAVIOUR THERAPY
PROBLEM STATEMENT: Feeling ignored, ridiculed, and hated by best friend

❖ BIOPSYCHOSOCIAL MODEL

The client was asked about her physiological and psychological symptoms. It covered all the
cognitive components of attitude I.e., thought, emotion and behaviour. The client was also asked
about her behaviour in social context.

Physical symptoms: Breathing issues, Headache, less appetite

Thoughts: The client is having recurrent thoughts of how her friend has become so mean to her and
are ignoring her for days.

“Why do friends always hurt so much?”

“I did not do anything wrong or try to hurt her”

“We had so many happy moments together”

“I feel very sad, lonely and not confident enough to handle situations alone”

Behaviours: She tries to talk with others, watch movies, studying

Emotions: confused, sad, unmotivated.

The client was asked to share the negative thought she had about herself and how that negative

thought resulted into negative thoughts about the world and the future.

NEGATIVE THOUGHT ABOUT YOURSELF: “I must be a mean person that is why they are ignoring
me.”

NEGATIVE THOUGHTS ABOUT THE WORLD: “All friends always hurt each other by ignoring their
best friends”, “They never respond back, even if we try to find why they are ridiculing us”

NEGATIVE THOUGHTS ABOUT THE FUTURE: “I will not be able to make true and long - lasting
friendships”
NEGATIVE THOUGHTS ABOUT THE WORLD

“All friends always hurt each other by ignoring their best

friends”, “They never respond back, even if we try to find why
they are ridiculing us”

NEGATIVE THOUGHT ABOUT YOURSELF NEGATIVE THOUGHTS ABOUT THE FUTURE

“I must be a mean person that is why they are ignoring “I will not be able to make true and long -
me.” lasting friendships”

The client stated her core belief and how it was attracting negative thoughts.
CORE BELIEF OF THE CLIENT: Friends should always be there, and they should not be hurtful or
ignoring.

GOAL SETTING: Understanding that some people might be having trust issues and friends cannot
always be on our side or always be polite due to some reasons.

❖ TECHNIQUES USED:

As the client stated that friends should always be there, and they should not be hurtful or ignoring
few techniques were used to challenge her core belief.s

VALIDITY TESTING: The client was asked if there is any objective evidence about what she was
talking. Evidence which supports the core belief- she was ridiculed by her friend, and she was not
talking to her. Evidence which contradicts the core belief- she has seen other friends of her friend
circle getting distanced from each other.

❖ OUTCOME

The client accepted that it is natural to be feeling this way. She feels that she is on the right track and
will soon be over it. She knows where she needs to work and what is to be done.