SUMMER PLACEMENT REPORT

Submitted to the University of Madras

in partial fulfillment of the requirements for

the award of the degree

MASTER OF SCIENCE IN FAMILY COUNSELLING

By

Samruthi. P. Raja

MADRAS SCHOOL OF SOCIAL WORK (AUTONOMOUS)

DEPARTMENT OF FAMILY COUNSELLING

CHENNAI – 600 008

June 2023

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Samruthi. P. Raja

Post-Graduate Student,
Department of Family Counselling
Madras School of Social Work (Autonomous)
Chennai – 600 008

DECLARATION

I, Ms. Samruthi. P. Raja hereby declare that this report work “SUMMER PLACEMENT” has been
originally carried out by me. This work has not been submitted either in whole or in part for any
degree at any university.

Date: 27/ 06/ 2023 ( Samruthi. P. Raja )

Place: Chennai

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 ACKNOWLEDGMENT

I would like to extend my sincere gratitude to KMCH Institute of Health Science and Research for
accepting my request for the summer placement and to the Department of psychiatry for this
opportunity to contribute to outpatient management. I would like to thank my supervisors Dr.
Sathya Seelan as well as Ms. Kasturi for their guidance, expertise, and support which played a
significant role in shaping my professional journey.

I am truly grateful for the knowledge, skills, and practical insights they have shared with me
throughout this journey. Their dedication and commitment to my professional development have
been inspiring, and I am fortunate to have had the opportunity to learn from their expertise.

I extend my deepest appreciation for their patience, encouragement, and constructive feedback,
which have significantly contributed to my personal and academic growth. The lessons learned and
experiences gained under their mentorship will undoubtedly shape my future endeavours.

I am incredibly grateful for the chance to gain practical experience and learn from professionals in
the field. This opportunity will undoubtedly contribute to my growth and development, and I am
eager to make the most of it. I also look forward to mandating long lasting connections with my
mentors.

I extend my heartfelt acknowledgment to my college and the Department of Family Counselling for
providing me with the internship opportunity. I would like to thank the Program Head, Dr. Hannah
John and the Assistant Professors Ms. Ashwini Rao and Ms. Sona Varghese who have been
instrumental in providing me with the invaluable internship opportunity. Their guidance, wisdom,
and unwavering support have been paramount to my growth and development during this
experience. Being a part of this esteemed institution has been an honour, and I am truly thankful for
the knowledge and experiences gained here so far.

Once again, I express my sincere thanks to all my professors and mentors for their unwavering
guidance and the remarkable internship opportunity they have provided.

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 TABLE OF CONTENTS

S.NO TOPIC PAGE

NO.
Introduction 8- 9

Institutional analysis 10- 11

Activities Performed in the Organization 12- 57

Personal Appreciations, Suggestions and 58

Recommendations

References 59

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 ACTIVITIES DURING THE INTERNSHIP

Week Activities Duration ( hours )

Week 1 (From 22 May to 27 Ward rounds, Basic skills of 51 Hours

May, 2023) taking case history, Major
domains of MSE, Multiaxial
classi cation of diagnosis,
Clusters of personality, Mini
Mental Status Examination,
Addenbrooke’s cognitive
examination, Vineland Social
Maturity Scale

Week 2 (From 29 May to 2 Ward rounds, Outpatient 43 Hours

June, 2023) management, Cloninger
classification of alcoholics,
Kirby’s Proforma, Cognitive
distortions, Motivational
interviewing, NIMHANS SLD
Battery, PGI Brain Dysfunction
Battery, MOCA, Yale Brown
Obsessive Compulsive Scale,
HAM- D, HAM- A, BPRS,
Young’s Mania Scale, CAGE,
AUDIT, Acceptance
Commitment Therapy,
Weschler’s Intelligence Scale
for Children, Master and
Johnsons technique

5
fi
.

Week Activities Duration ( hours )

Week 3 (From 5 June to 10 Ward rounds, Outpatient 51 Hours

June, 2023) management, Anger turned
inwards model, Object loss
model, Cognitive model, Self
esteem model, Learned
helplessness model,
Reinforcement model,
Biological models of
depression, Lazarus theory,
Goldstein-Scheerer Object
Sorting test, child behavioural
checklist ( CBCL), Binet-
Kamat test (BKT), Gesell
drawing test, Developmental
Screening test, Seguin
Form Board Test, Rorschach
ink blot test, Thematic
Apperception Test, Children
Apperception Test,
International Personality
Disorder Examination,
NIMHANS index for specific
learning disabilities, Bender
Gestalt test ( BGT), CBT,
DBT, theories of emotion:-
James- Lange theory, Cannon-
Bard theory, Schachter- Singer
theory, cognitive appraisal
theory, facial feedback theory
and somatic sensory theory,

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Week Activities Duration ( hours )

Week 4 (From 12 June to 17 Wards rounds, Case history 51 Hours

June, 2023) taking, MSE taking,
Administration of various tests,
Neurological deficits- Body
schema deficits, Agnosia, Left,
right disorientation, Social
neglect, Route finding
difficulty, Narrative Therapy,
Motivational interviewing,
Change worksheet, Observed a
session of ECT, DBT skill
worksheet, CARD model,
Applied behaviour analysis,
Priming effect, Script fading,
Chaining, Shaping, Exemplar
training, Discrete trial training,
Pivotal response training
Picture exchange
communication training,
Denvers model, Carolina
curriculum, Naturalistic
training, Negative cycle of
communication in
relationships, DARN- CAT,
Observed Occupational
Therapy,

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 INTRODUCTION

For the internship at Kovai Institute of Health Sciences and Research I was posted in the
Psychiatry department. I worked under a psychiatrist as well as a clinical psychologist. Working
under the psychiatrist and clinical psychologist included observing sessions, participated in ward
rounds, out patient management, learnt history taking, mental status exam, observed and performed
various psychological assessments.

Our daily routine began with going to the psychiatric ward for rounds. Visiting the ward
everyday gave us an in-depth understanding of how well the medications as well as therapy is
helping the patient improve is his/ her bio psychosocial functioning. Observing sessions helped us
understand how to have a humanistic approach to every client, how to deal with resistant or even
aggressive clients, how to establish and build rapport with a patient as well as how to psycho-
educate them.

I was able to master the skill of taking case history as well as mental status examination as
we were required to take at least 2-3 per day and present them to either the psychiatrist or the
clinical psychologist. The internship also included interacting with various populations, people of
different ages from different religious and socioeconomic backgrounds. This helped me gain a
multicultural perspective of mental health care.

I gained vast knowledge on different psychological testing tools like different intelligence
tests, personality tests, OCD tests, memory tests, SLD tests, projective tests, autism tests and
ADHD tests. We also had the opportunity to observe and interact with patients with disorders like
OCD, Schizophrenia, schizotypal disorder, bipolar disorder, borderline personality, antisocial
personality, depression, autism spectrum disorder, substance use disorder, specific learning
disabilities, severe intellectual disabilities, ADHD, adjustment disorder, emotionally unstable
personality disorder, and many more. We were able to observe how these symptoms manifest in the
clients as well as what to look out for or obvious signs for diagnosis. I was able to learn how to
come up with diagnosis or a differential after taking case history and MSE after which identify
which tests would be appropriate to administer to confirm diagnosis. I learnt how to administer
those tests, how to score it as well as interpret the score and decide which therapy would be apt for
treatment.

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 In terms of therapy we learnt about CBT (cognitive behavioural therapy) , DBT (dialectical
behaviour therapy), MET (motivational enhancement therapy), REBT (rational emotive behavioural
therapy), ACT (acceptance commitment therapy) and some relaxation techniques for patients with
anxiety which includes JPMR and guided imagery.

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 INSTITUTIONAL ANALYSIS

A division of Kovai Medical Centre and Hospital Ltd., Coimbatore, is the KMCH Institute of
Health Sciences and Research. KMCH is affiliated to the Tamil Nadu Dr, M.G.R Medical
University. The most reputable multi-specialty hospital in the southern Indian city of Coimbatore is
KMCH, a healthcare provider with a Western approach and an Indian touch. The tireless efforts of
KMCH over the past 30 years have raised the standard of healthcare in the area, serving both urban
and rural residents. They support combining cutting-edge contemporary methods with providing
exceptional care to the sick population while upholding the highest moral and ethical standards.
Department of Psychological medicine combines compassionate care and medical expertise to
provide comprehensive in-patient and out-patient treatment for psychiatric disorders. Treatment is
voluntary and individually tailored ,provided by a multi-disciplinary team consisting of a
Psychiatrists, Psychologists, Occupational Therapists and Trained Nurses.

The types of psychiatric problems usually managed by the department include:

• Acute stress reaction

• Addictive disorders
• Anxiety disorders:-
• Generalized anxiety disorder
• Panic disorder
• Phobias / Social anxiety disorder
• Post-traumatic stress disorder
• Obsessive compulsive disorder
• Depression
• Bipolar disorder
• Sexual dysfunctions
• Somatoform disorders
• Schizophrenia and other psychotic disorders
• Stress and related disorders
• Delirium
• Dementia and other cognitive disorders
• Psychological reactions to medical illnesses
• ADHD and learning disorders
• Autism
• Behavioural disorders

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They provide variety of assessment, evaluation and management of psychiatric conditions, utilizing
different type of testing. Their services include:
• Psychiatric assessment and evaluation
• Attention & behaviour testing
• Full neuropsycological screening
• Medication / psychopharmacotherapy
• Counselling
• Marital and family therapy
• Pre Marital counselling a right step in preparation for a healthy Marital bliss
• Group therapy
• Hypnotherapy
• Psychotherapy
• Occupational therapy assessment and treatment
• Personality testing
• Intelligence, developmental and academic testing
• Memory and perception testing
• smoking cessation clinic

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 ACTIVITIES PERFORMED IN THE ORGANISATION

WEEK 1

Day- 1

Today was the first day of the summer internship at Kovai medical centre and hospital ( KMCH). I
was requested to meet the HR manager at 9:00 am for the enrolment procedure. Once i filled all the
forms and completed the registration I was given a temporary ID card so I could get access to enter
the hospital. After meeting with the HR I was instructed to meet Dr. Sathya Seelan at the psychiatry
department.

At the psychiatry department I waited in the hall till sir was free. Once sir finished seeing a case he
called me inside and introduced me to the other interns. Along with me there are 4 other interns
from Christ university Bangalore. We were allowed to sit in with sir and observe as he conducted
his psychiatry sessions. Every session started off with rapport building even if it was clients that are
coming back after several sessions sir always had a general conversation first to make the patient
comfortable before discussing about their symptoms. Since Dr. is a psychiatrist. He doesn’t dive
much into counselling. It’s more about checking whether the medication worked, have the
symptoms lessened. If the symptoms haven’t become better then the Dr. either changes or increases
the dose of medication.

For the first time I had the experience of seeing patients with depression, double depression,
schizophrenia and personality disorders. I have studied about various disorders in the textbooks but
for the first time I was able to see how the symptoms actually manifests in a person. We also
observed patients with co- morbidities like alcohol dependence along with depression or anxiety.
One client had grief, depression along with a personality disorder. Aside from observing clients Dr.
Sathya seelan was extremely patient with us to explain what the disorder was, the symptoms how to
diagnose the disorder and the possible treatments. We learnt that only if a patient has
biopsychosocial occupational impairment it is considered to be a psychiatric disorder. We learnt
about the multiaxial classification of diagnosis which include:

• Axis 1- mental health and substance use disorders

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 • Axis 2- personality disorder and intellectual development disorders

• Axis 3- general medical conditions

• Axis 4- environmental and psychosocial problems

• Axis 5- Global assessment of functioning.

We then learnt about the different branches of psychiatry. Dr. gave us a few important texts books
we can refer to to increase our knowledge which will be further cemented with practical knowledge
learnt during the internship. We also learnt about mental status exam in brief.
We then looked at personality disorders and learnt about the clusters of personality which include:

• Cluster A- schizoid, paranoid, schizotypal

• Cluster B- EUPD, BPD, histrionic, narcissistic, antisocial

• Cluster C- OCPD, dependant, anxious, avoidant

We then had an overview of case history and MSE( mental status examination) skills.
After this the clinical psychologist had a brief talk with us and asked us to try to take a case history
for a patient. With the consent of the patient and after informing that we are students we tried taking
a case history to practise. I was a little nervous for the first time and jumbled a few questions. But it
was a good learning opportunity.
Sir assigned us each a patient to work with after which we were done for the day. We were
instructed that once Ma’am taught us how to take case history properly before we will be able to go
meet our patients.

Day -2

On day 2 of the internship the five of us interns were split between Dr. Satya Seelan and the clinical
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psychologist Ms. Kasturi. I was under Kasturi Ma’am. We had a detailed discussion about case
history taking. We stopped the discussion halfway to go for rounds in the psychiatric ward. We

interns accompanied the psychiatrist and the clinical psychologist as they went on rounds checking
on the patients and their improvement in functioning as well as response to treatment. Once we
finished the rounds we resumed our discussion on case history taking.

Once we were familiar with the aspect Kasturi ma’am asked us to go to the ward and collect a
detailed case history from the patients that were assigned to us. The patient who was assigned to me
let’s call her AD to maintain confidentiality was an elderly women who was unable to communicate
so the case history was taken from the informant who was her son. Before taking the case history I
established rapport by asking general questions and interacting about current affairs. Once we took
case history we had a small discussion where we had to present our cases. This way we were able to
listen to the case history of the other interns. We were able to understand what he had left out or
where we could improve on. Ma’am then gave us a feedback of our case history. Applying what we
learnt practically helped cement the concepts.

The interns all went to Dr. Satya Seelan sir’s office to observe a patient with treatment resistant
schizophrenia. The patient has not recovered after being on high dose of medication for 8 years as
well as electroconvulsive therapy. Once we observed the case sir gave us a detailed orientation into
how to conduct a mental status exam and what are the aspects involved in it. We first discussed the
basic skills which include:

• Observation skills

• Conversation skills

• Exploration of resistance

• Testing
We discussed in detail of the two major domains of MSE which are:

• Examination of cognition

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 • Examination of psychological domains

We first discussed the psychological domains in detail. We spoke about rational, imaginative and
fantasy thinking. We discussed the thought disorders like form, stream and content. Under which we
learnt about Formal thought disorders , disorders of stream and content disorders. Once we had the
discussion we were asked to apply it practically. We went to the ward and tried to conduct a mental
status examination on as assigned client. Our goal was to establish rapport and collect a case history

along with the mental status exam for the psychological domains. We were instructed to gather
enough information from the client so as to make a proper diagnosis. Once we finished working in
the ward it was already 4:30 and it was time to leave. Sir said we will continue the discussion in the
next class. After which we signed our attendance and left work for the day.

24/05/2023
Day- 3
Timing- 8:00 am - 4:30 pm

Once we all arrived at the psychiatry department we waited for Dr. Satya Seelan and Kasturi Ma’am
to finish up some work before going for our daily rounds to the ward.

After we came back from the round Kasturi ma’am taught us how to take a mini mental status
examination (MMSE). Which is used to test cognitive deficits. Along with MMSE, ma’am also
taught us how to administer the Addenbrooke’s cognitive examination ( ACE- III). We learnt how to
administer both the test and also how to score and interpret the scores of the participant. We then
administered the tests on our assigned patients. Ma’am gave us both the literate and illiterate
version of the ACE- III test so we could administer it to both the population. We administered the
test of patients with intellectual disabilities or cognitive impairment to understand how their
responses would be. Ma’am asked us to administer the same test again after a while. We could
observe that the patients were more comfortable in answering and were more confident with their
answers. They even scored a little higher the second time. We were instructed to administer the test
everyday in order to understand the fluctuations is patients answers and scores.

Later, Dr. Satya Seelan called us into his room to observe a very rare case. The patient was suffering
from emotional incontinence which causes pathological laughter and crying. The patient suffered
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from inappropriate involuntary laughter and crying due to a nervous system disorder. It affects the
limbic system. After observing the case sir continued which where we stopped off the previous day.
We first had a discussion of the mental status examination we conducted. Last class for the theory
aspect we stopped with quality of affect.

Today we continued with Intensity of affect under which we learnt about-

• Blunted affect

• Shallow affect

• Flat affect

• Mobility of affect

• Range of affect

• Appropriateness

• Communicatibility

We then spoke about subjective questioning. Sir then asked us to read about the different types of
depression and the different types of hallucinations

Next we looked at perception which includes:

• Sensory deception

• Sensory distortion

We looked into both these domains in detail.

Next we started with the other half of the mental status examination which is the cognitive
assessment. Under cognitive assessment we learnt about attention, concentration, orientation,
memory, etc.
We then spoke about few interesting psychological phenomena’s like the gun point effect and the tip
of the tongue phenomena. We also looked at earlier psychological tests like alpha test and beta test.

16
We then looked at a patient with Wilson’s disease which caused copper to accumulate in the organs
and another with trichotillomania which is a disorder that involves recurrent, irresistible urges to
pull out body hair.
Sir then gave me some books that very family counsellor must read they include:

• Attached by Amit Levine

• Walking the tiger by Paul Levine
• Body keeps core
• Hold me tight

We then learnt a bit about diagnostic psychometry and testing. After which we dived into memory.
We looked at what an iconic image is. We discussed about short term memory, long term memory
and about how we store and recall it. Sir asked us to read about the quality of memory at home as
well as some memory techniques. We also learnt about Smiling depressions Lilliputian
hallucination Metamorphic hallucination.
With this we completed day 3. Signed our attendance and left for the day.

Day- 4

We started off today by presenting the case history we had taken previously to Kasturi ma’am. We
all took turns to present and once we did Ma’am corrected us on where we went wrong. She
appreciated the places we did well and also pointed out the areas we had to improve in. She also
explained to us how a case history presentation must be. The way we present and well as the
language that must be used.

We then learnt how to administer the Vineland Social Maturity Scale( VSMS). We learnt about the
uses of it, the different dimensions as well as how to score and interpret the scores. Since most of
the inpatients we have at the ward are all adults maam said we could go to the paediatric ward to
administer the tests with consent from the parents.

After learning about the VSMS scale we went on our daily rounds to the psychiatric ward. We could
observe how the medications were working for some individuals. Day by day the difference we
could notice in their appearance and behaviour was evident. After we came back for our rounds we
accompanied Dr. Dhakshana, a senior resident psychiatrist. We had a discussion about motivation,
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theories of motivation, importance of motivation therapy for SUD. We also learnt about what
gateway drugs are and about poly drug use.

We then observed a case of a patient suffering from agitated depression and also a family therapy
case where it was a complex mix of genetic disorders. The mother was suffering from paranoid
schizophrenia, the son was suffering for MR with ADHD, the daughter was suffering from MR and
psychotic symptoms and the father was suffering from dysthymia. Hence it was a very complex
gene poor and tricky to treat. After this case we had a discussion about the different clusters of
personality.

Dr. Satya Seelan sir then asked us to learn about psycho education. He explained to us the important
of psycho education and about its usefulness as an effective tool to help individuals and families
understand what their loved one is going through. Sir then asked us to read a psychological journal
every month. He stressed on the importance of being up to date in the work of psychology as
changes are being made constantly. He told us to pick out 5 journals with good impact factor and
start reading them.

Sir now finished explaining the whole MSE. With teaching us about general appearance,
psychomotor activity, signs of Catatonia, speech, intelligence, judgement, insight and attitude
towards the examiner. We completed MSE as a whole. Sir asked if we had any doubts in it after
which he informed us that we have all the tools necessary to collect a details case history with MSE
and expects us to collect a very details and we’ll structured case history. He also mentioned that
until we master the skill of taking and presenting a case history we won’t be moving forward. Once
we go get the hang of it. Sir said we will move to individual disorders in detail.

We were asked to observe a group session conducted by the occupational therapist but it took time
for it to begin so sir asked us to leave and be ready to take case history the next day. He also gave us
homework to find psychological journals, read about psycho education and the Bush- Francis
catatonia rating scale.

Day-5

We started off the day with a new patient. We were asked us to try and pick up symptoms and come
up with a diagnosis. The patient presented with feelings of fear and sadness as soon as he wakes up.

18
Which subsides as he goes through the day. This is a classical symptom of depression. The patient
also had psychomotor agitation, early signs of dementia which caused superstition anxiety. He had
vascular dementia.

Sir then explained to us the diagonal variations of mood and how it helps a clinician to diagnose
certain disorders. Variations in mood in the morning be indicators of depression and similarly
variations in the evening can be signs of delirium.

We then looked at the 6 A’s of dementia which will be a helpful diagnostic tool to identify it in its
early stages. They are:

• Anosognosia

• Amnesia

• Aphasia

• Agnosia

• Apraxia

• Altered perception

• Apathy

We then saw another case of a child. The symptoms as explained by the mother all pointed toward
ADHD but then sid explained that co morbidities in children were very common and also told us
that a disorder in child is never what it seems. It’s important to understand that it’s never exactly
what it presents to be. The child was actually suffering from oppositional defiant disorder (ODD)
along with dyslexia. Sir explained that we could use an IQ test, Binet-cometh test or the NIMHANS
SLD battery. The clients parents had a lot of marital disharmony. For that they were asked to attend
sessions for supportive psychotherapy.

Sir then told us that as psychologist is very important to read. He told us to text our average reading
speed so we can understand whether we are effectively reading or not.

Next we had a case of a 23 year old male presenting with symptoms of increased fear and
palpitations. As the client kept talking about getting palpitations when he goes out in public. He also

19
mentioned he had a willed in the merry where he felt like he was getting a heart attack and he
fainted after which his fear of going out in public increased. He cannot be alone or travel alone
anymore. With all the symptoms presented it was clear to be panic disorder with agoraphobia. We
also had a patient come in with generalised anxiety disorder (GAD) for which sir recommended a
treatment of mindfulness, JPMR and breathing exercises.

We then discussed about few journals and spoke about the history of psychiatric practice. About the
mental care act of 2017 as well as the evolutions of different laws around mental health. Sir asked
us to read about the experiment called “being sane in insane places”.

We then learnt about a few mindfulness techniques. Sir administered a session on ACT( acceptance
and commitment therapy) along with guided imagery. He also taught us about the lead technique to
remove anxiety provoking thoughts. Sir asked us to read a somatic therapy book to further
understand. He explained the importance of understanding the neurobiological basis of any disorder.
We need to understand how non- pharmacological interventions are equally as important as
prescribing psychotropic medications. Sir spoke about how mindfulness techniques helps as
individual connect with their wise mind and helps them become one with the universe. For asked us
to read another book called the peaceful warrior. We learnt that the effects of the basal ganglia in
psychiatric disorders is so immense. The manuals by Marshall helps us to understand the
importance of the basal ganglia. Another book sir recommended us to read was the happiness trap.

Day- 6

Today we saw a case of a child with herpes zoster also knows as shingles. Sir was telling us that the
child would have life long cognitive impairment. It’s a very preventable disease but due to the
negligence or the poor awareness of the parents now the child will have to suffer.

After the case we went for our daily rounds to the ward. We had a patient come in on Monday
having severe withdrawal symptoms and delirium. He was suffering fork alcohol dependency. I’m
just a few days we could see how his tremors stopped. His speech became more clear and he was
able to return to normal level of functioning. But we could also notice another case of a young girl
with bipolar get better and worse. She has complete lack of social disinhibition. She was making
inappropriate comments to the doctors and the nurses, was behaving aggressive to come if the other
patients and their attenders. Sir asked us to stay back and take case histories. He gave us one hour
20
time to take individual case histories and asked us to present it after. Once we finished we went
down and presented it. I made the mistake of using colloquial terms or more textbooks terms while
presenting it. I used terms like alcohol dependence, perpetuating factors. So sir corrected me and
mentioned that while presenting a case history I must only use words that the patient used. I need to
present it in the words of the patient and should avoid using my own words as it would become
labelling without a proper diagnosis.

Later sir spoke to us about the importance of sleep. And how sleep disturbance is a common theme
seen if every psychiatric case. Sleep hygiene is important to learn and understand. Sir asked us to
read about IPSRT which is interpersonal social relations with therapy and asked us to learn all the
steps involved. After this sir got another client. A couple who were referred to from the ENT
department. Since it was a couple who came in and I’m doing family counselling sir gave me the
responsibility of taking case a thorough case history and coming up with a diagnosis. One of the
psychiatrist was on leave so sir asked me to take her room. It was a complete shock to me I was not
prepared. I was very nervous. Sitting in an office room felt very exhilarating. It felt like i could
envision my future plans and felt like I was living my dream. Since it was a couple who came in for
therapy. I first saw them together. I collected general demographic details and established rapport
with both of them by talking to them. I asked the reason for referred as they came from the ENT
department. The husband spoke about domestic violence. He had hit her very badly which caused
damage to her ear and hence they referred them to see the psychiatrist. I asked the husband to wait
outside sheik I first spoke to the wife. I collected a detailed history from her. About her personal
history, family history, occupation and marital history. I asked if she consented for the marriage for
which she mentioned it was forced. Once I took a history I also asked her to describe what she
thinks of her husbands personality. Once I collected all the details I asked her to wait outside while I
spoke to her husband alone. I collected all the same details from him as well. Once I collected all
the information it was clear that both of them have attachment issues that stem from their families
of origin. They have anxious - avoidant attachment style that leads to major conflict. They had
martial conflict along with attachment disorder. Now I asked sir for guidance. He asked me to refer
them to the clinical psychologist to do some assessment and set dates for marital therapy. When i
presented how went about the case to sir. He was impressed with my diagnosis and he was happy
that I individually spoke to them. Handling this case gave me such a boost of confidence. I always
wondered how I would be in a counselling session but I felt like I handled myself with confidence. I
was very nervous so the session was a case of fake it till you make it. I internalised my mentors and

21
asked myself what they would do in this instance and that’s what helped me carry out the session.
When the clients called me ma’am and opened up to me I felt very accomplished.

With this we were done with the first week of the internship. In just a week I feel like I’ve learnt
and experienced a lot. It’s been a very informative week.

WEEK 2

Day 7

Our first case of the day was an individual suffering from generalised anxiety disorder. After seeing
the client sir explained to us the difference between generalised anxiety disorder and phonic anxiety.
Sir said that GAD is characterised by free floating anxiety. He told us the most difficult disorders to
treat were hyperchondriasis, GAD and then OCD. next we saw a patient with irritable bowl
syndrome. The third patient was an individual suffering from emotionally unstable personality
disorder along with boderline intelligence. This leads to extreme disinhibition in the patient to an
extent where she tried to first her husband to be sexual intimate with her in public to prove to others
that they are happily married. We also saw a patient with organic personality change which is
characterized by a change of premorbid behaviour due to an organic impairment or disease of the
central nervous system. Post an accident the individual suffered injuries to the head which has now
made him a very impulsive and aggressive person.

We then went on our daily rounds and to the ward after which sir explained to us the importance of
always checking for suicidal tendencies in patients. It is unethical for a psychologist to send a
patient back home if they have severe suicidal thoughts or ideation especially is the client as
attempted for suicide already. The counsellor must check for lethality, remorse and intention. For
the next patient sir asked us to give a spot diagnosis by the initial observation. Sir told us that
though it is unethical to diagnose on the spot. It is essential for counsellors to have good
observational skills and to be able to pick up symptoms. The patients walked in with tremors in his
hands. His speech was slurred and his eyes were yellow. From his behaviour we could point out that
it was SUD. Sir also pointed out that yellow eyes is classical of jaundice.

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Sir then taught us a little about Autoimmune encephalitis which is a collection of related conditions
in which the body's immune system attacks the brain, causing inflammation. The immune system
produces substances called antibodies that mistakenly attack brain cells. Sir said that there was a
patient in the female ward with this condition and asked me to take a case history and MSE from
her. We then looked at the Kirby’s proforma which is a tool used to examine uncooperative patients.

We then looked at certain ethical rules we need to follow as mental health practitioners. Sir spoke
about the Hippocrates oath that doctors take which should extend to all mental health practitioners.

We then discussed about Cloninger classification of alcoholics which include type I and type II. We
learnt about covert sensitisation, aversion therapy and types of aversions. We also had a discussion
on Rational emotive behavioural therapy which sure asked us to do further reading on. We spoke
about some anti craving strategies and the defence mechanisms in alcoholics.

The next client sir has was a patient with hyperchondriasis which is obsession with the idea of
having a serious but undiagnosed medical condition. Before sir called the client in he had a
discussion about cognitive distortions which is errors in the thought process. He told us to monitor a

brief therapy session where sir tries to make the patient understand what cognitive distortions are
and to understand the errors in his way of thinking. Sir first established rapport and asked the
patient what was troubling him to which he replied that he would get chest pains randomly, fear of
dying and fear of abandoning family after death. Sir explained various distortions like jumping to
conclusions, catastrophisation, all or none thinking and emotional reasoning to the patient is very
simple terms. He did small activities like giving the client a situation where his wife was suffering
from the same things he was suffering from. His wife was complaining about the chest pain and fear
of dying. Sir asked the patient what his response would be to his wife. The patient said that he
would say all the reports are normal, stop overthinking about it, it will all be fine. Sir then pointed
out that it was easy for him to console another person. But when it comes to him he’s not able to
accept that it might all just he in his head. This made the patient a little aware about the distortion.
For the next activity sir gave the patient a hypothetical questions. Sir asked him “ you are now 90
years old, you lived a healthy life. How would you look back at your life” to which the patient said
“I’ll be very disappointed looking back and thinking I wasted so many good years of my life in
hospitals instead of spending time with my family.” This is as another way the patient got insight
into his errors in thinking. Sir then asked the patient to close his eyes relax and think for 2 minutes

23
about every ailment and pain in his body. Once the 2 minutes were over he started talking about his
shoulder pain and chest pain. Then sir said him if he felt this pain the entire time or only now? To
which he said he only noticed it when he was giving it attention and didn’t feel pain before when
they were having a general conversation. Sir explained to us how these activities help in challenging
the errors in his ways of thinking. Sir said that this was a very brief example and CBT has more
aspects to it.

We then had a detailed discussion on the importance of motivational interviewing, the principles
and steps in MI. We then had a small role play activity were we trying to demonstrate MI
techniques. Sir picked one person to be the client in need of motivation and one person to be the
counsellor who is going to engage in change talk. Once the activity was done. Sir made all of us
take turns to be the counsellor. He pointed out the mistakes we made. We all engaged is sustained
talk. Sir said that we should avoid sustained talk and only engage in change talk. Sir also asked us
to avoid righting reflexes. He asked us to follow the 30:10 or 60:10 rule where the counsellor talks
for 10 meanwhile the rest of the time the client must be the one talking. With this activity we
punched out for the day as it had already become 4:50 pm.

Day- 8

The previous day we had a patient suffering from organic personality changes after a suffering head
injuries due to an accident. Kasturi ma’am the clinical psychologist was conducting assessments to
test his sustained attention, focused attention and divided attention. Ma’am called me in to observe
how she administered the NIMHANS SLD battery on the patient. The total tests takes
approximately 4 hours to complete. It can be used for individuals between the age group of 16- 65
years. The scores can range from 15-85. I observed tests like:

• Tower of London -which was administered to test his planning

• Triad test- for divided attention

• Rays complex figure test

• Stroop test

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 • Auditory- verbal learning test

• Digit symbol substitution test - for mental speed

• Colour triad test I and II- for focused attention

• Digit vigilance test

• Animal naming test- for fluency

• COVA

• Bhatias- picture test, pattern test, kohs block test, pass along test

• PGI brain dysfunction battery

• Finger tapping test- for motor speed

• Design frequency test

• Wisconsin card scoring test

• Token test- for comprehension

• Logical memory test

• MMSE and MOCHA

I observed ma’am administer each and every test. I was able to learn how to give the instructions,
how to time each trial, whether I need to count the number of moves attempted etc. ma’am also
taught me how to score each test and it’s interpretations.
After this I joined the rest of the interns who were with Dr. Satya Seelan sir. We discussed Y-BOCS
25
which is the Yale- Brown obsessive compulsive scale used to test for OCD. It includes a severity list
as well as a symptoms checklist. Sir asked us to administer the test on an individual who’s been
getting treatment for a while to test the improvement. His initial score when he came for therapy
was 41. After treatment when we administered the test on him he scared 29 which meant there was
major improvement. After this coincidentally we got another case where an individual came in with
symptoms of OCD sir asked us to administer the test on her as well. She got a total score of 41
which indicated she suffered from OCD. while conducting the test on her it was seen evidently the
amount of distress this disorder was causing her. She spoke about how she feels her life and the
lives of people around her depend on her. If she doesn’t wash her hands or clothes the proper way or
if she doesn’t arrange things the right way someone could get harmed severely. This feeling caused
server distress in her life and she couldn’t function normally. She also said she keeps checking,
double checking and triple checking the stove, whether the door is locked. If she is going to close
the door. She gets stuck in a loop of opening and closing the door because of her paranoia. Sir asked
her to come for therapy and prescribed her some medication as well.

Later in the day Dr. Dhakshana introduced some scales to us like the:

• HAM- D scale for depression

• HAM-A scale for anxiety

• BPRS- for psychiatric symptoms

• Young’s Mania Scale

• CAGE and AUDIT- for alcohol dependence.

Sir asked us each to choose and scale and administer it on patients in the ward to test whether the
psychotropic medications are working effectively or not.

Later we had a discussion on grief. We spoke about how to evaluate grief. Sir asked us to read the
chapter called death and dying from Kaplan and Sadocks book. Sir said that onco- psychology
involved a lot of grief therapy. Supportive psychotherapy works effectively for it.

26
We also looked at acceptance and commitment therapy ( ACT) is a type of psychotherapy that
emphasizes acceptance as a way to deal with negative thoughts, feelings, symptoms, or
circumstances. It also encourages increased commitment to healthy, constructive activities that
uphold your values or goals. With this we ended the working day, signed our attendance and left for
the day.

Day-9

We started off today with a presentation of emotions. Sir asked us to brush upon the theories of
emotion. All of us presented about what emotions are, the physiology is emotions, the brain and
emotions, arousal and stress.

We then spoke about thought action fusion in patients with OCD. Thought-action fusion is when
you believe that simply thinking about an action is equivalent to actually carrying out that action.
For example, if a thought randomly pops into your mind about something unacceptable—such as
murdering your partner—you would believe this to just as bad as actually harming them.

We then had a very interesting and interactive session with dr. Satya Seelan sir. Since he had less
cases he told us we were gonna have an interpretation class where we would as a group interpret
tough theories and make an understanding of it. We chose relational frame theory as it was a theory
that even sir felt like he didn’t fully understand. We divided the group into two people who stood by
the white board to draw a schema or a mind map of the theory as we discuss it to make a better
understanding. Sir and another person were the meditators. Samyuktha and myself were the ones
who were reading out the theory. We chose to work on relational framework theory. As I read out
the therapy. We broke it into smaller parts and interpreted it. Thought the theory was complicated
and very theoretical working on it as a group helped simplify it. The session was very interesting
and fun. We decided to stop after while to back to seeing cases. Sir became busy after that so we
decided to continue it another day.

We then looked at the types of peer pressure which include:

• Spoken

• Unspoken

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 • Direct

• Indirect

• Positive

• Negative

Later we discussed naturalistic and non naturalistic training. We then looked at how dopamine gets
secreted in our body for different acts.
We discussed about what core beliefs are. Sir conducted an activity to show us how to identify
anyone’s core beliefs. Sir first asked me about any event that distressed me in the recent past. He
then asked me what I thought about it and then how I felt when it happened. With just a few simple
questions sir was able to give me insight on what my core belief was and it was actually shocking
cause it was very accurate. It made me more aware of why I react to certain things the way I do. We
also spoke about intermediate beliefs, our adaptive behaviours and the situations.

We then got a case of an individual suffering from dissociative disorder and dissociative stupor. Sir
pointed out that she also may have boderline intelligence due to her cranial deformity. It was
interesting to learn that face shapes can be used as tools to identity certain characteristics.

We then read on Howard’s laws of human nature. After which we had a discussion on the
importance of studying neuroanatomy and the importance of the basal ganglia as well and the
limbic system for many of the psychological or psychiatric problems. We also learnt about several
neural pathways.

Next we had a discussion of addictions counselling. We spoke about the various types of substances
and how it affects an individual. Sir also explained how weed increases the chance of getting
schizophrenia by two folds. With this we signed our attendance and left for the day.

Day 10

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As soon as I arrived Kasturi ma’am asked me to come in so she could teach me a test separately.
Ma’am wanted me to learn about Weschler’s intelligence scale for children ( WISC- IV). I learnt
how to administer all the tests, which were:

• Block design

• Similarities

• Digit span

• Picture concepts

• Coding

• Vocabulary

• Letter - number sequencing

• Matrix reasoning

• Comprehension

• Symbol search

• Picture completion

• Cancellation

• Information

• Arithmetic

• Word reasoning.

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Out of all these tests 10 tests are compulsory to administer. The remaining are optional which can
be used if the child is unable to do any test.
From these ten tests we are understanding 4 main domains which are:

• Verbal comprehension

• Perceptual reasoning

• Working memory

• Processing speed

Ma’am also taught how to score and interpret the results. Once I got familiar with the concept
Ma’am asked me to administer it on a patient who came in with learning disability. Before
administering the test u took a detailed case history along with an MSE for children. After that I
administered the test. Once I administered the scale the first time I got even more familiar with it.

Next while the others were learning how to administer bhatia’s scale ma’am asked me to administer
the VSMS scale to a mother of a child with autism to understand the child’s social maturity. While
the patient was in occupational therapy I spoke to the mother and established rapport so she feels
comfortable enough to share sensitive information regarding her child to me. Her mother was very
cooperative and was willing to talk about anything. The patient is 15 years and 10 months old but
from administering the VSMS scale we understood that she only had a social maturity of a 1 year 7
month old child. After finding out the social age, Using the chronological age and the social age we
can calculate the social quotient which was 10 which is considered to be profound.

After administering these two tests maam asked me to monitor the others while they administered
bhatias scale to a child. After we all administered the scales assigned to us we went to Dr.
Dhakshana’s room to observe a few cases. Sir taught us a little about projective tests and we got an
introduction to Binet- Kamat intelligence tests.

Later sir got a very interesting case of a woman complaining about dissociative episodes. She was
resistant while talking to sir so he asked me to take a detailed case history and present it to him. I
took her to the other room and. Collected the history. Once she got comfortable with me she started
30
opening up about everything. She even told me she lied to sir because she couldn’t say the truth and
continued to tell me everything she left out from her initial story. I was able to take a detailed
history from her as well as an informant who was her son. Once I was done I presented the case
history to sir and we discussed about the possible diagnosis.

Overall today was a very productive day. Got a lot of practical knowledge. With this we signed our
attendance and left for the day.

Day- 11

We started off today by directly going for rounds. A 16 year old patient with bipolar disorder
admitted in the ward was getting increasingly more violent. She started attacking her mother and the
nurses the previous night. The hospital got special permission from the medical board to do
electroconvulsive therapy on the patient. Usually ECT is done on patient above 18 years only but
the hospital got special permission. Previously ECT already helped her once. She remitted well
from it but now has relapsed again. So they decided to go for another round of ECT.

While we were finishing up the rounds Satya Seelan sir got a call from the OP room. The nurse
called to say there was a very aggressive patient. Sir asked us to go alert the security and go along
to see what happens. Sir said it’s important for us to see aggressive patients as well and get used to
it as it is common in the mental health practice. Sir came with us to see the patient but he was very
aggressive. He was in a manic episode and he wasn’t speaking coherently. Sir asked the security to
find out if he had any family and to call them in as he wasn’t able to communicate and they can’t
admit him without a guardian present.

Then we learnt about pygmalion effect which refers to refers to situations where high expectations
lead to improved performance and low expectations lead to worsened performance. We had a
discussion about our opinions on it. Personally for me I think it works. I have always been told I’m
an average student. I’ve heard the word average my whole life and my performance has been
average I never put any extra effort. But recently in MSc. because of supportive and motivating
favourite and their expectations I have started performing better and I have ale extra effort to want
to perform. We then also spoke about galatea effect which involves raising an individual's self-
efficacy which results in an increase in performance. The Galatea effect only occurs if there is an

31
actual increase in self-efficacy, as well as an increase in performance. Then we had a discussion on
self efficacy.

We then got a patient suffering from schizoaffective disorder. He was showing increased social
responsibility. We also looked at the s Schneider's First Rank Symptoms (FRS), which include:
auditory hallucinations; thought withdrawal, insertion and interruption; thought broadcasting;
somatic hallucinations; delusional perception; feelings or actions as made or influenced by external
agents.

Sir then taught us about Saturday night paralysis. It occurs when someone compresses their arm
overnight usually after heavy drinking. This can easily help us identify that a patient suffers from
substance use disorder.

Later we looked at sex therapy. We say the different kinds of sexual dysfunctions and then read
about Master and Johnson’s techniques. We also looked at the phases of sexual response which
include: 1) excitement, 2) plateau 3) orgasm, and 4) resolution. Sir explained that sleep, sex and
eating disorders are the most common. These are also the three factors that get affected in every
disorder. Every disorder involves some level of impairment in sleep, eating habits and sexual
activities. We also looked as Freud’s works, human sexual cycle and human sexual inadequacy. We
then saw the Plissit model of sex therapy which is one of the most widely used interventions in the
field of evaluating and managing sexual problems. The model consists of four steps for addressing
sexual concerns: Permission, Limited Information, Specific Suggestions, and Intensive Therapy.

After then we went back to discussing the relational framework therapy that we stopped the
previous day. We saw a few more pages and then finished up for the day.

WEEK 3

Day- 12

32
After our routine morning rounds we started talking about the rapid cycling of
One of the patients recurved ECT for bipolar as she had rapid cycling. Rapid cycling refers to four
or more episodes of mania, hypo mania or depressive episodes within a year.

We then discussed about dysgeusia which is an altered or impaired sense of taste. It can be
symptom of depression. Whereas ageusia refers to total loss of taste which is commonly substance
induced. Sir rock us to read about Veraguths fold which is a type of skin fold next to the upper eye
lid and is considered to be a characteristic for patients suffering from depression. He told us the
importance of observation. We then spoke about anger turned inwards which is a notion of
depression as anger turned inward. The stages are as follows:-

• Loving an object

• Introjection

• Ambivalence

• Guilt

• Frustrated parent

• Retroflexed anger

• Depression

We discussed thanatonic energy, depression model and well as the defence mechanism introjection.
Introjection occurs when a person internalizes the ideas or voices of other people. Usually occurs
during grief or separation.
We then look at few depressions models:

1. Object loss model which talks about the actual loss of a person who has served as a good
object, which precedes introjection and is involved in separation anxiety. Anxiety about the

33
 possible loss of a good object begins with the infant's panic when separated from its mother.

2. Cognitive model or configure triad proposed by Aaron beck which talks about negative
feelings about the world which leads to negative views about the future which leads to
negative views about oneself.

3. Self esteem model of depression model suggests that life experiences shape an individual's
beliefs about the self, others and the world. These 'schema' shape how a person perceives
(filters) and understands their life experiences.

4. Learned helplessness model has important implications for depression. It posits that when
highly desired outcomes are believed to be improbable and/or highly aversive outcomes are
believed probable, and the individual has no expectation that anything she does will change
the outcome, depression results.

5. Reinforcement model of depression asserts that depression results from a loss of adequate
reward contingencies. Specifically, when positive behaviors are no longer rewarded in ways
that are perceived to be adequate, those behaviors occur less frequently and, eventually,
become extinct.

6. Biological models of depression has several theories concerning the biologically based
cause of depression have been suggested over the years, including theories revolving around
monoamine neurotransmitters, neuroplasticity, neurogenesis, inflammation and the circadian
rhythm.

Later we discussed about the Lazarus theory. Lazarus and Folkman believe that the way we
interpret or react to an event can often have a more powerful impact on our stress level than the

34
event itself. They developed a framework to help people to manage stressful situations using
objective appraisal and coping strategies.

We also saw the Goldstein-Scheerer Object Sorting test which is used to assess abstract thinking
and how well concepts are formed. The patient is required to sort objects by colour or material,
copy block patterns with coloured cubes. The tests are mainly used to diagnose neurological
problems. Along with that we saw how to do the house- personality- tree test. Test takers are
instructed to draw a house, a tree, and a person as accurately as possible on separate sheets of paper.
They are then asked a number of questions about their drawings. With the help of this test a persons
cognitive, emotional and social functioning. We also administered the 3 wishes test.

Sir spoke about how ambivalence resolution is an important technique that every psychologist must
know and we looked at what choice point is. We also discussed about delusions of presence and
persistent delusions disorders. We had a discussion about the difference between somatofrom
disorder, delusion disorder, schizophrenia. We then looked at autism spectrum disorder and its
classification in brief.

Lastly we went to Kasturi ma’am to learn about child behavioural checklist ( CBCL) so administer
on few children to understand their diagnosis better. We first took a detailed case history from the
mother about the kids. Then we took MSE from each of the kids to understand their level of
functioning. After which we administered the children behaviour checklist on the mother. With this
we finished up work for the day. Since it had already become 5:10 sir asked us to do the scoring the
next day.

Day- 13

We started off the day with Kasturi ma’am the clinical psychologist. She taught us all about the
Binet- Kamat test (BKT). The test consists of six dimensions- Language, Memory, Reasoning,
Conceptual thinking, Visual Motor and Social Intelligence (Verbal & Non Verbal). The age range is
from 3 to 22 years. One we finished learning how to administer each test Ma’am gave us all a
patient to administer the test individually. I administered BKT on a 17 year old boy with Down
syndrome. Once all the tests were completed we identified the basal age, terminal age and the
mental age of the patient. Ma’am then taught us how to score and interpret the IQ.

35
Maam also said that we can use other tests if the child is unable to perform on the BKT like:

• Gesell drawing test- which tests cognitive language, motor and social emotional response. A
child's natural behavior will be assessed against three levels of age appropriate norms

• Vineland Social Maturity Scale

• Developmental Screening test- The tools used for developmental and behavioral screening
are formal questionnaires or checklists based on research that ask questions about a child's
development, including language, movement, thinking, behavior, and emotions.

We then learnt how to administer the developmental screening test and u administered it on the
parent of the patient with Down syndrome. After establishing rapport and collecting a history I
administered the test. From the test we were able to understand that the patient got a score of 41
which indicates moderate intellectual disability.
Next we learnt another test called the Seguin Form Board Test. The test is based on the single factor
theory of intelligence, which measures speed and accuracy. It is useful in evaluating a child's eye-
hand coordination, shape-concept, visual perception and cognitive ability. The test is primarily used
to assess visuo-motor skills. We administered the test on each other to understand how it works. We
took three trials each which was timed. the the average of the three scores or the least time taken is
considered from which IQ is calculated.
After that I administered Weschler’s intelligence scale for children on a 11 year (10 years 7 months)
old boy. I tested him on vocabulary, comprehension, information, similarities, picture concept,
matrix reasoning, picture comprehension, digit span forward and backward, letter number
sequencing, arithmetic, coding and symbol search. From all these tests we got the scores of 4
domains- verbal comprehension, perceptual reasoning, working memory, processing speed. From
the scores of the 4 domain we for the full scale score which indicated an IQ of 88 which is
interpreted as below average IQ.
After administering all the tests ma’am taught us how to write a proper report. She told us that it
should include:

36
 • The demographic details of the patient

• Date

• The referral source

• Salient features of history

• The assessment or test which consists of cognitive, personality, emotionality and

psychopathology assessments.

• Behavioural observation of the client

• Whether eye contact was made and sustained

• Whether rapport was established

• The patients speech whether it is coherent

• Attentions and comprehension

• Cooperation of the patient because

• Behaviour during assessment and towards the examiner

Ma’am then told me that she will assign a new case just for me soon. A random case with no prior
diagnosis. I will have to handle the patient all by myself under ma’am guidance. I will take case

37
history, MSE and decide where there is impairment and choose the right test accordingly administer
it and present the report to ma’am and Satya Seelan sir. I am nervous but also excited to handle the
case.
Post lunch since I finished all the IQ tests maam asked me to go o serve cases under Satya Seelan
sir while the rest of the interns stayed to complete the other tests. With Satya Seelan sir we spoke
about the Flynn effect which states that intelligence or IQ increases worldwide from decade to
decade. We spoke about Rorschach interpretation. Then we discussed behavioural activation.
Behavioral activation is an approach to mental health that focuses on using behaviors to “activate”
pleasant emotions. The idea is that by putting action first, a person does not need to wait to feel
motivated, but they can still gain the benefits that the action has on their well-being.
Later after seeing a few patients we discussed about theories of intelligence. Sir asked us to read
about it and be thorough with all the theories. We then had a discussion on the Harvard longitudinal
study that’s going viral recently.
Lastly we spoke about somatic therapy. Somatic therapy, sometimes known as body psychotherapy,
is a therapeutic approach that places importance on what we experience in the mind and the body as
well as the connection between the two. “Somatic” itself means “of or relating to the body.” Before
we left for the day sir asked us how we feel about monotonous work. He said that depression is the
most common disorder and we may see a minimum of 4 patients with depression everyday which
means that we have to repeat the same questions over and over again. Sir asked us how we feel
about this. He told us the importance of not letting our sessions with the clients become just a
checklist. We discussed the importance of not losing a humanistic approach. Sir said a line that
really stuck with me. He said for us the patient might be the 4th or 5th for the day but for the patient
it’s their first experience with the counsellor. So it’s important to keep in mind and understand that
working with every patient is a new experience and we must show the same amount if empathy and
genuineness. With this we signed our attendance and left for the day.

Day- 14

We started off today with Kasturi ma’am. We learnt about a few personality tests. We started off
with the Rorschach ink blot test. The Rorschach test, used in conjunction with other diagnostic
tools, is a projective measure for identifying a person's state of mind and various personality traits.
The inkblots have up to 300 different reported interpretations for each blot. Ma’am showed us the

38
entire test. We saw each card and gave our own interpretations. We learnt the entire administration
process. We learnt how to collect the response, total time taken, response phase and enquiry phase.

Next we looked at the thematic apperception test. The Thematic Apperception Test, or TAT, is a
type of projective test that involves describing ambiguous scenes to learn more about a person's
emotions, motivations, and personality. We looked Henry Murray’s version of the test as well as the
Indian adaption by Uma. We looked at all the cards and administer it on each other. We also looked
at the children apperception test (CAT) which contains cards of both human figures and animal
figures. The cards with animal figures are used for children with low IQ and the cards with human
figures are used for children with higher IQ.

We also looked at the International Personality Disorder Examination. The IPDE Screening
Questionnaire is a self-administered carbonless form that contains 77 DSM-IVTM or 59 ICD-10
items written at a 9-10 year old reading level. The patient responds either True or False to each item
and can complete the questionnaire in 15 minutes or less. Ma’am asked us to administer the test on
ourselves after we go home.

After learning these tests we went to Dr. Satya Seelan sir to observe cases. We saw a patient who
came in with an addiction to inhaling paint thinners and tube sealants. We learnt about the effects of
inhalants in addiction counselling so it was very interesting to practically see how it affects the
individual. The patient had to be admitted for treatment. This gives us an opportunity to observe
him in the ward and keep track of improvements.

Next we looked at Electro convulsive therapy ( ECT). One of the patients in the ward suffering
from bipolar disorder was undergoing ECT help with the manic episodes. We all had permission to
observe the session one be one. Since we could observe sir wanted us to learn about it before we
observe the session. We learnt that Electroconvulsive therapy (ECT) is a procedure, done under
general anesthesia, in which small electric currents are passed through the brain, intentionally
triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse
symptoms of certain mental health conditions. We also learnt about the history of ECT. how it
originated because a psychiatrist Meduna, in a descriptive study found that many patients who had
seizures has reduced psychotic symptoms post the episode. After many unethical and dangerous
ways used to induce a seizure Ugo Cerletti and Lucio Bini used an electric current to elicit an

39
epileptic seizure for therapeutic purposes. Thus they were called the fathers of ECT. we also spoke
about the types of ECT-

• Bilateral ECT. This is when the current is passed through both sides of your head.

• Unilateral ECT. This is when the current is only on one side of your head.

Sir then asked me to take a case history and MSE from a new case who came in. It was a 9 year old
boy. Once I completed the case history and MSE I presented it to sir. There were a lot of cognitive
deficits. The latient also presented with episodes where he would lose control, run palms, chew on
the tongue and blabber. The patient was never aware of what happened after. Sir called in the
patient to confirm the diagnosis. They explained that it could possibly be Automatism caused be
Complex Partial Seizure. We then saw a few videos of children with CPS to relate the symptoms to
what the patient was presenting with.
We got another case where a lady was only conformable in talking to another female. So sir asked if
it was okay for me to take the history. She consented and I took a case history. She was actually a
practising psychologist herself and had 17 years experience which made me very nervous. After
letting her vent out her feeling. I collected the history. The patient then asked to come back later

when the female psychiatrist came back from leave. But from the case history we understood that
martial discord occurred due to infidelity on part of the husband. She agreed to bring her husband
for marital counselling and decided a date with Ma’am. She also presented with symptoms of
dysthymia.

Next we continued talking about ECT. We spoke about how it can be used to treat depression,
mania, Catatonia, suicidal ideation, sever neglect etc. we then spoke about neuroplasticity and
vascular theory. We also looked at similar types of therapies like:

• Repetitive transcranial magnetic stimulation (rTMS). This coil delivers magnetic pulses that
stimulate nerve cells in the region of your brain involved in mood control and depression.
It's thought to activate regions of the brain that have decreased activity during depression

40
 • Transcranial magnetic stimulation (TMS)is a noninvasive technological breakthrough that
involves applying a series of short magnetic pulses to stimulate nerve cells in areas of brain
known to be associated with major depression.

• Magnetic seizure therapy (MST) is being investigated as an alternative to electroconvulsive

therapy (ECT) in order to find a beneficial treatment for depression, psychosis and
obsessive-compulsive disorder with fewer cognitive side effects.
We then looked at McNaughton’s rule and Durham’s rule when we discussed about whether
individuals with psychological disorders get convicted when they commit crimes. We also
learned about testimony capacity.

Lastly we looked at the marriage acts in India. There are four marriage laws in India; Hindu
Marriage Law, Christian Marriage Law, Muslim Marriage Law, and Special Marriage Law. A
marriage certificate appears to be the only legal declaration that confirms two adult Indian citizens
are married. We also discussed “nullity of marriage” and “ grounds for divorce”. With this we
finished today’s day.

Day-15

We started today with going for rounds to the ward. After the rounds ma’am gave me a case to
handle on my own. Ma’am asked me if I wanted to handle a child case or an adult. I asked ma’am
for a child case. She asked me to take case history, MSE and then present it to her with a possible
diagnosis or a differential diagnosis.

The patient X was a 13 year old female. First I took a detailed case history from the informant who
was her grandmother while the patient was in occupational therapy. I collected demographic details,
presenting chief complains, the course and duration of the problem, current stressors, pre and post
natal history, birth history, childhood history, family history, Pre- morbid personality and well as a
negative history to rule out organic causes.

Once I got a good understanding I conducted an MSE with the patient. The patient’s general
behaviour was observed, whether eye contact was made and sustained, whether rapport was
41
established, how her rate of speech was, how her attention and concentration was, whether she was
cooperative and also her general behaviour during the assessment and behaviour towards the
examiner. From the MSE it could be observed that X had severe Cognitive Impairment. Rapport
was hard to establish, X could not sustain attention and also could not comprehend simple tasks.
From the behaviour and other observations I made the diagnosis of possible mental retardation
(MR).

After collecting both the case history and MSE I presented it to Kasturi ma’am. We had a discussion
and then she asked me which test I could administer and also asked me to give a rationalisation as
to why I chose that test. From the MSE it was clear verbal tests won’t work and patient X was
unable to talk or form complex words. Her vocabulary was limited to just names of family
members. Performance tests could also not be used as it may be too complex. Patient X was unable
to follow simple instructions in the MSE. This ruled out BKT, WISC, Bhatia’s, CAT. I suggested
that we could use the Seguin Form Board Test (SFBT) as it was a very simple test to measure
intelligence. I also suggested that we could administer VSMS on the parent to understand the social
quotient of the patient and where training can be useful. Ma’am agreed with my suggestion and
asked me to administer SFBT and VSMS on the patient. Since they left after occupational therapy

ma’am asked me to administer when they come back for their next session. I was very happy with
how it went it gave me alot of confidence to handle my own cases in the future.

Later while ma’am was teaching others how to administer WISC I went to the ward to administer
HAM-D on one of the patients. After that we observed a few cases with dr. Dhakshana. Sir asked us
to take a few case histories. After which we signed our attendance and left for the day.

Day- 16

After our daily rounds to the ward. Kasturi ma’am taught us how to administer the NIMHANS
index for specific learning disabilities. The NIMHANS index for SLDs is a battery of tests used for
confirming the diagnosis of SLD. The test consists of two levels:

• Level I- Younger students, for the age group between 5 - 7 years old. It consists of tests for:
1. Attention, 2. Visual discrimination, 3. Visual memory, 4. Auditory discrimination, 5.
Auditory behaviour, 5. Auditory memory, 6. Speech and language, 7. Visual- motor skills

42
 and 8. Writing skills.

• Level II- Older students, for the age group between 8-12 years old. It included tests for: 1.
Attention, 2. Reading, 3. Comprehension, 4. Writing, 5. Spelling and 6. Arithmetic.
We learnt the administration as well as the scoring and interpretation for this test. As well as
why and when to apply this test.

Next we learnt about the Bender Gestalt test ( BGT). It is used to test perceptual motor abilities. It
tests for both visual perception as well as visual memory. It is a test of simple motor and perceptual
ability which helps to identify specific visual-motor deficits. This test can also be used to assess
neurological damage and emotional disorders. The Bender Visual Motor Gestalt test consists of 9
cards. The test consists of a series of stimulus cards, each displaying a unique figure. The individual
is asked to draw each figure as he or she observes it. The stimulus card is not removed until the
drawing is complete. Once all the figures are drawn. The individual is asked to draw as many
figures as he can recall from memory in a different sheet of paper. The scoring is given for the
correct diagram. Errors are given a mark of zero. Errors include overlapping, rotation,
perseveration, closure difficulty, simplification, angulation, retrogression, etc.

I then administered BGT to a 46 year old male to test for specific visual motor deficits. I found it a
little harder to establish rapport with an older male. During the process of case history I was able to
make him more comfortable around me to answer the questions. I also administered the mini mental
status exam (MMSE) and well as the Montreal cognitive assessment ( MoCA).

Once we finished administering these tests and discussing the scores with Ma’am we proceeded to
learn about:

1. The importance of a therapeutic contract. Ma’am also taught us about all the aspects of a
contract and what needs to be included.

2. The importance of getting consent from the patients before administering any test. Also all
the information that has to be present in the consent form.

43
 3. Ma’am told us to importance of creating a therapeutic plan for what is going to be covered
in each session.

4. The importance of psychoeducation.

5. The role of a psychologist.

6. How to conduct an online session. Ma’am said it’s better to have the first meeting face to
face
to have a good understanding of the patient before switching to online sessions. If a good
understanding has not been established even after face to face meeting it may be even harder
to understand through an online session.

7. The do’s and don’ts of a psychologist

8. Ethics in psychology

9. Importance of reading and keeping updated in the field.

We also looked at the mental health act of 2017. After which ma’am asked us to read and
understand the DSM. Ma’am also asked us to read about the functions of the lobes of our brain to
refresh our memory.

Later we were observing ma’am administer BKT (Binet Kamat test) for a 13 year old girl. The test
was too complex for her and she was unable to answer the questions. So ma’am decided to stop the
test. She then asked me to administer SFBT ( Seguin form board test) for her. She was very tired
after trying the BKT test but she found it happy that SFBT was very simple. She had fun doing it
even asking for more tries.

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Next we went back to the ward to administer the Michigan Alcohol Screening Test ( MAST) for
some of the patient difference from ADS ( alcohol dependence syndrome). I administered the test
on a 60 year old male. The test consists of 24 yes or no questions.

After this we signed our attendance and left for the day.

Day- 17

As usual today also started off by visiting the psychiatric ward for rounds. The ward is very busy as
most of the patients are symptomatic. Since it’s around festival time we are getting a lot of ADS
( alcohol dependency syndrome) patients to be admitted after a spree of drinking which lead to
server withdrawal and delirium tremens.

Once we came back from the rounds we had a discussion on salutogenesis which is the study of
origin of health. We also looked at the salutogenesis model. Next we looked at Eudaimonism which
was the dominant theory in ancient Greek ethics. The name derives from the Greek word
'eudaimonia,' which is often translated 'happiness' but is sometimes translated 'flourishing.
Accordingly, the fundamental principle of eudaimonism is that the highest good for each person is
his or her well-being; the fundamental principle of egoism remains, as before, that the highest good
for a person is his or her happiness. Volunteering one's time. Giving money to someone in need.
Writing out one's future goals. Expressing gratitude for another's actions are all examples of
eudaimonism.

We then looked at Allostasis and homeostasis, allostatic variables like socioeconomic status, aging,
work related stress, care giver burden, allostatic load and health. We also learnt about coping
mechanisms and coping theories like:

• repression sensitisation theory- Repression-Sensitization (R-S) refers to a personality trait

that focuses on individual differences in coping with threat and anxiety. People cope in two
ways they either repress their emotions by trying to deny it or they sensitise it by over
thinking about it or ruminating.

• Lazarus theory- Lazarus' transactional model of stress. During primary appraisal, an event is
interpreted as dangerous to the individual or threatening to their personal goals. During the
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 secondary appraisal, the individual evaluates their ability or resources to be able to cope
with a specific situation .

• Millers model- The monitoring-blunting theory of coping suggests that when faced with a
threatening situation, individuals can respond by either monitoring or avoiding (blunting)
threatening information.

We then looked at CBT ( cognitive behavioural therapy) given by Aaron Beck. Any situation has
two types uncontrollable and controllable or unmodifiable and modifiable. Based on the situation
our cognition interprets it. This is the thought. Thought can either be rational or irrational. Based on
the cognition we react to it. This is the emotion. With respect to emotion CBT looks at naming the
emotion, quantification of emotion and appropriateness of the information. And finally comes the
behaviour. One question that must be asked is is this behaviour going to make my life better or not?
CBT aims to help people become aware of when they make negative interpretations and of
behavioral patterns which reinforce distorted thinking. Cognitive therapy helps people develop
alternative ways of thinking and behaving to reduce their psychological distress. Sir took us that we
have about 75-90 thousand thoughts a day out of which 95% of them are irrational. Critical thinking
involves argument, evidence and warranty for each thought.
Next we discussed the DBT given by Marcia linehan. We looked at the principles of radical
acceptance and the key features of DBT. Sir told us the way for psychologists to understand if
people are rejecting reality is by observing if they they take a “why me” approach to every situation.
We then looked at some major theories of emotion like the James- Lange theory, Cannon- Bard
theory, Schachter- Singer theory, cognitive appraisal theory, facial feedback theory and somatic
sensor theorist.

We then learnt about autonomic intro period. We actually brought two patients from the ward to the
consultation room. One who has hyperchondriasis and the other has generalised anxiety disorder.
We first made them close their eyes and count their heartbeat for a minute. Next we inducted
distress by introducing a stimuli. We put the sound of a clock ticking next to their ear and again
asked them to try to differentiate their heartbeat from the ticking and count for a minute. We

46
compared their responses to the pulse oximetry. We also conducted the test on each other to see how
it differs from a person with an anxiety disorder to a normal person.

Later I also helped ma’am administer BGT ( bender gestalt test) to en elderly make patient suffering
from a disorder of organicity. Most likely frontotemporal dementia. With this we finished our work
for the day. Signed our attendance and left.

WEEK 4

Day- 18

We started off discussing about cognitive distortions like jumping to conclusions which include
mind reading and fortune telling, all or non thinking, overgeneralisation, mental filter,
magnification, minimisation, emotional reasoning, should statements, labelling, personalisation and
blame. Sir then asked us to think about all the cognitive distortions we use in our day to day life. He
asked us to think about an event caused us distress and asked us to think about which distortions we
used to manage it. I feel like I use jumping to conclusions, minimisation, emotional reading and
should statements the most.

We then spoke about the topic of suicide. All of us had a doubt as to whether talking about it or
asking about suicidal intentions may trigger the patient. Sir spoke to us about breaking the stigma of
talking about suicide. He said that talking about it never triggers it. It is in fact is the opposite where
the patients finally feel a sense of relief to talk about it. We learnt never to shy away from asking
about suicidal ideation.

We then observed a case of social anxiety. It is a chronic mental health condition in which social
interactions cause irrational anxiety. For people with social anxiety disorder, everyday social
interactions cause irrational anxiety, fear, self-consciousness and embarrassment. The patient
evidently nervous to be in the room, he was constantly fidgeting, sitting on the edge of the seat and
speaking in a very low monotonous voice.

We then spoke about treatments for depression. Sir said that even for mild depression along with
CBT it is necessary for pharmacological interventions as well. The medications include SSRI and
other antidepressants.

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We then spoke about neuroprogression of psychiatric illnesses. It starts with functional deficits
which leads to morphological changes then cognitive impairment and eventually dementia. Next we
observed a patient presenting with symptoms of OCD and GAD. And a patient with persistent
delusional disorder.

Sir then had to go to teach the MBBS students. So sir asked to us handle a new case each and come
up with a diagnosis. We were assigned a patient each. I took a detailed case history from the
informant. From the case history it was clear that the patient had some psychotic symptoms. The
family members spoke about how the patient talks to himself and smiled to himself. He constantly
talks to someone who isn’t real. They also mentioned that he’s been getting more and more
aggressive recently and blames it on the voices in his head. They said he’s been symptomatic for
over 20 years. When probing more into when this started the informant said it started off when his
wife got pregnant and didn’t tell him for a long time. The patient started suspecting that she cheated
on him and wouldn’t let that thought go. His wife and him spectated and from then the delusions
got worse. When talking to the patient it was clear that he had delusions of infidelity, delusions of
reference and delusions of grandeur. The patient also had thought broadcasting which is a formal
thought disorder. While talking to the patient I noticed that he would suddenly zone out and look at
different directions as if he was listening to someone. When asked about it the patient said it was his
lover Vimala who only he can see and talk to. He spoke about the different auditory and visual
hallucinations he experiences. When I presented the case to sir. It became obvious that he had
schizophrenia. Sir said that visual hallucinations were usually rare, this was atypical. Sir also said
that this disorder has a 5 year cut off. It is necessary to get treatment within those years to help the
patient remit. Post that the patient will have getting cognitive impairment.

After this sir asked us to go to the ward to take the case history’s of few new patients who were
admitted last night. The patient I was assigned was a new mother. She had a 3 month old baby and
was brought to the hospital which complaints of being too aggressive with the family members.
Talking to the family. It was clear that this wasn’t a case of post partum depression as she was very
caring and affectionate with the baby. There was family history of suicide. From a detailed history it
could be seen that the mother of the patient wasn’t willing to be very open and honest. The husband
mentioned that they were hiding something. The patient was pulled out of college for a few months
were she only went to attend exams. He said it was some mental issues. But they weren’t telling
him the full story. From taking MSE from the client herself it was clear that she was in a manic

48
episode. So we diagnosed it with bipolar disorder. During MSE she showed certain depressive
symptoms. She also had delusions like thinking people were doing black magic or cursing her and
her baby.

After this ma’am gave us the childhood autism rating scale which is a behavioral rating scale used
for assessing the presence and severity of symptoms of autism spectrum disorders. Ma’am asked us
to go through the scale so we could discuss it and administer it the next day. With this we signed our
attendance and left for the day

Day- 19

Kasturi ma’am taught us some focus signs of neurological deficit’s like :-

• Body schema deficits

• Agnosia which includes- Visual agnosia

Auditory agnosia, Asterognosis, Colour agnosia, Amusia, Apraxia

• Left, right disorientation

• Social neglect

• Route finding difficulty

We also had a discussion about happy mania and irritable mania. Next we went to the ward for our
daily rounds. The ward is currently at maximum capacity with almost all symptomatic patients.

After we came back we had a recap of all the assessments and tests we have learnt so far. Ma’am
asked us to take case history and MSE from a new patient in ward and administer MOCA
( Montreal cognitive assessment) to her. She was highly symptomatic. From the MSE we could
understand that she had sever impairments in cognitive functioning as well as comprehending and

attention. Ma’am told us that’s r cannot administer any assessments on a symptomatic patient. So
she told us that once the symptoms are relieved we can administer tests. She asked us what tests we
would suggest for her. We suggested young’s mania scale, BPRS ( brief psychiatric rating scale).

49
Next Dr. Sathya Seelan gave us an orientation on narrative therapy. Sir did a session of narrative
therapy on a patient in the ward suffering from ADS. Narrative therapy (or Narrative Practice) is a
form of psychotherapy that seeks to help patients identify their values and the skills associated with
them. It provides the patient with knowledge of their ability to live these values so they can
effectively confront current and future problems. Sir said that the patient was able to identify
deficits in their thoughts and values.

Sir said that when it comes to patients with SUD. We must never be overly critical or judgmental.
When patients relapse they may feel high level of guilt or abstinence violation effect which may
cause them to snowball into excessive drinking. Maintaining a good rapport with the patients will
make them seek out for help again without the fear of about judged for their actions. We also spoke
about how normalising thought is important in OCD before applying CBT.

We then spoke about the maladaptive pattern of reward system. We spoke about how people with
disorders generally choose temporal relief over quality of life.

Later we looked at Motivational Interviewing Workshop Types of Reflections which include:

• Simple reflection- which include repeat and rephrase.

• Complex reflections- which include amplified, come alongside, double sided, metaphor,
shifting focus, reframing, agreeing with a twist, emphasising personal choice, siding with
the negative, and reflection of feeling.

We then went to the ward to administer the change worksheet for few of the ADS patients. The
change worksheet consists of questions like:

1. The changes I want to make.

2. The reason why I want to make these changes.

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 3. The steps I plan to take in changing are.

4. The ways other people can help me are.

5. I will know that my plan is working if

6. Some things that could interfere with my plan are.

7. What will I do if the plan isn’t working.

These are the questions in the change worksheet. It helps us identify which stage of change the
person is in and helps us to administer motivational enhancement therapy accordingly.

After this we observed a few cases, after which we signed our attendance

Day-20

We started off today a little earlier than usual. One of the other intern and I came to the hospital by
7:45 to observe a session of ECT ( electroconvulsive therapy). The sessions started at 8:30. It was a
very surreal experience. As soon as we walked into the operation threaten complex we went to the
changing room. We changed into our scrubs and walked out of the changing room through a
different door where we disinfected ourselves, got head caps and masks. We then went to the ore
operation theatre where the patient was kept. From there we took her to the operation theatre. In the
operation theatre sir showed us the ECT instrument and explained everything. Once the anaesthesia
was given the ECT began. We observed how the electric currents were passed through the brain and
how the brief seizures were triggered. One arm was isolated so the seizures were mainly observed
only on the one arm. The first infused seizure was too short. Sir said they need to have a 20 second
long seizure for it to be affective. The second seizure lasted for exactly 20 seconds so we were done
with the ECT. The duration of the therapy was only 5 minutes but the preparation time was atleast

51
30 minutes. After the therapy we shifted the patient to the post operation theatre after which we
went back to the changing rooms to change out of the scrubs and left the operation theatre complex.

After ECT we came back to the psychiatry department we had a discussion on DBT. Sir said that
DBT follows a chain analysis of vulnerability, promoting event, thought emotion, behaviour,
immediate consequence and late consequence. Cutting the loop is what helps change maladaptive
behaviour. The loop should be changed in the vulnerability itself. The question asked is “what was

the vulnerability that made you act that way?” The next question is, “what was the prompting
event?” We then discussed the DBT skill worksheet by Linehan.

Sir said the most important aspect is changing an individuals attitude and willingness regarding to
change. He explained anxiety treatment with an example, When a person is made to jump hurdles.
The smaller side hurdles will be easy to jump. When the hurdle come to the chest level it increases
hesitancy in the client. This is when it’s important to help with the willingness to take the foot off
the ground. This will guarantee that they will jump. Another technique sir demonstrated on us. He
told us to close our eyes and picture a mountain. He told us to picture the mountain in different
seasons like summer, spring, winter, monsoon and autumn. He said that this activity makes people
understand that though the surface may keep changing, the core remains the same. It is important to
experience bodily symptoms as just the bodily symptoms and not let it go to your head. It is
important to learn to sit with the emotion. Sir said that any somatic sensation will stay only for 90
seconds. For example in anxiety disorders a panic attack lasts only for 90 seconds. If it lasts longer
it’s because it’s being maintained by other thoughts. Sir said there are few activities to stimuli the
vagus nerve and demonstrated a few with us.

Sir then asked us to read about hedonism. After which we had a discussion on:-

• CARD model

• applied behaviour analysis

• priming effect

• script fading

• chaining

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• shaping

• exemplar training

• discrete trial training

• pivotal response training

• picture exchange communication training

• denvers model

• Carolina curriculum

• naturalistic training

Sir then asked us to take case history and MSE for few new cases. We each got a case to handle
alone. After taking case history and MSE I was able to identify that my patient had erectile
dysfunction, premature ejaculation and reduced desire and around Al for sexual activities secondary
to dysthymia. Initially it was hard for me to get this patient to open up to me as I was a young girl
but he was able to be open and talk to me about all his issues. Sir initially did not feel it was
dysthymia when I presented the case but after reviewing the case himself he confirmed my
diagnosis.

I then got another case which was harder to diagnose for me. So I had a discussion with her. After
we saw the patient together we were able to say that she’s under a lot of distress which makes it
hard to diagnose. She also has boderline intelligence. Our next step is to do an IQ test and help
refuse distress with therapy before we can make any diagnosis.

Lastly we looked at the negative cycle of communication in relationships. Between an anxious and
avoidant couple. The cycle goes like:

1. The anxious person reaches for a connection.

2. The avoidant person gets defensive

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 3. The anxious person attacks or accuses

4. The avoidant person counter attacks or invalidates the partner

5. The anxious person starts protesting and emotional flooding occurs

6. The avoidant person then tried to appease and rescue the partner.

With this both the partner have ended the conflict but have not solved the root of the issue. Breaking
this cycle helps the couple improve their relationships.

Day-21

After we came back from the daily rounds to the ward, Kasturi ma’am asked me to administer
colour trial I & II, Digit span test as well as MOCA to a 28 year old male patient. The patient got

brain fever due to which he now suffers from Prosopagnosia also called called face blindness. After
completing all the three tests I finished the scoring before discussing the results with Ma’am.

As I finished this test. Dr. Satya Seelan asked me to take case history of another case. The patient
was 9 years old. She had epilepsy. Her first seizure was when she was 3 years old. Her parents were
worried that due to the medications her memory was being affected. I took a detailed case history
from her mother and then took an MSE from her. I discussed the MSE with sir and we concluded
that an IQ assessment had to be done to rule out intellectual disability.

After this we observed few cases. Sir asked to learn the Conner’s parents rating scale for ADHD.
The test has 27 items. We also read about DARN-CAT. The acronym DARN CAT summarizes
different kinds of change talk and commitment language:
DARN:

Desire: "I want to be a good parent."

Ability: "I can quit any time I want."
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Reasons: "I think I'm getting too old for this lifestyle."
Need: "They will take away my kids unless I go to this program."
CAT:
Commitment: "I am going to get help with my drug problem."
Activation: "I've erased the dealers' phone numbers from my contact list, and I am getting a new
phone number so they can't call me anymore."
Taking steps: "I've started taking a fitness class at the community centre twice a week in the
evenings."

After this Kasturi ma’am called me to administer Binet- Kamat scale for the patient. After BKT
ma’am asked me to administer NIMHANS SLD battery to test for specific learning disability. The
patient got very tired so we took breaks in between to keep her active and alert for the test. From the
rest we observed that her mental functions was at the level of an 8 year old. Which indicates that
she needs some training to catch up to her chronological age. After getting the result we psycho
educated the mother about the need for remedial training.

With this we finished work for the day and left by 5:00pm after signing our attendance.

16/06/2023
Day- 22
Timing: 8:00am- 4:30 pm

We started off the day as usual with our rounds to the ward. The patient who’s been receiving ECT
finished all 6 sessions. We were able to observe the difference in behaviour before and after ECT.
before ECT she became very aggressive, extremely disinhibited, and displayed hyper arousal and
hyper sexual behaviour. She would take all her clothes off and run into the male ward, beat her
mother and talk endlessly without any filter. Post the ECT session we could observe that she was a
lot more calmer, she was able to voice out her anger instead of directly beating her mother, she did
not have the impulse to take her clothes off and her speech became more coherent. This was the
second round of ECT. The first time she received ECT was a year back when she became
completely catatonic. Post ECT she was able to speak again.

After the rounds, Dr. Satya Seelan sir split and gave us few patients to take case history and MSE
for. My first patient was a review case so sir just asked me to collected the presenting complaints.
The first patient was admitted in the psychiatric ward for 2 months to treat psychotic symptoms. He
55
was diagnosed with schizo-affective disorder. The patient was very resistant to treatment. Got
discharged after two months. During my internship period, I built a rapport with this patient before
he got discharged and I administered a few tests. Hence sir asked me to collect the presenting
complaints. After I collected the details and presented it to sir I then went on the see the new case.
The patient was a 55 year old male. The informant who was his son gave details for the case history.
It was a case of alcohol dependance. Once MSE was taken from the patient I presented the case to
sir. Since they refused admission sir asked them to come in once a week for counselling and also
prescribed some medicine to treat the jaundice.

We then read about death and dying, the concept of bereavement. How children, adolescents and
adults perceive dying as well and how they perceive the death of loved ones.

We then accompanied the Occupational therapist to the OT centre and observed a few sessions.
After this we came back to the department. We then observed a few cases with sir. After which we
signed our attendance and left for the day at 4:30 pm.

Day- 23

Today is the last day of internship. It was a very bitter sweet day. I was happy to have completed my
internship but at the same time I was sad to leave as I made a lot of good friends. For the first few
hours I was running around shuffling between the psychiatry department and the HR office. I had to
fill in few forms, write letters and complete certain procedures to be able to receive my completion
letter. Once I revived the letter from the HR I came back to the department where Dr. Dhakshana
asked me to take few case histories.

Later I administered the child autism rating scale for a 3 year old girl with autism. I was able to
observe different symptoms of autism. She refused to make eye contact, did not respond to her
name, was very hyperactive, disinhibited to strangers, sensitivity to pain was very less, motor
movements were impaired, unable to respond to questions, poor listening skills, unable to imitate
others, improper use of body and objects etc.

After this we observed a few cases. Sir then kept a viva before signing the feedback form. Viva
went well and sir was happy with my overall performance. Similarly with ma’am. She kept a small
viva regarding the assessments when and why we administer them. Ma’am as well was happy with

56
my performance during the duration of the internship. Once I received all the documents I said bye
to everybody, signed my attendance and left for the the last time.

57
 PERSONAL APPRECIATIONS, SUGGESTIONS AND RECOMMENDATION

I went in to the internship wanting to work more with the clinical psychologist to understand
and learn more about that field. Before I went for the internship I had a notion that psychiatrists
only saw patients for a few minutes, prescribed medication and sent them. During my internship
period I had immense learning from the psychiatrist. The psychiatrist Dr. Satya Seelan taught us a
lot about having a humanistic approach to each client. Working with the psychiatrist changed my
opinion on that field. Clinical psychology was a field I was interested in but had a lot of queries
about the role of a clinical psychologist as well as the scope. Working with Kasturi Ma’am opened
my eye to this field. I really enjoyed working in the hospital setting. Because it was a college
hospital we were able to prove a lot of concessions as well as free treatment for those who couldn’t
afford it. This service also made me feel good about working there. I also learnt a lot about work
ethic from my mentors, though they were busy with cases they were able to make time to teach us
interns as well as take class for MBBS students. I was in awe of their time management and
patience.

Both the psychiatrist and the clinical psychologist appreciated my willingness to learn and
readiness to participate in all activities as well as administer tests. The suggestions they gave me
was to be more confident and sure of myself while administering the tests. They also recommended
to read. They asked me to read a lot of articles and keep with with all the new information as well
the basics and become strong with all the theories.

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 REFERENCES

Freud, S. (1971). Abstracts of the standard edition of the complete psychological works of Sigmund
Freud (Vol. 21). National Institute of Mental Health.

KMCH Institute of health sciences and research. (n.d.). KMCH Institute of Health Sciences and
Research. https://kmchihsr.edu.in/dept-psychiatry.html

Morgan, C. T., & King, R. A. (1986). Introduction to Psychology: 7th Ed. McGraw-Hill.

Nolen-Hoeksema, S., Fredrickson, B. L., Loftus, G. R., & Wagenaar, W. A. (2009). Atkinson &
Hilgard’s introduction to psychology. Cengage Learning EMEA.

Shea, S. C. (2016). Psychiatric interviewing E-Book: The art of understanding: A practical guide
for psychiatrists, psychologists, counselors, social workers, nurses, and other mental health
professionals. Elsevier Health Sciences.

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