Counselling Session Report

Case no: 1
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 2nd February, 2020
Termination date: 07/03/2020

1) Case introduction:
A student hailing from outside valley having come to Kathmandu for further studies
approached for counselling having recommended by one of his friends. He had
complaints of having severe headaches and the physiological aspect had been ruled
out by the hospital and had been eventually recommended to the psychiatrist who
prescribed small doses of medicine for depression. While the headaches persisted
specially during the time of his preparation and any challenging tasks at hand. He
very much loves to visit new places, take photos, enjoy various kinds of food stuffs
but with the onset of the issue has begun to lose interest in previously enjoyed
acitivites. Wanting to get rid of his issues and as being recommended by his friend has
taken shelter of counselling.
2) Family history:
He hails from a poor family living in the hills of Palpa district consisting of father (45
years), mother(35 years), younger brother(18 years) and himself. His father works as
security guard in India and only visits them once a year and mother work as a
housewife. Both mother and father are less educated.
His relationship with his brother who is the only person living with him at present in
his small rooms is okay but the relationship with his father who works in India and
mother who stays in Tansen is not so pleasant as he doesn’t wish to reveal the
problems he is facing to them. Due to his lack of communication with them is
building tension in the relationship.
3) Genogram( Family Tree):

------
Husband

---- Wife

------
Children

----- Client

----
45 Intimacy
3
35
 21 18

4) Problem history:
Kamlesh having grown in a low socio-economic status had the tremendous burden of
excelling in his studies and eventually help the family come out of the circle of
poverty. This tremendous pressure upon his shoulder eventually brought him from his
village to nearby Tansen city and from there to Kathmandu. This pressure has led him
to be very sensitive towards his study but not much joy in life which is enjoyed by
other students of his own age. After having come to Kathmandu and preparing for his
medical examination he has been experiencing this severe episodes of headache.
Besides headache, he has also anxiousness, lack of concentration, nervousness and
excessive sleepiness.

5) Psychological problem:

6) Physical Emotional Social

Head ache Anxiousness No close friends
Tiredness Lack of concentration Weakened relationship with
parents
Nervousness

7) Psychological Testing
Beck Anxiety Inventory
SELF-ESTEEM scale
Evaluate your STRESS LEVEL
8) Observation:
Client was usually nervous in the beginning. But as time passed gained confidence
increasingly. He at times became very willing to confide everything but in relation to
some issues with his family members he is not confident to open up. Overall, he
looked satisfied with the end of the session and looked forward to visit every time.
9) Diagnosis/ Problem identification:
 Somatic symptom disorder.
10) Treatment plan:
 Cognitive behaviour therapy.
11) Intervention:
 Stress management and relaxation techniques such as deep breathing.
 Cognitive restructuring
 Tests:
Beck Anxiety Inventory
SELF-ESTEEM scale
Evaluate your STRESS LEVEL
12) Impression:
Although the rapport between the client and the counsellor was good but it
was not enough for the client to reveal the underlying issues of his problems.
So, the core issue of the matter could not be addressed as much as it should
have been.
13) Termination:
The client felt some improvement with the relaxation techniques and stress
management. Because of his unwillingness to reveal the fact of the matter and
no further intervention could be applied , the case was terminated with client
not coming for any further session.
Session No: 1
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 2nd February, 2020
Duration: 50 mins
Goal: To build therapeutic relationship

Presenting Problems:

According to Client According to Informant(Brother)

i) Constant headaches of non- i) Not willing to talk frankly
physical origins ii) Always sleepy and tired
ii) Not able to accept any iii) Very easily annoyed
responsibility
iii) Lack of concentration
iv) Loss of interest in enjoyable
things

Intervention

The counsellor remained focused in rapport building with the use of communication skills.
He put forth open ended question and tried to put the client at ease with friendly gesture and
sitting in the right posture. He tried to take the client into confidence by talking with a frank
tone how counselling could help. Towards the end the counsellor gave empathy and emotive
support and positive enforcements for his willingness to talk. Counsellor also applied
reflection and paraphrasing.

Observation

The client observed to be quite nervous in the beginning but gradually built up momentum
with his willingness to take part in the counselling process. His body posture was erect at
times but would soon lean upon the chair as if due to sudden drain of energy. His words and
non-verbal gestures matched.

Impression of the Counsellor

Client seems sincere and much willing to talk further about his issues to get them resolved.

Finding and Outcome

Client is very much willing to reveal his heart for good. A good rapport was built and
evidently the client has trust upon the counsellor.

Plan for the Next Visit

The counsellor and client have decided to meet on 8th February, 2020
Session No: 2
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 8th February, 2020
Duration: 40 mins
Goal : To go deeper into rapport building and do psychological tests

Intervention

Psychological testing: Beck Anxiety Inventory

The counsellor asked questions in relation to the tests.
.

Observation

The client was excited and seemed to gain faith and understanding in therapeutic relationship.

Impression of the Counsellor

A good rapport seems to have built between the client and the counsellor.

Finding and Outcome

The result of the psychological test showed that the anxiety level of the client was severe.
There are more things that client needs to speak up so that the intervention becomes more
effective.

Plan for the Next Visit

The counsellor and client have decided to meet on 15th February, 2020 .
Session No: 3
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 15th February 2020
Duration: 30 mins
Goal: Further psychological testing and find core issue

Intervention

Relaxation techniques
Psychological testing: SELF-ESTEEM scale
The counsellor asked questions in relation to the tests.

Observation

The client seemed more nervous and when probed further regarding the causes of stress, was
unwilling to answer.

Impression of the Counsellor

The client seems to be unwilling to reveal his inner heart. There are certain issues that his
unwillingness to reveal.

Finding and Outcome

The client has a low self-esteem. Relaxation techniques when feeling of stress overwhelms
was taught in the form of deep breathing. The client also shows the symptoms of stress
therefore an additional testing for stress evaluation is needed. His unwillingness to reveal
things in relation to his family attachments is posing obstruction to take ahead the counselling
process.

Plan for the Next Visit

The counsellor and client have decided to meet on 21th February, 2020.
Session No: 4
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 21th February 2020
Duration: 30 mins
Goal: Further psychological testing and cognitive restructuring

Intervention

Cognitive restructuring
Further Psychological testing: Evaluate your STRESS LEVEL
The counsellor tried to apply the five steps of cognitive restructuring.

Observation

The client looks nervous and dissatisfied at times. He is no comfortable sharing and
discussing some specific problems.

Impression of the Counsellor

The client seems unhappy with continuous test results indication towards his problems, but he
is unwilling to dealt deeper into them.

Finding and Outcome

The stress level of the client shows that he is experiencing intense stress.

Plan for the Next Visit

The counsellor and client have decided to meet on 28th February, 2020
Session No: 5
Name of the Client: Kamlesh Rana
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 28th February 2020
Duration: 40 mins
Goal: To probe deeper into the core issue of the client.

Intervention

The counsellor used questioning, paraphrasing and psycho education.

Observation

The client seemed happy and excited in the beginning of the session but he lost his interest
with discussion in relation to the underlying issues of his problems.

Impression of the Counsellor

The client is determined not to express his main issues probing further seemed to discomfort
him more and more.

Finding and Outcome

Since CBT works with finding out the core issue of any problem, the somatic symptom
disorder of the client in the form of manifesting severe headache has links to his core issues
and requires a good client-therapist relationship. But, unwillingness of the client to allow the
counsellor to probe into his issues demands the sessions to be stopped and the client should
better approach next counsellor.

Plan for the Next Visit

Terminated
Case no: 2
Name of the Client: Surya Pun (Pseudo name)
Age/Gender: 15/M
Name of the Counsellor: Lawesh Rawal
Place: School
Date: 6nd January, 2020
Termination date: 02/02/2020

14) Case introduction:

The client is a 15-year-old boy living in Kathmandu. He has some disciplinary
problems and disinterest in studies. The client wants to pursue other extracurricular
activities besides studies which creates a conflict with his teachers and family
members. He is upset that no one understands him properly and force him to do
against his desire. He was referred to counselling by counselling authorities.
15) Family history:
The client hails from somewhere else and several generations back the family moved
into Kathmandu. His father works abroad and he is the sole provider for the family
financially and mother is housewife. He also has a sister and an elder brother. He
shares very intimate relationship with his elder brother

.
16) Genogram( Family Tree):

17) Problem history:

The client has been observed to lose interest in his studies and at times be aggressive
with even the teachers. He is studying in grade 9 and has keen interest in karate and
video making for which his passion is so much that he does not mind compromising
his studies. When in class 8 his standard of studies had been above average. But now
he has failed in multiple subjects.
18) Psychological problem:

Physical Emotional Social

Dissatisfaction Conflicting relationships with
parents and teachers.
loneliness

Uncontrolled anger

19) Psychological Testing

Evaluate your STRESS LEVEL
Novaco Anger scale
RIASEC test

20) Observation:
The client was timid initially but gradually gained more and more confidence with the
progression of each session. He seemed happy and joyful in being allowed to express
his heart
.
21) Diagnosis/ Problem identification:
 Emotional and behavioral problems.

22) Treatment plan:

 Client centered approach.

23) Intervention:
 Unconditional positive regard.
 Empathy
 Active listening
 Psychological Tests:
Evaluate your STRESS LEVEL
Novaco Anger scale
RIASEC test

24) Impression:
The client seemed enthusiastic for the sessions. A very good rapport was built
between the counsellor and client, leading to smooth application of
interventions. The client seemed to be a transformed person and willing to
pursue his passions without being careless towards his studies.
25) Termination:
The client sensed improvement and willingness to change for good. Since
there was nothing much needed in relation to intervention, the case was
terminated with the client’s agreement.
Case no: 3
Name of the Client: Sharmila Gurung (Pseudo name)
Age/Gender: 16/F
Name of the Counsellor: Lawesh Rawal
Place: School
Date: 10th January, 2020
Termination date: 05/02/2020

1) Case introduction:
The client is a 16-year-old female with symptoms of crying and inattentiveness in the
class. She was sent for counselling by the class teacher. She is well disciplined in the
class and has good friends as well. The kind of behavior in recent days was not typical
of her nature. Therefore, the teachers were particularly alarmed and sent her for
counseling sessions.
2) Family history:
She hails from a nearby village from the district of Dhading. She lives with her
mother and her father is abroad for work. Her grand-mother and other family
members are living in village. She has a small younger brother as well.

.
3) Genogram (Family Tree):

4) Problem history:

The client recently experienced bereavement from passing away of her old
grandmother who had been so dear to her. This has been a great loss for her leaving to
problems recently observed by the teachers.
5) Psychological problem:

Physical Emotional Social

Crying Inattentiveness

6) Psychological Testing

Beck Anxiety Inventory

Evaluate your STRESS LEVEL

7) Observation:

The client was happy and satisfied after expressing her core issue. She very much
looked forward to meeting in each succeeding session. She just needed a place to
open up her heart.
.
8) Diagnosis/ Problem identification:

 Bereavement.
 Grief

9) Treatment plan:

 Allow client to express her heart without interruption and with repetitions .

10) Intervention:

 Client centered approach,

 Empathy,
 Active listening,
 Paraphrasing,
 Basic communication skills,
 Psychological Tests:
Beck Anxiety Inventory
Evaluate your STRESS LEVEL
11) Impression:

The client and counsellor enjoyed a good rapport. The client finding place to
pour the heart expressed her grief without reservation, this led to her
improvement in terms of concentration and focus in the classroom.
.
12) Termination:

Upon inquiring, if there was a need for any further intervention with the client,
there were no pressing issues and thus with mutual agreement the case was
terminated.
Case no: 4
Name of the Client: Govinda Regmi (Pseudo name)
Age/Gender: 25/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 20th November 2019
Termination date: 25/12/2019

1) Case introduction:
The client was recommended by his friends to visit the counsellor due to his issues
with low self-esteem.
2) Family history:
He comes from a poor family. Both of his mother and father live in the village. Father
(50 years), mother (40 years) and younger brother (21 years). Other family members
who live along with mother and father in the village are his younger uncle (32 years )
and old grandmother. On the expense of his father’s and mother’s money he has been
studying in Kathmandu.

.
3) Genogram (Family Tree):

4) Problem history:

Govinda hails from a low socio-economic status currently situated with his distant
relative’s place. For him to face any big mass or coming in front of the classroom to
speak or to inquire with the teacher has been a great difficulty which he is unable to
do. Time to time he becomes anxious about his future an his indecisive about his
career as well.
5) Psychological problem:

Physical Emotional Social

Tiredness Anxiousness No close friends.
Nervousness

6) Psychological Testing

Self-esteem test
RIASEC test

7) Observation:

The client is respectable and quiet. He likes coming to the counselling sessions,
speaks less but honestly. He has desire to get rid of his problems and he is willing to
take appropriate steps towards it.
.
8) Diagnosis/ Problem identification:

 Low self-esteem,
 Inferiority complex.

9) Treatment plan:

 To help the client to understand self-value and allowing him to express and
boost his confidence based upon principles of sound mental health.

10) Intervention:

 Communication skills,
 Empathy,
 Active listening,
 CBT- Cognitive restructuring,
 Psychological Tests:
Self-esteem test
RIASEC test
11) Impression:

The client seems to be much helped and grateful for the counselling sessions.
The rapport between the client and the counsellor was also good. Significant
improvement was observed in the attitude of client.
.
12) Termination:

The client had a changed outlook and perception. He looks forward to dealing
his life situations with confidence. With the permission of the client, the case
was thus terminated.
Case no: 5
Name of the Client: Jagannath Dawadi (Pseudo name)
Age/Gender: 24/M
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 15th October 2019
Termination date: 20/11/2019

1) Case introduction:
The client is a 24-year-old male with serious problem of substance abuse and suicidal
tendencies. He was referred to counselling by his family members. He has disturbed
relationship with all the family members. He has been seen stealing money from his
own house, so the family members are not in the position to trust him. Time to time
there are marks of bruises and cuts observed in his body.

2) Family history:

The client comes from upper-middle class socio-economic status. Father (age 56) is a
retired government officer and mother (age 45) is housewife. His elder brother(age
28) stays separately from his father and mother.

.
3) Genogram (Family Tree):

4) Problem history:

The client suddenly fainted one day due to overdose of the substance consumed. Upon
examination of doctors, it was found that he had very high level of Opiates. The client
admitted about his addiction and sort for help with psychiatrists and counselling.
5) Psychological problem:

Physical Emotional Social

Continuous weight Uncontrolled anger Spoiled family relationship.
loss
Bruises and cuts in Loneliness Ill social repute
the body
Anxiousness
To much stress

6) Psychological Testing

Hamilton Depression Rating Scale (HAM-D)

Beck Anxiety Inventory
Anger Inventory Novaco Anger Scale
Evaluate your STRESS LEVEL

7) Observation:

The client is respectable towards the counsellor and reveals his issues and history with
seeming honesty. Although at the request of the family members the client has no
objection and likes talking to the counsellor about his issues.

13) Diagnosis/ Problem identification:

 Substance abuse,
 Anxiety with suicidal tendencies,

14) Treatment plan:

 To motivate the client towards positive change , inspire him to accept suitable
interventions like medical treatments or admission in rehabilitation center
voluntarily.

15) Intervention:

 Communication skills,
 Empathy,
 Active listening,
 Psychoeducation,
 CBT: Learn coping skills, improve motivation, change old habits,
  Psychological Tests:
Hamilton Depression Rating Scale (HAM-D)
Beck Anxiety Inventory
Anger Inventory Novaco Anger Scale
Evaluate your STRESS LEVEL

16) Impression:

The client seemed to be manipulating the counsellor into giving suggestion to

his parents favourable to his wants. He did not show much sign of
improvement except that he agreed for medical treatments.
.
17) Termination:

The counsellor feeling used by the client for his purposes terminated the
session with suggestions for parents to seek further medical help.
Case no: 6
Name of the Client: Damayanti Dorje(Pseudo name)
Age/Gender: 28/F
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 4th October 2019
Termination date: 10/11/2019

1) Case introduction:
The client is a 28-year-old female having come to Kathmandu from her village for
further studies. She has a background of low socio-economic status, she suffers from
severe anxiety which she confided to her close friend. Thus, having recommended by
her close friend for counselling, she visited the counsellor. .
2) Family history:

The client’s family has eight family members including herself. Father (age 65),
mother (age 50) and the client have her brother (age 38) with his wife (age 30). She
also has three sisters (ages 25,23 and 19). The client has very close relationship with
her mother.

.
3) Genogram (Family Tree):

8) Problem history:
Ever since the client has come to Kathmandu, leaving behind her family she
has been going through severe bouts of anxiety and even nervous breakdown
sometimes. She feels severe homesickness and her present life style is severely
different from how she was living back in her native place.
9) Psychological problem:

Physical Emotional Social

Occasional loneliness No close relationship with
headaches friends and teachers in the
university
Loss of appetite Crying

Nervousness
Homesickness

10) Psychological Testing

Beck Anxiety Inventory

Self-esteem test

11) Observation:

The client was very respectable and polite towards the counsellor. She talked very less
but to the point . At times she seemed dissatisfied but none the less willing to take part
in the counselling process.

4) Diagnosis/ Problem identification:

 Adjustment disorder,

5) Treatment plan:

 Help the client develop coping skills,

 Inspire self-exploration through journaling and recording gratitude

6) Intervention:

 Communication skills,
 Empathy,
 Active listening,
 Psychoeducation,
 CBT: Learn coping skills, improve motivation, change old habits,
 Psychological Tests:
 Beck Anxiety Inventory
Self-Esteem test

7) Impression:

Client was willing to develop coping skills, she also accepted self-exploration
activities which led to a significant fall of her anxiety and stress.
.
8) Termination:

The client was very willing to reframe her thoughts and behaviors and use
coping skills to deal with her adjustment related issues. Thus, with the
agreement of the client the case was terminated.
Case no: 7
Name of the Client: Sucharu Viswakarma(Pseudo name)
Age/Gender: 20/F
Name of the Counsellor: Lawesh Rawal
Place: Private room
Date: 21st October 2019
Termination date: 19/11/2019

9) Case introduction:
The client is a 20 year old female who had been sent by her parents for studying +2
after successful completion of her see. Although as a child she stayed here in
Kathmandu but her
10) Family history:

The client’s family has eight family members including herself. Father (age 65),
mother (age 50) and the client have her brother (age 38) with his wife (age 30). She
also has three sisters (ages 25,23 and 19). The client has very close relationship with
her mother.

.
11) Genogram (Family Tree):

12) Problem history:

Ever since the client has come to Kathmandu, leaving behind her family she
has been going through severe bouts of anxiety and even nervous breakdown
sometimes. She feels severe homesickness and her present life style is severely
different from how she was living back in her native place.
13) Psychological problem:

Physical Emotional Social

Occasional loneliness No close relationship with
headaches friends and teachers in the
university
Loss of appetite Crying

Nervousness
Homesickness

14) Psychological Testing

Beck Anxiety Inventory

Self-esteem test

15) Observation:

The client was very respectable and polite towards the counsellor. She talked very less
but to the point . At times she seemed dissatisfied but none the less willing to take part
in the counselling process.

12) Diagnosis/ Problem identification:

 Adjustment disorder,

13) Treatment plan:

 Help the client develop coping skills,

 Inspire self-exploration through journaling and recording gratitude

14) Intervention:

 Communication skills,
 Empathy,
 Active listening,
 Psychoeducation,
 CBT: Learn coping skills, improve motivation, change old habits,
  Psychological Tests:
Beck Anxiety Inventory
Self-Esteem test

15) Impression:

Client was willing to develop coping skills, she also accepted self-exploration
activities which led to a significant fall of her anxiety and stress.
.
16) Termination:

The client was very willing to reframe her thoughts and behaviors and use
coping skills to deal with her adjustment related issues. Thus, with the
agreement of the client the case was terminated.