Verbatim for Attending Behaviour and Observation Skills

Identifying Information
Name: ST
Age: 21
Gender: Female
Language: Hindi, English
Occupation: Student
Education: Post graduation
Religion: Hindu
Marital status: Unmarried
Economic strata: Middle-class
Informant: Self
Referral: Self
Information: Reliable

Presenting complaint:
“I have a problem with using sleeping pills”.

History of the presenting problem:

ST is a 21-year-old female living in Bangalore. She is a final-year MBA student studying at a
private university. She was asymptomatic before the second year of college. Toward the end of
her second year, she first used sleeping pills (prescribed by a doctor) as a way to calm herself
after a fight with a friend resulting in the friend self-harming. The client believes that she takes
the pills whenever she feels overwhelmed by emotions like anxiety and anger. When she first
started taking them, the frequency was once in 6 months. Presently, she reported taking them at
least once a week. She reported experiencing side effects like headaches and dizziness.

Verbatim:

Sr. Client/ Verbatim content Process comments

No. Therapist
1 T1 Hello, good morning! The therapist begins to build
rapport.

C1 Good morning The client gives a prompt

response.

2 T2 My name is Rasika, and I am a The therapist uses attending

counseling psychologist. What is behavior skills by nodding her
your name? head to convey understanding.

C2 My name is Shweta. The client maintains a neutral

expression.

3 T3 Hello Shweta, nice to meet you. The therapist leans forward to

Tell me more about yourself. How express interest (attending
old are you? behavior)

C3 I am 21. The client maintains a neutral

expression.

4 T4 And are you a student or are you The therapist asks a close-ended
working? question.

C4 I am a student. I am doing MBA The client slumps slightly in her

from a private university. chair.

5 T5 Oh, are you enjoying your course? The therapist asks a probing
question.

C5 No, it is very hectic. After college, I The client frowns.

don’t have time for anything else. I
used to draw and paint in UG, now
I don’t have time for hobbies.

6 T6 Okay seems like you have a lot on The therapist acknowledges the
 your plate. Do you live with your client’s problems in her academic
parents or are you staying away life. She asks another close-ended
from home? question.

C6 I live in a hostel with a roommate. The client maintains a neutral

expression.

7 T7 And are you happy with your living The therapist asks a close-ended
arrangement? question.

C7 It’s alright, I have less personal The client nods while talking.
space though.

8 T8 Okay. How often do you talk to The therapist asks an open-ended

your family? Can you tell me about question.
your family?

C8 In my family there’s me, my The client appears to be at ease.

parents, my younger brother and my
older sister. I talk to them every
day.

9 T9 What do your family members do? The therapist asks a probing

Tell me about their studies or work. question.

C9 My father runs the family business, The client uses hand gestures.
my mother is a school teacher and
my sister is an architect. My
younger brother is studying in 11th
standard.

10 T10 Okay Shweta, so have you been in a The therapist has gathered the
counseling session before? basic information and proceeds
to talk about the counseling
 process.

C10 No. The client shakes her head.

11 T11 Alright, then I will explain to you The therapist clarifies the
how counseling works. Our duration and fees for the sessions.
counseling sessions will last for
about 45 minutes. We usually
charge 500 rupees per session. Are
you comfortable with this amount?

C11 Yes. The client leans back in the chair.

12 T12 Okay. And we will have about The therapist clarifies the number
20-30 sessions total, the exact of sessions.
number of sessions depends on your
needs. If any session gets extended,
we will have to charge extra for that
one. Okay?

C12 Okay. The client nods.

13 T13 Also, whatever you share in this The therapist clarifies

session shall remain between us. confidentiality and the limits on
But if there is possible harm to you it.
or anyone else, then I am obligated
to disclose this information. Also,
sometimes I discuss my cases with
my colleagues so that they can help
me understand you better. So in that
case, I will share the information
but not your details like your name,
age, and so on. Are you okay with
 that?

Cl3 Yes. The client nods.

14 T14 Also, I shall be voice-recording our The therapist clarifies recording

sessions so that we can keep a of sessions.
record of our conversations, and
also we can see the difference
between how things were in the
beginning and how they are after a
few sessions. Are you okay with
that?

C14 I may be embarrassed to record The client seems hesitant and she
certain things, what if I don’t want gives an awkward smile.
to record?

15 T15 I understand your concern. We can The therapist acknowledges her

decide and stop the recording concern and suggests an
whenever you feel uncomfortable. adjustment.
But I would suggest that we record
everything. Anyway, it is your
choice.

C15 Okay. The client nods.

16 T16 Okay, so here’s a consent form, it The therapist hands over a typed
has all the details that I discussed consent form.
with you and more. Read it
carefully, and sign it if you agree
with the rules. I will sign it too so
that we can proceed with our
counseling relationship.
 C16 Okay, I will read it. The client glances through the
form.

17 T17 Great. So Shweta, do you have any The therapist gives the client a
questions about what we just chance to clarify her doubts.
discussed?

C17 No. The client shakes her head.

18 T18 Okay, now tell me, how did you Therapist attempts to know how
decide to come in for counseling? the client was referred.
How did you come across our
organization?

C18 One of my classmates referred this The client maintains a neutral

center to me. expression.

19 T19 Okay. So what do you want to talk The therapist asks an open-ended
about in counseling? Is there question about the client’s chief
anything, in particular, you want to complaints.
work on?

C19 Yes, I have a problem with using The client talks without hesitation
substances. It’s been there since I and to the point,
was in college. I didn’t think it was
a problem back then, but a month
ago I am feeling that I am addicted.

20 T20 Okay, what substance do you The therapist asks a probing,

usually take? close-ended question.

C20 I take sleeping pills. The client has a neutral

expression.
21 T21 Okay, you mentioned that earlier it The therapist paraphrases the
did not seem like a problem, but client’s statement and asks the
now you think that you are client to elaborate.
addicted. What makes you say that?

C21 I thought I can control myself, but The client seems distressed while
last night I got an anxiety attack and talking about her desperate efforts
I took five pills. to avoid taking the pills.

22 T22 Looks like you had a hard time last The therapist addresses the
night with the anxiety attack. In client’s distress and asks an
what other situations do you feel open-ended question.
like taking the pills?

C22 I am the kind of person who doesn’t The client speaks with conviction
like to get emotional. Whenever I in an even tone.
feel that my anger or stress is
unbearable, I take the pills. It makes
me feel calm.

23 T23 Okay, so you’re saying that you The therapist paraphrases the
take the pills when you are client. She then starts asking
overwhelmed by your emotions. Do about the history of the habit.
you remember the first time this
happened?

C23 When I was a kid I was very The client seems upset while
irritable and angry. My mother used talking about her friend. But she
to tell me to be quieter. And then in shares without hesitation.
college one day I fought with a
friend. I am the kind of person who
won’t go to console people when
they are angry. But she self harmed,
 after that i became very anxious.
And I took the pills for the first
time. Now when I take them I don’t
feel like crying, I feel very calm.

24 T24 Okay, so the fight you had with The therapist paraphrases the
your friend overwhelmed you and client. Then she asks about the
that’s when you started taking the frequency of taking pills.
pills. How often were you taking
them when you started? Do you
remember? And how often does it
happen now?

C24 When I started taking them it was The client speaks without
once in 6 months. Now it is almost hesitation.
once a week.

25 T25 Okay, so you’re saying the use of The therapist asks a probing
pills has increased. Do you question.
experience any side effects?

C25 Yes, sometimes I have a headache. I The client speaks slightly faster
also feel dizzy. The next day I feel than before.
fine, but the day I take the pills, I
have these side effects. My doctor
told me about the side effects when
he prescribed, he also told me in
what quantity to take.

26 T26 Alright, have you talked to anyone The therapist asks a close-ended
else about the pills? question.

C26 No. The client shakes her head.

27 T27 Is there, anyone, in your life that The therapist asks a probing
you would be comfortable talking question.
to?

C27 Perhaps my sister. If it was anything The client frowns.

else she would keep it between us.
But once she knows that the pills
are involved, she will tell my
parents and I don’t want that.

28 T28 Have you sought help for this The therapist asks a close-ended
problem before? Have you tried question.
anything on your own?

C28 I have not sought help from anyone. The client talks with a sense of
Last night I controlled myself for 15 helplessness.
minutes but then I took them
anyway.

29 T29 Okay, so I think we have a rough The therapist asks an open-ended

idea of what you are going through. question.
We can explore some of these
topics in the next session. Before
that I want to know, what are your
expectations from counseling?
What do you want to achieve
through our sessions?

C29 I just want to stop feeling The client uses hand gestures.
overwhelmed by my emotions so
that I don’t need the pills.

30 T30 Okay, so you wish to manage your Therapist summarises the things
 substance use. You believe that the discussed in the session to make
reason you take the pills is being sure she is on the same page with
emotionally overwhelmed. You the client.
want to manage your emotions
better so that you don’t feel the
need to take the pills. Is that right?

C30 Yes, that is right. The client nods.

31 T31 That’s fair. I am glad you came in The therapist appreciates the
today and took a step toward client for seeking help to
working on your habit. I look encourage active involvement.
forward to seeing you in the next
session.

Consolidated report:
The client was a 21-year-old female pursuing an MBA from a private university. She was
well-groomed and neatly dressed. She was frank and open in discussing her problems. She had
great clarity about the reasons behind her substance use. She was responsive and motivated to
make changes in her life.

Introspective report:
I had difficulty multitasking since I was taking notes and listening at the same time. It was
difficult to capture all nonverbal behavior in the notes. It took longer than expected to establish
rapport with the client. I could sense that the client was bored or tired of the long list of questions
I was asking about her in the beginning, but I did not know how to make the process more
interesting for her.