Case presentation

Supervisor: Abraham George

Smriti Pradhananga
PG2222
Identifying information
Name: P
Age: 15
Gender: Male
Religion: Hindu
Culture: South Indian
Marital Status: Single
Languages known: English, Kannada, and Hindi
Occupation: Student
Education: 10th standard
No of sessions: 05
Referral: Self
Presenting • “I cannot control my anger if someone triggers me verbally
Problem or physically”
History of the Presenting Problem

• P has repeatedly been physical with anyone who scolds him or attacks him
• P mentions that he has been an angry child. He recalls swinging a stick and attacking a
man who yelled at his father.
• P describes how he is unable to think when someone yells at him or hits him. He
states that he has “head pain” whenever he gets mad.
• P had a fight when he was in 3rd standard with his classmate, B. B was in coma. P
showed no signs of regret or remorse. When asked the details, P recalls the incident
by the other group of classmates hitting his friend when he was absent. P could sense
something was wrong when he came back and when the fight broke out, P ended up
hitting B in his stomach. P was immediately given a transfer certificate.
History(Continued)

• P was kept in the juvenile jail for a day, and was released later by bail. When asked how he felt about his friend
getting hurt, P mentions “he got what he deserved.”
• When asked about B’s family, P looks away and says he feels bad for them. When asked why, P says that it was
their only son.
• P along with his friends has destroyed school properties. He says that if they are not being used, there is no
need for the products to be there. He proudly mentions how he and his friends “smashed” the switch boards
of the fan in his school. The fans in his classroom were not working, thus making him frustrated and angry.
• P mentions about Y, a girl in his class he detests. Y had complained to their teacher regarding P and his friends.
P wanted to “smash her”, but did not act on it.
• P hates his teacher, Ms. R who always beats and complains to the principle about P. P states that Ms. R makes
up things just to create problems for P. P also wants to “smash her”.
History(Continued)

• P is extremely angry at A, who is his classmate. P shares that A came and beat him for
no reason, making P lose his senses. P in return, “smashed” A.
• P cannot bear it If someone hurts him or his friends. P states that if you do not hit
them back, the other person will think that you are weak and come and hurt him
again. “That’s why I hit them in such a way they will never be able to touch me again.”
 Biological Functioning

SLEEP: NORMAL APPETITE: NORMAL ENERGY: NORMAL

 • Nil
Treatment History
Genogram
Family History
• P has a father who he is close to, mother and a younger sister.
• P’s father works as an auto driver.
• P’s mother is a home maker.
• P’s sister studies in 5th standard in a different school.
• P says that his father is very supportive of him.
• P mentions his father saying “if you are not wrong, then smash them.”
• P mentions not having an abusive childhood, or does not remember any incident of
violence growing up in his family or close friends.
Social/ Developmental History
• P loves to play volleyball and wants to become a volleyball player.
• All his friends at his previous school would play volleyball and go to coaching institution.
P feels sad that he cannot join coaching since it is expensive, but loves to play it with his
friends and plans to join state level and then finally national level.
• P won a match last year, but could not come in the first place from his school. He wishes
to play again this year.
• P is not that religious, but helps out in temples whenever there is an event.
• P has a close group of friends who he loves and cares about. He does not like anyone
hurting his friends, and cannot tolerate if anybody yells or hits them.
• P is jolly, loves to hang out with his friends and have fun.
Mental Status Examination
I. General Description:

Appearance: Not well-dressed. Mostly has shirt hanging out from his pants and never seen in well-ironed clothes.
Looks lean but looks strong. Shows no sign of physical illness.
Eye contact: Maintains eye contact when he has no answer. Looks away when he tries to maintain normal eye contact.

Overt behavior and psychomotor activity: Calm and composed.

Attitude: Cooperative, rapport was established.

II. Speech Characteristics:

Fluent in putting forward what he wants to say. Expresses what he can.

III. Cognition:
P had an average attention span.
P had no problem recalling the time, place and recognizing people.
P had a concrete thinking
IV. Mood and Affect:
Normal range.
Subjective affect: “Angry”
Objective affect: tensed, angry
THOUGHT STREAM: THOUGHT FORM: THOUGHT CONTENT:
NORMAL NORMAL NORMAL
Thematic Groupings
P feels the need to be extremely aggressive whenever he feels attacked.

In his judgment if P is right, i.e., “If I have done nothing wrong, I will not stay quiet.”

P is ready to go to any measures to make sure the other person will never be able
to shoot again.
Once someone pushes his buttons, P tends to lose control and lose his judgment,
which has resulted in hurting the other person badly.
This can be seen in his childhood with his father, his classmate B and Y, his teacher
Ms. R.
Diagnosis
312.34( F63.81): Intermittent
Explosive Disorder
MORAL
DEVELOPMENTA
L THEORY
Therapy model

Cognitive Rational Emotive

Person Centered
Behavior Behavior
Therapy
Therapy Therapy
Progressive Therapy

Behavior Behavior Core Issues

Stability Regulation
• Behavior • Person- • Cognitive
Therapy(REB Centered Behavior
T) Therapy Therapy
Rational Emotive Behavior Therapy
 Person Centered therapy:

Carl Rogers believes that people are trustworthy, resourceful, capable of self-understanding and
self-direction, able to make constructive changes, and able to live effective and productive lives.

This approach looks at the therapist not as an authoritative figure, but as an instrument of change-
their role is to be without the roles.

If the therapeutic core conditions exists over some period of time, constructive personality change
will occur.

The focus is on the person and not the problem.

Action Plan

The therapist tried to establish the rapport by allowing P to express his frustrations.

Therapist used reflection of feeling to get more clarity into P’s story.

Therapist allowed the client to explore his feelings, beliefs, and worldview.

Therapist was genuine, empathetic and accepting P’s perspective.

Therapist used open-ended questions, along with close-ended ones whenever necessary.

Therapist along with the client explored the P’s view of right and wrong, justice, and “anger”.
Future Plan
1. It's crucial to challenge P's belief that violence is the only way to
protect himself and his friends. Therapeutic interventions can focus
on teaching P alternative conflict resolution strategies, such as
assertive communication, de-escalation techniques, and seeking help
from trusted adults or authorities when faced with aggression.
2. P's self-preservation and dominance overlooks the feelings and
experiences of others involved in conflicts. Developing empathy for
others is essential for understanding the consequences of his actions
and fostering healthier interpersonal relationships. Interventions can
include role-playing scenarios, discussing the impact of his actions on
others, and practicing empathetic listening and communication.
3. Channeling his in terms of sports; since he enjoys volleyball allow his
energy to be spent on playing