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Periyar University

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    Psychology Internship Report Psychology Internship Report Document Transcript

    • TABLE OF CONTENTS Contents Contents......................................................................................................................................................1 ACKNOWLEDGEMENT.................................................................................................................................2 INTRODUCTION...........................................................................................................................................3 HISTORY OF THE INSTITUTION.....................................................................................................................8 PSYCHOLOGICAL THERAPIES......................................................................................................................12 Features ................................................................................................................................................22 CASE STUDY – I..........................................................................................................................................24 CASE STUDY – II.........................................................................................................................................29 CASE STUDY – III........................................................................................................................................33 CASE STUDY –IV.........................................................................................................................................38 CASE STUDY – V.........................................................................................................................................42 REFERENCES..............................................................................................................................................46 1
    • ACKNOWLEDGEMENT With grateful heart I would like to remember the persons who have helped me during the course of my internship program. I wish to place on record my words of gratitude to Dr.S.Kadhiravan, Associate Professor and Head of the Department of Psychology for being the enzyme and master mind behind my internship program. I owe warm-hearted acknowledgement of gratitude to Dr Vedagiri Ganesan, Ph.D. (PSY.), HONORARY DIRECTOR of Global Institute of Behaviour Technology & Former Syndicate Member & The Ex-Professor & Head, Dept. of Psychology, Bharathiyar University, Coimbatore. I sincerely thank him for his guidance and information. I express my sentiment of gratitude to my guide Mr. D. V. Nithyanandan, Assistant Professor, for his guidance and support. G. Saravanan 1
    • INTRODUCTION An internship is a trained and supervised experience in a professional setting in which the student is learning and gaining essential experience and expertise. Internship is meant for introducing candidates either full-time or part-time to a real world experience related to their career goals and interests. It may, but does not have to be related connected to one’s academic major or minor. Internships can be done during the academic semester and or summer depending upon the spaced out curriculum. There are several varieties of internship: some are paid some are not and some offer credit towards graduation. Internship is an excellent way to build those all important connections that are invaluable in developing and maintaining a strong professional network for the future. Internships provide real world experience to those looking to explore or gain the relevant knowledge and skill required to enter into a particular career field. Internship is relatively short term in nature with the primary focus on getting some on the job training and taking what’s learning in the classroom and applying it to the real world. Interns generally have a supervisor who assigns specific tasks and evaluates their overall work. For internship for credit, usually a faculty sponsor 1
    • will work along with the site supervisor to ensure that the necessary learning is taking place. Internship can be done by high school or college students to gain relevant experience in a particular career field as well as to get exposure to determine if they have a genuine interest in the field. An internship is an excellent way to determine if the industry and the profession is the best career option to pursue. Interns not gain practical work experience in a field that students intend to pursue but also build experience in local, national and international platforms. Internship helps individual to combine theory with practical work experience. Internship helps develop professional work habits; provides an understanding of professional cultures, gives an opportunity to analyze workplace setting, and offers platforms to compare difference in work styles. Internships, taken internationally, offer the privilege to observe differences in businesses, and see how projects are handled in different cultures, which might be conducted differently in the intern’s home country. Internships may present a potential for an offer of full time employment. Professional work experience is the most beneficial advantage that can be acquired 1
    • by completing an internship for students or fresh graduates, having this work experience on their resume can be the best way to get the foot in the door. This can result in more job offers as compared to individuals who lack such work experience. OBJECTIVES OF INTERNSHIP The main objective of the internship course is to facilitate reflection on experiences obtained in the internship and to enhance understanding of academic material by application in the internship setting. Internships will provide students the opportunity to test their interest in a particular career before permanent commitments are made. Apart from it is more important because: 1. Internship will help the trainees to develop skills and techniques directly applicable to their careers. 2. Internship will provide students the opportunity to develop attitudes conducive to effective interpersonal relationship. 3. Internship will provide students with an in-depth knowledge of the formal functional activities of a participating organization. 4. Internship programs will enhance advancement possibilities of graduates. 1
    • 5. Internship students will develop employment records or reference that will enhance employment opportunities. 6. Internship will provide students the opportunity to develop attitudes conducive to effective interpersonal relationships. PURPOSE OF INTERSHIP IN PSYCHOLOGY 1. To develop facility with a range of diagnostic skills, including: interviews, case history-taking, risk assessment, child protective issues, diagnostic formulation, triage, disposition, and referral. 2. To develop further skills in psychological intervention, including: environmental interventions, crisis intervention, short-term, goal-oriented individual, group, and family psychotherapy, exposure to long-term individual psychotherapy, behavioral medicine technique, and exposure to psychopharmacology, case management, and advocacy. 3. To develop facility with a range of assessment techniques, including: developmental testing (elective), cognitive testing, achievement testing, assessment of behavior, emotional functioning, assessment of parent-child relationship and 1
    • family systems, and neuropsychological evaluation (elective). Assessment training across will include both current functioning and changes in functioning. 4. To develop facility with psychological consultation, through individual cases and participation in multidisciplinary teams, including consultation to: parents, mental health staff (e.g., psychiatrists, social workers) medical staff (e.g., physicians, nurses, PT, OT, etc.), school systems, and the legal system. Consultation training occurs in both the inpatient and outpatient setting, both downtown and in the suburbs, and ranges. 5. To learn the clinical, legal, and ethical involved in documentation of mental health services within a medical setting. 6. To learn to promote the integration of science and practice, related to theories and practice of assessment, intervention, and consultation. Interns are trained in empirically-supported treatments (e.g., parent training groups, inpatient treatment protocols for school avoidance, eating disorders), and behavioral medicine protocols (e.g., medical noncompliance, pain management, headache treatment, toilet training). 1
    • HISTORY OF THE INSTITUTION Global Institute of Behaviour Technology is situated at Vellingiri Nagar (South) Navavoor in Coimbatore. It offers solution for most health problems, which have emotional causes by the use of appropriate Behaviour Tehchnology, without the use of drugs, within a specified period of time and with a guarantee. It creates safe, lovely, homely and enabling environment for patients. It is a mental health care and de-addiction centre. It is in service of people for around 43 years. It is owned and operated by Rtn. PP. PHF. Prof. Dr. Vedagiri Ganesan, PhD. 1
    • It is a well established institution for treating and caring for patients who are suffering from different psychiatric disorders. It also functions as a De-addiction centre for different substance abused or dependent people. It is the only institute in India which treats the patients by physiological manipulation to bring neurobiological changes in the patients and recondition their Mind-Body relationship. People from all over the country visit the institution. Internship in this institution Over the last 43 years, students of psychology, psychiatric social work, nursing students and psychiatric nursing students from across the country come to this institution for their internship and training programs. The management of this institution provides all facilities for these students. When I approached this institution for my one month internship, they happily received my request. The Director encouraged us to interview the patients and asked us to come with new ideas to provide new exercises creatively. It was both Work experience internship as well as Research internship. He taught us various ancient techniques taken from scriptures and urged us to explore the hidden knowledge in our culture and apply it innovatively according to the need of the hour. It was a kind of Guru-Shishya 1
    • experience and he cared about our spiritual life in addition to the transferring his knowledge and expertise. Profile of the Director Dr. Vedagiri Ganesan, Ph. D., is a renowned counseling/ clinical/ Business/ Organizational/ Environmental Psychologist with over four decades of experience in Training and Consultancy at National and International levels. He has served in various capacities in number of Professional Bodies of Psychology, Industrial Psychiatry, Management, and Andrology as President, Vice - President, Secretary, Executive Committee Member, etc. Prof. Ganesan was awarded the Young Scientist Award by the Indian Science Congress Association, Calcutta in 1982 at Mysore, the Visiting Associateship Award (Yoga Techniques and Behaviour Modification Techniques), and Source Material Collection Award for his research on Organizational Climate for Knowledge Workers and Creativity. He had presented research papers in over two hundred National and International Conferences, Seminars and Workshops, and published papers over 1
    • two hundred papers in National and International Journals and Magazines and Dailies. Prof. Ganesan has been serving as Expert / Consultant for various Public and Private Sector Organizations. He holds patent right for Sea Shrink Technology. 1
    • PSYCHOLOGICAL THERAPIES 1. BEHAVIOURAL THERAPY Behaviour therapy refers to psychological treatments, which are based on experimental psychology and intended to change symptoms and behaviour. It assumes the role of learning in the aetiology, maintenance and treatment of some psychiatric disorders. Some of these disorders are due to a lack of learning, e.g. enuresis; some to over-learning, e.g. obsessional rituals; and others to loss of previous learning, e.g. institutionalisation. Behavioural therapy has beneficial change in behaviour as the goal. The methods used may be based on Pavlovian classical conditioning (1927), Skinnerian operant conditioning (1938), learning principles, experimental psychology, or behavioural sciences in general. Whereas psychoanalysis is concerned with understanding how the individual's past experiences (e.g. childhood trauma or conflicts) influence behaviour, The behaviour therapy focuses on the behaviour of the here-and-now. Criteria for behavioural treatment: 1. The problem can be defined in terms of observable and measurable behaviour. 2. The problem is current and generally predictable. 3. Therapist and patient can agree on already defined behavioural goals. 4. Patient understands the treatment offered and accepts it. CONDITIONS SUITABLE FOR BEHAVIOUR THERAPY 1. Phobic disorders 2. Obsessive compulsive disorders 3. Generalised anxiety disorder 4. Panic disorders 5. Habit disorders 6. Sexual deviations/dysfunctions 7. Social skills deficits 8. Enuresis 1
    • CONDITIONS WHERE BEHAVIOUR THERAPY MAY BE USEFUL 1. Eating disorders 2. Alcohol dependence 3. Post-traumatic stress disorder 4. Marital disharmony 5. Rehabilitation of chronic psychiatric patients 6. Behaviour modification in the mentally retarded Behavioural approaches may be categorised into: 1. Anxiety reduction techniques a) relaxation therapy b) autogenic training c) guided imagery d) systematic desensitization e) exposure therapy f) response prevention g) modelling h) thought stopping i) biofeedback 2. "Appetite" reduction techniques a) aversion therapy b) habit reversal c) mass practice d) response cost 1
    • 3. Addition (development) of new behaviour a) social skills training b) modelling c) shaping d) token economy Relaxation Therapy The simplest form of relaxation therapy involves regular deep breathing exercises. The patient chooses a quiet spot e.g. a dimly lit room, rests on a comfortable armchair, and closes his/her eyes. He/ She thinks about nothing, and just focuses on his/her breathing. As he/she does that, he/she takes in a slow and deep breath, holds it for a few seconds, then gradually breaths out. By breathing slowly and regularly at a respiratory rate of 10 to 12 breaths per minute, he/she will begin to feel the relaxation coming upon his/her body. Another form of relaxation exercise is muscle relaxation. First described by Jacobson (1938), it was an elaborate procedure intended to bring about reduction of individual groups of skeletal muscle tone. It involves alternate contraction followed by relaxation of different muscle groups e.g. the arms, shoulders, neck, jaw, face, etc. This can be taught individually or in groups using a video or an audiotape with recorded instructions and demonstration. It should be practised regularly, especially in anticipation of any imminent stressor. Relaxation therapy is effective for the management of generalised anxiety disorder, mild hypertension and migraine. It can also aid in the dose reduction of benzodiazepines for the treatment of anxiety and sleep disorders. Autogenic Training Developed by Schultz (1905) from the work of Oskar Vogt, this involves a series of standard relaxation exercises followed by meditative ones to induce feelings of heaviness, warmth or cooling in parts of the body and to slow 1
    • respiration. Autogenic training can be used to treat generalised anxiety disorders and stress related disorders. Guided Imagery Here the patient is presented with a series of mental images depicting peace and rest. Sceneries such as the tranquillity of a clear blue lake, the morning break by the golden beach, or the cool and refreshing dew in the woods, are used to induce relaxation. Often soothing music or sounds of chirping birds or waves in the background help enhance the relaxed state further. The purpose is to involve as many sensory modalities as possible in the imagery in order to achieve optimal relaxation. The indications are similar to those prescribed with relaxation therapy. Systematic Desensitization Developed by Wolpe (1958), it begins with the construction of a list of anxiety-evoking situations in an ascending order (hierarchy). Relaxation is taught, and the patient is presented with the hierarchy of feared situations (either live or by imagination), beginning with the least feared one. Mild anxiety is experienced initially, and this is paired with relaxation exercise. Once the anxiety diminishes, the next level of feared stimulus is presented. In this way, while never experiencing intolerable anxiety, the patient proceeds from mildly anxious situations to progressively more terrifying ones. Gradually he will be able to cope with the most anxiety evoking situations. Systematic desensitization is commonly used for the treatment of phobic disorders. Exposure Therapy This is similar to systematic desensitization except that no attempt is made to relieve the anxiety during the period of exposure. Instead, with time, the anxiety will subside or disappear through a psychological process of habituation. This deliberate exposure aims at confronting the fear instead of avoiding, and can be graduated (graded-exposure) or else "flooding" the patient with the most feared situations all at once. Exposure therapy is now the mainstay of behavioural treatment for obsessive-compulsive disorder and phobias. Response Prevention 1
    • Often used in combination with exposure therapy, response prevention aims at prolonging exposure to ritual-evoking cues by refraining from carrying out the rituals that would normally follow e.g. hand washing. With time, the urge to perform the rituals will subside. Response prevention can be used for obsessivecompulsive disorder and eating disorders. Modelling Modelling refers to the acquisition of new behaviours by the process of imitation. The patient observes someone else carry out an action, which he has problem with. It is often used in conjunction with other techniques like exposure therapy and role-playing for the treatment of obsessive-compulsive disorder and phobias, as well as in social skills training. In the phobic child, modelling is especially useful e.g. the phobic child watches other children play with dogs and is then encouraged to join in subsequently. Thought Stopping Here chains of repetitive thoughts or obsessional ruminations are suddenly interrupted overtly e.g. by a sudden loud noise or by shouting the word "STOP!" The snapping of elastic bands worn over the wrist can also act to interrupt these thoughts. Alternatively, the patient could say the word "STOP" subvocally, which is probably socially more acceptable. Biofeedback Biofeedback involves the use of electronic instruments to monitor small and otherwise undetectable changes in the biological state of the patient. These are then fed back to him (visually e.g. colours or by auditory means e.g. low or high pitched sounds), so that he can in turn gradually learn to alter and control them. Biofeedback has been used to train individuals to gain control over heart rate, blood pressure, skin temperature, EEG activity and muscle tension. It has been used in the treatment of cardiac arrhythmias, hypertension, tension headache, migraine, tics, generalised anxiety and stress related disorders. Aversion Therapy 1
    • In aversion therapy, the undesirable behaviour is paired with an unpleasant consequence. It may take the form of imaginable aversion (also called covert sensitization) or physical aversion e.g. electric shock. A paedophile when imagining touching a naked child shocks himself or imagines himself being arrested and publicly humiliated. Besides deviant sexual behaviour, aversion therapy has also been used in the treatment of alcohol dependence and pathological gambling. The ethanol-alcohol reaction following alcohol ingestion with disulfiram is an example of chemical aversion. Mass Practice In mass practice, the patient is asked to deliberately practise the undesirable behaviour e.g. motor tics. This will lead to boredom and eventually extinction of the behaviour. Habit Reversal As its name suggests, habit reversal attempts to extinguish undesirable habits like tics, trichotillomania, stammering and stuttering. Described by Azrin and Nunn (1977), it involves the use of a competing action, which is incompatible with the habit. A nail biter can grasp an object while a person with motor tics may be taught to contract the muscle of his upper limb isometrically. Response Cost This is a form of aversion in which the patient agrees to pay a forfeit, not necessarily monetary, for every exhibition of an undesirable behaviour. Widely practised as the form of fines for offending the law for instance, the person could prearrange to make a donation to his least liked charitable organisation for every stick of cigarette he smokes. Social Skills Training Social skills consist of verbal and non-verbal behaviours, which a person needs in order to form and/or maintain social relationships with other people. It can be taught to those who are deficient in such skills. The training involves a step-bystep programme including the breaking down of a social interaction into different stages like initiating, maintaining and terminating social contact, personal 1
    • grooming, modelling, rehearsal and role-plays, and finally video feedback. Attention is drawn to details like eye contact, voice volume, body language, posture and social distance. It has been employed successfully to institutionalised chronic schizophrenics, depressives, psychopaths and the mentally retarded. Although it may not play a direct therapeutic role like drugs in terms of cure for the illness, it has an important role in the overall management of the patient in enhancing a better quality of life during rehabilitation. Shaping It is a form of operant conditioning in which rewards are given for successive approximations towards the desired new behaviour e.g. a mentally retarded child dressing himself. The desired behaviour is broken into many steps, and often the therapist also acts as a model for the child to follow. It is a laborious process, and used only if a new behaviour is totally absent from the patient's repertoire. Token Economy Also based on operant conditioning as in shaping, desired behaviours necessary for day-to-day functioning are specified. A unit of exchange (the token) is presented to the patient contingent upon the occurrence of the desired behaviours. The tokens accumulated can then be exchanged for other objects or privileges. Token economy is often used to avoid institutionalisation of long stay psychotic patients and the mentally retarded. 2. PSYCHOTHERAPY Psychotherapy is a form of treatment based on the systematic use of a relationship between therapist and patient (as distinct from pharmacological or social methods) to produce change in feelings, thinking and behaviour. The advantage of this definition is that it highlights how the quality of the interpersonal relationship forms the basis for therapeutic efficacy, whatever techniques are 1
    • employed to this end. As with all interpersonal relationships, communication is an intrinsic aspect of psychotherapy. The predominant medium of communication involves the use of spoken language. However, non-verbal means (e.g. body sculpting, drama, music, art and play) have been employed for psychotherapeutic purposes as well. The Goals of Psychotherapy In general, the goals of psychotherapy are as follows: (1) removal of distressing symptoms; (2) altering disturbed patterns of behaviour; (3) improved interpersonal relationships; (4) better coping with stresses of life; (5) personal growth and maturation. Types of Psychotherapy Broadly, there are 4 different theoretical approaches adopted in psychotherapy. They have their basis in: (1) psychoanalytic tradition; (2) cognitive-behavioural theory; (3) interpersonal or systemic theory; (4) existential or gestalt philosophy. Psychotherapy can be carried out in 4 modes, namely with: (1) individuals (2) couples (3) families (4) groups By convention and for historical reasons, individual psychotherapy is often identified by its theoretical orientation. Thus, we have 4 main types of individual psychotherapy, namely psychodynamic psychotherapy, cognitive-behavioural psychotherapy, interpersonal psychotherapy and existential/experiential psychotherapy for individuals. When the mode of delivery involves more than one person, the theoretical orientation is often left out in the reference (i.e. couple or marital therapy, family therapy and group therapy). 1
    • Despite the diversity of techniques employed in psychotherapy, the following are beneficial functions that most, if not all effective psychotherapies have in common: (1) Developing a therapeutic relationship (2) Generating positive expectations (3) Facilitating cognitive and experiential learning (4) Facilitating emotional arousal and catharsis (5) Engendering a sense of mastery (6) Application of new skills developed 3. COGNITIVE THERAPY Cognitive therapy (CT) is a brief structured form of psychotherapy, which deals with the identification of maladaptive cognitions (thoughts, attitudes, images and dreams) and its substitution with more adaptive ones. Cognitions, emotions, behaviours, bodily symptoms and environmental factors are intricately linked. Change in any one of these may lead to changes in the other four. As emotions are less directly amenable to change, changes of cognitions, behaviour and the environment are more practical means of effecting emotional changes. CT is concerned primarily with current problems the sufferer is faced with and possible solutions. The therapist is active and interactive, seeking to secure a collaborative relationship with the client. The therapy is based on empirical data and is education and skills oriented with the aim of guiding the client to “discover“ solutions. There is a myth that CT is not interested in emotions or the client’s past. Contrary to these beliefs, in CT, emotions and shifts of emotions are important to the therapy. Strong emotions are often the best time to explore cognitions (“hot cognitions”). Although CT is primarily focused on current problems the client faces, the past is extremely important in helping both client and therapist understand and conceptualize the current problem(s). 1
    • Fig. 1 The interplay of environment, behaviour, emotions, thoughts and bodily symptoms. The environment, behaviour and thoughts are more amenable to change than emotions and bodily symptoms. Cognitive therapy has its roots in the empirical method much espoused by the early Greek philosophers. Indeed, “Socratic” questioning (inductive questioning which seeks to lead the client to answers based on knowledge already available to the patient) is held to be a key therapeutic tool in CT. Until the end of the Second World War, analytical psychotherapy was the primary form of psychotherapy practiced in much of the Western world. In the fifties, behaviour therapy became popular. In the sixties, both Aaron Beck and Albert Ellis independently introduced cognitive models mental distress and its accompanying therapy - cognitive therapy. They hypothesized that thinking mistakes were behind much of the emotional distress in people and that people would be able to change the way they feel if they first changed the way they think. Today, cognitivebehaviour therapy stands alongside analytical psychotherapy as the most commonly prescribed form of psychotherapy in the Western world. Efforts by Anthony Ryle and his team have focused on merging psychoanalytical and cognitive-behavioural principles (cognitive-analytical therapy). 1
    • CT is an empirical method, driven by cognitive models derived from social psychology, cognitive psychology, psychiatry, behaviour therapy and dynamic psychotherapy. Its efficacy is supported by empirical scientific studies. The nature of CT has lent itself well to the manualisation of therapy, aiding standardization of research and its availability to the lay-person in the form of “self-help manuals”. Features As with other forms of psychotherapy, a good therapeutic relationship is critical for the successful outcome of psychotherapy. Factors that are responsible for patient improvement in psychotherapy or counseling are no less important in CT. These include: the instillation of hope; the provision of an alternative view to the problem; confidence in the therapist and the therapy; acceptance of the therapeutic model; warmth, genuineness and concern; the development of patient skills; and patient co-operation and openness. CT is indicated for the following conditions: Anxiety disorders, Depressive disorders; Marital Problems; Personality disorders; Eating disorders; Additive disorders and Somatoform disorders. It is a useful adjunct in bipolar and psychotic conditions, where it can be used to improve the detection of early signs of relapse and improve medication compliance. Modifications may have to be made when CT is used in children, those with psychotic conditions and those with personality disorders. Clients should be assessed on their ability to be collaborative, to develop a good rapport and to accept the cognitive model. If both therapist and patient agree on cognitive therapy, a fixed number of sessions (usually 8-12) are decided upon, as is the focus of therapy (based on the patient’s problem list and the priority of each problem). Ideally sessions should be weekly or fortnightly and lasting for 45 minutes to an hour. Assessment should include the following: • What are the patient’s problem(s)? • What is the diagnosis? (use of the DSM-IV pentaxial classification is recommended) • What are the negative automatic thoughts and schemas operating • What are the cognitive models available • How do the patient’s cognitions, behaviours, emotions, bodily symptoms and 1
    • environmental factors interact? • At what stage of readiness for change is the client? • Can the client form a collaborative working relationship? • What is the client’s perception and beliefs of his or her “problem”? • What are the client’s strengths and weaknesses? • How can the case be best conceptualized? (predisposing, precipitating, perpetuating factors) • What interventions are most suited for the case? • What scales and questionnaires may be useful in this case? • What is the client’s view about the cognitive model and cognitive therapy? • Should cognitive techniques or therapy be used • What are the therapist’s own negative thoughts and schemas which may affect therapy? 1
    • CASE STUDY – I Client Profile Name :K Age : 66 Gender : Male Marital Status : Married Religion : Hindu Socio Economic Status : Middle Class Occupation : Nil Domicile : Urban Informant : Son Reliability : Reliable Chief Complaints 1. Fear of Death 2. Heart palpitation 3. Excessive burning sensation all over the body 4. Constipation 5. Throat irritation 6. Sense of vomiting 7. Lack of appetite and sleeplessness 1
    • 8. Diabetics 9. Erectile Dysfunction Complaints by Family 1. Does not allow the family members to sleep 2. Does not speak with family members 3. Complaints about family members and doctors 4. Unnecessary physical touch on his daughter-in-law History of Present Illness The above symptoms has been reported by the client since last 7 months and visited around 11 doctors. Doctors certified that there was underlying physical cause and referred him to a psychotherapy. History of Past Illness Nil Medical History Under the treatment for Diabetics since a year Personal History He was born as 8th child in his family. He got married to his niece by force after having coital relationship as a result his wife never enjoyed sex till date and does not cooperate for it. Both are excessively religious. Sexual History He had extra-marital affairs and now suffers from erectile dysfunction. 1
    • Mental Status Examination General Appearance • Dressed Neatly • Proper Eye contact is maintained. • Psychomotor activity was not normal Speech • Slurred and incoherent Attention and Concentration • Normal Diagnosis The client has been diagnosed to be suffering from Psychosomatization with Phobic Anxiety and Fear of Death. Treatment 1. Paradoxical Intensive Technique The client was asked to bring out the burning sensation and increase it to the highest level and face the death for an hour. The harder he tried, 1
    • the harder it was to feel his burning sensation and he lost the fear of death and never reported the burning sensation again. 2. Enema Enema was administered to clean the stomach for constipation. Once it was given, the client had good appetite and peaceful sleep. 3. Genital Muscle Relaxation Technique It involved the contraction of genital muscle and withholding it for a specified period and releasing it. Hence, the genital muscles become under the voluntary control of the client and enhance sexual behavior. 4. Wall pushing Wall pushing makes the client realize that the effort on certain things does not bring any change and therefore redirect the energy on more fruitful away. This also makes the person physically active. 5. Incremental Walking The client is asked to count each step there by bringing presence of mind in him and productive physical activity. 6. Rate of Breathing Rate of Breathing is the counting of inhale and exhale of a person in a minute. In this process, the client is aware of each and every part of his body and mind and he is able control it on his own will. This enables the client to manage his stress and keep him calm and composed in any anxiety provoking situation. 7. Imagery Guidance (“Om” Khar) The client was asked to imagine his favorite God and chant “OM” in order to remove his guilt feelings and fear of death. 8. Mirror Gazing 1
    • Looking at the mirror increases liking for the person and develops positive image and self concept of the person 9. Boxing This makes the client active and provides a sense of achievement. 10.Laughter Therapy The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy. 11.Sex Therapy to his wife was administered Sexual therapy involves various exercises involving both husband and wife. The wife is given hip movement to remove her sexual inhibition and proper sexual positions are demonstrated. 12.Varma Therapy Varma points were pressed in order to alert her and bring her back to conscious and overcome the effect of the tranquilizer. PHARMACOLOGICAL White Leninment was applied for burning sensation and salt gaggling was administered for vomiting sensation. 1
    • CASE STUDY – II Client Profile Name :V Age : 20 Gender : Male Marital Status : Unmarried Religion : Hindu Socio Economic Status : Middle Class Occupation : Student Domicile : Urban Informant : Sister 1
    • Reliability : Reliable Chief Complaints 1. Unrealistic goals 2. Anger 3. Abusing family members 4. Poor social skills 5. Breathing problem 6. Poor memory Complaints by Family 1. Does not respect anybody in the family 2. Demands bulk of amount for unrealistic goals 3. Cries when he is alone History of Present Illness The above symptoms have been reported by the client since last 4 years and consulted 6 doctors for counseling. History of Past Illness Nil Medical History 1
    • Under the treatment for stomach problem such as poor digestion and lack of appetite due to acidity. Personal History He was born as 2nd child in his family. He lost his father when he was 5 years old and he is under the control of his grandparents. He is forced to get married soon by his grandmother to get his ancestral property. And his mother is being neglected by his grandparents leading to conflicts in him. Educational History He started schooling at the age of 5. He excelled in his studies and joined BE in Sathyabama University, Chennai. He was forced to discontinue the course by his mother due to family issue and join BCA in AVS college, Salem. This created trouble in him Sexual History Failed intercourse with his ex-lover due to anxiety. Mental Status Examination General Appearance • Dressed Neatly • Proper Eye contact is maintained. • Psychomotor activity was normal Speech • Slurred Attention and Concentration • Distracted Diagnosis 1
    • The client has been diagnosed to be suffering from Anxiety about Future and Social Anxiety Treatment 1. Rate of Breathing Rate of Breathing is the counting of inhale and exhale of a person in a minute. In this process, the client is aware of each and every part of his body and mind and he is able control it on his own will. This enables the client to manage his stress and keep him calm and composed in any anxiety provoking situation. 2. Anger Reversal Technique The clients sat in front of a mirror and exhibited anger on start and relax on stop. This brings anger under the voluntary control of the client 3. Wall pushing Wall pushing makes the client realize that the effort on certain things does not bring any change and therefore redirect the energy on more fruitful away. This also makes the person physically active. 4. Incremental Walking The client is asked to count each step there by bringing presence of mind in him and productive physical activity. 5. Genital Muscle Relaxation Technique 1
    • It involved the contraction of genital muscle and withholding it for a specified period and releasing it. Hence, the genital muscles become under the voluntary control of the client and enhance sexual behavior. 6. Imagery Guidance (“Om” Khar) The client was asked to imagine his favorite God and chant “OM” in order to remove his guilt feelings and fear of death. 7. Candle Gazing It increases the concentration of the client and able to focus on the task at hand. This also increases assertiveness of the client 8. Laughter Therapy The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy. 9. Tossing the Coin Tossing a coin and guessing the result makes the client realize that the outcome of an event is beyond our control and therefore accept the life events as it comes and go ahead with the life irrespective of the past. 10.Skipping Skipping brings coordination between mind and body. It increases concentration and provides a sense of achievement. CASE STUDY – III Client Profile Name : KN 1
    • Age : 24 Gender : Male Marital Status : Unmarried Religion : Hindu Socio Economic Status : Upper Class Occupation : Student Domicile : Urban Informant : Father Reliability : Reliable Chief Complaints 1. Suicidal Thoughts 2. Obesity 3. Anger 4. Obsessive Thoughts 5. Poor social skills 6. Emotional Instability 7. Poor memory Complaints by Family 1. Poor academic performance 2. Avoids social gatherings 1
    • 3. Gets annoyed soon for no reason History of Present Illness The above symptoms have been reported by the client since last 1 year after a girl commented about his physical appearance in front of everyone in the class and rejected his proposal History of Past Illness Nil Medical History Nil Personal History He is the only child in his family. He lost his mother when he was 4 years old Educational History He started schooling at the age of 5. He excelled in his studies and joined M.Tech in USA. He was forced to discontinue the course due to failed love affair Sexual History Nil Mental Status Examination General Appearance 1
    • • Dressed Neatly • Proper Eye contact is not maintained • Looks very shy • Psychomotor activity was normal Speech • Slurred Attention and Concentration • Normal Diagnosis The client has been diagnosed to be suffering from poor Self Concept and Social Anxiety Treatment 1. Rate of Breathing Rate of Breathing is the counting of inhale and exhale of a person in a minute. In this process, the client is aware of each and every part of his body and mind and he is able control it on his own will. This enables the client to manage his stress and keep him calm and composed in any anxiety provoking situation. 2. Anger Reversal Technique 1
    • The clients sat in front of a mirror and exhibited anger on start and relax on stop. This brings anger under the voluntary control of the client. 3. Mirror Gazing Looking at the mirror increases liking for the person and develops positive image and self concept of the person 4. Wall pushing Wall pushing makes the client realize that the effort on certain things does not bring any change and therefore redirect the energy on more fruitful away. This also makes the person physically active. 5. Incremental Walking The client is asked to count each step there by bringing presence of mind in him and productive physical activity. 6. Genital Muscle Relaxation Technique It involved the contraction of genital muscle and withholding it for a specified period and releasing it. Hence, the genital muscles become under the voluntary control of the client and enhance sexual behavior. 7. Laughter Therapy The client was asked to laugh for 30mins. This released neurochemical in the brain and made him feel happy. 8. Tossing the Coin Tossing a coin and guessing the result makes the client realize that the outcome of an event is beyond our control and therefore accept the life events as it comes and go ahead with the life irrespective of the past. 1
    • CASE STUDY –IV Client Profile Name : PD Age : 11 Gender : Female Marital Status : Unmarried Religion : Hindu Socio Economic Status : Upper Class Occupation : Student Domicile : Urban Informant : Father Reliability : Reliable Chief Complaints 1. School Phobia 2. Excessive Sweating 3. Obsessive Thoughts 4. Anger 5. Emotional Instability 1
    • Complaints by Family 1. Breaks things and adamant 2. Refuses to go to school 3. The schooling is not challenging to her and it is of no use 4. Changes cloth three to four times before going to bed 5. Gets annoyed soon for no reason History of Present Illness The above symptoms have been reported by the client since last 1 month after being shifted to new school due to professional transfer of her father. The new school has a system of seating arrangement in which a boy and girl sits alternatively. This creates anxiety in her. History of Past Illness Nil Medical History Nil Personal History He is the only child in her family. Her parents show excessive love. She got annoyed when her mother threatened her that she would adopt another child. Her mother reported similar problem when she was 11 years old before attaining puberty. Educational History She started schooling at the age of 5. She excels in her studies. Sexual History 1
    • Nil Mental Status Examination General Appearance • Dressed Neatly • Proper Eye contact is maintained • Psychomotor activity is normal Speech • Normal Attention and Concentration • Normal Diagnosis The client has been diagnosed to be suffering from Aversion to Boys and Anxiety Treatment 1. Rate of Breathing Rate of Breathing is the counting of inhale and exhale of a person in a minute. In this process, the client is aware of each and every part of his body 1
    • and mind and he is able control it on his own will. This enables the client to manage his stress and keep him calm and composed in any anxiety provoking situation. 2. Candle Gazing It increases the concentration of the client and able to focus on the task at hand. This also increases assertiveness of the client 3. Behavioural Contract Both the parents and the child have come to an agreement and listed out the expectations from each other and abide by that. This reduces the conflict and creates better understanding. 4. Training to Teachers The therapist contacted the school management and arranged for a workshop and train them on how to handle the teenage students. 1
    • CASE STUDY – V Client Profile Name : VI Age : 17 Gender : Male Marital Status : Unmarried Religion : Hindu Socio Economic Status : Middle Class Occupation : Student Domicile : Urban Informant : Father Reliability : Reliable Chief Complaints 1. Addicted to Gadgets and porn movies 1
    • 2. Obsessive Thoughts 3. Excessive Anger 4. Emotional Instability Complaints by Family 1. Breaks things and adamant 2. Refuses to go to school 3. Does not concentrate on studies 4. Uses abusive words 5. Gets annoyed soon for no reason History of Present Illness The above symptoms have been reported by the client since last 2 year after being criticized by a lady teacher in front of classmates. This created an emotional trauma in him. History of Past Illness Nil Medical History Nil Personal History He is the only child in his family. His parents show excessive love. He got annoyed when his class teacher slapped in cheek and scolded him in front of girls. 1
    • Educational History He started schooling at the age of 5. He excelled in his studies up to 9th standard and his performance decreased from SSLC onwards. Sexual History Nil Mental Status Examination General Appearance • Dressed Neatly • Proper Eye contact is maintained • Psychomotor activity is normal Speech • Normal Attention and Concentration • Normal Diagnosis The client has been diagnosed to be suffering from Aversion to girls and Poor Self Concept Treatment 1. Developing Multiple Response to a threatening stimulus 1
    • The client was asked to image the teacher he hated most and morphine her like a monkey, dog and various other funny creatures. This reduces the anxiety in the client 2. Candle Gazing It increases the concentration of the client and able to focus on the task at hand. This also increases assertiveness of the client 3. Mirror Gazing Looking at the mirror increases liking for the person and develops positive image and self concept of the person 4. Skipping Skipping brings coordination between mind and body. It increases concentration and provides a sense of achievement. 5. Incremental Walking The client is asked to count each step there by bringing presence of mind in him and productive physical activity. 6. Wall pushing Wall pushing makes the client realize that the effort on certain things does not bring any change and therefore redirect the energy on more fruitful away. This also makes the person physically active. 7. Rate of Breathing Rate of Breathing is the counting of inhale and exhale of a person in a minute. In this process, the client is aware of each and every part of his body and mind and he is able control it on his own will. This enables the client to 1
    • manage his stress and keep him calm and composed in any anxiety provoking situation. 8. Genital Muscle Relaxation Technique It involved the contraction of genital muscle and withholding it for a specified period and releasing it. Hence, the genital muscles become under the voluntary control of the client and enhance sexual behavior. REFERENCES 1. Theory and Practices of Behaviour Therapy, J. Wolpe. (1969), New York: Pergamon 1