Summer Internship Report

A Report submitted in Partial fulfillment of the Requirement for the completion of the Master

of Science in Clinical Psychology

Riya Rai

2239361

M.Sc Clinical Psychology

Department of Psychology

CHRIST (Deemed to be University)

Yeshwanthpur Campus

July 12, 2023

The North Bengal Medical College and Hospital, originally envisioned by Dr. B. C. Roy, was

established in 1968 as the First Medical College of North Bengal. It is a government-based

Multi-speciality Hospital located in Sushrata Nagar, Siliguri, West Bengal. The hospital has

psychiatric inpatient and outpatient treatment facilities under the North Bengal Mental Health

Program. The Department of Psychiatry is headed by Dr. Nirmal Vera, MBBS, DPM

(Psychiatry). The department has a male ward and a female ward for the inpatients and

training college for psychiatric nurses. They provide internships, volunteer, and awareness

programs for the local youths and students. The NBMCH is the only government-based

hospital with a psychiatry department in the district of Darjeeling.

The clinical psychologist Mr. Saptak Halder was my supervisor who has been working in the

hospital for the past 9 years. The supervisor worked in rehabilitation centers, prisons, and

mental health establishments once a week. He kept records of the progress of the patients in

the hospital. He handled all kinds of cases such as court cases, academic, family, couples,
children, sexual abuse, substance abuse, etc. Mr. Saptak Halder was also responsible for the

supervision of interns and nurses.

The psychiatric ward had inpatients with serious mental disorders such as schizophrenia,

substance-induced psychosis, dissociative identity disorders, obsessive-compulsive disorders,

patients with mania, anger and conduct issues, etc. The outpatient handled developmental

disorders, mood disorders, intelligence disability, learning disability, etc. The ward had

playgrounds, and activity areas for recreational purposes for the patients. The outpatient

department has a pharmacy where the residential psychiatrists take care of the medication of

the patients.

Duty/ tasks assigned

Observership

As interns, our main responsibilities included observing the counseling and therapy

sessions taken for the outpatients at the hospital. We were supposed to track the patient's

therapeutic progress through the progress, make a report and observe changes in their

thought patterns. We were taught to use our theoretical knowledge to prepare a diagnostic

formulation. Through this, we were also able to see how the same disorder manifested itself

in different ways for people. We also learned how reports were made in detail for different

references, such as academics, court, family, etc. We had to make a report of the cases we

observed and encountered. We had to report our subjective opinions on the cases and what

we learned during the sessions.

Case history and MSE

The supervisor assigned all the interns including myself to take case history and MSE of the

patients at the outpatient department (OPD) before the beginning of the observation sessions.

The responsibilities were to talk to patients and their family members. The supervisor

informed us to not take more than 15 mins with a single patient. He also asked us to
understand the patient’s state of mind and behavior through observation and non-verbal cues.

we were specifically told to learn the art of doing MSE while taking case histories of the

patients. The rapport building was essential for the new clients. We were asked to genuinely

empathize with the patients and understand what they are going through instead of just

interviewing and making reports.

Assessments

Another important responsibility was to conduct assessments of the patients under the

supervision of the psychologist. Some senior interns helped us carry out assessments of the

children who came for various development disorders, mood disorders, anxiety disorders,

etc. I got to conduct assessments which I had learned in my courses. I also got to learn many

more assessments such Vineland social maturity scale (VSMS), DST, MINI 7, Hamilton

anxiety rating scale, etc. These assessments have truly enriched my experience and

knowledge in conducting tests on patients.

Case discussions

Case discussion included us discussing in detail the patient cases with our supervisor. This

was done to track their progress, maintain, suggest changes, or make changes in their therapy

or lifestyle. The supervisor would also give lectures to us on topics such as substance abuse,

personality disorders, and criminal cases. He always advised us on doing research on

different topics and being familiar with psychological terminology. Case discussion helped us

understand the cases better and provided answers to our questions.

Psychoeducation

Another important duty assigned to the interns was to provide psychoeducation to the family

members of the patients. We talked to parents individually and helped them understand the

disorder and how the support of family members can help a patient. I also understood the
difficulty of the family members /caretakers on how the state of the patient has affected their

life and well-being as well. We educated them on the importance of asking for help and

taking care of their mental health.

Case formulation 1

Ms. RS is a 57-year-old widowed female, with two children. She lives in Siliguri, west

Bengal with her son and belongs to a low socioeconomic status. She was born in Bihar and

married a man from West Bengal at the age of 16. She had no educational background and

has always stayed as a housewife. She lost her husband to an undiagnosed disease 10 years

before and has been struggling financially since then. Ms. RS came with a chief complaint of

forgetfulness and low mood. She also complained about having negative thoughts, anhedonia,

the feeling of anger and irritation. Ms. RS has no family history of psychiatric illness. She is

on medication for diabetes and recently had her leg surgery. The patient is an occasional

drinker and a regular user of chewing tobacco. Ms. RS lives with his younger son, who she

states makes her life more difficult. He always asks for money and spends a lot of time with

the wrong crowd. She hears neighbors complaining about her son which makes her angry and

more frustrated. She has stopped going out and completely isolated herself. Ms. RS married

off her elder daughter at the age of 14 in Bihar. She has lost contact with her family members

and doesn’t want to bother them with her worries. She feels like a burden and hopeless about

her son’s future. She has lost interest in everything, always feels bad, and has constant bodily

pain. Her head hurts and feels anger all the time. She has started forgetting things and thinks

she has started to lose her mind. She forgets the places where her things are kept, forgets to

switch off the gas, etc. which has caused her more stress for a few months. Ms. RS was

poorly dressed and disorganized. She was cooperative and oriented, her mood was low, and

showed broad affect. Her speech was normal with a low tone. Thought contents were
negative with guilt and hopelessness, however, her cognitive abilities were intact. She

showed level 4 insight with intact judgment.

Multiaxial Diagnosis

Axis 1

Provisional Diagnosis- Major Depressive Disorder

Differential Diagnosis- Depressive Pseudodementia, Dementia, Medication-Induced

Depression.

Axis 2

Duration: Current- 6 months Total- 2 years

Impairments in

Personal: 5 Occupational: 3

Family: 4 Social: 5

Axis 3

Psychosocial Factors

 Financial struggles

 Loss of a spouse

 Social Isolation

 No educational background

 Stranded relationship with her children

 Physical and Medical conditions.

Mr. S is 26 years old unmarried male, who lives alone and works as a teacher. He has

completed his higher secondary education and belongs to a middle-class family. The chief

complaint of the patient was, he was struggling with constant and repeated coughs which

started 2 months ago and have caused serious problems in his work and social life. The

patient complained that as soon as he talks, the cough automatically starts and it gets intense

during the night and morning. He is constantly worried that he might lose his job and he is

paranoid that he has some serious disease. The patient’s report on X-Ray, CT-Scan, Blood

test, etc. was all negative. The patient underwent a stone removal surgery 2 years ago and had

a minor bike accident months ago. The medical report showed no injury or physical

problems. Mr. S has a family history of high blood pressure and alcohol abuse. He has no

family history of mental illness. Mr. S had a normal childhood and he was an average student

in school. He liked school but he had problems making friends. He was shy and struggled to

talk in front of the class. He participated in group events when it was mandatory but he didn’t

like it very much. He stated that he liked to stay at home and it was the first time going away

from home and living alone. Mr. S was employed as a clerk in the bank in which his father

worked but he left it because he didn’t have the skill. His father got him a job as a teacher in

West Bengal, far away from home. He was hesitant at first but he decided to take the job. It

has been almost 2 years, he has friends in the workplace and everything was going fine and

then he started to cough, which has gotten worse with time.

MSE revealed restlessness, psychomotor agitation, speech was fast with less reaction time,

low mood, and negative thoughts. MR. S showed intact judgment and level 3 insight. He was

aware he was sick and needed help to get better.

Multi-Axial Diagnosis
Axis-1

Provisional diagnosis- Somatoform Disorder

Differential diagnosis- Adjustment disorder, OCD, Hypochondriasis

Axis-2

Duration: Current- 6 months Total- Unspecified

Impairments in

Personal: 5 Occupational: 3

Family: 3 Social: 5

Axis-3
Psychosocial factors

 Unstable jobs

 Personality

 Adjustment problems

Case formulation 3

Ms. TS, 18 years old female, unmarried was brought by her parents. She lives in Siliguri,

West Bengal, and belongs to a middle-class family. She has completed her education till 11 th

standard and is currently unemployed. The parents came with complaints of substance abuse

and behavioral issues. The father informed the psychologist that the patient has also been

involved in a court case for the possession and intoxication of illegal substances. Ms. S has

been running away from home and rehabilitation centers. She is aggressive, impulsive, and

always involves herself with the wrong crowd. Ms. S has no family history of psychiatric

illness or substance abuse. Ms. S started taking substances when she was in 10 th standard at
the age of 16. She was sent to a rehabilitation center, from where she ran away after 4

months. She was caught by the police in a state of intoxication and was brought back home.

She ran away from home several times. She is a single child and lives with her father and

stepmother. She lost her biological mother when she was 2 years old and has stranded

relations with her stepmother. She feels her father doesn’t trust her. She stays alone and

doesn’t have any close friends. She has lost contact with all her school friends. She regrets

not completing her education and misses her biological mother. She feels her life would have

been different if she hadn’t lost her mother. Ms. TS feels all other girl's life are perfect and

she can never have such a life.

Ms. TS was neatly dressed and cooperative throughout the session. Her mood was normal

and the affect was broad. She was oriented and had intact cognitive abilities. Her speech and

tone were normal. Her thought form was negative with guilt, and hopelessness. Ms. TS

showed level 3 insight with intact judgment.

Multi-Axial Diagnosis

Axis-1

Provisional diagnosis- Polysubstance dependence.

Differential diagnosis- Substance-use disorder, bipolar disorder, Oppositional defiant

disorder.

Axis-2

Duration: Current- 12 months Total- 2 years

Impairments in

Personal: 5 Occupational: 3
Family: 5 Social: 5

Axis-3
Psychosocial factors

 Loss of mother in childhood

 Dysfunctional family dynamics

 Absence of meaningful relationships

 Personality

 Negative peer influence.

Reflections

The internship was an opportunity that helped me gain new experiences in the professional

field. It exposed me to learn how sessions are taken and therapies are done in a clinical

setting. The key reflections from my experiences are stated below:

• The setting of the hospital was very different from what I had expected. Each patient

was different in their own experiences and circumstances. So, I understood how

theoretical knowledge is not enough to understand an individual patient. We, as a

psychologist, should have the skills necessary especially when it comes to how

mental health disorders manifest themselves in different people

• I also understood the importance of professional flexibility and adaptability. It is very

important to know people’s cultures and communities. Psychologist deals with people

with diverse cultures, age, social status, and educational background, hence we

should be able to deal with them appropriately and ethically.

• The internship also helped me realize my strengths and weakness. I struggled to build

a rapport with some patients. They were finding it very hard to talk to me and I

always knew that I was not very good at communicating but I never thought this
 would be so hard. So, I have to work on my communication skills. I also understood

that sometimes you have to be very patient with the clients because sometimes it's not

about you but it’s the nature of the patient. I also came to learn that I have a good

observation of non-verbal cues when it comes to understanding the patient.

• During the observation of sessions, I learned how my supervisor was conducting

therapies. The therapies were not systemic and as simple as we have learned in

theory. We have to understand what therapy is appropriate for the patient and what is

the possibility of that therapy being effective.

• Psychoeducation is very important for patients undergoing treatment as well as their

caregivers. Many patients were admitted who were being admitted for the 3 rd or 4th

time to the same or similar inpatient facility. This happens because many times the

family members either leave the treatment midway or they stop treatment

(pharmaceutical and/ or therapeutic) once they are discharged. People need to realize

that for disorders there is only treatment and no cure.

• It is known that empathy is a very important skill for a psychologist, but empathy

alone can make you vulnerable to manipulation and exploitation. So, I understood it

is also important that you have authority over your patients and clients. Sometimes

clients come to you for mental health certificates to clear their names and to get a job

or benefits. You must not be threatened, you must be able to act with authority and

work ethically.

• The importance of logical reasoning is another point I want to stress upon. When

patients come to you for a counseling session, they usually want your advice to

change their life. The patients, want to hear the truth and the logical answer which

they can believe. My supervisor always said to us “Show them the mirror”. When a

patient with alcohol abuse came for the session, the psychologist calculated the
 money he has wasted drinking and told him how he has lost his money, physical

health, mental health, and self-worth. Although it is not the way to deal with every

patient, it seemed to be effective. He told stories to children, to make them

understand and I thought it is a good way to make a logical point.

• The internship has also increased my interest in the field. When I saw the patients, I

felt good after talking to them. I got to understand the circumstance and behaviors of

the patient. I had the clarity and understanding of the responsibilities of a clinical

psychologist. I found the profession to self- satisfactory, a chance to make a

difference in people’s lives. I found it to be a noble profession.