Internship at

PSYCHEDD PSYCHOLOGY SERVICES PVT.LTD

Submitted for the partial fulfilment

For the degree for
Master of Arts in
PSYCHOLOGY
2019-2021

Topic- clinical Psychology

SUBMITTED BY
NIKHIL MISHRA

UNDER THE SUPERVISION OF

Ms. MUKTI SINGH THAKUR

DEPARTMENT OF PSYCHOLOGY
 ACKNOWLEGDGEMENT

I would like to express my special thanks of gratitude to our principal Dr. Fr. John P. J. who
gave me the golden opportunity to do the wonderful project.

I take this opportunity to express my profound gratitude and deep regards to my guide Ms.
Mukti Singh, Asst. Professor for her exemplary guidance, monitoring and constant
encouragement throughout the course of this internship report. The blessing, help and
guidance given by her time to time shall carry me a long way in the journey of life on which I
am about to embark.

I also take this opportunity to express a deep sense of gratitude to Ms. S. Alankritha, Clinical
psychologist, Supervisor of PsychEDD Psychology Services., for her cordial support,
valuable information and guidance, which helped me in completing this task through various
stages.

I am obliged to staff members of the PsychEDD Psychology Services for the valuable
information provided by them in the respective fields of Clinical Psychology. I am grateful
for their cooperation during the period of my assignment.

Lastly, I thank almighty, my parents and friends for their constant encouragement without
which this assignment would not be possible.
 INDEX

Topic Page no.

Acknowledgement I

Introduction 1.

Profile Of the organization 4.

Introduction of Clinical psychology 5.

DSM 5 and ICD 10 7

Case history and Mental state examination 8.

Psychotherapies 10.

Case Study – I 13..

Case Study – II 15..

Case Study – III 17.

Case Study –IV 19.

Case Study – V 21.

Learning Outcome 23.

Conclusion 24

References 25
 INTRODUCTION

The purpose of the internship in clinical psychology is to provide a systematic program of

supervised, professional training in a clinical setting. This internship training program is
provided us to integrate scientific, professional, and ethical knowledge in a way that will
permit us to demonstrate autonomous and responsible functioning as a practicing
psychologist. Consistent with the individual’s previous graduate education and skill
development, the internship experience provides an atmosphere of professional socialization
that is necessary for the development of a firm professional identity as well as the
enhancement of professional clinical proficiency.

An internship is a 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.

It also assists students in making informed career decisions. Through daily activities and
interpersonal interactions, interns are able to gather valuable information about their field.
They also get a chance to evaluate their own strengths and preferences before they formally
enter the job market. Such information can be helpful in deciding if they have made the right
career choiceand can reinforce doubts or resolves relating to their career goals.

Internships may present a potential for an offer of full-time employment. Professional work
experience is the most beneficial advantage that can be acquired 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 Clinical Psychology 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. This Internships program provide us the opportunity to
test their interest in a particular career before permanent commitments are made. Apart from
it is more important because:

1. Internship program provide the best overview about the field of clinical psychology.
2. Internship will provide students the opportunity to develop attitudes
conducive to effectiveinterpersonal relationship.

3. Internship will provide students with an in-depth knowledge of the formal

functional activitiesof a participating organization

4. Internship programs will enhance advancement possibilities of graduates

5. Internship will help the trainees to develop skills and techniques directly
applicable to field of clinical psychology.
6. Internship will provide students the opportunity to develop attitudes
conducive to effectiveinterpersonal 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 family systems, and neuropsychological evaluation
(elective). Assessment training across will include both current
functioning and changes infunctioning.
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).
 PROFILE OF THE ORGANIZATION

PsychEDD which was founded by Kuljinder Singh he is a psychologist and a counsellor.

Psychedd is dedicated to training the next generation of mental health professionals in the
areas of psychological assessment and clinical service, with practices informed by
psychological science, theory, and research. We are committed to providing psychological
assessment and Counselling services to children, adolescents, and adults, and to expanding
the reach of psychological services through practice and research.
PsychEDD is group of enthusiastic psychologists and mental health professionals initiated
with the purpose to promote Psychology and its applications. PsychEDD regularly conduct
training programs for young budding psychologists to disseminate the recent advancement in
theory and practice in Psychology. Our team is dedicated to training the next generation of
mental health professionals in the areas of psychological assessment and clinical service, with
practices informed by psychological science, theory, and research. We are committed to
providing psychological assessment and Counselling services to children, adolescents, and
adults, and to expanding the reach of psychological services through practice and research.
PsychEDD also running many centres for individual clinical services along with online
counselling and home visits to provide best in class psychological, counselling and
therapeutic services for you and your close ones in different settings of life. Our team of
professionals are dedicated to excellence in behavioural assessment & restructuring of all
types of behaviour with constant focus on quality of care.

About supervisor

Ms. S. Alankritha, she is RCI licensed Clinical Psychologist and a renowned counsellor. She
was one of the most trusted members of PsychEDD with wide of experience in clinical and
child psychology. In this whole program of 60 hours, she provided us the hands-on
experience about the field of clinical psychology.
 INTRODUCTION TO CLINICAL PSYCHOLOGY

Clinical psychology is the psychological specialty that provides continuing and

comprehensive mental and behavioral health care for individuals and families; consultation to
agencies and communities; training, education and supervision; and research-based practice.
It is a specialty in breadth — one that is broadly inclusive of severe psychopathology — and
marked by comprehensiveness and integration of knowledge and skill from a broad array of
disciplines within and outside of psychology proper. The scope of clinical psychology
encompasses all ages, multiple diversities and varied systems

Clinical psychology is the branch of psychology concerned with the assessment and treatment
of mental illness, abnormal behaviour, and psychiatric problems. This field integrates the
science of psychology with the treatment of complex human problems, making it an exciting
career choice for people who are looking to work in a challenging and rewarding field.

 History

Early influences on the field of clinical psychology include the work of the Austrian
psychoanalyst Sigmund Freud. He was one of the first to focus on the idea that mental illness
was something that could be treated by talking with the patient, and it was the development
of his talk therapy approach that is often cited as the earliest scientific use of clinical
psychology.

American psychologist Lightner Witmer opened the first psychological clinic in 1896 with a
specific focus on helping children who had learning disabilities. It was also Witmer who first
introduced the term "clinical psychology" in a 1907 paper. Witmer, a former student
of Wilhelm Wundt, defined clinical psychology as "the study of individuals, by observation
or experimentation, with the intention of promoting change."1

By 1914, 26 other clinics devoted to the practice of clinical psychology had been established
in the United States. Today, clinical psychology is one of the most popular assssubfields and
the single largest employment area within psychology.
  Approaches

Clinical psychologists who work as psychotherapists often utilize different treatment

approaches when working with clients. While some clinicians focus on a very specific
treatment outlook, many uses what is referred to as an "eclectic approach?" This involves
drawing on different theoretical methods to develop the best treatment plan for each
individual client.

Some of the major theoretical perspectives within clinical psychology include:

 Psychodynamic approach: This perspective grew out of Freud's work; he believed

that the unconscious mind plays an important role in our behaviour. Psychologists
who utilize psychoanalytic therapy may use techniques such as free association to
investigate a client's underlying, unconscious motivations.3
 Cognitive behavioural perspective: This approach to clinical psychology developed
from the behavioural and cognitive schools of thought. Clinical psychologists using
this perspective will look at how a client's feelings, behaviours, and thoughts
interact. Cognitive behavioural perspective therapy (CBT) often focuses on changing
thoughts and behaviours that contribute to psychological distress.4
 Humanistic perspective: This approach to clinical psychology grew out of the work
of humanist thinkers such as Abraham Maslow and Carl Rogers. This perspective
looks at the client more holistically and is focused on such things as self-actualization

.
 DSM 5 and ICD 10

DSM 5

The new edition of Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the
product of more than 10 years of effort by hundreds of international experts in all aspects of
mental health. Their dedication and hard work have yielded an authoritative volume that
defines and classifies mental disorders in order to improve diagnoses, treatment, and
research.

Used by clinicians and researchers to diagnose and classify mental disorders, the criteria are
concise and explicit, intended to facilitate an objective assessment of symptom presentations
in a variety of clinical settings—inpatient, outpatient, partial hospital, consultation-liaison,
clinical, private practice, and primary care.

ICD 10

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and
Related Health Problems (ICD), a medical classification by the WHO. ICD-10 codes hold
critical information about abnormal findings, complaints, diseases, epidemiology, external
causes of injury, managing health, treating conditions, signs and symptoms, and social
circumstances. There are more than 14,400 different codes in ICD-10 which can be further
expanded to over 16,000 codes by using optional sub-classifications.

The U.S. Department of Health & Human Services (HHS) has designated ICD-10 as a code
set under the Health Insurance Portability & Accountability Act (HIPAA) and it will be
required for use by physicians and others in the health care industry beginning October 1,
2015. It will replace all ICD-9 code sets. Thus, for any healthcare service that occurs on or
after October 1, 2015, providers must use ICD-10 codes. This mandate applies to healthcare
reimbursement, research, and reporting services. CMS has stated that they will offer no grace
period and no additional delays for the transition.
 CASE HISTORY AND MENTAL STATE EXAMINATION

History taking, risk assessment and the mental state examination are core clinical skills. They
are best learned by practice and repetition, and we recommend that you see as many patients
as possible in order to enhance your skills. The purpose of the videos and this accompanying
resource pack is to give you a starting point to work from as you learn to take a psychiatric
history and do a mental state examination. The History Taking and Risk Assessment video
and The Mental State Examination video feature extracts from patient interviews (conducted
by Dr Jan Melichar), divided into sections to illustrate various stages of the interview process.
There is also a submenu for further study and revision designed for use with the exercises
suggested in this pack. They are suitable for varying levels of skill and can be used
independently or in groups. A facilitator or clinical tutor should be able to offer further
assistance with the tasks if necessary.

HISTORY TAKING & RISK ASSESSMENT

Taking a psychiatric history has things in common with any clinical history you take. The
major difference is in the social and developmental history, which we cover in more depth.
You may find it helpful to jot down notes as you go along, and this can help you to be
methodical in your history taking. The areas you need to cover include:

 presenting complaint/history of presenting complaint

 past psychiatric history
 past medical history
 medication
 family history
 family psychiatric history
 personal history –

o birth & early life

o school & qualifications
o higher/further education
o employment
o psychosexual history
o forensic history
 o substance use

 premorbid personality

It’s not always appropriate to ask all of the questions all of the time. Sometimes it can be
better to leave gaps to fill in later, especially if your patient is particularly suspicious and
paranoid, or acutely distressed. Some of the history can be gathered from old notes, and from
speaking to an informant. Start off with open questions and focus in on areas with more
specific, closed questions as necessary. This gives the patient a chance to talk about their
experiences and concerns, whilst allowing you to get the information you need. Over time
you will develop your own style of interviewing. You need to feel comfortable with the style
you adopt, so that your questions don’t seem awkward or forced.

MENTAL STATE EXAMINATION

The mental state examination is an important clinical skill. You will become more
accomplished at performing it the more you practise. Some areas of the mental state
examination will be covered in your history taking and will not necessarily need to be
revisited. What is important is that you develop a framework in your mind so that you are
aware of gaps still to be filled in. It can help to start with a list written down, with space to
write in the relevant sections. This will help you to be methodical, but be careful not to be too
rigid, and remain empathic. Areas we look at in the mental state examination DVD:

 Appearance and Behavior

 Speech
 Mood
 Thought
 Perception
 Delusions
 Cognition
 Insight
 PSYCHOTHERAPIES

Psychotherapy is the use of psychological methods, particularly when based on regular

personal interaction, to help a person change and overcome problems in desired ways.
Psychotherapy aims to improve an individual's well-being and mental health, to resolve or
mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve
relationships and social skills. 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 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

Psychologists generally draw on one or more theories of psychotherapy. A theory

of psychotherapy acts as a roadmap for psychologists: It guides them through the
process ofunderstanding clients and their problems and developing solutions.
Approaches to psychotherapy fall into five broad categories:
1. PSYCHOANALYSIS AND PSYCHODYNAMIC THERAPIES. This
approach focuses on changing problematic behaviors, feelings, and thoughts
by discovering their unconscious meanings and motivations.
Psychoanalytically oriented therapies are characterized by a close working
partnership between therapist and patient. Patients learn about the
MENTAL STATUS EXAMINATIONlves by exploring their interactions
in the therapeutic relationship. While psychoanalysis is closely identified
with Sigmund Freud, it has been extended and modified since his early
formulations.
2. BEHAVIOR THERAPY. This approach focuses on learning's role in
developing both normal and abnormal behaviors.
a) Ivan Pavlov made important contributions to behavior therapy by
discovering classical conditioning, or associative learning. Pavlov's
famous dogs, for example, began drooling when they heard their dinner
bell, because they associated the sound with food.
b) "Desensitizing" is classical conditioning in action: A therapist might help
a client with a phobia through repeated exposure to whatever it is that
causes anxiety.
c) Another important thinker was E.L. Thorndike, who discovered
operant conditioning. This type of learning relies on rewards and
punishments to shape people's behavior.
d) Several variations have developed since behavior therapy's emergence in
the 1950s. One variation is cognitive-behavioral therapy, which focuses on
both thoughts and behaviors.

3. COGNITIVE THERAPY. Cognitive therapy emphasizes what people think rather

than what they do.

a) Cognitive therapists believe that it's dysfunctional thinking that leads to

dysfunctional emotions or behaviors. By changing their thoughts, people
can change how they feel and what they do.
b) Major figures in cognitive therapy include Albert Ellis and Aaron Beck.

4. HUMANISTIC THERAPY. This approach emphasizes people's capacity to

 make rational choices and develop to their maximum potential. Concern and
respect for others are also important themes.
a) Humanistic philosophers like Jean-Paul Sartre, Martin Buber and
Søren Kierkegaard influenced this type of therapy.
b) Three types of humanistic therapy are especially influential. Client-
centered therapy rejects the idea of therapists as authorities on their clients'
inner experiences. Instead, therapists help clients change by emphasizing
their concern, care and interest.
c) Gestalt therapy emphasizes what it calls "organismic holism," the
importance of being aware of the here and now and accepting
responsibility for yourself.
d) Existential therapy focuses on free will, self-determination and the search
for meaning.

5. INTEGRATIVE OR HOLISTIC THERAPY. Many therapists don't tie

themselves to any one approach. Instead, they blend elements from
different approaches and tailor their treatment according toeach client's
needs.
 CASE STUDY 1

 CHIEF COMPLAINT

A 27-year old female, enters the emergency room after experiencing an episode of extreme
chest pain, difficulty breathing, and numbness in her arms. She states the following to the
admitting physician:

“I was walking my dog earlier when I started sweating. Since it isn’t hot outside, I couldn’t
quite understand why…then I started having trouble breathing and really got scared. My heart
was pounding so hard I thought it might explode out of my chest. My knees felt weak – it
seemed like my whole body was shaking, then my arms went numb. Apparently the whole
thing only lasted a few minutes, but it felt like each second was an hour. Did I have a heart
attack? Am I going crazy? I felt like I was going to die.”

Katie is given an ECG, but the test comes back in normal range, indicating that she did not
have a heart attack.

 MENTAL STATUS EXAMINATION

 GENERAL BEHAVIOUR

A 27 year old female, properly groomed, and well dressed

She was anxious and fearful. It was also seen during the session that she was inappropriate
and hyperactive.

 PSYCHOMOTOR ACTIVITY
Minimal psychomotor agitation present
It was also observed her slow movement, tremors during walking, regular posture.

 SPEECH

Rate: slow
Tone: whispering
Quality: clear
Reaction time: slow

Excessive thought and rate of production

 THOUGHTS

Pre-occupation overvalued ideas

FORM: No formal thoughts disorder
STREAM: Circumstantial thought process
CONTENT: somatic Delusion, she believes that there is something abnormal about her body
functioning

 MOODS

“Frightened”
Quality: anxious
Congruency: congruent
Range: exaggerated
Mobility: constricted
Appropriateness of situation: appropriate

 PERCEPTION

Dissociation, as she described the inappropriate functioning of the body which seems to be as
traumatic and stressful experience.

 DIAGNOSIS
She is diagnosed with the anxiety disorder.
 CASE STUDY 2

 CHIEF COMPLAINT

Allen, a 22-year old man, came to a mental health clinic for treatment of anxiety. He worked
full-time as a janitor and engaged in a very few activities outside of work. When asked about
anxiety, Allen said he was worried about contracting diseases such as HIV. Allen said that he
avoided touching almost anything outside of his home. He said that if he even came close to
things that he thought might have been in contact with the virus, he had to wash his hands
many times with bleach. He often washed his hands up to 30 times a day, spending hours on
this routine. Physical contact was quite difficult. Shopping for groceries and taking the
subway were big problems, and he had almost given up trying to go to social events or
engage in romantic relationships. Allen used gloves at work and performed well. He spent
most of his free time at home. Although he enjoyed the company of others, the fear of having
to touch something if he was invited to a meal or to another person’s home was too much for
him to handle. He knew that his fears and urges were “kinda crazy,” but he felt they were out
of his control.

 MENTAL STATUS EXAMINATION

 GENERAL BEHAVIOUR
A 22 year old male, properly groomed, and well-dressed He was anxious. It was also seen
during the session that she was inappropriate and hyperactive.

 PSYCHOMOTOR ACTIVITY
Minimal psychomotor agitation present It was also observed her slow movement, and regular
posture.

 SPEECH
Rate: normal
Tone: normal
Quality: clear
Reaction time: slow
Excessive thought and rate of production
  THOUGHTS
Pre-occupation overvalued ideas
FORM: No formal thoughts disorder
STREAM: Circumstantial thought process
CONTENT: somatic Delusion, she believes that there is something abnormal about
Her body functioning

 MOODS
Quality: anxious
Congruency: congruent
Range: exaggerated
Mobility: constricted
Appropriateness of situation: appropriate

 PERCEPTION
Tangential thought process, he even came close to things that he thought might have been in
contact with the virus, and he had to wash his hands many times with Bleach.

 DIAGNOSIS
Allen the 22 years old person has been diagnosed with obsessive compulsive disorder.
 CASE STUDY 3

 CHIEF COMPLAINT

MYLES was a 20 year-old man who was brought to the emergency room by the campus
police of the college from which he had been suspended several months ago. A professor had
called and reported that Myles had walked into his classroom, accused him of taking his
tuition money and refused to leave. Although Myles had much academic success as a
teenager, his behavior had become increasingly odd during the past year. He quit seeing his
friends and no longer seemed to care about his appearance or social pursuits. He began
wearing the same clothes each day and seldom bathed. He lived with several family members
but rarely spoke to any of them. When he did talk to them, he said he had found clues that his
college was just a front for an organized crime operation.He had been suspended from
college because of missing many classes. His sister said that she had often seen him
mumbling quietly to himself and at times he seemed to be talking to people who were not
there. He would emerge from his room and ask his family to be quiet even when they were
not making any noise. His parents also reported that he sits in odd positions for hours. Myles
began talking about organized crime so often that his father and sister brought him to the
emergency room. On exam there, Myles was found to be a poorly groomed young man who
seemed inattentive and preoccupied. His family said that they had never known him to use
drugs or alcohol, and his drug screening results were negative. He did not want to eat the
meal offered by the hospital staff and voiced concern that they might be trying to hide drugs
in his food.

 MENTAL STATUS EXAMINATION

 General behaviour
Myles, 20 year old, he found to be poorly groomed, he used to wear dirty clothes and seemed
to bathe seldom bathed. He seemed to be inattentive and preoccupied. He is indifferent in
nature and used to talk to someone who is not present.

 Psychomotor activity
Normal psychomotor activity.
  Speech
Rate: slow
Tone: whispering
Quality: clear
Fluency: incomprehensible
Word salad: incoherent thinking expressed as a sequence of words without a logical
connection

 Thoughts :
No formal thought of disorder
Stream: loose association as incoherent thinking expressed as illogical
Content: paranoia delusion as Myles continues to talk to the people who are not there.

 Mood
Myles act seem he is angry and frustrated
Quality: dysphoria
Congruency: incongruent
Range: blunted
Mobility: constricted
Appropriateness of situation: inappropriate

 Perception
Auditory hallucination, the false perception of the sound
As Myles mumbled quietly to himself and at times he seemed to be talking to
People who were not there.

 Insite
It can lie under grade 1 and 2 as the person is completely unaware the situation is into it.

 DIAGNOSIS
Myles has been diagnosed with the Schizophrenia
 CASE STUDY 4

 CHIEF COMPLAINT

Mary is a 26-year-old African-American woman who presents with a history of non-suicidal

self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two
suicide attempts by overdosing on prescribed medications, one as a teenager and one six
months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to
think about suicide as a “way out.” She also has a longstanding pattern of changing her
hobbies, style of clothing, and sometimes even her job. At times, she thinks that her partner is
“the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send
caring text messages, and the like; however, at other times she admits to thinking “I can’t
stand him,” and will ignore or lash out at him, including yelling or throwing things.
Immediately after doing so, she reports feeling regret and panic at the thought of him leaving
her. Mary reports that before she began dating her current partner she sometimes engaged in
sexual activity with multiple people per week, often with partners whom she did not know.

 MENTAL STATUS EXAMINATION

 General behaviour
Mary 26 year old African American women, well-dressed It was noticed that she had injuries
in her hand. She were elated and were cooperative

 Psychomotor activity
Psychomotor activity showed slowness and was, increased in some cases

 Speech
Rate: slow
Tone: normal
Quality: clear
Fluency: incomprehensible
She began with push or pressured speech, later on the rate of speech increased. She spoke
slowly, sometimes in whispers or muffled voices and at other times were loud.
  Thoughts :
No formal thought of disorder
Stream: loose association as incoherent thinking expressed as illogical
Content: No sign of feelings of unreality or depersonalization, no illusions & hallucinations.
Suicidal ideation was seen in her

 Mood
Mary was marked by feelings of anger, hurt, boredom, and depression
Quality: anxious, irritable, sad, and angry
Congruency: incongruent
Range: blunted
Mobility: constricted
Appropriateness of situation: inappropriate
She showed intense and labile emotions like elation, excitement, irritability, anger, fear and
distrust. Affect was not compatible with the idea and content of thoughts and situations

 Perception
No sign of feelings of unreality or depersonalization, no illusions & hallucinations

 Insite
She had the knowledge and accepted that they have some mental problem; she admitted that
she causes trouble to others and is different from others in their behaviour; she insisted that
their problems were not severe

 DIAGNOSIS
Mary is diagnosed with borderline personality disorder.
 CASE STUDY 5

 CHIEF COMPLAINT
Jane Aged 34,Single , reports these symptoms-feeling tearful with low self-esteem, Has
trouble sleeping at night but sleep many hours a day time, Has nothing in her life which
brings her enjoyment, Has suicidal ideas, Gained weight, Feeling despair, Isolation from
friends and family, sense of worthlessness, Concentration difficulty, Jane said• When I am
down, I want to be alone• I shut out everyone and hide• I cry for no reason• I don’t know why
I am scared• I cannot see anything good in my future• My head is filled with dark thoughts• I
no longer want to be here• I often think about ways to end this misery life• I have to fight the
thoughts in my head• I feel like I cannot breathe these symptoms has given me the worst
days in my life especially the mornings , I hate my morning , and I feel worthless all the
time..

 MENTAL STATUS EXAMINATION

 General behaviour
Jane aged 34 years, she is single
It was noticed that she was anxious and fearful.

 Psychomotor activity
Psychomotor activity showed slowness in actions.

 Speech
Rate: slow
Tone: weak
Quality: clear
Fluency: hesitant
She spoke slowly, sometimes in whispers or a muffled voice..

 Thoughts
There is flow of thoughts
Stream: incoherent thinking
Content: suicidal
Suicidal ideation was seen in her

 Mood
Jane was marked by feelings of, hurt and depression
She showed intense and labile emotions like elation, irritability, fear and distrust. Affect was
not compatible with the idea and content of thoughts and situations

 Perception
No sign of feelings of unreality or depersonalization, no illusions & hallucinations

 Insite
She had the knowledge and accepted that they have some mental problem; she admitted that
she causes trouble to others and is different from others in their behaviour; she insisted that
their problems were not severe.

 DIAGNOSIS
Jane is diagnosed with the depression
 LEARNINGS

During 60 hours of internship, I have accumulated various experiences and wider new
knowledge through activities and tasks had been assigned to me. This program has also make
me learn that how psychologist, mostly clinical psychologist works. This whole internship
program give a wide knowledge. I got to learn about how to apply my theoretical knowledge
during the intervention of clients. I learn to apply practical knowledge, like assessment tool,
history taking and mental health examination, clinical interviews, and tests like DASS, EPQ,
Hamilton Anxiety and depression scales, etc. Practicing diagnostics become possible by the
task and the case history provided to us. I was able to be more concise in case studies after
completing the internship. I was able to participate in individual and group treatments,
which had a different focus. I observed psychodynamic and cognitive-behavioural individual
therapy, and cognitive behavioural, systemic, and transactional group treatments. I also
participate in group therapy in the regular departments and especially in socio-therapy. I was
able to conduct simple therapeutic interventions during the role play module of learning. Due
to frequent practice I got more confident in using clinical tools. Also discussing potential
problem with my supervisor was very helpful.

In general, I am very satisfied with my clinical psychology internship, although it was very
laborious and demanding. However, I think it gave me a good insight into the occupations of
a clinical psychologist
 CONCLUSION

I truly appreciate the support I received from my college throughout the internship period. I
was put in a constant touch with the college supervisor and was observing closely all my
activities which encouraged me to put more hard work every day, as I mentioned earlier, it
did reflect in my duties which got noticed by the team of this Psychedd. And working in
diverse and multicultural environment had me an opportunity to utilize and improvise my
communication skills by interacting with the team of psyched of various hierarchy,
nationality and cultural background. In conclusion, I am able to state that this internship
program gave me a platform to apply my theoretical knowledge in practical life. And this
practical implementation of my academic knowledge has helped me to understand the
complexities, challenges and prospects that lie in a real world. Much as I enjoyed my eight
weeks term, I certainly did learn a lot from each day of work and everyone I had a chance to
interact with.
 REFERENCE

 BOOKS

 Shorter Oxford Textbook of Psychiatry. M Gelder, R Mayou and P Cowen. Oxford

University Press 2001, 4th edition.
 Examination Notes in Psychiatry. G Harrison, J Bird and P Buckley. Wright 3rd
Edition 1995.
 Symptoms in the Mind. An Introduction to Descriptive Psychopathology. 3rd.
edition.2002. A. Sims WB Saunders Co.
 The Psychiatric Interview. Daniel J Carlat MD. LWW 2nd ed 2004
 American Psychiatric Association,(2013) Differential Diagnosis in Psychiatry
Diagnostic and statistical manual of mental disorders fifth edition,
 World Health Organization, the ICD-10 Classification of Mental and Behavioural
Disorders.
 Abnormal psychology, Jill M. Hooley • James N. Butcher • Matthew K. Nock • Susan
Mineka, Pearson 2016, 17th edition.
 R.E. Kendell, Differential Diagnosis in Psychiatry (2015), University Of Naples Sun
Italy.

 WEBSITES

 https://psychedd.com
 https://www.verywellmind.com/what-is-clinical-psychology-2795000
 https://www.who.int/standards/classifications/classification-of-diseases
 https://www.psychiatry.org/psychiatrists/practice/dsm
 https://www.medicalnewstoday.com/articles/types-of-
therapy#:~:text=Therapy%20is%20a%20form%20of,understand%20certain%
20feelings%20and%20behaviors.