Case Summary

M.A 14 years old boy studied in class 8th. He was referred by the father for the management of his
academic problems. Complaints which were reported by his teacher were weak in studies, problem in
reading and writing and didn’t speak in class. During the session in clinical interview client report certain
presenting complaints like being fearful while giving oral test in class or while reading in class, difficulty
in memorizing science related subjects lesson, difficulty in reading and writing difficult words of Urdu
and English, some class fellows make fun of him. Different assessment modalities like behavioral
observation, Clinical Interview, Subjective rating scale, Baseline charts, Emotional behavioral
assessment (School children problem scale), Academic assessment (reading, coping, Dictation),
Cognitive assessment (paired associate learning test, Urdu reading, digit span test, logical memory test)
and reinforce identification were done with the boy in order to assess his problem.

The assessment results reveal that he was victim of bullying. certain counseling strategies were
suggested with the client like rapport building, prioritizing goals, daily activity scheduling and psycho-
education, Assertiveness training (broken record technique) Chunking (making outline of a paragraph),
Cost and benefit analysis, study skills, changing old rules assumptions into new rules assumptions,
Situation exposure hierarchy technique and for phonetic awareness flipbook and words family chart.
Identifying Data

Name M.A

Age 14 years

Gender Male

No. of siblings 5 (2 sisters and 3 brothers)

Birth Order 4tt Born

Occupation Student

Education 8th Class

Marital Status Unmarried

Address Kotli

Religion Islam

Socio-economic status Middle class

Informant Father
Reasons and Source of Referral:

The client was referred to clinical psychologist by his father for psychological assessment and management.
Presenting complain (according to informant)
Frequency, intensity and duration table

Complaints Frequency Intensity Duration

Always 8/10 15 years

Always 7/10 8 years

Sometimes 7/10 8 years

Always 8/10 5 years

Sometimes 9/10 5 years

Sometimes 7/10 15 years

Always 9/10 3 years

Initial Observation of the client

Client M.T belonged to a middle class and separate family system his birth order was 4th and he was
14years old boy studied in class 8th. When M.A entered in the session room his head and back was bend. His
facial expressions were fearful and he was grinding his finger by putting it in mouth. He was sitting at the left
side of the chair with twitching legs. His hygiene condition is not appropriate as he wore tainted dress. He
didn’t maintain and take initiative in eye contact. His voice tone was not audible. Still after defining the
therapist role and insured him about confidentiality client was seems anxious in the whole session

History of present illness

Problem of the M.A was started 5years earlier when he was moved from private school to the current
Government school. But problem of the client triggers again in last 2years. Earlier he studied in a private
school where his performance was 70 percent and his favorite subjects there were Urdu and Islamite and his
favorite teacher was Urdu subject teacher. But he moved to Gov School 5years back in 2011 because his
parent’s didn’t bear the expenses of private school. His performance was average till 5th class but in previous
two years his academic performance decline rapidly as he faced difficulty in memorizing science lesson and
remembering and reading Urdu and English words. Addition of some new class fellows in client’s class from
previous two years was a big change for him as they make fun of the client and call him with different names
and even sometimes take his money and force him to do certain tasks like go out of class and bring something
for him.

At home from last some months he often do demands with his parent’s like buying a new bicycle or
clothes but parent’s sometimes couldn’t meet his expectations and he started showing tantrums like crying for
whole day, stops taking daily food and refuses to go to school or tuition for studies.

Client reported that he had difficulty in reading and writing English and Urdu words and he tried to
memorize science lesson but he couldn’t memorize even a single passage. He had joined tuition for extra help
but still he didn’t sort out his academic problem. He thought that his class fellow’s know more than him. It
was reported by the child whenever there is any test or paper and he studied at home his mother or someone
from his neighborhood ask him to bring something from bazaar and after that activity he lose his attention in
studies. Parents of the client demand about good grades but when client hardly gets passing marks father of
the client beat and scold him and often mother of the client also beat and scold him on his demanding
behavior.

Background Information Personal history

Birth and Early childhood

 Abc went through developmental delays in childhood due to her mother’s infectious pregnancy. After
undergoing certain therapy sessions including physical therapy, speech and language therapy and behavioral
therapy, she got a lot better. However, she still faces problems when she has to socialize with other people
and when she tries to communicate.

Educational history
Schooling history concluded that she was a very bright student till BS level of education. Also she
used to take part in every activity related to sports. But due to this incident she couldn’t cope up and had
developed a fear of making new friends or getting involved in any sorts of sports. Currently, she is in the
process of completing her M-Phil degree which is based on theoretical learning and she is trying her best to
produce good grades in which she is succeeding. However, she still faces difficulty when she has to work
practically or when she has to collaborate with other people
Sexual history
No sexual history was reported.

Family history
Abc belongs from middle class and joint family. Her family is very supportive. She is very close to her
mother. Abc went through developmental delays in childhood due to her mother’s infectious pregnancy.
After undergoing certain therapy sessions including physical therapy, speech and language therapy and
behavioral therapy, she got a lot better. However, she still faces problems when she has to socialize with
other people and when she tries to communicate.
Drug history
The client reports no history of drug abuse.

Forensic history
No court or police was case reported.

Past medical & psychiatric illness

The client reported her leg got fractured in 2005. Other than this she had developmental delays. She had to
attend several talk therapies.

Pre-morbid personality
According to clients mother she was very confident and lively person before her leg got fractured. She
wants to become a cricketer. She had a caring and loving personality.

Assessment
The assessment was done on two levels i.e.: Formal and Informal

Informal Assessment

The informal assessment was conducted on the following levels.

• Clinical interview

• Behavioral Observation

Clinical Interview
An interview was conducted in light of the client’s history and current circumstances to obtained
detailed information about the client to identify significant factors that predisposed and maintained the client
illness and prognosis, as well as to formulate an effective therapeutic plan.

Behavioral Observation

The client seemed to be very cooperative and elegant. Her voice tone was medium. She answered every
question gently but she got little confused after sometime.

Formal Assessment

The formal assessment was conducted on the following level

• Social Anxiety Test

• Screening for Social Anxiety Disorder

• Advanced Progressive Matrices (APM)

Table 2

Advanced Progressive Matrices

Raw Score IQ Level
57 Above average

Qualitative Analysis

The Social Anxiety Test was administered. The diagnostic scale rating was done by the abc. The
results indicated that he had social anxiety disorder.

Another test administered was Screening for Social Anxiety Disorder to test. The diagnostic scale
rating was done by the client abc. The results indicated that he had social anxiety disorder

In the APM Test, she was presented with a geometrical design and she had to find one missing piece.
The raw score was converted into percentile. The raw score was, 57 percentiles was 76th and it fell under
the category of grade II+. It was interpreted that she was intellectually above average.
 Case Formulation

Miss abc went through developmental delays in childhood due to her mother’s infectious pregnancy.

After undergoing certain therapy sessions including physical therapy, speech and language therapy and

behavioral therapy, she got a lot better. However, she still faces problems when she has to socialize with other

people and when she tries to communicate. In 2005 when she was 13 years old, due to a disastrous

earthquake, her leg got fractured. She couldn’t walk properly after this incident. Furthermore, she lost one of

her sisters in this earthquake who was very close to her. Also due to this event her education got disturbed and

she had to take two gap years. Her mental health also got affected badly and she went into depression.

Furthermore, Miss abc reported that she had a dream of her life to become a cricketer but now there was

hardly a chance for her to play cricket with a fractured leg. Schooling history concluded that she was a very

bright student till BS level of education. Also she used to take part in every activity related to sports. But due

to this incident she couldn’t cope up and had developed a fear of making new friends or getting involved in

any sorts of sports. All these factors contribute to the client’s problem. According to Burcu Karaşar (2018),

Social anxiety seems to be related to the need for social approval. The need for social approval, a concept

related other's admiration and to the concern of “What others say”, is believed to be associated with social

anxiety. Currently, client is in the process of completing her M-Phil degree which is based on theoretical

learning and she is trying her best to produce good grades in which she is succeeding. However, she still faces

difficulty when she has to work practically or when she has to collaborate with other people.
 Bio Psycho Social and Spiritual Model

Biological Factors
Psychological Factors
She went through developmental
delays inchildhood due to her mother’s
infectious pregnancy Low confidence and Low self-esteem

Diagnosis
300.23 (F40. 10) Social Anxiety Disorder (Social Phobia)

Social Factors

Her leg got fractured in 2005. Spiritual Factors

She couldn’t walk properly after this Positive relation towards Allah
incident.
Diagnosis

300.23 (F40. 10) Social Anxiety Disorder (Social Phobia)

Prognosis

Points in favor of prognosis

• Educated

• Strong desire to change her behavior

• Strong desire to receive treatment

• Family support

Points against the favorable prognosis

• Feelings of embarrassment due to her fractured leg

• People mocking

Management plan

• Cognitive Behavioral Therapy

Try these when you're feeling anxious or stressed:

• Take deep breaths. Inhale and exhale slowly.

• Count to 10 slowly. Repeat, and count to 20 if necessary.

• Do your best. Instead of aiming for perfection, which isn't possible, be proud of however close you get.

• Accept that you cannot control everything. Put your stress in perspective: Is it really as bad as you
think?

• Learn what triggers your anxiety. Is it work, family, school, or something else you can

identify? Write in a journal when you’re feeling stressed or anxious, and look for a

pattern.

• Distract yourself. with an iPod or other portable media player to download audiobooks, podcasts, or
music. Many people find it’s more fun to exercise while listening to something they enjoy.
Appendices

1. Social Anxiety Test

2. Screening for Social Anxiety Disorder