Psychological Assessment Example
Age 12 years
Education 3 class
Number of siblings 4 (2 Brothers, 2 Sisters)
Birth order last Born
Date 15 March, 2017
Reason and source for Referral
The client referred by his aunt for the purpose of psychological assessment and management. The client had fear and anxiety. Refusal to go to school, had nightmares, complaints of headache, lack of interest in activities and low mood.
History of Present Illness
The client had been living in his Aunt’s home since 2016. His mother left him at her sister-in-law’s home, because his mother could not afford her children’s expenses. His father was an addict and was involved in gambling. His father used to beat client’s mother. He was unemployed and also stole things as all the addicts do. Client’s grandfathers financially supported his father and send him to foreign country for a job, where he was arrested for four years in cause of theft. When he came back in Pakistan, he started gambling, drinking and beating client’s mother.
The client problem started at age of 9 years old, when he came in orphan age. Initially, he was so worried and crying for going to his mother. He used to weep and showed tempered tantrums. He was sad and used to remember his mother. He wanted to go with his mother. He tried to run away from his aunt’s home many time. He was not eating food properly. Her sister lived in orphanage. After passing 6 months, at the age of 9, he was admitted in school. He used to refused go to the school. He was sent school forcefully. His class performance was not good. He did not learn his lesson as he did not have interest in study. He did not participate in any kind of class activity. He had a lack of confidence. He did asked any question in the class and remained silent in class. He was biting his nails and moving his hands during the class. He often got punishment from teachers due to not doing work his homework properly. Due to this his teachers did not satisfied with his performance. Client complained that he felt headache, and had nightmares. After passing of 1 year, client made few friends. Once his mother came to meet him. The child got anger. When he saw his mother, he started to beat his mother. His mother again left him in her house. After going his mother, he did not eat food for one day. He was sent school forcefully. He did not take in interest in study.
Client’s father was 38 years old. He studied till matric. His father was an addict and was involved in gambling. His father used to beat client’s mother. He was unemployed and also stole things. Client’s grandfathers financially supported his father and send him to foreign country for a job, where he was arrested for four years in cause of theft. When he came back in Pakistan, he started gambling, drinking and beating client’s mother. After this, with the support of client’s mother, his father made a shop but he could not pay attention on his shop due to gambling and addiction. Client had not good relationship with his father. Under the influence of drugs, his father used to beat him. His father did not fulfill their basic needs.
Client’s mother was 35 years old. She studied till primary. She worked in small food making factory to financially support her family. Initially client’s had close relationship with his mother. Whenever his father used to beat him and his sisters his mother saved him from her husband. When her mother forcefully left him to his aunt’s home, he became angry with his mother. In spite of this, client wanted to live with her mother. No psychological and physical problem was reported.
The Client had 4 siblings. He was last born. His first born sister was died in the age of 1 year due to fevear. His second born was also a sister 15 years old. She lives in orphanage. Where she started to study and now she is in 7th class. Client had close relationship with his elder sister because his elder sister used to take care of him in the absence of her mother. 3rd born was also a sister. She was 14 years old. She also lived in orphanage. She also studied in class 6th. Client also had good relationship with sister.
Client belonged to lower middle class family. He reported that he had great affection with his mother. General atmosphere of the home was strict. He was very attached to his mother and sisters and shared distant relationships with his father because his father was very aggressive and strict.
Birth and Early Childhood
He was born through normal delivery as her aunt told. It was without any prenatal and postnatal complications. He achieved all his developmental milestones at appropriate age level and did not experience any serious illness or accident during his childhood.
Client was started his schooling at the age of 9 years as his mother did not admit in school due to financial problem. When client came in her aunt’s home, there he started schooling. He had no interest in studies. Therefore, he used not to learn his lesson. That’s why he had not good relationship with teachers and often got punishment. He did not participate in any kind of curricular activities in school due to lack of confidence. He had few friends in school.
Informal Academic Assessment
Reading He could not easily read English and Urdu
Writing He could not write in Urdu and English well according to his class.
Mathematics He did not perform good in general Mathematics sums.
English Client has difficulty in speaking and writing English.
Urdu He could speak Urdu good.
The client did not reach to the age puberty. According to his aunt he had no sexual abuse experience in his past life.
He was active and naughty child. He had many friends in his street. He used to play with them. He used to play football with his friends. He was talkative and used to asked many questions. He used to love his sisters and also played his sisters. Whenever any issue arises, he used to tell his mother and never solved the problem by himself. He was social as he had many friends.
- Informal Assessment
- Formal Assessment
Mental State Examination
General Appearance and Behavior
The client was well and season appropriate dressed. He 12 years old boy with age appropriate height. He seemed to be fragile and weak apparently. His shoes seemed impaired. His hair looked messy. His eye contact was frequent. He was not comfortable at first but when confidentiality was assured he easily explained all issues. He kept his hands and legs in a comfortable posture throughout the sitting.
Speech and Thought
His content of speech was adequate and understandable with appropriate answering of all questions. Progression of speech was quite slow. He was logical and meaningful. His speaking was in an organized way. He was frequently speaking Urdu.
He spoke in average and serious tone, his volume was quite low and his speech was comprehensive.
Client’s thought process was quite inadequate. As following questions were asked to the client.
Client did not know why he got angry.
The client’s receptive speech seemed to be good. It was relevant.
He could easily tell the meaning of home, sky and balloon.
He could easily identify his right left parts very well.
Mah – Tuh – Suh- Puh
He was able to recognize information well.
The client’s expressive speech seemed to be Excellent. Although at starting of assessment he was hesitant but after some motivation it seemed that he had no difficulty in expressing himself in speech.
Sp (as a spot), PL (as a play), Th (as a thing)
Mood and Affect
The client seemed to be with anxious mood. His mood got low at explanation of his father and mother behavior in past.
He reported that he is in anxious mood.
Affect Client’s affect was appropriate to the situation.
Range His affect was restricted did not show high emotions.
Intensity Client’s intensity was flat.
Quality He was sad and after sometime he became anxious.
The client’s visual perception seemed to be adequate. He can easily read and understand the things. He can easily read all the formal tests provided him.
He was having an excellent auditory perception. He was able to understand the instructions given to him and could hear the questions easily. He could easily differentiate between the sounds of people around. He could understand the conversation indicating well auditory perception.
Gross Motor Assessment
Client’s gross motor activities seemed to be fine. He could walk, run and climb stairs easily and did not find any difficulty to handle these skills.
Fine Motor Assessment
Client’s fine motor activities also seemed to be fine. He is right handed. He was able to hold pencil the correct way. He can cut things, use scissors properly with other hand.
General Fund of Knowledge
The client seemed to be having good general fund of knowledge. He responded to questions correctly. Following questions were asked by the client to access the general fund of knowledge.
1: What is capital of Pakistan?
2: Who is the poet of Pakistan?
Ans: Don’t know
3: When do we celebrate Independence Day?
Ans: 14th august
He had easily answered some of these questions but he was unable to answered other questions.
The client’s abstract reasoning seemed to be average. He could easily explain the similarities and differences between things e.g book and laptop, television and computer. But he did not answer the difficult.
The client’s vocabulary of English was quite below average as he was not able to spell communication, celebrity, generation, but the vocabulary of Urdu was better as compare to English. As he tell the correct meaning of Urdu word.
Attention and Concentration
The Clients attention and concentration seemed to be above average. He remained attentive during the sessions and answered to questions attentively but did not show interest in attempting psychological tests.
Short Term Memory
The client’s short term memory was good. He was able to recall things properly. He could memorize the name of his institute and his teacher’s name. Which dress he had worn yesterday.
Long Term Memory
The client’s long term memory was also above average. He can recall his address, his date of birth. He also memorized the incidents concerning to his past life. He also remembered all about his father’s reputation.
The orientation of time place person was accurate. He could report the time exactly. As some questions were asked what is day today? What is date today? How would you describe this situation? He knew the persons around well, also was well aware of the place he was living in. He easily answered all the questions.
Insight and Judgment
The client had well developed insight of his problem. He knew that his mother did wrong to her children. He knew that his father had bad habits. He knew studies is essential part of life. As some questions were asked by him
The ratings of the symptoms of the client were taken from the client. These ratings were made out of 10 in the increasing order of the severity.
The client’s and the informant’s ratings of the symptoms from 0 – 10 in order of the severity
Symptoms Client’s ratings
Refusal to go school 8
Bad nightmares 7
Low mood 7
Complaints of headache 7
Lack of interest in activities 6
Comprehensive behavior rating scale for children was used for formal assessment.
Comprehensive Behavior Rating Scale for Children
Comprehensive behavior rating scale for children was applied to check client’s behavior.
Showing raw score and range
Scale Raw scoring T Score Percentile
ID 28 54 54
RP 20 51 56
CD 17 52 51
OP 27 57 86
MH 11 58 59
AN 38 73 73
ST 12 61 65
DA 10 63 62
SC 10 63 97
In this subscale teachers perceived deficits in child’s social competence. The person has poor peer relationship. The client had percentile 97 which indicated that child had poor peer relationship and deficits in social competence.
Oppositional conduct from parents
In this subscale the person has difficulty admitting being wrong, disrespect, stubbornness, destroying things, fighting and lying. The client had percentile 86 in this scale which indicated that he had some behavioral problem like lying, disrespect and stubbornness.
Manifested more common anxiety in the children, excessive wrong, excessive self-consciousness, fear of school and test and need frequently reassurance, somatic complaints and distress resulting from separation from parents. The client had percentile 73 in this subscale which indicated that client had fear of school and test, and frequently need reassurance, somatic complaints and distress.
The client was referred from the orphanage with the symptoms fear, anxiety, refusal to go school, had nightmares, complaints of headache, lack of interest in activities and low mood. These symptoms showed that he had anxiety disorder.
Client Z.A was 12 years old boy who was suffering from symptoms of low mood, fear, anxiety, refusal to go school, had nightmares, complaints of headache, and lack of interest in activities. His assessment suggested that he was suffering from anxiety disorder.
According to socio-cultural theorists, generalized anxiety disorder is most likely to develop in people who are faced with ongoing societal conditions that are dangerous. Studies have found that people in highly threatening environments are indeed more likely to develop the general feelings of tension, anxiety and fatigue and the sleep disturbance. Sociocultural perspective also explained that poverty is powerful stress. People without financial means are likely to live in rundown communities with high crime rates, have fewer education and job opportunities, and run a greater risk for health problems. These things can create anxiety disorder. In present case, client faced highly threatening and dangerous situation. (comer, 2013) His father used to beat him and his mother as he played gambling and do addiction. His father also did not do job nor financially support his family. Therefore client’s and his family had to face financial problem. This type of home environment may create tension and anxiety in the client.
In psycho-dynamic perspective, Sigmund Freud believed that all children experience some degree of anxiety as part of growing up and all use ego defense mechanisms to help control such anxiety. Children experience realistic anxiety when they face actual danger; neurotic anxiety when they are repeatedly prevented, by parents or by circumstances, expressing their id impulses. Anxiety disorder can also be traced to inadequacies in the early relationships between children and their parents. According to Freud, some children experience particularly high levels of such anxiety, or their defense mechanisms are particularly inadequate, and these individuals may develop anxiety (comer, 2013). In the present case, client used to live restricted environment and his parents were also strict. Client may have weak defense mechanisms and may not bear these pressures.
According to humanistic perspective anxiety and other psychological disorders arises when people stop looking at themselves honestly and acceptingly. Repeated denials of their true thoughts, emotions, and behavior make these people extremely anxious and unable to fulfill their potential as human beings. Rogers believed that children who fail to receive unconditional positive regard from others may become overly critical of them and develop harsh self-standard which is called conditions of worth. They tried to meet these standards by repeatedly distorting and denying their true thoughts and experiences. Despite such efforts, however, threatening self-judgments keep breaking though and causing them intense anxiety. In present case, client did not receive unconditional positive from his family as is father was very aggressive and strict. This thing may lead anxiety in the client.
Behavioral theory holds that anxiety results from not knowing how to behave in a given situation. The possibility of suffering negative consequences because of inappropriate behavior may result in hesitation and inaction. The anxiety may be generalized to similar situations. For example, anxiety over taking a particular test may be generalized to taking all tests in the future. In the present case, clients faced many threatening circumstance as he was only 10 years old. He did not know how behave in the threatening situation. Therefore. He may develop anxiety.
There are three reasons for the motivation of fear and anxiety from the cognitive perspective; loss of control, inability to make a coping response, and state anxiety versus trait anxiety. Loss of control refers to a situation when there are unpredictable or uncontrollable events in one’s life which lead to anxiety and or depression. As a result, feelings of helplessness develop. The unpredictability which may be associated with a task may cause anxiety (Seligman, 1975). The inability or perceived inability to make an adaptive response to a threatening event or the fact or perception that no such response is available will lead to feelings of anxiety. Since anxiety is very ambiguous, it is the key which prevents the elaboration of clear action patterns to handle the situation effectively (Lazarus, 1991). His father used to beat him and his mother left him in orphanage as he wanted to live with his mother. Client did not control the events in life which lead to anxiety or depression.
Empathetic/ Reflective Listening
Progressive Muscle Relaxation Techniques and Deep Breathing
Problem solving technique
Sleep and Eating Healthy
Problem solving technique
Summary of Therapeutic Interventions
Supportive psychotherapy is used primarily to reinforce a patient’s ability to cope with stressors through a number of key activities, including attentively listening and encouraging expression of thoughts and feelings; assisting the individual to gain a greater understanding of their situation and alternatives; helping to buttress the individual’s self-esteem and resilience; and working to instill a sense of hope (Dombeck, 1995). In this case supportive work will be done to encourage the client to eliminate his negative thinking pattern, and also to lower down his anxious feelings of this child.
Progressive Muscle Relaxation Techniques and Deep Breathing
This is a technique for reducing anxiety by altering tensing and relaxing. It will be useful for the client by reducing anxiety by altering tensing and relaxing muscles. The client may start by sitting or lying down in a comfortable position. With the eyes closed, the muscles are tensed and relaxed sequentially through various parts of the body. It will be helpful for the client to reduce his depression (Chida, & Steptoe, 2009).Practicing regular and mindful breathing can be calming and energizing and can help to prevent stress related health problems. Relaxing breath is a natural tranquilizer for the nervous system. It is effective for the relaxation of body and mind (Weil, 2014). In the present case deep breathing will be used to overcome the client’s worries and tension.
Distraction is a surprisingly effective technique for changing mood. In this technique when a person is upset, his negative mood is interrupted by engaging in something that distracts him from what has upset him. For best results, the thing a person is engaged in as a means of distraction should be both absorbing and interesting to that. Doing this thing should either require person’s full attention, or be so absorbing of his attention that he will forget himself (Dombeck, 1995). It can be helpful for the client to divert his attention from anxious feelings tension provoking situation.
Psycho education can be beneficial in the treatment of patients of anxiety (Tracey, 2005). Psycho education refers to the education offered to the people who live with a psychological disturbance. Psycho education is important in treating anxious people. The better knowledge the patient has of illness, the better he can live with his conditions (Lefley, 2009). It will be helpful for the client to know the unwanted outcomes of anxiety so that he may overcome it.
Problem Solving Technique
Problem solving refers to the mental process that people go through to discover, analyze and solve problems. This involves all of the steps in the problem process, including the discovery of the problem, the decision to tackle the issue, understanding the problem, researching the available options and taking actions to achieve their goals (Mayer, 1992). In this case, client by using this technique can successfully find more acceptable way for solving problem than showing hopelessness and tension.
Sleep and Eating Healthy
Living a healthy lifestyle is also important. From sleep to nutrition to hydration, the healthier your body is the better it works, and the better it works the less you’ll experience anxiety. These aren’t anxiety cures – anxiety, of course, is more of a mental health disorder forged through years of experiences, and simply sleeping more isn’t going to magically take it away – but they’ll drastically reduce the symptoms, which should help you cope with anxiety much more easily. In present case if client started to take proper food and sleep, this may help to overcome on anxiety.
Exercise is most important thing for physical health, but when you don’t exercise, your ability to cope with stress takes a huge blow. Your anxiety will often become much worse when you don’t exercise, because your muscles turn that pent up energy into physical stress, which in turn becomes mental stress. On the flip-side, when you exercise, you not only reduce that extra energy, you also improve hormone balance, release neurotransmitters that improve mood, and improve breathing. Exercise is easily one of the most powerful, healthy anxiety management tools available. In the present case, thought exercise client may relax his muscles. This thing may help to reduced anxiety.
Another strategy that many people don’t realize is effective involves simply creating memories. This can be very hard for those with severe anxiety, since it requires them to go out into the world, but the more you can force yourself to do and enjoy every day (they need to be happy memories, of course) the more positive thoughts you’ll have when you’re struggling with stress. In the present case, this technique may effect to cope with anxiety and worry.
Writing thoughts down in a journal may seem like something you only did as a child, but it’s actually a powerful coping tool. It benefits anxiety in two ways. First, of course, is that it gives you a chance to simply let out your thoughts – something that far too many people hold inside them. Second, however, is that it also puts your thoughts in a permanent place, and that tells your brain that it doesn’t have to focus on remembering them as much as it did previously. This technique will help him practice to explore client anxious feelings and cope them.
Supportive psychotherapy is used primarily to reinforce a client’s ability to cope with stressors through a number of key activities, including attentively listening and encouraging expression of thoughts and feelings; assisting the individual to gain a greater understanding of their situation and alternatives; helping to buttress the individual’s self-esteem and resilience; and working to instill a sense of hope (Dombeck, 1995). In this case supportive work will be done to encourage the client to eliminate his abusive way of talking and shouting and also to lower down his sad mood and addiction.
Problem solving technique
Problem solving refers to the mental process that people go through to discover, analyze and solve problems. This involves all of the steps in the problem process, including the discovery of the problem, the decision to tackle the issue, understanding the problem, researching the available options and taking actions to achieve their goals (Mayer, 1992). In this case, client by using this technique can successfully find more acceptable way for solving problem than showing anxiety and tension.
Limitations and Suggestions
- There was no proper room for counseling and assessment of client and the place where client sat was distracting.
- Time was very short for getting in depth history from the client.
- Time for building rapport was very short.
- Time period should be extended for taking in depth information from client.
- Separate room should be provided for the process of counseling and assessment.
- Environment should be peaceful and calm without any distraction.
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- Comer. J. (2013). Abnormal psychology (8thed.). USA:Worth Publishers
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- Lazarus, R. S. (1991). Cognition and motivation in emotion. American Psychologist, 46:352-367.
- Seligman, M. E. P. (1975). Helplessness: On Depression, Development, and Death. CA: W.H.Freeman.