COUNSELING CASE REPORT

Counseling Psychology
Table of Contents

Case Report No 1 Page #

Presenting Complaints 6

History of present illness 6

Family History 7

Personal history 8

Premorbid Personality 10

Informal Psychological Assessment (MSE) 10

Formal Psychological Assessment 12

Identification of Problem 16

Management plan 19

Recommendations & Limitations 23

References 24

Appendices

Bio Data
Name: T.A
Age: 13 Years

Gender: Male

Education: 6th grade

No. of Siblings: 5 sisters

Birth Order: Middle born

Religion: Islam

Informant: Father

Date of Referral: Feb 09, 2017

Reason for Referral

The client was taken from the PSRD and referred to trainee psychologist. Already the client was under the treatment of psychiatrist and a
physician and referred to counselor for psychological assessment and management.

Presenting Complaints
According to Client
The client reported that following symptoms were present

I am Always sad. (six months)

I get very angry whenever I’m not able to do my own work. (six months)

Children make my fun when they see m hand in the school. (six months)

I don’t want to go out of the home because everyone watches me weirdly. (four months)

According to Informant (Father)

The informant reported that following symptoms were present in client
Most of the rimes he remains sad. (six months)

He gets very angry as compared before. (six months)

He feels that everyone make fun of his hand. He goes outside the house for lesser time. (six months)

He has become weak in education. (three months)

His sleep time is very short. (six months)

History of Present Illness

The client was taken from PSRD with complaints of sadness, anger, sleep disturbances, poor academics and low self-esteem. The client had
an accident eight months before a bike hit him as he was crossing the road. When the client was taken to hospital his hand was completely
damaged and doctors had to amputee his hand. He was discharged from hospital after two week and his wounds were recovered after three
months but he sometimes felt phantom limb pain in the area where the limb was amputee. The client continued his school after 3 and half
months of his injury as he was recovered now but his hand was amputee which was the cause of distress for him. The client was feeling
depress on losing his hand as it was badly effecting his body image. The client felt humiliated when his school fellows made fun of his
amputee hand. The client was angry that why this accident was happened to him. The client was very upset that he was not able to do his
work by himself. He was worried that his family was not financially strong they were not able to spend enormously for the treatment as
artificial hand for their child so it will be helpful for him to perform his daily tasks. The client was uncomfortable while facing other people
according to him they looked at him in a strange way.

Family History
The client belonged to middle class family. The client lived in a joint family system with his parents, his Uncle and aunts. His father A.M was
35 years old and driving an Auto Rakshaw. The client had a satisfactory relationship with his father. According to client his father was very
religious and also takes him to mosque at the time of prayers. His father always taught him to differentiate between right and wrong. His
father helped him in his studies and had not allowed him to take tuition instead he personally sits with him to get his problems solved. He
also played with him in his leisure time. His father played cricket and football with him on Sunday. His father tries his best to keep their family
happy. His father worked hard to make money for their family. According to client his father loved him a lot and always tried to cheer him up
when he was in sad mood. His father always taught him good values and not spoiled him by bought him all the things that he wanted. The
client had a very good relationship with his father as he discussed everything with him without hesitation.

The client’s mother was N.A and she was 30 years old. She was a housewife. The client had satisfactory relationship with his mother. He can
talk to her about his problems he had in his life and in school. He talked to her because she listened him and gave good advises to him. His
mother cooked his favorite food for him when he came home from school. His mother was very caring and loving and helped him in doing his
homework. According to client her mother taught him how to eat healthy food and dress himself, to how to react to the situation. His mother
taught him little things as how to tie his shoes and to be polite and respectful to adults. The relationship of client’s parents was satisfactory as
they have mutual understanding.

He had three sisters one was 16, 15 years old and youngest one was 7 years old and his brother was 5 years old. He had a satisfactory
relationship with them. He played with them in his free time. He also quarreled with them during playing. He had also very good relationship
with his cousins, uncle and aunt. They loved him very much because he was the first born child at their home. They always cared him and
taught him good manners. The client was very obedient of his parents and uncles and aunts. The home environment of client was very good
all the problems were solved by mutual discussions.

Personal History
Birth and Early Development
According to client’s mother client was born in hospital and his birth was normal. All the developmental milestones were reported to be
achieved at appropriate age. No neurotic traits were reported. The client was very healthy at the time of birth. The client started sitting with
the help of support at the age of approximately 5 month and started standing at the age of 9 month. According to informant the client had
some problem in speech and started complete talking at the age of approximately 3-4 years. The client had not any problem in eating and
started eating solid food at the age of approximately 5 month. The client had normal sleep patterns in his childhood. His mother did not face
 any problem during pregnancy or at the time of birth. No history of smoking or alcohol use was present. There were no prenatal or postnatal
complications reported. No physiological illness, psychiatric disorder or major injury was reported in the client.

Educational History
The client started his studies the age of 5 years. As his father reported that he was a very bright student in his class he always got good
grades in all subjects. Mathematics was his favorite subjects. But after that incident he mostly missed his classes because he felt humiliated
when his class fellows made fun of his hand and that’s why his academic performance decreases with time. His parents and teachers paid
full attention on him and helped him in studies. At home he studied under the supervision of his parents.

Informal Academic Assessment

Reading He said that I could read well Urdu and English.
Writing He could write comfortably in Urdu and English well according to his class.
Mathematics He is quite good in Mathematics.
English Client has bit difficulty in speaking and writing English.
Urdu He could speak and write Urdu good as well.
Social History
The client was friendly in nature and had many friends in his school. He played with his friends in his free time. He liked to play cricket and
football with his father on Sunday. He usually play with his cousins. He liked to watch cartoon of tom & jerry with his siblings and cousins.
The client was very helping at his home.he helped his grandmother and paternal aunt in doing house chores. The client had satisfactory
relationship with his siblings and family members. After that incident he mostly spent his time at home and did not play with his friends
outside the home. He had three close friends in schools and played with them in the break time.

Pre morbid Personality

The client was very friendly and happy before this accident. The client was very lively and enjoyed every moment of his life now he remained
sad for a long period of time. The client had very calm personality before this accident now he became angry on small things and started
fighting with his family members. The client was a very hardworking and brilliant student. The client liked to participate in sports and games.
He had many friends in his school. The client was a shy person and did not talk too much with strangers. He was very helpful in nature and
helped his grandmother, Uncles and aunts.

Psychological Assessment
The psychological assessment was carried out at two different level

 Informal psychological assessment

 Formal psychological assessment.

The informal assessment included mental state examination, symptom checklist and formal assessment included Child Depression Inventory
(CDI), The Self Image Profile (SIP-C) and The Adolescent Anger Rating Scale (AARS).

Informal Assessment
Mental State Examination.
General Appearance and Behavior
The client was well and season appropriate dressed. He 13 years old boy with average height. He seemed to be fragile and weak apparently.
His shoes was neat and clean. He combed his hair well. 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

 Content
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 speak Urdu.
 Form
He spoke in average and serious tone, his volume was quite low and his speech was comprehensive.
 Thought
Client’s thought process was quite inadequate. As following questions were asked to the client.

Client reported that he do not know why he get angry on certain things without any reason.

He said that he has been living a purposeless life. Which has no direction. Client’s answers showed that he has inadequate thought content.

Language Assessment
 Receptive Speech
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 identified his right left parts very well.

Mah – Tuh – Suh- Puh

He was able to recognize information well.

 Expressive Speech
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

Objective The client seemed to be with fine mood. His mood got low at explanation of his accident.
Subjective He reported that he is in fine mood was comfortable in sitting.
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.
Perception
 Visual Perception
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.
 Auditory Perception
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.

Motor Assessment
 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.
Cognitive Assessment
 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?

 Ans: Islamabad

2: Who is the poet of Pakistan?

Ans: Allama Iqbal

3: When do we celebrate Independence Day?

Ans: 14th august

He was easily answered all these questions.

 Abstract Reasoning
The client’s abstract reasoning seemed to be average. He could easily explain the similarities and differences between things e.g book and
laptop, Tiger and Leopard.

But he did not answered the difficult. Like

 Vocabulary
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 and also showed high interest in attempting psychological tests.
Memory
 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 was able to memorize
his early school days. He also memorized the incidents concerning to his past life.
Orientation
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 describes 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 his responsibilities, he knew that studies is essential part of life. So, he worried
about his studies. As some questions were asked by him

Symptoms Ratings
The ratings of the symptoms of the client were taken from both the client and the informant who was his father in this case. These ratings
were made out of 10 in the increasing order of the severity.

Table. 1
The client’s and the informant’s ratings of the symptoms from 0 – 10 in order of the severity
Symptoms Client’s ratings Informant’s ratings Mean
Sleep disturbances 8 9 8.5

Depression 7 8 7.5

Self image 8 8 8

Anger 8 9 8.5
 ___________________________________________________________________________

Formal Psychological Assessment

As the client was very cooperative and motivated to take part in the session. After taking his consent to complete the tests relevant to his
problem they were filled by him as the tests were too long so client was able to complete them in two settings. Formal assessment was done
with the help of standardized tests and inventories which are described as follows:

1. Child Depression Inventory (CDI)

2. The Self Image Profiles for Children (SIP-C) and Adolescents (SIP-A)

3. The Adolescent Anger Rating Scale (AARS)

Child Depression Inventory (CDI)
The Child Depression Inventory (CDI) is a symptom-oriented instrument for assessing depression in children between the ages of seven and
17 years. The basic CDI consists of 27 items, but a 10-item short form is also available for use as a screener. The CDI was first published by
Maria Kovacs in 1992. It was developed because depression in young children is often difficult to diagnose, and also because depression
was regarded as an adult disorder until the 1970 (kuvacs,1992).

Test Administration
Child Depression Inventory (CDI)was administered on the client on Thursday, May 5, 2015, in a well and ventilated room of the hospital. The
client was sitting on a chair, behind the table and the instructions were given to him according to the manual. The difficult items or their
responses were repeated again for his convenience when he asked for, so that he could comprehend the test easily. He took her 10 minutes
to complete the test.

Quantitative Analysis
Table 1.The client’s total raw score, range and remark on CDI

Total Raw
T score Cut off Remark
Score

Slightly above average

05 56 56-60 Depression

Qualitative Analysis
The client completed the CDI in ten minutes and obtained the raw score of 05 which means that his t-score was 56 which suggests slightly
above average depression. The CDI was able to screen out slightly above average depression in the client. The CDI was able to screen out
depression in the client. The results of the test applied on the client placed him among the category of slightly above average depressed
children individuals. His results are consistent with the symptoms he was experiencing.

The Self Image Profiles for Children (SIP-C) and Adolescents (SIP-A)
The Butler Self Image Profiles (SIP) is brief self-report measures that provide a visual display of both self-image and self-esteem. There are
two forms; the SIP-C for children aged 7-11 years and the SIP-A for adolescents aged 12-16 years. Both of the forms have different item
content appropriate for respective age levels, but an identical format and scoring procedure. The SIP taps the individual’s theory of self. Both
the SIP-C and SIP-A consists of familiar self-descriptions; 12 of a positive nature, 12 with a negative slant and one neutral item. All self-
descriptions are words or short statements generated by children and adolescents (Butler, 2001).

Test Administration
The Beck Depression Inventory (BDI)administered on the client on, march, 2017, in a well-lit and ventilated room of the hospital. The room
was peaceful and noise free and there was not any distraction. It was not crowded and the client was made to sit in a comfortable chair with
a desk in front of it, placed on one side of the room. The client was sitting on a chair, behind the table and the instructions were given to him
according to the manual. The client was provided with a copy of the Beck Depression Inventory, so that she could follow along and was
asked to report his feelings for the past two weeks, including today. He 5 minutes to complete the test.

Quantitative analysis
Table 1. The scores of The Self-Image Profile

Cut
Responses Items no. Scores Description
off

low positive
SI+VE Sum of items 1-12 33 35
self-image

Sum of items 14- High Negative

SI-VE 52 52
25 self-image

sum of discrepancy
SE 87 76 Cause of concern
scores
Qualitative Analysis
The client obtained a raw score of positive self-image 33 which was lower than the cut off score which indicated that the client low positive
self-image and it was a matter of concern. The raw score of negative self-image was 52 which were equal to the cut off scores and it
depicted that the client had high negative self-image. The raw score of self-esteem was 87 demonstrated that the self-esteem of client was
very low and it was matter of concern. The high score of self-esteem scale reflect significant difference between “what I am”, “what I like to
be” and thus is indicative of low self-esteem. This score may indicate that how much the subject does not like what already he is Self-Image
Profile was able to screen out positive self-image toward oneself, negative feeling toward one’s own self and self-esteem of one’s self. These
results are consistent with his background as the client was taken from the hospital with low self-esteem.

The Adolescent Anger Rating Scale (AARS)

The adolescent anger rating scale (APS) was designed to help clinician’s asses several aspect of anger, total anger, specific type of anger
(i.e., instrumental anger and reactive anger) and anger control in adolescent ages 11 to 19. The AARP is appropriate for use in clinical
settings as both a screening measure for social maladjustment behaviors and as a measure of treatment affects. In school setting, the AAPR
provides an efficient and economic screening, instrument for adolescents who demonstrate anger pattern that are potentially harmful to
themselves or others (Deanna,2000)

Test Administration
The adolescent anger rating scale (AARS) was administered on the client on Thursday, May 5, 2015, in a well lit and ventilated room of the
hospital. The room was peaceful and noise free and there was no distraction. The client was made to sit comfortably in his bed. The
instructions were given to him according to the manual. The test was orally administered to the client. The client was provided with a copy of
the (AARS), so that he could follow along. The difficult items or their responses were repeated again for his convenience when he asked for,
so that he could comprehend the test easily. He took 20 minutes to complete the test.

Qualitative Analysis

Scale Raw Score T score % ile Interpretation

Total Average Level

90 55 73
Anger of anger

Average Level
IA 33 53 73
of anger
 Average Level
RA 20 57 78
of anger

Average Level
AC 28 46 40
of anger

Qualitative Analysis
The client obtained the raw score of 90 which t score was 55 and percentile was 73. The results of the test showed that client had average
level of anger.

Summary of Psychological Assessment

The client’s scores on child depression inventory showed that he had slightly above average depression. According to the scores on self
image profile for children showed that he had low positive self image, high negative self image and low self esteem. The scores on
adolescent anger scale showed that client had average level of anger.

Identification of Problem
The client was taken from the Jinnah Hospital with complaints of sadness, anger, sleep disturbances, poor academics and low self esteem.
The client had an accident eight months before as his left hand was seriously injured by chaff cutter machine. When the client was taken to
hospital his hand was completely damaged and doctors had to amputee his hand. The client was feeling depress on losing his hand as it was
badly effecting his body image. The client felt humiliated when his school fellows made fun of his amputee hand. The client was angry that
why this accident was happened to him. The client was very upset that he was not able to do his work by himself.

Case Formulation
The client was taken from the hospital with the problem with his hand. His hand was completely damaged in that accident and doctors had to
amputee his hand. The client worried and depress about his condition because he had to face difficulty in his daily life activities. The
psychological assessment was carried out on informal as well as formal level. The informal assessment included mental state examination
and formal assessment included Child Depression Inventory (CDI), The Self Image Profile (SIP-C) and The Adolescent Anger Rating Scale
(AARS). The results of the tests indicated that client had slightly above average depression, had low lev el of positive self image and high
negative self image and average level of anger,

The word amputation is derived from the Latin amputare, “to cut away”, from ambi- (“about”, “around”) and putare (“to prune”). Amputation is
the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. There are many reasons an amputation
may be necessary. The most common is poor circulation because of damage or narrowing of the arteries, called peripheral arterial disease.
Other causes for amputation may include: severe injury (from a vehicle accident or serious burn, for example), cancerous tumor in the bone
or muscle of the limb and serious infection that does not get better with antibiotics or other treatment etc (McNaughty, 2015). In clients case
he was seriously injured by the chaff cutter machine and when he was taken to hospital there was poor circulation of blood in hand and
doctors had to amputee his hand.

Most patients who lose a limb as a result of traumatic or surgical procedures encounter a series of complex psychological responses
(Cansever et al 2003). Many people successfully use these responses to adjust to amputation, but others develop psychiatric symptoms
(Frank et al 1984). Shula and colleagues (1982) and Frierson and Lippmann (1987) note that as many as 50% of all amputees require some
sort of psychological intervention, and Shula and colleagues (1982) reported that depression is the most common psychological reaction
among amputees. The client was feeling depress on his condition because he had lost his body part and he was not able to perform his
tasks easily by himself.

According to research by Kindon and Pearce (1982), Kohl (1984), and Cansever and colleagues (2003), psychological reactions to
amputation depend on a number of factors, which include age and sex, type and level of amputation, lifelong patterns of coping with stress,
value placed on the lost limb, and expectations from the rehabilitation program. Kohl (1984) added that the individuals affected by the
traumatic loss of a limb are required to face a redefined body and self as well as a new reality. The client had to face problem regarding his
self image as the client was in the age of pre adolescence but children adapt well to the loss of function and manipulate prostheses and other
 limbs with great agility. They are particularly sensitive to peer acceptance and rejection. The client was also worried that how he will
participate in physical activities that required both hands as cricket etc.

The loss of limb through accident is a tremendous shock. Unless your child is very young, they will feel the same emotions as adult
amputees – grief, depression and anger. In addition, children often feel guilt for bringing pain and problems to their parents (Ratto, 2014). In
client’s case he was very angry that why that accident was happened to him and it caused problems for him and his family.

Management Plan
Management plan is designed to help the client to resolve his problems and to return his back to the community sound and healthy. Several
therapeutic interventions are designed for this purpose to be used with the client. Some of the therapies that can be used for the client who is
suffering from depression, problems of anger and negative self-image are as follows

 Supportive work

 Psycho education

 Behavior Therapy

 Cognitive Behavior Therapy

 Rational Emotive Behavior Therapy

 Family Therapy
Summary of Therapeutic Interventions
The client can be helped by using a number of therapeutic interventions, some of which are as follows:

Supportive work
Supportive psychotherapy is the attempt by a therapist by any practical means whatever to help patients deal with their emotional distress
and problems in living. It includes comforting, advising, encouraging, reassuring, and mostly listening, attentively and sympathetically. The
therapist provides an emotional outlet, the chance for patients to express themselves and be themselves. Also the therapist may inform
patients about their illness and about how to manage it and how to adjust to it. Over the course of treatment he may have to intercede on a
patient’s behalf with various authorities, including schools and social agencies, and with the patient’s family- indeed, with all of those with
whom the patient may be contending (Neuman, 2013).
Psycho education
Psycho education refers to the education offered to people who live with a psychological disturbance. Frequently Psycho educational training
involves clients with complaints of depression, anxiety, hopelessness, loneliness, eating problems, and sleep problems etc. The main
purpose of psycho education is to educate the client about his condition and also its management to help the client to deal with the problem
by himself. The client needs to be educated about his problems and what factors are affecting on it and how he can control it. The client
should be educated about the importance of self-management and how he can cooperate with his psychologist to make him better. The
client’s family also needs to be educated to support him when he needed. Amputation is a triple threat. It involves loss of function, loss of
sensation and loss of self-image so it is very important to deal with it. First of all the client will gain insight about the aspects of his problem
then he will be able to easily deal with it. The theory is, with better knowledge the client has of her illness, the better the client can live with
her condition. Psycho education can be provided to the client and family members together or separately (Hudak& Dougherty, 2011).

Behavioral Therapy
Contingency Contract
Contingency Contracting is a type of intervention that is used to increase desirable behaviors or decrease undesirable ones. A contingency
contract may be entered into by a teacher and student, a parent and child, or a therapist and client. It specifies the target behavior, the
conditions under which the behavior will occur, and the benefits or consequences that come with meeting or failing to meet the target. This
technique will be used to change the behavior of client during studies to motivate him to work hard. This technique will also be used to
decrease the anger level in client.

Sleep Hygiene Principle

General
Go to sleep at about the same time each night, and awaken at the same time each morning. Wide fluctuations between workdays and days
off can further impair your sleep. Try not to nap. If you do, restrict this to about an hour per day, and do it relatively early (before about 4 in
the afternoon). If you are not sleepy, either don’t go to bed or arise from bed. Do quiet, relaxing activities until you feel sleep, then return to
bed. Avoid doing stimulating, frustrating, or anxiety provoking activities in the bed or in the bedroom (watching television, studying, balancing
the checkbook, etc.). Try to reserve the bedroom and especially the bed, for sleep.

Exercise
Exercise, particularly aerobic exercise, is good for both sleep and overall health and should be encouraged. Avoid stimulating exercise in the
evening (do this at least 5 hours before bedtime).

Bedtime Ritual
Perform relaxing activities in the hour before bedtime. Make sure your sleeping environment is as comfortable as possible, paying attention
to temperature, noise, and light. Do not eat a heavy meal just before bedtime, although a light snack might help induce drowsiness. It is
sometimes helpful to place paper and pen by the bedside. If you find yourself worrying about completing or remembering a task the next
day, write it down and let it go.
During the night
If you awaken and find you can’t get back to sleep, arise from bed and do quiet, relaxing activities until you are drowsy. Then return to bed.
Place clocks so that the time is not visible from the bed (Bazil, 2015).

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Cognitive behavioral therapy addresses negative
patterns and distortions in the way we look at the world and ourselves. CBT is one of the most effective treatments for depression, and has
been found to be useful for a wide range of people, including children, adolescents, adults and older people.

Behavior Activation
As a treatment for depression and other mood disorders, behavioral activation is based on the theory that, as individuals become depressed,
they tend to engage in increasing avoidance and isolation, which serves to maintain or worsen their symptoms. The theory holds that not
enough environmental reinforcement or too much environmental punishment can contribute to depression. So, the treatment tends to
increase environmental reinforcement and reduce punishment. The goal of treatment, therefore, is to work with depressed individuals to
gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood. Many
times, this includes activities that they enjoyed before becoming depressed, activities related to their values or even everyday items that get
pushed aside such as:

Exercising, going out to dinner, improving relationships with their family members, working toward specific work-related goals, learning new
skills and activities, Showering regularly and completing household chores etc. this technique will be used for client to decrease his
depression level by involving him in different activities (Leahey, 2003).

Activity Schedule
Activity schedule is a written plan of a client’s daily activities. The client and therapist schedule activities for most hours of each day and often
incorporates those activities too which the client finds pleasurable. The activity schedule provides clients a sense of direction and control
(Leahey, 2003).

Cognitive Rehabilitation
The objective of this technique is to improve cognitive functions of patient, reduce the symptoms and enhance the patient’s adaptive
functioning in the real world. It focuses on memory, attention and executive functions (Seligman, Walker & Rosenhan, 2001, p. 462). It will
enhance the memory, attention, concentration, problem solving skills and executive functions of the client.

Rational Emotive Behavior Therapy

Rational Emotive Behavior Therapy (REBT) is both a psycho therapeutic system of theory and practices and a school of thought established
by Albert Ellis.
Disputing
This is an active approach for helping clients evaluate the helpfulness and efficacy of elements of their belief systems. Once the client is
familiar with the ABCs of REBT, disputing will allow her to identify debate and ultimately replace her thinking and beliefs which are generally
getting her into trouble and are the cause of her compulsive acts or maladaptive behavior patterns (Ellis & Maclaren, 1998).

Philosophical Disputes
The philosophical approach addresses a life satisfaction issue. Often the client will have been too focused on the identified problem that he
has lost perspective on the other areas of his life. The problem has subsequently become the defining element of the client’s existence. It
can be helpful to do some reality testing about other aspects of their life (Ellis & Maclaren, 1998).

Rational Coping Statements

Rational coping statements are self statements which usually are implemented after disputing has been accomplished, but they can also be
used when the client is in the process of exploring her beliefs. These factual, encouraging phrases are consistent with social reality and client
can be encouraged to repeat them consistently to reinforce the ideas for her. The may be encouraging statements such as “I can accomplish
this task” or “I don’t have to get upset in these situations” (Dryden, 1994; Ellis, 1957, 1988; Yankura & Dryden, 1990 as cited in Ellis &
Maclaren, 1998).

Biblotherapy / Psycho educational Assignment

In this technique therapist supplement the therapy content with bibliographic / psycho educational assignment to further reinforce the work
the client doing in session. Assigning helpful audio cassette, videos, pamphlets, books, lectures, workshops and topic specific group can all
contribute to client understanding of his problem and progress in changing inappropriate and unhelpful reactions. As in the client case
material was provided to motivate him that many people also have amputee of different limbs but they cope with the situation and are
working in a good way (Ellis &Maclaren, 1998).

Mindfulness based cognitive therapy (MBCT)

MBCT is generally delivered in groups and involves learning a type of meditation called ‘mindfulness meditation’. This meditation teaches
people to focus on the very present moment, just noticing whatever they are experiencing, be it pleasant or unpleasant, without trying to
change it. At first, this approach is used to focus on physical sensations (like breathing), but later it is used to focus on feelings and thoughts.
MBCT helps client to stop their mind wandering off into thoughts about the future or the past, or trying to avoid unpleasant thoughts and
feelings.

Self Esteem Building

Building your self-esteem and creating a positive self-awareness comes from taking an inventory of your own strengths and abilities as a
human being. This “inner peace” does not mean that you are unaware of your weaknesses; it merely means that you accept who you are
and genuinely like the person you have become. Low self-esteem is often linked to depression or anxiety. If your emotions feel overpowering
or out of control, one way to build self-esteem around this issue is to learn to manage your mood and gain control over your feelings. Some
people are able to do this with the help of friends and family. Others need to work with a mental health professional to manage the problems
that may lie beneath the surface of low self-esteem (Ponton, 2013).

Anger Management
Relaxation Exercise
Psychologists train patients in a technique called “progressive relaxation” until they’re able to relax simply by thinking of a particular word or
image. Psychologists then ask patients to spend a minute or two thinking intensely about a situation that makes them excessively angry,
such as other drivers going too slow. Psychologists then help patients relax. Psychologists and patients practice this sequence over and over
again. After about eight sessions, patients are typically able to relax on their own (Stearns & Stearns, 1989).

Listing of advantages and disadvantages of anger, distraction from negative thoughts, identifying bodily symptoms associated with anger,
using positive statements and identifying positive solutions etc will also be used to treat anger.

Traffic Signal Technique

When teaching anger management to client, a traffic light is effective at encouraging the identification of angry emotions. The color red
represents stopping, and is useful when client begin to lose control of their emotions. Yellow offers client an opportunity to think and find an
appropriate solution to their problem, and green lets them know they can move forward in a responsible way. Just as a driver who runs a
 traffic light risks getting a ticket or causing an accident, a client risks punishment, personal injury, or inflicting injury on someone else by
running an anger traffic light. The three colors on a traffic light can represent the three stages of emotion a client passes through when
becoming angry. Green represents calm and relaxation, or the state before anger begins to develop. Yellow symbolizes the build-up of angry
emotion that typically occurs when the client first encounters a stressor. Red represents the client’s reaction to the angry emotions.

Once the client learn to recognize what stage of anger they are in, they can utilize coping strategies learned in anger management programs
to stop the progression of their emotions before they reach red. Anger is a complicated and overwhelming emotion, but using a traffic light for
anger management allows client to visualize their anger and the steps necessary for controlling their reaction to angry emotions (Ketcham,
2015).

Family Therapy
All human beings require a support system throughout life in order to maintain emotional health. However, not all are so blessed, and many
find themselves transiently or permanently in state of isolation. Single and widowed individuals suffer more psychological distress and
difficulty in adapting to amputation than do those who are married and have a family. Particularly helpful in adjustment of the adult amputee
is the presence of a supportive partner who assumes a flexible approach, takes over functions when needed, cuts back when the amputee is
able to manage, but at all times maintains the amputee’s self-esteem. Parents are the major source for children and adolescent amputees
but peer acceptance beyond the family is critical in the successful adaptation of all amputees and especially children and adolescents (Racy,
2015).

Limitations
 The environment of hospital was not appropriate for psychological assessment. There was not any appropriate place for conducting
assessment and the place where the assessment was carried out had many distractions which sometimes made it difficult for the client to
concentrate.

 The time given to carry out the assessment was too short and it was impossible to collect the complete, detailed and in depth information
about the client in that short period of time.

 No follow up session was done to see the effect of techniques that client learned in session.
Suggestions
 The client and his family should accept that client’s was amputee and it takes time for him to cope with this problem a disease in which
progress is very slow so they have to work together for the treatment to work.

 Client’s family should support him so that he will be able to fight with that problem.

 The client and family should be prepared that it is a long term treatment for that problem so time needs for him to reach his normal
emotional state and do his tasks by himself.

 There should be a proper room for carrying out the psychological assessment and intervention of the client. A place where there is no
such thing which can distract the client during assessment.

 Sufficient time should be given for the rapport building and for getting the complete and comprehensive information about the client and
also for the follow up sessions.

Also Study:
Psychological Assessment Example
References;
 Cansever A, Uzun O, Yildiz C, et al. Depression in men with traumatic lower part amputation: A comparison to men with surgical lower
part amputation. Mil Med. 2003;168:106–9. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526369/

 Ellis, A. &Maclaren, C. (1998). Rational emotive behavior therapy: A therapist guide. USA: Impact Publishers, Inc.
 Frank RG, Kashani JH, Kashani SR, et al. Psychological response to amputation as a function of age and time since amputation. Br J
Psychiatry. 1984;144:493–7.Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526369/

 Frierson RL, Lippmann SB. Psychiatric consultation for acute amputees. Psychosomatics.1987;28:183–9 Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526369/

 Hudak, R. & Dougherty, D. (2011). Clinical obsessive-compulsive disorders in adults and children. UK: Cambridge University press
 Ketcham, S. (2015). Using a Traffic Light for Anger Management. Retrieved from
http://stress.lovetoknow.com/Using_a_Traffic_Light_for_Anger_Management
 Kindon D, Pearce T. In: Psychosocial Assessment and Management of the Amputee in Rehabilitative Management of the
Amputee. Banerjee S, editor. London: Williams and Wilkins; 1982. pp. 350–71.

 Kohl S. The process of psychological adaptation to traumatic limb loss. In: Krueger DW, editor.Emotional Rehabilitation of Physical
Trauma and Disability. New York: SP Medical and Scientific Books; 1984. pp. 113–48.

 Kohl SJ. In: Emotional Coping with Amputation in Rehabilitation Psychology: A Comprehensive Textbook. Krueger DW, editor. Rockville,
MD: Aspen; 1984. pp. 273–82.

 Leahy, R. L (2003). Cognitive Therapy Techniques. New York: Guilford Press.

 McNaughty, J. K. (2015). Amputation: Evaluating Psychological Injuries in Children and Adults. Retrieved from
http://www.experts.com/Articles/Amputation-Evaluating-Psychological-Injuries-Children-Adults-By-Dr-Jane-McNaught

 Neuman, F. (2013). Supportive Psychotherapy. Retrieved from https://www.psychologytoday.com/blog/fighting-fear/201306/supportive-

psychotherapy

 Ponton, L. (2013). Building Self Esteem. Retrieved from http://psychcentral.com/lib/building-self-esteem/

 Racy, J. C. (2015). Psychological Adaptation to Amputation. Retrieved from http://www.oandplibrary.org/alp/chap28-01.asp

 Ratto, L. L. (2014). Coping with a Siblings Disability. Retrieved from http://www.amputee-coalition.org/inmotion/jun_jul_96/copsibs.html

 Seligman, M. E. P., Walker, E. F., & Rosenhan, D. L. (2001). Abnormal psychology (4thed.). USA: W W Norton & Company.
 Shula GD, Sahu SC, Tripathi RP, et al. A psychiatric study of amputees. Br J Psychiatry.1982; 141:50–3. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526369/
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