Case Reports 1 (draft 1)

Participant’s Name: Samra Shehzadi

Participant ID: S2022146004
Supervisor
Sir. Umar Sultan
Department of Clinical Psychology
School of Professional Psychology
University of Management and Technology
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Summary of the Case

A 13-year-old girl in grade 7th (A) from mainstream school was referred to the
trainee clinical psychologist for the presenting complaints of difficulty in understanding
mathematics, difficulty in remembering long questions of Geo and History, and
adjustment issues. Various assessment modalities were used in this case to identify the
child’s presenting problems. Assessments included behavioral observation; clinical
interview with the teacher, perceived severity of the problem, School Children Problem
Scale (SCPS), Curriculum-based Assessment Curriculum(CBA), and Cognitive
Assessment Battery (CAB) including Paired Association Learning Test (PALT). The
assessment revealed that the child had difficulty in remembering long questions of history
and difficulty in understanding mathematics concepts. Based on the assessment
modalities, an intervention plan was devised which included rapport building through
object play (to strengthen the therapeutic relationship), psycho-education to her teacher
about her adjustment problems.
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Identifying Data
Initials: H.W
Age: 13 years
Gender: Girl
Grade: 7th A
School: CRAMTGHS
No of Sessions: 5
Initial Date Seen: October 25th, 2023
Last Date Seen:
Source and Reason for Referral

The child was referred by the class teacher to the trainee clinical psychologist for
the assessment and management of the presenting complaints i-e difficulty in
understanding mathematics, difficulty in remembering long questions of Geo and
History, and adjustment issues in school.

Presenting Problems
Table 1

Duration and Presenting Complaints Based upon the Clinical Interview Taken from the
Child
Duration Presenting Complaints
6 ‫ماہ سے‬ ‫ کی سمجھ نہیں آتی۔‬Math’s
6 ‫ماہ سے‬ ‫کا یاد کرتی ہوں پھر بھول جاتا ہے۔‬Geo,history
6 ‫ماہ سے‬ ‫اس اسکول میں ایڈجسٹ نہیں ہو رہی۔‬
6 ‫ماہ سے‬ ‫ ہے‬slow writing speed‫میری‬
Note. Presenting complaints were probed in the clinical interview.
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Table 2

Duration and Presenting Complaints Based upon the Clinical Interview Taken from the
Teacher

Duration Presenting Complaints

‫جب سے اسکول آۂی ہے‬ ‫ اور ہسٹری کی سمجھ نہیں آتی۔‬Math’s
‫جب سے اسکول آۂی ہے‬ ‫ پیپر چھوڑ آتی ہے۔‬،‫آہستہ لکھتی ہے‬
Note. Presenting complaints are discussed in detail in the clinical interview with the
teacher

Initial Information

During the initial session, the trainee school counselor observed a child who was a
13-year-old girl in class 7th. The trainee went to her class when the child was sitting on
the front seat and taking her English class. The trainee introduced herself to the child’s
class teacher as a trainee school counselor and requested permission to conduct a session,
which was granted. The child appeared to be a little confused when the trainee
approached her and moved toward the session room. In order to make her comfortable,
the trainee engaged in a friendly conversation and asked about her breakfast. The girl
replied with a smile that she had eaten pancakes made by her mother. The trainee then
asked about the girl’s health, to which the child replied that she was fine with a smiley
face. After sitting in session room, the trainee introduced herself and mentioned her role
as a school counselor. The child nodded her head which was an indication that she
understood what the trainee was trying to say. For rapport building the trainee started the
session with a normal routine conversation and the girl participated.

The H.W was a girl of 13 years old, studied in class 7th (A) in a mainstream
school. The child seemed to be well-groomed and attractive by her appearance. It was
seen that the child had a normal height and weight that was appropriate for her age. Her
uniform was neat and clean, her shoes were polished, her nails were trimmed, her hair
was combed and she wore glasses. So, it concluded that the overall hygiene of the child
was adequate. She had a smile on her face throughout the session and seemed to be a
little shy. She maintained eye contact properly during the session. She was polite and
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spoke slowly in a low tone, making it hard to understand her. when the trainee asked her
to speak louder, her tone improved. The child had a comfortable sitting posture, with her
hands resting on the chair and sitting straight. She showed compliance throughout the
session. It was seemed that, the child’s behavior was appropriate as she was focused and
attentive throughout the session. However, the trainee observed that the child appeared to
be anxious when discussing her educational history and school performance. She had
recently been admitted to this school, with Urdu as the medium of instruction, and she
was struggling to adapt to the new environment. The trainee learned that the child had
issues with some subjects, such as Mathematics, Geo, and history, as she mentioned that
she had less interest in Maths from the beginning. She was having difficulty remembering
long questions about Geo, and history and her writing speed was slow therefore she
didn’t perform well in her first term exams. The girl also reported having difficulty
making friends at this school. She had discussed these issues with her mother, but her
mother had not paid any attention to them. The child had an insight about her problems
and knew the purpose of referral as she mentioned that she reported these issues to her
class teacher and she wanted to take sessions. The counsellor took note of all this
information, which will be helpful in providing the girl with the support she needs to
overcome her challenges.

Developmental History of the Presenting Problem

The child herself reported that she has been experiencing adjustment and
academic issues for the past 6 months. Despite attending a private school earlier where
English was the primary language of instruction, she is now struggling to grasp math
concepts, recall long questions about geography and history, and make new friends. The
child mentioned that the syllabus at this school is quite demanding and challenging, and
she finds it difficult to understand the teaching methodology. When asked to compare her
current government institution with the private school she attended earlier, the child
spoke about her idealized perception of the latter and how it was far better than her
current situation. The school environment and the behavior of her classmates have made
her feel uneasy and uncomfortable.
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It is evident that the child is trying to cope with the adjustment issues that come
with transitioning to a new school. The child's academic struggles may be attributed to
the differences in the teaching methodology and syllabus, which are yet to be adapted to
her learning style. The child's emotional well-being is also important, and it is crucial that
the school administration addresses her concerns and provides a comfortable and safe
learning environment.

Background Information

Personal History

The following was a detailed account of the client's daily routine, as per her
statement. She began her day early and got up at 5:00 AM to perform the Fajar prayer, a
significant religious obligation for her. She then went back to sleep and woke up again at
7:00 AM, feeling refreshed and ready to start her day. Her breakfast at 7:30 AM usually
consisted of bread and eggs, which she loved. After that, she proceeded to get ready for
school, where her father dropped her off, and she arrived on time at 8:00 AM. After
school hours, the client followed a set routine. She changed her uniform, performed the
Zohar prayer at 2:30 PM, and then had her lunch. After lunch, she took some time to
clean her house and then took a nap at around 3:30 PM. She woke up at 4:30 PM to
perform Asar's prayer, which was another important prayer for her because if she missed
her prayers her mother scolded her. She then recited the Quran from her mother, as she
was on the fifteenth Parah of the Quran.

Studying was an essential part of her daily routine, and she dedicated four to five
hours every day to learning her school lessons and completing her homework until 9:00
PM. After completing her studies, she took a break to use her mobile phone for half an
hour until 10:00 PM. The client then helped her mother with household chores, after that,
she had her dinner around 10:30 PM, washed the dishes, and made some dough for
breakfast. She then ironed her uniform for school, ensuring that she was well-prepared
for the next day. The client performed Isha's prayer around 11:30 PM, and then she went
to bed at 12:00 . The client shared her Sunday routine, stating that she woke up at 8 a.m.
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and had breakfast with her family that they ordered from outside. After breakfast, she and
her siblings watched movies together until she fell asleep at around 11 a.m. She got up
again at 2 p.m. for Zohar prayer and spent the rest of her afternoon cleaning the house or
going to the park with her brothers. If they have guests, she spends time with them
instead.

The client enjoyed eating beans and fast food, especially loaded fries. She also
liked to play games, such as Ludo, with her siblings in her free time. Her mother was a
religious woman, and the client shared her interest, in reading Islamic books as a hobby.
She had studied many books related to "Ashara Mubashra," "Gunahe Kabeera," "Gunah e
Sagreeha," and many others. Her favourite food was biryani, and her favourite subjects
were English and Islamyat. She aspired to become a social person and run an NGO for
the rights of needy people.

Family History

The client belongs to a nuclear family system and a middle-class family. There
were 7 members in the family i.e., mother, father, client's elder brothers and younger
brother and sister. The client lived in a small house of 6 Marla’s which consisted of 3
bedrooms, a kitchen, a gallery, a TV lounge, and a garage. The client used to share her
room with her younger siblings. the overall home environment was peaceful and
comfortable.

The client’s father's age was approximately 42 years and educated till
intermediate. He was a businessman and ran his own business. She mentioned that the
client’s father had a positive attitude towards all siblings but sometimes he used to show
strict behavior regarding rules. The client reported that she had a satisfactory relationship
with his father and he loved her very much. She mentioned that her father used to bring
all her siblings to the park.

The client’s mother was a housewife at the age of 36 and studied till metric. She
had done the Ulama course due to which she was very bound to perform religious rituals.
She used to teach the client. She was a very soft and kind-hearted woman but sometimes
she gets angry and, scolds her for not praying. She mentioned that her mother loved her
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very much. She had a satisfactory relationship with her mother. The child reported that
her mother and father relationship was also satisfactory. They rarely fight with each
other. According to the child’s perception, her mother loved her elder brother more.

The client had five siblings, 3 brothers and 2 sisters. The client’s elder brother
was 18 years old university-going boy who studied in 12 grade. She reported that her
brother was a Hafiz e Quran and also did his own work as a Graphic Designer. She stated
that he was her favourite brother because he took her for an outing and loved her very
much. The client had a satisfactory relationship with her brother. The client’s 2nd born
was her brother who was 15 years old and studying in 1st year. The client reported that he
was a very angry person in her house, he mostly used to shout and fight with her and her
relationship with his brother was not very satisfactory. The client was the 3rd born of her
family. The client’s 4th born was her younger sister who was 5 years old and studied in
nursery. She mentioned that her younger sister was very smart and active and the client
loved her very much. The last born of the client’s family was her youngest brother who
was 1.5 years old. He was a very pampered child of her house and he used to annoy her
because he took her things whenever she sat down to study. But she loved her very much.

It seemed that the overall home atmosphere was satisfactory, the client was a very
sensitive and responsible child of her house.

Educational History

The client reported that she started attending school at the age of three, but
couldn't recall anything about her first day of school. She initially enrolled in The Spirit
School, which was a private institution. The girl made friends and found the teachers
polite and sweet. She actively participated in class and extra activities, and her class
performance was at 90%. The child studied at this school from playgroup to nursery but
had to switch schools due to a house move. The Jinnah Basic School of Mansara was her
next private school, with a stricter teaching system where teachers used to beat and scold
the children. Nevertheless, she made good friends and repeated the nursery class in the
same school. Due to her father's job, the family moved again, this time to Abbottabad,
where she attended Montessori, another private school. The child had friendly teachers,
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made friends, and performed well in her studies. However, she had to leave the school as
her family moved once more.

After moving to Lahore, the client was admitted to Dar-e-Arqam School, where
she studied from grades 2 to 3. Despite having excellent performance, with marks up to
97%, she did not like the teaching environment as the teachers kept changing, and she
struggled to understand their teaching methods. The child made friends easily in this
school too, but due to the frequent changes in teachers, she left this school as well.
Unique High School was her next school, where she studied from grades 4 to 6, and was
a position holder. She appreciated the school environment, made good friends, and
admired the teaching system. However, the school was far from her house, causing
problems with commuting, so she left this school too.

She joined a government school in the seventh grade around six months ago but
disliked the school's environment. It was completely different from the private schools
she had attended before. Consequently, she found it challenging to make friends and
struggled to adjust to the new environment. Additionally, the syllabus was much more
difficult, especially in math and geography, and the history and geography teacher was
strict and spoke harshly. The girl reported that she had difficulty understanding the
teaching methodology of her math teacher. The girl had previously studied in English
medium and Oxford syllabus schools, but the current school's syllabus was burdensome,
causing her to struggle. The client mentioned that she was getting Quranic education
from her mother and had already completed fifteen Parahs of the Quran. Due to the
constant changes in schools and the varying educational systems, the girl faced
difficulties adjusting to the new school environment. She became disturbed due to these
changes, and the new school's environment and educational system posed new challenges
for her, making it hard to adjust.

Provisional Formulation

Based on initial observation, history, and other available information, the

trainee clinical psychologist hypothesized that the child faced adjustment issues after
getting admission to her current school. As she mentioned she studied at private schools
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from the beginning and now she is in a government school and the mode of education
(Urdu medium) was also disturbing her. These factors led to her problems in her studies.
The environment of the class and her class fellow’s non-serious behaviour affected her
and she was unable to make any friends in her class. The teaching methodology of the
math teacher was not suitable for her as she mentioned that she studied Oxford books
from nursery and now it was very challenging for her to understand the concepts of
Punjab textbooks. As she was a good student and concerned about her studies this was
her protective factor. Currently, the child is facing academic problems i-e difficulty in
understanding math concepts and difficulty in remembering geo, and history-long
questions.

Assessment

Psychological assessment is a testing method that uses a number of techniques to

find hypotheses about individuals and their behaviour, abilities, and personality
(Framingham 2016). It is a procedure in which a clinician evaluates a person in terms of
the psychological, physical and social factors that have the most influence on the
individual ‘s functioning (Halgin, 2010). The following are some assessment modalities
used:

 Behavioral Observation (Bakeman & Haynes, 2014)

 Clinical Interview
 Clinical Interview with Teacher
 Clinical Interview with Client
 Subjective Rating of the problem
 Curriculum Based Assessment (CBA)
 Reading assessment
 Writing assessment
 Dictation
 Cognitive Assessment Battery (CAB) (Naeem & Mehmood, 2011).
o Paired Association Learning (PALT)
 School Children Problem Scale (SCPS) (Saleem & Mehmood, 2011).
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Behavioural Observation

Behavioural observation is useful for the assessment of persons with limited

verbal abilities, the measurement of persons' behaviour in their natural environments, and
the measurement of functional relations among contemporaneously occurring behaviours
and environmental events. It is particularly useful for measuring clinically important
sequences of interactions between persons and for examining how these sequences
influence behaviour and vary across contexts (Bakeman & Haynes, 2014). The purpose
of the behavioural observation was to assess the variety of the dimensions of the
behaviour in both structured and unstructured manners. It was used to assess the client’s
behaviour during the session and was done to assess the present level of functioning and
problematic behaviour in order to formulate a comprehensive and effective management
plan.
During the client's initial session, it was observed that the child had an average
weight and height for their age and was compliant and fully engaged in the session.
However, the child seemed nervous and shy in the beginning but became more
comfortable during the following sessions. The trainee school psychologist used various
worksheets to build rapport, which was successful. The child's overall attention and
concentration level were satisfactory, and the child showed sensitivity and emotional
intelligence while discussing their difficulty adjusting to the school environment. The
child's cooperative nature and understanding attitude were also evident throughout the
sessions. It was observed that the child belonged to a loving and caring family, where she
was the center of attention since childhood. Her mother taught her all the social and
moral values of society, and she was a smart and active child who loved to study.
However, the child became anxious and depressed sometimes due to her class
performance, as she wanted to achieve higher grades and fulfil the expectations of her
family.

Clinical Interview

The clinical interview is a fundamental component of psychological and mental

health treatment. It represents a professional relationship between a mental health
provider and a patient or client and is a cornerstone across all major mental health
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treatment disciplines. The clinical interview comprises an informed consent process and
has several primary objectives. These objectives include initiating a therapeutic alliance,
gathering necessary diagnostic or assessment data, formulating a case, and implementing
psychological interventions ( Sommers-Flanagan et al., 2015). A clinical interview was
conducted with the client and as well as with the teacher of the client. The aim of
conducting that interview was to understand the background and current situation of the
client and obtained detailed history of the problems of the client. the clinical interview
helped the trainee to identify the presenting complaints and probe the history of the client
and teacher for a clear picture of the case formulation. The clinical interview is important
to fill the history gaps.

Clinical Interview with Client. A clinical Interview was conducted with the client
in which the trainee school counsellor introduced herself as a counsellor and engaged the
client to introduce himself the client reported her likes and dislikes, favourite subjects and
teachers, and a brief introduction about himself and the trainee school counsellor asked
different questions about her daily routine. The trainee school counselor asked the client
about the problems she was facing in her studies as well as in her personal life. The client
reported that ‫ کی سمجھ نہیں آتی۔‬Math’s” and ‫ اس اسکول میں ایڈجسٹ نہیں ہو رہی۔‬Trainee
counsellor probed her about what did she meant by “samaj nhi aati”. Client answered that
she “acha nahi lagta maths or teacher ki b samj ni aati jab sy is school main aai hun". The
client reported that in Geo and History, she had difficulty remembering long questions.
The client reported that she had difficulty in making new friends in this school.
Moreover, in clinical interview the trainee counselor asked the client about her personal,
family and educational histories. During the interview trainee used the techniques of
summarizing and paraphrasing techniques. Which was helpful in building rapport and it
also increased client interest level. Trainee also used active listening which was also very
helpful in building therapeutic relationship. Client was showing cooperative behavior
during interview which showed her willingness. Hence, clinical interview was very
helpful, it helped the trainee to make a clear picture of client’s problems.

Clinical Interview with Teacher. A Detailed clinical interview was conducted

with class teacher of the child. The duration of the interview was 20 minutes in which
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trainee school psychologist asked to inform about the presenting complaints of the client.
Then trainee cleared the ambiguity in the given presenting complaints by asking the class
teacher to operationally defined and used probing in the interview. The teacher used the
verbatim “maths or history ki samj nahi aati” trainee counselor asked her to explain that
what did mean by “samj na aana” explain a little bit detail of it by answering that what is
the problem with these subjects, which things the chlid was having difficulty to
understand either the concepts or teaching methodology. The class teacher replied that
she referred her on the wish of the child as she was having adjustment issues and
academic issues but overall, the child was very smart and active student of the class. She
mentioned that the child had difficulty in understanding the complex contacts of maths
and remembering the long questions of Geo and History. The teacher also stated that the
child participated in class and all other activities. She was a confident student and very
obedient. She also reported that the child inquired the questions which she found to very
difficult during class and raised her hand. The child had also slow writing speed as
mentioned by her class teacher due to these issues she left her paper incomplete. All the
presenting complaints were probed in the clinical interview. The clinical interview was
well conducted with teacher it cleared the ambiguities of trainee counselor regarding the
presenting complaints. Teacher was showing cooperative behavior during clinical
interview. Teachers attitude towards trainee school counselor was concerned and she was
showing her willingness during interview.

Subjective Rating of the Problem

Perceived severity rating scales are indirect assessment methods whereby the
information gathered is subjectively recalled and rated on a scale. It can be conducted
with individuals that are in contact with the client, e.g. teachers, caregivers, or parents
(Cooper et al., 2007).

The client was asked to rate her symptoms on a 10 point scale where 0 meant no
symptoms, 5 meant average and 10 meant maximum severity of symptoms. The
subjective rating was taken from the client as well as the class teacher. It will be helpful
for psychologists to check the differences in pre-rating assessment.
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Table 3

Presenting Complaints and Subjective Ratings Taken from the Child

Subjective Ratings (0-10) Presenting Complaints
6 ‫ کی سمجھ نہیں آتی۔‬Math’s
7 ‫کا یاد کرتی ہوں پھر بھول جاتا ہے۔‬Geo,history
6 ‫اس اسکول میں ایڈجسٹ نہیں ہو رہی۔‬
7 ‫ ہے‬slow writing speed‫میری‬
Note. 1= minimum, 5= average, 10= maximum

Table 4

Presenting Complaints and Subjective Ratings Taken from the Teacher

Subjective Ratings (0-10) Presenting Complaints

6 ‫ اور ہسٹری کی سمجھ نہیں آتی۔‬Math’s
7 ‫ پیپر چھوڑ آتی ہے۔‬،‫آہستہ لکھتی ہے‬
Note. 1= minimum, 5= average, 10= maximum

Curriculum Based Assessment (CBA)

Educational assessment or educational evaluation is the systematic process of

documenting and using empirical data on knowledge, skill, attitudes, and beliefs to refine
programs and improve student learning (Ostrander & Herman, 2015). The aim of the
academic assessment was to check the client current performance in all subjects. The
main purpose of conducting curriculum-based assessment was to check the clients current
performance in the class and assessed client in reading and writing. There were
presenting complaints by client difficulty in remembering and understanding of maths
and geo, history concepts. The teacher also reported that she had difficulty in maths and
geo, history as well, therefore there was need of curriculum based assessment.
Checking of Books &Copies. The child was asked to bring her bag with her so
that trainee school counselor checked the copies and books. The child used to bring the
bag with her during session. She placed the bag on floor, trainee checked the bag. In the
bag the books and copies were placed separately and in organized way. The binding of
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copies and books were in their good state. Trainee counselor checked the notebooks in
which classwork and homework were checked. There were silly mistakes in homework
and classwork. Client scored satisfactory in all subjects excepts math and geo class tests.
In Math client scored above average.

English Reading Assessment. An assessment that examines a student's decoding

skills looks at a child's reading accuracy. One example of this type of measure is to have
a student read a passage of text as clearly and correctly as possible (Meisinger et.al,
2010).

The aim of the English reading assessment was to assess the fluency and
recognition of letters and words. For the English reading, trainee asked the client to open
her favorite chapter of Geo book. The child selected the paragraph that she was also read
in class but had difficulty to remember it. The child read the paragraph of the four lines in
which she didn’t found any difficulty to pronounce words. She was reading fluently and
seedily within one minute and 28 sec. The Child was able to read the words through
segmentation. In the paragraph there were 20 words from which 10 words were correct
but 10 words were incorrect. But she had difficulty in understanding the meaning of
tough words and comprehend the overall picture. Which was the reason of her
remembering issue it was observed that she lacks study skills. Through English reading it
cleared that client known the sounds of words he had recognition but she had difficulty in
remembering and understanding the meaning of unknown words. During assessment of
English client was a little bit confused. But the trainee praised her during reading it also
motivated and reinforced the client.
Table 5
Clients Score on Reading Assessment of English

Subject Total Words Incorrect Words Correct Words

English 39 0 39
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English Writing Assessment. Writing assessment can also refer to the activities
and practices used to evaluate student writing and learning (Hout et al., 2012).

A written assessment of English was done with the client to assess her
performance in English writing. The client was written with the right hand. She was
asked to write a paragraph from her favourite chapter of history subject. In history, she
selected a paragraph of 4 lines, and she started writing the paragraph in English. She used
to see the words again and again while writing. The child was looking confident and
focused while writing. The Client was paying appropriate excessive pressure on the
pencil while writing. She used to write most of the words between the lines. It was
observed that her writing speed was a little slow as she was putting pressure on the pencil
and also writing neat and clean. She looked very conscious about the neatness of her
written expression. She completed the 4 lines paragraph in 2 minutes and 37 seconds. She
produced all words correctly and there were no spelling and grammatical mistakes.

Dictation. Dictation is a technique where the learners receive some spoken input,
hold this in their memory for a short time, and then write what they heard (Nation, 1999).
The purpose of the dictation was to assess the child's ability to recall the correct spelling
of the words as well she had the recognition of letters or not. The words of the dictation
were taken from the child’s favourite chapter, from that paragraph which she read.

Moreover, the trainee school counsellor used to dictate the words and the client
wrote them. When she didn’t understand what the trainee spoke, she asked again to repeat
the word. In the English Dictation assessment trainee dictated 10 words from the client’s
favorite chapters. It was from the paragraph that the client read also. The client's facial
expression was calmed while English dictation. The client was able to write all words
correctly and there were no spelling mistakes. Through English dictation, it seemed that
client had the phoneme awareness as she had the recognition of letters as well as sounds.
She had the awareness of blending the sounds of words properly.
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Table 6
Responses of Client on English Dictation

Words Responses of client Errors

Bigger Bigger No
Village Village No
Population Population No
Universities Universities No
Commercial Commercial No
Recreational Recreational No
Capital Capital No
Areas Areas No
Important Important No
Millions Millions No
Coming comming Addition
.
Cognitive Assessment Battery (CAB)
The cognitive assessment battery (CAB) is based on different tests to identify the
learning abilities and disabilities of a child of 7 years and older. This test was
administered to the child to identify the learning difficulties of the child as well as a
neuropsychological tool to understand the child’s current cognitive status, strengths, and
weaknesses. The cognitive assessment battery also identifies the brain function of the
child (Naeem & Mehmood, 2011). In this battery, different tests were mentioned that had
different functions and all were based on the child learning in different domains.

Paired Associate Learning Test (PALT)

The paired associate method requires client to learn pair of items by forming an
association between them. It can be used to measure the verbal learning and verbal
retention. Paired associate learning test was a classic memory paradigm that was used to
understand how people encode and retrieve newly formed associations among stimuli. It
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was used to assess verbal learning and verbal retention. It was also used to assess the
child ability to associate things to each other (Arndt, 2012). The rationale behind using
this tool was to check was client able to associate things it would be helpful for learning
the new study skills.

Table 7

Clients Score on Paired Associate Learning Test

Category Trial 1 Trial 2 Trial 3

Easy 5 6 6

Difficult 4 6 8

Qualitative Interpretation

The paired associate learning test was administered to check the child’s learning
through association. She maintained eye contact all the time and she seemed very excited
about this activity. She looked very comfortable and her sitting posture was also
appropriate during this activity. She showed very compliant behaviour with the trainee
school counsellor. She was listening to all the verbal instructions given by the trainee
school counsellor very carefully. When the trainee school counsellor started
administering the test, the child was very excited and showed willingness. During
administering the test, the child was engaged and focused on listening and recalling both
easy and difficult words. And when the trainee repeated the words, she was really
enjoying the association between words. She answered all questions very confidently but
on difficult words she was a little confused. Though the child was finding a bit of
difficulty in difficult words but gradually did very well after the first trial and so on.
Behavioural observation of the child was very helpful in qualitative analysis.

The child’s performance on the test reflected that she was trying her best to
remember the words. Her performance in the test showed that she had a sound retention
power in easy words but a bit weak in difficult words. As her vocabulary was up to the
mark, she was finding difficulty in remembering the association of difficult words but
only in the first two trials. The child reported that she had difficulty in remembering long
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and short questions of Geo and History. But as she performed better and better in
successive trials, it could be expected that in future it will be helpful in her academic
learning and the child could get insight from it that she can perform better by learning
tasks with successive trials and forming associations between them.

School Children’s Problem Scale

The School Children Problem Scale was developed to assess emotional and
behavioral problems in school children. The scales comprise about 6 factors namely
Anxiousness, Academic Problems, Aggression, Social Withdrawal, Feeling of Rejection,
and Psychosomatic Complaints, termed the School Children Problems Scale (Saleem &
Mehmood, 2011).
The scale was administered to assess the problem area of the child so as to
develop an understanding of the problems and to manage them. The scale had a total of 6
domains namely; F1, F2, F3, F4, F5, and F6, each assessing the following problems
respectively Anxiety, Academic Problems, Aggression, Social Withdrawal, Rejection,
and Psychosomatic complaints (Appendix).

Table 8

The Child’s Scores, Mean, SD and Category on Different Domains of School Children’s
Problems Scale (SCPS)
Domains Scores M SD Category
Anxiety (F1) 23 13.48 7.28 Very severe
Academic Problems (F2) 9 7.11 4.42 Severe
Aggression (F3) 3 7.05 4.35 Mild
Social Withdrawal (F4) 4 8.51 3.94 Mild
Rejection (F5) 3 3.30 3.25 Severe
Psychosomatic Symptoms 9 4.03 2.54 Very severe
(F6)
Total 52 42.45 19.17 Severe
The child scored a total of 23 in the F1 domain (anxiety) which falls in the
category of very severe. The child reported being scared “sometimes”. The child further
explained that she only got scared when she did something wrong and her mother used to
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scold her. On the second item, the child reported “sometimes” being worried about
anything. She mentioned that she mostly thinks about her previous schools and friends
she missed them a lot. The child also mentioned “rarely” being scared to take initiative
and “sometimes” not completing what she has started. She stated that when she starts her
school's homework, she finds it difficult to complete it because her teacher allotted them
a lot of homework tasks which she felt was a burden. The child mentioned that she
“often” worries unnecessarily and often overthinks. When the trainee probed her further,
she reported that she mostly had thoughts of her old friends and teachers and the burden
of the new school. She mentioned that “rarely” be on the lookout at all times so that
nothing happens. The child revealed that she rarely stayed understated and very often she
not being able to speak in front of anyone. She explained fearing failure very often. She
mentioned that all family members would tease me and my parents showed anger toward
her. Based on the responses the child was suspected to be suffering from a severe level of
anxiety.
The child scored a total of 9 in the F2 or academic problems domain which
indicated a severe category. The child reported “never” not being interested in studies and
finding it difficult to maintain interest in them. The child “sometimes” thought classwork
was a burden and she stated in this school the teachers gave them extra homework and
she felt the burden of it. And also, reported that she “rarely” not being able to remember
lessons from school. However, the child reported that she “never” felt unable to focus on
and take things seriously. She never felt that his home environment was a hindrance to
his studies and she also participated in class very often. She mentioned that her parents
compare her school performance with other siblings and put pressure on her as the best
achiever.
In the aggression domain or the F3 domain, the child secured a total of 3 scores.
She reported that she never got angry at little things and never cursed when angry. She
also said that she never got angry in class as she rarely talked loudly or was rarely
mischievous. The child recalled never throwing things out of anger and also explained
sometimes she did not follow her brother’s commands. From history, it was evident that
she was a very obedient and innocent girl in her house. The child was suspected to be
suffering from mild aggression by her responses.
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The child secured a total of 4 scores only in the withdrawal or F4 domain. The
child reported rarely feeling the following; not wanting to meet her friends, not being
able to express her anger, not wanting to talk to anyone, and feeling irritated. But she
mentioned “rarely” felt like sitting in a place and wanting to remain silent. These
responses showed that the child suffered from a mil level of withdrawal.
The F5 domain was to assess the level of rejection in the child’s life. The child
scored a total of 4 scores in this domain. The domain had a total of 5 items. The child
reported that he “rarely” felt that nobody loved her, and “rarely” felt that her parents
loved her siblings more than her or they didn’t give her proper attention and/or care.
However, the child mentioned that she “never” felt that nobody loved her or that she was
inferior to anyone. However, the child was suspected to be suffering from mild rejection,
based on his responses according to the SCPS scale.
The last or the F6 domain was to assess the psychosomatic symptoms. F6 has a
total of 4 items and the child scored 9. The child reported rarely ever feeling any of the
following symptoms; stomachache and heart palpitations. And often feeling abdominal
discomfort and bodily strain or stress. The child also reported that he never felt light-
headed or dizzy. Keeping in view the responses it was derived that the child felt a
moderate level of psychosomatic symptoms according to SCPS. The child’s total score
on SCPC was 52 and the percentile was 70 which stated that the child falls into the
category of severe problems in different domains of this scale.
Graph 1
Graph Representing Six Factors School Children’s Problems Scale (SCPS)
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18
16
14
12
10
8
6
4
2
0
Anxiety Academic Problems Aggression Withdrawal Rejection Psychosomatic Symptoms

Scores

Summary of Assessment Results

Overall, the assessment results showed that the child had issues with some
subjects, such as Mathematics, Geo, and history, as she mentioned that she had less
interest in Maths from the beginning. She was having difficulty remembering long
questions about Geo, and history and her writing speed was slow therefore she didn’t
perform well in her first term exams. The girl also reported having difficulty making
friends at this school. She had discussed these issues with her mother, but her mother had
not paid any attention to them. The child had an insight about her problems and knew the
purpose of referral as she mentioned that she reported these issues to her class teacher
and she wanted to take sessions. Client was showing cooperative behavior during
interview which showed her willingness.

Case Formulation
Case Formulation is a sort of hypothesis regarding the psychological condition of
the client, the factors causing it, responsible for it, perpetuating it, and maintaining it, as
well as the factors that can possibly lessen the symptoms or make the overall condition of
the client better. A case formulation should give a logical description and explanation of
a client’s symptoms and issues (Wilson, 2018).
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The case was formulated keeping in mind the bio-psycho-social model, to identify
precipitating, predisposing, perpetuating (maintaining), and protective factors of the
child’s presenting complaints and to conceptualize the entire case. H.W. was a 12-year-
old girl suffering from academic issues and adjustment issues. The history of the child
was obtained from 2 different accounts i.e. through the class teacher’s interview and the
child’s clinical interview. The history gathered from these accounts revealed that
predisposing factors for the child’s academic problems could be her gender, birth order
and temperament.
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Figure 2
Pictorial Description of Case Formulation

Presenting complaints
 Adjustment issues
 Academic issues

Assessment
 Behavioral Observation
 Clinical Interview with teacher
 Subjective Rating of the Problem
 Curriculum Based Assessment
 School Children's Problem Scale
Predisposing Precipitating Perpetuating Protective Factors
Factors Factors Factors

 Gender  School  Lack of  Teacher’s

 Temperamen environmen peer’s concern and
t t support support
 Change of  Overburde  Child’s
education n of study understandin
medium g and
compliant
behavior

Suspected Problem

Adjustment issues

Intervention Plans

Rapport Building, Reinforcement,

psychoeducation, study skills
enhancement, cognitive restructuring
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Intervention Plan

On the basis of assessment results, these are the goals for the management of
client’s problem.

 Rapport Building in order to make the child at ease so that problem of the client
would be effectively formulated and managed.
 Psycho-education in order to increase client awareness the client about her
problem.
 Teacher’s counseling in order to psycho- educate her about current problems and
the contributed factors so that she would manage it effectively.
 Study skill training in order to teach the client to improve her study skills
 Social skills training in order to improve client social skills
 Cognitive restructuring in order to change her perspective about ideal studentthe

Implementation of Therapeutic Strategies

Rapport Building

Rapport building is the most important step in the process of treatment plan. It
refers to the relationship between client and therapist. The better the relationship, the
better are the chances of therapy process being successful, in order to make the client
follow the treatment plan successfully, the therapist gain the trust of the client and
provide them with unconditional support (Fritscher, 2019).

The purpose of rapport building was to build a sense of connection with client,
client feel free to share his information. Rapport building plays a very crucial role in
client- counselor relationship. It made the session effective or productive. Trainee
psychologist started the session with greeting. Trainee makes sure about her self-
management i.e. Session diary, proper setting and provides the client conducting
environment. Trainee used basic communication skills hold her head up and maintained a
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Case report 1

good posture. For rapport building trainee school counselor used active listening and
calling clients name .

Effective Communication. Effective communication is a connection between

people that allows for the exchange of thoughts, feelings, and ideas, and leads to mutual
understanding (Watson., 2019). The trainee school counselor used the technique in order
to build a strong rapport building. The client became very satisfied with the effective
communication of the trainee school counselor.

Active Listening. Active listening is a pattern of listening that keeps you engaged
with the therapist. It is the process of listening attentively while someone else speaks,
paraphrasing and reflecting back what the client said, and withholding judgment and
advice (Ahmad et al.,2012). During session, trainee school counselor gave the client full
attentiveness. Trainee school counselor was non-judgmental. She used to listen the client
attentively, which was very helpful in building rapport. During session trainee
paraphrased the client statement by calling his name. It developed a sense of individuality
and importance in client.
Calling client’s name. In rapport building clients name play an effective role.
When trainee school counselor call client by his name, he used to listen the trainee very
carefully. It was very effective strategy to deal with client by calling his name. It
develops a sense of belongingness and trustworthy relationship.
Activities. For the purpose of rapport building these techniques were used
 Playing games
 Coloring in drawing
In initial session trainee school counselor used to done some interesting activities
with client so that it developed client interest in the session. After identifying reinforce,
trainee used to talk about games in the session which developed client interest in the
session. Client also used to color in the games drawings which he really liked and
enjoyed to color in it. It was observed in the session during coloring in the drawing of
game client had a big smile on his face. Client had also interest in math activities. Trainee
used to give him some math activities which he really liked. These activities helped in
building rapport as well increasing client interest to take session. (appendix)
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Psycho-education

Psycho-education provides information to help people deal with a mental

health condition, such as how to manage symptoms and medication side-effects, and how
to prevent relapse. It also provides information on the recovery process, such as how to
maintain a sense of well-being and how to develop skills to manage stress and solve
problems. (Baker, S. & Martens 2010).

Psychoeducation of the Teacher

Psychoeducation is the process of providing information and resources to school

staff, families, and students by mental health professionals to better educate them about
the nature, causes, and associated difficulties related to students’ emotional, behavioral
and academic problems (Brown et al., 2020).

Psycho-education was provided to the teacher verbally and also by providing an

informative psychoeducation form (Appendix). The teacher was made aware of the
importance of treating the children with respect in class. Also, the teacher was told about
how to handle such students who had adjustment issues.

Study Skill Training

Students study skills refer to the strategies they use to learn. This includes
everything from memory techniques to better studying or test-taking strategies, such as
the use of questions before, during, or after instruction, which has been demonstrated to
promote learning (Huffman & Huffman, 2012). The following approaches will be
employed with children to help them improve their reading skills. The aim of using this
skill will to improve the reading skills of the client.
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References

Gu, D., & Dupre, M. E. (Eds.). (2021). Encyclopedia of gerontology and population
aging.

Cham: Springer International Publishing.

Bakeman, R., & Quera, V. (2012). Behavioral observation.

Sommers-Flanagan, J., Zeleke, W. A., & Hood, M. E. (2015). The clinical interview. R.,
Cautin,

S. Lilienfeld,(Eds.), The encyclopedia of clinical psychology, 1-9.

Pawlowska, D. K., Westerman, J. W., Bergman, S. M., & Huelsman, T. J. (2014).

Student personality, classroom environment, and student outcomes: A person–

environment fit analysis. Learning and Individual Differences, 36, 180–193.

https://doi.org/10.1016/j.lindif.2014.10.005

Sucgang, M. C., & Fabella, F. E. (2018). Relationship between the Academic

Performance and

Birth Order of Grade 10 Students from Nuestra Seeora De Aranzazu Parochial

School, Academic Year 2017-2018. SSRN Electronic Journal.
https://doi.org/10.2139/ssrn.3176933