CASE HISTORY

Registration No.: 01 Date:03-Dec-2019

Name: Mr Nikhil
Age: 23 Years
Gender: Male
Referred By: Dr Venkata Subbaiah

Referred For: Anticipating Failure, Fear of Failure

Date Of Birth: 2007

Educational Qualification: B. Tech , Computer Science

Economic Status: Middle Class

Marital Status: Unmarried (Bachelor)

Religion: Hindu

Children: Not Applicable

Client Stays With: Parents

Siblings: Has three years younger sister

Position In The Family: Eldest

Any Other information:

MEDICAL STATUS EXAMINATION

Chief complaints And Duration:

1. Anticipating Failure in every work, activity, education and career

2. Not able to have a life objective

3. Not having passion on any specific area.

Presenting Problem:

Date Of onset of Problem And Duration: Since his school days.

Precipitating Factors:

 Less Interaction with father

 Too much pressure in school and tuition. Long hours in school education.
 Peer pressure from sister

Intensity Of The Problem:

1. Episodic

2. Continuous ( √ ): Yes. It is continuous

Any Counselling Taken (If Yes Then Suggested Solutions): Not taken any counselling

History of Presenting Illness (HOPI):

Since his early years, he was scared of his father and hence was not too intimate with him but he
was very close to his mother and used to reveal his feelings and share his problems with his
mother. He said that he is unable to complete any activity that he takes up – education, work, or
errand at home. He has fear of failure. His school education was not good. Intermediate is
another failure story. Engineering was a hard course to work on because suddenly he had to study
on his own. After the completion of his Engineering he landed a job in an IT company. He was
not able to match the capacity of his peers. That built into an inferiority complex. He began
receiving frequent complaints from his bosses. he failed to meet the expectations. He has
resigned.
FAMILY HISTORY:

Family Tree:

Relationship With Family Members: Zealous of sister. Used to get scared of father in child
hood

Conflicts In The Family(If Yes Then Specify): No Conflicts

Physical Disorders In The Family(If Yes Then Specify): No

Interviews With Family Members, Friends And Concerned Persons:

Father told me that his son was fine till tenth standard. He did not perform well in intermediate.
He spent time playing video games. He did not have many friends and he didn’t spend much time
on his studies. The father told me that he imposed some restrictions on his son. Nikhil did not
have an objective ahead and had little interest in anything. He did not get along with his relatives,
did not have many friends, couldn’t spend much time playing outdoors. He did not fare well in
his Engineering either. For some time, he has been feeling that he was experiencing depression
and anxiety.

BIOLOGICAL HISTORY:

Illnesses and medications: Visited a psychiatrist who prescribed some medicines. The
psychiatrist advised him to visit a psychologist.

Sleep: Nikhil gets a lot of dreams. He gets snakes in dreams.he shivers and sweats; he also
screams.
Appetite: Normal
Libido: No
General Health Complaints(If any): No Health Problems
CHILDHOOD HISTORY:

Birth Weight and complications (If Any): Unknown

Behavioural: Not use to mingle with people. Not had friends
Emotional: Feeling low, Sad and sorrow, Unhappy
Developmental: Normal
Temperament: Feeling low

EDUCATIONAL HISTORY:
Not great in Intermediate. Joined B Tech. He lost interest in studies. Could not
perform well in Engineering

WORK HISTORY:
Joined in NIIT (Training and Job) after his engineering. Did not perform well and
discontinued. Then joined another job, where he was under performing, he had problem
with his manager and finally quit second job also

PRE-MORBID PERSONALITY:

Attitude:

Towards Self: Low feeling. Helpless ness

Towards others: Jealous about others

Social Behaviour/ Religious Inclinations : Normal

Habits: / Interests: / Moods : No Hobbies / No special interests/ Low feeling

MENTAL STATUS EXAMINATION

Appearance: Well dressed

Movement and Behaviour: Normal.
Response: Conscious and Polite
Affect:Normal
Mood:

Subjective: Normal.

Objective: Normal
Speech:
Type: Normal

Clarity: Very Clear

Volume: Normal

Relevance: appropriate

Psychomotor Activities:

Prompt Responses : Yes

Appropriateness of the questions : Yes.

Delayed Answers : No. Was able to answer quickly

Cognitive Functions:

Orientation:

Place: Appropriate

Person: Appropriate

Physical: Very good

Mental: Normal

Memory: Good memory. Able to recollect all the incidents and tell very naturally

General Intellectual Functioning : Normal functioning

Thought Content: Fear of failure, Anticipated failure

Thought Disorders : No
Attention/Concentration: Very good

Perception Abnormalities: None

Judgement

Personal : Normal

Social : Good
Insight : SelfAwareness
Level 1 : Denial
Level 2: Indirect Acceptance
Level 3:Blaming Others
Level 4: Not ready to accept
Level 5: Intellectual Acceptance
Level 6:Complete Acceptance and Ready for the
Treatment (√)
CASE FORMULATION:
Nikhil - Since his early years, he was scared of his father and hence was not too intimate
with him but he was very close to his mother and used to reveal his feelings and share his
problems with his mother. He said that he is unable to complete any activity that he takes
up – education, work, or errand at home. From his childhood times, he could not make
many friends. He has fear of failure. His school education was not good. Intermediate is
another failure story. Engineering was a hard course to work on because suddenly he had
to study on his own. After the completion of his Engineering he landed a job in an IT
company. He was not able to match the capacity of his peers. That built into an inferiority
complex. He began receiving frequent complaints from his bosses. He failed to meet the
expectations. He has resigned. He visited a psychiatrist who prescribed some medicines.
The psychiatrist advised him to visit a psychologist.

TESTS

 DASS - Depression Anxiety Stress Scales. Number of questions 42, each reflecting a
negative emotional symptom. Scale four point of 0 - 3. Zero is low severity of the
feeling, 3 is very high.
 MHQ - Middlesex Hospital Questionnaire. Clinical Diagnostic Self-Rating Scale for
Psychoneurotic Patients. Patients variously diagnosed as suffering from anxiety states,
depressive states and personality disorder tend to score very highly on several scales.
 EPQ : Eysenck Personality Questionnaire is a questionnaire to assess the personality
traits of a person. There are two versions (Long Scale Version 100 yes/no questions, 48
yes/no questions in its short scale version)
 TAT : Consists 10 cards - Based on that subject’s narrative responses from the pictures
of 10 card responses, reveal their underlying motives, concerns, and the way they see the
social world
 Rorschach : Consists 10 Cards - The Rorschach test is a psychological test in which
subjects perceptions of inkblots are recorded and then analyzed
using psychological interpretation
PSYCHOLOGICAL ASSESSMENT - Mixed Anxiety Depressive Disorder-
 Depression , Anxiety and Stress are significant
 Somatic Anxiety, Phobic anxiety , OCD and depression were significant
 High scores in Neuroticism, Borderline in psychotic features Significant family history
and developmental history in rearing to childhood development pathology where
significant
 Emotional disturbances and indecisiveness and more disturbances are indicating mixed
anxiety depressive features

TREATMENT PLAN

 Behavioral therapy to minimize the anxiety symptoms to improve his behaviours. (2

sessions)
 CBT - to restructure his cognitions and to minimize cognitive errors
 Relaxation technics and error correction
Case : 01 Date : 03-Dec-2019
Client : Mr Nikhil Time : 2:00 PM
Session No :1

Purpose: The client Mr. Nikhil was referred to me for taking a detailed case history.

The client Nikhil came in. I greeted him and he also greeted me. I requested him to take a sit
before me. I asked him if he was comfortable. I took care of the physical conditions: adjusted
the fan, checked on the convenience of the seating and so on. I gave him the space to breathe.
Once I found him comfortable enough, the session began.

I started the session by introducing myself. I told him that the conversation that happens in
the room stays between us. We maintain strict confidentiality. He can completely trust me.
He is free to communicate everything and anything. Whatever was discussed between us
would not be shared with anybody. After I clarified this, Nikhil too felt slightly comfortable
as testified by his subtle smile and his relaxed face. He then asked me if the conversation
between us would be disclosed to his family. I said no. With his permission we discuss if
required.

He was well-dressed and well-groomed hair, with only a little stubble. He looked like a quiet
and composed person. However he was always squeezing his own hands – but without
attracting much attention. He said that he is unable to complete any activity that he takes up –
education, work, or errand at home. He is overcome by the fear of failure. I asked more for
the details of the problem. After the completion of his Engineering he landed a job in an IT
company. He was not able to match the capacity of his peers. That built into an inferiority
complex. He began receiving frequent complaints from his bosses. To overcome these
challenges, he began working overtime but he was still unable to meet his own expectations.

In one case, a manager assigned him a task but without preparing him with the know how
required to execute it. When he failed to meet the expectation, he was blamed with
inefficiency despite little fault on his part. Distressed by the incident, he resigned from work.

Then I inquired if he was sharing these stories with his colleagues, friends, or family. I
learned that since his childhood times, he could not make many friends. However he
informed the incidents to his parents.
I then began exploring his childhood. Since his early years, he was scared for his father and
hence was not too intimate with him but he was very close to his mother and used to reveal
his feelings and share his problems with his mother. He has a sister three years younger to
him. He added that he was always a mediocre student. Around fifth and sixth standard he
built a liking for a science but eventually that too has subsided. In tenth standard he was sent
to a private tuition which trained from 4:30 to 6 in the morning. School then stretched from
7AM to 7PM. There was a mismatch in the course material covered in these two spaces. He
was left confused henceforth and was unable to do justice to either role. Since he was unable
to meet his parents’ expectations, they were disappointed and began scolding him every now
and then.

I asked for specific incidents that he could remember from the time. He told me that when he
scored less in a biology test, his tuition teacher hit him. He developed aversion for tuition
classes so he quit going for tuition. He felt relieved that he was able to take on burden off. He
aimed for 10 CGPA. He earned 8.5 and felt that was okay.

As the time allocated for the session was over we have set up a fresh appointment and
concluded the session. I asked them to leave for the day. First session details have been
updated to my Guide / supervisor.

Summary of the session : I have summarized the discussion as, he has developed an
inferiority complex from his childhood. He did not have much friends. He was scared of his
father. He was close to mother. He use to share all his feelings with his mother. He was good
in studies up to 6th grade. He had tough time in 10th grade. Bad experience with Biology
tuition teacher. What ever the activity he takes up he feels he is going to fail. His IT job also
another failure. He is not able to compete with his peers.

My Observation:

When Mr Nikhil left the room he was comfortable compared to the beginning of the session.
He was relaxed and seems to he bit happy.

Plan of action:

Continue to interview him to gather more details about his background and his problems.
Scheduled another session with client.

Duration of the session: One Hour

Case : 01 Date : 07-Dec-2019
Client : Mr Nikhil Time : 3:00 PM
Session No :2

Purpose: To gather further details about client’s background and his problems

Mr Nikhil was on time for his appointment. I enquired him how he was for the past few days.
Infact, he said he is feeling bit better now. He said he was curious to explain all his thoughts.
I re-collected and summarized the previous session details. I said we were discussing about
his studies and we need to continue. I said we have discussed about his studies till 10th grade.

I started inquired furthermore, about his intermediate studies. Since he had aimed for a
BTech degree, he chose MPC for his intermediate. In his first year, he worked hard but he
secured a very low score. He wrote an improvement exam and was able to score 64%. Since
he worked harder because of preparation for AIEEE and EAMCET he was able to score well
– he secured 85% in his second year of intermediate. However in EAMCET, he was not able
to secure a sufficient rank. In AIEEE, he was able to get a decent rank with the help of which
he was able to get a seat in an Engineering college, paying fees.

Engineering was a hard course to work on because suddenly he had to study on his own. By
the time he came to his second semester, he was tired of studying. He arrived at a stage
where he began questioning the purpose of the education that he was undergoing. On the
other hand, he was not able to discover his area of interest. His attendance also turned erratic.

He told me that he was an enthusiastic reader always. He believed that he had not succeeded
so far and hence he would not fit for anything in life. He did not think he was creative either.
He couldn’t be productive in any way – he thought. For four months after Engineering, he
did not get any work. Through his father’s connection he was able to acquire a position in
some company. In this first job, he was not able to perform well, nor did he enjoy the
experience, so he quit it. After six months he got the job that was described in the beginning.

I then switched tracks and inquired about his sleep condition. He told me that he gets lots of
dreams. One example is the slither of the snake. When this happens he shivers and sweats; he
also screams. He feels like a burden upon his family. He questions the point of his being. He
never considers suicide however. The exception was when he once attempted to kill himself
by controlling his breath.
Another aspect he said was that while he felt like he was under performing, his sister always
shone. She is a psychology graduate and a good student. She landed a job before her
graduation. He was jealous of her.

As he narrated earlier, his mother was close to him and was concerned. Her brother also
never occupied a job so she was worried that her son would have acquired his traits.
Although he was always scared of his father, since his Engineering study his interaction with
his father improved and began sharing his worries, concerns, and difficulties.

My interaction with his father

Mr. Radhakrishna, 56 y old. He was well-dressed and had well-kempt hair. I greeted him and
he also greeted me. I requested him to take a sit before me (the session only involved the
father initially). Once I found him comfortable enough, the session began.

Then I asked him to narrate his experience of the problems that his son was facing. His father
told me that his son was fine till tenth standard. He did not perform well in intermediate. He
spent time playing video games. He did not have many friends and he didn’t spend much
time on his studies. The father told me that he imposed some restrictions on his son.

He told me that although nobody was interested, for the sake of building a steady career they
paid for his engineering seat. They had expected him to earn a government seat which he did
not earn. Hence, the paid seat. Mr. Radhakrishna said that Nikhil did not have an objective
ahead and had little interest in anything. He did not get along with his relatives, did not have
many friends, couldn’t spend much time playing outdoors. He did not fare well in his
Engineering either.

His father said that after his son idling for four months, with his network, he had him joined
in a job-oriented course at NIIT. At the project level itself, due to a reason not known to Mr.
Radhakrishna, he had to discontinue the NIIT course. He later joined another job. There too,
a problem occurred between him and his manager and he had to quit the job.

For some time, he has been feeling that he was experiencing depression and anxiety. He
visited a psychiatrist who prescribed some medicines. The psychiatrist advised him to visit a
psychologist.
Both Radhakrishna and Nikhil were invited. I summarised the information collected from
both. The two agreed that they had shared the same information.

I asked both Nikhil and his father to wait in reception. Briefed the total case history to my
Guide / Supervisor.

My Guide called them and suggested there are few Psychological tests to be conducted and
suggested me to fix a fresh appointment. Fixed a fresh appointment and concluded the
session

My Observation:

Since total problems were discussed, both Client (Nikhil) and his father are also look relaxed.
They are comfortable in sharing minute level of details.

Plan of action:

On the advice of our supervisor, to diagnose the issues Nikhil we planned to conduct the
tests. This was communicated to Nikhil and his father and took fresh appointment

Duration of the session: One Hour

Case : 01 Date : 12-Dec-2019
Client : Mr Nikhil Time : 3 PM
Session No :3

Purpose: To carryout the Psychological tests to Nikhil and diagnose the root cause of the
problem

Mr Nikhil came in and I greeted him and asked him to make himself comfortable. He was in
good spirits and we decided to start with the tests. The following assessments have been
carried out under the supervision of my guide. I was observing the entire process.

DOSS
MHQ
EPQ
TAT
Rorschach Test

My Observation:

After the above tests were conducted, I sat with Nikhil and asked him how he was feeling.
He said he is tired after assessment.

Plan of action:

I told him that test scores will be analysed and reports will be shared with him through an
email by my Guide. We will have another session to discuss the next course of action with
Superior (Psychologist).

Duration of the session: 4 Hours

Case : 01 Date : 19-Dec-2019
Client : Mr Nikhil Time : 5:00 PM
Session No :4

Purpose: To discuss the results of the tests with Mr Nikhil and to discuss further treatment
plan

Today Nikhil has come and I greeted him and enquired about him. He said he is fine. I took
him to my Guide / Supervisor.

Guide has explained him that Nikhil is experiencing

 Depression , Anxiety and Stress are significant.

 Emotional disturbances and indecisiveness and more disturbances are indicating mixed
anxiety depressive features

The treatment suggestions given by guide (Psychologist) are:

 Behavioral therapy to minimize the anxiety symptoms to improve his behaviours. (2

sessions)
 CBT - to restructure his cognitions and to minimize cognitive errors (2 Sessions)
 Relaxation technics and error correction

Plan of action:

On Supervisor’s suggestion he has been informed to come for treatment. Appointments are
given.

Duration of the session: 1 Hours

Final summary after 4 sessions of therapy:

Client underwent the above sessions. Reviewed the progress. Client felt he is better
now and he is trying to mingle with people. Trying to build his relation with family members.
He would like to try further and we asked him to take an appointment and visit us after three
months.