International Islamic university Islamabad

IDENTIFYING DATA:
Name: ABC Age: 43 Gender: Female Education: Primary Marital status: Married Husbands Name: XYZ Husbands Occupation: OGDC Employee No. of Children: 8, 2 daughters and 6 sons No. of Siblings: 6 Birth order: 3rd one Father: Dead Mother: Alive Mothers Occupation: House Wife Family Monthly Income: 35,000 Religion: Islam

REASON FOR REFERRAL:The client has been brought into the psychiatry ward of shifa international hospital by her husband for showing complaints such as i-e headache, back pain, loss of appetite, lack of sleep, losing control, fear of heart attack, fatigue or loss of energy, lack of interest in all pleasurable activities, low mood.

Presenting complaints:
The client has been suffering from these complaints for last 4 months.

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According to the client:

Following symptoms has been observed according to the DSM-4 TR (2000). y y y y y y y y Losing control Having a heart attack Going crazy Insomnia Low mood Fatigue or loss of energy Restlessness Lack of interest in all activities

FAMILY HISTORY
Client belongs to a middle class family a having a nuclear family system. It has been reported by the client that she has 3 brothers and 3 sisters and she is on 3rd number. Her father was died when she was 35 years old and her mother is still alive. Her parents were very caring and loving and her relation with her siblings was quite good. Client reported that no one in her family suffering from this problem. She is the only one who suffers from this problem. -2-

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Client gets married 24 years ago with her first cousin. Her marriage was an arrange marriage. She is living with her husband and children. Her husband is working in OGDC and they belong to a middle socio-economic status. Client reported that currently her relation with her husband and children is not much good. Before this problem her relation with her husband and child was quite good.

PAST PERSONAL HISTORY

It has been informed by the client that her birth was normal. Her relation with her parents was caring and loveable especially she was quite attached with her mother. It has been reported by client that in her childhood, she was so quiet person, she made friend but rarely. She didnt like to play with everyone. Client reported that her mother told her when she was 1 year old, she had some problem in her leg and due to this reason she cant walk easily (she started walk at the age of 1 but suddenly she suffered with that problem). Her parent didnt take her to doctor, they show her to baba and after 6 months she started walk normally. After that she had never suffer from this kind of problem. She studied at primary level, she told that she was good in her study and get good marks in exams. She had not enough friends because she remain quiet in her class, she dont like to talk to others or made friends. She also told that she wanted to study further but her parents didnt allow her because there was no concept of education for girls in her family thats why she couldnt study further.

HISTORY OF PRESENT ILLNESS

Client was in complete state of health 4 months back when her problem started because of weakness in her body, headache, lack of sleep, loss of appetite and lack of interest in all activities. Client reported that 4 months before she attend the event of muharam, when she was listening the lecture of ALIM, during the lecture she feel uncomfortable and started sweating. She suddenly losing control on herself and become faint within 10 minutes. -3-

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Then her family took her to shifa hospital in emergency after 3 days she had been discharged. Her reports were cleared there was no any medical illness. After that day she started fear to go outside or to meet any one. she reported that she had a fear that if she go outside, again this will happen with her, so she try to avoid to go outside in gathering or public place. She further told that now she dont like any one not even her husband and children. She said that she was quite religious, but now she cant properly offer prayer.

Premorbid personality:
Before the onset of the problem, the client was quite social and interactive, has much interest in different activities like stitching, and cooking, and she also stitched clothes professionally.

PSYCHOLOGICAL ASSESSMENT
Client appearance was quite normal and looking neat and clean. She was very communicative and talkative. She was also very co-operative in giving her life history, but she was not interested in administering the test. Its quite difficult to convince her for administering the test. She also takes time to giving the tests. Client was given by some formal tests which she done properly. These tests and scales are: y y y Case history interview. Clock Drawing Test (CDT). Beck Depression Inventory (BDI).

Intellectual Functioning:
To measure the client intellectual functioning, CDT is used to determining the mental ability of client and it has been measure that client intellectual level is very low and below average. Another problem was that client was not agreeing to administer the test, so its difficult to judge her in some manner.

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International Islamic university Islamabad Personality Assessment:

As client depressed about herself and her problem, so when Beck Depression Inventory (BDI), of the client was administered, she score 34 in the range of 31-40 which depicts strong evidence of severe depression.

MULTIAXIAL DAIGNOSIS
Axis : 300.21 Panic disorder with Agoraphobia
296. Xx Major Depressive Disorder.

Axis 2: Axis 3: Axis 4: Axis 5:

Avoidant Personality features. None None GAF= 60 (current)

CASE FORMULATION:The client is 43 years old married women. This was her 4rth appointment with Dr. and she come with her husband to a clinic having complaints of bodily pain and insomnia, low mood, lack of interest in all activities and headache. A behavioral therapy approach focuses on how your behaviors are contributing to and maintaining your symptoms and difficulties. It is believed that maladaptive behaviors are learned through a conditioning process and that bad, or unwanted, behaviors may be unlearned. As client has fear of going outside in public places that brought her into uncomfortable situation so she avoids going outside. But this avoidance behavior doesnt help, it does, unfortunately, serve to reinforce the behavior. A cognitive therapy approach focuses on how your thoughts perceive and give meaning to your world. Distorted and unrealistic thoughts result in misinterpretations that -5-

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are believed to contribute to and maintain your symptoms. As client was in the majlis and she had a panic attack. A person feels immediate danger or experiencing a life-threatening event. As client became faint, so she learned that negative behavior, that whenever she goes outside she will face this dangerous situation. This line of thinking has not helped your situation. Unfortunately, it is laying the ground work for reinforcement of an illogical fear.

THERAPUTIC SUGGESTIONS:As the client was suffering from panic disorder and depression. To overcome this problem some therapies are: Systematic desensitization can also be effective. This approach involves gradual exposure to real-life feared situations. Cognitive-behavioral therapy reflects the importance of both behavioral and thought processes in understanding and controlling anxiety and panic attacks. The focus of treatment is on inadequate, obstructive, and damaging behaviors and irrational thought processes that contribute to the continuation of symptoms. For example, uncontrolled worrying (thoughts) about what may or may not happen if you have a panic attack may lead to avoiding (behavior) certain situations.

PROGNOSIS:As the client has an insight of her problem and she was also motivated to take the proper treatment and wanted to recover as soon as possible so that she can happily live with her family and continue her all activities normally. So the prognosis or the chances of recovery /betterment is good.

SESSIONS REPORT:-

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1st Session:
During first session, I have developed rapport with my client and take some initial information e.g. identifying data.

2nd Session:
During second session, the main problem and its causes were asked from the client and also take some history of her family and her illness too.

3rd Session:
During third session, some tests e.g. clock drawing test (CDT) and Beck Depression Inventory (BDI) were administered from the client.

4th Session:
The fourth session is the termination session. So it was informed to the client that to take medicines regularly and also give some suggestions and instructions that how to improve your health and what possible steps should be taken her to live a stable life with her family. Furthermore, ask her try to interact with others family members for few moments and try to remember good memories which you spend with her family, feel relaxed. Also suggests her that if you follow these instructions, you herself feel a great improvement in your health and you can live a happy life.

LIMITATIONS:All the information was taken from the client, there was no informant. As the client has well oriented towards time, place and person and has an insight of her problem and the client was also co-operative in giving information about her problem.

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IDENTIFYING DATA:
Name: ABC Age: 11 Gender: Male Education: one class Fathers Name: XYZ Mothers Name: XYZ Marital status: Single No. of Siblings: 6 Birth order: 6th one Father: Alive Mother: Alive Fathers Occupation: Mothers Occupation: House Wife Family Monthly Income: 25,000 Religion: Islam

REASON FOR REFERRAL:The client has been brought into the special education school for mentally retarded children by his parents for showing complaints, lack of facial expression, impairment in eye contact, slow learner, lack of interest, and nail biting, Show repetitive patterns of behavior, concentrating on single object for long time period.

Presenting complaints:
The client has been suffering from these complaints by birth. According to the Informant:

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Following symptoms has been observed according to the DSM-4 TR (2000).

y y y y y y

Lack of social interaction. Lack of facial expression. No eye contact. Inability to initiate a conversation to others. Stereotyped and restricted pattern of interest. Persistent preoccupation with parts of objects.

FAMILY HISTORY
Client belongs to middle class family a having a nuclear family system. It has been reported by clients informant that he has 3 brothers and 3 sisters and he is on last number. His father is alive and working in a private company. Their monthly income is 25000. Clients mother reported that her others children are normal and they have never complain such time of problems, there is no any such type of illness in their family except him. His relation with his parents and siblings are quite good. Clients mother told that before her delivery time, she felt fever but her delivery was normal.

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PAST PERSONAL HISTORY

According to clients mother before her child delivery she felt fever but her delivery was normal. After 14 days he suffered from measles but after treatment he was fine. Clients informant told that he started walk at the age of 1 year and start talking at the age of 3 year. Further clients informant reported that at the age of 3 year of her child they came to know that their child having the problem, she said that doctors told her that her child situation always remain same. Clients mother also told that, when he was 7 years old he had tonsils in his neck and he had operation at age of 7 year. After operation he was totally fine, he didnt even complain about neck pain and no problem in speech and no effect on voice. But he was still unable to cope with his problem. At the age of 9 they admit him in special education for mentally retarded children school (MRC).

HISTORY OF PRESENT ILLNESS

Client was not in complete State of health by birth, two years before he was admitted to special school for children (MRC). According to clients mother he is not socially interactive. Client show repetitive pattern of behavior like persistently focus on one object. He also is doing nail biting. He was moving his body all the time while giving interview. Asking again and again same question, what time is it now? Client also showing such kind of problems i-e lack of interest and attention (client was not paying attention to whatever asked from him), and not initiative to anything (if asked from him then he answered otherwise he didnt talk to anybody). No eye contact and lack of facial expression (his eye contact was not good and flattened expression).

PSYCHOLOGICAL ASSESSMENT
Client appearance was quite normal and looking neat and clean. He was not communicative and also not initiative to communicate with others. Client was not interested in administering a test, his main focus on writing tables. Client has lack of

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concentration. Client was too young to give history of their family. Family and past history was taken from his mother. Client was given by some formal tests which he has done. These tests and scales are: y y y Case history interview. House Tree Person (HTP) Draw A Person (DAP)

Intellectual Functioning:
Client can now recognized some objects, he can only write tables up to 20 but not having logical concept and having inability in other areas.

Personality Assessment:
Client keeps himself all the neat and clean. Try to make everything proper and perfect and dont like untidy things.

MULTIAXIAL DAIGNOSIS
Axis : 299.0 Autistic Spectrum Disorder Axis 2: 318.0 Moderate Mental Retardation Axis 3: Axis 4: Axis 5: None Educational problem GAF= 51 (current)

CASE FORMULATION:The client is 11 years old boy, living with his parents. He was studying in special education school for children (MRC) for last two years and he is still there with such complaints, slow learner, lack of attention and interest in all activities, lack of speech, flattened expression and no eye contact. According to Applied Behavioral Analysis: A 2007 clinical report of the American Academy of Pediatrics concluded that the

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benefit of ABA-based interventions in autism spectrum disorders (opinion that one ABAbased approach (theLovaas technique created by Ole Ivar Lovaas) is "well-established" for improving intellectual performance of young children with ASD. Different techniques are used to change the behavior of autistic child that are: ASDs) "has been well documented" and that "children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior. Researchers from the MIND Institute published an evidence-based review of comprehensive treatment approaches in 2008. On the basis of "the strength of the findings from the four best-designed, controlled studies," they were of the task analysis, chaining, promoting, fading, shaping, and video modeling.

THERAPUTIC SUGGESTIONS
Behavioral therapy and other therapeutic options: Behavior management therapy helps to reinforce wanted behaviors, and reduce unwanted behaviors. It is often based on Applied Behavior Analysis (ABA). Speech-language therapy can help people with autism improve their ability to communicate and interact with others. Occupational therapy can help people find ways to adjust tasks to match their needs and abilities. Physical therapy design activities and exercise to build motor control and improve posture and balance. Educational and/or school-based options: Public schools are required to provide free, appropriate public education from age 3 through high school or age 21, whichever comes first. Typically, a team of people, including the parents, teachers, caregivers, school psychologists, and other child development specialists work together to design an Individualized Education Plan (IEP) to help guide the childs school experiences.

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International Islamic university Islamabad

Medication options: Currently there are no medications that can cure autism spectrum disorders or all of the symptoms. The U.S. Food and Drug Administration has not approved any medications specifically for the treatment of autism, but in many cases medication can treat some of the symptoms associated with autism. Selective serotonin reuptake inhibitors (SSRIs), tricyclics, psychoactive/anti-psychotics, stimulants, and anti-anxiety drugs are among the medications that a health care provider might use to treat symptoms of autism spectrum disorders. Secretina hormone that helps digestionis not recommended as a treatment for autism.

PROGNOSIS:Clients mental age is too weak then its chronological age, he is intellectually disable but according to clients informant he is being improving himself since he come, according to informant he can improve himself, some behavior pattern cannot be change but his recovery chances are good in some manners.

SESSIONS REPORT:1st Session:

During first session, I have developed rapport with my client and take some initial information e.g. identifying data. As the clients was not much able to give history about his problem so further family and past history was taken from his mother.

2nd Session:
During second session, the main problem and its causes were asked from the clients mother and also take some history of his family and his illness too.

3rd Session:
During third session, some tests e.g. draw a person (DAP) test and House Tree Person (HTP) was administered from the client, but client was not interested in making drawing, he was focusing on writing tables all the time in session.

4th Session:
The fourth session was the termination session. So it was informed to the clients mother - 13 -

International Islamic university Islamabad

that how she will improve performance of her child. Involve him in different mental and physical activities so that there should be improvement in his sensory processing and movement.

LIMITATIONS:All the information was taken from the clients informant. Client has no insight of his problem. Client behavior was under analysis.

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International Islamic university Islamabad

IDENTIFYING DATA:
Name: ABC Age: 30 Gender: Male Education: F.SC Fathers Name: XYZ Mothers Name: XYZ Marital status: Single No. of Siblings: 6, 5 brothers 1 sister Birth order: 3rd Father: Alive Mother: Alive Fathers Occupation: Businessman Mothers Occupation: House Wife Family Monthly Income: 40,000 Religion: Islam

REASON FOR REFERRAL:The client has been brought into WADAH Clinic by his elder brother. The client has been taken drugs and for having complaints such as lack of sleep, feeling of restlessness and fatigue, lack of appetite, lack of interest in daily life activities and weight loss.

Presenting complaints:
The client has been suffering from these complaints from last one month. According to the client:

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International Islamic university Islamabad

Following symptoms has been observed according to the DSM-4 TR (2000). y y y y y y y y Dysphoric mood Nausea or vomiting Muscle aches Diarrhea Yawning Fever Insomnia Pupillary dilation, piloerection, or sweating

FAMILY HISTORY
Client belongs to an upper middle class family a having a nuclear family system. It has been reported by the client that he has 3 brothers and 1 sisters and he is on 3rd number. His father and mother are alive. His parents relation was good before they know about his drug addiction, after that his relation with his parents and family was not as good as before the problem. Client reported that no one in his family suffering from this problem. He is the only one who suffers from this problem.

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International Islamic university Islamabad

Client is 30 year old single person and working in his brother shop, they had their own business and he is helping to his brother in his business. Client reported that currently his relation with his parents and brothers are not much good, but only his sister understands him better. His relation is good with her sister.

PAST PERSONAL HISTORY

It has been reported by the client that his birth was normal and there was no problem with him in his childhood. He completes his all mile stone normally. Client reported that he started his education at normal age, he was good in studies. His teacher likes him because of his good behavior in class and he gets good marks in studies. he likes to made friends. Client told that after matric he had a bad company of friends from there he start taking drug (chars) with them, then after 4 months he stopped taking drug and continue his studies. After FSC he join a private company, and there he found a girl, he likes him but when she refused him, he became more depressive and he started again taking drug (chars) and this time he takes in high quantity. And then left that job also, he dont like to work anywhere, then his brother asked him to sit in shop with him. After two years his family comes to know when they noticed him quite weak and his behavior become changed, he become so aggressive any time without any reason family. Then his family warned him to leave it but he still continues taking drug for 3 years. His family leaves him alone; his parents dont like to talk with him and this behavior made him more depressive. Even in his shop, he mostly fights with his worker. Then his elder brother took him to WADAH clinic where he treated for three months but he leave without completion of his treatment, he gave the reason that they are not treated well. After this treatment his left to take the drug (chars) but still he was taking drug (niswar). Now this time he comes by self to take treatment in WADAH clinic.

HISTORY OF PRESENT ILLNESS

Client was incomplete state of health 9 years back when his problem started because of taking drug (chars). And he suffers from these problems such as vomiting, headache, lack

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of sleep, loss of appetite, weakness and restlessness. Now client is taking treatment from WADAH clinic and he is in withdrawal situation. Client reported that when he stopped taking drug (chars) he suffered from these complaints such as restlessness, weakness, fatigue, and feeling of fever and lack of sleep. client also reported that he didnt like this place and he wanted to leave that place as soon as possible he become fine. He wanted to continue his life normally and wanted to study further. Client said that he never take drugs again in his entire life.

Premorbid personality:
before the onset of the problem, the client was healthy and very joyful person. He was very social but after having bad company and taking drug his family avoid him and nobody like to talk with him.

PSYCHOLOGICAL ASSESSMENT
Client appearance was not good and he was not properly dressed. He was not communicative, slow voice and giving pauses during speech. Client was interested in administering a test, Client was given by some formal tests which he has done. These tests and scales are: y y y y Case history interview. HTP DAP RISB

The client on RISB scored 127 which indicate a little difficulty in adjusting to his environment as he now lifted his addiction of 9 years so sees word as new. His most responses reveal his guilt and regret on his addiction.

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His response reveals the other factor of his continuous addiction other than peer pressure.

His responses show his self motivation and willingness to leave the addiction which was due to his friends.

On HTP the client draws all three things very alternatively. He draw house and tree with heavy pressure and indicate his tension, as he reported that he was worried about his treatment, the tremors of line shows that he was in the withdrawals phase. The house drawing shows his social personality, he wanted to hide himself or his feelings from others as he didnt draw the windows. The tree was drawn more or less countered on the page, which indicate clients well balanced personality and he was receptive to both masculine and feminine influences and able to create both man and women. The person drawing reveals that his guilt feelings as he okay tiny eyes. The unusual treatment may indicate his feeling of inferiority and impotency. His emphasis on the mouth suggests his oral conflicts that in his addiction. Omission of the arm and legs reveal the client inadequate and guilt feelings. Emphasis at waist show his tension conversing his bodily impulse that his urge to continue with addiction. On DAP the client score 31 and his IQ level is 103.33% thats mean client IQ is above average and he seems to be good in mental health.

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International Islamic university Islamabad Intellectual Functioning:

clients intellectual functioning was good, he give all information which is needed. He was good in administering the test. He easily and quickly did the test. Is IQ level is above average that means he is intellectually good.

Personality Assessment:
Client appearance was not much good and his dressing was also not proper. His behavior was normal. He sit properly and listening carefully whatever asked by him.

MULTIAXIAL DAIGNOSIS
Axis : 292.0 Opioid Withdrawl Axis 2: v71.09 No Diagnosis Axis 3: Axis 4: Axis 5: None Occupational problem GAF 51(current)

CASE FORMULATION:The client is 30 years of age, resident of Rawalpindi and belongs to the middle class family. He has been a opioid (chars) user for 9 years. Due to the peer pressure and continued in order to get pleasure and calmness, at that time he was too young. After 2 years his parents came to know about his addiction which was shocking for them and this situation cause some disturbance in relations with his family. He took his last dose 3 days back of admission in clinic. He has presented with withdrawal symptoms. According to the reinforcement theory reduction of tension, rising of spirit, a sense of well being produced by a drug has a reinforcing effect and increases the likelihood that user will seek this reaction again (Cappell & Greely, 1987). In this case the client used chars which gives him an analgesic effect and that provoke him to

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continue this substance. As reported by client that when he wanted peace he was urged toward, chars addiction. The cognitive factors also play important role in addiction. According to Kandel modeling of drug taking behavior by peers is also quite important in the development of drug problems. Seeing other using any substance including chars and dealing with their problem of entertaining themselves will encourage the observer to use drug for similar purpose (Kandel, 1994), the client started his addiction as his friends used chars and reported him that it had soothing & pleasant effects, so his cognition changed and he wanted to try the chars like his friends. According to social perspective exposure to psychoactive substances serves as a necessary prerequisite to their use and possible abuse (Pierce & Gilpin, 1995). The client is exposed to chars by his friends and with the passage of time it became the necessary part of his life.

THERAPUTIC SUGGESTIONS:Aversive therapy can be effective for the client. The theory is aimed at creating negative association with drug use. This therapy can provide prevention against restraining of heroin addiction by the client. Peer-Pressure Resistance Training can help the client to learn skill that will help him in avoiding or resisting peer pressure.

PROGNOSIS:As client shown relax 3 times. As this is 3rd admission of client, although he has insight of the problem but he is not willing to leave the drug as he said he wanted to but cant. Attitude of family was also not good so the prognosis of client is not better or good.

SESSIONS REPORT:- 21 -

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1st Session:
During first session, I have developed rapport with my client and take some initial information e.g. identifying data.

2nd Session:
During second session, the main problem and its causes were asked from the client and also take some history of his family and his problem too.

3rd Session:
During third session, some tests e.g. HTP, DAP and RISBE were administered from the client.

4th Session:
The fourth session is the termination session. So it was informed to the client that to take medicines regularly and also give some suggestions and instructions that how to improve your health and what possible steps should be taken him to live a stable life with his family. Furthermore, ask him try to interact with others family members for few moments and try to remember good memories which you spend with his family, feel relaxed. Also suggests him that if you follow these instructions, you himself feel a great improvement in your health and you can live a happy life.

LIMITATIONS:All the information was taken from the client, there was no informant. As the client has well oriented towards time, place and person and has an insight of his problem and the client was also co-operative in giving information about his problem.

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IDENTIFYING DATA:
Name: ABC Age: 40 Gender: Male Education: FSC Marital status: Married Wife Name: XYZ Wifes Occupation: house wife No. of Children: 4 sons No. of Siblings: 3 brothers and 1 sister Birth order: 2nd one Father: Alive Mother: Alive Fathers occupation: Retired Officer Mothers Occupation: House Wife Family Monthly Income: 15,000 Religion: Islam

REASON FOR REFERRAL:The client has been brought into the psychiatry ward of poly clinic hospital by his wife for showing complaints such as i-e headache, back pain, loss of appetite, lack of sleep, low mood, , fatigue or loss of energy, lack of interest in all pleasurable activities, always worried and right hand and right leg was not working.

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Presenting complaints:
The client has been suffering from these complaints for last 3 weeks. According to the client:

Following symptoms has been observed according to the DSM-4 TR (2000). y y y y y y y y Weight loss Feeling of guilt Psychomotor agitation Insomnia Low mood Fatigue or loss of energy Restlessness Lack of interest in all activities

FAMILY HISTORY
Client belongs to a lower middle class family and having a nuclear family system. It has been reported by the client that he has 2 brothers and 1 sister and he is on 2nd number. His father and mother are alive. His relation with his parents and other family members was good. Client reported that his younger brother is also suffering from this problem.

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Client is 40 year old married person and working in PM house as an electrician. His marriage was an arrange marriage, his wife is his first cousin. He is living with his wife and his 4 children. Their monthly income is 15000 in which their survival is quite difficult. Client reported that currently his relation with his wife and children is good. Client said that he love his children a lot.

PAST PERSONAL HISTORY

It has been informed by the client that his birth was normal. Her relation with his parents was caring and loveable. Client told that his upbringing was normal. It has been reported by client that in his childhood, he was so active and fun loving child. Every one loves him. Client also reported that he was good student in his class and take average marks in exams. He further told that he has a lot of friends in his child hood. He likes to play and he mostly plays in street with his friend. Client reported that when he was 8 years old he had a fracture on his arm for 1 month he cant move his hand properly for one month but after that till now he never feels pain in his arm. Client told that before 5 years, he and his parents live together but because of some financial crisis his parents and his elder brother separated and take another house. Client informed that some he feels quite alone he miss his parents a lot.

HISTORY OF PRESENT ILLNESS

Client was in complete state of health 3 weeks back when his problem started because of weakness in his body, headache, lack of sleep, loss of appetite and lack of interest in all activities, low mood, and cant move his arm and leg. Client reported that 3 weeks before when he was at home he wake up in the morning and then he suddenly unstable and fall down, he feels that his right arm and right leg is not working. He couldnt stand up properly. His wife took him to the hospital and there he - 25 -

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admitted for 3 weeks. His reports were clear there is no any medical illness, but still client was complaining that he cant move his arm and leg.

Premorbid personality:
Before the onset of the problem, the client was quite social and interactive, he like to spend time with his family. He was doing his work properly. But after the problem he becomes so depressed and his social interaction is also finished, he become aggressive very soon.

PSYCHOLOGICAL ASSESSMENT
Client appearance was quite normal and looking neat and clean. He was very communicative and talkative. He was also very co-operative in giving his life history, and he was also interested in administering the test. He also takes time to giving the tests. Client was given by some formal tests which He done properly. These tests and scales are: y y y y Case history interview. DAP BGT Beck Depression Inventory (BDI).

On BGT client score 7 that mean there is evidence that he has some brain impairment. Because the score is high from its range.

Intellectual Functioning:
Client score very low in DAP 13, his IQ level is 32.5 which is below average that mean Clients IQ level is very low and his intellectual functioning is not much good. In a few minutes he becomes tired and bored to administering the test.

Personality Assessment:
Client appearance was normal, properly dressed. As client depressed about his financial problem and also regret about separation of others family members, so when Beck Depression Inventory (BDI), of the client was administered, he scores 31 in the range of 31-40 which depicts strong evidence of severe depression.

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MULTIAXIAL DAIGNOSIS
Axis : Axis 2: Axis 3: Axis 4: Axis 5: 296.2x Major Depressive Disorder v79.01 No diagnosis None Financial problem GAF= 61(current)

CASE FORMULATION:The client is 40 years old married man. This was his first admission in poly clinic hospital, and he comes with having complaints of fatigue restlessness and insomnia, low mood, lack of interest in all activities and headache. From a Behavioral Perspective, learning theorists assume that depression and lack of reinforcement are related. Behaviorists have theorized that once a person becomes depressed, they become less likable, thus getting less reinforcement because more friends and acquaintances avoid a depressed person and as a result the depressed person may become more depressed. According to Lewinsohn, depressed people are precisely those people who do not know how to cope with the fact that they are no longer receiving positive reinforcements like they were before. From a Cognitive Perspective, the theory is that depression is a result of faulty thinking about oneself, one's current life situation, or the future. Cognitive theorists assume that the cognitions of depressed people differ from people with an anxiety disorder. Those with an anxiety disorder have thoughts that focus on uncertainty and worry about the future. The thoughts of depressed people focus on the negative aspects of past events and project a negative outlook on what the future might bring. (Sarason & Sarason, 1989).

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International Islamic university Islamabad

From a Humanistic - existential perspective the view of depression is as a result of a loss. The loss does not have to be the loss of a loved one, it can also be the loss of status, power, social rank or even money. The nature of the loss itself is not important, it is the effect on the individual's self-esteem as a result of the loss. "As Kierkegaard pointed out, depression is likely to result when the difference between the ideal and the real becomes too great for the individual to tolerate." (Sarason & Sarason, 1989)

THERAPUTIC SUGGESTIONS:As the client was suffering from depression. To overcome this problem some therapies are: Cognitive-behavioral therapy (CBT) is one form of psychotherapy that has been shown to be successful in treating major depression. CBT combines the fundamental concepts of behavioral therapy and cognitive therapy. The term cognitive refers to our thought process and reflects what we think, believe and perceive. Put together, CBT focuses on the behaviors and thoughts and how they are contributing to our current symptoms and difficulties. Psychodynamic therapy, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. Behavioral therapy help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression. Short Term Psychotherapy Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapy focus on the patient's disturbed personal relationships that cause and increase the depression.

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International Islamic university Islamabad

PROGNOSIS:As the client has an insight of his problem and he was also motivated to take the proper treatment and wanted to recover as soon as possible so that he can continue his life normally with his family. So the prognosis or the chances of recovery /betterment is good.

SESSIONS REPORT:1st Session:

During first session, I have developed rapport with my client and take some initial information e.g. identifying data.

2nd Session:
During second session, the main problem and its causes were asked from the client and also take some history of her family and his illness too.

3rd Session:
During third session, some tests e.g. BGT, DAP and Beck Depression Inventory (BDI) was administered from the client.

4th Session:
The fourth session is the termination session. So it was informed to the client that to take medicines regularly and also give some suggestions and instructions that how to improve your health and what possible steps should be taken her to live a stable life with her family. Furthermore, ask him try to interact with others family members for few moments and try to remember good memories which you spend with his family, feel relaxed. Also suggests him that if you follow these instructions, you himself feel a great improvement in your health and you can live a happy life.

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International Islamic university Islamabad

LIMITATIONS:All the information was taken from the client, there was no informant. As the client has well oriented towards time, place and person and has an insight of his problem and the client was also co-operative in giving information about his problem.

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International Islamic university Islamabad

References

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