Neurosis Case

Test report of BDI, BAI and TAT

Hajra Khan (1536)

Department of Applied Psychology, Riphah International University

APSY-4104: Case Report II

Dr. Hina

July 4th, 2021

The client was a 52-year-old woman who was suffering from depression. The client

was brought to seek practitioner’s help after she faced a tragic incident that she believed

‘turned her life upside down’. After complete history taking and evaluation of the client, it

was reduced that there was an intense need for therapeutic intervention. Cognitive

behavioural therapy was utilised to recognize and change the maladaptive behaviour and to

help client learn healthy coping mechanisms which would also help in preventing relapse.

Biodata

Name: S.B

Age: 52

Gender: Female

Education: 8th grade

Number of siblings: 6

Birth order: 1st

Marital status: Married

Informant: Husband

Reason and source of referral

Client was brought to the clinic by her husband to seek practitioner’s help. The

services being provided intended to evaluate and diagnose client’s problem. This report

intends to fulfil the partial academic degree requirement.

Presenting complaints

The client had presented the following complaints by the time he arrived to seek

practitioner’s help:

‘Mai aksr chahti hu k sab sy door kahi reh saku’.

maar du’.

‘Hr waqt mai istarah mehsoos nhi karti balky khabi khabr both shadeed negative or

suicidal khyalat aty hy’.

‘Mai bs chahti hu log mujh sy kuch na kahy or apny kaam sy kaam rakhy’.

‘Jab sy meri beti mujh sy alag hue hy mera hr kisi sy or hr cheez sy dil bhar gaya hy’.

Background history

Family history

The client is currently living with her family members which included her husband,

two sons and their wives and a grandson. All of the family members are caring and loving.

Client has a friendly relationship with everyone at home. The family faced no as such any

financial issues. Client’s husband aged 60 was a retired UN employee and received a

handsome amount of pension. The sons were also having jobs with considerable amount of

pay. But recently they were in debt of huge amount after buying a house, so the family lived

in a bit tight budget these days. Furthermore, there has been no such reasonable mental or

physical illness among family members or in forerunners.

General home atmosphere

The client belonged to a middle-class family. Each and everyone in the house had

equal to say in decision making since no such dominancy was expected by anyone at home.

Family dealings were somewhat handled by client’s husband which everyone would obey and

agree upon. The client always lived free life without any restrictions. The client mentioned

that everything was normal in her life until now when her daughter forcibly left the house and

settled in another city for job but the family did not agree on that. This completely brought

chaos and tensed environment at home lately. The daughter never contacted her mother or

anyone at home, would meet very rarely and in fact she wanted to cut ties with her family as
mentioned by the client. There was an ongoing kind of conflict between the daughter and rest

of the family members. This created very tensed environment at home but mostly affected the

client as she was very close to her daughter.

Personal history

The client specified that she was born through normal delivery and faced no physical

illness at the time of birth. Client achieved all her developmental milestone at adequate time

and did not face any difficulty through any phase. Throughout the childhood client remained

a joyful kid and had a bunch of friends. Client had a normal childhood and spent most of her

childhood with her aunt as she was adopted by her. Client made a lot of good memories and

had good friends in childhood and adolescence. At the earlier age of 16 client got married. As

elaborated by client, she had an extrovert personality type throughout her life until now as she

began struggling for her own mental peace.

Educational history

Client has qualification of matric. She used to attain quite good score and was

an obedient student. Client’s parents had always been very motivating and supported her

regarding her studies. Soon after matriculation, client had to quit her studies as she was

getting married and did not continue after marriage. Through her studying phase client

remained active student and had healthy relationships with friends and teachers.

Sexual history

The client did not specify her sexual history.

Occupational history

The client has never worked as an employee anywhere but was looking forward to

settling a small business of her own.

Premorbid personality
 The client was an active and social person before the incident occur and would have a

positive view on things. Prior to the illness, client had an extended circle of friends. Client

would have always somebody at their home so that she can have a company but after the

incident occurred client stopped socialising and did not appreciate or liked anyone visiting

her either. Client liked to cook delicious dishes and travelling.

Medical history

Few years back, the client was diagnosed with diabetes. It was at very minor ratio, but

client would very consciously take care of her good diet which was probably by efforts of her

husband and others at home to prevent any diverse outcomes. In last months, client also had a

menu pause and underwent a surgery. Surgery involved stiches within abdomen; blockage of

the fallopian tubes. Client also once paid a visit to a psychologist to seek help when her

mental condition was very deteriorated due to her and her daughter’s separation. Other than

that, client did not have any medical history neither has there been any such reasonable

mental or physical illness among family members or in forerunners.

Present illness history

The client began facing the issue by multiple strikes of extreme sadness. Client

attributed all of the uncertainty in her life to separation of her daughter. Before the incident

occurred, client was a normal woman with peaceful state of mind and happiest people around.

But now there was nothing that could made her happy at all and she also sometimes want to

end her life. Client believed the incident began to turn her life upside down wanted to live

alone without anyone approaching her. Client also started losing weight and appetite as she

began suffering from the issue.

Psychological Assessment

The assessment was carried out both formally and informally.

 Informal assessment
  Formal assessment

Informal Assessment

Informal assessment was carried out by using behavioural observation and mental

status examination.

Behavioural observation

Overall behavioural assessment of client indicated that there was something that was

not normal about her. The client was well dressed suitable according to weather conditions of

the region, sat straight and had potential to answer each question thoughtfully but the answers

were very blunt and somewhat harsh. The client also maintained eye contact, talked in a

continuous rhythm and provided sensible answers that were relevant to the questions asked.

The way client communicated and answered questions showed that client was forcibly

brought to the clinic.

Formal Assessment

In formal assessment following psychological tests were used:

 Beck Depression Test (BDI)

 Beck Anxiety Test (BAI)

 Thematic Apperception Test (TAT)

1) Beck Depression Test (BDI)

Quantitative assessment. After being assessed through BDI, scoring for each of the

twenty-one questions indicates 31 points of the client. Score was obtained by counting and

adding the numbers to the right of each question. Scoring of client falls in Severe depression

category of the test i.e.

Score of 31-40 = Severe depression

Qualitative assessment. Client used to be a very social and welcoming person but

after losing her nearer family member she became more pessimist, became more anti-social
and had feelings of failure and helplessness. Test findings indicates moderate depression

level of client and that the client needs to seek help from an expert through proper sessions in

order to overcome and cope with depression.

2) Beck Anxiety Inventory (BAI)

Quantitative analysis. BDI was followed by another self-report test called BAI. The

21 items scale resulted in 30 scoring which indicated that the client has moderate level of

anxiety and needs i.e.

Score of 22-35 = Moderate Anxiety

Qualitative analysis. Answers provided to each item of the test give client a

moderate level of anxiety. Intervention is needed to help client cope with the problem.

3) Thematic Apperception Test (TAT) interpretation

Overall qualitative analysis.

8GF

Client has talked about a girl who recently got married but lives far away from her

husband. She does not receive much time from her husband but she waits for his calls and

keeps thinking about the good old memories they had made. The story symbolizes feelings of

strong attachment, closeness, affection or respect toward another person including feelings of

remaining faithful or falling in love. The client has mentioned about the happily ever after of

the girl and her husband which identifies that the client is not fed from hardships but she

hopes for the best.

13B

Client has referred to the boy in the pic as herself. She thinks she wasted all her

childhood by being ungrateful and wanted to have more. But she grew up and was blessed

with everything she realized that money doesn’t matter but prosper does. This identifies that

the client might have history of lacking opportunities for enjoyment or advancement. The
heroine was poor and lacked status. Such needs are motivated by the desires for property

power etc. the client had a high opinion of one’s own self-worth as a kid and kept her self-

respect or to dreamed of a great future (ego ideal) but as she grew up all this appears of no

worth to her. All that matters is happiness and not money.

Risk factors for relapse

There is a strong need of social and moral support by immediate family members and

those who are in touch with the client. The client herself needs to practice resiliency,

cooperate and look forward for better outcomes to cope with the issue. If these factors are

missing, treatment or intervention may not be very effective and there would be thus greater

chances for relapse.

Diagnosis

After successfully administrating 3 of the tests, it is reduced that the client is

diagnosed with Major depressive disorder, recurrent, moderate, specified with Anxious

distress. Client is also having minor symptoms of suicidal thoughts. There is an immediate

need for starting of therapeutic intervention.

296.33 (F33) Major Depressive Disorder (Recurrent episode, Severe)

Prognosis

The client has a supportive family and after being interviewed, the helpless and

sentimental statements apart, client showed conceivable potential to begin normal functioning

in life. Personal and surrounding factors indicate that the client may recover soon. Client has

caring and supportive family who themselves are looking forward for speedy recovery of the

client so the chances for relapse may be none or very little and the overall prognosis seem to

very favourable.

Case formulation
 In the past few years, client has faced a constant pressure and tensed state of mind. It

was a very sudden shock for the client to live apart from her close daughter and not being

able to meet her at all. This eventually led to a depressive state and client began to complaint

self-injuring thoughts as well. Client also has lost weight and appetite recently. It has been

inferred from the tests results and history taking that the client is diagnosed with Major

depressive disorder as well as Anxiety. There is need of Cognitive behavioural therapy so

that client’s maladaptive thoughts can be recognised and fixed. Client would be helped learn

new and healthy ways of coping stress.

Management plan

Proper timings would be scheduled for client’s and practitioner’s sessions. Sessions

would be pre-planned and would take around 45 to 60 minutes and would acquire 10 – 20

sessions. Initial sessions would focus on client and therapist discussing client’s problems.

Through collaborative way of discussion between client and therapist, client would detect

pattern of thoughts and behaviors that may contribute to the depressive state of client.

Probing questions would be asked to more specify the problem; however in the beginning,

simple discussion on emotions and feelings triggered due to certain issues, is to be carried on.

The therapist would work on identifying the errors in thinking so that new automatic thought

would be develop in place of it. Cognitive Behavioural Therapy would be used so that client

can recognize and change her maladaptive behavior. Different strategies would be applied to

increase positive thoughts. Current life situations would be identified that are contributing to

depression. Client will recognize and learn risky situations, coping skills and how to prevent

relapse. Techniques used by the client to cope with depression will include journaling,

activity scheduling and behaviour activation, relaxation and stress reduction technique and

role playing. Moreover, the final sessions would focus on termination of the therapy and
relapse prevention. The client would be asked to practice what they learnt in sessions in their

daily life and thus enhance self-management skills.