FIELD TRAINING REPORT

A Report Submitted as a partial Fulfillment for the Requirement of

the Degree of Advanced Diploma in Counseling psychology

Submitted By
Twinkle

ADCP 08: Practicum: Field Training Part II

Health & Personal/Relationship Counselling

Advanced Diploma in Counseling Psychology

2022-2023

DEPARTMENT OF
PSYCHOLOGY

JAMIA MILLIA ISLAMIA

New Delhi-110025
 TABLE OF CONTENTS

S. NO TOPIC PAGE NO
1. Declaration
2. Internship Certificate
3. About the Internship
4. Acknowledgement
5. Introduction
6. Case Study 1
7. Case Study 2
8. Case Study 3
9. Case Study 4
10. Case Study 5
11. Case Study 6
12. Case Study 7
13. Case Study 8
14. Case Study 9
15. Case Study 10
16. Learning Outcomes and Personal
Reflection
17. References

DECLARATION
I, Twinkle, a student of Advanced Diploma in Counseling Psychology, Jamia
Millia Islamia, New Delhi: hereby declare that I have undergone the internship
program at Synapses Neuropsychiatry Clinic, TDI Centre, New Delhi, Delhi for
one month (30 days), from 13th February 2023 to 13th March 2023.

I also declare that the present report is my original work. The content of this report
has not been submitted to any other university or institute, either in part or in full
for the award of any degree, diploma or fellowship.

Twinkle

Advanced Diploma in Counselling psychology, 2nd semester

Enrollment No.: 22ACP016

ABOUT THE ORGANIZATION

Synapses Neuropsychiatry Clinic is a psychiatry and psychology treatment
based clinic in Jasolla, New Delhi, Delhi. It is run by Dr. Namrata Upadhyay,
a RCI registered licensed Clinical Psychologist and Dr. Vikram Singh, a
psychiatrist with MBBS (MAMC), MD (USA), MPH (USA). Synapses
Neuropsychology Clinic ensures a safe place for their clients where they can
talk about their concerns, issues experiences without any judgement. Both the
Mental Health Professionals are highly Empathetic and sensitive towards the
clients as well as well-trained with right qualifications.

Synapses offer internships in psychology to offer tangible experience to

interns where they can learn practical applications of psychology.

The clinic also offers free workshops and seminars on important

and relevant topics related with mental health like stress management,
identifying depression, building emotional resilience as part of their
community service program.

ACKNOWLEDGEMENT
I would take this opportunity to thank the Department of Psychology, Jamia Millia
Islamia for providing me with the opportunity to get on experience of the practical
training of any specialization in the field of counseling. I would like to extend my
utmost gratitude to Prof. Sheema Aleem, Head of the Department and Dr. Meena
Osmany, my course-coordinator for their guidance, knowledge, constructive
criticism and inspiration which made me do my best possible work through the
training.

I am using this opportunity to express my deepest gratitude and special thanks to

our coordinator, Dr. Fariha Ishratullah who with her immense dedication, love,
care, and selfless support guided me throughout my internship.

My thanks and appreciation also goes to my colleagues who have helped me in

developing the project and who willingly helped me out at various occasions with
their abilities.

Last but not least, I express my deep regards to my parents for their moral and
emotional support during the length of internship.

Twinkle

Advanced Diploma in Counselling Psychology

(2nd Semester)

Enrollment No.: 22ACP016

 INTRODUCTION

What is mental Health and its importance

Mental health can be simply defined as emotion, mental and psychological well-
being. Citizens’ overall health is important for development of the country. World
health Organization (WHO) defines health as “a state of physical, mental, social
and spiritual well-being and not merely the absence of disease or infirmity”. WHO
defines mental health as mental well-being in which an individual realizes his or
her own abilities, can cope with the normal stresses of life, can work productively
and is able to make a contribution to his or her community. Thus it can be said that
mental health is the foundation for individual well-being and the effective
functioning of a community. Mental health impacts one’s educational outcomes,
overall productivity, personal relations, social functioning, mood and happiness
etc.

Mental health also has impact on the overall health of the individual. Physical
health and mental health are closely associated and it is proved beyond doubt that
depression leads to heart and vascular diseases. Mental disorders also affect
persons health behaviour like eating sensibly, regular exercise, adequate sleep,
engaging in safe sexual practices, alcohol and tobacco use, adhering to medical
therapies thus increasing the risk of physical illness.

Mental ill health also leads to social problems like unemployment, broken families,
poverty, drug abuse and related crime. Poor mental health plays a significant role
in diminished immune functioning. Medically ill patients with depression have
worse outcome than those without. Chronic illnesses like diabetes, cancer, heart
disease increases the risk of depression

Over the globe, around 450 million people suffer from mental disorders. Global
burden of mental ill health is huge and thus, promoting mental health as well as
preventing and treating mental illness has become essential to reduce the social and
economic costs associated with it.

Despite this, it is difficult to manage and treat mental illnesses because of the
stigma associated with mental illness. Psychologically ill patients are discriminated
in the society in all aspects like education, employment, marriage etc, which leads
to delay in seeking medical advice. Vagueness in concepts of mental health and
illness, with lack of definitive signs and symptoms result in diagnostic confusion.
People feel that mental illnesses occur in those who are mentally weak or due to
spirits. Many people are in the opinion that mental illness is irreversible that lead to
therapeutic avoidance. Besides, many people believe that preventive measures are
unlikely to succeed. Many people believe that drugs used to treat mental illness
may cause many side effects and leads to addiction. They feel that these drugs
merely induce sleeping. Data collected by WHO demonstrated that there is large
gap between burden caused by mental health problems and the resources available
in countries to prevent and treat them, which is also one of the main reasons that
mental health is less catered to. Also, in most parts of the world, the treatment of
mental illness was alienated from rest of medicine and health care until recently.
Psychiatric patients and their families fail to act like pressure groups as they are
reluctant to come together because of severe social stigma and lack of knowledge
about their rights. Even Non-Governmental Organizations (NGOs) consider this as
a difficult field as it needs long term commitment and they are scared to deal with
mentally handicapped.

There is not one cause of mental illness. The biopsychosocial model explains the
causes of mental illnesses from all aspects. Biopsychosocial model, given by
George Engel, conceptualises health as consisting of multiple dimensions. It is
based on the idea that “humans are inherently biopsychosocial organisms in which
the biological, psychological, and social dimensions are inextricably intertwined”
(Melchert, 2007). This model suggests that other than physiological abnormalities,
germs and viruses, one’s behaviours, thoughts, and feelings may also influence our
physical state. Further, Engel also argued that physicians should also give
importance to subjective experiences and social and cultural environment of their
patients.

Broadly, there are three areas of the biopsychosocial model:

 Bio (physiological pathology)

 Psycho (thoughts emotions and behaviours such as psychological distress,
fear/avoidance beliefs, current coping methods and attribution)
 Social (socio-economical, socio-environmental, and cultural factors such
as work issues, family circumstances and benefits/economics)

Thus, it can be said that mental illness is caused through the interaction of
biological, psychological and social factors.
Counseling

Counseling can be defined as a professional and collaborative work between the

counselor and the client wherein the counselor listens to the client with empathy
and helps the client to resolve emotional, mental and personal problems thereby
helping the client to grow personally. Counseling not only focuses on growth but
also on remediation, development, wellness and treatment. Counselors help
individuals, couples, groups, family and social systems to deal with situational,
developmental and long - or - short term problems. It has evolved over the years
from diverse disciplines including anthropology, education, ethic, sociology,
medical sciences, philosophy, psychology etc. As a profession, counseling
developed from mere guidance, during early 1900s, focusing on prevention and
purposefulness, to a professional field encompassing wellness, development,
mindfulness, meaningfulness, growth, as well as the remediation of mental
disorders and even more today. Counseling is different from guidance, in which
experts help individuals to choose what they value most, and from psychotherapy,
which focuses on more serious and intra-psychic issues. According to the 20/20: A
Vision for the Future of Counseling consortium counseling can be defined as:
"Counseling is a professional relationship that empowers diverse individuals,
families, and groups to accomplish mental health, wellness, education, and career
goals".

This definition contains a number of implicit and explicit points that are important
for counsellors as well as consumers to realize:

• Counselling deals with wellness, personal growth, career, education, and

empowerment concerns. In other words, counsellors work in areas that involve a
plethora of issues including those that are personal and those that are interpersonal.
These areas include concerns related to finding meaning, adjustment, and
fulfillment in mental and physical health, and the achievement of goals in such
settings as work and school. Counsellors are concerned with social justice and
advocate for the oppressed and powerless as a part of the process.

• Counselling is conducted with persons individually, in groups, and in families.

Clients seen by counsellors live and work in a wide variety of settings and in all
strata of society.
Their problems may require short-term or long-term interventions that focus on
just one person or with multiple individuals who are related or not related to one
another.

• Counselling is diverse and multicultural. Counsellors see clients with varied

cultural backgrounds and at different ages and stages of life. Those from minority
and majority cultures are helped in a variety of ways depending on their needs,
which may include addressing larger societal issues, such as discrimination or
prejudice.

• Counselling is a dynamic process. Counsellors not only focus on their clients’

goals, but they also help clients accomplish them. This dynamic process comes
through using a range of theories and methods. Thus, counseling involves making
choices as well as changes. Counselling is lively and engaging. In most cases,
“counseling is a rehearsal for action” (Casey, 1996, p. 176) either internally with
thoughts and feelings or externally with behavior.

Characteristics of Effective Counselors

Some effective characteristics that motivate a person to pursue career in

counselling and help them to work well in this field by helping others are:

• Curiosity and inquisitiveness—a natural interest in people

• Ability to listen—the ability to find listening stimulating
• Empathy and understanding—the ability to put oneself in another’s place,
even if that person is totally different from you
• Capacity for self-denial—the ability to set aside personal needs to listen
and take care of others’ needs first
• Tolerance of intimacy—the ability to sustain emotional closeness
• Flexibility—the ability to adapt what one does to meet clients’ needs
• Support—the capacity to encourage clients in making their own decisions
while helping to engender hope
• Self-awareness—a knowledge of self, including attitudes, values, and
feelings and the ability to recognize how and what factors affect oneself.

Goals and Objectives of Counselling

  To help the client to accept actual or impending changes that are resulting
from stress, it involves psychological, emotional, and intellectual.
 To encourage the client to examine the available alternatives decide choices
are appropriate and useful for problem solving.
 To relieve distress among people who are reacting to difficult circumstances.
 To change the behavior by reducing the stress or risk.
 It helps the counselee to acquire independence & sense of responsibility.
 It helps the client to explore and fully utilize his potentialities and self-
actualize.
 To encourage & develop special abilities and right attitudes.
 To assist the student in planning for educational & vocational choices.
 To help student to work out aplan for solving his difficulties.
 To help one grow, explore & maintain or develop their overall personality.
 To help individual in checking wastage and stagnation.

Nature, Need and Purpose of Field Training

Counseling is, if anything, a practical and application field. We, as students, have
been taught the basics of counseling in theory but without practical exposure there
remains a lack of skills overall. Thus we underwent field training as per the
demands of our course to enhance and polish our skills. The field training
incorporated exposure to various cases of individuals with different types of issues
along with management plans for their treatment.

The field training involved active involvement in case discussions, identifying

particular issues and possible diagnosis, and making management plans. It also
encompassed various assignments in which DSM criteria of major mental
disorders were made to revise. It encouraged brainstorming for the ideas on
different strategies that can be used in counseling.

Moreover, the purpose of the field training was:

 To enhance practical skills in the field of counseling

 To learn how to manage clients with different needs in the real world in the
counseling set-up
 To know and understand the manifestation of mental disorders in real life
 To learn counseling skills for psycho-educating significant others and
caregivers of the clients
  To improvise verbal and non-verbal communication skills in the counseling
set-up
 To learn style of communicating with clients in such a way that build
rapport, is not intimidating and encourages open expressions

Procedure of Internship

As a part of curriculum of the course Advance Diploma in Counseling Psychology

provided by Jamia Millia Islamia University, it was required to do a one-month
field internship in school or differently-abled child counseling. Thus, for the same
purpose, I engaged in seeking an internship that provides insights and exposure in
the area of counseling. As a result, I came across this organization called
“Synapses Neuropsychiatry Clinic”. It offered an offline counseling psychology
internship for the month of February-March.

The purpose of this internship was to provide the interns with knowledge and
experience in history taking, interventions and management of different types of
clients. Thus, I applied to this internship by filling an online form. The application
form got approved soon and the consent to join the internship also came by.

The internship began starting mid-February and continued till the mid of March.
The course and structure of this internship focused on discussing major mental
health disorders along with the counseling plans that can be followed. The classes
were taken by Dr. Namrata Upadhyay (RCI licensed clinical psychologist) and Dr.
Vikram Singh (psychiatrist) on a daily basis for two hours in the clinic itself. Some
classes emphasized case discussion, counseling plans and were interactive and
engaging, whilst, in others I took case history of different clients.

Specifically, the internship focused primarily on issues such as major depressive

disorder, schizophrenia, anxiety disorders, OCD, mood disorders and possible
management plans.

CASE STUDY 1
Demographic Details :
Name- Mr. R

Age-26

Gender-Male

Educational Qualification-Graduate

Occupation-Not working

Socio-economic Background-Upper class urban family

Chief Complaints :

 Anxiety of being alone

 Uncertainty and anxiety regarding future and career
 Self-esteem issues
 Loneliness

History of Presenting Illness

The client reported having anxiety since 2015 when he was in 12th standard after
classes in his school got shuffled and he got alone and separated from his friends.
He fears being alone and worries about future and wants to have a stable job. He
broke up with his girlfriend 3 days back because she told him that she was after his
money and thus he found her toxic and he also has not been picking her calls since
then. He reported that his anxiety got somewhat better after he broke up because he
felt that he removed toxicity from his life. He also said that although he fears being
alone but before he used to be very self-critical and unforgiving of himself but now
he has started to realize his value and that if he would love himself he can live
happily alone by himself. Also he reported started taking week since he entered
college in 2018 to enjoy with his friends but has reduced the intake to occasionally
once in a few months since then.

Details of family members and home environment :

The client lives with his mother and sister. He told that his father had always been
physically, verbally and emotionally abusive since his childhood. His parents, thus,
are getting divorced after 5 years of efforts. He told that he is happy about getting
rid of his father.
Temperament, Personality and General IQ of the client :

The client seemed to be bending towards neurotic personality type having

uncertainty, apprehensions and fears.

Assessment Done :

Beck’s Anxiety Inventory was suggested.

The Beck Anxiety Inventory (BAI) consists of 21 items with a Likert scale ranging
from 0 to 3 and raw scores ranging from 0 to 63. It was developed in 1988 and a
revised manual was published in 1993 with some changes in scoring. The BAI
scores are classified as minimal anxiety (0 to 7), mild anxiety (8 to 15), moderate
anxiety (16 to 25), and severe anxiety (30 to 63). Because the instructions for the
BAI are written at an 8.3 grade level, oral instructions should be given to persons
with lower reading skills.

Case Formulation :

A 26 year old male came to the clinic. He reported having fear of being alone.
Before he used to be very self-critical and unforgiving of himself but now he has
started to realize his value which is helping him to live his life alone happily. He
recently broke up with his girlfriend and reported being at peace with it. He also
reported having anxious feeling regarding his future and career life. He wants to
have a stable job. He lives with his mother and sister. He doesn’t like his father
who had always been abusive and he is happy that his parents are finally getting
divorced.

Counselling Plan :

A 6 month plan with 2 sessions per week in the beginning was proposed for this
client.

Based on the complaints of the client, the following goals were made to help him:

 To work on self-esteem through positive self-talk practice and challenging

negative core beliefs
 To improve coping mechanisms by practicing problem-solving and
encouraging optimistic/realistic thinking
  To enhance relationship skills through social skills training

It was decided that session-wise plans would be made in collaboration with the
client to incorporate his strengths and lifestyle while executing the counseling
plans.

Description and Details of techniques :

Three major techniques were supposed to be used in this case:

 CBT- Cognitive Behavioral Therapy was decided upon to be followed to

help the client identify and challenge his negative core beliefs and replace
them with healthier ones. And thought record diary was decided upon to be
taught to the client in the next sessions to help him identify his cognitive
distortions. Journaling was also suggested.
 JPMR- Jacobian’s Progressive Muscle Relaxation was also included in the
plan. The client would be taught tensing and relaxing his muscles
progressively throughout the body giving specific time for each muscle.
 Problem-solving skills training- It was planned that the client will be taught
the basics of problem-solving and will be helped through this process in his
career-related issues. Moreover, the counselor would help the client to come
up with alternate options for his career through brainstorming and then
eliminating some while choosing others as final options, and, at last, coming
to final decision considering his interests and vocational strengths.

Outcome/Process :

Could not be known

CASE STUDY 2
Demographic Details :
Name-Mr. N.

Age-38

Gender-Male

Educational Qualification-Graduate

Occupation-Not working

Socio-economic Background-Urban family

Chief Complaints :

 I feel sad and hopeless

 I get dissociated from the world and take time to come back on track again
 Due to my condition, I am suffering financial loses

History of Presenting Illness

The client reported that he would get dissociated from reality and would enter a
world of his imagination, which, he can’t realize is not real. This started 15-16
years ago. His period of being in an imaginary world would last for about 3-4
months. In that period, he would leave home and supposedly becomes a very
famous person who comes on TV and radio shows. He would talk to and have
many girlfriends. After he would come back to reality, each time he underwent
many loses financially as well socially and also he would undergo period of
depression, sadness and hopelessness. He reported having been taking medicines
since 4-5 years and feels a 50 percent improvement in his condition due to
medication effects, however, his condition worsened again during COVID for
about an year despite taking medicines and again improved after the COVID
situation. He also told that the last manic episode occurred in February of 2022
which lasted for 2-3 months.

Details of family members and home environment :

The client lives with his mother, father, wife and children. According to him, his
family has become quite annoyed because of his illness. He would also have fights
with his wife sometimes due to his condition.
Temperament, Personality and General IQ of the client :

The client, as of during the session, appeared having neurotic and anxious traits.

Assessment Done :

Bech–Rafaelsen Mania Scale (MAS) was suggested - The Bech–Rafaelsen Mania

Scale (MAS) was originally published in 1979 (Bech et al., 1979). The scale was
intended to complement existing rating scales developed by Hamilton for the
assessment of depression and anxiety (Hamilton, 1959, 1960) who had not
developed a comparable scale for rating mania. It is widely used in treatment and
basic research. The MAS consists of 11 items that assess motor activity, verbal
activity, flight of thoughts, voice/noise level, hostility/destructiveness, mood
(feelings of wellbeing), self-esteem, contact with others, sleep changes, sexual
interest, and work activities. Each item is rated on a five-point scale with 0
indicating normal mood and behavior and “4” indicating severe impairment .

Case Formulation :

A 38 year old male came to the clinic. He reported having depressive symptoms
with predominant feelings of hopelessness and sadness. He has been going on and
off between manic episodes, periods of grandiosity and depressive, low-mood
episodes since last 15-16 years. In the manic episode, he would run away from
home and assume a grandiose personality famous on TV and radio shows and
would make and talk to many girlfriends. His manic episode lasts for about3-4
months each time. He started taking medicines 3-4 years ago and saw half
improvement in his condition. With medications, the time gap between two
consecutive manic episodes has reduced for him, except during the COVID time,
when his condition again worsened for about an year, after which it started
improving again. He had his last manic episode in February, 2022 which lasted for
2-3 months.

Counselling Plan :

I, along with the leading psychologist and other interns, decided upon a tentative
counseling plan lasting for 8 months.

Based on the complaints of the client, the following goals were made to help him:
  To stick to his medications and reduce the impacts of manic episodes
 To improve coping mechanisms by involving and psycho-educating family
members
 To help him establish a suitable career based on his strengths and ability.

It was decided that session-wise plans would be made in collaboration with the
client to incorporate his strengths and lifestyle while executing the counseling
plans.

Description and Details of techniques :

The following techniques were supposed to be used in this case:

 Talk therapy- It is an important part of treatment for bipolar disorder. During

talk therapy, the client can discuss feelings, thoughts, and behaviors that cause
him problems. Talk therapy can help the client understand and hopefully master
any problems that hurt his ability to function well in life and career. It also
helps to stay on the medication regularly. It also has a major role in helping the
client maintain a positive self-image.
 Behavioral therapy- This focuses on behaviors that decrease stress. In this case,
activity rescheduling, adapting, identifying symptoms and developing effective
coping mechanisms would help the client.
 Cognitive therapy- This type of approach involves learning to identify and
modify the patterns of thinking that accompanies mood shifts. This includes
helping the client to identify any triggers that precede the manic and depressive
episodes and finding ways to better cope with them cognitively.
 Vocational training- This would involve assessing client’s interests, strengths
and ability to work well along with the illness so that he can find a suitable and
satisfying job for himself.
 Interpersonal therapy- This involves relationships and aims to reduce strains
that the illness may place upon them. The client’s family would also be
involved in this along with psycho-educating the family members about mania
and Bipolar disorder. The client would be taught interpersonal skills and ways
in which he can connect to his significant others deeply. The main goal of this
therapy is to make the client understand what it might be like to be in the
family’s place and also vice-versa so that a better empathetic and understanding
relationship among them can be established.
 Social rhythm therapy- This would help the client to develop and maintain a
normal sleep schedule and more predictable daily routines.
  Support groups also help people with bipolar disorder- They give
encouragement, teach coping skills, and a place to share common concerns.
The client would feel less isolated as a result. Family members and friends may
also benefit from a support group by gaining a better understanding of the
illness, sharing their concerns, and learning how to best support their loved one
with bipolar disorder.
Outcome/Process :

Could not be known

Learning Outcomes and Personal Reflection

I learnt the following during the internship:

 Practical skills: Through exposure to real cases, I learnt how to cater to

different types of clients. I got to learn how to go about sessions
progressively in the right manner. Also, through case discussions, I learnt
various techniques that we can use to elicit more information from the
clients.

 Communication skills: As a counselor, I learnt the importance of right verbal

and non-verbal communication skills and tactics in front of the client which
can hamper or catalyze rapport formation, efficacy of therapeutic
relationship and trust on the counselor. Also, sometimes a counselor has to
use certain tactics to offer a non-judgemental, bias-free and safe talking
space to the clients

 Relevance of asking negative history: While taking case history, I learnt the
importance of asking and ruling out negative history and other symptoms or
else some major symptoms might remain hidden and unrevealed which can
turn the whole diagnosis.

 Detailed case history: Sometimes due to the factor of social desirability,

clients tend to hide and even fake facts. A detailed case history is thus
needed over 2-3 sessions to identify all aspects and any discrepancies in the
clients’ description of problems and symptoms.

 Progressing patiently: Many times, clients tend to hide and not reveal
certain incidents and emotions. As counselors, it is not suggested to force
eliciting of information by clients. Rather, a counselor should work steadily,
building trust and rapport with the client and using open-ended and reframed
questions, to improve therapeutic alliance and encourage expressions.
 REFERENCES
https://vikaspedia.in/health/mental-health/importance-of-mental-
health#:~:text=Mental%20ill%20health%20also%20leads,worse%20outcome
%20than%20those%20without.

UNIT 2 MODELS OF HEALTH AND

ILLNESS* egyankosh
Bech, P., Bolwig, T. G., Kramp, P., & Rafaelsen, O. J. (1979). The Bech‐Rafaelsen Mania Scale and the
Hamilton Depression Scale: evaluation of homogeneity and inter‐observer reliability. Acta Psychiatrica
Scandinavica, 59(4), 420-430. DOI: https://doi.org/10.1111/j.1600-0447.1979.tb04484.x