Internship Report

Rachana Muralidhar (2137443)

Department of Psychology

Christ (deemed to be) University

Dr. Alafia J

November 30, 2022

 Reflective Report
I did my clinical Internship in the Mind Calm Centre (MCC) located in Kalyan Nagar. It
is a mental health initiative started by Dr. Haleema (founder) who is the chief clinical
psychologist. MCC is a private practice that was started in september 2021 and includes a team
of ABA therapist, couple counselor, psychologists, occupational therapist, speech therapist and a
special educator.
I worked in MCC for four months on Tuesdays and Thursdays from 11 am to 6.30 pm.
As an intern my day to day responsibilities included doing intake interviews of new patients,
detailed workups, administering and scoring assessments, role plays, observation and case
discussions and other work related to the clinic. I also got an opportunity to work on Suicide
prevention awareness and facilitate a workshop on mental health for general public on the
occasion of world mental health day in october. MCC conducted a competition for high school
students with the theme ‘mental health awareness’, to which I’m grateful I was a part of.
During my time there I got to see cases of neurodevelopmental disorders, impulse
control and conduct disorder, personality disorder, mood disorder, anxiety disorders and
obsessive compulsive disorder.The difference that I observed in the presentation of a disorder
compared to a theoretical understanding of it is distinct. Interning in a clinical setting helped me
understand that there is no one rigid way in which a disorder manifests. There are various
different ways that an illness could look like and it is important for one to work around the core
symptoms. Another stark observation I made was the impact of the pandemic, especially on
young children and toddlers. These children spent about two years of their developmentally
sensitive period with restricted interactions and decreased learning which now presents as
symptoms similar to ASD, with some of them even qualifying for specific learning disabilities.
Another observation I made was the vividly present apprehension of an ID or SLD diagnosis by
the parents.
Most learning that I gained from this experience comes from assessments. I was
introduced to a range of objective and projective assessments. The assessments I was
familiarized with include; BDI, BAI, Trait and state anxiety inventory, MCMI, Rorschach,TAT,
Draw a person test, Sentence completion test, Nimhans Neuropsychological Battery, children’s
behavior checklist, BASC, BKT, WISC, Vineland’s adaptive behavior scale, Bender Gestalt test,
Benton Visual Retention test, MCHAT, DT-ADHD and standard progressive matrix (SPM).
Initially I was allowed only to observe the administration and the scoring process after which I
got an opportunity to administer some of them on the clients and score and interpret them.
Some of the interventions that I did were behavioral training for a 3 year old client with
autism, cognitive retraining for a client with a previous psychotic episode and JPMR for clients
with anxiety.
My role as an intern had a huge influence in the dynamic that played out with the clients.
Some of them were playful because of my age and some of them did not want to be interviewed
by an intern. An ethical issue that came up multiple times when working with children was the
presence of the parents. Many times the parents were intervening and influencing the child’s
responses during assessments.
Working in this setting also helped me understand and remember the theoretical content
of psychopathology better. My existing knowledge was just limited to knowing the symptoms
and the criteria one should meet to be given a diagnosis. Having a practical exposure to patients
with various disorders helped me better understand the underlying basis of the theoretical
concepts and gave it a holistic view. It allowed me to connect my theoretical knowledge to real
world applications.
Interning in MCC also gave me the confidence to continue in this line of work. With the
opportunities and the freedom given to me by the supervisor, I was able to learn and make
mistakes with responsibility. I was constantly encouraged to take up new initiatives and was
provided support to work on projects I’m interested in. Working in a private setting proved to be
an advantage due to close supervision I received along with necessary teaching and training. By
the end of the internship I was confident to come up with a tentative diagnosis for a client,
formulate their case and design a treatment plan, administer and score assessments and provide
basic interventions.This gave me reassurance about my efficacy in working in a clinical setting in
the future in professional capacities.
In the initial month of my internship I missed out on a lot of opportunities for
administering assessment as I was expected to already know it from the academics in college.
Another challenge I faced was in framing the questions in the best way possible during probing.
Asking questions in layman terms or in the most simplest way, moving away from the DSM
criteria was challenging. I found it difficult to cite examples for different symptom presentations
in order to convey the point across to the client in simplest terms. Working with children was
exhausting as they were either uncooperative or hyperactive and making them do a task took a
lot of time.
The internship experience has expanded me both on a personal and professional level.
Professionally, I move forward with a practical experience that has given me a better and more
holistic understanding of clinical psychology.
Internship Case
Name : N
Age: 28 years old (13 june 1994)
Gender: Female
Qualification: BBA
Marital Status: Married (years)
Place of Residence: Bangalore
Type of Family: Born in joint family and currently living with husband, child and mother in law
Chief Complaints
The client describes her mood to be unstable and has feelings of hopelessness. She has
palpitations every morning and is unable to stop overthinking. The client finds the presence of
her mother in law in the household difficult (3 years). She feels that she is constantly under
surveillance. The client is easily irritable and gets angry towards family members and others.
The client experiences feelings of hopelessness.
History of Presenting Illness
The client lived in Dubai as a child and moved to Bangalore three years ago. In 2020
during the pandemic, they physically came together as a family. As a clean freak, she found how
others did things messy. She and her mother in law did not get along on the way things were
done.
She experienced hot and cold sweats when she looked at her MIL. She found it
increasingly difficult to come out of her room and stayed in her room throughout the year only
while coming out for breaks. The client used to binge eat during this period.
In 2021, the client started working to distance herself from her mother in law. Initially,
she was able to cope better but then found the workload too much. She felt stuck and was not
happy with her job.Her sleep was disturbed and she felt she did not take care of her child. She
would overeat and binge on junk food.
In the end of 2021, the client got into a huge argument to move away independently from
the mother-in law as she was feeling suffocated. There was a lot of conflict with family during
this period and consequently she quit her job due to frustration.
In 2022, the client got back from her mother’s place and she wanted to rest. However,
her mother in law arrived with her daughter and children, and the house got crowded. She had an
episode of panic where she was not able to breathe and was sweating profusely. They later
shifted to a bigger house in May 2022, and the client says she has gotten used to the presence of
her mother in law in the house. Every morning she wakes up early and spends time in her room
for about two hours, till she builds courage to step out of the room to face the day.
Her last episode of panic attack was in July 2022 when she got to know her mother in law
is planning to move to dubai and settle with them permanently. She felt like she was having a
heart attack. She has suicidal ideations and passive death wishes.
Associated disturbances
Delayed onset of sleep; the client goes to bed early but is not able to sleep and finds it
difficult to wake up in the morning. She only gets about five hours of sleep.
Appetite is as usual and is possible because of working out
Sexual libido: there is a decrease in drive due to possible rejection from the husband
Social life has reduced, she spends time only with her sisters.
Negative history
No history of head injuries, trauma, seizures, substance use etc.
Family History
Currently stays with husband, child and mother in law. As a child, she lived in Dubai
with her extended family, for a long time she was the only child in the family, so she was
pampered by her family. Client mentions that her father had an extramarital affair and had a
second marriage. Post their marriage she lived with her father and stepmother for about 6
months. Stepmother is said to have been abusive and would beat her and her siblings. She is
close to her sisters and they fight a lot.
Husband: she describes her husband to be supportive and understanding. They have their
own differences and come from different backgrounds but find solace in each other. They have
been married for 6 years and it was an arranged marriage. She did not want to get married but her
parents coerced her into it when she was 22 years old.
Son: Her son is 4 years old and is said to be a sweet boy. He is very naughty and shows
hyperactivity traits.
Father: Relationship with her father was described to be rocky. They are not very
connected and he was very controlling of her choice of clothes and friends.She used to do what
she wanted behind her back and he used to shame her for it, calling her a disappointment. She
was holding anger and frustration against her father for the affair and doing her mother wrong,
Mother: The client’s mother is uneducated, she describes her to be naive, dependable. She
was not happy with her husband but remained in the marriage because of her kids. She describes
talking to her mother to be exhausting, judgemental, taunting, passive aggressive, anxious and
negative about everything. Her mom has a psychiatric history of anxiety and is on
medications/therapy. Mother has thyroid and diabetes.
Mother in law: She feels her mother in law is nosy and is breathing down her neck. She
feels stuck and suffocated in her own house. Her relationship with her mother in law is cordial
and describes her MIL to be dominant and the one to claim authority. She gets frustrated and
upset with the client when she delays making breakfast or things do not go her way.
Past History
Psychiatric history: She has been previously diagnosed with depression and anxiety.
Medical history: She has been diagnosed with PCOS and anemia. She is taking
metformin for PCOS.
Coping style: She hits the gym when she feels distressed. She overeats when she is
stressed.
Personal History
The client was delivered through a C section, there were no complications during
pregnancy or birth. Her mother was anemic throughout while she carried the client. The
milestones were on time but she says she started talking late.
The client was not good in academics in school and declined in studies after 5 th grade
because of conflicts in the family. She did well in her 11th and 12th as she liked the subjects she
was studying.
Menstrual history: The client is on medication for Pcos. Her periods are regular but her
cycles vary in durations.
Premorbid Personality.
Attitude to self: the client has low self esteem and has an external locus of control.
Attitude to others: She feels like she is a victim of decisions made by others.
Mood: client's mood before her complaints started was stable and euthymic. She was worried
about her husband’s mental health as he was not happy with his job in dubai.
Hobbies: The client enjoys singing, coloring, drawing, doodling, swimming, skating. She used to
write stories and songs.
Mental Status Exam
General Appearance. She was dressed well and appeared well groomed. The patient
was cooperative and opened up easily. Good rapport was established. She maintained good
eye contact.
Psychomotor Activity. She showed reduced psychomotor activity.
Speech. The patient speaks spontaneously. Her speech was slow and the volume was
little. Her speech was coherent and relevant. Her reaction time was good.
Thought. She presented with ideas of worthlessness, guilt, hopelessness and suicidal
ideation
Mood. Her mood was low, but she showed congruity and appropriateness.
Perception. No perceptual disturbances, delusions are absent.
Cognitive Functions
Orientation- well oriented
Attention- not able to concentrate
Memory- intact
Judgment- good
Insight. Grade 5

Provisional Diagnosis: Depression

Investigations
Administration of Beck’s Depression Inventory, Beck’s Anxiety Inventory, Sacks Sentence
Completion Test and MCMI personality assessment
 Pro Bono Sessions
Total number of hours: 6
Total number of clients: 2
Client 1
Number of sessions: 4
Name: GK
Sex: Female
Age: 20
Education: Third year BA LLB
Religion: Hindu
Socio-Economic Status: Upper middle
Residence: Delhi
Presenting Complaints
“Feeling low”
“On the verge of emotional breakdowns most of the time”
Case Summary
Subjective
The client experiences intense anxiety related to her relationships. She came with
the complaint of experiencing high emotional dysregulation and fluctuations in mood. The client
also finds it difficult to manage her anger. The client indulges in non-suicidal self-injurious acts
(mainly cutting herself).
Objective
The client was previously diagnosed with clinical depression, Relationship OCD
(R-OCD) and Borderline Personality Disorder (BPD). DASS, PBQ were administered on the
client.
Assessment
The client has trouble regulating emotions and feels anxious about small disagreements in
her relationships. She feels overwhelmed easily and has frequent crying spells.
Plan
 As a part of symptom relief, the client has also been taught some relaxation techniques
and grounding techniques. Here, relaxation therapy has been used as complementary therapy to
help the client soothe her senses and become mindful. Relaxation techniques have been shown to
reduce emotional distress and unpleasant consequences. Further there is a need to administer
ROCDS scale and GAD scale.
Process Analysis
The client shared that she was anxious as she had already been to therapy earlier and was
reluctant to open up all over again. The first session was done in an unconventional way where
the client was encouraged to share about her hobbies and self. The client eased into the sessions
and it facilitated the rapport building. There was transference from the client’s end when she was
upset when I was a few minutes late to sessions, making her think that I won’t show up like
many in her life. This was addressed in the session.
Client 2
Number of Sessions: 2
Name: VK
Age: 21
Education: Final year BBA
Sex: Female
Residence: Gurgaon
Socio-Economic Status: Upper Middle
Religion: Hindu
Type of Family: Nuclear family; lives with parents and brother
Presenting Complaints
“Complicated relationship”
“Not being productive”
“Not being able to sleep”
Case Summary
Subjective
The client has been involved in the current romantic relationship since 2020. The first
few months of their relationship is described to be rosy after which her partner had an affair
multiple times. When she confronted him there was a lot of gaslighting, manipulation, physical
and verbal abuse involved. Their relationship was on and off after which she broke up with him
in April 2022. During this period, her weight increased by 10 kgs and she used to engage in
stress eating to cope up with her breakup. She met another person a month later in May and
started dating a few months later. She described the relationship to be perfect, however she
carries the guilt of dating this new person without moving on from her earlier relationship. He
withdrew from her completely after he found a tattoo of her previous boyfriend’s name on her
body. She stayed in touch with her previous partner and communicated with each other indirectly
through whatsapp status.
Objective
Assessments are not yet administered on the client
Assessment
 The client carries a lot of grief from the loss of both her relationships. As a result she
faces sleep and appetite issues and is not able to concentrate on her college work. The client
experiences lack of motivation, body image issues, low self esteem and low mood.
There is a pattern of needing to be in a relationship and fear of abandonment. The client
shows personality traits of cluster B disorders.
Plan
There is a need to elicit more information about the client’s past relationship history and
family history. Assessments that would be administered include Depression Anxiety Stress Scale
(DASS) and MCMI to make a provisional diagnosis and plan treatment.
Process analysis
I was feeling anxious as this was my first client in therapy. The rapport was easily
established and the client was cooperative and showed willingness to share.