Preparation

1) Patient: Casus for your role play

Diagnosis and/or problems/issues

In my roleplay as a patient, I played the role of an insecure teenager who was very
concerned about her body image and “looks”as I was keen to take up modelling as a
career. I was diagnosed with anorexia after fainting in class one day for not consuming
food for at least two days. My anorexia later became bulimic after long starvation periods
that can last up to two/three days. After the starvation period, my body would react to
food in an extreme manner causing me to binge eat. I would then compensate for it by
working out excessively till I got seriously injured. After the binge eating episode, I would
again resume my routine of calorie counting and starving myself.

How will you discuss this with the psychologist?

I discussed the matter very casually with the psychologist as I believed it was a mistake
for the school’s counselor to refer me to her. I would try to tell her that it was relatively
common for the girl’s in my school to have starvation period because ultimately we just
want to “look good'' which I thought was normal. I would defend my “eating disorder” and
would come up with reasons why I wanted to continue with it and how much it means to
me as it can affect how the society look at me

Think of examples

“I think its perfectly normal for us girls to starve ourselves as at the end of the day we
just want to look as good as models in the Victoria Secret fashion show

“Looks is ultimately what that matters. The society would not like you if you’re fat and
ugly”

“I still don’t think I have worked out enough even though the doctors said I have after I
accidentally broke my arm”

What do you want from the psychologist?

I wanted my psychologist to agree with me defending my eating disorder as I wanted to

continue to it

Will you be cooperative?

At first, I would not as people with eating disorder usually have distorted cognition where
they would always defend the disorder. Towards the end I would eventually cooperate
Psychologist: Prepare how you will talk to your patient, as a psychologist.

Communication techniques (Paraphrase, summarize, clarify, reflect, empathise)

1. I would actively listen to what my patient has to say and occasionally nodding and
saying “I see/understand. When I pick up potential leads that can propel the
conversation deeper I would ask question like “Why so/ What happened next”
2. I would ask my patient to clarify what she said if I do not catch such as Could you
repeat that sentence again/ I do not quite understand, Can you explain further?
3. I would paraphrase sentences that were brought up when talking about an issue
and summarizing the topic of discussion.Example: I understand that you have a
family history of anxiety disorders. Does that sound correct?
4. I would use encouraging words and empathise when my patients talks about a
negative event: Example: I’m so sorry to hear that, I think you’re a very brave
individual
5. I would ask my patient for their perspective after they have voiced their concerns.
Example: What actions do you think you will take to overcome your agoraphobia

Possible questions

“Why do you think causes your panic attack to worsen

“How does the problem affect your mood/ self esteem”

“How do you see your panic attack / how do you define it”

Follow up

Close Observation of patient after asking them to imagine the stimuli that is thought to be
the cause of the panic attack

Administering the Agoraphobic Cognitions Questionnaire (ACQ) and Body Sensations

Questionnaire (BSQ), Panic Disorder Severity Scales (PDSS)

Intervention

One way I plan to intervene my patient’s agoraphobia is to introduce graded exposure to

the feared stimulus which is train and being in public. First, I will teach my patient
relaxation techniques such as deep breathing methods and positive visualization (focus
on something non-threatening in the environment/ thinking of a situation/ thing that
makes her feel at ease. I will then ask her to practice this while imagining that she’s near
a train / in public places. Later, I will ask her to pick a co-therapist (friend) to help her
follow through with the graded exposure plan in case of a relapse. I will introduce
increasingly “anxiety-provoking” situation for my client and if the client should have a
panic attack during any phase of the treatment plan, she should practice the relaxation
technique. My client will also have to record her physical bodily sensations, thoughts and
behaviour in a journal of the attempts to follow through the desensitization phase ‘.

Example of the journal log

Day 1:

Physically- breathing difficulties, disoriented, nauseous,

Thoughts: embarrassment, possible death

Behaviour: deep breathing, staying in the train station until the panic attack passes

The treatment plan with increasingly provoking situations in descending order

● Visiting the train station with a co-therapist

● Visiting the train station alone
● Taking the train to a designated stop with a co-therapist
● Taking the train alone to a designated
● Going to the grocery store with a co-therapist
● Going to the grocery store alone
● Going to the park with the co-therapist
● Going to the park alone
Reflection report 500-1000 words

Description of one role play where you were the psychologist

- What went well

- What could be improved

- Which part was difficult

- Which part was challenging?

- Did you feel well prepared?

- Did you find out what was the problem?

- Were you able to think along?

- Was the communication positive?

- Was the communication hostile?

- Did you manage to really involve in the role play?

- Were there issues that you were not prepared for?

When I roleplayed as the psychologist, my friend roleplayed as a new client who was
in her late twenties who worked as a journalist focusing on writing articles about
accident. The client of a sudden, developed a “panic attack” in the train station one
day out of the blue on her way to work which affected her severely till the point she
got fired from her previous job. The panic attack has caused her to avoid the trains
as a medium of transportation to work and she struggles to leave her house due to
the fear of getting into an accident. Because of this, she had lost quite a lot of friends
and it had impacted her self-esteem. The client has a family history of anxiety where
her aunt suffers from Generalised Anxiety Disorder.

Throughout the intake interview, the client was very compliant and did not hesitate
to answer any questions that were directed to her. Because she was very

responsive, the interview did not go “awkwardly” and we generally maintained a

good relationship with one another. Throughout the intervention session, I was

able to convey the intervention plan smoother than the first session as it was

non-structured. The flexibility of the second session made me feel less anxious

and confident as a psychologist. It was then that I was able to execute the

communication technique as planned. I was more responsive in the second session

whereas in the first session I was a lot more silent. Therefore, I clarified on

more information that was vaguely clarified from the first session. Consequently,

I thought I fulfilled all the communication technique in both the session with

the first session of reflecting and empathising while the second session;

paraphrasing, summarizing & clarifying

I definitely think the first intake is more difficult than the second intake as there is a
lot of information that needs to be obtained from the client. It appears they would
need to have to be a certain flow to the questions which will then later form “clues”
for the diagnosis. Even information that I thought was insignificant, apparently is
important to make up the diagnosis later. Also, it is difficult to empathise without
taking the client’s matter at heart and therefore to maintain as a professional and
not to discuss the matter as I would with a friend is rather difficult for me. The
challenging part probably to maintain the intake interview for as long as 20 minutes
as I did not have a flow to my question, I did not structure question that have leads
so I can propel the conversation deeper. Therefore, I would say that I felt more
prepared for the intervention session compared to the intake session. This might also
be because I felt more “in control” in the intervention compared to the intake
session.

For my client, at first it was a bit difficult to come up with a fixed diagnosis because
of the comorbidity of the subtypes of anxiety disorders. Therefore, I before I came
up with the agoraphobia diagnosis I came up with a few differential diagnoses like
Generalized Anxiety Disorder & Panic Disorder. Because my client was very
cooperative, it was easier to maintain our psychologist-patient role, although we
were not fully serious for 20 minutes. We did have side conversations on how we
could resume when I got “stuck” and she sometimes completes my sentences for me .
Although overall, I would say that we were quite involved in our roleplay. Overall
my client was very compliant, and the conversation never once got hostile. The only
issue that I wasn’t prepared for is the structuring of the question during the intake
session where I finished the intake way earlier than I should have even though there
were missing & insufficient information such as age and etc that was required in
making the diagnosis. Secondly, I did not write any notes down, as I thought it not
necessary, therefore I could not remember some of the tiny important details of my
client which may be crucial in the intervention phase