PSYCHODIAGNOSTIC REPORT

Identifying Information

Client name A

Father name M.A

Gender Male

Date of Birth 20-06-2006

Age 18 years

Assessment date 03,05,10,13,20,24 March 2025

Examiner Faisal khan

Reason for Referral

The client was referred by Umeed Clinic and Rehabilitation Center to a trainee clinical

psychologist for assessment and management

Presenting Complaints

‫جلدی غصہ آتا ہے‬

‫باتیں بھول جاتا ہوں‬

‫چڑچڑاپن محسوس کرتا ہے‬

‫جلدی باتوں کی سمجھ نہیں آتی‬

)‫ناامیدی(گھر کے حاالت ٹھیک نہیں ہے‬

Clinical Interview

The client was presented with complaints of getting angry quickly and often feeling

irritable. I tend to forget things and struggle to understand conversations or situations right away,

and I feel hopeless, especially because the situation at home is not good.
 I used to work as a security guard at a mosque in Muslim Town, where my shift was 19

hours long. Out of the 6 hours left in the day, I could only sleep for 3 hours. Because of this, along

with the stress of managing my home, I started having problems. I would get angry easily, have

trouble sleeping, avoid talking to people, forget things often, and feel hopeless.

Then I started treatment at Umeed Clinic to fix these problems. Over the past six months,

I have improved a lot, but I still struggle with controlling my anger. Because of this, I try not to

talk much, as I am afraid I might say something wrong in anger.

The client was born into a middle-class family. He is the 3rd number child, and the total

number of siblings is 4. The father’s age is 42 years, he has a private job, and he has completed 5th

grade. His mother is 38 years old and is a housewife. He has a good relationship with his parents.

My family has been facing financial problems. I took a bank loan for my brother’s wedding, and I

am still paying it back while also managing household expenses. My father and brother work as

laborers, but even with their help, it is very hard to meet our daily needs. This stress affected my

sleep and appetite, making me feel tired and frustrated all the time. Eventually, I couldn’t handle

it anymore and left my security job. Now, I work as a cook at Umeed Clinic, which helps me

support my family.

The client has done a 5th-grade government school. His orientation to time, place, and

people was intact.

Test Administered

 Bender Gestalt Test -KOPPITZ-2 (BGT-KOPPITZ-2)

 Test of Non-Verbal Intelligence(TONI-4)

 Patient Health Questionnaire-9(PHQ-9)

 The Depression Anxiety and Stress(DASS)

  Thematic Apperception Test (TAT)

 Rotter Incomplete Sentence Blank (R.I.S.B)

Behavior Observation

The client was 18 years old. The session was held in the therapy room. He was adequately

dressed and looked neat and clean. The client dressed according to the weather. He seemed relaxed

and had no hesitation in discussing his problems in detail. He maintained proper eye contact.

There was no problem observed in his verbal and nonverbal communication. He could speak

fluently and could articulate himself properly. During the assessment session, he showed great

compliance and was very engaged in completing different assessment tools (BGT, TONI, DASS,

PHQ-9 and RISB).

Psychological Evaluation

Table no 1-Bender Gestalt Test -KOPPITZ-2 (BGT-KOPPITZ-2)

Raw Score Visual Motor Index Percentile Rank Descriptive Rating

25 90-109 25 Average

The client took 15 minutes to complete the Bender Gestalt test; his total raw score was 25,

with a visual motor index of 90-109. The client's score falls in the category of Average rating. The

minor mistakes may reflect common challenges with slight motor coordination difficulties, but

they do not suggest any significant deficits in the individual’s ability to process visual information

or execute motor responses. The overall performance indicates adequate cognitive and motor

functioning. Emotional indicator, Overworked reinforcement line. Design numbers 6 and 11 were

associated with impulsiveness and aggressiveness.

Table No. 2- Test of Non-Verbal Intelligence (TONI-4)

Raw Score Index SEM Percentile Descriptive

Score Rank Term

33 93 3 32 Average

The client’s raw score falls in the category of Average functioning. An average score on a

non-verbal intelligence test indicates that an individual has a typical level of reasoning and

problem-solving ability compared to the general population. This reflects an adequate capacity to

recognize patterns, analyze visual information, and solve abstract problems. Individuals within this

range can effectively process non-verbal information in everyday situations and structured

environments. While their problem-solving speed and accuracy might not be as high as those with

superior scores, they can still develop these skills further through practice. This level of

performance is sufficient for handling tasks that require logical thinking, spatial awareness, and

pattern recognition.

Table no 3-Patient Health Questionnaire-9 (PHQ-9)

PHQ-9 Normal Mild Moderate Severe

1. Little interest or pleasure in doing things. 2

2. Feeling down, depressed, or hopeless. 2

3. Trouble falling or staying asleep. 0

4. Feeling tired or having little energy. 1

5. Poor appetite or overeating. 0

6. Feeling bad about yourself. 2

7. Trouble concentrating on things. 2

8. Moving or speaking so slowly 1

that other people could have noticed.

9. Thoughts that you would be better off dead. 0

Total Score 10

The total score on the PHQ-9 is 10, which indicates moderate depression. The individual

has experienced noticeable depressive symptoms over the past two weeks, including reduced

interest in activities, feelings of worthlessness, difficulty concentrating, and low energy. These

symptoms interfere with daily tasks and overall well-being, but do not reach a severe level.

Moderate depression requires attention beyond basic self-care. Maintaining a balanced routine,

ensuring proper sleep, regular exercise, a healthy diet, and effective stress management supports

mental well-being. Consulting a mental health professional, psychologist, or counsellor provides

guidance and effective strategies to address these symptoms and improve overall functioning.

Table no 4-The Depression, Anxiety, Stress Scale (DASS)

Sub-Scale Total Score Severity Category

Depression 16 Moderate

Anxiety 07 Normal

Stress 11 Normal

The Depression, Anxiety, Stress Scale (DASS) was administered to assess his symptoms.

His score on the depression subscale was calculated to be 16, which falls within the category of

moderate level of depression. Within the depression subscale, statements related to hopelessness,
worthlessness, and feelings of insignificance were rated high. The total score of the anxiety

subscale was found to be 07, which falls within the category of moderate anxiety. In the anxiety

subscale, he scored high on statements related to shortness of breath, palpitation, and worriedness.

In the stress subscale, the client scored 11, which falls within the normal level of stress category.

DASS isn’t a diagnostic test upon which a diagnosis can be made. It helps the professional

understand the client’s problems that might be missed in an interview.

Table no 5- Table showing evaluation of Thematic Apperception Test (TAT)

TAT Needs Conflicts Anxieties Defense Perception of

Cards Mechanism Environment

1 Achievement Internal Performance Rationalization Stress and pressure

anxiety and

fear of failure

2 Affiliation and Internal Nill Compensation, Safe and supportive

Achievement identification environment

3BM Need for love, support Emotion and Separation Regression, Unsafe environment

and care reality face anxiety and withdrawal

the loss of lonely

parents

4 Affiliation, emotional Interpersonal Loss of love Suppression and Unstable emotional

connection rationalization environment

7BM Achievement Fear of Financial Intellectualization Business focused

failure anxiety or
 financial

security

12M Achievement/survival Internal Economic Suppression and Supportive and

conflicts insecurity identification caring family system

14 Achievement Internal Lonely, fear Intellectualization Quiet, calm and

conflict of failure and suppression isolated

The Thematic Apperception Test (TAT) gives a clear view of the client's emotional and

psychological state. It shows that the client is motivated to succeed and achieve their goals; this

drive comes with significant challenges. They often feel stress, self-doubt, and fear of failure,

which can be overwhelming. The pressure to perform creates anxiety, and sometimes it indicates

worries about money or feeling emotionally distant from others. Rather than confronting these

feelings head-on, the client tends to hide their emotions, preferring to stay logical and controlled,

or they try to rationalize situations to avoid showing vulnerability.

The client also has a strong need for love, affection, and emotional support, especially in

situations involving loss or separation. This need is indicated in stories where they experience loss

of parents or emotional absence, pointing to a fear of loneliness and abandonment. In response,

the client withdraws or emotionally shuts down, sometimes acting in a way that is more childlike

to handle overwhelming emotions. these struggles show strength and resilience. Instead of being

overwhelmed, they find ways to adapt, like learning from others or focusing on their strengths, to

cope with difficult situations.

The way the clients see their environment changes. Sometimes the client sees the world as

safe and supportive, especially about family or close relationships, which provides them with
comfort. However, at other times, the environment feels stressful, unstable, or unwelcoming,

which indicates that their emotional state influences how they view the world. This indicates an

internal conflict or mixed emotions, where the client feels supported and feels isolated or unsafe.

Overall, the TAT responses show someone ambitious and capable, but also emotionally

vulnerable and inclined to hide their feelings. The client is trying to find a way to balance client

success and emotional well-being in a world that often feels uncertain or emotionally difficult.

Table no 6- Shows the subject’s scoring on RISB

Items No. of Responses Total Score

P3 00 0

P2 03 03

P1 04 08

N 11 33

C1 10 40

C2 11 55

C3 01 6

40 Total Score = 145

The overall score of 145 on the Rotter Incomplete Sentences Blank (RISB) indicates a high

range, reflecting emotional distress, adjustment difficulties, or unresolved internal conflicts.

The client's total score of 145 on the Rotter Incomplete Sentences Blank (RISB) indicates

a high level of emotional involvement, with noticeable engagement in negative and conflict-related

areas. The highest scores appear in C2 (55) and C1 (40), showing a strong cognitive and emotional

focus on certain concerns, which may involve stress, over-analysis, or unresolved internal
struggles. The N (33) score highlights the presence of negative emotions, including dissatisfaction,

frustration, or anxiety. Lower scores in P1 (8) and P2 (3) show positive or neutral emotions are

present but do not dominate the responses. The single response in C3 (6) shows minimal

engagement in this category, while P3 (0) remains unaddressed, reflecting avoidance or difficulty

in expressing thoughts related to this area. Overall, the subject appears to experience notable

emotional or cognitive distress, with a tendency to over-engage in certain thought patterns,

potentially affecting psychological well-being. A deeper exploration through clinical assessment

will provide further clarity on these underlying concerns.

In the family dynamic client's situation at home. My mother is very kind and caring, always

supportive in every situation. My father is also a good client who plays a positive role in the family.

In client dynamics, the client's responses reflect frustration and disappointment with

people, likely due to negative experiences. The statement about hatred and unpaid money shows

feelings of disloyalty and broken trust. Overall, these responses reflect emotional distress and a

negative outlook on relationships.

Interpersonal dynamics. The client's responses reflect self-exploration and a desire for

client growth. The statement about not thinking about people suggests emotional detachment or a

lack of interest in social connections. The desire to understand cliental abilities shows curiosity

and a search for self-identity. The discomfort when others do not listen reflects a need for

validation and respect in relationships. Overall, these responses reflect a mix of self-reflection,

emotional needs, and interpersonal concerns.

Tentative Diagnosis

(F32.1) Major Depressive Disorder, Moderate

Prognosis
 The prognosis for the client is unfavorable due to several factor depressive symptoms and

the significant external stressors such as ongoing financial difficulties and long work hours. The

client shows limited progress in managing his emotional regulation and cognitive distortions, and

there are indications of worsening irritability and social withdrawal

Conclusion

The assessment findings indicate that the client, an 18-year-old male, is experiencing

moderate major depressive disorder (F32.1). Client symptoms include persistent irritability,

forgetfulness, difficulty understanding conversations, and feelings of hopelessness, primarily

influenced by financial stress, long work hours, and familial responsibilities. Psychological

evaluation results align with the clinical interview, emotional distress, moderate depression, and

cognitive strain. Despite these challenges, the client has demonstrated resilience and shown

improvement through treatment. The client's ability to seek help, strong family bonds, and shift to

a less stressful job serve as protective factors. However, unresolved anger issues and ongoing

financial stress remain potential relapse risks.

________________ ___________________ ____________________

Faisal Khan Dr. Muhammad Amjad MS. Lubana Dar

MS Internee External Supervisor Internal Supervisor

 Management Plan
Patient's Name A is an 18-year-old male

and Age

Presenting Quick temper, forgetfulness, irritability, difficulty understanding conversations, and

Complaints hopelessness due to family and financial stress

Test  Bender Gestalt Test -KOPPITZ-2 (BGT-KOPPITZ-2)

Administration  Test of Non-Verbal Intelligence (TONI-4)

 Patient Health Questionnaire-9 (PHQ-9)

 Depression Anxiety Stress Scale (DASS)

 Thematic Apperception Test (TAT)

 Rotter Incomplete Sentence Blank (RISB)

Tentative (F32.1) Major Depressive Disorder, Moderate

Diagnosis

Major  Cognitive Behavior Therapy (CBT)

Therapies  Group Therapy

Goals of Short-Term Goals

Therapy Domain Client Level Techniques

Functional Physical weakness due Journaling for self-care(Write down

Impairment to stress, sleep anger triggers, thoughts, and emotions

disturbances, emotional to gain better insight and control),

distress, irritability, and cognitive restructuring (CBT), sleep

negative thoughts
 hygiene techniques, deep breathing

exercises

Limited social Group therapy, assertiveness training

Social
interaction, aggressive (role-playing), relaxation techniques,
Interaction
behavior with family Deep Breathing

Subjective Low self-esteem,

Distress negative thoughts about Psychoeducation on emotions, deep

self and others, and breathing

emotional instability

Anger management (Grounded

Long-term stress and
techniques -Identify 5 things you see,
emotional distress,
Problem 4 things you touch, 3 things you hear,
struggles with financial
Complexity 2 things you smell, 1 thing you taste to
burden, history of anger
stay present), problem-solving
outbursts
exercises

Coping Avoidance of emotions, Role-playing scenarios for social

Styles social withdrawal interaction

Resistance Nill

Stage of
Action Cognitive Behavior Therapy (CBT)
change

Long-Term Continuation of short-term goals

Goals Improved emotional regulation

Enhanced coping strategies for financial stress

Session plan

Initial Sessions Sessions Techniques use

(1-3) Rapport building, history taking and clinical Confidentiality, Group therapy

interview, psychoeducation on depression

Journaling, deep breathing,

Psychological assessments, cognitive
Middle group therapy, assertiveness
restructuring (CBT), relaxation techniques,
Sessions (4-8) training (role playing), Deep
and social skills training
Breathing

Final Sessions Psychoeducation and relapse prevention Anger management strategies.

(9-10) Encouragement for self-

Review of progress, discussion on relapse
maintenance, follow-up
prevention, and future coping strategies
Termination recommendations

Duration of
30-45 minutes
Each Session

Sessions
10
Planned
 Case formulation:

Presenting Complaints

Name: A Quick temper, forgetfulness, irritability, difficulty

Age:18 understanding conversations, and hopelessness due to
Gender: M family and financial stress

Predisposing
Factors Precipitating Factor
 Family Financial
Stress  Job Stress
 Sleep  Change work
Deprivation
Environment
 Limited
Education
Maintaining Factors
 Unresolved Anger
Issues Tentative Diagnosis
 Ongoing Financial (F32.1) Major Depressive
Stress Disorder, Moderate

Assessment
 Clinical Interview
 Behavioral observation
 Bender Gestalt Test -KOPPITZ-2
(BGT-KOPPITZ-2) Protective Factors
 Test of Non-Verbal  Supportive family
Intelligence(TONI)
 Patient Health Questionnaire-9
(PHQ-9)
 Depression Anxiety Stress Scale
(DASS)
 Rotter Incomplete Sentence Blank
(RISB)
Case Conceptualization

The client, an 18-year-old male, presented with symptoms of irritability, forgetfulness,

difficulty understanding conversations, and feelings of hopelessness, primarily influenced by

financial stress, long working hours, and familial responsibilities. Psychological assessments,

including the Bender Gestalt Test, Test of Non-Verbal Intelligence, PHQ-9, DASS, and RISB,

revealed moderate depressive symptoms, emotional distress, and cognitive strain. The clinical

interview further indicated that prolonged occupational stress and financial burdens significantly

contributed to the client’s emotional dysregulation and social withdrawal.

From a biopsychosocial perspective, the biological aspect of the client’s condition is linked

to neurochemical imbalances in serotonin and norepinephrine, as research indicates that such

imbalances contribute to depressive symptoms (Nestler et al., 2002). Additionally, chronic stress

activates the hypothalamic-pituitary-adrenal (HPA) axis, increasing cortisol levels, which can

exacerbate mood dysregulation (Heim & Nemeroff, 2001). Psychologically, the client exhibits

cognitive distortions, such as catastrophizing and overgeneralization, which reinforce feelings of

hopelessness and lead to avoidance behaviors (Beck, 1976; Abramson, Seligman, & Teasdale,

1978). Socially, financial instability, family obligations, and occupational exhaustion have

contributed to increased stress and emotional distress. The client's strong familial relationships

serve as a protective factor, but unresolved anger issues pose a risk for relapse.

The treatment plan primarily involves Cognitive Behavioral Therapy (CBT), which is

effective in modifying maladaptive thoughts and behaviors associated with depression (Beck,

Rush, Shaw, & Emery, 1979). Techniques such as cognitive restructuring, journaling for self-care,

relaxation exercises, and social skills training will be incorporated to enhance emotional regulation

and coping mechanisms. Group therapy will also be utilized to improve intercliental interactions
and reduce social withdrawal. Additionally, anger management techniques, such as grounding

exercises, will help the client develop better emotional control. Given the moderate severity of

depressive symptoms, a holistic approach integrating psychotherapy, lifestyle modifications, and

social support is essential for long-term improvement (Cuijpers et al., 2013). While the client has

demonstrated resilience and progress in treatment, ongoing therapy sessions will focus on relapse

prevention, strengthening coping mechanisms, and fostering long-term emotional well-being.

References

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 Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of

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 Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2013). Psychological

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