Psychological Assessment

1. Introduction
Psychological assessment is a structured process of gathering
information to understand an individual's psychological functioning
across cognitive, emotional, behavioral, and interpersonal domains.
During my internship, psychological assessments were a core part
of the clinical exposure. They played a crucial role in diagnosis,
treatment planning, and monitoring therapeutic progress. This
section of the report outlines in detail the processes, tools, and
experiences related to psychological assessment during my
internship tenure.

2. Purpose of Psychological Assessment

Psychological assessments serve multiple purposes, depending on
the client's needs and the context in which they are used. Some of
the major purposes include:

●​ Clinical Diagnosis: Helps in identifying psychological

disorders like anxiety, depression, ADHD, and personality
disorders.​

●​ Therapeutic Planning: Provides clarity on the client’s

strengths and weaknesses, aiding in setting therapeutic goals.​

●​ Educational Planning: Used for children to assess learning

disabilities, school readiness, or giftedness.
 ●​ Occupational Assessment: Measures aptitude, personality,
and emotional intelligence relevant to work settings.​

Types of Psychological Assessments Encountered

During my internship, I was exposed to various psychological
assessments. These included both standardized tools and
qualitative methods. Below is a detailed explanation:

A. Clinical Interview

●​ Type: Structured/Semi-structured​

●​ Purpose: First step in assessment to build rapport, gather

case history, and understand presenting problems.​

●​ Components: Developmental history, family background,

educational/occupational history, social relationships, and
current issues.​

●​ Skills Practiced: Active listening, open-ended questioning,

empathic responses, and accurate documentation.​

B. Intelligence Tests
 1.​Binet-Kamat Test of Intelligence (BKT)​

○​ Used for: Children aged 3–22 years.​

○​ Measures: Verbal and non-verbal IQ.​

○​ Experience: Learned administration, establishing basal

and terminal ages, scoring, and calculating IQ.​

2.​Raven’s Progressive Matrices​

○​ Used for: Non-verbal reasoning across age groups.​

○​ Strengths: Culturally fair; useful in group testing and in

clients with speech/language difficulties.​

C. Personality Tests

1.​16 Personality Factor Questionnaire (16 PF)​

○​ Format: Self-report inventory.​

○​ Measures: Broad personality traits like dominance,

warmth, sensitivity, anxiety, etc.​

○​ Use: Helpful in personality profiling, career guidance,

and clinical settings.​
 ​

D. Behavioral Assessment

●​ Tools: Observation checklists, behavioral rating scales like

Conners’ Rating Scale and CBCL (Child Behavior
Checklist).​

●​ Used for: Children with suspected ADHD, conduct disorders,

and learning difficulties.​

●​ Experience: Observed classroom behavior simulations and

parent reports.​

Steps in the Psychological Assessment Process

1.​Referral & Case History Intake​

○​ Client referred by counselor, teacher, psychiatrist, or

parent.​

○​ Detailed case history recorded during the intake session.​

2.​Informed Consent​

○​ Client/guardian informed about the purpose, procedure,

and confidentiality of the assessment.​

○​ Written consent taken before test administration.​

3.​Test Selection​

○​ Based on the referral question and age of the client.​

○​ Ensured appropriate tools were selected as per standard

guidelines.​

4.​Test Administration​

○​ Followed standard protocols.​

○​ Maintained ethical practice: no hinting, balanced pacing,

proper encouragement.​

5.​Scoring and Interpretation​

○​ Raw scores converted to standardized scores.​

○​ Results interpreted using manuals and with supervisor’s

assistance.​

6.​Report Writing​

○​ Comprehensive report prepared covering:​

■​ Identifying information​
 ■​ Presenting concerns​

■​ History​

■​ Assessment results​

■​ Interpretation​

■​ Conclusion and recommendations​

7.​Feedback Session​

○​ Provided to client or guardian in clear, sensitive, and

simplified language.​

○​ Included psychoeducation and future steps.​

6. Ethical Considerations
●​ Strict confidentiality was maintained throughout the
assessment process.​

●​ Test materials were handled with care and not shared without
authorization.​
 ●​ Reports were not disclosed without client consent.​

●​ Observed the principle of non-maleficence (do no harm)

during interpretations and feedback.​

8. Conclusion
Psychological assessment is not merely a technical task but an art
that requires sensitivity, ethical responsibility, and scientific
understanding. My internship provided me with first-hand
experience of how assessments are conducted in real-life clinical
and educational settings. It deepened my theoretical knowledge
and helped me develop as a future mental health professional with
a practical understanding of psychological testing and its impact on
individuals.
Goal Setting and Planning

1. Introduction
Goal setting and planning are critical components of the
therapeutic process in counselling and clinical psychology. It
provides a clear direction and helps both the client and therapist
monitor progress effectively. During my internship, I had the
opportunity to observe and assist in the goal-setting phase with
multiple clients under supervision. This process involves
collaborative decision-making, realistic planning, and structured
follow-ups.

2. Purpose of Goal Setting in Counselling

●​ To motivate the client by providing a sense of direction.​

●​ To organize the therapy process with achievable steps.​

●​ To evaluate progress over time.​

●​ To help clients develop problem-solving and

self-regulation skills.​

●​ To maintain focus and avoid therapy drifting off-topic.​

3. Process of Goal Setting and Planning
A. Initial Assessment

●​ Goals are based on the client’s presenting concerns and

assessment results.​

●​ Areas often identified include emotional regulation, academic

issues, relationship problems, self-esteem, and behavior
modification.​

B. Collaborative Approach

●​ Goals are set with the client, not for the client.​

●​ This increases commitment, autonomy, and trust in the

therapeutic relationship.​

C. Use of SMART Goals

●​ SMART stands for:​

○​ Specific – Clear and well-defined.​

○​ Measurable – Progress can be tracked.​

○​ Achievable – Realistic given the client’s capacity.​

○​ Relevant – Related to the client’s needs and values.

 ○​ Time-bound – Has a deadline or time frame.​

●​ Example:​
“I want to reduce my anxiety in social settings” →​
“I will attend one social gathering per week for the next
month to build comfort in social settings.”​

4. Types of Goals Observed During Internship

1.​Short-term Goals​

○​ Achievable within a few sessions.​

○​ Focus on immediate behaviors or thoughts.​

○​ Example: “Practice deep breathing for 10 minutes every

morning.”​

2.​Long-term Goals​

○​ Spanning several weeks to months.​

○​ Related to deeper personal change or coping

strategies.​

○​ Example: “Build healthier relationships by

communicating assertively over the next 3 months.”​
 3.​Therapist-guided Goals​

○​ Identified by the therapist based on psychological

assessment or case history.​

○​ Often include therapeutic objectives like building

emotional insight or increasing distress tolerance.​

4.​Client-driven Goals​

○​ Come directly from the client’s desires or expectations

from therapy.​

○​ These reflect intrinsic motivation and are often more

sustainable.

Planning for Goal Achievement

A. Step-wise Breakdown

●​ Larger goals are broken into manageable steps.​

●​ Reduces overwhelm and promotes steady progress.​

B. Use of Worksheets or Diaries

●​ Clients were often encouraged to maintain progress records.​

 ●​ CBT-based worksheets were used to track thoughts,
behaviors, and outcomes.​

C. Review and Feedback

●​ Regular review sessions were scheduled (usually weekly or

biweekly).​

●​ Progress was praised, and obstacles were discussed openly.​

●​ Goals were modified if needed.

6. Ethical Considerations
●​ Ensured that client’s autonomy was respected while setting
goals.​

●​ Avoided imposing goals from the therapist’s perspective.​

●​ Maintained confidentiality when goals were discussed in

group sessions.​

●​ Clients were reminded that progress may not always be

linear and that change takes time.​
7. Challenges Faced
●​ Clients sometimes set unrealistic or vague goals ("I want to
be happy").​

●​ Some clients lacked motivation or insight into their own

problems.​

●​ Time constraints in short-term therapy made it hard to follow

through with long-term plans.​

●​ Emotional resistance or fear of failure delayed progress.​

8. Conclusion
Goal setting and planning are not just administrative tasks—they
are deeply therapeutic in nature. They help clients stay focused,
feel empowered, and track their own growth. During my
internship, I saw how structured planning and collaborative
goal-setting contributed significantly to therapeutic success. The
process also enhanced my understanding of client-centered work,
motivational strategies, and therapeutic patience.
Repo Building

Definition:

Rapport building is the process of creating a trusting,

comfortable, and open relationship between the
counsellor and the client. It forms the foundation of
effective counselling, allowing the client to feel safe,
understood, and willing to share their thoughts and
emotions. Without rapport, therapy may be
ineffective, as clients may hold back or feel
misunderstood.

Importance of Rapport in Counselling:

Encourages open and honest communication.

Helps the client feel valued, respected, and
understood.
Creates a safe and supportive environment.
Increases client engagement and cooperation in
therapy.
Enhances the effectiveness of interventions and
problem-solving strategies.
Key Elements of Rapport Building:

Active Listening

Fully focusing on what the client is saying, without

interruptions.
Using verbal (e.g., “I understand,” “Tell me more”)
and non-verbal (nodding, eye contact) cues to
show attentiveness.
Paraphrasing and summarizing to confirm
understanding.
Example: “It sounds like you’ve been feeling
overwhelmed with work responsibilities lately.”

Empathy & Validation

Empathy = Understanding the client’s emotions
and perspective.
Validation = Acknowledging and accepting their
feelings as real and important.
Example: “I can see why this situation is making you
feel anxious. That sounds really difficult.”

Non-Judgmental Attitude
Accepting the client’s thoughts, experiences, and
emotions without criticism.
Avoiding bias, personal opinions, or unnecessary
advice.
Example: Instead of saying “You shouldn’t feel that
way,” say “It’s understandable to feel this way
given your situation.”
Trust & Confidentiality

Ensuring that whatever the client shares remains

private (unless there is a risk of harm).
Being consistent and reliable in responses and
actions.
Explaining confidentiality policies at the beginning
of therapy.

Body Language & Non-Verbal Communication

Maintaining comfortable eye contact (without

staring).
Open body posture (leaning slightly forward,
avoiding crossed arms).
Facial expressions that match the tone of the
conversation
Mirroring the client’s tone or posture subtly to
create a sense of connection.

Personalization & Adaptability

Adjusting the tone, communication style, and

approach based on the client’s personality and
comfort level.
Using simple language based on the client’s
understanding.
Mental Status Examination (MSE)

Definition:

A Mental Status Examination (MSE) is a structured

assessment used by psychologists and mental health
professionals to evaluate a person's cognitive,
emotional, and behavioral functioning. It helps in
diagnosing psychiatric conditions and determining the
severity of mental health issues.

Importance of MSE in psychology

Provides a snapshot of the client’s psychological

state at a specific moment.
Helps in diagnosing mental illnesses like
depression, schizophrenia, anxiety disorders, etc.
Guides treatment planning and tracks progress
over time.
Identifies risk factors (e.g., suicidal thoughts,
aggression).
Ensures a comprehensive understanding of the
client's condition.
Component of MSE :

MSE covers different areas of mental functioning, often

categorized into eight major sections:

Appearance

Observations about physical appearance, grooming,

and hygiene.
Notable features:
a. Dressed appropriately for the situation?
b. Well-groomed or disheveled?
c. Unusual physical features (e.g., scars, tremors)?
d. Body posture (relaxed, stiff, or restless)?
e. Example: "Client appears neat, well-dressed, and
maintains good hygiene."

Behavior & Psychomotor Activity

Body movements (normal, slow, agitated, or restless).

Any tics, tremors, or involuntary movements?
Eye contact (maintains, avoids, or excessive staring)?
Facial expressions (neutral, sad, anxious, blank)?
Unusual behaviors (e.g., repetitive movements,
aggression, catatonia)?
Example: "Client is restless, frequently tapping their
foot, and avoids eye contact."
Speech

Rate: Slow, normal, or fast.

Volume: Soft, normal, or loud.
Fluency: Smooth or interrupted by
pauses/stammering.
Coherence: Logical or disorganized?
Unusual patterns: Slurred, pressured, mutism,
echolalia (repeating words)?
Example: "Client speaks in a low tone, with long
pauses before responding."

Mood & Affect

Mood (subjective): How the client describes their

emotions.
Example: "I feel sad and hopeless most of the time."
Affect (objective): How emotions are displayed
outwardly.
Normal, flat (no emotions), blunted (minimal
emotions), or exaggerated?

Thought Process & Thought Content

Thought Process: How thoughts are organized.

Logical, coherent, disorganized, tangential (jumping
topics), circumstantial (over-detailed), flight of ideas?
Perception

Any hallucinations (false sensory experiences)?

Auditory (hearing voices), visual (seeing things),
tactile (feeling things crawling on skin)?

Cognition

Orientation: Awareness of time, place, and person.

Example: "Client knows their name and location but
is unsure of the date."
Attention & Concentration:
Can they stay focused? Perform simple tasks like
spelling “WORLD” backward?

Insight & Judgment

Insight: Awareness of their mental health

condition.
Do they understand they need help, or do they
deny having a problem?

Judgment: Ability to make sound decisions.

Can they recognize right from wrong?

Example: "Client expresses unrealistic expectations
about managing finances despite past bankruptcy."
Ethics in Counselling

Ethics are the moral principles that guide professional

counselling. They ensure the client’s well-being and
protect their rights.

Core Ethical Principles in Counselling:

Confidentiality

Information shared in sessions must remain

private.
Exceptions: When the client is at risk of self-harm,
harming others, or when legally required.

Informed Consent

Clients must voluntarily agree to counselling after

understanding the process, benefits, and risks.

Non-Maleficence & Beneficence

“Do no harm” and always prioritize the client’s best

interest.
Autonomy

Respecting the client’s right to make their own

decisions.
The counsellor provides guidance, but the final
choice is the client’s.

Competence

Counsellors must provide services only within their

expertise and continuously improve their skills.

Dual Relationships & Boundaries

Avoid close personal relationships with clients to

prevent bias and ethical conflicts
.
Cultural Sensitivity & Non-Discrimination

Respecting different cultural beliefs, gender

identities, and backgrounds.

Ethical Dilemmas in Counselling:

A client confesses to illegal activity – Should

confidentiality be broken?
A client develops romantic feelings for the
counsellor – How to maintain professional
boundaries?

A minor seeks counselling without parental consent

– What are the legal and ethical considerations?
Counselling

Counselling is a professional process where a trained

counsellor helps individuals explore their thoughts,
emotions, and behaviors to resolve personal, social, or
psychological issues. The goal is to empower the client
to make informed decisions and cope better with life’s
challenges.

Elements of Counselling:

Confidentiality: Ensuring that whatever is shared

remains private unless there is a risk of harm.
Empathy: Understanding and sharing the feelings
of the client without judgment.
Non-judgmental Approach: Accepting the client’s
emotions and experiences without criticism.
Active Listening: Paying full attention, using verbal
and non-verbal cues to show understanding.
Goal Setting: Helping clients define and work
toward their personal goals.
Types of Counselling:

Cognitive-Behavioral Therapy (CBT):

Focuses on identifying and changing negative

thought patterns.
Uses techniques like cognitive restructuring and
behavioral experiments.

Humanistic Counselling (Person-Centered Therapy):

Developed by Carl Rogers, emphasizing self-

acceptance and personal growth.
The counsellor provides unconditional positive
regard, empathy, and genuineness.

Solution-Focused Brief Therapy (SFBT):

Short-term therapy that focuses on solutions

rather than problems.
Encourages clients to use their strengths and
resources to find answers.

Key Objectives of Counselling:

Self-Exploration: Helping clients understand their

emotions and behaviors.
Problem-Solving: Finding effective ways to handle
difficulties.

emotional Support: Providing a safe space for

sharing personal issues.

Behavioral Change: Encouraging healthier thought

patterns and actions.

Personal Growth: Enhancing self-awareness and

self-acceptance.
Case Study in Psychology

Definition:

A case study is an in-depth examination of an

individual, group, or situation over a period of time. It
is used in psychology to understand behavior, mental
health conditions, thought processes, and emotional
responses in real-life scenarios. Case studies provide
valuable insights into human psychology and help
develop treatment plans.

Importance of Case Study in psychology

Helps in understanding complex behaviors and

mental disorders.
Provides real-life context for psychological
theories.
Assists in diagnosing and treating psychological
conditions.
Allows for detailed observation of a person’s
experiences over time.
Used in research and therapy to develop better
psychological interventions.
Key Elements of Case Study:

Background Information

Name, age, gender, occupation (if applicable).

Family history and medical history.
Socioeconomic background.

Presenting Problem

The reason for psychological evaluation or therapy.

Example: "The client reports severe anxiety and
difficulty maintaining relationships."

Psychological History

Past mental health issues (previous diagnoses,

therapy, medications).
Family history of mental illnesses.

Assessment Methods

Clinical Interviews (structured or unstructured).

Behavioral Observations (how the client acts in
different situations).
Psychological Tests (e.g., MMPI, Rorschach test, IQ
tests).
Diagnosis (if applicable)

Based on DSM-5 or ICD-10 criteria.

Example: "The client meets the criteria for
Generalized Anxiety Disorder (GAD)."

Intervention & Treatment Plan

Types of therapy used (CBT, psychoanalysis,

trauma therapy, etc.).
Medications (if prescribed).
Lifestyle modifications suggested (exercise,
journaling, mindfulness, etc.).

Progress & Outcome

Changes in behavior and emotional state over time.

Effectiveness of therapy and treatments.
Example: "After six months of therapy, the client
reports reduced anxiety and improved
relationships."
From the “Shorter Oxford Textbook of Psychiatry, 7th Edition”

Chapter 1 introduces the foundational concepts of identifying and understanding the

symptoms and signs of psychiatric disorders—an essential skill in psychiatry.

1.​ Dual Capacity of a Psychiatrist​

○​ Psychiatrists must combine objective clinical data collection with an intuitive

understanding of the patient’s subjective experience.​

2.​ Psychopathology​

○​ The study of abnormal mental states.​

○​ Divided into:​

■​ Descriptive Psychopathology – Objective observation of symptoms.​

■​ Experimental Psychopathology – Attempts to explain symptoms using

cognitive, behavioral, or biological models.​

3.​ Symptoms vs. Signs​

○​ In psychiatry, the distinction is often blurred; most diagnostic data come from
the patient’s history and observed behavior.​

4.​ Distinctions in Symptom Presentation​

○​ Form vs. Content: The type of symptom (e.g., hallucination) vs. what the
symptom is about (e.g., being watched).​

○​ Primary vs. Secondary: Whether the symptom is a direct manifestation of

illness or a reaction to another symptom.​

○​ Subjective vs. Objective: Patient-reported vs. observed features.​

5.​ Cultural Considerations​

○​ Culture shapes symptom expression and interpretation (e.g., somatic

symptoms in Asian populations, beliefs in curses in African cultures).​
Major Symptom Categories and Descriptions

1.​ Mood and Emotional Disturbances​

○​ Abnormalities include depression, anxiety, elation, irritability.​

○​ Variations: lability, blunting, incongruity with situation or thoughts.​

2.​ Perceptual Disturbances​

○​ Hallucinations (auditory, visual, tactile, etc.) are perceptions without stimuli

and often indicate psychosis.​

○​ Illusions are distorted perceptions of real objects.​

○​ Pseudohallucinations lack the full features of true hallucinations.​

3.​ Disturbances of Thought​

○​ Delusions: Fixed, false beliefs not based on reality (e.g., persecution,

grandeur, reference, control).​

○​ Thought Insertion/Withdrawal/Broadcasting: Classic psychotic symptoms.​

○​ Formal Thought Disorder: Disorganized thinking seen in speech patterns

(e.g., loosening of associations, flight of ideas, thought blocking).​

4.​ Obsessions and Compulsions​

○​ Obsessions: Intrusive, distressing thoughts.​

○​ Compulsions: Repetitive behaviors aimed at reducing anxiety.​

○​ Common in OCD and sometimes mistaken for delusions.​

5.​ Overvalued Ideas​

○​ Strong, culturally grounded beliefs held with excessive emotional investment

(e.g., body image in anorexia nervosa).​
THERAPEUTIC INTERVENTION

What is Goal Setting in Counselling?

Goals in therapy are about what the client wishes to achieve.
Goals can be created by asking clients what they hope to get
from treatment and what they want to work on in therapy. As
a counsellor, it is your job to set expectations with your
client. Goals in therapy pertain to what the client hopes to
achieve in working with you. Therefore, goals should be
clear, concise, and have measurable outcomes.
Writing and assessing goal progress collaboratively with
clients is a potential option that can benefit both the client
and the therapist. Using tools such as treatment planners,
goal worksheets can help you write goals and keep track of
goal progress.

Goals of Counselling
Counselling theorists don’t always agree on what is an
appropriate counselling goal, however, there are some
common threads when it comes to standard goals you should
be including as part of your practice.
The five most common goals of counselling include:
1. Facilitating behavioural change.
2. Helping improves the client’s ability to both establish
and maintain relationships.
3. Helping enhances the client’s effectiveness and their
ability to cope.
4. Helping promotes the decision-making process while
facilitating client potential.
5. Development.
These goals are guidelines when it comes to helping your
clients make positive changes. A big part of the counselling
process involves enhancing your client’s ability to cope.

Asking Clients about their Goals

Before starting any kind of counselling or treatment plan, it’s
also important to set the stage by asking your clients:
●​ What they want to get out of the counselling or
therapeutic process.
 ●​ What they believe is inhibiting them from achieving
this.
●​ What their expectations are.
●​ What their motivations are for making said changes.

Goals Setting should be SMART

To set SMART goals, is the best method of setting goals in
counselling. SMART goals can be beneficial for clients and
counsellor.
Writing SMART Goal is easy. SMART is an acronym that
stands for:
S-Specific
When being specific about your client’s goals, you leave no
room for misinterpretation. For example, a particular goal
might be “The client states they want to decrease stress at
work. The client will implement three stress management
techniques and report on progress in the next two months.
The client will track their stress levels each work day.” If
you’re indeterminate about your client’s goals, it may look
like this, “The client wants to decrease stress at work.”
M-Measurable
When you’re setting goals with your clients, you need to
ensure that the goals you’re setting are measurable.
Measurable goals provide you with a standard to track
progress and evaluate outcomes.
A-Attainable
Attainable goals are ones that the client can reach. For
example, if a client says their goal is to save a million dollars
by tomorrow, that is probably not attainable. However, it
would be more feasible if your client said they wanted to
save $50 weekly for the next three months to help with
financial stress.
When assessing whether a goal or objective is attainable, it
may be helpful to determine if your client has the time and
resources to achieve the goal. Identifying potential obstacles
to an objective can help you decide whether it is something
your client is capable of doing.
R-Realistic
Realistic goals are similar to attainable goals. If you’re
setting a realistic goal with your client, you aren’t putting too
much on them simultaneously. Instead, realistic goals help
your client work towards something achievable.
T-Timed
Timed goals have a time frame attached to them so you can
evaluate your progress with a goal. Without adding a
timeframe, it’s unclear when the clients may reach their goals
or their target date for completion.

How Goal Setting Works in Therapy

Standard Goal Setting Approach:
1. Identify your goal.
2. Choose a starting point.
3. Identify the steps required to achieve the goal.
4. Take that first step and get started.
The first step may sound simple, but it is often challenging.
Helping your clients fine-tune and get crystal clear on their
goals may be harder than you think. Start by asking them
what their overall goal really is.
Identifying a starting point is next. Helping your clients face
and understand exactly where they are in terms of this goal is
a good place to start. It’s important that they are honest with
themselves as well, by examining where things currently
stand.
FOLLOW-UP & TERMINATION

Termination or we can say closing up the counselling. It is the final

stage of a counselling process. Termination is not so much an ending
as it is a transition from one set of functioning to another. This step
is as important as other steps, because it the transition between
assisted functioning to counselling-free functioning.

Beginning and ending often prove problematic to people,

particularly to sensitive people. These individuals are more aware of
the importance of good beginnings and aware of the implications of
ending relationship that have been productive, rewarding and
meaningful.

Termination may not seem like a stage, but the art of ending the
counselling is critical. Drawing counselling to a close must be
planned well in advance to ensure a positive conclusion has reached,
while avoiding anger, sadness, or anxiety in client.

Different Reasons to Terminate Counselling

The various reasons for termination can be:

●​ The client or therapist feels that there is not in a good fit

between them, and this will retard treatment progress. This
often occurs early in treatment.
 ●​ The therapist or the client is moving away.
●​ New symptoms arise for the client that are outside of the
therapist’s expertise, and they recommend another provider to
ensure that the client gets the best possible care.
●​ The client has seen their current therapist for a long time and
feels that a new counsellor might help them address things or
make progress in a different way than the current therapist can.
●​ The client chooses to stop coming regardless of whether they
feel they have made progress. Dropping out of treatment
prematurely can prevent them from getting appropriate
support, and giving clients a voice in their treatment is an
important factor in ensuring that clients get appropriate care for
as long as they need it.
●​ The client wants to take a break from treatment for any reason
and plans to return in the future.
●​ The client is out of money and cannot pay the counsellor
anymore.
●​ The client has achieved their treatment goals and no longer
needs continuing services.

When a Counselling Process should be Terminated?

In practical terms, counselling ends when the client, the counsellor,
or the process indicates that termination is appropriate. Probably the
most pragmatic answer to the question of when counselling should
end:
 Therapists know that clients are ready to terminate when they
have converging reports of client change from three different
sources-

(I) When clients report that they consistently feel better, can respond
in more adaptive ways to old conflict situations, and find themselves
capable of new responses that were not available to them before.

(2) When clients can consistently respond to the counsellor in new,

more direct and reality-based ways that do not match their old
interpersonal coping styles or maladaptive relational patterns.

(3) When client’s acquaintances give compliment or feedback to

client that he is different something has changed in him.

Ask Questions to know Client’s Perspective about

Termination
Ending therapy is an integral part of the overall therapeutic process.
If the termination process is begun early, with clear therapeutic
goals, it can be a positive experience with a long-lasting impact. As
counselling draws to a close, it is essential to assess the client’s
readiness for termination through observation and discussion.

Counsellor should ask questions to the client, such as, have you
felt happy, have you been more able to cope with the problems
that brought you to counselling, is your life better now, have you
been sleeping better, have you been living more healthily (diet,
exercise, etc.), have you been able to focus?
 Counsellor should know about the readiness of client to end
counselling for that he may ask-

· What do you see as some of the key changes that have taken

· What have been some of the most significant impacts on your life
as a result of the changes?

· What are your thoughts about no longer coming to therapy?

· What thoughts do you think you will have before the last time
you come to see me?

· Do you have any concerns regarding ending therapy?

· For some, ending therapy can give a sense of loss. How do you
feel you will handle it?

Ways to Smoothly End Counselling

·​ Agree on how the therapy will end from the outset
Clients need to know the intended duration of treatment from the
start. If it is to be open ended based solely on the progress made
during sessions, clients need to be aware that limitations may
result from time available, client insurance, or other factors. Only
when the client has all the information can they make an
informed choice and receive the maximum benefit from the
treatment.

·​
Agree on treatment goals and what success looks like
Ideally, when treatment ends, the therapeutic process will have
met all treatment goals. But to do this, the therapist and client
should agree on the intended outcome of therapy. While changes
in circumstances and insights experienced during treatment may
transform goals, they should be set early to inform the “nature,
focus, and scope of the treatment” and its intended duration.

· Plan for termination

In the ordinary course of events, termination should not be a
surprise. Instead, it should be planned and prepared for, working
collaboratively toward the end of successful treatment.
Termination is a phase of treatment like any other. It should help
the client prepare to build on what they have learned and move
forward positively.

Barriers in the Termination

· Emotional attachment between client and counsellor.

· Unresolved issues of client.

· Fear of regression in client. Client may worry that without the

ongoing support of counselling, they might regress or return to old
habits and patterns.

· Unclear goals and expectations of client make him feel that their
goals are not accomplished.
· Wrong timing for termination or lack of readiness from client.

· If client has history of loss, abandonment or trauma, termination

may trigger painful emotions or remind them of past experiences.
These clients may struggle more with the end of the therapeutic
relationship, causing significant distress.

How to Mitigate These Barriers?

●​ Prepare Early: Introduce the concept of termination early in
the therapy process, and revisit it periodically to ensure the
client is aware that therapy will eventually come to an end.
●​ Collaborative Planning: Work together with the client to
review progress, celebrate achievements, and create a plan for
how they can maintain gains after therapy.
●​ Gradual Termination: If appropriate, a step-down approach
can help, where sessions become less frequent over time,
allowing the client to transition out of therapy gradually.
●​ Follow-Up Sessions: Offering follow-up sessions or check-ins
after termination can reassure clients and provide additional
support during the transition.
Case Study-1 (Adult)

Client Name: Mr. A (Name changed for confidentiality)​

Age: 27​
Gender: Male​
Marital Status: Unmarried​
Occupation: Software Developer​
Date of Session: 12th March 2024​
Referred By: Self-referred​
Mode of Session: Online (Video call)

Presenting Concern:
Mr. A reported persistent feelings of sadness, low motivation,
disturbed sleep patterns, and difficulty concentrating at work for
the past 5–6 months. He also reported a recent breakup which
has affected his emotional state significantly. He experiences
moments of worthlessness and often isolates himself socially.

Onset of Problem:
The onset of the problem was approximately 5–6 months ago,
following a breakup from a long-term relationship. Mr. A began
experiencing consistent low mood, lack of interest in activities,
sleep disturbances, and low energy levels.

History of the Problem:

Mr. A shared that his symptoms began gradually after the
breakup. Initially, he attributed it to temporary sadness but over
time, he noticed it interfering with his work performance and daily
functioning. He also began isolating himself socially and reported
feelings of worthlessness and helplessness. This emotional
decline coincided with increasing job pressure.

Predisposing Factors:
●​ Low self-esteem since adolescence due to school
bullying.​

●​ Lack of emotional validation during formative years.​

●​ Personality traits such as sensitivity, overthinking, and

emotional dependency.​

●​ No previous professional psychological support taken

despite signs of distress in the past.​
Perpetuating Factors:
●​ Isolation from social support systems like friends and
family.​

●​ Lack of emotional outlets and healthy coping mechanisms.​

●​ High-stress job with long hours and limited work-life

balance.​

●​ Ruminating over past relationship and self-blame

associated with it.​

Family Details:
●​ Mr. A is the eldest of three siblings.​

●​ His father works in a private company and is often

emotionally distant.​

●​ His mother is a homemaker, more affectionate but not very

expressive.​

●​ The family maintains a functional dynamic but with limited

open emotional communication.​

●​ No reported family history of psychological illness, but

emotional neglect was present in subtle forms.​
Case Study-2 (Child)

Client Name: Master R (Name changed)​

Age: 10​
Gender: Male​
Class: 5th Grade​
Date of Session: 15th February 2024​
Referred By: School Counselor​
Mode of Session: Offline (In-person School Setting)

Presenting Concern:

Master R was referred due to increased classroom

aggression, difficulty concentrating, poor academic
performance, and withdrawal from peers. Teachers noted
sudden behavioral changes and reported that he often
appears irritable and distracted.

Onset of Problem:

The onset of the problem was around 3 months ago, shortly

after his parents' separation. Teachers and family members
noticed a decline in his academic interest, as well as a
noticeable change in behavior—becoming more aggressive,
restless, and emotionally distant.

History of the Problem:

Previously, Master R was considered a cheerful and active

child with moderate academic performance. He was socially
engaged and had a good circle of friends. After the parental
separation, he started becoming withdrawn and frequently got
into conflicts with classmates. At home, he often locked
himself in his room, avoided conversations, and showed signs
of emotional insecurity.

Predisposing Factors:

●​ Parental conflict and lack of emotional stability at

home.​

●​ Sensitive temperament and attachment

style—emotionally dependent on both parents.​

●​ History of mild social anxiety during transitions (e.g.,

shifting school, change in environment).​

●​ Inconsistent parenting and limited expression of

affection by the father.​
Perpetuating Factors:

●​ Poor co-parenting post-separation, leading to

confusion and divided loyalty.​

●​ Ongoing exposure to parental arguments, even

post-separation.​

●​ Lack of a structured support system or consistent

emotional check-ins.​

●​ Academic pressure from school and parental

expectations despite current emotional state.​

Family Details:

●​ Nuclear family. Master R lives with his mother and

younger sister.​

●​ His father moved out after the separation and currently

has limited contact with the child.​

●​ The mother is working and often finds it hard to maintain

consistent supervision.​

●​ The home environment has become emotionally tense.​

●​ No reported history of psychiatric illness in the family, but
the father is described as emotionally detached and the
mother reports high levels of stress.