Individual Therapy: Background Information, Presenting Problem (Other (Not Listed) Sample)

INDIVIDUAL THERAPY
BACKGROUND INFORMATION
A 40 years old female married, Muslim, Swahili speaking, educated up to form four, house wife belonging to middle socio-economic status, hailing from Nanyuki came to Nyeri Referral Hospital in psychiatry OPD by herself with the chief complaints of bed wetting with duration of 6 years. Due to this she complained of decreased interest in work, increased sleep and decreased appetite. These symptoms were present for the last four months. She was apparently well before 6 years. After death of her husband she noticed her problem of bed wetting started. In the beginning the frequency of bed wetting occurred once in 3-4 months. Gradually frequency increased and bed wetting was 4-5 times in a month. She was shown to a physician and detailed examination was done but there was no any medical condition was found which could be causing indicating bedwetting. She was referred to psychiatricy OPD for management. She complained that before bed wetting she was dreaming that she is passing urine in bed after sometimes she felt that she has passed urine.
PRESENTING PROBLEM
For the past 3 months she was feeling sad and embarrassed to face others. Often she feels that her problem of bed wetting has become uncontrollable. Gradually her sleeping increased. She started sleeping more than usual. Her appetite reduced and she was showing less interest in doing any work.
There was no history of head injury, mental retardation, epilepsy, which can cause bed wetting and mental illness. There was no past history of physical and mental illness. Before starting psychological management, underlying medical conditions as the cause of bed wetting were ruled out.
On behavioral analysis, behavior excess was found in bed wetting, e.g. Getting irritated, sleeping more. For these behaviour short term target was reduced frequency of bed wetting and frequency of irritability (anger and bursts) and increased the level of functioning (activity). Long term goals brought this behavior under control removed the irritable behavior and increased sleep hygiene rules. After this, functional assessment of behavior was done.
Bed wetting: She eats food late, drinks water before sleeping and sleeps early. Nature of her behavior was bed wetting after sleeping for at least one and half hour. The frequency is one time at night to 1-2 times in a week.
Chain of behavior: Generally it occurs between 10 p.m. or 3 a.m. at night; and she realizes when her clothes become wet. She changes the bed sheet and clothes and then sleeps again. Consequences: She gets up at night and becomes sad, irritated & angry.
Getting irritated: after bedwetting, when she does not share it with others, she does not perform household activity carefully and gets scolded by her son. Behavior: shows sad facial appearance expression, decreased talking.
Consequences: poor interaction with others and decreased interest in others.
Sleeping more than usual: sleeps late. Behavior: poor sound sleep till 10 a.m. Consequences: feels fatigue most of the day, gets up late.
THERAPEUTIC GOALS
Behavioural deficits: not interested in doing any work does not interact with others. Short term targets were increased the level of activity and increased her interpersonal skills. Long term targets were vocational rehabilitation and social skill training.
Less interest in doing work: sleeps more than usual and gets up late. Behavior: doing household work nicely but at present not interested, appears sad and fatigued. Consequences: she criticized by son and criticizes herself.
Poor interaction: her neighbors and relatives came to meet. Behavior: she feels embarrassed and unable to maintain eye to eye contact. Consequences: inadequate social behavior, less speaks to others.
Behavioural assets: Good in tailoring and making delicious food.
COUNSELLING INTERVENTIONS
Psychoeducation
Behavioural monitoring diary
Activity scheduling
Dry bed method
Effective use of punishment
I held individual session and c...