• 11 Jul
    eWellness Expert

    Case history discussion of Emetophobia

    Emetophobia case history discussion

    Shiva Raman Pandey: Welcome Back Sareeta

    Shena Shaikh: Good evening, Ma'am

    Sareeta Behera: Hi Everyone. Hope you had a great day so far.

    Sareeta Behera: thanks for adding me up Shiva

    Sareeta Behera: Did you get time to reflect on the case that I had shard yesterday? Please come up with your intervention plans.

    Shena Shaikh: Hope you had a good day, Ma'am

    Shena Shaikh: This is my take on the case

    Shena Shaikh: I think he suffers from Emetophobia. Since anxiety lies at the heart of phobias, I also think his profuse sweating is the way his anxiety manifests.


    I propose the following intervention plan:


    1. An empathetic therapist providing unconditional positive regard, who works with the client to reduce his anxiety (anti-anxiety medication and systematic desensitization)
    2. CBT to alter faulty schemas and overcome catastrophic thinking.

    3.Relaxation techniques to help the client cope with perceived/actual phobic situations.

    4.Flooding and exposure therapy have found tremendous application in the treatment of phobias, but the availability of these stimuli may be an issue in this case, so I am not too sure how this could play out, Ma’am

    5.Therapy can be supplemented with counselling to help the client cope with his illness and overcome his phobia

    Sareeta Behera: Excellent Shena! Keep it up. Hope  got your name correct today

    Sareeta Behera: Any more inputs by anyone?

    Shena Shaikh: Thank you Ma'am :D

    Sareeta Behera: do we have anyone else aboard? Or shall I discuss the case further?

    Sareeta Behera: Shena and Shiva....shall I move forward?

    Shena Shaikh: As per your convenience

    Radhika Goel: Ma'am what is flooding therapy?

    Sareeta Behera: Shena would you like to explain about it?

    Shena Shaikh: Yes Ma'am

    Sareeta Behera: cool....please go ahead

    Shena Shaikh: Flooding is a form of therapy where intense exposure to the aversive stimulus is given to the client.

    An example may be to ask a client who is afraid of spiders to hold one


    Modeling is usually a part of this therapy wherein the therapist models how to deal with the stimuli

    Following the same example, the therapist would hold the spider and show the client that it's not dangerous

    Radhika Goel: Okay, thank you!

    Shena Shaikh: Anytime

    Sareeta Behera: U r absolutely right Shena

    Sareeta Behera: Any more questions Radhika?

    Radhika Goel: How would one go about Flooding in this case?

    Sareeta Behera: I will add to it once we start with the interventions part. This case is an example of Emetophobia. Among all the phobias this is one of the complicated one to deal with and intervene

    Ayushi Jolly: Same query

    Ayushi Jolly: Sure!

    Radhika Goel: Okay

    Sareeta Behera: The throwing up or vomiting of the client during the initial therapy sessions were the most difficult part to deal with

    Sareeta Behera: Let's begin the intervention part:

    Sareeta Behera: Please feel free to ask questions in the process

    Sareeta Behera: There are times when core psychotherapies need a lot of groundwork to be intervened with the client. And there are times when counselling and allied alternative therapy techniques kind of help a lot. The intervention scenario in this particular case is a classic example of the same.

    The intervention plan in this case included:

    1)            Assurance of non-breaching of confidentiality: the client had a lot of inhibitions and stigma attached to the idea of counselling and therapy. He was also afraid of the fact that others may come to know about his psychological stage and despise him. He sought therapy because one of his close friends had forced him for it. It took 2-3 sessions for helping him build a positive attitude towards counselling and therapies n cross-cut through the stigma attached as well.

    2)            Intensive rogerian and gestalt approach towards counselling: With the help of unconditional positive regard, shifting chair gestalt technique, multi-dimensional analysis; the client was helped to build insight on his strengths, abilities and his potentials across different life modalities.

    *Hope you all know what unconditional positive regard is. It means to respect and accept a person irrespective of the presenting problems he has or what his condition is.

    *The shifting chair gestalt technique is one of the important techniques of gestalt approach. It can be individualized as per the therapy needs of the client. It involves placing two chairs in the therapy setting. The client is asked to sit in one chair and visualize a better/healed version of himself/herself in the other chair. In both the chairs, the client has to speak about the present conditions and what life could be on the better side plus what he/she ought to be doing in order to achieve that.

    *Multi-modal or multi-dimensional analysis was also used in order to expand his outlook into the different aspects of his life. At the time of therapy, all he used to talk was about his symptoms and how to get rid of them. He was not able to look into other aspects of his life like peers, studies, profession, and so on. It was a symptomatic manifestation and his concern to get well. So, he could not be judged here on this part.

    3) Alternative Therapies and Lifestyle Management: The client’s lifestyle was not healthy. Consumption of junk food, oily and spicy food, sleeping late and getting up really late, lack of exercise and healthy living styles were lacking from his lifestyle. Owing to the fact that he was resistant towards core psychological therapies, he was given inputs of lifestyle management first. Then he was taught about alternative techniques for managing the physical symptoms of anxiety.

    Sareeta Behera: *Other alternative techniques included nature-cure techniques like use of lemon aroma to deal with nausea sensations, mud pack on palms to reduce sweating, using ice on palms to control the extra opening of skin pores leading to sweating

    Sareeta Behera: After all this, the client somewhat felt good and started showing interest towards the core psychological therapies

    Sareeta Behera: In this case, flooding was not used at all because it was beyond the therapist's reach to use flooding in the case. It would have been possible with intermittent flooding. But, since there would have been no scope for generalization of the same, so flooding was not imparted as a technique

    Sareeta Behera: Are you all clear until this part?

    Aparna Kanmani: Yes mam

    Sareeta Behera: The core psychological therapies included:

    Sareeta Behera: 1) Timeline Technique: A technique in which a client has to visually represent or draw the life journey so far in three to four phases: What life was before, what changed it, how it is now and what the client thrives it to be

    Sareeta Behera: 2) Cognitive Restructuring along with Response Prevention Technique

    Sareeta Behera: 3)Gradual Exposure Therapy along with systematic desensitization

    Sareeta Behera: got it?

    Shena Shaikh: Yes Ma'am

    Radhika Goel: Yes

    Sareeta Behera: I guess you know about points 2 and 3

    Sareeta Behera: Since the client got failed in his exams and losing confidence with every passing moment, he was also taught about mirror technique, positive thinking and positive self-affirmations

    Sareeta Behera: Apart from all these, he was motivated for yoga, pranayam or breathing exercises and related pacifying techniques when he got the urge to throw up

    Sareeta Behera: The therapy terminated when the client recovered almost up to the par and due to the approaching dates of his final year exams

    Sareeta Behera: He is still in touch with the therapist. At this stage he did not relapse emetophobia so far. And is seeking career counselling as of now

    Sareeta Behera: Any queries on this particular case? I was expecting more intervention plans...

    Sareeta Behera: Are you all here?

    Shena Shaikh: I have no further queries, Ma'am

    Sareeta Behera: ok

    Sameeksha Pavaskar: Hello Miss

    Sameeksha here

    This is my first session

    Aparna Kanmani: What are the chances of relapse in such cases mam?

    Sareeta Behera: There are possibility of relapse indeed

    Sareeta Behera: Particularly when there is no regularity in the practice of the therapy techniques or proper lifestyle management and medications of course

    Sareeta Behera: Some Emetophobia cases may require hospitalization if vomiting does not subside

    Sareeta Behera: It tends to take a toll both on the physical and psychological well-being of a person

    Minaish Dhabhar: Hi ma'am, my name's Minaish. Sorry if this comes off as a ignorant, but can you tell me about the mirror technique and how it's used to relieve anxiety?

    Sareeta Behera: Sure...np

    Shena Shaikh: How often does this have a physiological cause to it or is it purely psychological

    Sareeta Behera: Mirror technique was used to build self confidence and self concept rather than core anxiety symptoms

    Sareeta Behera: The mirror technique includes making the client stand in front of a mirror, teach him or her about ideal body language and speak positive aspects about himself or herself

    Minaish Dhabhar: Ideal body language, in the sense?

    Aparna Kanmani: I missed yesterday's session mam. I'm not able to understand emetophobia completely. Sorry if my question is a repetition. I know it is the fear of vomiting. But is it followed by a medical condition that has continues vomiting as a symptom or side effect?

    Sareeta Behera: Emetophobia is purely psychological. As in its roots lies in psychological aspects rather than the body

    Sareeta Behera: To answer your question Aparna: in cases where a physical problem is thought of to be a cause, a complete routine physical check up is done for a differential diagnosis

    Sareeta Behera: In this case the client was referred for a physical check up indeed in order to psychoeducate him also and to overrule the odds

    Sareeta Behera: Hope I am clear to all of you

    Aparna Kanmani: Yes. I understand that mam. I mean, since it is a specific phobia the anxiety or unrest will not appear unless there is a exposure right. Unless I see a lizard in my room my anxiety will not shoot up. So for him, if vomiting is the fear, he needs a trigger right. Does he have nauseating feeling at unpredictable times.

    Aparna Kanmani: I don't know if I worded it well

    Shena Shaikh: Yes Ma'am :D

    Aparna Kanmani: Yes mam

    Sareeta Behera: You are right Aparna...a very good question

    Sareeta Behera: For him the trigger was heat wave and hot temperature

    Sareeta Behera: He always said about hot weather in his region

    Radhika Goel: So, if he were to give an exam in an Ac room and restrict himself to such an environment?

    Sareeta Behera: AC rooms were not possible to get always. And the travel time and exposure/experience to the specific area or destination would have already triggered the anxiety symptoms

    Aparna Kanmani: Okay. Got it!

    Sareeta Behera: He felt the urge to vomit even at the smell of his own sweat, seeing others sweating and related stuff

    Sareeta Behera: The AC thing is a good idea

    Radhika Goel: Thank you, as a hypothetical he wouldn't feel that way then?

    Sareeta Behera: makes sense. We really wish we could change his living conditions.


    Sareeta Behera: Any further questions? Or shall I put across the next case?

    Sareeta Behera: Let me put across the next case....

    child case history


    Shena Shaikh: Welcome

    Sareeta Behera: This is about the case of a child in which he was referred for therapy by one of the elders in his family. The child was being sexually abused by his mother’s sister or Masi. When the child disclosed about the same with his parents, he was thrashed, he was rebuked that he is watching much TV and other stuff. Parents started fighting and even filed a divorce due to it. The father considered the mother to be at fault since her sister abused the child.

    Gradually the child started becoming isolated, didn’t talk much, didn’t mingle with his peers anymore and cocooned himself. He missed his school quite often and would often complain about feeling sick

    Sareeta Behera: Finally he was referred for therapy. During the therapy sessions he did not talk at all. All he would do was this drawing

    Sareeta Behera: Let us phase off today with this case in mind and how we would have interpreted the drawing and intervened

    Aparna Kanmani: Child's age mam?

    Sareeta Behera: The age of the child was 6 and half years

    Aparna Kanmani: And the symptoms were for the past..?

    Sareeta Behera: It would be great to have more responses tomorrow

    Sareeta Behera: Past as in? Sorry I couldn't get your question

    Shiva Raman Pandey: Hi Sareeta - I will prefer  to give them few days to digest the cases discussed till now. Also we are thinking of how can we include few more interested psychology students in this discussion. So, the next session would be after 2-3 days, I will let you all know.

    Aparna Kanmani: Past how many years

    Sareeta Behera: Okk

    Sareeta Behera: He shared about the abuse since a year or even more than that

    Sareeta Behera: But his parents didn't take this as a sign of his decline

    Aparna Kanmani: Looking forward to discuss further. Thanks for your time mam. :)

    Sakshi Bajaj: Can we have a look at the drawings, if that's allowed. In children it does happen that after a traumatic incident they project their trauma through pictures. It also happens when adults who have had a traumatic childhood manifest it through art? Is that right?

    Sareeta Behera: Then roughly 6 months back he was referred

    Sareeta Behera: That's right Sakshi

    Sareeta Behera: I am OK with it Shiva

    Sakshi Bajaj: Sorry ma'am. Wasn't aware that time is up. Shall continue it later. Thank you.

    Sareeta Behera: It is always good to have more people to share, discuss, learn and do

    Sareeta Behera: No problem

    Sareeta Behera: Please refer to the discussions again to have a more clearer picture

    Sareeta Behera: Thank you everyone for your time and active participation today. Please try to work on this case and reflect your ideas.

    Shiva Raman Pandey: Thank you everyone. I am seeing better participation now.

    Sakshi Bajaj: Sure

    Sareeta Behera: Let's commence when we get a heads up from Shiva again

    Sareeta Behera: Take care and best wishes....

    Shena Shaikh: Thank you for your time Ma'am

    Sareeta Behera: Goodbye for now

    Sareeta Behera: My pleasure

    Responses 1

    • Sanjna Verma
      Sanjna Verma   Aug 03, 2017 06:56 PM

      Both these cases indicate how the environment and the psychological make up is necessary for the development of psychological disorders, and also how important it is to treat them accordingly. I liked the first case wherein the details of the therapy is explained. The second case highlights about sexual abuse in India. A typical example wherein the relative is always defended by persuading the child that they cannot do them any harm inspite of seeing their child suffer.

  • 11 Jul
    eWellness Expert

    Case history discussion of Hoarding Disorder

    psychotherapy group discussion

    Shiva Raman Pandey: Welcome back Sareeta
    Sayantani Dey: Good evening ma'am!
    Sareeta Behera: Good evening everyone
    Sareeta Behera: Hope you all had a good weekend!
    Shena Shaikh: Good evening, Ma'am
    Sayantani Dey: Yeah Ma'am
    Sareeta Behera: any questions about the case or techniques we shared last week?
    Sayantani Dey: From my side, no questions
    Sareeta Behera: ok
    Sareeta Behera: anyone?
    Reshma Venugopal: : Hi ma'am
    Sareeta Behera: Hi Reshma....welcome aboard
    Reshma Venugopal: : Sorry for the late reply
    Reshma Venugopal: : No questions
    Radhika Goel: : Radhika here, pursuing Psychology at Ashoka University, I have been following the conversations later, I was just curious if the client followed music therapy later? Like did he take the music form you or say that he listens to music when he feels agitated?
    Sareeta Behera: I started off with the music therapy for him. I am a trained in musicology. Later he was taught and follow up also revealed that he was religiously adhering to the therapy
    Sareeta Behera: he did not only listen to music when agitated, but made music a part of his daily life thereon
    Sareeta Behera: shall we move to today's case?
    Radhika Goel: : Thank you, yes!!
    Sayantani Dey: Yes
    Reshma Venugopal: : Yes
    Shena Shaikh: Yes
    Shiva Raman Pandey: Hi Sareeta
    Sareeta Behera: Mr D was a 45 yr old male, dwelling in the suburbs of Maharashtra. He had a habit of keeping or holding on to each and every thing in his house or possession. Be it a chocolate wrapper or an empty chips packet, he did not throw it after using them with the thought that he would need these in some or the other way. Gradually his house started accumulating with similar stuff including garbage. His wife and children tried a lot to make him understand that they did not need these articles. But, he did not listen to them. One day his wife and children left him and went away. Mr D continued with his accumulations. With the flow of time he was seen less in the neighbourhood or venturing out of his home. His neighbours reported to the police that he was not seen coming out of the house for 5 days at a stretch. All the newspapers and milk packets were seen lying out of the house. The neighbours called the police in suspect of death or illness.
    The police broke the main door of the house. Mr D was found unconscious in his bedroom under a pile of different types of material accumulations including garbage. His house and every room was filled and spilled with litter.
    Sareeta Behera: Hi Shiva
    Shiva Raman Pandey: There was a question from some interns - if discussing all the minute details except the identity of the client is still within confidentiality limits?
    Sareeta Behera: yes it is.....Unless and until we are sharing the name, not adhering to the informed consent of the client....then its fine
    Sareeta Behera: the cases that I will be sharing here are all subject to informed consent of the client. In fact, some are also keen to let their stories spread for others to know and learn
    Sareeta Behera: but you can land into problems if no prior INFORMED CONSENT is taken
    Sareeta Behera: Ok?
    Sayantani Dey: Sure
    Reshma Venugopal: : Okayy
    Shiva Raman Pandey: OK. Sure
    Sareeta Behera: any ideas on the present case?
    Shiva Raman Pandey: Shruti (Delhi) any questions on this?
    Reshma Venugopal: : I feel like holding on to unnecessary stuff is a cause of negative energy. And that causes clutter and hence all the conflicts between them
    Sareeta Behera: okk
    Sareeta Behera: and?
    Reshma Venugopal: : Maybe he fears that if he loses or gives up on one thing, he will lose a part of him.
    Shena Shaikh: Ma'am, did he suffer from a hoarding disorder that went undiagnosed?
    Sayantani Dey: Ma'am, at the Anal stage of psychosexual development of a child, it is seen that, child has a tendency to control his poop, because the child thinks that it is a part of the child's body, and he is loosing it. According to me, the present case is quite similar to that factor. I don't know, may be I am wrong!
    Sareeta Behera: There is nothing wrong in it s such. There are different ways of looking at it
    Sareeta Behera: no Shena....he did not suffer from any past history of hoarding disorder, until he was referred for psychological management. The present case is a scenario of hoarding disorder
    Sareeta Behera: Earlier it was not given much importance, however, gradually with the rise in the epidemiological aspects, today hoarding disorder is one of the most significant forms of psychopathology
    Sareeta Behera: In everyday lives, some of us do tend to kind of hoard to some specific things that are close to us or hold some special meaning to us. But, when this hoarding becomes excessive turning into a psychopathological stage and interfering in the daily life of a person…problems tend to begin
    Sareeta Behera: In terms of psychopathology, hoarding disorder is the inability of the owner to discard things, even if they are of no use or meaning to the owner
    Sareeta Behera: Any queries so far? Can you all come up with ideas on the possible management of hoarding disorder?
    Reshma Venugopal: : You mean how it can be helped ?
    Sareeta Behera: yes
    Sayantani Dey: Yes ma'am
    Sareeta Behera: Please come up with your thoughts and ideas on management of the disorder
    Reshma Venugopal: : Perhaps it's the same way as helping any other obsessive disorders... maybe the use of CBT in order to reconstruct his or her thought process on the hoarding. Letting them understand that they don't need to hold on to everything they have... and changing the direction of their thoughts basically
    Sareeta Behera: Good try Reshma
    Sareeta Behera: Keep it up
    Shruti Gupta Delhi: Good evening Shiva, I have no more questions. Thank you for letting me know about the informed consent bit.
    Shruti Gupta Delhi: I am Shruti, Currently pursuing B.A(H) Philosophy from Daulat Ram College, Delhi University. Pleasure to have Dr Sareeta with us.
    Shena Shaikh: Can we work towards understanding faulty schemas associated with the hoarding and change them?
    Understand why they've felt compelled to start in the first place?
    Sareeta Behera: Thanks Shruti
    Sareeta Behera: Very good Shena
    Sareeta Behera: Any other ideas?
    Reshma Venugopal: : Also maybe analyze the history behind hoarding. Is it a childhood thing? Then maybe we can say that it has stemmed from someone in his family during primary and secondary socialization. Or is it a more recent thing, which has stemmed after an event that caused a change in him?
    Sareeta Behera: It's a great brainstorming by everyone
    Sareeta Behera: For the present case, the management began with hospitalization first, since he was dehydrated, starving and unconscious
    Sareeta Behera: After getting discharged from the hospital he was admitted to the in-patient care of the psychiatric department
    Sareeta Behera: The further management was: Anxiety pacifying techniques first because he was greatly anxious and started searching his possessions
    Sareeta Behera: He was given biofeedback treatment procedures also
    Shruti Gupta Delhi: Has he lost something precious or something that really meant to him in his past such that he is compelled to holding on to even the minutest of the things?
    Sareeta Behera: Yes...we will come up to that
    Sareeta Behera: That was the precipitating factor
    Reshma Venugopal: : What is this ?
    Sareeta Behera: After anxiety mgmt and biofeedback, he kind of stabilised a bit. He loved to write poems. So, he was motivated for a cathartic writing first. He shared about a break up in the past prior to his marriage
    Sareeta Behera: I will say more about biofeedback Reshma
    Reshma Venugopal: : Okay ma'am
    Sareeta Behera: He shared that he was ditched by his ex and then he started holding on to the things that they had shared with each other during their relationship courtship
    Ayushi Jolly: So ma'am can the break up be related to it? Like maybe he's afraid to let things go
    Ayushi Jolly: Oh,right there
    Sareeta Behera: Yes
    Ayushi Jolly: How long ago was the break up?
    Sareeta Behera: Hardly one month prior to his wedding
    Ayushi Jolly: All right.
    Reshma Venugopal: : How long was his relationship
    Sareeta Behera: He did not get ample time to get over the break up
    Sareeta Behera: More than 8 yrs
    Reshma Venugopal: : Wow ..
    Ayushi Jolly: Is there a possibility of marrying to get over the break up?
    Reshma Venugopal: : Thanks
    Ayushi Jolly: That's a lot!
    Sareeta Behera: He was forced by his parents to get married. He couldn't deny
    Sareeta Behera: He said that he needed someone to be by his side
    Sareeta Behera: So marriage was a good option for him as reported by him
    Ayushi Jolly: Sure.
    Shruti Gupta Delhi: Had he been given at least some time to get over his past relationship, maybe things would have worked out for the better for him. ^This is so important.
    Ayushi Jolly: Was he able to feel towards his wife the same way he felt for his ex?
    Shruti Gupta Delhi: But what if he wasn't ready
    Shruti Gupta Delhi: And does his wife know about this?
    Ayushi Jolly: I think he wanted someone to help him get over so he decided to get married. Probably the best option available
    Sareeta Behera: the upcoming sessions included of extensive CBT and CR. Apart from that he was taught stress relieving techniques
    Sareeta Behera: The wife came to know about it, but she didn't blame anyone
    Sareeta Behera: She was cooperative upto the time the condition got worse
    Shruti Gupta Delhi: Another partner is not responsible neither obliged to help him get over the previous partner. This is unfair to his wife, I feel.
    Ayushi Jolly: Agreed.
    Reshma Venugopal: : I feel for the wife too. Like she was super cooperative
    Reshma Venugopal: : But then eventually it lapsed.
    Sayantani Dey: I agree
    Ayushi Jolly: Yes, took responsibility for something she wasn't involved in at all
    Sareeta Behera: In a continuum the interventions included:
    Psychiatric meds
    Cathartic writing and relevant counselling
    Article Hierarchy
    Response Prevention
    Shruti Gupta Delhi: Has there been any improvement?
    Shruti Gupta Delhi: Will these techniques be effective in letting him learn and understand the importance of letting go?
    Sareeta Behera: You all are right in your perspectives. The worst and best part of being a Psychologist is we can't be judgemental
    Ayushi Jolly: Ma'am can you please elaborate on article hierarchy? Haven't heard about it much before
    Sareeta Behera: Yes.
    Shruti Gupta Delhi: Yes, please.
    Sareeta Behera: Article Hierarchy is a way of re-understanding the value if different items
    Sareeta Behera: The items that he was hoarding on to were categorized into different types
    Reshma Venugopal: : I'm assuming this is specific for treating hoarding disorder, or is it used for other disorders also?
    Sareeta Behera: Eg: Kitchen items, Food items, medical items, and so on. Under each category the items that he has hoarding were mentioned and then he was asked to reflect on each of the item separately
    Ayushi Jolly: Reflect in the sense?
    Sareeta Behera: The CR technique that we discussed yesterday was intensively used if he would come up with irrelevant thoughts of hoarding it again
    Shena Shaikh: Significance of the item
    Reshma Venugopal: : Like how important was Each thing for him. Like to rate them
    Sareeta Behera: Yes
    Sareeta Behera: Exactly
    Sareeta Behera: Sure
    Ayushi Jolly: Thank you
    Sareeta Behera: The ERP or the emotional response Prevention technique was used when he was unable to let go of any item
    Sareeta Behera: For example, chocolate wrapper eaten by the ex and similar stuff like empty deo bottles etc
    Sareeta Behera: The ERP involved letting go off pent up emotions related to a particular item by either writing it, sharing it or self-analysing it
    Sayantani Dey: Sure
    Sareeta Behera: Am I clear?
    Reshma Venugopal: : Yes
    Sareeta Behera: The client was on extensive therapy for more than a year
    Ayushi Jolly: Yes ma'am
    Sareeta Behera: Gradually he started letting go off things and lead a meaningful life. He started his job again and with due course of time the spouse and children returned
    Ayushi Jolly: What about the family members? How supportive were they throughout sessions or when they realized the mental condition?
    Ayushi Jolly: That's great!
    Reshma Venugopal: : How long was he married to this lady?
    Sareeta Behera: Since the house was full of clutter, the family did not return immediately
    Reshma Venugopal: : His wife I mean
    Sareeta Behera: More than 5 yrs. The Disorder triggered in full swing when another friend of him disclosed about his divorce and how shattered he was after that
    Sareeta Behera: This also kind of flipped back the client to the situations in which he lost his ex
    Reshma Venugopal: : Ohh
    Sareeta Behera: In this case, unresolved emotional turmoil of the client due to the break up, inability to manage emotions and letting go off things subsequently hit him hard in the form of a severe hoarding Disorder
    Reshma Venugopal: : Getting over a breakup is so important honestly..
    Sareeta Behera: Sometimes unattended or mismanaged anxiety and depression can lead to fatal circumstances
    Ayushi Jolly: Very. No wonder where in life it develops into something worse
    Sareeta Behera: Right
    Sareeta Behera: Any questions about today's case ?
    Reshma Venugopal: : Wanted to know what is biofeedback
    Sareeta Behera: Yeah. I remember. Have anyone of you read or seen biofeedback before?
    Shena Shaikh: I have administered it as a part of lab coursework
    Sareeta Behera: That's great
    Sareeta Behera: Now to answer Reshma's query: A biofeedback is a machine kind of a thing that works on the brain-body mechanism
    Ayushi Jolly: Read.
    Sareeta Behera: There are almost 6 types of biofeedback. There would be electrodes attached to the forehead or fingers ...depending on the kind of biofeedback being used. During its administration, the Therapist would be saying about different suggestions, auto-suggestions
    Sareeta Behera: The response of the client to this would be shown in different light bars or readings of the biofeedback machine. This technique works wonders in stress management. It can also be amalgamated with music in the background
    Sareeta Behera: Please Google it further to look into the images of a biofeedback. That will give you a clearer picture
    Sareeta Behera: Any more questions?
    Reshma Venugopal: : The more you know! Thank you
    Reshma Venugopal: : Yes I will
    Ayushi Jolly: Yes ma'am. Performed the music one during practicals.
    Sareeta Behera: Sure
    Reshma Venugopal: : I have no further questions
    Sareeta Behera: OK....before we phase off today, I will share tomorrow's case so that you can come up with your own intervention plan. Please come up with a relevant diagnosis and a rough intervention sketch
    Reshma Venugopal: : Alrighty
    Sareeta Behera: Please remember that there is no right or wrong answers. Psychotherapy are manifold in nature. It is upto us to work in the best interest of the client and administer the techniques
    Sayantani Dey: Yes ma'am
    Ayushi Jolly: Agreed.
    Sareeta Behera: The Case:Mr M was a final year student in Law. He sought counselling and therapy for his uncontrollable fear of throwing up/vomiting in public. The symptoms also comprised of profuse sweating in palms and feet to the extent that his exam papers got wet. He could not concentrate in his classes and got flunked in his exams once. The aggravating factors were seeing others throw up, hot summer weather and illness of others.
    Sareeta Behera: He could not attend any of his exams because he couldn't stay outside for more than an hour. Later he left his studies and finally was referred for therapy
    Sareeta Behera: This is a brief layout of the case.
    Sareeta Behera: I have an idea of discussing some failure cases, ethics in the practices of Psychology and some specific psychometric tests if you all agree
    Ayushi Jolly: Thank you.
    Reshma Venugopal: : That sounds great.
    Sayantani Dey: Thank you ma'am. I would like to know about those cases...
    Sareeta Behera: That will add a lot to our learning, practical capacity building and help those in need to the best of our ability
    Shena Shaikh: Thank you Ma'am :)
    Sareeta Behera: Are you OK with it Shiva?
    Shiva Raman Pandey: Yes
    Sareeta Behera: Thank you Shiva and everyone for being so understanding, patient and yet so enthusiastic in learning
    Sareeta Behera: This will definitely take you a long way
    Reshma Venugopal: : Thank you ma'am for sharing your knowledge with us. Always a pleasure learning from you
    Sareeta Behera: My pleasure and duty Reshma
    Ayushi Jolly: Thank you so much ma'am. It was very informative.
    Sareeta Behera: Let's catch up tomorrow with inputs from all of you regarding the case
    Sareeta Behera: Thanks a ton
    Ayushi Jolly: Yes ma'am. Looking forward to it.
    Sayantani Dey: Thanks Ma'am. Goodnight.
    Shiva Raman Pandey: Thank you everyone for such a interactive session
    Sareeta Behera: Goodnight...
    Sareeta Behera: Bye for now
    Sareeta Behera: Mention not Shiva

    Responses 1

    • Ayushi Jolly
      Ayushi Jolly   Jul 20, 2017 01:10 PM
      Being a part of the discussion was a pleasure. The cases actually opened my eyes regarding how much effect a person can have on someone's life. We can actually make or mar a man. We should realize how important it is to help the other person in whatever possible way and help him through difficult situations. The interaction made me realize how a person's growth is related to the social environment. A successful ,mature person is also vulnerable to emotional trauma if someone hurts him. We easily fall in the trap of casual relationships but it is the aftermath that drives us crazy. This is one of the times when we united for a mental cause to understand theories by case study and spread knowledge and awareness among masses.
  • 09 Jul
    eWellness Expert

    Case history discussion of anger management and relationship issue

    Case History Discussion

    Psychotherapy case history discussion

    Case History

    Mr. A was an Officer in Command in the Indian Naval Aviation. He was considered to be very agile and dedicated towards his work. His battalion members reported that he was often very demanding and seemed to be agitated if things did not work out as per his expectations. Gradually, the agitations transformed into anger outbursts.

    His marital life was also falling apart. He had certain expectations from his wife that she should be grooming her well, present herself well in the military parties, pursue her educational career again and lead an enthusiastic life rather than a gloomy one.

    Aggravating Factors: Third party involvement of the other family members made the scenario even more complicated that Mr. A had to file a divorce.

    Consequence: The Chief of the Naval Aviation saw his deteriorating personal and professional output. He was referred for counseling to deal with such issues otherwise he would be facing a court Marshall.

    Question: As a counselor or Psychologist, what would have been your approach to deal with the case?


    Day 1


    Shiva Raman Pandey: Dear friends - Let me introduce you to Sareeta Behera, one of our senior psychologists.

    Sareeta Behera: Hello everyone

    Reshma Venugopal: Hi ma'am. Good to finally meet you.

    Shiva Raman Pandey: She is very talented (kind of God gifted), a great dancer, singer, painter, writer, human being and what not...

    Sareeta Behera: My pleasure....

    And please it's Shiva's modesty of imparting so much respect.

    Shiva Raman Pandey: I have shared the short write-up you gave yesterday with the team.

    Shruti Gupta Delhi: Good evening ma'am

    Sareeta Behera: Hi everyone.... This is Sareeta Behera. At present I am a Doctoral researcher in Clinical Psychology (Autism and Child Rights). I have been in the area of Psychology since 2005

    Sayantani Dey: Hello Ma'am!!

    Sareeta Behera: Hope you have read about the case which was shared today morning. I would appreciate your precious answers on that

    Sareeta Behera: Hi

    Reshma Venugopal: Hi, my name is Reshma Venugopal and I am going into my second year of BSc Psychology in Dubai.


    Yes. It was Very interesting to hear about the Officer. From what I understood, he is someone who takes his job and career very seriously. It is then makes him want to do everything perfectly. And all of the efforts into perfecting his life eventually caused anger issues, which is a common trait in many perfectionists. And that's where things went wrong for him. I think regular anger management wouldn't suffice and perhaps deeper psychotherapy which could identify the deeper meaning of his issues would help him. That way he could learn to control and avoid the areas that trigger him.

    Sareeta Behera: Well said Reshma! Let's brainstorm more

    Sareeta Behera: What would have been a step by step approach, any idea?

    Reshma Venugopal: Maybe, first begin by understanding the kind of person he is. We know that he is a perfectionist, but that's not the only thing that makes him. We could maybe use more of talk therapy to understand what his weaknesses are, and maybe direct him in fixing those issues first.

    Sareeta Behera: Ok....and his marital issues?

    Reshma Venugopal: Then maybe understand his upbringing and childhood, coz maybe there are some deep rooted facts that made him who he is now .i.e a man with a short temper and a perfectionist.

    Sayantani Dey: Hi, I am Sayantani Dey. I am doing my MA in psychology from BHU.

    It seems that Mr. A is not a bad person from heart. He is so much dedicated to his work that he can't tolerate any kind of mistake. His perfection becomes over perfection which turns into a nightmare.

    Relationships are very sensitive part of our life. He applied his life rules there, which leads him to this situation.

    I think he need. two or three type of therapies.

    1. Stress management sessions
    2. Anger control therapy
    3. Relationship counseling

    It would be helpful, I think so.

    Reshma Venugopal: His marital issues were only deteriorated because no one was there to tell him that he was expecting a bit more than what is usually expected. The couple should've communicated better and maybe before it got to divorce they should've visited a counselor than listen to relatives.

    Reshma Venugopal: Also, I don't think his ex wife would be able to forgive him unless he shows that he is a changed man. So for that she needs to know what the real problems are be more understanding towards the situation, but then again, I can see why that would not be the ideal situation.

    Sareeta Behera: Very good

    Shiva Raman Pandey: Question from a layman - Is expecting your wife to be well dressed and good looking a bit more? I agree they both need to discuss, but a person can want his/her spouse to be well dressed and carry well

    Sareeta Behera: Right

    Sareeta Behera: What core qualities do you think as professionals you would be inculcating within yourselves to take up the case?

    Reshma Venugopal: That's absolutely fine. But clearly, it was a bit much for his wife. Maybe if he had put up realistic goals for her she would've been able to keep it up. Because I know for a fact when husbands want something from their wives, unless it is communicated nicely without any force and all, then the wives will not like it

    Shubhanshi Singh: Hello!

    I am Shubhanshi Singh pursuing Psychology hons from Daulat Ram College for Women, Delhi University. 2nd year.

    Like it's mentioned, his battalion members reported that he would get agitated if things did not as per his expectations.

    Then in his marital life, his wife didn't stand to his expectations.


    I don't think of it as so much of a problem related to aggressiveness or stress. It's more cognitive in nature. His expectations and emotions get the better of him.

    Shubhanshi Singh: No. It's not.

    Infact his wife should have made sure that she dresses well considering it's an important part of social status. Dressing properly is about impression. Anyone would want to be portrayed in an impressive way. It is rather irresponsible of his wife to not understand his perspective. Ofcourse she failed to communicate as well. She is his wife, she should be comfortable talking to him about things.

    Reshma Venugopal: 1) be calm because we are going to be working with someone who has a very powerful and determined mind.

    2) Be open to all possibilities of him being the way he is.

    3) Show that you are optimistic that he will find a solution because often people lose hope if their therapists / counselors don't show any positivity.

    Sareeta Behera: Good

    Sareeta Behera: Any other comments?

    Sayantani Dey: First of all he is a much reputed man, and he work in a high rank. So, I should have minimum skills to communicate with that person.

    Then, his nature is very aggressive, so I should have patience when I am working as his counselor.

    Thirdly, He may argue or may deny accept his faulty behavior; try to convince him without argument.

    Sareeta Behera: Good

    Sareeta Behera: Anyone who would like to share more?

    Reshma Venugopal: I have a question, how many years into his marriage was he?

    Sareeta Behera: 4 years

    Sareeta Behera: During the initial phases of his marriage, he was just commissioned as an officer

    Priya Ratti: Hello ma'am, this is Priya Ratti. I'm doing BA (Hons) Psychology from Keshav Mahavidyalaya, Delhi University


    As Mr A is a perfectionist and things being out of order (the way he wants) perturbs him so much, can we look and find whether he is showing symptoms of an OCD? Could it be possible?

    Shiva Raman Pandey: I am not able to stop myself, though I am illiterate in the subject. In my therapeutic relation, the rank of officer is irrelevant. Good communication is key for a counselor any way.

    Sareeta Behera: After that he got promoted

    Sareeta Behera: Hi Priya

    Sareeta Behera: Here is some information about the wife:

    Shiva Raman Pandey: Second thing - We need to understand why he can't accept change or things when they don't go as per his expectation. There could be some childhood history connecting to this.

    Sareeta Behera: She belonged to a simple family. Her father had succumbed to an illness. Her mother wanted her to complete graduation so that she could get married off

    Reshma Venugopal: Maybe the reason why she couldn't hold on was because she had her on aspirations? And on top of that, if someone forces or expects more, then she may have felt overwhelmed?

    Sareeta Behera: She married at the age of 22-23. She didn't have any professional or educational ambitions. She wanted to become a good homemaker

    Reshma Venugopal: *own

    Reshma Venugopal: Oh never mind...

    Sayantani Dey: I understand what you are saying. But I was saying that, when I am talking to a normal person, the way I will communicate will be any how different when I am talking to P.M. Modi. There have some differences, because when I am talking to a very reputed man, I need some spoken skills.

    Sareeta Behera: U r right Reshma

    Sareeta Behera: Each one of you are correct as per your perspectives

    Shiva Raman Pandey: Some Indian ladies (simple Indian girls who only aim to be a good house wife and take care of family) start detaching themselves when they find husband very advanced/modern/demanding and then they develop a tendency to not do anything that he wants. Hope I am not prejudiced

    Aparna Kanmani: Hello mam. This is Aparna. I am doing my masters in Clinical Psychology from Manipal University. 


    I feel the client has ideals for his life. He wants to control all aspects of his life. As an officer it helped him to an extent. They realized the pressured perfectionism only when the stress/anger followed it if things didn't go as per his plan. In the similar lines he tried to control the activities of his wife too according to his expectations.

    Sareeta Behera: You are not prejudiced Shiva. There are always exceptions

    Reshma Venugopal: Perhaps she had more to just being a home maker. Maybe she felt pressured because she isn't used to that kind of life and in addition she had the stress of taking care of her father, and a mother who just wanted her to get married and settled. I could see why she felt frustrated because she prolly felt like there is too much expectation from her.

    Sareeta Behera: Hello Aparna

    Sareeta Behera: Yes

    Sareeta Behera: Let's hear to Aparna's words and then we will proceed to what was the approach that was used

    Shanmugi B.P: Hello mam I am Shanmugi BP. I am pursuing my BE in Computer Science stream


    I think some Indian wives also think their husband as a great man and believe them as everything; and if there is anything bad or worse happens they will first try to bring the solution for that.This is my point of perspectives.

    Aparna Kanmani: Additionally, I feel he is a person giving importance to social status and is easily embarrassed if things go wrong. There is a strong necessity to maintain a social image, which is why he is so specific about his wife being presentable in the party. That is also why he couldn't take it when some third person involved in their relationship and commented on it.

    Reshma Venugopal: Agreed

    Sareeta Behera: Hello Shanmugi

    Sareeta Behera: Third party involvement was both the aggravating and precipitating factor here. Well pointed out Aparna

    Sareeta Behera: Any more comments or queries? Shall I start with the interventions modality?

    Aparna Kanmani: What was the presenting complaint and was he willing to take up counseling with an insight?

    Sayantani Dey: I have no queries.

    Sareeta Behera: OK....About the presenting complaint:

    Sareeta Behera: He had come through a referral of the Naval Aviation Commander and the Unit. His initial referral papers showed anger and marital issues

    Sareeta Behera: Any more questions? Please feel free to ask....

    Reshma Venugopal: How was his rapport with all of his colleagues? Was it always anger filled or did he have some fun sides?

    Sareeta Behera: He did have his lighter side too. He was bit picky in revealing that side of his personality. His colleagues had mixed feelings regarding him

    Aparna Kanmani: Did he have at least a slight idea that he is the one causing trouble and needs to change is behavior?

    Reshma Venugopal: I think he has been through a lot in his childhood that he is even picky at revealing his fun side. Sometimes all it takes is to bring that side out more than the sad side

    Sareeta Behera: Partly Aparna

    Sayantani Dey: Do you think that he was happy when he married his wife? I mean, was he ready for this marriage?

    Aparna Kanmani: Thanks. No queries from my side.

    Sareeta Behera: There was non-consanguinity in his marriage. And he was quite happy in the beginning

    Sayantani Dey: Thanks. No more questions.

    Sareeta Behera: Good

    Reshma Venugopal: I have no more queries

    Sareeta Behera: Do u all know about the level of insight parameters that we use in the Clinical area?

    Aparna Kanmani: I do.

    Sareeta Behera: Good

    Reshma Venugopal: I'm not aware of it as of now

    Priya Ratti: I'm afraid no

    Sayantani Dey: I also have no idea

    Sareeta Behera: OK....no problem.

    To add more, there are 6 parameters in the level of insight of a person. Insight in Clinical Psychology refers to how much the person is aware of or knows about his/her presenting problems

    Sareeta Behera: The present client was in the Level 3 of insight.

    Sareeta Behera: So shall I begin with the therapy approach?

    Sayantani Dey: Yes

    Aparna Kanmani: Yes

    Priya Ratti: Madam How is this ascertained?

    Sareeta Behera: Please remember that the approach that I used is not a Hitler type that needs to be followed at any cost.It's more of a reflection on how to proceed forward in such a case

    Sareeta Behera: There are Clinical protocols to ascertain the level of insight. We are trained with the APA format

    Reshma Venugopal: Yes

    Priya Ratti: Oh, alright. ☺

    Sareeta Behera: At the outset...thank you everyone for your interest and for venturing into the journey of helping the ailing

    Sareeta Behera: Kudos to all of you

    Sareeta Behera: Let's begin.....

    Sareeta Behera: Initial Phase: Preparatory Phase of the Therapist/Counselor:

    As soon as the case was assigned, a SWOT analysis was done both on the case and the Counselor. SWOT refers to Strengths Weakness Opportunity Threat

    Sareeta Behera: After that a comprehensive analysis of the need and gaps was done

    Sareeta Behera: Following were the gaps in the case: Since the Naval Aviation Commander and the entire unit had already known about the issues and court Marshall Threat that the client was facing, there was already a breach in the CONFIDENTIALITY aspect

    Sareeta Behera: This had further aggravated the disappointment and frustration level of the client

    Sareeta Behera: Secondly the gap also included the interference of a common relative who was infusing negativity in the minds of both the client and his wife

    Sareeta Behera: Got it?

    Sayantani Dey: Yes.

    Sareeta Behera: Any questions so far?

    Reshma Venugopal: Yes

    Sareeta Behera: Ok

    Priya Ratti: Yes

    Shanmugi B.P: S

    Sareeta Behera: The Counselor's part: Since it was a referral that involved a military base, the first step was to psycho-educate self on military life and lifestyle first. Of course the initial knowledge was present, but a deeper reflection was worked out and researched by the Counselor.

    Sareeta Behera: Secondly, even before starting the initial interview and stuff, an INFORMED CONSENT of both the parties was taken

    Reshma Venugopal: Okay that makes sense

    Sareeta Behera: Yes

    Sayantani Dey: Yes

    Sareeta Behera: Qualities that the Counselor has to stick to:

    1) Ensuring confidentiality of the client at any cost. This also included not revealing all the intricate and sensitive issues of the client with the Naval Unit.

    2) Building good rapport and professional clientele space

    3) Genuineness and non-judgmental attitude

    4) Respecting the Right to Life with Dignity of the client

    Sareeta Behera: Other aspects like patience, empathy, active listening were an obvious part of the core values

    Sareeta Behera: To add more: Right to Life with Dignity is a Constitutional mandate enshrined in the Indian Constitution too. From a psychological perspective and Rights based perspective, it means to respect a person without being judgmental or thrashing our own subjective opinions

    Sareeta Behera: The Session: The session began with the initial formalities mentioned earlier.

    It began with understanding the client's POV on counseling and clearing all his stereotypes and prejudiced notions and myths about counseling.

    Sareeta Behera: A strong rapport was established, his counseling expectations were understood and the expected outcome of the therapy//counseling was clearly defined

    Sareeta Behera: Then the goals were charted out after initial insight building and psycho-education of the client regarding his presenting issues

    Sareeta Behera: The first session was a bit long but his negative thought clouds and resistance was successfully dealt with

    Sareeta Behera: With the consent of the client, the second session included separate one-to-one sessions with him and his wife then a combined couple therapy session thereafter.

    Sareeta Behera: The wife revealed about her struggles of coping with the military parties, how much she loved her husband and how much she longed to live a happy life with him. She was sad about the over expectations and comparisons that the husband did with other military wives.

    The session with the client revealed a history of Child abuse, a strict childhood environment and his father's call to be a perfectionist always. His father was an ex-army officer BTW

    Sareeta Behera: Other issues revealed by the client involved his work pressures, wife's lack of quality education and complete dependence on him, fertility issues also.

    Sareeta Behera: All these were brewing up the challenges on his part even more.

    Sareeta Behera: The couple therapy session was mostly based on behavior therapy, ice-breaking games between the partners and writing love letters to each other.

    Sareeta Behera: The third session included CBT approach, REBT and neo-rogerian approach. The session for the wife included enabling and empowering her plus the neo-rogerian approach

    Reshma Venugopal: Wow

    Aparna Kanmani: Great

    Reshma Venugopal: That's amazing

    Reshma Venugopal: Thank you Ma'am, I've learnt so much today :")

    Sareeta Behera: The inputs also included anger management strategies

    Sayantani Dey: So much to know

    Sayantani Dey: Thank you ma'am.

    Sareeta Behera: The training also included music therapy, JPMR, cathartic writing and cognitive restructuring

    Sareeta Behera: The icing on the cake was the last session, that is:

    Sareeta Behera: Both the partners were made to write about the expectations they had from each other and what were the different ways in which they could achieve those

    Sareeta Behera: Unachievable and unrealistic expectations were again psychoeducated were overruled by both of them. They were asked to write about each other's good quality and qualities that needed improvement

    Sareeta Behera: Finally they were made to share it with each other

    Sareeta Behera: No negative word was encouraged

    Aparna Kanmani: Sounds great! Looks like they responded very well!

    Sareeta Behera: Yes

    Aparna Kanmani: Thank you for your patience mam! It was lovely hearing you!

    Sareeta Behera: Both of them cried in the end and hugged each other. The termination was done by starting a positivity portfolio by both of them which they had to complete during the follow up

    Sayantani Dey: >appy to hear that...

    Sareeta Behera: In between the termination and follow up both of them were seen moving in the streets with hand in hand, eating ice cream, sharing with each other and getting cozy

    Aparna Kanmani: Crying is often a good sign when it comes to counseling! Lightens the burden held.

    Sareeta Behera: Exactly

    Priya Ratti: Oh wow, this is so amazing!

    Reshma Venugopal: Awwh that's a job well done

    Sareeta Behera: This was the basic logistics of the case. Can we all discuss about the particular therapy techniques that helped in another discussion tomorrow?

    Shiva Raman Pandey: Yes, We would love to.

    Sareeta Behera: As in out of numerous CBT, BT, REBT techniques what were the pin-pointed ones

    Priya Ratti: That sounds great

    Sareeta Behera: Is it OK Shiva?

    Shiva Raman Pandey: Perfect

    Sayantani Dey: Would love to hear...

    Aparna Kanmani: Sure

    Sareeta Behera: Tomorrow it would be on CBT, Music Therapy, REBT and Positivity Portfolio


    Day 2


    Shiva Raman Pandey: Welcome back Sareeta

    Sareeta Behera: Hello Shiva and Hi everyone

    Sayantani Dey: Hello Ma'am. Good evening

    Sareeta Behera: Thank you for an interactive session yesterday. Hope we will do much better today

    Sayantani Dey: Yes

    Sareeta Behera: Do share your feedback so that the efficacy can be improved

    Sareeta Behera: As a continuation of yesterday's case, today we will look into specific psychological techniques that worked

    Sareeta Behera: Any queries before that?

    Sayantani Dey: Actually Ma'am, I am doing my MA in OP.... But I find it interesting and helpful for me. I would love to learn in details. No Ma'am, I have no queries

    Sareeta Behera: cool.....good to know about your area of interest

    Sareeta Behera: are you all aware about CBT? It would be great if someone throws some light on it

    Sayantani Dey: No Ma'am!

    Sareeta Behera: It’s ok...np

    Reshma Venugopal: I know it stands for cognitive behavioral therapy

    Reshma Venugopal: But would like more insight in it

    Sareeta Behera: That’s right Reshma

    Sareeta Behera: CBT stands for cognitive behavior therapy. Please say more on what you know about cognition and behavior

    Reshma Venugopal: I think it's the process of therapy where we try to make the client understand their thinking processes and how they can be better by helping their mind and stuff. So like mindfulness and exercises that help the cognitive part of the process

    Reshma Venugopal: I'm not completely sure though.

    Sareeta Behera: that’s right

    Priya Ratti: Ma'am from what I know, CBT is used when a person's problems arise from certain cognitive distortions. These distortions are treated through questioning and exercises that help them overcome such beliefs

    Sareeta Behera: In simple terms, cognition refers to higher thinking processes like planning, decision making, memorizing something and so on

    Sareeta Behera: Behavior in books is usually defined as any observable or measurable activity. But in real time psychological practices, behavior is an off-shoot of thinking process

    Sareeta Behera: CBT has manifold techniques including deep thinking, processing, and mindfulness and so on. In the case that we discussed yesterday, Cognitive Restructuring helped

    Sayantani Dey: Human behavior is governed by cognitive aspects like sensation, perception, memory, learning etc. And this therapy is used if any problem arises with the function of behavior because of the cognitive aspects.

    Sareeta Behera: Do you all know about the cognitive restructuring technique?

    Reshma Venugopal: Does cognitive restructuring mean changing their thinking?

    Sareeta Behera: Well said Sayantani

    Sayantani Dey: Thank you ma'am

    Reshma Venugopal: Like if they believe in one thing, and then cognitive restructuring sort of helps them to see things differently?

    Sareeta Behera: kind of....in a structural systematic approach

    Reshma Venugopal: Okay

    Sareeta Behera: Good

    Sareeta Behera: Cognitive restructuring is all about getting rid of negative or harmful thoughts and restructuring or reframing them positively/appropriately

    Sareeta Behera: Reshma pointed out well

    Sareeta Behera: CR is done systematically, gradually moving from one thought to another

    Sareeta Behera: got it?

    Reshma Venugopal: Yes

    Sareeta Behera: in this case when the client said, "I don't like my wife to be so backward and dull" CR was used

    Sareeta Behera: In the CR approach a hierarchy of all the inappropriate thoughts was done

    Sareeta Behera: the thought with the highest negative valence was given the first priority

    Sareeta Behera: like in the above example, when the client said so, he was asked another question, "In what way is your wife dull and backward? How do you define backwardness or dullness?

    Sareeta Behera: once we got to know about his definition and thinking, appropriate positive thoughts were conveyed to him

    Sareeta Behera: makes sense?

    Reshma Venugopal: Yes

    Sayantani Dey: Yes

    Aparna Kanmani: Yes!

    Reshma Venugopal: So how do we know which is the highest negative valence? A series of questions were asked?

    Sareeta Behera: In the second phase, the client was helped to make a pocket behavioral logbook of positive thoughts

    Sareeta Behera: yes

    Reshma Venugopal: Is there a format to follow?

    Reshma Venugopal: Okay

    Sareeta Behera: there's no format

    Sareeta Behera: you need to assess what is the most harmful thought of the client

    Reshma Venugopal: Oh okay

    Sareeta Behera: and then make a hierarchy

    Reshma Venugopal: Okay makes sense

    Sareeta Behera: any ideas of a behavioral logbook?

    Sareeta Behera: A behavioral logbook is more like a scrapbook used for children. It is divided into different topics like Marital Life, Professional Life, Personal Value systems, etc

    Aparna Kanmani: Note down their behavior and the thoughts related to it?

    Reshma Venugopal: Okay

    Sayantani Dey: I guess, it is a list of positive behaviors which will be induced in him.

    Sareeta Behera: the client is made to write positive self-suggestions on that, so that whenever he faces any negative thought related to any of the life dimensions, he can open that section, read it and train his mind to manifest it behaviorally

    Sareeta Behera: This is how the CR is done phase by phase. With gradual smooth transition from negative thoughts and behaviors into positive ones

    Reshma Venugopal: Makes sense

    Sareeta Behera: There were some instances in which the client showed resistance in listening to the transitioned thoughts

    Sareeta Behera: can you guess why?

    Sareeta Behera: Anyone?

    Sayantani Dey: May be it hurts the client's ego!

    Reshma Venugopal: Because it's hard for a new change. And people can't just change their thought process, hence the resistance, like ego

    Sareeta Behera: Because the thoughts were already deeply etched in the belief system of the client. The belief systems were hard to shake off. So in-depth questions in different permutations and combinations were asked

    Sareeta Behera: Mere thoughts and Belief Systems are two different things. That’s where CBT works wonders in cross-cutting through the different types of thought processes

    Sareeta Behera: Any questions so far? Shall we move forward to another CBT method?

    Reshma Venugopal: I did not know that! That's interesting

    Sareeta Behera: yes

    Reshma Venugopal: Yes

    Sareeta Behera: The other method used was Thought Stop and Thought Shift method

    Sareeta Behera: these CBT methods are magical in many of the mental health issues. They are most effective in OCD management

    Sareeta Behera: heard about it before?

    Reshma Venugopal: Not about though stop and thought shift as such

    Reshma Venugopal: But I'm assuming it's to train the client to stop the negativity and shift more towards the positive thinking

    Sareeta Behera: the thought stop method includes: Taking a long deep breathe, closing one's fists tightly and then mentally shouting the word STOP and finally releasing once breathe

    Sareeta Behera: Any idea about the neuropsychology rationale behind doing this?

    Sareeta Behera: the brain releases certain neurochemicals at the trigger of every thought, right? When there's a negative thought, the brain, synapses, neurons are kind of bombarded with gushes of unhealthy neurochemicals

    Reshma Venugopal: Breathing is helped to keep calm? I'm not sure. I am just guessing. Breathing is said to relive stress

    Reshma Venugopal: Oh

    Sayantani Dey: Interesting

    Sareeta Behera: that’s why when you start feeling angry, if you don't stop it or channelizing it, you will feel angrier and finally take it out behaviorally

    Sayantani Dey: Is it related to meditation? I mean meditation is helpful in anger control.

    Reshma Venugopal: I was thinking in the same lines

    Sareeta Behera: when you stop the breathe, the neurochemical is stopped to be further flowing due to a pit stop in the blood and oxygen flow in the brain. During that vacuum phase, if one mentally shuts STOP and releases the breath, the negative neurochemical kind of stabilizes and starts flowing with ease.

    Sareeta Behera: secondly, the the vacuum phase and the word also creates healthy neurochemical as an antidote

    Sareeta Behera: For e.g. if you are angry, your brain produces adrenaline, if you engage in any positive activity your brain starts producing nor adrenaline as an antidote and u start feeling better

    Sareeta Behera: this is the neurochemical behind the thought-stop method.

    Sareeta Behera: the thought-shift method involves asking the client to engage in a positive activity of almost equal valence

    Reshma Venugopal: Okay

    Sayantani Dey: Understood

    Ayushi Jolly: Good evening ma'am. I'm Ayushi, a recent graduate in Psychology. Thank you for the enlightenment. That was a difficult process broken into simple words.

    Sareeta Behera: for e.g.: if someone is angry and yelling, asking him or her to sing or keep calm would be unwise. But giving him/her a stress buster ball, a boxing bag and so on would help him/her pacify better

    Sayantani Dey: I heard somewhere, cutting papers by scissor is also effective to reduce anger.

    Sareeta Behera: in the thought shift method, the client is asked about his/her likes/dislikes, motivating factors beforehand. During the thought shift technique his/her inputs are shared as positive clues/cues

    Sareeta Behera: yes

    Sareeta Behera: there are many techniques. It depends on the valence and acuteness of the condition and then intervened accordingly

    Sareeta Behera: Hope you all have understood?

    Sayantani Dey: Yes

    Sareeta Behera: I shall move now to the next therapy used: Music Therapy

    Sayantani Dey: Yes

    Reshma Venugopal: Yes

    Sareeta Behera: Music therapy involved knowing about the music preferences of the client in the first hand and then gradually introducing him to the real time therapeutic music. Music therapy for the client was blended with JPMR and Yog Nidra

    Sareeta Behera: After knowing his preferences, first JPMR along with his fav music was played. Then JPMR with monotone sounds like sound of sea waves, purling sounds of rivers, rains nd chirping birds was used one by one

    Aparna Kanmani: Mam, but this method will be effective only when the patient is bombarded with negative thoughts, right?

    Sareeta Behera: yes......negative thoughts also include symptomatic psychopathologic thoughts too

    Sareeta Behera: Monotone sounds were included first to improve concentration, stress and tension release, pacifying

    Sareeta Behera: Finally Yog Nidra along with Indian Therapy Raga with Western Melody system was used

    Sareeta Behera: this was mostly instrumental in form to keep subjective biasness, religion, ethnicity issues at bay

    Aparna Kanmani: When the client mentally screams STOP, Isn't that a temporary avoidance of the thought. How long should this be done to have a significant effect.  Also, what is the significance of the word STOP here? Will it work just as fine with any other word?

    Sareeta Behera: May be we can take separate sessions on Yog Nidra, JPMR and Hypnosis

    Sayantani Dey: Buddhist chants and music is also helpful if I am not wrong. And I heard somewhere that the songs of the band “Pink Floyd” are also helpful for patients who are suffering from mental disorders.

    Sareeta Behera: Good question Aparna

    Aparna Kanmani: Would love one on Hypnosis!

    Sareeta Behera: that is why CR is used as a combo. All these are not used as separate entities.

    Aparna Kanmani: Alright, so all these are done simultaneously!

    Sareeta Behera: thought stop is used when one is not at all able to control the negative gush of thoughts and when one is not able to control the outbursts or reactions both mentally, verbally, behaviorally

    Sareeta Behera: Yes

    Sareeta Behera: The client reported that when the client was upset at night, he used to resort to a painful sex with his wife deliberately

    Sareeta Behera: Thought stop and shift method helped him to pacify and transform his sexual activity from mere reaction to love-making

    Sareeta Behera: got it?

    Reshma Venugopal: Wow yes.

    Sayantani Dey: Yeah Ma'am

    Sareeta Behera: any questions?

    Sareeta Behera: Positivity portfolio and timeline are some other technicalities that we will discuss in our upcoming cases

    Aparna Kanmani: Can you give an example. Or the type of questions you asked for him to make the transformation?

    Sareeta Behera: I didn't ask him about the sexual activity. He shared it by himself after he practiced the methods

    Sareeta Behera: He said Ma'am aapko ek baat bolna chahta hoon agar aap bura na maane to...and then he described his sexual activity with his wife

    Sareeta Behera: Then he only said ki aapke techniques use karke mujhe laga ke main apni patni ke saath bohat bura kar raha tha

    Sareeta Behera: Ab main aisa nahi karunga aur usko pyaar ka ehsaas karwaunga na ki zabardasti

    Sareeta Behera: These were the verbatim used

    Sareeta Behera: For tomorrow, may be you all can pick a case from: Child sexual abuse, emetophobia, hoarding Disorder and incest

    Sareeta Behera: So which Disorder or issue shall we discuss the case on?

    Sareeta Behera: ?

    Sayantani Dey: Emetophobia or hoarding disorder. These are not familiar to me.

    Sareeta Behera: Ok

    Sareeta Behera: Everyone is OK with it?

    Reshma Venugopal: Yes I agree

    Sareeta Behera: Cool

    Aparna Kanmani: Incest sounds interesting

    Aparna Kanmani: Emetophobia and hoarding are anxiety based. One of it would be good I feel.

    Sareeta Behera: Ok

    Sareeta Behera: If time would permit we can deal with both the Disorders

    Sareeta Behera: And then move to incest

    Sareeta Behera: Sounds OK?

    Aparna Kanmani: Sure mam

    Sayantani Dey: Yeah. Great!

    Sareeta Behera: OK done

    Sareeta Behera: Please let me know if I tend to move fast or get too much technical to understand

    Sareeta Behera: I will simplify the concepts further

    Sareeta Behera: So let's phase off now. That's all from my side for today. If you have further queries then let's discuss them tomorrow first and then commence with the cases

    Sareeta Behera: Goodbye for now....See ya tomorrow. Thank you everyone for all your enthusiasm, interest and active participation

    Sayantani Dey: Thank you ma'am. Good night.

    Sareeta Behera: My pleasure

    Sareeta Behera: Good night

  • 02 Jul
    Prasha saggu

    Success Story of a transgender to the world of dance

    narthaki natraj

    Classification is important as it makes the complex life much simpler. We classify things everyday and even put the stimuli from environment into groups. From the time we are born, we are subjected to be classified according to our sex which helps the society assign the gender roles and decide the way an individual is to be brought up.

    If it is a girl, she is to be dressed in pink and made to play with dolls while boys are to be dressed in blue and it is presumed that they will play with cars and action figures. But what happens when someone does not fit into the criteria that the society has formulated. Those who do not fit into either of the criteria are declared abnormal and are discriminated against from the time they step into this world.

    What it feels like being “different”, when your biological sex does not match your sexual identity. It is like living your whole life as a beautiful and attractive lady but one sudden day, you wake up as a man with strong built, muscles, body hair and facial hair. You can no longer dress up in the exquisite manner the way you used to, can no longer be who you are. This is what it is to be “not normal” or what we call as transgender. It is like being trapped inside yourself.

    We all are born with a sense of self identity and a sexual characteristic of either male or female. But these both may not always match and most transgender realize this incongruence as early as at the age of 4. This incongruence is attributed to the hormonal imbalances in the developing fetus which results in a brain which develops outside of the norm of the physical sex. The person thus develops a sexual orientation opposite to that of the physical sex. And what after that? No, these individuals are not just struggling within themselves but face hostility and harassment but the world too.

    At home, they feel dejected and at schools these kids get bullied and are mocked at for their gender and sexuality. This continues as they grow up and struggle to get a job where again they are discriminated against. But there have been certain people who have managed to break the prejudice and stereotypes people have towards transgender. They have managed to come out of the shackles of the slumber and made it to their dreams. Narthaki Nataraj is an example of a woman (not naturally born as one) who made it to her dreams despite all the hindrances and inhibitions on her way.
    Narthaki Nataraj, India’s first transgender Bharatanatyam dancer made it to the apex of her dance form in spite of exclusion and derision faced by her.
    It was at the age of 10 that Nataraj realized that he was born in the wrong body and driven by social insecurity he left his home at the age of 12. Nataraj had interest in dance which made him fall in love with it since an early age. He would perform at his school functions and wipe off his makeup but always got caught by his parents. After leaving his home, he and his friend did menial jobs to earn a living and Nataraj kept searching for a guru who would accept him and help him with his dream. He finally found Thanjavur Kittappa Pillai in 1984. As he pleaded his heart out, hoping to be accepted Kittappa rechristened him Narthaki Nataraj.

    narthaki natraj

    Classical dance at that time was still female dominated and was far from reform but bharatanatayam in the 20th century went through some reformulations and male performers were finally starting to be accepted. Narthaki then studied bharatanatayam from the guru- kittappa. When presented before the dance community, she was laughed at but ultimately accepted and she grew as a phenomenal dancer. She went on to establish her own dance schools in Chennai and Madurai. In 2007, she was honored by the government of Tamil Nadu with the Kalaimamani award. And in 2011 she was honored with the Sangeet Natak Akademi award by the president of India, a first for any transgender.

    Responses 1

    • Radhika Goel
      Radhika Goel   Jul 31, 2017 05:49 PM

      Hii, this is such a beautiful story. We all need to question what is 'normal' for any gender. People often talk about stereotypes associated with males and females and the importance of breaking them. We need to analyse and realise the source of these stereotypes and why they exist at all. We create triple the number of barriers for a person who already find it difficult to understand their place. What is sad is that they need to find a place for themselves in society and it's not already created for them. Who they are is as normal as it can be.

  • 10 Jun
    eWellness Expert

    Diary of a sexually abused girl

    girls help

    Dear Diary,

    It’s been so long since I wrote to you. Years, maybe. I do remember the time I stopped writing. It was actually the time I stopped doing pretty much everything. I was raped, you see. I stopped doing anything the minute I was groped and pulled aside. The only thing I wished I had stopped doing was breathe, which I didn’t. It felt so unfortunate to have lived after.

    It was my friend’s birthday. We had all had decided to meet at her place and then go out to party. The party was in CP. We all were so dolled up. I was wearing a dress. Life was so good back then. Laughing the way we used to seems almost impossible now. The party ended around 9:25 pm.

    I didn’t drink at all, because like everyone else, I didn’t have an extra car to pick me up from home. I used to travel by metro. So my friends dropped me at the nearest metro station of Barakhamba Road. I was in a hurry because I was already very late. When I reached the platform, the train was going away so I ran and entered the general coach.

    It was really crowded but I didn’t have the time to run towards the women coach. Over that, there was something wrong with the metro and it was stopping for more than ten minutes at every station. I remember thinking about how everything in the world makes us even more late when we already are. I also remember smiling at the view outside. I liked travelling late at night.

    The city lights looked so beautiful from above. Because it was getting late and the metro was also moving slowly, I decided to get down at Laxmi Nagar metro station and take a bus towards Anand Vihar, the nearest bus stand to my house. I waited for five minutes and then the bus arrived. I got in. I scanned the bus to see four men and a woman inside. I was actually comforted when I saw the woman.

    I actually wished, at that moment, that she would get down after me. But she got down just two minutes after I got in. It wasn’t my lucky day. It was the first time I thought about how crowded buses are actually better than deserted ones. I sat in the front. It was only my third time ever in this bus.

    I was just hoping to get home as soon as possible. Next, I noticed the bus wasn’t on it’s normal route. The driver had taken one wrong turn. Being the shy girl that I am, I stayed quiet assuming it must be a short cut. Just five minutes later, I realised it wasn’t. The bus was approaching a deserted petrol pump. That’s when I decided to ask the bus driver about it.

    I got up and started walking towards the driver when I felt someone’s hands grab me from behind, one hand on my mouth and the other on my stomach. I can’t describe what I felt at that time. It was something I had feared more than death, like all other girls. Except, it was my time.

    I tried to fight back. I did. Only everything I did couldn’t make a difference. Those men were like huge monsters and I was too little to hurt them. I couldn’t even hurt one, even a little bit. It’s one of the things I regret about that night. I wanted to hurt them so much. They took their turns and got done with me. Then they left me at that place. They threw my bag outside, after they did me. I was too hurt to move. I didn’t feel like doing anything. But I fought that feeling, gathered myself and opened my bag. I took my phone and called home. I couldn’t speak but I knew they could hear me crying. I didn’t even know where I was to tell them. I don’t know how they found out, but they did and came to get me.

    Today’s entry isn’t only about what happened, how it happened, or why. I try to not give it that much power over me now. This entry is also about my come back, my breakthrough, or some would say, my recovery.

    A few weeks after the incident, my family started pestering me to go see a psychologist. I couldn’t see why it would help and said no a hundred times. I was convinced later. The therapist was nice and just wanted to help but I didn’t feel like talking to her in the first few sessions. I only spoke for like four times in those three hours and that was enough for her, for some weird reason. Once, I asked her if the pain would ever end, and she said yes. It hasn’t ended yet. But, it has reduced. Earlier, it felt as if I had this huge boulder on my heart that made it feel so heavy. It’s a pebble now. It’s always there. I can always feel it. I’m just glad it’s smaller now.

    In one of my sessions with her, I remember, I really got it all out. I spoke about how it would never leave my mind. I told her about how much guilt I used to feel, how I wished I had not gotten into that bus, maybe if I had worn something else; it wouldn’t have happened. She told me I would not have been raped had the rapist chosen to respect me, to not commit a crime or to be a decent human being. I did have the right to wear what I wore, to get on that bus. They did not have the right to rape me.

    After grief came anger and after that, came a combination of both. My journey was long and is still going on. I don’t know when it will end, or if it will ever end, for that matter. I’m just glad I’ve started being alive again. I’ve started doing things again, including writing to you. I’m glad I was able to make this possible, what seemed so impossible a few years back, to smile again.

    Responses 2

    • Sanjna Verma
      Sanjna Verma   Aug 01, 2017 10:26 PM

      This account is horrifying but rapists can never ever understand their plight. They only know how to gratify their sexual desires and overpower women and this has increased also because of the fact that women are trying towards getting their rights and respect and they cannot bear that because of their male ego. This mindest needs to be changed. Boys at a young age should be made to be respectful and empathetic towards others. This will take lot of generations to happen, unfortunately.

    • Heena Sheth
      Heena Sheth   Jul 18, 2017 01:10 AM

      I believe that our society still has a long way to go when it comes to respecting women and the choices that they make. It does seem like a difficult process when you have to alter the minds of hundreds and thousands of people who have the potential of becoming a rapist in them. It saddens me further when I recall about the history lessons where we learnt that women in the Early Vedic period enjoyed equal rights as men did, are now limited to only a little section of our society. One can only hope that one day, as women we will be in a place "Where the mind is without fear and the head is held high".