Clinical Case Formulation of Mr Sediki

CLINICAL CASE STUDY CLINICAL CASE STUDY 1 1 CLINICAL CASE STUDY Theoretical approaches to clinical case formulation Author Note: Answer 1 According to the psychodynamic theory, childhood events have a significant impact in shaping one’s personality and transforming adult life. As per this theory, people might experience self-contradicting thoughts and emotions in a situation as responses of the mind occur parallel to the sub-conscious mind. This theory also explains that the social

Running head: CLINICAL CASE STUDY
Theoretical approaches to clinical case formulation
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Author Note:

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Answer 1
According to the psychodynamic theory, childhood events have a significant impact
in shaping one’s personality and transforming adult life. These events stay in the unconscious
adult mind and are the reason for many of the problems faced in adult life. Mr Sediki, too
mentions having a troubled childhood. He remembers instances of being bullied by his father
which remain in his mind even today. As per this theory, people might experience self-
contradicting thoughts and emotions in a situation as responses of the mind occur parallel to
the sub-conscious mind. Mr Sediki became anxious with the sound of the baby crying and
could not analyse any explanation for his increasing anxiety. He could not understand the
reason for his behaviour and distress caused by the crying child. This theory also explains
that the social interactions of individuals depend on their psychological comprehension of
themselves as well as others. Mr Sediki does not seem to have a good impression of himself
in his mind as he mentions of not feeling good enough. This might also be a reason for
having less social relationships such as close friends and low interactions with his brothers.
All the above factors can be organized to form the basis of a psychodynamic approach of
theory (Kets de Vries & Cheak, 2014).
Answer 2
Mr Sediki’s unconscious thoughts and motives can be understood well by the assessment
technique called the Rorschach inkblot test. It a typical projective test in clinical psychology
and involves 10 cards consisting of inkblot images. Each of these cards should be presented
to the respondent, Mr Sediki, in this case, and asked for interpretation. The cards may be held
in any manner, straight, inverted or sideways. The ambiguous image can be interpreted in any
form by Mr Sediki. The respondent might observe single, multiple or even no object at all.

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After the psychologist notes the responses, a more elaborate impression of the images can be
gathered by asking additional questions to Mr Sediki. The evaluations of the psychologist are
based on rating the responses of Mr Sediki on several factors, for example, the part of the
image taken into consideration. The overall evaluation of Mr Sediki is compiled to build a
profile of his personality. The content of the described image is a major evaluating factor.
However, some other factors are also considered by many psychologists to get a more
comprehensive result. Some of the responses obtained are popular and common which is
suggestive to less disturbance in mind. However, many responses are highly atypical and
might be indicative of severe mental distress. For example, a typical response to the first card
involves imaginations of animal figures such as a bat, moth or butterfly. The relative
promptness in describing the images is also a significant determinant. The inkblot on the third
card frequently depicts as two humans engaging in some activity. Relatively faster response
to this card may be indicative of healthy and smooth social relationships while delayed
responses may suggest struggling relationships (Choca, & Rossini, 2018).
Answer 3
A projective method such as the Rorschach test is a useful tool to detect accurate personality
dynamics and traits in people representing psychological disorders and suggesting suitable
treatment strategy for the individual. Based on the evidence provided for Mr Sediki,
psychodynamic therapy (PDT) seems the most suitable treatment plan. PDT is among the
oldest methods of therapy and is based on the psychodynamic approach proposed by
Sigmund Freud. This therapy helps individuals understand the impact of their past or
childhood events on their current behaviour and outlook. It also aids in finding the greater
purpose of their lives (Keefe et al., 2014). This therapy will help Mr Sediki develop a
connection with the external world. This therapy involves intensive sessions for about 1-1.5

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hours per session. This therapy will target specific issues already identified by his statements
and with the Rorschach assessment. Therapy targetted at specific issues eases the treatment
plan and helps in faster control of symptoms, anxiety and tension in Mr Sediki’s case. The
duration and efficacy of the treatment depend on the adversity of the physical and emotional
symptoms and the daily functioning of the individual. While mental therapy is sufficient for
most individuals, psychological therapy in combination with appropriate medication is more
effective in treating social anxiety in Mr Sediki. Medication aids in controlling the symptoms
rapidly. The psychotherapy sessions for Mr Sediki will primarily involve training in reducing
anger and developing social skills (Busch, & Sandberg, 2016). Social skills training will help
Mr Sediki to learn methods to keep his anxiety under control in social situations and develop
suitable behavioural characteristics acceptable in society. The psychologist might also
address issues related to his childhood experiences which might have led to the episode in the
bus and attempt in suggesting ways to eliminate them.
Answer 4
The cognitive approach is based on various mental parameters such as thinking, learning,
communication language and remembering. This theory states that a person’s thinking
determines their actions and behaviour. According to this theory, information collected from
the senses is processed in the brain and causes the actions (Greene, 2014). The noise created
by the continuous crying of the baby disrupted Mr Sediki’s attention and aggravated his
anger. These signals came in the form of sweat at first which heightened to finally make the
mother and the child leave the bus. Another very essential element of this theory is the role of
the schema. Schema is similar to an internal transcript of behavioural actions present
unconsciously within the mind (Fiske, 2014). In the case of Mr Sediki, his hand raised as an
immediate response to stimuli which can be interpreted as an unrecognized internal schema

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of raising hands and hitting children which he probably experienced during his childhood.
This approach states that cognitive processes have a significant contribution to the learned
behavioural actions defining an individual’s personality. In contrast to the psychodynamic
model, this approach provides a scientific basis to analysing human cognition and behaviour.
Also, the learned behaviour mentioned above acts as an algorithm in processing the
perceptions of the five senses. Thus, a summation of these factors can be explained by the
cognitive theory.
Answer 5
Mr Sediki’s cognitive state can be assessed by a multifaceted technique which evaluates the
cognitive function of the mind by measuring the performance of the task. It is a common test
applied in clinical neurophysiology and identifies a person’s rhythm of strengths and
weaknesses on a variety of cognitive criteria. The measurement of performance allows the
psychologist to compare the patient, Mr Sediki with people similar to his age group, gender
and educational background. This standard cognitive assessment consists of three parts
including clinical interview, sets of cognitive and non-cognitive psychological examinations
and the time taken to inegrate and interpret the given data. This test takes into account the
neurophysiological and psychological functioning of the mind. The duration of the test
primarily depends on the purpose of the assessment and the extent of dysfunction estimated
in the patient. Different types of cognitive tests are used depending on the severity of the
case. As Mr Sediki does not display any significant cognitive impairment, his test will solely
focus on evaluating his concentration and attentiveness which was affected while driving the
bus. A practical test for Mr Sediki is the abbreviated mental test (AMT). most commonly, this
test is used to check dementia but is a useful tool to measure the attention and orientation of a
person’s mind. It is a brief assessment measuring an individual’s cognitive status on a scale

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of 10. A score of less than eight depicts cognitive deficiency and acts as a cut-off value
(Tangsrikiatkul, 2014). This test can check recent cognitive changes caused by any
noteworthy event such as the incident on the bus with Mr Sediki. Another useful test for Mr
Sediki is the six-item cognitive impairment test (6CIT). This test is also called the short-
orientation-memory-concentration test and consists of two quantitative analyses, one memory
and three orientation-based questions. Higher scores display more significant cognitive
dysfunction (Gale & Larner, 2017).
Answer 6
After organising Mr Sediki’s conditions into a cognitive approach followed by a
comprehensive cognitive assessment reveals cognitive behavioural therapy as the most
suitable treatment plan for him. This therapy aims at providing a target-oriented
psychological therapy to modify the thought patterns that are causing difficulties in the
person (Wilding, 2015). It will be a useful treatment plan to control Mr Sediki’s anxiety and
increase his focus which was distracted by a baby’s cry while driving the bus. This therapy
will also help in changing Mr Sediki’s behaviour by stressing on cognitive factors such as
thoughts, attitudes and beliefs. These factors are directly correlated with the behaviour and
emotional status of the person (Robertson, 2019). The treatment plan consists of one session
of about 50 minutes a week for nearly 6 months. The strategies developed by the psychologist
must be consulted with the patient, Mr Sediki in this case for improved results. Improvising a
treatment plan after discussing with Mr Sediki and taking his opinions will create a more
suitable and patient-oriented plan and address the needs of the patient better. A combination
of psychotherapy with behavioural therapy provides the optimum result. This combination
will focus on the perception of Mr Sediki of his surroundings based on his childhood events
and provide a relation between these perceptions and the associated actions (Robertson,

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2019). The objective of this treatment plan is to change Mr Sediki’s meaning of the events
that trigger him or bring discomfort. In many cases, cognitive therapy is accompanied by
pharmacological therapy. However, medication is not very crucial in Mr Sediki’s case as he
does not present severe cognitive impairment. Therapy sessions with the psychologist will be
sufficient to improve his focus and orientation.
Answer 7
Psychodynamic therapy for the treatment of Mr Sediki by assessment through the Rorschach
test has many benefits as well as some limitations. To begin with, the first significant
advantage of using psychodynamic therapy is the ability to relate the present-day issues faced
by the patient, Mr Sediki such as anger to its roots in his childhood events. It helps to identify
the past experiences of Mr Sediki which might be interfering with healthy behaviour of the
present. It reveals the unrecognised subconscious feelings underlying in the patient’s mind
which provide better targets to focus during the treatment. Also, this treatment plan helps Mr
Sediki to realise his internal emotional state and troubling thoughts which he can be careful
about improving. In Mr Sediki’s case, his acute anxiety and violence caused by the crying of
the baby on the bus may be a result of his troubled personal childhood. Thus, a clear
understanding of one’s problems and the underlying causes of it helps the individual to face
and improve them more precisely (Cook, Schwartz & Kaslow, 2017). However,
psychodynamic therapy lags in several aspects. Firstly, using only this treatment suffers in
providing immediate treatment response to the symptoms of the patient. Psychodynamic
therapy is thus, supported with medication to control the emergency responses (Busch, &
Sandberg, 2016). Psychodynamic therapy only is not active in immediate situations and
requires considerable time for recovery. Besides, this assessment and treatment plan is highly
explanatory but has no scientific basis. This approach provides appropriate explanations as

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causes of various disorders such as childhood events but it lacks sufficient research to back it
(Shedler, 2020). Also, the psychotherapy suggested for Mr Sediki is mainly based on the
psychologist’s interpretation of the Rorschach test and his statements. This subjective
evaluation by the psychologist might not always be very accurate to the actual problem. This
might slow down or even halt the patient’s progress.
Answer 8
Mr Sediki’s treatment plan based on cognitive behavioural therapy is a proven strategy giving
assured recovery. It is as useful as medication in treating psychological disorders and in some
cases, has proven successful even where medication failed. This therapy requires relatively
less time compared to other similar techniques of treatment. Also, this treatment plan
emphasises on correcting the assumptions causing the problem and provides long-term
improvement rather than focusing on transient betterment of the patient (Jones et al., 2018).
Another significant advantage of this treatment plan is that it incorporates the patient’s
opinions as well in formulating the strategy which develops their self-counselling skills.
Besides, the features of cognitive therapy are cross-cultural and based on universal human
behaviour. The structure of the treatment plan is very efficient and can be applied in different
formats such as self-help books, patient groups and computer programmes. Also, the
approach of cognitive therapy proposes strategies which are very practical and can be applied
in everyday life. Lastly, this therapy is in contrast to the psychodynamic therapy in not being
entirely based on the interpretations of the psychologist and the strategy proposed by them.
Along with the many benefits, cognition-based treatment plan also has some inherent
disadvantages. Cognitive therapy is useful only if Mr Sediki commits to the strategy entirely.
Any reluctance in the process will result in lowered output. Often, individuals are unable to
take out sufficient time from work to attend the therapy sessions and fail to meet the

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therapists regularly. As this approach is highly structured in nature, it might not be
appropriate for patients with increased complexity of disorders (Wilding, 2015).

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References
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