Psychological Case Report

Abstract

Bilal, a 30-year-old married man, presented with symptoms of depression, anxiety, and social withdrawal due to prolonged unemployment and escalating financial debt. Psychological assessment included measures of depression (BDI-II), personality (Ten-Item Personality Inventory), social functioning (Social Adjustment Scale), and cognitive ability (Raven’s Standard Progressive Matrices). Results revealed moderate depression, high neuroticism with low extraversion, impaired social adjustment, and average intellectual functioning. Findings highlight the psychological burden of financial instability and societal expectations on emotional wellbeing and self-worth. Cognitive Behavioral Therapy (CBT), problem-solving training, stress management, and financial counseling are recommended to enhance resilience, coping, and long-term adjustment.

Identifying Information

Client ID: 2025-004
Name: B.A
Age: 30 years
Gender: Male
Date of Assessment: June 3, 2025
Assessor: Muzna Touheed, Psychology Student Intern
Institution: Govt. Graduate College

I. Presenting Problem

CategoryPresenting Complaints
Emotional SymptomsFeelings of shame, hopelessness, guilt about inability to support family.
Cognitive SymptomsPreoccupation with debt, self-blame (“I am a failure”), negative future expectations.
Behavioral SymptomsSocial withdrawal, irritability, avoiding relatives and friends.
Physiological SymptomsHeadaches, disturbed sleep, fatigue, poor appetite.
Mood SymptomsDepression, anxiety, irritability, loss of interest in hobbies.

II. Referral Information

Reason for Referral:
Bilal was self-referred to a community counseling center after experiencing prolonged sadness, anxiety, and family conflict linked to unemployment and financial burden. The purpose was to assess his emotional functioning, coping capacity, and to plan psychological support.

III. Background Information

  • Family History: Eldest son in a lower middle-class family; father retired, mother homemaker. Married with one child. No history of psychiatric illness in family.

  • History of Present Illness: Lost job one year ago during organizational downsizing. Since then, accumulating debt has worsened stress and self-blame. Conflict with spouse increased, with feelings of failure intensifying over time.

  • Academic History: Bachelor’s in Business Administration; good student, above-average academic performance.

  • Social History: Previously outgoing and social; now avoids gatherings due to shame of being unemployed. Limited support from friends.

  • Medical History: Generally healthy; occasional gastritis and headaches linked to stress.

IV. Behavioral Observations

  • Appeared anxious and tense, clothes untidy.

  • Spoke softly, with frequent pauses; low confidence.

  • Affect flat; mood depressed.

  • Judgment impaired under stress, partial insight.

  • No psychotic features observed.

V. Psychological Testing

Table 1. Beck Depression Inventory (BDI-II) Results

ScoreSeverityInterpretation
26Moderate DepressionFeelings of sadness, guilt, hopelessness, worthlessness, poor motivation.

Qualitative Analysis:
Depressive symptoms strongly linked to unemployment stress and financial insecurity.

Table 2. Ten-Item Personality Inventory (TIPI) Results

TraitScore / TrendInterpretation
ExtraversionLowSocial withdrawal, avoids interactions.
AgreeablenessAverageCooperative but conflict-prone under stress.
ConscientiousnessAverageMaintains responsibilities but struggles with motivation.
NeuroticismHighEmotionally unstable, prone to stress and worry.
OpennessLowDifficulty adapting to new opportunities during stress.

Qualitative Analysis:
Personality reflects emotional sensitivity, self-doubt, and difficulty in adapting to adverse situations.

Table 3. Social Adjustment Scale Results

Total ScoreInterpretation
39 / 75Moderate Social Maladjustment

Qualitative Analysis:
Findings indicate avoidance of social interactions, reduced confidence, and feelings of shame in social circles. Financial pressure and unemployment contribute to impaired adjustment.

Table 4. Raven’s Standard Progressive Matrices (SPM) Results

ScorePercentileInterpretation
44 / 6055thAverage Intellectual Functioning

Qualitative Analysis:
Cognitive functioning is intact; difficulties arise from emotional distress rather than intellectual limitations.

VI. Diagnostic Impression

ICD-11 / DSM-5 Formulation:

  • F32.1 – Moderate Depressive Episode

  • Z56.0 – Unemployment, unspecified

  • Z59.6 – Low income / economic hardship

VII. Treatment Plan

Goals:

  • Reduce depressive symptoms and anxiety.

  • Reframe negative beliefs linked to unemployment and debt.

  • Strengthen problem-solving and coping strategies.

  • Improve social and family support system.

Interventions:

  • Cognitive Behavioral Therapy (CBT): Identify and restructure negative self-beliefs.

  • Problem-Solving Training: Practical strategies for job-seeking and debt management.

  • Stress Management: Breathing, mindfulness, and relaxation training.

  • Psychoeducation: Normalize unemployment stress; address self-worth beyond job status.

  • Social Support Mobilization: Engage family and peers in emotional and practical support.

Duration: Weekly sessions for 2–3 months.

VIII. Conclusion and Recommendations

Bilal demonstrates average intellectual functioning but significant emotional distress due to unemployment and debt. His depressive symptoms, high neuroticism, and poor social adjustment highlight vulnerability to stress.

Recommendations:

  • Continue CBT with focus on self-worth and stress regulation.

  • Provide financial counseling and support in job-seeking.

  • Encourage gradual re-engagement in social activities.

  • Strengthen spousal and family support for emotional stability.

  • Regular follow-ups to monitor improvement.

IX. Counseling Sessions

Session 1 – Rapport Building & Psychoeducation
Established a supportive and nonjudgmental space, allowing Bilal to openly share his struggles with unemployment and debt. Provided psychoeducation on depression and stress to normalize his experiences. Built trust to encourage consistent participation in therapy.

Session 2 – Emotional Expression & Validation
Encouraged Bilal to verbalize his feelings of guilt and worthlessness. Validated his emotional pain as a natural reaction to financial hardship. Introduced journaling and emotional tracking as tools for releasing suppressed feelings.

Session 3 – Cognitive Restructuring (CBT)
Focused on challenging Bilal’s negative beliefs such as “I am a failure because I am unemployed.” Used evidence-based questioning to replace them with balanced alternatives. Encouraged practicing positive affirmations daily.

Session 4 – Problem-Solving & Coping Skills
Worked on practical problem-solving steps regarding job applications and debt management. Practiced stress-coping strategies including deep breathing and guided relaxation. Introduced structured daily routines to rebuild self-discipline.

Session 5 – Future Planning & Empowerment
Focused on building resilience and hope for the future. Encouraged short-term goals like skill development and networking. Helped Bilal create a long-term plan for financial stability and emotional self-care. Reinforced his strengths to promote empowerment and independence.

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