Hello young people. Hello summer of 2026 with Adayu mindfulness for this healthcare for school mental health program. A warm warm welcome to all you budding psychologists, psychology enthusiasts tuned in from all across our country and looking forward for this six days of interaction with you. These six days we'll go around the field of psychology. Touch a lot on the clinical aspects of psychology. Understand social psychology. Explore the world of creativity and music. Touch on community mental health with a special focus on psychological first aid. In this journey every day 5 to 6:30 uh p.m. I am going to be joined by the one and only one Dr. Mimmansa Singh Tanwar who is RIGHT NOW ON THE PHONE. Just when I was about to say that young people keep your phones away, Dr. Mimmansa Singhan picks up her phone. Well, what do you do? So, Mimmansa Singtan is a clinical psychologist, heads the photo school mental health program and is an accomplished speaker, author, so on and so forth. And as you can all see, still on her phone having >> back in issue. Back in >> said that we will let that moment pass and try and focus on learnings and some fun. Since it's one and a half hours, keep your water bottles ready. Hydrate yourself. Feel free to ask questions, but give me time to read. If you are going to send a few hundred messages, it'll be beyond me to be able to filter them. Although we have lots of people behind including Mana Kana our artbased therapist who's looking at the back end to see what all you are writing and typing. Yes, we'll be kind to each other if we we are not. We'll just have to delete a couple of messages and people here and there. But then that's a part of learning and navigating the world of digital health. Okay, on that note, let's not waste much time. Let's start. Also, you will receive an ecertificate in about a month, month and a half's time. We are not the fastest when it comes to ecertificates and I I really can't help it. The head of the program is sitting right here next to me. Uh so, you can just talk to her that why do they take two months? I really can't help it. I I'm I'm quite efficient that way. >> That's that's because it's thousands and thousands of enthusiastic kids who come. >> Well, you heard it from the person responsible for the delay. If you're satisfied, that's fine. If you're not really not my fault fault, I tried, right? Um your attendance is going to be there. it. We are going to be sharing a link of attendance and uh you can just fill in through the day any time. This uh link that we are on today will be active for a couple of days. So by chance some of your friends or you have not been able to see this, you can have a look at it all over again and you can mark your attendance then as well. Right? If there are any other questions otherwise we'll just take it forward. Okay, you don't have to apply for the certificate. You just get it because you are here and you would have filled in the attendance and okay now you don't need to write your um names. You don't need to write your school name. You do not need to do anything extra. There is going to be a link which will eventually be shared and I'm hoping be pinned on the chat so that you can fill in your attendance. Till then relax it's one and a half hours you have a lot of time to fill in and including the attend uh including your links for tomorrow. You are logged in today. Same way you'll be logged in tomorrow. Thank you. You do not need to give us your names and any other details given that this is a forum open to everyone. Right, we have just shared the attendance form and I'm going to ask our backend team mana.kana kana at fortisalthcare.com to kindly pin it so that we don't have these questions. Okay, can I start? Yes, I am going to and we will start today with an important topic of psychological interviewing learning therapeutic skills. Take a pause here. You will hear the word interview. You will hear the word psychological interview but for me it is a therapeutic interview. I have never used the word psychological interview in itself even though that's how uh books would mention this because I believe that all interactions that a psychologist is going to have with any client patient that needs to have and it does have a therapeutic aspect to it. Meaning the mere fact that we are talking and I'm talking in a structured manner and I'm talking in a non-judgmental open manner that has its own therapeutic connotation. That's why the psychological interview is also called the therapeutic interview. Right? So today we'll start with how do you take this therapeutic interview and we'll request the slide to change itself. Oh and the slide changed. I am sometimes so impressed with her efficiency. Let's bust some myths about therapy and let's let's quiz Mimsa Singh Tanar on that. Right. um you mentioned that isn't it called the interview method of collecting information from the client like I said collection of the inter information in the interview form is the therapeutic intervention also so the therapeutic interview right okay let's bust myths with mimmansa singar ma'am our first question Yes, psychotherapist is just like a friend. Psychotherapist is like a friend. Dr. Mana, absolutely not. I can be a friend to a friend, but I cannot be a friend to a patient. That's because psychotherapy is about having a certain boundary. And over here it's about my therapeutic skills which I have earned my degree in and how I have been trained to do this kind of a work which is evidence-based in a safe space in a non-judgmental skills approach with an empathetic approach to maintain my professional boundaries. So if let's say somebody says that why don't you come and do therapy in cafe just like how I would talk to a friend I would want it >> okay so be empathetic boundaries are important understand the importance of this no you don't take a walk no you don't sit in a cafe no you don't have it over a cup of tea no You don't send messages. No, you don't add as a friend and randomly also text in between your sessions. No, a friend is a friend. A therapist is a therapist. Both have their own roles in life. None of them are in a position to exchange these roles. And that's not how it works. Okay. Anyone can do counseling. Anyone can do counseling. I mean mansa I I heard that yesterday when uh uh your mom was telling you that she can do counseling and you were saying no that's not possible. That's not cool. >> Well, she's always I've always heard from that from either I don't know what do you do in counseling because I'm the best counselor. That's how what my mother says. But her mother is a mother again. she cannot be a counselor because for counseling for all these years of studying that I have done and the training that has gone and the ethics that I have learned in my practice that I continue to follow I need I have the skills and somebody needs to have the skills to be able to do counseling so it's an evidence-based approach you are trained in it and no anybody cannot do counseling but yes as young people we are going to talk on day fifth or sixth about psychological first aid that's something that anyone can provide but not counseling first the counseling is the skill and need to be done by an expert. >> Okay. So the so which what you're trying to say is that this is a technique which is learned like how let's say um if you're an endocrinologist you learn that technique uh so on and so forth you're a surgeon you learn the technique so is this right? Absolutely. So I would uh to be able to let's say work on depression with the patient with depression, I would use cognitive behavior therapy or a patient who has emotional dysregulation, I would use dialectical behavior therapy. So these are some skills which has has an evidence-based approach, I will I would use that and use it in my work with the patient. >> Okay. I hope you understood that. uh we need to treat our our expertise with respect. We need to be respectful to our branch. Psychology is an expert field and those people like Mimmansa who are working in the field are experts in their own right and we go to the next myth. Psychotherapy could happen anywhere. Dr. Singh ma'am psychotherapy in a cafe. >> Oh no not at all on the on the beach walking and I saw it in some film. Cool it looked can we do it therapy? >> That's how stereotypes and misconceptions are formed. When we do some of these things and media plays a very important role in that how we continue to uh maintain and perpetuate those myths and that's where we are here to bust it that it's always done in a safe space. Confidentiality needs to be maintained. The setting needs to be professional. We tend to maintain this safe space which is away from the external world which is where the privacy is maintained. The confidentiality is maintained. Whatever is shared in the room remains in the room until unless it's something which is harm to our life in which yes of course we involve the family but whatever is spoken is absolutely confidential and a comfortable non-judgmental empathetic space is what is provided. >> Okay. So which basically means in the space of a therapeutic consult is where the therapeutic alliance would happen. An important question came here uh two questions mimir one is that okay the speed which you are writing your questions and the comments both it's almost impossible and yes I do realize you are here from all parts of the country thank you for being here and we can let the geography be and let's focus on this ecology question one ma to you how can we trust a stranger and question uh two is but what if somebody feels psychotherapy more comfortable in some place so wouldn't giving where they are already comfortable help them more two questions for you ma'am >> no absolutely not because for that matter if you say that I feel space in my room and please come to my house and do psychotherapy that's not how it works it has to be the professional boundary is the key over here and which is why not anybody can do counseling I am an expert would you call let's say a dentist to your home and say or a dentist to a cafe and say you will go to the doctor for the kind of issue that you have and get the treatment where it needs to be given. In the same way as an expert we would only and only provide counseling and therapy in the setting that we've created. >> Okay. So structure and structure happens in a helps a clinical rapper which allows an evidence-based clinical intervention and those are integral to the efficacy of psychotherrapeutic approach. Would that be right? >> Absolutely with you on that. And which is why it's important that we bust these myths and these misconceptions. >> You mentioned a particular film that in that film you saw counseling happening in the beach. Do these things really happen? God know absolutely not. And if somebody is doing these walk walks as a part of a therapy and our therapist then to be honest it's an absolute ethical uh violation. Um you talked about privacy and yes privacy and confidentiality are integral and there are rules there are norms. We have our own act which is the mental healthcare act which is applicable in India. There are laws as well to ensure that uh patient confidentiality is uh absolutely taken care of and which is why the boundary professional boundary is so important because otherwise it does tend to create bluring of boundaries would create some unrealistic unprofessional expectations which is something that we need to need to completely keep out of our professional work. >> You ask if they need a friendlike figure then what then that's what friends are for. You you you have friends to be friendlike figures because then they are friends. You help a person develop and build social skills and communication skills to be able to make friends. But friends are friends. Therapists are therapists and that's how it needs to be for the efficacy to be maintained. Yes. And that's how we see that over a period of time when we tend to work professionally in the setting there is change and growth that happens. And let's say over here we would also look at how the frequency of meeting a therapist is also set which is not like how you would call a friend any time of the day on every day but it's something that we see it as a professional aspect of how we decide how frequently in the week that we meet which could be once a week or twice a week depending upon the purpose or thrice a week depending upon the issue. Okay. Uh these myths matter because a lot of times people lose trust in therapy especially when confidentiality is breached. Um when individuals are not able to maintain their non-judgmental approach when they pass judgments. They themselves have their own stereotypical views which they try and impose. They're not able to maintain boundaries. Sometimes they end up creating unrealistic expectations. Oh, you'll be fine in three sessions. This is something that uh patient testimonials I think it's it's it's a dark dark side of health care which needs to be um frankly just got rid of and patient testimonials should not find any space in dignified healthcare. Yes, individuals have a right to be able to um share what they want to share, but I think it been hosted on platforms by healthcare providers or therapists is probably a line that's best not crossed and that's something I at least I very strongly do believe in. Uh can a counselor also counsel a family member, a friend? Uh, no. Shouldn't um uh an individual should be working with one person but not with uh multiple people in the family on one-on-one therapeutic alliances. No, that wouldn't work. No, you're right. I mean there's a lot of throwing around of names of psychology which are happening. I mean, OC, psychosis, narcissism, depression, um, gaslight, um, impostor syndrome. It just, we just keep throwing them away. There's little we can do about it except creating awareness, except making sure more people know the difference between uh what is clinically correct and not. There is no other way uh to look at this and which is where platforms like this I mean all of you are psychology students who are here and it's important that you as psychology students uh ensure that um there is the right information if you are on social then uh share the correct information with references and that's how you break a lot of these stigmas. The family can take family therapy which is therapy that is working therapist working with the family together that's one part of it which is okay but individuals doing therapy let's say person A going to a therapist like mimmansa and person B who's either very close a friend a family member also going to mimmansa There may be things that they might end up sharing which may have some kind of an interface. That's where it it it's something which is avoidable. Do psychology also go for counseling sessions? I mean supervision is is the norm in the industry which is taking supervision sessions. So yes uh like how medical practitioners would also have their continued medical education and CMS. So yeah okay I shall now go to the others we'll move on and there are some questions I'll keep coming back to them. Yeah. Okay let's talk about the psychological interview. And the font that is there is almost impossible for me to read. I will let Mimmansa read this slide because I am not going to be able to read this except the title side which is psychological interviewing. I mean I I I can go ahead but Bmana if you don't mind you can have your cup of tea but it'll be nice if you can just help me with the slides also please. I'll greatly appreciate. >> Yeah given I'm not doing therapy right now. So along with tea I am going to help you and understand what is psychological interviewing which is also a way that how we take a therapeutic interview where I would not be sitting with a paper and a pen to sort of start writing the symptoms and start noting down what the patient is saying but I'm actually going to focus on asking the questions and understand from the patient what is it that they're going through. So it's a formal structured interaction where the focus is on building the rapo and rapo is the most important part of just because you're a patient and I am your therapist doesn't mean and I may have whatever years of experience doesn't mean that you will automatically build a rapper with me. A rapo is something that is built by the therapist by providing a comfortable space in a non-judgmental empathetic way. It is formal because it is being done in a particular setting. it is structured and that we are going to go on uh as we go further where in my way whatever I ask in terms of the question there are certain things that I'm trying to gauge from the questions that I'm asking whether it is the mood whether it is the symptoms whether it is uh the history whether it is this 360 degree aspect of the patient which is important for me to understand from a therapeutic sense that's what I am trying to boost from that interaction So I'm trying to understand the psych I was also feeling that your voice seems a bit soft and coming from way too far. Lots of people are saying that your voice is not clear. Can you make it louder please? Thank you. I also felt the same. So I have requested mansa ma'am to be kind enough that it she is not so faint that even I can't listen to it. >> Okay. So what we are trying to do over here is we are try we as a therapist I am taking a formal structured interaction where >> in between it was fine but your voice is slightly missing in between or sort of it's coming from a bit of distance it's faint up you continue let me just see peaches if I can do something about the voice So psychological interview is both structured and has a semiructured aspect to it. Psychological interview is something that helps us understand what is going on with this individual at a given moment in time. It's also an interview where you bring in empathy so that this person is able to feel that they are being heard that there is that they are being able to express themselves and that surely helps individuals share their thoughts their feelings which helps in the intervention both by developing insight which the individual develops which helps them in their future as Well, all of that is a part of psychological interviewing which also helps in diagnostic clarification also helps in understanding the nature of goals that we'll be having and both of those things are going to be helpful. Right. Next slide one. Now like I was just mentioning the goals. So the goals would be you're building rapper. Why are you building rapper? Because rapper also helps in developing trust. It also helps the person feel that you have the expertise that can help me in my experience currently. This rapper holds the key. Coming to what the earlier times earlier slides we were talking about which is why is there a structure because in during this rapo it is possible that individuals may start feeling for the therapist something that's also called as transference. So this this rapo can sometimes be interpreted more and different by the individual which is where structure boundaries ethics tend to matter so much. So yes you the psychological interview's goal is to build a rapo as a part of the rapo you're gathering information like when you just mentioned there is an information gathering yes it is also information gathering I use the word also because while I am gathering the information I'm also having therapeutic intervention and ensureing that this individual's distress is also being acted upon in a positive manner during this interaction I am having and then I also formulate a clinical understanding. Clinical understanding does not mean only diagnosis. Clinical understanding is understanding various aspects of your personality uh your experiencing what experiences what all has shaped your being your early experiences childhood your friends your aspirations your thought processes your background I'm understanding all of that so that I can help you guide you as the unique individual that you are without my judgment ment of how people should be because that would not be scientific and that's where one needs to understand. So it's not going to happen that on day one first session an individual will end up saying a lot of things. You were quite right. Some of you asked that why would I speak to a stranger? Why would I share something with a stranger? Yes. But that sharing is an evolution itself because initially I may be hesitant then I may share some things then I gather some confidence. I just the rapper and that's when I start sharing a lot more that aspect is going to happen during the sequence of these sessions. Those would be the ways to understand the psychological interview. Namat are you back? >> Yes. And over here when we are making the clinical diagnosis per say what is important for us to understand is that we are gathering all of this information to make the 360deree understanding about the patient. It's not just that you're merely picking one element and aspect and saying this is what the patient has but it's also understanding the psychosocial element the emotional aspect the environmental stressors that may be adding to the ongoing problem the presenting complaints what may be also bringing up as a change in the behavioral aspect. All of these things are important because that's how then we tend to work using let's say cognitive behavior therapy which we're going to talk about tomorrow or any other form of therapy based on the information that we get. So if somebody is sharing and the person is hiding things and not opening up uh then what >> and we allow the patient to sort of have their time and space to build that trust and rapo >> also volume. We allow the patient to have the time and space to build that trust and rapo to slowly open up with the kind of issues that they feel comfortable to talking and sharing with the therapist. We never ever impose or sort of try and investigate like how anybody else would do it by trying to ask more why and why and why and what may be happening there and what may be happening there like how let's say a parent would try and get an information from you. We create that space to be more safe and more comfortable and that's how we give the patient the time to open and that's an important aspect of rapid. How does one build rapper with a patient in a good way? >> Like I said, by being by giving them a safe space, by giving them that comfort, by asking less of why questions, but allowing them through some of the questions that we ask which we are going to talk further in an open-ended way through our both comfortable verbal and non-verbal gestures. All these things are important to build the rap. >> Two aspects to a question. Uh how does a therapist avoid um attachment and more importantly a lot of people are asking what if somebody develops an attachment um then what do you call then what do you do? So this is an aspect of transference and counter transference that is learned by therapists as a part of their training. You must understand that a lot many times yes as a patient there are emotions that the patient may project onto the therapist as a part of their transference. And it's the therapist's expertise of recognizing that transparence and then helping the patient understand how this plays out in their real world in those relationships. That's what helps them and helps us to sort of work on some of those feelings and emotions and the attachment issues that the patient may have. >> And how does a psychologist prevent exhaustion? I I just saw that. By doing everything else that we must do to take breaks, you switch off once your day is over. Both Dr. Parak and I go have our own favorites when it comes to listening to classical music as a means to just relax. Um I also have my 13year-old that I like to spend some time with, some exercise. So, anything else that one would do to sort of de-stress and relax? That's how you switch off from work once you're done. >> Okay. Lots of questions have come. I'll take some of them. Uh it'll be nice if you don't repeat these questions because when you type it several times, it's very difficult to keep a track. But some of these questions I think are important. I'm going to uh um take some of them. U how do therapists combat counter transference? uh if you have counter transference then to be honest a therapist needs to work upon themselves because transference where is the part of therapy counter transference is the therapist's feelings um you need to make sure that they don't interfere in the treatment process otherwise you should refer uh the individual to someone else and you should take it up with your supervisor or your uh mentor um who's giving you supervision but you should take that Um would you initially avoid probing questions to avoid antagonizing? No, I don't think that'll be the right way to look at it. You ask questions which you think would be the right fit at that given moment. It's not about whether you are validating or antagonizing. Like I mentioned, this is a therapeutic interview, which means whatever I'm saying needs to have a therapeutic component to it. Sometimes um giving a counter view has therapeutic um role as well but it may typically not happen too soon because for that I need to be able to have some rapo and trust happening as well. Are there ethical concerns with treating friends and family? Yes, there are. I don't think it would be very ethical. I don't think it's ethical to see uh at the same time at least uh people from the same family. I I don't advise that. >> Dr. Parik, there's a question in some cases do psychologists have to break client confidentiality. >> No, you don't break confidentiality. If you go by law that the only time when you may need to do that would be when an self harm uh or others harm you feel is an absolute uh high probability. Even then you will need to inform the person. Try and get their consent. Uh use your positive rapo and help them guide in a way that you take their consent to be able to share for that brief moment support from a family member or a guardian somebody they would they are okay talking to. And in absence of that in the rarest of rare case you may be able to but you need to understand if you are doing this you will need to be able to back this decision because if your decision is not lagging enough scientific backing then that's a major major ethical uh violation and a violation of the mental healthare act. Um that's something one will need to understand. A lot of you are asking is there scope for psychiatry and psychology in India? My answer is a simple yes. Um there is almost a 250 to 300% shortage of experts in our country. Uh more experts will be very very good for for the last mile connect in a way or reach of mental health support. So yeah and yes absolutely we are removing from back end some comments any comments which are not related to psychology any comments which cross a line will have to be removed at the end of the day we want to do this uh in the right manner. So we'll be seeking your support also to maintain the um the nicity of being on an online platform where we are discussing academics and that too of a branch as lovely as psychology is. Uh if people have issues like you mentioned about trusting people or strangers that's where your therapeutic abilities start coming in. How well do you bring trust and you also understand that trust will also evolve you just because you are a therapist just because somebody's come to you that does not mean that trust is going to be an by a default mode that's not how it works. >> Um >> question for you Dr. Parik your thoughts on AI as a therapist. >> Well AI is not a therapist. I mean simple as that. I mean um there is no evidence to say that AI can be or is a therapist. Yes, you may sometimes feel relaxed or relieved or uh better while you are interacting with AI but that is not therapy. Um simple as that and yes in the future AI will have a role to play. I do believe that AI will have a role to play but at the same time for me to say that where we stand today AI would be um good enough for therapy no and frankly right now there are very clear guidelines around it as well. Okay. Uh I'll we'll go to the next slide but but did you cover those topics all of them? Yeah, we covered about trust, confidentiality, rapo, non-judgmental, >> please. So, the psychological interview which is the therapeutic interview, we will also be doing a mental status examination. Mental status examination is the status of the mental functioning at a here and now given cross-sectional moment which helps us understand how the person's feeling, thinking right now. It helps us also measure the progress over time. It also helps that when you record this and if this individual is going to go to someone else for some opinion and therapy or treatment and they would want notes from you, these would actually be very very helpful. We'll be talking about certain specific interview techniques especially at the start of the sessions and various therapeutic approaches that are there and largely athletic approaches and some of the new age approaches but most importantly my fundamental belief that ethics is the first thing when it comes to any form of um work not just in the field of psychology but otherwise also um if you don't maintain ethics then I think that's a problem for whichever branch we are talking about. Um you ask me how to overcome through anxiety where you are an athlete you're quite right um elite athletes athletes at the highest level do tend to have at times uh need to work upon what we also call as their mental conditioning component and that aspect is important. Sports psychology is a field which works especially on that uh area >> on your next slide. >> It's not a very simple question that if a teen comes and shares something with you, you will share with the parent. No, that's an that's not an automatic yes. There are various aspects to that and like I said it's the rarest of the rarest of the rare cases. Okay, I'm just going to them now. The Yes, there are sports psychologists. In fact my colleague uh Diva Jen is uh is a leading sports ecologist had also gone to the Olympics Paris Olympics as a part of the Indian contagent. Um um do people do you come to know when people are lying? Is is is that how you look at things as a psychologist? >> No I I don't do those things. It's for me it's not I cannot I cannot make out if somebody's lying. It's more about what the patient gives me as an information is what I take as an information based on and that's what the trust is. The trust is about trusting what the patient is bringing to you and eventually the patient also recognizing that they need to be more and more honest in a therapeutic setting for it to kill them. So if something is not helping them eventually as a part of the uh therapeutic alliance rapper and the therapeutic relationship that is built between the patient and the therapist the patient begins to develop that kind of trust to be able to open up about okay. uh somebody let's say has traumatic experiences and they have a reluctance to trust people in that situation as a psychologist how do you build rapo how do you get that trust uh that's it's a very valid question >> trust is about what you what you put in in the patient at that point in time in Each therapy session you continue to keep working on what the patient is bringing to you along with the validation and the kind of expertise that you have the knowledge that you have about the problem at hand. So trust is something which is also built over a period of time between the patient and the therapist. It's it's it's normal for a patient to also take their own time to open up about issue and sometimes we also see patients may be more silent or may not talk in some of the sessions and that's also because sitting with silence in a comfortable way is also part of health. So for the patient to know that my therapist can also sit with the discomfort of the silence that I am bringing in in the session that also is important in building that trust. It's the entire aspect of being there that we are able to provide in an absolute empathetic non-judgmental way that continues to build that trust in the patient. >> So yes, sport psychology is a career option. Yes, forensic and criminal psychology is a career option. Organizational psychology is as well a career option. Clinical psychology as well. Counseling psychology. A lot of you are asking about these fields. So yes, there is significant scope uh in these field including art based therapist. Uh we do have an art based therapy program as well. >> Okay. What are your slides? >> Okay. Um so we start with case history. First we look at what is the identifying data which is collecting the basic information of what the patient is bringing which is their age their name and in fact a lot many times when the patient comes and brings in a certain kind of a u we don't always directly sometimes ask the age but we read it also from what they bring in uh as a part of the of the invoice and that's also a subtle way to see what is the name and what is the age of the book if you ask about the demographics, where do they live, where where do they come from, where are they born and brought up, so on and so forth. What is the socioeconomic background? All of these identifying data are important as a part of it. In this one also looks at and since we do talk about childhood history over here we also look at the family history over where we are trying to understand if there have also been any kind of mental health condition let's say in the family. Have there been any mental illnesses in the family? Have they ever visited a mental health professional in the past? because that also is relevant in understanding the kind of genetic passing on that we are looking at in terms of the symptoms what is already there and what is it that the patient is bringing to you. So it gives you that understanding if there are mental health conditions already running in the family. From there we also look at the chief complaints which is what is it that the patient is bringing to you at this point in time. What are their chief concerns? So the patient may say I've been feeling sad for the last couple of months. I have been feeling anxious uh particularly around >> vimmansa your voicemansa your voice lots of people are writing I'm also struggling at times your voice just keeps coming and going and throws up it just gets a bit too low. Well, ma tries and sort that. I'll continue with this. So, identifying data. Family history matters because a lot of times, at least from my address, the family history matters because it may help me decide on the choice of biological intervention. chief complaints is what my patient tells me that this is what I'm feeling today or this is what brings me to you. It also helps me course a path of where and how I need to move forward to help this individual and then the personal history because a lot of things around us are shaped in in how our personal history has been shaped and then the origin duration and progress of my current symptoms which means if I'm saying sadness of mood then since how many days I started feeling initially how it was now how it is getting so on and so forth and that's how I try and understand so from identifying data, family and personal history, chief complaints and the history of present illness or origin, duration and progress and we used to call it in medical college. So that's how you start working on what's called as your case history. Yeah, slide man. So identifying data would also include things like age. Age matters because you will also know that with with certain age there is more prevalence of the nature of problems. So with the occupation aspect as well and those are some of the common things uh that one looks at. Next slide please. Chief complaints is the primary complaint the individual shared with me. Primary complaint this is very important. So I am not deciding what you are saying or what you have. It's what you are telling me where you feel you want to start and you want to tell me what your current concerns are. For example, my sleep is impaired. I struggle in social situations. I feel low. Chief complaint also is a reflection of where this individual wants intervention happening that will help them. So that's how one needs to uh look at this. and history of present illness. Like I said, how did it start? Where did it start? What was the duration and frequency earlier? Were there any precipitating factors? Is the severity going up? Is it coming down? Is there a gradual degenerate deterioration happening? Is it having episodes of feeling better or lucid intervals? are there uh how is the how is the symptom shaping over a span of time that helps me understand a lot more about the nature of the problem and how the diagnosis might be going and then let's come to mental status examination and let's see if ma'am's voice is back >> hello am I audible more I mean you're audible. It's just that if you can sustain the audibility then we'll be very happy to sustain our attention and continue the learning from you ma'am. >> Okay. So this is something which is important for us to understand that what is it that we observe from what the patient is showing to us in terms of the mood affect and a lot of these um symptoms that we are able to objectively see their behaviors the signs which is different from what they tend to express their own internal thoughts their own feelings what is it that they are perceiving receiving what is reported by the patient. So objective observation is what I see and observe as a clinician and clinician's observation is also an important aspect of mental status examination versus what is it that the patient explains to you um in terms of what they have been experiencing and the changes they have been experiencing as a part of their signs and symptoms. So it's almost like an equivalation of when you go to a a let's say a doctor an internal medicine or your physician who are going to look at why are you experiencing some of the symptoms that you're experiencing um whether it is because of your upset stomach or fever and thermometer and other things that they're going to use. The same way we have some of these questions that we look at and the observations, the clinical observations that we make to understand and conduct our own MSE again without having a paper and a pencil and doing a cross and a and a tick mark over there. But that's something that is all registered over here in our head while we are doing this. So it helps us to make the diagnosis. It also helps us to see that today if I am seeing a patient and these are the signs and symptoms that I'm seeing this is the condition or the severity of the patient that I can sense how is it that I over a period of time when I see the patient over let's say four sessions five sessions where they've started therapy and they've started medications what are the changes now that I'm able to see in their own signs and symptoms so it also helps me track the improvement and obviously U because we work as an integrated team, a psychologist, a psychiatrist, we are also able to share that feedback with each other so that the treatment is more comprehensive, more integrated and together one is able to work and track the symptoms and understand let's say you know in my sessions I saw the patient is getting more irritable. there is more sadness that I'm I'm seeing clinically observing even the patient is subjectively uh expressing that kind of sadness. So that will be communicated uh to our psychiatrists and so that that MSE and the examination that we've been done uh through our clinical observation allows them to also then work on some of those things and similarly vice versa where they if they observe there are certain things that needs to be worked on together we work as a team. So it provides us a snapshot in a given point in time. So what are the things that we end up looking at? We look at the general appearance. We look at the grooming, the hygiene part. So let's say a patient with um schizophrenia, one would see that there might be certain aspects of the grooming and the hygiene that may be compromised because of the symptomatic slowness that the patient may be experiencing. Even let's say a patient with depression. uh and oftentimes they also tend to uh express that uh when they are talking to a therapist that that's not how I would generally dress up. I did not even feel like uh dressing myself. I just came in and dressed up and wore whatever I found in uh the first thing in my closet. So these are certain things that one is able to observe as a part of grooming and hygiene. Eye contact. Are they seeing you or are they feeling more anxious and moving keeping less and less eye contact while talking to you or let's say in a child with symptoms of autism spectrum there is a poor adequate eye contact. So all of these things again as a part of the observation posture and body language is it is it uh strooping is it slow is it there is a certain sense of uh lack of confidence that you can see facial expressions sometimes the patient may show blunt a effect over there may say I'm feeling sad but you all you see is just more bluntness over there you are not able to uh look at the sadness aspect or they see I feel I'm feeling okay and yet you see u there is a certain sense of sadness that you can experience uh from the observation and the level of cooperation that the patient is making which means are they cooperating with the questions that you're asking are they giving you one word answer are they giving you more detailed answer how comfortable are they already feeling in terms of being able to express themselves all these things are important aspect of general general appearance and behavior. So it helps us to have an insight on the emotional functioning, the behavioral aspect, the social functioning of the patient and the level of distress that the patient is having. So the observation is an important aspect of the interview speech. So the rate of speech whether it is slow or whether the speed is high slow we would see let's say in depression or in a patient with symptoms of schizophrenia or we would see pressured speech in patient having with having manic symptoms where there is the speed and the rate at which what is being said is very fast. It's pressured. It's the need to keep expressing everything that is coming to one's mind. The tonality may change. In depressive symptoms for example, you may see the tone may be slow. Sometimes the volume of with which you are saying is also very slow. In a patient who is experiencing certain aggression or irritability, you may see certain change in the tonality of what they are saying, how they are saying, the volume at which they are saying and all of these things also then uh influence the productivity aspect as well in terms of how many words are they saying at a go. Is it slow? Is it high? Is it pressured? All of that. And again another example is equalia which means if I say how are you feeling today? The patient may say back how are you feeling today? If I ask how are you feeling? Tell me something about you. They may say tell me something about you. So it's the repetitive aspect in speech that you can see in uh schizophrenia or also in young kids with autistic spectrum disorder. So speech reflects the underlying thought process, the mood state and the mental functioning of the patient. Now what's the difference between mood and a effect? Mood is something which is more pervasive. Mood is something which is long-term. It's something that the patient experiences internally. It's their internalized uh emotional state. So the patient may be feeling depressed. But when they are ex talking about how they are feeling sometimes they may might be a smile on their face while they are saying I'm feeling sad and that's the affect a effect is the external expression what uh that is observed by the by the psychologist or the therapist and the external expression which is being shown uh by the patient. So for example in uh euthyic patient you would see a normal mood an appropriate effect which means if I'm feeling sad I am showing sadness if I'm feeling happy I am showing a sense of happiness in whatever um whatever I'm talking and seeing in depression you may say sad mood and the affect may be a little more constricted for example so it's mood is more of a subjective feeling it's what is reported by the individual may fluctuate over a period of time while affect is something which is more observed externally uh by the therapist. certain thought process disturbances that are again important to look at to understand the cognitive functioning of the patient and cognitive by one would uh say over here the the thought process of how it is u at this point in time running in the uh with what the patient is experiencing let's say for example flight of ideas which means I am starting from one idea and I'm talking about how my day was and from there I began to talk about what I want to eat and what I like to eat and then from there I may go on what I want to do in life and it's it's it's just there is no one particular structure of how it is going it is going from one thing to the other tangentiality is I may start from one topic and then I go on a different tangent and I start going on that tangent I may start again talking about how I felt during the day and from there I may start talking about uh completely different uh aspect of what I want to share rather than my feeling and my emotion and I may just begin to start talking about what I like to eat. So it's a completely different tangent from the topic that one is talking about. Circumstantiality is where you're not being able to come around to what the patient is wanting to explain. They keep circling around and circling around and circling around without coming to the point of what they want to share. Loosening of associations over here we one would see that from one thought process that the patient is talking about there is no connection to the second one uh that again the patient has expressed. So some of these we we would see in patients with manic episodes and patients with schizophrenia symptoms. That's what we would look at. So the disruption in the thought process is something which is important to note over here. Now what are the perceptual disturbances that one would look at in how the person experiences and interprets the world around them which is what is by perception of uh over here and what kind of disturbances can be there. So hallucinations is extra sensory perception without a stimulus. So there is no stimulus. There is nobody over here but I'm yet seeing I can see someone. I may feel somebody is at this point in I can smell something even though there is no fishy smell that anybody else uh can experience at this point in time. I may hear something even though there is nothing which is playing in the background. So that's hallucinations which is without the presence of an external stimuli the patient experiences something over here. Illusions. Illusion is something where uh there is a certain change in the structure or the form of what we experience. Let's say mirage. Mirage is an aspect of uh illusion. So when you are sometimes traveling and you see the reflection of the uh of the sun making creating an illusion of a puddle or water that's illusion for you. Depersonalization and derealization. Depersonalization means I am not being able to feel connected with who I am and derealization is I may not feel connected with where I am. So both of these symptoms can be experienced in patients with um dissociation uh related symptoms. Cognitive functions over here what we look at is the orientation which is your date, day, time, place. In patients let's say for example with delirium you may see and that's what we check uh when it comes to the cognitive function the orientation of what is it today uh what is the time of the day where are you at this point in time when were when were were you last brought in so that's part of the orientation when were you last brought in is part of the memory attention let's say count backwards from 10 to 1 or add whatever um numbers that are given to you. So that's part of attention which is again used to check in attention deficit in patients with ADHD. Memory would be again to check what is the recent memory uh how is the recall? What do you remember from the past? What do you remember from your present? So that's how we check memory. concentration again you may ask certain questions um also spell something backwards and again over here you need sustained attention to be able to have that concentration ability. So cognitive function is again checked in terms of how well the patient is able to concentrate and focus on the question that is being asked. Abstract reasoning over here you may ask certain questions uh which helps us to understand the level at which the patient is able to comprehend and give you the right answer. So that's abstract reasoning for you. Insight now in a clinical sense um and when it comes to insight in today's world which I'm sure sir will be able to help you understand a lot better uh but I'm only going to focus on the clinical insight over here. The first one is the denial of the illness which means there is no awareness of the problem. The patient may deny that I even have a problem. And which is why you would see patients with mental health condition often saying I don't have a problem. I don't need to go to a psychologist. I don't need to go to a mental health expert. Do not ask me to do it. So at that point in time they're at stage one of denial. Second partial awareness. They may be aware that yes I may be sad. My functioning may be getting a bit affected. My problem may be such that I find it difficult to wake up in the morning but I want to handle it on my own because this is my problem. I don't think so a mental health expert can help me deal with this. So that's partial awareness. If it is impacting your mood, your emotions, your behavior, your day-to-day functioning, then you need to go and seek a mental health professional for help and support. So patients who recognize that people who recognize they have symptoms but yet deny it or don't want to seek help, that's partial awareness. Intellectual insight in insight. Intellectual insight would be understanding the int in the illness intellectually yet not being able to um so I have a problem. Yes. At the same time somebody else may need need to change because if I only continue to change then there will be no problem. And that's part of intellectual insight which means I understand there's a problem. I understand there is an illness. I understand there is change that is required but somebody else needs to change too. That's intellectual insight. Emotional insight is when I completely understand and accept my illness and the fact that I need treatment and the fact that it is me who needs to change because what is in my control is what I do about the problem at hand and it's not about just the XYZ and the change that can happen in the XYZ because the environment is not in my control. the person is not in my control. So the emotional insight is that what I need to do to the problem that I have in hand. So that's your insight judgment and there are two three aspects to the judgment. One is the social judgment which is what do you do if let's say Um and you may ask a patient that what would you do if let's say uh you you are feeling anxious in a social setting. What would be your judgment in that situation? How would you handle it? Or let's say in a very uh relatable way, if there is a bullying episode that you're seeing in the class, how would you respond at at that point in time to help or support the peer or would you not do anything and would you be a bystander? That's also part of the social judgment. Personal judgment is that in a given scenario, what will I do to sort of help me come out of that particular situation? Let's say somebody is pressuring you to do something which you don't want to do and you are uncomfortable about it. What is it that you're going to do in that particular scenario and situation? That's personal judgment for you. Would you just give in to the peer pressure of following and conformity that your p peers are going to put on you or would you take a call on how uncomfortable you feel and the choices that you make? Then the third is the test judgment and one of the examples for that is let's say you find a wallet on the road in today's time because it is uh agent day of um e-wallets so you don't find that but let's say on a digital platform you see somebody asking you for certain personal information and you see that what do you do over there that's your test judgment and Dr. Par going to talk about inside. >> I'll take some questions. Is psychiatry all about medicine? I am a psychiatrist. I do prescribe medications. To say that anything is all about one thing would probably not be correct. Uh uh no the presentations will not be available for download but you can keep seeing this again. Um yes I do agree there are times where even I feel that the screen was blurry and at least unclear but I think that's also because of the remarkable size of font um these people are using so that people like me can struggle more. I think they're all getting back at me for all the nudges and pushes to try and bring the sense of efficiency and efficacy. That's the price you pay for um seeking excellence. Uh you just have to deal with mediocrity. So profound, isn't it? Okay. Um let me look at some more questions. I don't think it's about intuition. I think all of those things are just um a bit of here and there, but certainly not science. Denial is uh so try and understand this. Denial would be a defense mechanism. Maybe on one of these days if we get time and we can look at defense mechanisms. Um I or mim would try and maybe teach you defenses. But since you are asking a uh question on defense, let me rather talk about the mature defense mechanism which we all need to work hard to inculcate which is acceptance, altruism, sublimeation, suppression and humor. Uh humor uh there will be struggles in life but can I find my humor acceptance because there will be things it is what it is. Sometimes there are things which are outside my control and I need to find an acceptance or I need to accept the way people are. I can't do things in things which are beyond my control. Uh altruism doing genuinely things for others. Um sublimation which means how do I positively deal with the emotional arousal that I'm experiencing in an adaptive manner rather than a maladaptive manner and suppression which is not reacting right now. So some of these aspects are mature defense mechanisms. Um okay I think I've taken a few of these question that just came. Um yes we do feel sometimes when we start something we feel more motivated and thereafter not because sometimes it's more to do with the the that that feeling of the something new or feeling of a start but motivation is a lot intrinsic for it to sustain. External motivations don't really matter much eventually if you aspire if you really feel like doing it then you'll end up doing it also. Okay. Interviewing skills. Let's move forward. Mansa, please move forward. Okay. So, one is active listening and the other is passive listening. The difference between passive and active listening. Let's say two friends are talking to each other and one is while talking is also texting and at the same time um is scrolling and do scrolling and doing a lot of other things while the other person is continuing to talk. That is passive listening which means you're detached. You're just hearing words. There is lack of involvement. um you just hear certain things here and there and you just do hm and so on and so forth. So that's passive listening for you. In therapy there is a lot of role on active listening which means you have to be engaged. You have to ask uh both in verbal and non-verbal presence of the therapist or the psychologist needs to be u prominent for the patient to feel that you are listening to them. your eye contact, your body language, even the fact that and which we're going to come in the next slides. How are the questions that we ask, the probes that we make, the HS and I understand all of this is part of the active listening process. So which means your nods, your eye contact, uh the reflections that you make, slight encouragement that you make to the patient, tell me more, go on, understand. All of this is again important aspect of active listening and is again helpful in building a rapo and continuing to be make it an important part of the psych therapeutic interviewing. open-ended questions. So while we are doing our active listening and we want to know more from the patient as to what is happening and for them to open up about the problem or the concern at hand. You ask questions like how can I help you? What brought you here today? Where do you think you would like to begin? How do you think it troubled you? So open-ended question would make the patient think and express whatever they would want to express in the given context of what they are explaining. Viz a closedended question where you would say let's say I think you need to tell me more you I I want you to tell me about the relationship how did it affected you because I think it did. So that's a close-ended question as compared to tell me what are the challenges that you may be facing in your interpersonal relationship. That's an open-ended question. See, and try and understand this. All of this has its own meaning. There are times you will need to ask open-ended questions. There are times closedended question may actually help you. There are times you can use uh statements for clarification. And there are times that you will need to probe which means help the person express more. You will need to learn to summarize so that the individual feels that yes there is an understanding that you are gathering. Sometimes you may have to redirect if you feel that there is almost a detour happening. Um whether it is with insight or without and some of those aspects are going to be integral to the therapeutic approach that you will have. Um um okay the the if you just if you mention a question once and keep writing what happens is that it sends a lot of questions up there and it's very difficult to be able to read. Um okay. uh these sessions would be uh 90 minutes and you're free to attend it as per your comfort. Um having said that we will continue with this. So clarification, probing, summarizing and redirecting these are also tools that therapists use in their session and man you can go to the next slide. So clarification would be something like um man if you can go back to the previous slide. I >> meanwhile I'll just take this question on therapy sessions always effective. Nothing is always effective. Neither is nothing always ineffective nor are medicines always effective or always ineffective. There will be case when there may be resistance to treatment. There may be case that there may be more complications, severity, uh genetic aspects, other stressors, environmental factors which may also be h an hindrance to the overall development and progress of a person. Yes, you will need to have medical background to be a psychiatrist. So in my case, I did my BBS and then did my MD in psychiatry. No psychology as a part of medical as in the in the in healthcare has a significant role to play. Having said that there are other areas of psychology, sport psychology like I mentioned as well. But today since we are talking about and this internship is about the clinical aspect largely. So yes we are going to focus on the six days on those aspects as well. People will use these terms um very very inter way therapy counseling psychotherapy uh you will have people giving their own opinions of differences and all to me it's largely uh very very similar and it's also so when when I was a student we would we were using typically the term therapy or psychotherapy um lot more words like counseling now is also used uh there. I mean you can look at some subtle uh def definitions uh which may be the differentiator not necessarily uh from from my angle to be honest. Yeah. I don't think that'll be a fair thing to say that medications would numb emotions and especially with psychiatrists. Uh um I I it defies uh any kind of evidence that that's not true. What do you gain from signing up for physical internship up? Um, if you see it from my vantage, then it's going to be the same thing. Um, I do the online internship because a lot of people uh are not necessarily in the cities where healthcare exists. So it's easier for students to be able to have an insight from our vantage of how we see the branch. And uh this is the same presentation, the same slides uh that are going to be used by our experts across our network during the physical internship. So that's a call for individuals to make um uh introvertism, extrovertism, these are all they cannot be categories of people. That's not how it works. And psychologists are as are also coming from the same same population, right? Some people become athletes, some people become media personalities, some people become doctors, some people become psychologist, some people become something. So and all of these people will have their own personality attributes and components and which is quite fine. See subjective and objective actually goes together. So you don't have to split it. While I'm talking to you, I may be developing a an objective understanding of your subjective experience and frankly my subjective understanding of what what you are saying. um most countries in fact I think across the globe uh the field of psychology is growing and there is going to be um a significant career option for for most of you where individual showing resistance to treatment is is a is a part of the process. So it's not that on your day one people will be open to um having an interaction. Sometimes you may have come where you've been nushed by a friend or a family member or a teacher or a colleague. Uh but that does not mean that as a part of the therapeutic process in the alliance that you will have with this individual that they would in in in course of time not have that change. You don't take therapy because there is a family history or you don't take treatment because there is a family history. Family history is for an understanding. At the same time, when you you take help when there is a problem, you don't anticipate a problem and then take it once or yours. So communication tool in a therapeutic interviewing you take clarification. Let's say for example you ask the patient you said that you're feeling helpless. Can you help me understand what makes you feel so? So that's clarification. Probing further. Probing would mean something like you spoke about this particular aspect of the issue. Can you tell me a little more about this? leading questions. Do you think that the stress increased after you changed schools or after your examination? Summarizing is where you summarize as to what you understood from what the patient uh brought in into the session and whatever was discussed. And sometimes you may also need to redirect the patient from one topic uh to the other where you may say well we'll come back to this. I understand this is important but how about we try and discuss this right now and stay on this for some time. So that's redirecting to a particular topic and that's all again part of the therapeutic style of interviewing that we do. Mana next. So the role of the therapist over here is that how we tend to put the illness into perspective through psycho education by helping them understand the biocschosocial model of what the illness is about. We take a non-judgmental approach where we help them understand that it it's not them who's caused the illness. It's not the choice that they are making. It's something that has happened to them and even when it comes to how they have been responding and reacting to various situations it's not in their control and that is the reason why they are seeking and sorting help uh today over here empathetic listener we provide our empathy through our through our patient listening where we are just there our presence in itself is comforting ing and also expresses that empathetic approach towards the patient. We show our expertise by helping them understand the problem and what is it that needs to be done to deal with the problem? How to go about the treatment part. What are the things that one would as a part of the goal setting would work on? That's how you show knowledge your expertise as a therapist. But at the same time it's important to deal with that doubt. The doubts that would come in from the patient to you. The doubt could be about treatment process. The doubt could be in the form of myths that may happen. The doubt could be about various other things. How this is going to go on and so on and so forth. And eventually our important the most important aspect is to instill hope. Hope that this is going to get better. Hope that they are going to get better. Hope that this is something which is workable and we continue to do that as a part of this therapeutic alliance and treatment that they have now initiated. >> Okay. Uh as we come towards the end for today your summer project is you unmute yourself. We've been talking about other people unmuting themselves. How about you unmute yourself? Impact lives. Lives are impacted when we talk about correct information in a sensitive responsible manner about our branch that is psychology and that's how we bring the change. Uh share it with people around you. Um talk about it and that's the way forward. Next slide. Uh if you are not on social media that that's fantastic but if you are well then feel free to be connected with forest mental health um on various platforms. Uh we do share a lot of information on our uh YouTube as you see and our forest mental health um WhatsApp handle as well. say write to us at mental health atvortisalthcare.com if you need any more information some books we've written including the book the champion within that she wrote after the her experience with the Olympics in 2024 on behalf of all of us unmute yourself young people and I shall see you tomorrow sharp at 5:00 p.m. with man Sam ma'am and we'll take short 10-minut questions and then we'll start with tomorrow's session as we'll continue this uh I hope you enjoyed it as much as I did and I hope you learned as much as Mimasa taught on that note thank you and see you