Case study: Anand appeared for his 12th standard exam and it was during the summer vacation

when he first experienced extreme anxiety and irritability followed by sadness. He had been worried about his one paper which he could not complete. He hailed f rom a middle class family living in a small town. He was the younger of the two brothers. Being the brighter of the two and topper of his school, parents had a lot of expectations from him becoming an engineer. His results were not as per h is expectations; however he secured admission in a college in a metropolis as pl anned. During his first year of engineering he was perpetually anxious and worri ed about scoring marks. He started studying from day one however was unable to c oncentrate or retain the learnt matter. He would read without understanding or s pend a lot of time finishing the chapter. He tried various study skill technique s however the more he read the more he got entangled in the Nitti grit ties of t he techniques unable to improve his performance. He repeated the first year as h e did not appear for exams for which he thought he would not secure 1st rank. H owever, this lead to furthering the problem of anxiety and low self-confidence. He started getting more irritable and angry, slipping further into depression. He took 6 years to come to the final year of engineering. However by now he saw no hope of a bright future. He knew that there was no way he could explain thes e string of failures during a job interview. This was when he attended one of th e lectures arranged by revival.life on mental health. He decided to give psychot herapy another chance. During the first session he mentioned how he had become very particular about hy giene of his linen. He argued with me about his need to be very particular abou t his learning techniques etc. He seemed unrelenting to even consider another a pproach to solve his academic problem. He had somehow made up his mind that his life hence forth would be a string of failures. The sessions continued and as p er psychodynamic psychotherapy and we continued to discuss whatever was coming to his mind. He complained in the fourth session itself, as per his habit of as sessing and measuring the number of sessions and the improvement in his depressi on. By 12th session his depression seemed to have increased. However he was warn ed about it right in the first session and he continued therapy although with nu merous complaints and accusations. He was now bunking college and was unable to prepare for his exams. He would plan to appear for a job interview however that was also difficult and he would disturb any plans he himself had made. All this built up his frustration and he would often get angry with me during the sessio ns. By the 20th session, a trust relationship was established between the two of us, and he had accepted that he needed to focus on therapy if he were to get out of depression. That therapy had its own process and will work when it is not inte rfered with. Within 3 months, we got the first break when he appeared for all hi s exam papers for the first time. He cleared all his papers and was ecstatic. Ho wever this lasted only for a few weeks and he again started struggling in the se ssions and studies. This time the issue seemed apparently different but the outc ome was the same- his inability to study due to some other interfering thoughts. This time worked on his negative thoughts and his unconscious motives which were self-sabotaging. For the next few weeks although he understood the mechanisms, he did not experience it as his own self sabotaging strategy. This increased hi s frustration and he often complained that there was nothing further left to say . He even contemplated dropping out of therapy, but our conversation in the firs t session prevented him from doing so. Soon, he started pre-empting and avoidin g self sabotaging situations. As the results improved, so did his confidence and eventually his depressive motive and moods.