Thx isaround the same age and ethnicity of the client, in addition the thx and the

client are the same gender and hold the same gender identity. These similarities
may serve as an advantage in building rapport with this client,however the client,
given her increased social anxiety, may struggle in establishing rapport out of
nervousness or fear of being evaluated. It will be very important for the thx to
maintain the core conditions of the therapeutic alliance which will include empathy,
authenticity, congruence, unconditional positive regard, and support. In addition it
will be important to establish a safe, non-judgmental environment that will be
attained through active listening, such as reflections, summarizing, open body
posture and appropriate eye contact. The thx will demonstrate her support
throughout the sessions and move slow in order to allow time for the client to feel
comfortable. Therapist will provide structured sessions, and explain the process of
therapy so the cxwill know what to expect. Thx will discuss informed consent
which includes confidentiality and its limitations.

• Anxiety symptoms: “my life is falling apart”, shakey , took every thingfor her
to get here. Insecure, gets so stressed out that she can’t even speak,
avoides going to parties, going out with sister, talking to people in school,
thinks of dropping out of school, att
• Anxiety in social situations: wont date expects to get freaked out, and
embarrassed by anxiety symptoms, going to class is an ordeal
• Low self esteem: lacks confidence berates herself,
• Intensity of symptoms: wiches she can sleedforever.
• IBS
• Realizes the irrationality of worries, but cant relieve them

History: Client states that she has been presenting these symptoms as long as she
can remember, even as a yongchild, she states that she worried. She also showed
avoidance symptoms of social activities as a child. The client currently is taking
medication for IBS which commonly co-occurs with anxiety symptoms. She has had
previous experience in therapy when she was 12 however she states that she hated
it do to her extreme feelings of nervousness. She has attended college but is
currently considering dropping out due to the severetyof symptoms. It seems like
she has reletivly been able to cope up until this time, seeing that she is self
reffered. Client does not report any history of pathology, S.I,or H.I (however she
currently states that she thinks about not waking up. Client realized the irrationality
of worries but states that she cant’ overcome them. Cx’s parent are divorced, and
her father is a alcoholic, she doenthave contact with him. She reports no hx or
current s.a. mother is impatient.

Appearance: client is an 21 year old woman of irishdescent. Client is adequetly

grooming and hygene. Client is average S.E.S. Client appears tense.

Attitude: client appears to cooaperateive and motivated.

Eye contance: appropriate

Motor activity: speech is appropriate,

Affect: is mood congruent

Mood : anxious,

Thought process possible S.I. no plan or intent. No hi no delusions or hallucinations

Content: goal directed

Orientedx4

Memorty unimpaired

Attention appropriate

Intel: average

Judgement :impaired (considers dropping out of college, no social contact for out of
unreasonable fear)

Insite fair (cx understands the irrational nature of worries)

Strenghts: cx came to therapy on her own cx is in colledge, client is motivated to

change, client aspires to do things and has activities and hobbies

Axis 1: social phobia

Axis 2: none

Axis 3: IBS per cx report

Axis 4: academic problems, probmems with social environment,

GAF- 56 current

Anxiety related to social environment

Low self esteem

Goal: To decrease anxiety related to academic and social distress

Objectives: client will exhibit a decrease in physiological symptoms (shakings,

blushing, seating, unable to speak). Client will report less anxiety in social and
academic environment. Client will be able to accomplish some of her aspired goals
(having more friends, going to parites, ny ect)

Cognitive behavioral therapy has been shown to be effective in the treatment of

anxiety disorders. CBT which was founded by Aaron Beck and collegues,combines
two effective modes of therapy, behavioral and cognitive in synergic ways.
Behaivoral therapy, which weekens the link between situations and the troublesome
reactions connected to them, and cognitive therapy which targets the changing of
our dysfunctional thoughts, that affect the way we feel and behave.

The client is currently exhibiting anxiety both physiologically(), cognitively, and

psychologically and bahavioraly(). Systematic desensitization, which was
developed by Wolpe, is a technique that assist the client in reducing physiological
symptoms, through breathing and relaxation, in addition to eliminating avoidant
behaviors, allowing the client to function in academically and socially. andusing this
new coping technique to pair a troubling situation which we avoids, with the more
appropriate response. In order to weekenthe link between the situations and the
habitual responses connected to them.

The therapist will assist the client in implementing a relaxation technique that
consists of a progressive muscle relaxation. This intervention will target the
physicological component of the manifisations of the symptoms which will result in
a decrease of anxiety, sense the c b t model views all the components connected, in
that a change in one body feeling calm, client will perceive she is calm, and
wontavoid situations. The client will be invited to sit comfortably in her chair, and
begin to focus on her breathing starting by taking deep breaths in through her nose
and out through her mouth, this will be continued for a couple minutes. Once
breathing is calmed The thx will invite the client progressively tense and release all
major groups of muscles in her body starting from her toes, ankles and foot, to her
shins.

1. Tense your toes and feet. Hold the tension, study the tension, then relax, this
will be done from her thights, buttocks, fingers hands, oarmd, stomach.

Therapist will then assist the client in collaboratively developing a fear hierarchy
that consists of developing a list of situations that the client fears or avoids.

The client will then rate the expected level of anxiety that is experienced in each
situation on a scale of 1-10). The client will then place the stimuli in order from
most anxiety provoking to least

The thx will explain the process of systematic desensitization, and create a safe
envoirnment for the client to confront her fears and worries imaginallyin the
session. The therapist will explain to the client that if she feels unsafe at any time
during the process the therapist will work with the client to maintain a level of
relaxation.

The client will begin to confront the lowest situations, imaginally focusing on specific
details of the situation, imagining herself going to school, what she’s wearing, the
other students, sitting in class, the client will be asked to verbalie her level of
anxiety, making sure to keep breathing steadly and scanning her body for tension
then relaeasingthis. This process will continue until the anxiety is decreased to a low
level 1-3. This process will be applying to all the hierarchy stimuli.
The client is currently exhibiting faltyappraisals of herself and situations she is in.
forexample. CBT explains that the way we think about ourselves, and events, will
determine the way she feels about them for example. Thus CBT will be beneficial
for the client whos faulty cognitions, are causing her anxiety feelings, of
overwhelmness, and low self esteem.

The therapist will first utilize psychoeducation of the abc technique wichillustrates
how neutral situations evoke our automatic thoughts, which in turn evoke our
feelings and behaviors. The therapist will islustrate this using a unrlatedexample,
and then assist the client in using a personal example of how she has experienced
this. In order to indicate to the client how different more realistic thoughts, can
change her feelings and behaviors, in an attempt to show the client the benefits of
thinking about alternative apprasialsfor situations. HW: the client will Abc .

The therapist will assist the client in modifying her dysfunctional thoughts. The
client will bring in her thought records that she has been working on throughout the
week and be presented with a list of different catergoriesin which the dysfunctional
thoughts fall into. For example catostrophozing happens when the client makes a
little mistake into a big problem, labeling is when individuals will lable them
selvesincompetent over. The client will categorize her recorded automatic
thoughts.

Therapist will utilize the examining the evidence technique in order to challenge the
clients automatic thoughts and replace them with more reality based thoughts. We
will be challenging the thought

I am not interesting, the client will ask the client to describe someone who is
intesting, and wich then the client will go through all the areas and see if the client
has any percent of these traits, in an attempt to show the client that she is
interesting

I would assist the client in role playing both sides of a thought. The therapist will
play the role of the positive thoughts, and the client will play the role of the
negative thought and attempt to persuade the positive thoughts that she is more
valid.