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

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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.