Assessment Sessions

Andy
Therapist: As you know, this is an assessment for cognitive behavior therapy, or CBT for short. We
will be talking through what’s been happening for you and possible ways we can help. This particular
assessment is to see if CBT would be helpful. Very briefly, CBT is designed to explore how your
thoughts and ideas about the world affect how you feel and how you behave. But we will give you
lots more information on that and examples of how it works after we’ve finished the assessment. So,
what would be helpful is if you could start by letting me know what has been happening for you
recently.
Andy:I have been worried about my health, haven’t wanted to go outside …
Therapist: Can you say a bit more about that. What is it about being outside that feels difficult?
Andy: I don’t know, I just don’t want to go out, I don’t really know what else to say. I went to the
doctor because my chest was hurting and I thought there might be something wrong with me, but he
thought I was okay and sent me here … I don’t know what else to say, I’m not sure I should be here.
Therapist: You mentioned being uncertain about being here and what you need to say. Just to let you
know that lots of people do feel a bit worried about coming here and talking about their difficulties.
From the letter your doctor sent and from what you have said so far, we do see a lot of people with
similar difficulties. Can I just ask you a bit more about when this seemed to start?
Andy:[Nods.]
Therapist: When did you first notice that it was feeling difficult to go out?
Andy:I’m not sure really. I think looking back I haven’t been feeling quite right for about six months
now; for the last couple of months, it has been a lot more difficult.
Therapist: So, thinking back to six months ago, that would have been July.
What was happening around that time?
Andy:Not much really … work was okay, although, actually, I think that was around the time that my
old boss left, and my new one started.
Therapist: And what was that change like?
Andy: Well, my old boss was really good and I felt like I was doing well at work, but my new boss
has changed things. He made me do presentations, which I hate doing, and he pointed out that I didn’t
speak much in meetings. My old boss used to just let me get on with things, as long as I got my work
done. I started to dread going into work … but, anyway, the main thing is that I have noticed my heart
beating really fast, and I have had really bad pain in my chest. I was sure that there must be something
wrong with my heart. One time, I thought I must be having a heart attack, it was so bad. My
breathing also seems to go all over the place – I feel like I just can’t control it.
Therapist: When did you first notice your heart beating fast and the chest pain?
Andy: Don’t know really, that was probably about six months ago, maybe not quite that long.
Therapist:So, what did you think when your GP said that your heart was okay?
Andy: Well, I thought he must have missed something … but then he said it might be stress … panic
attacks … but the thing is, I just can’t see how stress can affect my body as much as it is … I just
can’t see how that works.
Therapist: Anxiety can have a huge effect on the body and it can really feel quite frightening, but the
good news is that there are lots of things that you can do to change these symptoms. It’s also much
more common than most people think. I won’t go into detail about this today but we can spend some
time exploring how anxiety and stress affect the body if you wish to meet again after today.
Andy: I suppose it might be worth a try …
Therapist: So, I’m wondering – as well as worrying that you might be having a heart attack, are there
any other thoughts that go through your head as you’re having these … shall we call them ‘anxiety
attacks’?
Andy: Umm, don’t know … What do you mean?
Therapist: Well, sometimes, people have thoughts such as: ‘I’m going to col- lapse’ or ‘Everyone’s
looking at me, they can see I’m nervous.’
Andy: Yes, yes, … those are my exact worries. I get really worried when I’m out and also what if I
can’t get back home and who’s going to rescue me if I don’t know anyone when I’m out and having
an attack … I also think everyone will see me sweating, especially if I have to stand in front of
people at work.
Therapist: It sounds really distressing for you … I’m wondering how your mood is?
Andy: Eh? Do you mean am I moody with people?
Therapist: Well, I just wondered how you feel in yourself. Do you find you feel ‘down in the
dumps’?
Andy: Oh right, yes, I get really down sometimes, I just want all this to go away …
Therapist: I’m just wondering how you’re managing to cope with these situations and feelings … It
does sound really difficult.
Andy: I really don’t know … How do I cope? Hmm, … actually I have felt quite a bit better since I’ve
been off work, and it’s been helping to not go out as much … actually, it’s been much better since I’ve
not been out as much … Not sure what else has been helpful.
Therapist: So, being away from the situation is helpful … but do you think it also makes you worry
about going back into the situation again?
Andy: Yeah, I suppose … ’cos I really feel worried about going into town now and places where it’s
very crowded.
Therapist: Okay … and sometimes people cope by drinking alcohol or taking drugs, as it helps to
shut out the worries.
Andy: I never take drugs … no, no, … but, yes, I do drink alcohol, it seems to calm my nerves a bit.
Therapist: It’s a way of coping, isn’t it? [Note: We would normally get more detail on quantities here.]
… Okay, so I’d like to change tack a bit. It might sound strange but it would be helpful to just find out
a bit more about you and how things were when you were growing up as that can help put things into
perspective a bit and give some background information to your current difficulties.
Andy: Well, everything’s been normal till now, so I’m not sure it’s worth saying anything … it’s all
been fairly normal, childhood was fine, happy …