1. Identifying Information (S.S.

)
a. White
b. Female
c. 7 years old (2nd grade)
d. At or approaching grade level on standardized grades report for trimesters 1 and 2
e. No siblings
f. Lives with her father and mother in Aliso Viejo, CA
g. Mother works from home

2. Presenting Problem
a. Anxiety
i. The student has missed school due to her fear of being sick at school. In the
video, she appears distraught (crying/unable to speak) because I called her out
of class, which I found out made her upset because she did not want to miss
out on classwork.
b. Panic
i. Worried about losing control of her body and throwing up or becoming sick
at school. She perseverates on her throat and fears she will lose control
of this specific part of her body.
c. Phobia
i. Fear of throwing up at school when her throat hurts

3. Diagnosis/ Eligibility
a. Generalized Anxiety Disorder
b. Other Specified Anxiety Disorder
i. I have not reached the conclusion of whether or not her symptoms “cause
clinically significant distress or impairment…in important areas of functioning.”
(criteria D). She has missed school for 5 consecutive days in the past due to her
anxiety.
ii. I only saw her become irritable (criteria C) once as a result of her anxiety.
c. Specific Phobia Disorder

4. History
a. This student does not have a history of seeing the school counselor/clinician prior to
this school year. She has not seen a private mental health practitioner.
b. Her mother reached out to the school counselor in September 2021 because S.S. had
anxiety about coming to school.
c. I met with her on October 4, 2021, but the mother requested I no longer see
S.S. because she felt that her anxiety had subsided.
d. Between January 5-11th, S.S. missed a week of school due to her anxiety about
 throwing up at school. The mother did not notice her daughter had any severe
symptoms (besides a sore throat), but she showed extreme fear and anxiety about
attending school.
e. After the absences, the mom asked me to see her daughter because S.S. enjoyed
our time together and she and mom agreed that it might be helpful to talk about
how she’s experiencing anxiety with me.
f. S.S. experienced anxiety again that kept her home from school the week of Feb 2nd.
g. Beginning February 7, 2022, we began regular counseling sessions.

5. Evidenced-Based Treatment
a. Cognitive-Behavioral Therapy (CBT)
i. CBT worksheets:
https://www.therapistaid.com/worksheets/worry-exploration-questions.pdf
https://www.therapistaid.com/worksheets/my-fears.pdf
https://www.therapistaid.com/worksheets/how-i-feel-cbt-tool.pdf
Sources:
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY, US: Guilford Press.
Durlak, J.A., Furnham, T. and Lampman, C. (1991). Effectiveness of cognitive-behaviour therapy for maladapting children: a meta-analysis.
Psychological Bulletin 110, 204-214.

6. Theoretical Conceptualization

S.S. is a second-grade student at Don Juan Avila Elementary School in Aliso Viejo, CA. She lives
with her mother and father in an apartment home within walking distance of the school. Her parents
report completing some college. S.S.’s grades either meet or approach grade-level standards. She
excels at math and states that it’s her favorite subject and part of the school day. She earned all
outstanding citizenship marks in the category of “skills and behaviors that support learning” for
trimester 2 grades. I often observe her playing with one or two other children at recess and she
does not report any peer conflict.

S.S. came to my attention after her mom referred her to see the school counselor at the beginning
of the school year. Her mother reported her daughter feeling anxious about leaving for school in
the morning. After winter break, this anxiety turned into fear about attending school with a sore
throat. S.S. reported to me that she did not want to go to school with a sore throat because she
feared throwing up in front of her classmates. S.S.’s mother shared that she was not contagiously
sick, but that she felt too anxious about returning to school to go.

After two separate weeks of missing school as a result of her anxiety, S.S. and I began to meet
regularly. We spent the first two sessions completing CBT worksheets and discussing how fears
and thoughts can affect the way we feel (cognitive triangle). In the video shown, we could not
complete any worksheets because S.S. came to my office distraught and unable to verbalize her
feelings. We discussed a time we could meet during the week that would make her the least
anxious about missing class. We also agreed to only do one worksheet/CBT activity and spend the
rest of the session playing a game.

7. Individual/Cultural considerations
a. Family/individual consideration: The mother responds reactively to her daughters’
needs. She will email me saying that S.S. does or does not want to meet. It seems
like her position as an only child result in an immediate and reactive parenting style. In
addition, the father does not participate in any of the counselor-parent communication.

8. Methods of Intervention
a. 3-4 individual counseling sessions per month.
b. 20-30 minutes per session.
c. Parent communication (email) and CBT resources sent home.

9. Transference/Countertransference
a. I also suffered from generalized anxiety disorder as a child. My GAD also kept me
from attending school. However, my parents were less reactive and often made me
go to school despite my challenge.

10. Response to Treatment

a. S.S. does not like attending our sessions if she feels like it’s taking away valuable
class time. In the most recent session, she cried and could not verbalize her frustration
after I called her into my office. Normally, she does respond to the CBT worksheets
we do together. However, she only appears happy when we play a game or do
something unrelated to talking about her anxiety.

11. Termination/Closure

I know the client will be ready for termination when she no longer misses school as a
result of her anxieties. Additionally, she will be able to attend our sessions without feeling
distraught about missing out on school.

12. Recommendations

I will recommend that her mother seek outside therapy services because S.S. does not
enjoy being pulled out from school.