Counselor’s name: Sophie Young Setting: Private Practice

Client’s name: Evelyn Client’s age: 23 years old

Estimated # of sessions required: 15 Theoretical Perspective: REBT

Client History

Evelyn is a reflective and sensitive individual who developed strong dependency needs at

a young age. She reports holding strong political and moral views and expresses these through

journalism. She developed intense social anxiety in college which presented as psychosomatic

symptoms, thus allowing her to avoid the event but perpetuate her fear of public speaking. She is

currently employed as a journalist but feels hindered from professional growth opportunities due

to her anxiety. Additionally, she desires a long-term intimate relationship despite growing up

with divorced parents.

Presenting concerns

Evelyn’s primary concern is public speaking anxiety. She believes that if she were to

speak in front of an audience, she would embarrass herself and be disliked by her coworkers. She

states that public humiliation would be “the worst thing that could possibly happen to me!” due

to her strong desire to be liked by others. Furthermore, Evelyn demands wanting an intimate

partner in phrases such as “I must find a guy soon who will love me. I refuse to end up single

like my mother”. The more Evelyn discloses, the more it is evident that her anxiety stems from

irrational beliefs.

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Actual or core issues

Evelyn’s irrational beliefs, which present as demanding, awfulizing statements, and low

frustration tolerance, have been perpetuating her public speaking anxiety (Murdock, 2017).

Another contributor to her core issues is a lack of self-esteem. Her inflexible wants and social

anxiety have resulted in the ego disturbance she experiences (Murdock, 2017). Evelyn wants to

overcome her public speaking anxiety but states that “it feels impossible. Plus, I’m a lousy

speaker anyways”. The combination of irrational beliefs, demandingness, and low confidence

has had negative impacts on her social and professional life.

Evelyn’s issues are consistent with the extant literature regarding the relationship

between core beliefs, automatic thoughts, and public speaking anxiety. Visla et al. (2013) found

that negative automatic thoughts mediate the relationship between irrational beliefs and anxiety,

implying that strong negativity can equate to more intense beliefs and fearfulness about public

speaking.

Course of treatment and interventions utilized

During Evelyn’s first session, our focus was on building a warm therapeutic environment

and establishing rapport. In the following few sessions, Evelyn disclosed the specifics of her

anxious thoughts, and we began using the ABCDE model. The client’s activating event (feeling

anxious about public speaking), belief about the event (“I will humiliate myself”), and

consequence (“No one will like me”) was identified (Murdock, 2017). Inference chaining was

also used during this process to identify the client’s core beliefs (Murdock, 2017).

Inference chaining example from a session:

Evelyn: If I gave a presentation at work, I would be terrified.

Sophie: Terrified of what?

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Evelyn: Terrified of messing up my words, or seeming stupid, or getting sick! My coworkers

would think I’m a mess.

Sophie: What would happen if they thought you were a mess?

Evelyn: It would be awful. I don’t want anyone to think that. I want people to like me.

The client and I have met for eight sessions thus far and have worked in collaboration to

identify Evelyn’s irrational beliefs. We have just begun the disputing component of the model in

which Evelyn will combat these beliefs with realistic and logical responses (Murdock, 2017). In

the following sessions, an effective new philosophy will be discussed and eventually established.

So far, the client is cooperative, active, and motivated in sessions. The second half of Evelyn’s

treatment will focus on integrating rational beliefs into her thinking. Furthermore, the client will

be asked to create an interpersonal nightmare script that will be recorded. After watching the

recording, Evelyn can identify her irrational beliefs more objectively. Ultimately, Evelyn will be

given the homework assignment of speaking publicly at her job. Once the client is able to

successfully speak to an audience, she will feel more confident in her ability to complete this

task in the future.

Counseling goals

Evelyn’s short term counseling goals are to actively recognize her irrational thought

patterns. Then, she can work on replacing irrational beliefs with rational beliefs and utilizing a

more flexible way of thinking (Murdock, 2017). By learning that she can only control her view

of events rather than the event itself, Evelyn will develop a higher frustration tolerance and

experience less anxiety (Murdock, 2017). Evelyn has stated that a personal goal of hers is to one

day work as a television journalist. This is attainable for Evelyn given that she meets her short-

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term goals, completes her homework assignments, and is willing to attempt public speaking

during the process.

Anticipated outcomes of counseling

After completing our work together, the client will be capable of controlling her

responses to external events her rather than resorting to frustration and anxiety. The client will

view her anxiety as an automatic response to an activating event, rather than truth. By having

power over her cognitions and emotions, the client will feel more confident in handling

previously fear activities like public speaking. Additionally, this gained confidence will translate

into the client’s personal life by weakening her dependent tendencies and setting her up for a

healthier partner finding process. As indicated by Hyland et al. (2019), individuals who have

high self-acceptance, low demandingness, and few irrational beliefs are more likely to

experience meaningful social relationships than their neurotic counterparts. This research further

confirms that Evelyn is more likely to attract a fulfilling partner once she is in a healthier mental

state.

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 References

Hyland, P., McGinty, G., Karatzias, T., Murphy, J., Vallieres, F., & McHugh Power, J. (2019).

Can the REBT theory explain loneliness? Theoretical and clinical applications. Cognitive

Behaviour Therapy, 48(1), 39-51. https://doi:10.1080/16506073.2018.1475505

Murdock, N. L. (2017). Theories of counseling and psychotherapy: A case approach (4). Boston:

Pearson.

Visla, A., Cristea, I. A., Szentagotai Tatar, A. & David, D. (2013). Core beliefs, automatic

thoughts and response expectancies in predicting public speaking anxiety. Personality

and Individual Differences, 55(7), 856–859. https://doi.org/10.1016/j.paid.2013.06.003