CASE MANAGEMENT of JUANA DELA CRUZ

Session Frequency: Ten (10) sessions

Level of Supervision: Minimal Supervision
Support Groups Identified: Not Applicable
Expected outcome and prognosis: Lessen anxiety and irrational thinking
Modality/Approach: Mostly REBT with other approaches
Meeting Details
• Preferred way of meeting: Meeting would be via zoom
• Potential Medication with Psychiatrist: Not Applicable
• Other Referrals: none at this time

IMPORTANT DETAILS RELATIVE TO THE CASE

Presenting Problem:

Juana shared that she fears being criticized by other people. This attitude triggers her stress
and anxiety as she feels being judged, rejected, and personally attacked. Such irrational
belief hinders her to submit the final revision of her thesis as she is led by fear of
criticism. She hopes that the counseling and psychotherapy will lead her to resolving
such issue: be resilient in the face of criticism and understand that it is part of life as
such attitude causes her further delay in attaining her goals in life

Diagnostic Impression
Based on the screening tests administered to Juana, she is experiencing mild anxiety.
Her symptoms, based on BAI, are as follows: unable to relax; fear or worst happening; dizzy or
lightheaded; heart pounding/racing; terrified or afraid; nervous; and scared.
During the interview, she narrated that she is in fact anxious. The main source of her
anxiety is coming from her irrational belief in the face of criticism. The feedback of people is
destructive on her part—she feels rejected, judged, and personally attacked. This kind of
irrational belief is causing significant interference in Juana’s life. She worries so much about her
delays in life, but her fear of criticism hinders her to submit the final revision of her thesis. She
often awfulizes even before her submission. For Juana, she cannot handle criticisms. Her fear to
be criticized are coming from: (1) her tendency to be a perfectionist as she was an achiever when
she was in elementary and high school; (2) the fact that her outputs must be free from errors as
this is her way to prove herself, not just to her mother and other significant people in her life, but
also to her father who abandoned them; and (3) her belief that criticisms destruct her from
obtaining her goals in life.
 Predisposing Precipitating Perpetuating Protective

Family history
of hypertension Food
deprivation
Healthy diet and
Biological Her mother was Hormonal change
exercise
diagnosed with Developed
benign breast eczema
cyst
“Delays” in life
Competitive, High Willingness to
achiever, grade- expectations of learn and grow
conscious herself
Criticisms/feedback
Psychological Leisure
from her thesis
Her tendency to Patterns of activities: music,
panelists
be a thinking movies, social
perfectionist Perfectionist media
Recent
Active church
retrenchment
participation
from work
Familial support
Lack of family’s
financial
They filed a case Forgave her
resources
against her father father and
on the ground of willingness to
Abandonment She was
Social economic abuse reconcile
by their father backstabbed by
(inadequate to no
her classmates in
support from the Workplace
high school
father) friendship
Conflict with her
Willingness to
boyfriend, e.g.,
negotiate
different
differences with
political
her boyfriend
principles
Initial Phase of the Treatment (Sessions 1-2)

• Establish therapeutic relationship with the client by having free-flowing conversation.

• Discuss and identify her thoughts and feelings which makes her feel good (wants and
needs) and ask her “what a quality world for her looks like.”
• Teach the client to engage in self-evaluation and build trust:
• How would you most like to change your life?
• What do you want in life that you’re not getting?
• What would you have in your life if you were to change?
• What do have to do now to make changes happen?
Homework: Identifying triggers worksheet

Working Phase of the Treatment (Sessions 3-8)

Sessions 3-4
• Discuss identifying triggers worksheet.
• Drive the discussion to what triggers her to feel anxious.
• Help client identify her patterns of irrational thinking, those habitual beliefs that lead her
to misperceive reality.
• Perform “As If” technique to make her visualize how she wants to be perceived by her
critics.
• Assignment: Keep a running list of automatic thoughts up until next week thoughts

Sessions 5-6
• Assist the client in analyzing her direction/doing. The following questions can be asked
(Corey, 2014):
• What are you doing now?
• What did you want to do differently the past few months?
• What stopped you from doing what you wanted to do?
• Assist the client in evaluating her choices. The following questions can be asked (Corey,
2014):
• Is what you are doing now what you want to be doing?
• Is what you are thinking helping or hurting you?
• Does it help you to look at it that way?
• Is there a healthy congruence between what you are doing and what you believe?
• Rationalize by compare the things she can’t and can do.
• Homework: Plan-Map about her own solutions; Practice Anchoring, Worry time and 3
questions, thought reframing and replacement and Focusing
 Sessions 7-8
• Discuss and explore the outcomes of client’s decisions: ABCDEF model.
• Illuminate activity that helps client focus on the strengths she already has inside of her,
i.e., her consciousness that she can improve and willingness to learn.
• Compliment technique/Self-compliment: Help in bringing a client into a strength
perspective.
• Replace the distorted messages with reality-based alternatives and positives, realistic self-
talk that will increase her self-confidence in coping irrational belief.
• Homework: Self-Affirmation Activity; Practice Anchoring, Worry time and 3 questions,
thought reframing and replacement and Focusing Homework: Plan-Map about her own
solutions
Ending Phase of the Treatment (Sessions 9-10)

Sessions 9-10
• Encourage and help the client to develop plan that she can carry out independently.
• Guide a little when struggling to express herself and insert a few leading questions to
help her execute her own therapeutic plan.
• Using Wubbolding’s SAMIC3, the following can be suggested:
• Go outside with friends more to strengthen her support and increase confidence level
• In stressful situations, contemplate and reflect before responding, to avoid conflicts
and misunderstanding.
• Continue serving in the church to increase morale and strengthen unconditional
positive regard
• Ask her to have a journal discussing her feelings and contemplate about it.

• Homework: The self-care worksheet and Journal Writing; Practice Anchoring,

Worry time and 3 questions, thought reframing and replacement and Focusing
COUNSELING/PSYCHOTHERAPEUTIC PLAN
Problem Terminal Specific Objectives Specific Plan of Action/ Duration/Time Progress
Identified Objective Intervention Frame Notes/
Actual
Result
Irrational belief To help the Establish rapport Establish therapeutic Sessions 1 Initial
of being rejected, client dispute or and therapeutic relationship with the client by Phase
judged, and reverse her alliance having free-flowing
personally irrational belief conversation; – Instilling
attacked in the in situations Make the client humor during the session, and
face of criticism where she is understand the incorporating empathy,
and as a result, exposed to approach of therapy unconditional positive regard,
being anxious criticisms and and genuineness, the therapist
and stressed be more Therapy goals: should be able to successfully
functional at 1. Check mood establish rapport to the client.
ease with 2. Establish rapport
and alliance with
herself client Establish Therapeutic
3. Identify Juana’s
Alliance – By involving the
chief complaint client in creating the treatment
4. Review case
plan and the goal of the
conceptualizat therapy, the client should feel
ion by involved during her therapy
gathering / session
verifying
pertinent Conduct Psychoeducation –
information Educating the client regarding
about the the Cognitive Behavioral
client. Therapy, its model, and how
5. Introduce the behavioral activation
Cognitive works
Behavioral Model
6. Describe Problem Homework – 1.The client will
 in Context of be asked to keep a running
Model list of questions that she may
7. Introduce think of about the therapeutic
behavioral process
activation
8. Set goals
2. Use the cognitive-
9. Give homework
behavioral model diagram for
10. Receive feedback
at least three situations you
experience this week. (up until
the next session)

Have the client Continue enhancing rapport and Session 2 Initial

therapeutic alliance Phase
Identify initial
triggers and
automatic thoughts In-depth interview
and
Set Initial Goals Discuss and identify her thoughts
and feelings which make her feel
good (wants and needs) and ask
her “what a quality world for her
looks like.”
Therapy goals:
1. Check mood
2. Establish rapport Psychoeducation: Teach the client
and alliance with to engage in self-evaluation and
client build trust:
3. Review Case • How would you most like
Conceptualization to change your life?
4. Review Cognitive
• What do you want in life
Behavioral Model
and behavioral that you’re not getting?
activation • What would you have in
5. Discuss and your life if you were to
feedbacking about change?
the homework • What do you have to do
6. Introduce quality now to make changes
world happen?
7. Set goals
8. Give homework
Homework: Identifying triggers
9. Receive feedback
worksheet ( 3 column thought
record)
Identify and Maintain Rapport and Therapeutic Sessions 3-4
understand Alliance. Continue to involve the Working Phase
automatic client in the treatment plan and
thoughts leading
to anxiety goals of therapy and ask for
feedback
Understand that
one can have Discuss identifying triggers
control over one’s worksheet .
thoughts
Learn guided Discuss automatic thoughts
meditation
Drive the discussion to what
Reduce symptoms triggers her to feel anxious
of stress and
anxiety
Help client identify her patterns of
Therapy Goals irrational thinking, those habitual
1. Check Mood beliefs that lead her to misperceive
2. Review triggers reality.
worksheet/ 3
column thought
record Challenge Maladaptive
3. Discuss and thoughts – Introduces the
feedbacking about following questions in order
the homework/s to challenge maladaptive
4. Introduce thoughts that the client
complete thought encounter:
record a. What evidence is
5. Introduce there that this
 Complete thought thought is true?
record b. What evidence is
6. Challenge there that this
maladaptive thought is not true?
thoughts c. What would I tell
7. Revisit goals
8. Verbalize faulty someone I loved
assumptions and if they were in
irrational beliefs this situation and
and how these had these
affect the client on thoughts?
a daily basis d. If my automatic
9. Set Homework/s thought is true,
what is the worst
that could happen?
e. If my automatic
thought is true,
what is the best
thing that could
happen

Assessment- can give BAI to

monitor level of anxiety brought
about by automatic thoughts and
irrational belief

Guided Meditation – for stress

management

Homework:
Keep a running list of automatic
thoughts up until next week using
the complete thought record
Learn Alternative Maintain Rapport and Therapeutic Sessions 5-6
tools of thinking Alliance. Continue to involve the Working Phase
client in the treatment plan and
Review set goals goals of therapy and ask for
feedback

Therapy Goals Psychoeducation – How

alternative tools of thinking
1. Check mood Helps replace the distorted
2. Teach alternative messages with reality-based
tools of thinking alternatives and positive,
that are more realistic self-talk that will
logical, consistent increase her self-confidence
and rational in coping with irrational
3. Discuss and
feedbacking about belief.
the homework Other techniques: Focusing
4. Implement guided Anchoring
meditation Worry time and 3 questions
5. Revisit and When a worry comes up write what
establish new worries you and ask relevant
goals questions
6. Receive feedback
7. Set Homework/s
Assist the client in analyzing her
direction/doing. The following
questions can be asked (Corey,
2014):
• What are you doing now?
• What did you want to do
differently the past few
months?
• What stopped you from
doing what you wanted to
 do?

Assist the client in evaluating her

choices. The following questions
can be asked (Corey, 2014):
• Is what you are doing now
what you want to be
doing?
• Is what you are thinking
helping or hurting you?
• Does it help you to look at
it that way?
• Is there a healthy
congruence between what
you are doing and what
you believe?

Rationalize by compare the things

she can’t and can do.

Homework: Plan-Map about her

own solutions; Practice
Anchoring, Worry time and 3
questions, thought reframing and
replacement and Focusing
Practice and Maintain Rapport and Therapeutic Sessions 7-8
strengthen Alliance. Continue to involve the Working Phase
Alternative tools of client in the treatment plan and
thinking goals of therapy and ask for
feedback
Do self-compliment/
affirmation Discuss and explore the outcomes
of client’s decisions: ABCDEF
 model.
Therapy Goals
1. Check mood Psychoeducation: Illuminate
2. Introduce the
activity that helps client focus on
effects of self-
the strengths she already has
affirmation
3. Discuss and inside of her, i.e., her
feedbacking about consciousness that she can
the homework improve and willingness to learn.
4. Continue guided
meditation Compliment technique/Self-
5. Revisit the goals compliment: Help in bringing a
and work towards client into a strength perspective.
a fully functioning
person, free from Strengthen Thought replacement
fear of criticism and reframing: Replace the
6. Receive feedback distorted messages with reality-
7. Set Homework/s based alternatives and positive,
realistic self-talk that will increase
her self-confidence in coping with
irrational belief. ; Anchoring,
Worry time and 3 questions and
focusing

Homework: Self-Affirmation
Activity; Practice Anchoring,
Worry time and 3 questions,
thought reframing and
replacement and Focusing
Express ability to Maintain Rapport and Therapeutic Sessions 9-10
care for one’s self Alliance. Continue to involve the Closing Phase
client in the treatment plan and
Express goals of therapy and ask for
commitment to feedback
 one’s goals
Encourage and help the client to
Therapy Goals develop a self-care plan that she
1. Check mood can carry out independently.
2. Discuss and
feedbacking about Guide a little when struggling to
the homework. express herself and insert a few
3. Refine and
continue leading questions to help her
intervention execute her own therapeutic plan.
techniques.
Discuss for Using Wubbolding’s SAMIC3, the
sustained self- following can be suggested:
implementation
• Go outside with friends more
4. Introduce and
to strengthen her support and
schedule an after
increase confidence level
care, self-care
plan. • In stressful situations,
5. Receive feedback contemplate and reflect before
6. Revisit the goals. responding, to avoid conflicts
and misunderstanding.
• Continue serving in the church
to increase morale and
strengthen unconditional
positive regard
• Ask her to have a journal
discussing her feelings and
contemplate about it.

Homework: The self-care

worksheet; Journal Writing and
reflections on the therapeutic
process; Implement self-care plan
My therapist and I have developed this plan together and I agree to work on the issues and goals. I understand the treatment goals that
were developed are for my treatment.
Client: _________________________ Date:
Name and Signature

Psychologist: Date:
Name and Signature/License #