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Counseling Intervention Report

Name: D (she/her/hers) Age: 13

School: Sierra Preparatory Academy Dates of Intervention: 9/21/23-11/16/23
Grade: 8 LPCC Trainee: Anwen Buu

Introduction

D is a female, Hispanic or Latina eighth-grade student who was brought to my attention

by one of the school counselors at my site for this project after D referred herself to meet with

the school counselor for mental health support. On the referral, the student had expressed

difficulty managing her anxiety symptoms at school, thus her school counselor asked me to teach

D beneficial coping strategies through brief counseling. In my initial meeting with D, she

explained that while her anxiousness is hardly an issue at home, her symptoms of overthinking,

or obsessive/intrusive thoughts mainly occur with regard to her grades and in school settings,

specifically crowded areas such as the lunch tables and hallways on campus. D’s somatic

symptoms for anxiety include hand sweating, shaking, slight headaches, and nausea. Per her

assigned school counselor, she currently has a boyfriend who is in the same grade as her,

however we do not know if this has a potential impact on her perceived anxiety.

Assessment and Case Formulation

According to D’s records, she is a high-achieving student with great attendance and has

good relationships with teachers and peers. Her teachers and school counselor have reported that

D is a hardworking student and has no behavioral issues in the classroom. With regard to persons

of support in her life, she has identified the three school counselors on campus, her dad, and

siblings to be people she can talk to. It was revealed that D feels the most anxiety in the midst of

large crowds during lunchtime or passing periods. D has stated that her anxiety is illustrated as

“people coming at her” and would usually cope with the situation by removing herself from it
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and walking around campus. This is followed by feeling overwhelmed or stressed with school

assignments. D struggles with managing her stress and anxiety indicating a lack of effective

coping skills, thus relying on the student self-referral system to talk to their school counselor for

individual mental health support.

My treatment approach for working with D mainly consists of mindfulness training and

cognitive behavioral therapy (CBT). I chose this treatment approach based on D’s descriptions of

her anxiety symptoms and the settings in which they occur and her goals. To support my

decision, Borquist-Conlon and colleagues (2019) concluded in their study that

mindfulness-based interventions, including interventions that included components of CBT had a

moderate and significant effect on the treatment of anxiety symptoms in adolescents who met

criteria for an anxiety disorder. Similarly, Caldwell et al. (2019) discovered that while there was

a lack of strong evidence to support CBT-based interventions in reducing anxiety

symptomatology in primary and secondary settings, mindfulness and relaxation-based

interventions had a significantly larger impact on anxiety symptoms of children and young

people in universal secondary settings. For the sake of this case study, the RCADS self-reporting

clinical tool was modified with the purpose of measuring severity and frequency of D’s anxiety

symptoms throughout the course of the intervention. Assessment items were also individually

selected based on D’s concerns and goals regarding perceived anxiety.

Goal 1: D will develop a growth mindset to grades lower than a C by catching negative thoughts
and reframing them to be more positive/helpful ones at least once a week for five weeks.

In collaboration with D, this goal focuses on the automatic negative thoughts that occur

when D sees any grade that is a lower than a C on Aeries. D is often worried about having “bad”

grades, however she considers a “C” to be a bad grade. At the onset of this counseling

intervention, D’s current grades were all A’s and B’s with the exception of one C. Upon asking
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her how nervous she was about the class she had a C in on a scale of 1-10, D had responded with

a 7. Thus, in order to guide D in the development of a more positive mindset, we would play a

game of “what-if’s and so-what’s” every week where we state our worries and find a possible

outcome that is more positive.

Goal 2: D will improve emotional regulation in large crowds using coping skills (mindfulness)
and cognitive restructuring to reduce the number of self-referrals from over three times per week
to once a week.

D and I created this goal based on the context of a majority of her referrals which mainly

pointed to anxiety and discomfort in large social situations. To expand her coping toolbox, we

practiced mindfulness and cognitive reframing using a resource provided by my supervisor

called “Cards Against Anxiety” (Kingsmith, 2020). With every weekly check-in, D would catch

me up on her week and discuss the circumstances in which she felt anxious and in which

situations she utilized her coping strategies. Utilization of coping skills was recorded onto her

behavior intervention plan. She was also given sensory stickers to stick onto her binder or

notebook as a reminder to practice mindfulness during stressful times inside and outside of the

classroom.

Goal 3: D will improve self-esteem by talking to two new peers by the end of our 6-week
intervention.

This goal was created primarily by D herself because if she could talk to new peers, she

would be more comfortable socializing in larger crowds than she is used to. Toward this end, I

provided D with a thought journal for her to record any efforts she may have made. This also

served as a way for us to talk about it the following week and discuss her strengths, struggles, or

concerns she may have had.

Analysis of Outcome Data and Discussion of Results

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D and I were able to establish a strong therapeutic relationship at the beginning of this

weekly counseling intervention. She was open, optimistic, and motivated to utilize learned

coping strategies outside of our sessions. While I do believe that D met expectations for our first

goal of managing stress and reactions to her grades on Aeries, D only experienced elevated

nervousness and anxiety once during the course of our intervention and it was when her grade for

Social Science dropped to a D as a result of her absence. D stated that this was easily resolved by

talking to a friend and mentioned that it wasn’t elevated enough to the point where it warranted a

referral to the counseling office.

For her second goal of coping with large crowds at school, D was, for the most part,

successful. She stated that the mindfulness strategies we practiced during our sessions were the

most helpful followed by the cognitive reframing techniques. Mindfulness in the form of deep

breathing and focusing on the colors in her environment were the most effective strategies that

helped ground and calm her down. D also mentioned that she plans to continue using even after

our counseling intervention. The chart above illustrates the gradual decrease of D’s self-referrals
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to the counseling office, demonstrating her ability and potential to wean off the support of her

school counselors and cope with stressful situations on her own.

D was able to meet her third goal of talking to at least two new peers toward the end of

the intervention. While there were no quantitative measures in place to measure her progress

toward this goal, she discussed how it went during our weekly check-ins by recording the details

of her conversation with these peers in the thought journal. The first person D befriended was

Joanna, a girl who was also in Leadership with her. This opportunity was fortunately brought

upon by their teacher when she assigned them to complete a task together for their school-wide

Halloween event. D explained that it was easy for her to talk to Joanna because they were

spending time together one on one, as opposed to talking to each other when surrounded by a

large group of peers. For her second new friend, she talked to a guy named Ziggy in her math

class to ask for help. While it did not go in the same direction as it did with Joanna, D shared that

it was an interesting experience and that she was glad she did it. The table below demonstrates

RCADS scores representing D’s self-reported measures for ability to cope with anxiety that was

administered every two weeks. A score of 24 on this modified RCADS was equivalent to always
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being worried or anxious. It is clear from the results that D’s perceived perception of her

anxiety-related symptoms decreased over the course of the intervention, contributing to the

overall efficacy of this counseling intervention.

Reflection

In reflection, there were some weeks I was unable to meet D due to other duties at my

site in combination with the student being sick. In addition, the measure for number of student

self-referrals did not accurately reflect D’s progress or goal monitoring for the week of 10/13

because D had stated that no referral was filled out that day solely because she was not in an

uncomfortable situation that provoked her anxiety symptoms. Thus, this event was evident of a

potentially major limitation that compromises the efficacy of this intervention. Finally, the

inclusion of social skills training may have benefited D regarding her goal to be a bit more

extroverted to build more healthy/positive relationships with peers and be less anxious in large

crowds. While I do believe this counseling intervention was somewhat effective, I feel that

effectiveness would increase if I had more time with the student in a clinical setting to avoid

various time conflicts during her school day.

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References

Borquist-Conlon, D. S., Maynard, B. R., Brendel, K. E., & Farina, A. S. J. (2019).

Mindfulness-based interventions for youth with anxiety: A systematic review and

meta-analysis. Research on Social Work Practice, 29(2), 195–205.

https://doi-org.chapman.idm.oclc.org/10.1177/1049731516684961

Caldwell, D. M., Davies, S. R., Hetrick, S. E., Palmer, J. C., Caro, P., López-López, J. A.,

Gunnell, D., Kidger, J., Thomas, J., French, C., Stockings, E., Campbell, R., & Welton,

N. J. (2019). School-based interventions to prevent anxiety and depression in children

and young people: A systematic review and network meta-analysis. The Lancet

Psychiatry, 6(12), 1011–1020. https://doi.org/10.1016/s2215-0366(19)30403-1

Chorpita, B. F., Ebesutani, C., & Spence, S. H. (2022). Revised Children’s Anxiety and

Depression Scale. Child FIRST.

https://www.childfirst.ucla.edu/wp-content/uploads/sites/163/2022/01/RCADSUsersGuid

e20220125.pdf