Case study : 2

Case summary:
Dine is a 20-year-old who reports to you that he feels depressed and is experiencing a
significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much
of his day in his dorm room playing video games and has a hard time identifying what, if
anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to
his professors to try to salvage his grades this semester. Dine has always been a self-described
shy person and has had a very small and cohesive group of friends from elementary through
high school. Notably, his level of stress significantly amplified when he began college. You learn
that when meeting new people, he has a hard time concentrating on the interaction because he
is busy worrying about what they will think of him – he assumes they will find him “dumb,”
“boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and
starts to sweat, which only serves to make him feel more uneasy. After the interaction, he
replays the conversation over and over again, focusing on the “stupid” things he said. Similarly,
he has a long-standing history of being uncomfortable with authority figures and has had a hard
time raising his hand in class and approaching teachers. Since starting college, he has been
isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his
cell phone when it rings, and habitually skipping class. Please help.

Chief complaints:

 feeling depressed
 stress about school.
 difficulty interacting with new people due to fear of being judged
 stuttering, feeling uneasy, and replaying conversations repeatedly.
 increasingly isolating
 turning down social invitations and skipping class.
 history of being uncomfortable with authority figures.

Diagnosis/ Problem: social anxiety disorder

No. of sessions required: 3-4 sessions

Goals: Improve Mental Health & Enhance Social Skills

Short term goal:

 Increase self-esteem and confidence

 Develop effective communication strategies to interact with new people, including practicing
active listening and assertive responses to reduce anxiety and stuttering.
 Set realistic goals for academic performance

Long term goal:

 Improve Mental Health

 Improve Mental Health
 Increase Productivity
 Build Support Network
 Develop Coping Mechanisms
Verbatim : 1

Session No. Objective Techniques : Psychotherapy (with

Counselling skills brief description)
1 1. Establish rapport and create
a safe environment for the
client to share their concerns.
2. Explore the client's current
feelings of stress and
depression related to school.
3. Identify factors contributing
to the client's increased anxiety
and social isolation.
4. Introduce relaxation
techniques, such as deep
breathing, to help manage
immediate symptoms of
anxiety.
5. Initiate discussions about
future sessions and potential
areas of focus.

speaker dialogue technique

Counselor Hi, it's nice to meet you. I’m glad that you came Greeting/Physical arrangement
today. Please have your seat and make yourself
comfortable. How are you feeling today?

client Not great, to be honest. I feel really stressed and

depressed about school. I think I’m probably going to
flunk out.

Counselor I want to let you know that this is a safe space where Confidentiality/Topic/Open ended question.
you can talk openly about what’s been going on.
Everything you share here is confidential. It sounds
like you’re feeling really overwhelmed. It’s important
that you’re sharing this, and I want to help you
through it. Can you tell me if anything has changed
recently to make you feel this way?
client I’ve always been shy and had a small group of
friends, but things got a lot worse when I started
college. Meeting new people is really stressful for me.
I’m always worried about what they think of me.

Counselor It sounds like social interactions are causing a lot of Reflection of thoughts.
anxiety for you. What kinds of thoughts go through
your mind when you meet new people?

client I assume they’ll think I’m dumb, boring, or a loser. I

get so nervous that I lose my concentration, start
stuttering, and sweating. Then, I keep replaying the
conversation in my head, thinking about all the stupid
things I said.

Counselor That sounds really tough, Dine. When you lose Reflection of feeling
concentration and start stuttering, it must feel very
uncomfortable.

client Yeah, it makes me feel even worse about myself.

Counselor I hear you. It sounds like this anxiety is really Paraphrasing/open ended question
affecting your interactions and making it hard to
connect with others. You mentioned you’ve been
isolating more since starting college. Can you tell me
more about that?

Client I’ve been avoiding my roommate, ignoring calls, and

skipping class. I just don’t want to deal with anyone.

Counselor It’s understandable that you might want to retreat Negotiation

when feeling so overwhelmed. It’s also important to
find ways to connect and feel supported. Over the
next few sessions, we’ll work on strategies to help
manage your stress and anxiety. For today, let’s start
with some deep breathing exercises. This can help
you feel more centered and calmer. Are you willing to
 try that with me?

Client Sure, I guess

Counselor Great. Sit comfortably and take a deep breath in Contracts/Negotiation

through your nose, hold it for a few seconds, and then
slowly exhale through your mouth. Let’s do this
together a few times.

Counsellor How do you feel after that?

Client A bit more relaxed, actually

Counselor I’m glad to hear that. This is a technique you can use Negotiation/Process limit
whenever you start to feel overwhelmed. We’ll
explore more strategies in our next session. For now,
is there anything specific you’d like to focus on next
time?

Client Maybe how to deal with my professors and get back

on track with school

Counselor That sounds like a good plan. We’ll work on that next Process limit.
time. Thank you for sharing today, Dine. You did
great.

NEGOTIATING HOME WORK

Session 1: Negotiation and Rapport Building

Name of the counsellor: AS

Name of the client: Dine
Date: 7/05/2024
Problem: social anxiety disorderNature:

 Client is experiencing significant stress and depression due to social anxiety, which is
impacting their academic performance

 Avoidance of social interactions and isolation is worsening the problem

Alternative home work:

 Deep breathing exercises

Home work/ contract:

 Commit to trying deep breathing exercises

Time schedule:

 Weekly 1-hour sessions

Strategies/ methods:

 Establish confidentiality and create a safe space for the client to open up

 Use open-ended questions, reflection of feelings, and paraphrasing to build rapport and
understanding

 Introduce deep breathing as a coping technique

Non-human resource:

 Counselling room

Challenges – ahead:

 Helping the client manage overwhelming thoughts and physical symptoms of anxiety

 Encouraging the client to engage socially despite their fears

Expected outcome:

 Client feels heard, understood, and empowered to work on their anxiety

 Client learns and practices deep breathing as a stress management tool

Percentage of completion of work:

 30%

Outcome:

 Client reports feeling more relaxed after practicing deep breathing

 Client agrees to continue using the technique and focus on dealing with professors and school
in the next session

Verbatim 2:
Session No. Objective Techniques : Psychotherapy (with
Counselling skills brief description)
2. 1. Review the client's progress
since the previous session and
reinforce positive changes.
2. Introduce cognitive-
behavioral techniques, such as
cognitive restructuring, to
challenge negative thoughts
and beliefs.
3. Practice social skills training
through role-playing scenarios
to improve confidence in social
interactions.
4. Set achievable goals for the
client to gradually increase
social engagement and
academic involvement.
5. Discuss strategies for
approaching professors and
seeking academic support.

Session 2: Cognitive-Behavioral Techniques and Social Skills Training

Counsellor Hi, welcome back. How have you been Greeting

since our last session?

Client A bit better. I’ve been trying the deep

breathing, and it helps sometimes.

Counsellor I’m glad to hear that. Today, you Paraphrasing

mentioned wanting to focus on dealing
with your professors and getting back on
track with school. Is that still your main
concern?

Client Yeah, I really need to figure out how to

talk to them and maybe fix my grades.

Counsellor Let’s work on that. One technique that Questions focusing on

might help is called cognitive thinking
restructuring. This involves identifying
and challenging negative thoughts. Can
you share some of the thoughts you have
about talking to your professors?
Client I keep thinking they’ll think I’m lazy and
that it’s too late to fix anything.

Counsellor Those are really tough thoughts. Let’s Reflection of words

challenge them. What evidence do you
have that your professors will think you’re
lazy?

Client I guess I don’t know for sure, but I haven’t

been to class much.

Counsellor It’s understandable to feel worried about Reflection of words

that. Now, what evidence do you have that
it’s too late to fix anything?

Client Well, the semester is almost over, but I

haven’t actually talked to them yet.

Counsellor So, it sounds like you don’t have concrete Indirect suggestion
evidence that it’s too late. How might
things be different if you approached your
professors with honesty about your
struggles?

Client Maybe they’d give me a chance to catch up

or offer some advice

Counsellor Exactly. Sometimes, taking that first step Direct lead

can open up new possibilities. Let’s
practice what you might say to a
professor. Imagine you’re walking into
their office. How would you start the
conversation?

Client Um, I guess I’d say, “Hi, and I’ve been

struggling a lot this semester. I’m really
worried about my grades and wanted to
 see if there’s anything I can do to
improve.”

Counselor That’s a great start. Clear and honest. Let’s Approval remark / Direct
role-play this scenario so you can feel lead
more confident. I’ll be the professor.

Counselor How did that feel? Close ended question/

Question focusing on
feeling

Client A bit awkward, but not as bad as I thought.

Counselor With practice, it’ll get easier. Another Indirect suggestion

thing that might help is building your
social skills gradually. Accepting small
invitations from your roommate or
responding to a text can be good first
steps. What do you think?

Client Yeah, I think I can try that.

Counselor Great. Let’s set a small goal for the week. Contract
How about trying to attend one class and
responding to one text or invitation?

Client Okay, I can do that.

Counselor Wonderful. We’ll check in on how that Approval remark/

 goes next time. Remember, small steps are Termination
progress. You’re doing really well

NEGOTIATING HOME WORK

Session 2: Cognitive-Behavioral Techniques and Social Skills Training

Name of the counsellor: AS

Name of the client: Dine
Date: 7/12/2024
Problem: social anxiety disorderNature:

 Client wants to focus on communicating with professors and improving academic

performance

Alternative home work:

 Cognitive restructuring to challenge negative thoughts

 Gradual exposure to social situations

Home work/ contract:

 Attend one class

 Respond to one text or invitation from roommate

Time schedule:

 Weekly 1-hour sessions

Strategies/ methods:

 Use cognitive restructuring to identify and challenge negative thoughts about professors and
social interactions

 Role-play conversations with professors to build confidence

 Encourage small steps towards social engagement

Non-human resource:

 Counselling room

Challenges – ahead:

 Helping the client overcome fears and take action despite anxiety

 Maintaining motivation and celebrating small wins

Expected outcome:

 Client feels more empowered to communicate with professors

 Client takes small steps towards social engagement and experiences some success
Percentage of completion of work:

 60%

Outcome:

 Client talks to two professors, who are understanding and offer extra assignments

 Client attends a class and responds to a text from roommate, feeling relieved and connected
afterwards

Session 3: Review, Reinforcement, and Termination

Session No. Objective Techniques : Psychotherapy (with

Counselling skills brief description)
3. 1. Reflect on the client's overall
progress and successes
throughout the counseling
process.
2. Review and reinforce
effective coping strategies
learned in previous sessions,
such as deep breathing and
cognitive restructuring.
3. Explore the client's preferred
techniques and support
systems for managing stress
and anxiety independently.
4. Discuss the importance of
maintaining progress and
seeking help if needed in the
future.
5. Provide closure and
termination of the counseling
relationship, emphasizing the
client's ability to continue using
learned skills and seeking
support when necessary.

Session 3 verbatim

Counselor Hi, it’s good to see you again. Greeting

How have things been going?
Client Better, actually. I talked to two
of my professors, and they
were understanding. I also
went to a class and responded
 to a text from my roommate.

Counselor That’s fantastic progress! How Approval remark / questions

did it feel to talk to your focusing on feelings
professors and engage more
socially?

Client It was nerve-wracking, but I

felt relieved after. My
professors offered some extra
assignments, and my
roommate and I hung out. It
felt good to connect.

Counselor I’m really proud of you for Approval remark / summary

taking those steps. You’ve reflection
made significant progress in
managing your stress and
anxiety. Today, we’ll review
what we’ve worked on and
discuss how you can continue
using these strategies.

Client Okay, sounds good

Counselor Over the past few sessions, Questions focusing on thinking

we’ve practiced deep
breathing, cognitive
restructuring, role-playing
social interactions, and setting
small goals. Which of these
techniques do you find most
helpful?

Client The deep breathing and role-

playing were really helpful.
Also, setting small goals made
things feel more manageable.
Counselor I’m glad to hear that. These Support system
techniques are tools you can
continue to use. Let’s also talk
about building a support
system. Who can you reach
out to when you’re feeling
overwhelmed?

Client My roommate has been really

supportive. I also have a
friend from high school I can
talk to

Counselor That’s great. Having a support Terminal reflection

system is crucial. As we
conclude our sessions, it’s
important to remember that
you’ve built some strong
foundations. If you find
yourself struggling again, it’s
okay to seek help, whether it’s
through friends, family, or a
counselor.

Client I’ll keep that in mind. Thank

you for all your help

Counselor You’re very welcome. You’ve Approval remark

done an amazing job, and I’m
confident you’ll continue to
make progress. Remember to
be patient and kind to
yourself. It’s been a pleasure
working with you.

Client Thanks, I appreciate it.

Counselor Take care, and best of luck Termination

with everything. Remember,
you have the tools to handle
what comes your way.
Session 3: Review, Reinforcement, and Termination

Name of the counsellor: AS

Name of the client: Dine
Date: 7/19/2024
Problem: social anxiety disorderNature:

 Client has made significant progress in managing stress and anxiety

Alternative home work:

 Continued practice of deep breathing, cognitive restructuring, and gradual exposure

Home work/ contract:

 Maintain support system and reach out for help if needed

Time schedule:

 Final session

Strategies/ methods:

 Review the techniques learned and their effectiveness

 Discuss the importance of a support system

 Emphasize the client's progress and provide encouragement

Non-human resource:

 Counselling room

Challenges – ahead:

 Maintaining progress and coping with setbacks

 Continuing to build confidence and social skills

Expected outcome:

 Client feels empowered with the tools to manage their anxiety

 Client has a plan for ongoing support and growth

Percentage of completion of work:

 100%

Outcome:

 Client expresses gratitude for the counselor's help and feels confident in their ability to handle
future challenges
  Client commits to continuing to use the techniques learned and reaching out for support when
needed

Verbatim 2:

References: