Case study clinical example: First session with a client with symptoms of social anxiety (CBT model)



hi Hannah nice to meet you hi so I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties hmm yeah um yeah I guess it kind of started like five six years ago okay um it kind of escalated a bit and I've just recently moved out um from living with my parents so it made it a bit worse I think okay is this the first time that you've left home yeah I am yes first time much the yeah um I was going to a few years ago just thought it would be easier to stay home okay so it's been quite a big step in a big change and and it sounds like that that was what led you to go to your GP yeah so how has that change things for you um Gennaro its kind of I haven't really told anyone so I mean it's made up like better and since I feel hopefully this is this is it like oh cool it'll help but I don't know I don't like thinking that I've like had to do this I never thought I'd like be the kind of person you'd have to actually go and like get help that makes sense okay so how do you feel about being here today fits like scared I don't know hopefully it will help okay so we'd be a little bit anxious about today yeah okay so I guess just going back to and why you went to the GP and how you've ended up kind of coming here today so it sounds like you've been experiencing anxiety for quite a few years but just recently moved out of home for the first time annum and that was what kind of led you to go to the GP so how did that change things how were things after you moved out and I thought that they'd be better but because I thought I'd have to kind of be independent and space actually a lot were so I'm just kind of staying in the house a lot I don't really have any friends or anything I mean my family come and visit a bit but it's not I don't know it's kind of scary because I've just been kind of let you just in the flat by myself which I always thought I'd like but I don't actually like it okay so what other kind of difficulties that you have been experiencing I mean I'm I'm a photographer and so I kind of it's been stopping me a bit my anxiety from being able to get work and because every time you know there's an opportunity that is kind of involving me having to interact with people I just tend to just turn it on so I was kind of making things hard in that respect and just kind of friends wise and everything I'd feel like I'm just kind of increasingly more alone so it's kind of stopping me from making friends and you know like relationships and stuff O'Casey said that your difficulties are getting in the way of you doing certain things so they're they're stopping you from taking up kind of certain types of work and as a freelance photographer I guess that that can be kind of a problem and they're also stopping you or you feel like it is stunting you socially you're not kind of able to make new friends and get to meet new people yeah yeah and it was kind of easier when I was at home because I was obviously I mean my parents as have lost fine but you know they would I'd go to places with them or I'd kind of have people there but more and more I'm just finding myself just staying again a lot I mean I went like two weeks give coffee with my friends and the whole time I was just kind of wanting to go home again so I don't I just don't want to I don't want that to happen I don't want to lose everyone so huh see kind of worried about how where this is going to lead to yeah um yeah so you said that you first noticed the anxiety kicking in when about five or six years ago so you would have been about 19 yeah and what was happening around that time I guess I'd finished school about a year before that and I mean I've always been a bit shy at school but it was never ever like it didn't really affect that things as much as not at all as much as it has been doing the last few years I guess it just started when it like my friends went to university and I don't know I felt like I was expected to kind of move out or do something and then it just kind of escalated from there I just stopped going to parties all right say no two invitations or and I thought my job would help because I mean I love it I really like doing photography but I'm just kind of getting less and less work as it goes on so which is my fire keep saying no but what kind of work is the most difficult for you am your job I guess when it I have to kind of be working with other people and I don't like that it's like when I'm trying to kind of would do an event or something where there's a lot of people they're not just photographers but actual you know if I like taking phrases of people that I don't know I just kind of find myself saying now I mean I want to do them but just scary so I just don't do it so I has tell me a bit more about what happens then so let's focus on maybe an invitation to do a job with you know it's going to involve photography with with a group of people and you're going to have to have social interaction what kind of thoughts go through your head just I mean I get really hot and sweaty and I don't I feel like everyone's kind of looking at me and thinking that I'm just like really stupid and feel like they're all going to be staring and thinking I just can't do my job and I'm just an idiot and I mean they'll think that I just look like a weirdo and I just try and I mean I just kind of just try and get out of the situation or just focus on something else so that's why I like doing shots where it's just me and the camera because then I can just put all my attention on that instead of having to you know be with other people okay so it sounds like you have quite a lot of thoughts rushing through your head then at another point where you get that invitation you think people look people stare people will think I'm a weirdo there's quite a lot about what what you think other people will think yeah and how does that make you feel and just makes me feel like an idiot makes me feel like I just shouldn't even bother trying to do it anyway I should just go home and I just I think I just don't want to be in that situation I just feel like everyone else is fine and they're normal and I'm just the freak you can't like do normal things and okay can you give me an example of a recent situation maybe we can focus on that like a work situation yeah time when you may be doing a job with some people and you've got the social anxiety you know that you're describing about that kick in yeah and I was doing a job where it was kind of like a nature shoe and I was having to work with a lot of different people and and and when they told me about the job I thought it would be fine I thought it was just going to be a few other photographers but there are actually people and you know I've taken photos of people kind of in the trees and stuff like that and I get they asked me to him that sounds quite interesting was that a fashion shoot yeah yeah it was a fashion thing I think it was for some kind of I'm not sure if it was a campaign or something but yeah it was really cool both find it found it really hard to try and focus on max I was so I was kind of feeling really anxious and so it wasn't what you expected no no so how long ago was that that was two weeks ago okay so it's quite recent yeah so on that particular day what were the thoughts that you had in your head when you were in that situation just felt really just really kind of heart I couldn't really breathe and just felt like I wanted to just get out and I was kind of trying really really hard to just focus and just you know like kind of hold the camera and just not think about anything but I just felt like everyone was looking at me and like when they'd say action and they'd try and get me to start and I was just felt like everyone was just thinking I was really stupid and I shouldn't have been there and I can tell you getting kind of anxious even just thinking about that day yeah okay so you describe him quite a lot there to me so you're saying that you kind of got hot and sweaty he said that you held the camera yeah what was do you mean you kind of trying to hide behind it or I was just like I focused on it I was just thinking if I could just hold it really tightly it would just I don't know I'd kind of just be able to just get through it and just further you're holding the camera very tight yeah and why was that why was that helpful because I felt like I was getting really like hot and flushed and I just though at least if I can just I don't know it sounds weird but I was just trying to keep my hands still on it because my hands are kind of sweaty and like shaking like loads like and I could just tell everyone was looking and they could see and I just thought if I just managed to hold on to it it wouldn't be as noticeable but okay so okay so it sounds like you had a lot of thoughts going through your head and he said that you worried that everyone's looking at you what other thoughts were there that were in your mind just I was just just stupid and was just really just felt really like a kind of like everyone was just going to be staring and just thinking that I just felt like everyone was looking at me and just they could tell and just thinking or what what's she doing and they could tell what that I was just really like sweaty and just so fat so oh like that they could see that yeah yeah and I was trying to wear black so this kind of tries to cover it up and just like a lot of layers so they can't tell but I mean my hands like they was so shaking I was really red and just was just wishing that I just wasn't there so I mean you've already described it to me a little bit but if you think about how you look that day how do you say how do you think he looked I think just really stupid and like I think my face was really red I could feel it flushing and I knew vow'd was probably sweating and shaking like my hands were definitely really really shaking and and ever it was like definitely really noticeable everyone could definitely stay ok and what did you do about how did you try and conceal that or hide that and well again I was trying to grip the camera just look down just trying not to do anything weird or because I mean that they could probably tell I was being weird anyway but hopefully if I just tried really hard to just focus and look down not try it like not look at anyone else and just yeah just kind of try and get on with it as best as I could but so you avoid looking at people and sounds like you wore black as well in kind of preparation anyway yeah no I always do that even if it's really hot or I wear just loads of layers and just because was I'll just be really sweaty and like people would definitely be able to see so okay and how did it end well it kind of went on for like an hour or so and then people were going and just after every shoot people go out for drinks after just to kind of celebrate like that we've done it I just I went home straight away just got in my car and went home I just didn't want to be around them especially after they would have seen me being weird and I just wanted to go get home straight away okay

47 comments

  1. I’m bummed this wasn’t real. I related to her so much! I felt like I was looking at myself in my therapy sessions!!

  2. I like to turn around what a socially anxious person is saying about others.
    Client: I just feel like people are staring at me and thinking I am weird.
    Me: So if you saw someone behaving like you do, you'd stare at them and think they are weird?
    Client: No, I don't think so.
    Me: Why would people do that to you, then?
    Client: Because people are always judging others.
    Me: Are you always judging others?
    Client: No, I just mind my own business.
    Me: Why do you think others aren't doing the same thing?

    Or If the client is absolutely convinced others are judging him/her, I ask so what?
    Me: So people are thinking you are weird because you act anxious around them. How does that affect you?
    Client: Well, it makes me more scared!
    Me: Really? Are they doing anything to threaten you?
    Client: No, just thinking I'm weird.
    Me: Why does their opinion matter?
    Client: Well, I want people to like me.
    Me: Is it possible for everybody to like you?
    Client: Well, no.
    Me: Right. No matter what you do or say, someone out there will not think very highly of you for any number of reasons, some of which might not be under your control.

  3. The nightmare is; you think everyone is looking, and indeed everyone is looking because you are extremely nervous and unrest.

  4. Thank you so very much for these videos!! I just found your channel and am currently binging your videos to try to be less anxious about finding another psychiatrist. I was crying tonight in fear of talking to my doctor about it. I personally want to go for social anxiety, depression and a form of OCD. These videos are helping me know what I'll be getting into- and it isn't as scary as I keep thinking it is. I hope who I talk to is as warm and supportive as you are.
    Also your actors and actresses are wonderful! I especially relate to "Hannah" she portrayed her character almost exactly how I feel.
    For future videos, just throwing an idea out here, how you might handle dealing with Dermatillomania – or any BFRB disorder. I can't find much on the topic.
    Again, lovely channel, thank you for easing my anxiety with these informative videos💞

  5. i knew she was an actor from the get go without reading the description, theres the little tell tale signs of nervousness you cant fake, like the nervous fidgeting, leg tapping finger tapping, the look of horror on your face, blushing sweating

    to me this was so obviously acting if wasnt for a few comments i was going to post a real nasty comment saying how she hasnt got it lol

  6. Does Atoractove Secrets really work? I see lots of people keep on speaking about Atoractove Secrets. But Im not sure if it's good enough to completely cure your anxiety.

  7. I'm half way through this interview and there has been no description of anxiety symptoms from the client, only "I don't like it" or "it's kind of scary".. Finally she says she gets hot and has stream of negative thoughts. Still sounds more depressive than anxiety, combined with low self-esteem. She seems ultra nervous because she has no self-confidence in her professional ability or personal presentation and is overly self-conscious. This is seems quite different to generalised social anxiety.

  8. Something I’ve learned to battle social anxiety is learning to laugh and laugh at myself even if others are laughing at me. We all do silly things, make mistakes, embarrass ourselves…it’s best not to take yourself so seriously. Even intentionally make a fool of yourself. Conan O’Brein has made millions doing it (among many other comedians) and people love comedians. Also, take the initiative to introduce yourself, hello I’m ____. People think you have huge balls then…most of them won’t even do that.

  9. I go to therapy for social anxiety currently. But It's nothing like this. I wish it was more structured like this and I would have a conversation like this. Great job guys!

  10. Aw too bad it was obvious at the first 3 seconds it's an actor. Sure, it's in the description, so no wonder, just saying. It's a bit of a stereotype, it's not necessarily general nervousness like she tries to play out. But then again the point of the video is to show what a session looks like, so all good. I'll just search for an actual session if it exists.

  11. I didnt know a Socially Anxious person can elaborate things this much clearly like this girl is doing !!! Amazed

  12. I can really relate to this , as I have bad confidence issues , i also get anxiety if I get any sort of attention with men , which is holding me back as I'm at that point in my life I would like to meet someone

  13. This still surprise me, how some people have no idea about Atoractove Secrets (just google it), although lots of people completely eliminated their social anxiety problem with this system. Thanks to my friend who told me about Atoractove Secrets, I finally eliminated my social anxiety for good by using natural and fast approaches.

  14. There are many factors in treatments for shyness. One resource I discovered which succeeds in merging these is the Sartar Shy Method (google it if you're interested) without a doubt the no.1 resource that I have ever heard of. Check out the unbelievable information .

  15. Dear mam
    Your videos are very educative.
    But it would be more beneficial if we can know the second or third sessions also, how the client's condition progress and so.
    Thank you

  16. Why didn't you ask the patient "what is normal?" when she keeps saying she's not normal. I am working towards being a counselor, and this is one of the most common assumptions people make and can never specifically answer because there is no such thing as "normal" in today's society.

  17. it is sooo sad to see people have such thing =(( i always feel sorry for them and I wish i could help them… just to tell them they dont need to feel that, you dont have to be afraid of anything or anyone, everything is always the same and nothing will happen, nothing special, so just relax be yourself, everyone has his own problems and worries, so dont think someone will notice you. you can be free, people are not so bad. =(( i don to know what else to say…

  18. I want to be a psychiatrist, I have anxiety myself and want to not only help people who share my issue but learn more about the issue generally speaking.

  19. I had CBT for anger and depression….it helped me view things differently and behave differently
    my negativity was challenged
    IT CONTRIBUTED TO KEEPING MY HEAD ABOVE WATERI felt like I was drowning in emotional content which was almost choking me…………….I was scared, confused and lost………
    Life/emotions can be overwhelming and CBT helped me to BREATHE MORE EASILY
    more effective than "TUNES" the cough sweet…..:)

  20. CBT is useless. It has an incredibly high relapse rate and depends strongly on sociocultural background. No one knows why it actually works, despite countless "studies". Pseudoscience at its finest.

  21. Hi Judith great insight into what takes place. I would like to know I think I have SAD I think its abbreviated too, would I see a therapist or a councillor for this. I have been out of work as of late and I find it hard to talk to people as it never mind an interview its embarrassing. Its only certain type of people I am just not sure why.the funny bit about this  my uncle and ant are practicing  Psychologists but I don't tell my family anything as I don't like it all I want to do is get rid of going red and having hot flushes, the rest I can put up with. Another question how does this differ from AVPD?Any tips?Mat

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