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Therapy Session Case Study: Dealing with Anxiety, Stress and Poor Self-Confidence

Therapist and counsellor Dr. Dawn Ferrara gives her perspective on a UPTV client session

Dr. Dawn Ferrara is a Licensed Professional Counselor and Licensed Marriage & Family Therapist specializing in Anxiety/Stress disorders

We’ve got something a little different for you this time. As you know, often I like to describe therapeutic approaches in depth.

This piece describes one therapy session in detail, but it’s a little different because it’s not written by me but by an “outside pair of eyes.”

Dr. Dawn Ferrara is a Licensed Professional Counsellor and Licensed Marriage & Family Therapist specializing in Anxiety/Stress disorders.

Dawn looks at the session from the perspective of her understanding and experience. It’s so valuable to get a perspective other than your own so we asked Dawn, a skilled psychologist to write a case study for us.

What you have here is an overview of one session with Alice* an Uncommon Practitioners TV client who came for help with anxiety, stress and low self confidence. Please let me know in the comments section if you find this useful and whether you’d like more professional summations of these therapy sessions.

Here’s to improving psychological knowledge and emotional health,


Case Study

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Identifying information

Alice (age unspecified) is a female client who works in the Information Technology (IT) industry. She has been in the IT field for 25 years and has run her own business successfully for the last 10 years. She is married and she and her spouse work together.

Presenting problem

Alice is seeking help for anxiety, stress and poor self-confidence.

Social history

Alice is married with one daughter. She reports a good personal and professional relationship with her spouse.

Alice’s parents divorced when she was young. She describes feeling “cheated” by that situation. Her father died in 1994 from cancer and never met her daughter. Alice expresses some regret that her father didn’t live to see her succeed as an adult or to meet his granddaughter. Alice’s mother is alive but Alice describes the relationship as strained.

Alice owns her own technology company. She reports that she learned her IT skills as an early adopter of emerging technology and built a career on those skills. She did not receive formal training.

Alice describes her job as quite stressful. She reports that she sometimes has difficulty dealing with demanding clients, especially when she is unable to help them in the ways they expect her to.

These situations evoke bothersome feelings of disappointment and anxiety, and worries about being criticized or judged. She states she becomes annoyed and that these feelings affect her wellbeing.

Mental health history

Alice reports that she has a history of anxiety and depression, for which she has received treatment. Past treatments have included antidepressant medication (unspecified) and diazepam for panic attacks. She is not currently taking medication.

Alice says that following her father’s death, her symptoms worsened.

Alice reports that she has previously used hypnosis for smoking cessation. It appears to have been only partially successful, as she continues to use an e-cigarette.

Session summary

This video is a single therapy session. The first part of the session consists of information gathering and a number of suggestions and reframes to encourage relaxation and assist Alice in gaining insight into some of her issues. The latter part of the session is direct hypnosis. Throughout the session, Mark uses a relaxed, conversational approach.

Mark engages Alice in conversation to clarify and discuss her concerns. As she becomes more comfortable, Alice offers more information and insight into her issues.

She admits to having bursts of intense anxiety but has had a reduction in panic episodes. She attributes that to making better choices about managing situations that she finds provoke anxiety. She identifies criticism and self-doubt as particularly problematic triggers.

Because of her history, Mark asks Alice a series of questions to assess the risk of post-traumatic stress disorder (PTSD). It does not appear that PTSD is a diagnostic consideration at this time.

Mark then reframes anxiety symptoms as an “exercise response”. This is done in order to normalize the anxiety response and reduce the tendency to pathologize its symptoms.

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A metaphor for stress and anxiety

To create a visual representation of anxiety, Mark makes an analogy between unchecked anxiety and a mental bucket of water. Anxiety (water) pours into the bucket and, if left unchecked, eventually fills the bucket and overflows (panic). He equates regular relaxation to emptying the mental bucket so that it doesn’t overflow (anxiety/panic).

Throughout the session, Mark references water creating a sense of calm and flow: filling the bucket, anxiety response as a whirlpool, the surface of water calm and reflective, feelings of calm streaming over.

During this discussion, Alice is attentive and calm with a relaxed posture. She makes good eye contact and responds with ease.

Depressive thinking styles

Now Mark describes the biases of globalizing, internalizing negatives and externalizing positives using a number of examples and analogies. Alice is able to recognize some of those biases in herself. Mark frames Alice’s insight into her biases as “seeing through” them.

As Alice becomes more aware of her biases, she becomes less affected by them because she can recognize them for what they are: inaccurate. The purpose of this reframing is to help Alice to separate herself from her biases, and accept that they do not define who she is.

Because Alice is particularly sensitive to perceived criticism, Mark makes a similar distinction between complaint and criticism, framing them as separate and not reflective of who she is as a person.

Tools for reducing anxiety

Following a discussion of Alice’s physical anxiety symptoms, Mark explains the dynamics of tactical breathing and invites Alice to try the technique. She readily responds and is able to practise the technique successfully and feel the sensation of relaxing.

Using conversational strategies, Mark encourages Alice to visualize scenarios and notice her reactions, first recalling her feelings in the bothersome scenario then visualizing it from afar and noticing differences while breathing and remaining in the moment.

This therapeutic presupposition allows Alice to see that she can react differently to difficult situations and allows her to move towards the hypnotic state.

Guided relaxation

The hypnotic induction begins with Mark describing hypnosis. He references Alice’s enjoyment of mandala painting on stones as an anchor, a way to help her connect with the state of mind-body relaxation and its link to unconscious thought.

The focus of the induction is relaxation training and helping Alice learn to manage her anxiety response. Using a series of embedded commands and visualizations, Alice is able to recognize her anxiety without panic or heightened responses and gently reduce it or brush it aside. She is able to experience remaining in control of her physical and thought responses.

Mark then gives several suggestions for actions going forward. These actions empower Alice to continue to recognize and manage her anxiety response by remaining calm and in control.

“What I’d like you to do is just to notice in the coming weeks and months what you notice about yourself, maybe after the event… telling yourself perhaps that: “at one point this would have been a problem for me but I just didn’t feel anything. I just put it in perspective.”

“You can just notice those times in coming weeks and months and forever.”

Further strengthening the link between conscious and unconscious thought, the induction is completed with a final suggestion that her unconscious mind and body will continue to be accessible when needed.

Did you find this case study useful? Let us know in the comments below if you’d like to see more professional summations of therapy sessions from Uncommon Practitioners TV, and if there’s anything we can add to them to make them more useful to you.

And if you haven’t joined yet, you can read about Uncommon Practitioners TV here and sign up to be notified when it’s open for new members.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

You can get my book FREE when you subscribe to my therapy techniques newsletter. Click here to subscribe free now.

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*Not her real name

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