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Case study clinical example: First session with a client with symptoms of social anxiety (CBT model)
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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 yeah um yeah I guess kind
it kind of started like five six years
ago okay um it kind of it escalated a
bit um I've just recently moved out um
from living with my parents so it's made
it a bit worse I think okay is this the
first time that you've left home uh yeah
I um yeah it is the first time actually
yeah um I was going to a few years ago I
just thought it would be easier to stay
home so okay so it's been quite a big
stth and a big change and and it sounds
like that that was what led you to go to
your GP yeah so how has that uh changed
things for you um you know it's kind of
I haven't really told anyone so I mean
it's made it like better in the sense I
feel hopefully this is you know this is
it like it will it will 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 if that
makes sense okay so how do you feel
about being here today
it's like scared I don't know hopefully
it will help okay so you've been feeling
a little bit anxious about today yeah
okay so I guess just going back to um
why you went to the GP and 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 um but just recently you moved out
of home for the first time and um 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 um I
thought that they'd be better but
because I thought I'd have to kind of be
independent and but it's actually a lot
worse I'm 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 literally just in
the flat by myself which I always
thought I'd like but I don't actually
like it okay so what are the kind of
difficulties that you have been
experiencing um I mean I'm I'm a
photographer um so I kind of it's 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 down so I was kind of making
things hard in that respect and um just
kind of friends wise and everything I
just 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 okay
so you said that um 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's
stunting you uh socially you're not kind
of able to make new friends and get to
meet new people yeah yeah um it was kind
of easier when I was at home because I
was obviously I me and my parents and so
that's 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 in 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 so you're kind of worried
about how where this is going to lead to
yeah um
yeah okay 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 uh I guess
I'd finished school about a year before
that um and I mean I I've always been a
bit shy um at school but it was never
ever like it didn't really affect 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 just do something and then it
just kind of escalated from there I'd
just stop going to parties or I'd just
say no to invitations or I don't know 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 fault I keep saying no but
what kind work is the most difficult for
you in your job I guess when it I have
to kind of be working with other people
um I don't like that it's like when I'm
trying to kind of do an event or
something where there's a lot of people
there not just photographers but actual
you know if I'm like taking photos of
people that I don't know I just kind of
find myself saying no I mean I want to
do them but just it's scary so I just
don't do it so I tell me a bit more
about what happens then so let's focus
on maybe an invitation to do a job with
uh you know it's going to involve uh
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 um 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 I 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 I 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 the point where you get that
invitation you think people look people
will stare people will think I'm a
weirdo there's quite a lot about what
you what you think are the people will
think yeah um and how does that make you
feel um just makes me feel like an idiot
it makes me feel like I just shouldn't
even bother trying to do it anymore 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 who can't like do normal things
and okay can you give me an example of a
recent situation maybe we can focus on
that um like a work situation or just
yeah time when you were maybe doing a
job with some people and you felt the
social anxiety you know that you
describing you felt that kick in yeah um
I was doing a job where it was kind of
like a a nature shoot and I was having
to work with a lot of different people
um 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 actually people
in you know as was taking 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 was
that a fashion shoot or something 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 it was
yeah it was really cool but I find it
found it really hard to try and focus on
that cuz I was so I was kind of feeling
really anxious and so it wasn't what you
expected no it was no so how long ago
was that that was two weeks ago okay so
it's quite recent so on that particular
day what were the thoughts that you had
in your head when you were in that
situation I just felt really just really
kind of hot 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 trying to 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're describing quite a lot
there to me so you're saying that you
you kind of got hot and sweaty you said
that you you held the camera yeah what
was do you mean you kind of trying to
hide behind it or I just trying to focus
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
focus so you're holding the camera very
tightly and why was that why was that
helpful cuz I felt like I was getting
really like hot and flushed and I just
thought 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 cuz
my hands were 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 um he said that you
worried that everyone was looking at you
what other thoughts were there that were
in your mind just I was just just stupid
and it was just really just felt really
like kind of like everyone was just
going to be staring and just thinking
that like I just felt like everyone was
looking at me and just they could tell
and just thinking what what she doing
and they could tell what I was just
really like sweaty and just oh so oh
like that they could see that there was
okay yeah um so 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
just 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 looked that day how how do
you say how do you think you looked I
think just really stupid and like I
think my face was really red I could
feel it flushing and I knew that I was
probably sweating and shaking like my
hands were definitely really really
shaking um and every it was like
definitely really noticeable everyone
could definitely see okay and what what
did you do about how did you try and
conceal that or hide that um well again
I was trying to grip the camera just
look down just trying not to do anything
weird or cuz I mean they could probably
tell I was being weird anyway but
hopefully I I just tried really hard to
just focus and look down not trying 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 avoided
looking at people it sounds like you
wore black as well in kind of
preparation anyway yeah no I I always do
that even if it's really hot or I wear
just loads of layers and just cuz
otherwise like I'll just be really
sweaty and like people would definitely
be able to see so right and how did it
end um well it kind of went on for like
an hour or so and then um people were
going um just after every shoot people
go out for drinks after just to kind of
celebrate like that we've done it but 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 get get home straight
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