A Snap-shot of My Practice

PROCESS RECORDING

Student: Mira Kim Client's First Name: Elle Date: March 17, 2009

Presenting Issue(s): Elle, a 25 year old female, presented with an anxious feeling about managing her time. She is married, attends school as fulltime, and works as part time. She is complaining that she does not have enough time to study and she can’t focus even though she has time. I assume that her anxiety about time will be reduced if I convince her not to perfect her work rather than just increase her studying time. The following process recording is our 4th assessment. I tried to apply the cognitive behavior treatment for generalized anxiety disorder and perfectionism from Dugas and Koerner (2005) and Ferguson and Rodway (1994).

Terms:Worker: W, Clinet: C, Gut feeling: GF, and Thinking :T

W: How are you today?
(T: It is an ordinary greeting question but I hope she feels welcome to come here)

C: I am fine, Thank you
(T: Her facial expression does not seemed fine, she looks tired. I know that most people responded automatically that they are fine.)

W: Okay that’s good to hear that. Did you bring the chart that you promised to me to keep the record of time you study and what you feel?
(GF: It is embarrassing to me to ask other people what to do because I am afraid that they are not ready.)

(T: I think that I have to hide my own embarrassment in order to show my competence as social worker.)

C: Yes, I am keeping the record and bring it with me. (she gave to me)
(F: I appreciated that she is following my plan voluntarily.)


W: You study 5hours and you describe that your anxiety is intensive for this week! You don’t mind if I am ask you to complete the Clinical Anxiety Scale before we talk about other issues.
(GF: Again, it is embarrassing to me to ask client what to do. I try to restate what are duration and her self anchored scales presented on the chart.)
(T: She seemed that she wants to talk rather than to fill the Clinical Anxiety Scale. I have to track this measurement to see difference between before and after the intervention.)

W: (after he finished Clinical Anxiety Scale) What makes you feel intense anxiety this week? Is that the reason that you studied less than previous week?
(T: This is the forth times I meet her and I have unexpected result that her anxiety level gets higher this week than two previous weeks! I understand that it can happen during baseline session and I hope that it gets better after I start my intervention.)

C: I feel anxious and depressed at the same time from last week. I received my midterm paper and I got B grade which was lower than I expected. I don’t understand why I got this grade. I won’t pass this class if I make another mistake. I am not sure I can get a job after I graduate during this economic crisis.
(GF: I also felt little depress last week because it was cloudy and raining during last week. I assumed that the weather also affected her mood as well as economic crisis today.)
(T: She worried about her uncertain future after she received her grade. It is hard to distinguish between feeling of anxiety and anxiety disorder. But I see her catastrophic thinking which is cognitive distortion. I assume that these dysfunctional thoughts were increasing anxiety of her imperfect performance.)

W: I understand that you did not deserve for a B grade but B is not a bad grade. Do you think your worries affect positively your other business?
(T: I found relevant research of cognitive behavior treatments for anxiety disorder but I don’t know how to apply to her real life. It is said that the level of anxiety will decrease when worry is decreasing. How can I make her not worried about the fact that she got B? I want to tell her that uncontrollable worries do not help to solve problem that she worried about?)

C: I know this worry grasp me and affect me negatively in my daily life. I can’t start final paper for that class because I am afraid that I won’t make my future better.
(GF: It is amazing that she has insight of the central characteristic of anxiety, and I worried that her cognitive distortion prevents her from doing homework.)


W: What would you expect to see in your life in two years?
(T: I used miracle question to give her hope which enabled her to do her homework.
This is not cognitive behavior treatment but I think it helps to solve the problem when you see the problem from the other point of perspective.)

C: I will graduate from my graduate school and have job. I think my unnecessary worries block me from moving forward. I need to do homework rather than thinking.
(GF: I am glad to hear that she understood my point.)
(T: I hope that she understands that her unexpected grade has nothing to do with her long term goal.)

W: I want you to think about difference between worries about current problem and worries about potential problem.
(GF: It is overwhelming to me to explore other people’s life as an imperfect human.)



References

Dugas, M. J., & Koerner, N. (2005, Spring). Cognitive-behavioral treatment for generalized anxiety disorder: Current status and future directions. Journal of Cognitive Psychotherapy: An International Quartely, 19(1), 61-81.

Ferguson, K. L., & Rodway, M. R. (1994, July). Cgonitive behavior treatment of perfectionism: Initial evaluation studies. Research on Social Practice, 4(3), 283-308.