Case Study on Anxiety Counselling

Recently, I received a call from Ramesh who was experiencing anxiety after the outbreak of Coronavirus and lockdown. He was wondering whether therapy can help him. After having an initial conversation over the phone, we scheduled a online consultation session.

Anxiety Counselling – Complete Session Flow

Initial Consultation or pre-therapy session: 

Ramesh : So Nitin, I will tell you everything from the beginning. 

I got married 2 years back. I have been working as a financial consultant for around 4 years. My wife, Radha, is an executive at a call center. And one fine day, the both of us were discussing having a child. Since the two of us are earning enough, we felt that we would be able to handle the additional responsibility of the child prior to the lockdown.

After the lockdown, Radha’s company decided to distribute only 50% of salary and the place where I work, had also reduced my pay drastically. This has put our future plans in question as both of us are worried about the finances.

After hearing Ramesh’s challenges, I began by psycho-educating Ramesh about the core concepts behind the process I follow. I suggested Cognitive Hypnotic Psychotherapy (which is an eclectic approach to Psychotherapy) for working with anxiety. Then I walked him through the pre-coaching process. 

After helping him understand the therapy process, I added that in his case, once we have defined the current problem and outcome clearly, I will help him –

1. Defining the Existing problem clearly
2. Defining the expected outcome from the sessions clearly
3. Understanding the kind of future, he would like to create
4. Understanding the current plans, they had including planning for the child
5. Creating a new plan of action
   1. With updated timelines to accommodate the financial challenges being currently faced 
   2. Including additional steps that can be taken or things that can be done to generate additional income from home 
6. Identifying the specific thoughts and emotions that may stop him from following the new plan of action.
7. Identifying the various triggers for anxiety
8. Restructuring the thoughts about the anxiety causing triggers
9. Systematically working towards applying the new plan of action for generating additional income and working confidently towards the desired future.

Session 1: Defining Challenge and Desired Outcome

The first session of anxiety counselling focused on helping Ramesh define his current situation, desired outcome, and expected future. 

I started the first session by asking Ramesh to summarize the challenges he wanted to overcome through therapy in his own words. 

Ramesh : I am worried about my future because of the financial strain caused by lockdown and I am finding it difficult to transition to working online.

I then asked Ramesh to reframe her problem statement using the following format: 

I feel …………… about …………… when ……………

Ramesh:

I feel anxious, worried and overwhelmed about my finances and future when I am trying to transition work online.

I asked Ramesh to read the statement a couple of times and tell me what was the desired outcome that he wanted to achieve at the end of these sessions in the format:

 I wish ……………………….

Ramesh: I wish to be able to calmly and confidently make the transition to working online with my consultancy services.

Nitin : Can you describe the dream future that you would love to work towards?

Ramesh : Nitin, I had recently attended a goal setting workshop, where I was asked to write down my future in detail, create a vision board based on the future and create a detailed plan of action as a part of the activity. I have noted down in a word document, I can screen share that with you.

I went through all his notes and was satisfied with the format in which the future and the plan of action was listed. 

For home assignment, I asked Ramesh to update both the future and the plan of actions keeping in mind the new challenges that he was facing as a result of the lockdown along with the steps he was now required to take to move consultancy services online. 

Session 2: Exploring Additional Options and Primary Task List

We began session 2 in the next week by asking him about the week and any changes that he noticed in his behaviors, thoughts, or emotions. Ramesh mentioned that while he was writing about the future, he actually started believing that it was possible to achieve that specifically.

I was going through his home assignment and I noticed that he was able to add a few more steps to the plan of action. Ramesh said that he was not really sure about how to move the services online and offer them via his website.

I asked him to think and make a list of steps he can take to understand or to find how other people were doing online consultation sessions. Ramesh said that can speak to a couple of his friends who have successfully moved to online consultancy and also a website developer on how the technology works with respect to online consultancy.

I asked him to do this as a part of his home assignment, I also asked Ramesh when he would be able to connect with his friends and the website developer?

Ramesh assured that he would be able to do that in that week itself.

During the session, I asked him to add the desired feeling that he would like to have while doing those tasks.

The constant desired emotion that he wanted to feel was Calmness. 

I asked him to tell me 1 situation from the past wherein he has experienced the most calm and list down 3 situations in the future where he would like to feel Calm.

Ramesh made a list of them and I did the NLP Anchoring process*¹ with him.

At the end of the session, Ramesh looked visibly calm through his facial expressions.

(During the week, I asked Ramesh to have this conversation and also review and update the plan of action if required with additional details and steps.)

Session 3: Creating detailed Task List

In the next session Ramesh informed me that he was able to get a better understanding of how the online consultancy would work and had also given the website developer the green signal to work on adding systems for booking consultancy services on his website and conducting the anxiety counselling sessions as well. 

Ramesh said, I was able to convince the web developer to take his payments in installments over a period of next 3 months.

I asked him meta model questions*² to make all the tasks in the plan more detailed and literally step by step. We chunked down literally each task into tiny bits, added hindrances that may occur while working towards those tasks and also created a weekly schedule to help Ramesh do the tasks in a timely and effective manner.

Session 4: Working with Anxiety and Worry

In the next session, the plan was ready, I started working on Ramesh’s thoughts that were the cause of worry and anxiety. 

I asked Ramesh what was the specific time when he mostly felt anxious, i asked him specific triggers, his thoughts and at the end i asked him to tell me:

1. Desired Thought
2. Desired Emotions

Once he listed down his desired thoughts and emotions, I worked with thought restructuring*³. The new restructured thoughts were in sync with Ramesh’s plan of action and reinforced the idea that he was following the plan of action. Things were getting better and he was getting prepared to handle the current challenges more effectively.

I then used the emotional anchoring process*¹ to help Ramesh develop confidence for being able to take the consultancy sessions online effectively.

Session 5: Closure

At the beginning of the session, Ramesh mentioned that his past week was really nice and that he was no longer feeling worried or anxious about the future. 

Ramesh mentioned that he is still a bit concerned but was also confident about his ability to adapt to the new requirements more effectively.

I taught him self hypnosis*⁴ for any future concerns.

My Observation: 

When a client is worried or anxious about the future, a detailed plan of action along with restructuring of thoughts can show wonderful results.

References for techniques used

1. Anchoring
2. Meta Model
3. Thought Restructuring
4. Self Hypnosis

The concepts and techniques discussed during this case study are based on the topics covered during the PROS Anxiety Counselling Certification, Cognitive Hypnotic Coaching® Diploma and the Cognitive Hypnotic Psychotherapy™ Diploma Program.