Counsellor Consult Note

Counsellor: Mental Health Counsellor Current Presentation: Patient presented with persistent feelings of anxiety and overwhelming stress related to her demanding job and recent family conflict. She reported experiencing frequent panic attacks over the past month, often triggered by work emails or discussions with her sister. These issues are significantly impacting her sleep, leading to increased irritability and difficulty concentrating at work. Her relationships, particularly with her partner, are strained due to her withdrawn behaviour and emotional reactivity. Session Content: Today's session focused on exploring the patient's coping mechanisms for stress and anxiety. We discussed specific instances of panic attacks, delving into the initial thoughts and physical sensations she experienced. The patient identified a recurring thought pattern of "I'm not good enough" whenever faced with challenging tasks at work or perceived criticism from family. We also explored her history of anxiety, tracing it back to childhood experiences of high parental expectations. She expressed feelings of frustration and helplessness regarding her inability to control her anxiety, stating, "It feels like it takes over completely." She realised that her current avoidance strategies (e.g., procrastinating on difficult work tasks, withdrawing from social interactions) are only exacerbating her anxiety in the long run. Obstacles, Setbacks and Progress: The primary obstacle is the patient's deeply ingrained belief system regarding self-worth, which fuels her anxiety. Socially, her tendency to isolate herself limits her support network. Emotionally, she struggles with self-compassion. Since the last session, she experienced a setback when a challenging work project led to a severe panic attack, causing her to call in sick. However, she demonstrated progress by actively trying a mindfulness exercise (deep breathing) during the onset of another panic attack, which she reported helped slightly to shorten its duration. Session Summary: The session provided a deep dive into the patient's cognitive distortions and the behavioural patterns reinforcing her anxiety. The patient was highly engaged, openly sharing her struggles and insights. We utilised cognitive behavioural therapy (CBT) techniques to identify and challenge her negative automatic thoughts. Psychoeducation on the anxiety response cycle was also provided to help her understand her physical symptoms. The therapist observed the patient displaying moments of frustration but also significant introspection, suggesting a readiness to engage with more challenging therapeutic work. Her affect was initially anxious, but became more settled towards the end of the session as she processed some core beliefs. Next Steps: Therapeutic homework includes daily journaling to identify anxiety-provoking thoughts and emotions, and practising the 5-4-3-2-1 grounding technique when feeling overwhelmed. We also discussed scheduling a brief, non-work-related social outing this week. The goal for the next session is to further develop alternative coping strategies and begin challenging her core belief of "I'm not good enough" using cognitive restructuring. The next session is scheduled for 1 November 2024 at 10:00 AM.