Counseling Session for Workplace Anxiety and Panic Disorder

Initial Counseling Session Transcript

The client is welcomed by the counselor; general conversation takes place to break the ice.

Counselor: Hello, come on in.

Client: Thanks.

Counselor: Can I offer you a drink?

Client: No thank you. I am not really thirsty.

Counselor: That's fine. I want you to know that it is okay to call me by my first name, unless a formal title makes you more comfortable. Okay?

Client: Okay.

Counselor: Please have a seat wherever you are most comfortable.

Client: Okay. I will sit over by the table if you don't mind.

Counselor: That's fine — whatever makes you comfortable.

Client: (sighs and takes a seat)

Counselor: So, have you been to counseling before?

Client: No, not at all. I mean, I never had a problem like this before.

Counselor: Okay. Well, let me start by telling you a little bit about the process, if that is okay. That way, if you have questions or feel something may cause a problem, we can resolve it now.

Client: Sure, that will be fine.

Counselor: Great! Well, for starters, you will be meeting with me on a weekly basis here in my office. Our sessions will be an hour, and if you are having any difficulties outside of our meeting times, feel free to call the receptionist and I will talk to you then, or as soon as I have some free time. We will only discuss the things you feel are important, and if at any time you are uncomfortable, make sure to let me know. We will always be respectful to each other, and if you need a minute to yourself during our sessions I will happily give that to you. It is also important for you to be able to ask any questions related to the situation at hand — there are no silly questions. I will always answer respectfully and make sure I have clarified my answer. I know this is a lot of information, and my intent is not to overwhelm you, so we will go through this transition together until you are familiar. Do you have any questions?

Client: Well, yes. Will you call my boss and discuss anything we talk about?

Counselor: No. Our conversations are confidential. The only time that information would have to be disclosed to anyone else is in the event that you are thinking of harming yourself or someone else. Otherwise, everything is privileged information. Okay?

Client: Okay, that sounds fine.

Counselor: So, what do you expect from our counseling sessions?

Client: Well, I honestly hadn't thought a lot about it. I mean, I didn't think I would even have the heart to come in here today. I know I hope that you can help me with these anxiety issues I have been having at work. I am having a real tough time finding ways to deal and feel less stressed about things that didn't bother me before. I am constantly feeling pressure and everything seems to be a really big deal. I just don't know what to do.

Counselor: We will definitely talk about those difficulties and try to find ways to relieve some of your anxiety. Sound good?

Client: Yes, that sounds good.

Counselor: I want to explain to you exactly what I can offer you in these sessions and a little bit about what each session will entail. If something doesn't make sense, just stop me and ask. Okay?

Client: Yeah, okay.

Counselor: I can offer you a listening ear. My job is not to judge you or ridicule you. My purpose is to listen to what is going on and help you develop new tools and methods for dealing with those situations — better coping skills. Each session will be relatively similar in length and location. The conversation may cover anything relating to the difficulties with your anxiety. Do you have any questions for me?

Client: No, not right now.

Counselor: Okay. If at any time you do, please ask me.

Client: I will.

Counselor: So, what brings you in to see me today?

Client: Well, I don't really know how to explain it. I started a new job, and there seems to be so much pressure on me. I don't think I can take all of this pressure. Sometimes it gets so bad I start hyperventilating and lose sight of where I am. My hands will shake and I feel like everything is closing in on me. I knew that something was wrong when I started making excuses so I would not have to go into the office — I mean, I was lying to my boss, and I didn't care, because at the time the most important thing was for me to feel okay. I have never had a problem with going to work and doing my job. Actually, I think I do an amazing job when I can stay focused. I just don't know how to feel like that again — calm and collected. Now my palms get sweaty and I can't think straight. I start focusing on what can go wrong, and trying to figure out how I will deal with it all. Then by the time I try to get myself back on track, things are really at a point of chaos and confusion, and I feel in over my head. I just wish I could figure out a way to just be okay — to be able to go to work and not feel so much pressure and stress. I mean, I want things to be like they were at my old job. I never thought anything like this would happen to someone like me. In school I studied psychology, and I just don't have these kinds of issues. I am not crazy and I don't want to be treated like I am some sort of psycho. I know I can beat this. I don't want to seem like I am pathetic and can't deal with this on my own, but my girlfriend thought this would help. And honestly, I want help.

Understanding Panic Disorder: Diagnosis and Assessment

Counselor: I am glad that you came in here today and are willing to work towards a better tomorrow. I promise to do my best to help you determine the underlying factors that are causing your anxiety. Together we will determine goals for each session and things for you to work on when you are not in the office with me. We will look at each part of the situation and find ways to strategize for when you find yourself in that situation — or a comparable one — again. We will also create ways to deal with some of the troublesome emotions you are experiencing. We will deal in the here and now, realizing the importance of not procrastinating and addressing difficulties head on. We will also develop methods to help you feel comfortable taking risks and making appropriate decisions with less anxiety.

Nothing is constant. Change occurs whether you welcome it or fight against it. You cannot be bypassed by change — you are inevitably caught up in it. You have only to examine your life in the previous six or twelve months to see changes: maybe small and subtle, or big and spectacular; some things improving, others possibly deteriorating. And you do not have to be clairvoyant to see that the same process lies ahead. The important point is how to make the process of change work beneficially for you — for example, improved well-being — rather than counterproductively — for example, an increase in personal distress.

Before admitting to a problem, you have to be aware that you have one. Others may be aware of it, pointing out changes in your mood and behavior — becoming increasingly preoccupied, keeping friends at a distance, or even a girlfriend's concern as you mentioned earlier — but you deny that anything is wrong. Awareness that something is wrong may gradually dawn on you when you notice how uncomfortable or out-of-sorts you feel; problems begin piling up that you cannot avoid, or a crisis erupts that forces you to conclude that all is not well in your life.

Admitting that you have a problem — for example, that you are having trouble coping with workplace pressures — may itself become a challenge. One of the biggest blocks to admitting personal difficulties is a feeling of shame: you are revealing to others what you perceive to be a weakness, inadequacy, or defect, and you fear they will criticize, reject, condemn, or mock you for it. In order to avoid experiencing shameful feelings, you may deny you have a problem, try to cover it up, or blame it on others. A very important aspect of admitting to a problem is to accept yourself for having it, regardless of how others may judge you. Most importantly, know that I am here to help you — not to judge you. I want to help you be more comfortable in your everyday life. I can only help you if you want the help. You have to make the first step, and I will meet you halfway. Okay?

Client: That all sounds good. I am glad that we have this all out in the open.

Counselor: Well, our time is about up. What I want you to do is try to identify some of the things at work that may be causing you to have panic attacks. Keep a journal, and whenever you feel you are getting ready to have one, write down what is happening — for example, what you were doing, what was said to you. Bring the journal with you to our next session. Then we can discuss what was going on and try to determine possible triggers and effective ways of dealing with those situations in the future. Okay?

Client: Thank you. I look forward to seeing you next week.

Zal (1990, p. 136) states that it can indeed be a very fragile and emotionally battered individual who comes to the office for evaluation. An adequate treatment plan for panic disorder must therefore comprise many specific aspects. The first is, of course, to make the diagnosis and share it confidently and directly with the patient. As the first person to encounter the patient with some understanding of his or her symptoms, the clinician is in a unique position to provide an enormous therapeutic service by giving the patient a clear, precise definition of their illness and demonstrating that their symptoms have meaning. The clinician should also inform the patient that it was only since 1980 that panic disorder acquired a formal name, and that it is only in recent decades that even psychiatry has begun to fully understand this condition.

Making the diagnosis requires that the clinician elicit specific information while also taking differential diagnosis issues into consideration. This begins with listening carefully to both the emotional tone and the facts the patient presents in their initial chief complaint. Questions should be asked and gaps in the patient's account identified. All information about prior physical evaluations, special tests, and consultations should be reviewed, along with a full medical history by system review. Any additional physical tests that may be helpful in making a differential diagnosis should be suggested, and all medications taken for either physical or emotional reasons should be reviewed.

A careful psychiatric history should also be taken, including a mental status examination. The clinician should inquire about prior psychiatric treatment or hospitalization, drug or alcohol use, and particularly the history of panic symptoms.

Conclusion: The Counselor's Role in Effective Treatment

There are so many factors that play a part in cognitive therapy and proper therapy techniques. It is imperative for a counselor to truly master these techniques and use them effectively in order to genuinely help a client. A counselor needs to deeply understand their impact in the whole therapeutic process. One of the main components of being truly effective with a client is recognizing the significant role that the counselor themselves plays in the entire therapeutic enterprise.