Ирина Архипова – English for Psychotherapy and Counselling: Handbook. Английский для психотерапии и консультирования: практическое руководство (страница 28)

James: Hi, Dr. Roberts. I’ve been… okay, I guess. Better than before I started therapy, but I still have difficult days.

Dr. Roberts: I’m glad to hear there’s been some improvement. Can you tell me a bit more about the difficult days? What makes them challenging?

James: Well, I still feel overwhelmed at work quite often. And I’m having trouble sleeping – my mind just won’t switch off at night.

Dr. Roberts: I understand. These seem like important things to address. Today, I’d like us to work on something specific – creating clear treatment goals and developing a plan for our work together. Does that sound good to you?

James: Yes, definitely. I think I need that. Sometimes I’m not sure what we’re working towards.

Dr. Roberts: That’s very honest of you, and it’s exactly why setting goals is so important. Let’s start with what you’d like to change. If our therapy together is successful, what would be different in your life?

James: I want to feel less anxious, especially at work. And I want to sleep better. Also… I’d like to feel more confident in general.

Dr. Roberts: Those are great starting points. Let’s work on making them more specific so we can track your progress. You mentioned feeling less anxious at work – can you describe what that would look like in practical terms?

James: I suppose… I’d be able to present at team meetings without my heart racing. And I wouldn’t spend my lunch breaks worrying about what might go wrong in the afternoon.

Dr. Roberts: Excellent. So, one goal could be about managing anxiety in specific work situations. Let’s make it even more concrete. How often do you present at meetings currently?

James: About once a week, usually on Fridays.

Dr. Roberts: And how would you rate your anxiety level during these presentations right now, from 0 to 10, where 0 means no anxiety at all and 10 means extreme anxiety?

James: Probably an 8 or 9. It’s really high.

Dr. Roberts: Okay. So, let’s create a SMART goal – that means it’s Specific, Measurable, Achievable, Relevant, and Time-bound. How does this sound: “Within 10 weeks, I will present at weekly team meetings and reduce my anxiety level from 8/10 to 4/10, measured before and during the presentation.”

James: That sounds… challenging but possible, I think.

Dr. Roberts: Good. It should feel like a stretch but not impossible. Now, what about sleep? What would better sleep look like for you?

James: Falling asleep within 30 minutes instead of lying awake for two hours. And maybe waking up feeling rested, not exhausted.

Dr. Roberts: How many nights per week are you having trouble sleeping currently?

James: Five or six nights. It’s pretty consistent.

Dr. Roberts: Alright. Here’s a possible goal: “Within 8 weeks, I will fall asleep within 30 minutes on at least 5 nights per week by practicing sleep hygiene techniques and relaxation exercises.”

James: That would make such a difference to my life.

Dr. Roberts: I believe it will. Now, you also mentioned confidence. That’s a bit broader. Can you give me an example of a situation where you’d like to feel more confident?

James: Social situations, I think. I avoid going out with friends because I worry I’ll say something stupid or that people won’t like me.

Dr. Roberts: How often are you declining social invitations right now?

James: Almost always. I probably say no nine times out of ten.

Dr. Roberts: And realistically, how often would you like to be able to say yes?

James: Maybe… half the time? At least at first.

Dr. Roberts: That’s a realistic target. So, our third goal might be: “Within 12 weeks, I will accept and attend at least 50% of social invitations I receive, with a minimum of two social events per month.”

James: Okay. These goals make it all feel more… real. More manageable.

Dr. Roberts: That’s exactly the purpose. Now let’s talk about how we’re going to help you achieve these goals. Based on what you’ve told me over our sessions, I think Cognitive behavioural Therapy would be very effective for you. Do you know anything about CBT?

James: Not really. What does it involve?

Dr. Roberts: CBT focuses on the connection between your thoughts, feelings, and behaviours. We’ll identify unhelpful thinking patterns that increase your anxiety and work on developing more balanced, realistic thoughts. We’ll also use exposure exercises to gradually help you face situations you’re avoiding.

James: Exposure exercises? That sounds scary.

Dr. Roberts: It will be gradual and at your pace. For example, we might start with smaller social situations before working up to bigger ones. And we’ll teach you coping strategies first – like relaxation techniques and thought challenging – so you have tools to manage the anxiety.

James: Okay. That sounds more manageable.

Dr. Roberts: Good. So, here’s our treatment plan: We’ll meet weekly for approximately 12—14 sessions. Each session, we’ll check on your progress, review any homework exercises, learn and practice new skills, and plan what to work on between sessions. For your work anxiety, we’ll use thought records to identify and challenge anxious thoughts. For sleep, we’ll implement a sleep hygiene plan and teach you progressive muscle relaxation. And for social confidence, we’ll create an exposure hierarchy – starting with less anxiety-provoking situations and gradually building up.

James: And the homework you mentioned – what would that involve?

Dr. Roberts: Between sessions, you’ll practice the skills we work on here. For example, keeping thought records, practicing relaxation exercises daily, or gradually completing exposure tasks. The homework is where most of the change happens – our sessions are for learning and planning, but you’ll do the real work outside this room.

James: That makes sense. I’m nervous but I’m ready to try.

Dr. Roberts: That’s a great attitude. Remember, we’ll review your progress regularly. Every few sessions, we’ll check whether these goals still feel relevant and whether we need to adjust them. This plan isn’t set in stone – it’s a working document we’ll adapt as needed. How are you feeling about everything we’ve discussed?

James: Honestly? A bit overwhelmed, but also relieved. It’s good to have a clear direction.

Dr. Roberts: That’s a very normal reaction. For next week, I’d like you to start monitoring your anxiety and sleep patterns. I’m going to give you a simple diary sheet where you can record your anxiety levels in different situations and note what time you go to bed and fall asleep each night. This will give us baseline data and help you become more aware of patterns.

James: Okay, I can do that.

Dr. Roberts: Excellent. Let’s summarize what we’ve agreed today. We’ve set three main goals: reducing your anxiety at work presentations to 4/10 within 10 weeks, improving your sleep by falling asleep within 30 minutes at least 5 nights per week within 8 weeks, and accepting 50% of social invitations within 12 weeks. We’ll use CBT techniques including thought records, relaxation exercises, and gradual exposure. Does that sound right?

James: Yes, that covers it.

Dr. Roberts: How helpful was today’s session for you?

James: Very helpful. I feel like I understand what we’re doing now and where we’re headed.

Dr. Roberts: I’m glad to hear that. I’ll see you next week, at the same time. And remember to bring your anxiety and sleep diary.

TASK 1: True / False / Not Mentioned

Read the statements below about the therapeutic session. Decide if each statement is:

• TRUE – the statement agrees with the information

• FALSE – the statement contradicts the information

• NOT MENTIONED – the information is not given

Statements:

1. This is James’s first therapy session with Dr. Roberts.

2. James is having difficulty sleeping because his mind won’t switch off at night.

3. Dr. Roberts plans to use Cognitive behavioural Therapy with James.

4. James currently rates his anxiety during presentations as 8 or 9 out of 10.

5. James has been diagnosed with panic disorder.

6. James accepts most social invitations he receives.

7. The treatment plan includes approximately 12—14 weekly sessions.

8. Dr. Roberts will adjust the treatment plan if needed as therapy progresses.

9. James needs to practice relaxation exercises twice a day.

10. Dr. Roberts assigns James an anxiety and sleep diary for homework.

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