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Case Study #2

Counselor’s name: Andrew Setting: Office

Client’s name: Evelyn Client’s age: 23 years old

Estimated # of sessions required: 8 Theoretical Perspective: Narrative

Client History:

The individual seeking therapy1, Evelyn, has expressed anxiety with a public voice since

adolescence and perhaps before. During high school she would contribute to her school paper but

remained cautious about when she would include a byline for fear of being ridiculed for her

expression, this manifested further in college when public speaking became important. Her

parents divorced when she was four and she possesses a potent memory about when she was

scolded for speaking her mind to her father, which she says resulted in her strong dependency

needs.

Presenting Concerns:

Psychosomatic illnesses derived from strong anxiety-provoking situations and strong general

anxiety regarding speaking publicly.

Want of mature, long-term relationship with someone who is true to themselves despite Evelyn

not having a proper image of how that would look due to her parent’s divorce.

Actual or Core Issues:

1
Narrative therapists do not typically refer to therapy seekers as clients or patients, therefore I will try to avoid
using such terms to the best of my ability.
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Evelyn possesses a problem-saturated story of herself regarding crowd interaction and

dependency. It is clear that she has adopted a dominant story that she cannot speak in front of

others, possibly in part garnered from a distinct interaction with her father when she was four. It

is also possible that the societal culture from which she comes deems that the ability to speak

publicly is an asset for all, for which she sees herself unable to live up to. This story about her

inability to speak publicly has been told and retold through her college course interactions

serving to reinforce her negative self-view, however, such a story fails to contain any aspects of

Evelyn’s strengths. In addition to the voiced issues about extreme anxiety and distress when

speaking publicly, Evelyn also expresses worry regarding finding committed and lasting

companionship because she has no example of what a healthy relationship looks like. She does

not want a partner to compromise her own life goals, perhaps indicating the societal “truth”

under which she lives indicates normalcy for women to trade certain goals for that of a

committed relationship.

Course of treatment and interventions utilized:

We should separate Evelyn from the anxiety that she experiences from speaking publicly,

therefore we will restructure the issue from Evelyn’s anxiety to Speaking Anxiety so that it is

outside of herself and we can begin to work together to overcome the problems that Speaking

Anxiety is causing for Evelyn. Through this process of externalizing, we will be able to see the

degree of impact the issue has on her sense of self, quality of life, and relationships (McGuinty,

2018).
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Once the issue is successfully externalized, we will be able to begin to implement

scaffolding, which stems from an extremely important therapeutic technique for NT, questioning.

Questions are the building blocks of scaffolding, which will allow Evelyn to examine her current

thought processes so that she can adjust and reorient them to rally them against Speaking

Anxiety. Another type of question that will be used are relative influence questions, which will

allow us to explore the influence that the issue has on her life and what influence she has on the

presenting issue (Murdock, 2016). By asking these types of questions we will be able to best

examine the dynamic individual-problem relationship and help Evelyn to develop initiatives, or

exceptions, that she can enact to overcome Speaking Anxiety.

Affirming that written words carry more weight than spoken words (Murdock, 2016), I

spend some time after the first session of getting to know Evelyn writing her a letter. I find this

important so that I could reiterate the goals that we have for our journey towards overcoming

Speaking Anxiety. The nature of the letter is to affirm her story while sharing analysis of her

strengths, perceived meaning and expected outcomes of therapy (Knoetze, 2013).

Seeing that Evelyn has overcome the stifling rule of Speaking Anxiety, I bestow upon her

a certificate of Heroic Courage and Bravery by the act of vanquishing the fiend known as

Speaking Anxiety. This counter document will provide evidence to Evelyn of her

accomplishment, helping to further saturate her new narrative (Murdock, 2016).

Counseling goals:

Short term goals are that of creating a meaningful and transparent relationship with Evelyn

during her journey, in hopes of facilitating a collaborative environment conducive to individual

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growth through flexible thinking while simultaneously reducing any resistance caused by a

failure on my part to be politically and/or culturally sensitive (Murdock 2016).

There are two long term goals: 1) Seeing that Evelyn possesses a problem-saturated story

regarding speaking publicly, we hope that by means of narrative deconstruction and reauthoring

of that story we will be able to send away Speaking Anxiety which will quell the anxiety she

feels about public speaking; 2) With reduced anxiety and a restructured narrative regarding her

family dynamic, she will suffer less confusion when navigating romantic relationships.

Anticipated outcomes of counseling:

Outcomes of therapy are expected to be alleviation of anxiety caused by the thought of having to

speak in front of numerous others as well as the hope for Evelyn to have a better idea of how to

navigate serious romantic relationships. These outcomes will inherently reflect the adoption and

integration of a deeper and richer life narrative.

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References:

Murdock, N. L. (2016). Theories of Counseling and Psychotherapy, 4th Edition [VitalSource

Bookshelf version]. Retrieved from vbk://9780134318295

Knoetze, J. (2013). Sandworlds, storymaking, and letter writing: The Therapeutic Sandstory

Method. South African Journal of Psychology, 43(4), 459–469. 

McGuinty, E. F., Bird, B. M., Nelson, J., McGuinty, J. L., & Cashin, A. (2018). Novel four‐

session treatment intervention for anxiety and high‐functioning autism: A single case

report for externalizing metaphors therapy. Journal of Child and Adolescent Psychiatric

Nursing.