Counseling Session With Client With Anxiety Disorder

Client Information

The subject of the case presentation is Suzana, a Portuguese-speaking middle-aged woman who may be perceived as a middle-aged Latina. The client’s occupational status is in the hairdressing industry and house cleaning for her income declaration. The patient has two children and currently lives with the children’s father despite being divorced for two years. Suzana identifies religiously as a Christian believer with a high sense of spirituality. She is grounded in her religious beliefs and relies on her spiritual faith as a mechanism to deal with her life challenges. Additionally, Suzana has no family support framework in the USA with her children and former husband as her existing family. She is open-minded and has been considering relocation back to her native country of Brazil. She considers the shift as an option for her current life situation.

Reason for Coming to Counseling/Presenting Problem

Suzana voluntarily came to counseling due to a reoccurrence of past challenges she faced with her former husband. She has been living with her former husband despite being divorced for two months, factoring their children by trying to keep the family together. This goal prevented her from leaving, something she had considered since the the divorce. Their financial agreement was based on shared responsibility for house expenses. Since Suzana works part-time, he was expected to pay for utilities. However, the father has been absconding from the responsibility, which forces Suzana to pay. Additionally, the father has neglected his child support duties for the two children. As a result, Suzana has experienced undue emotional and financial abuse which has triggered her choices. She and her children face a crisis with a lack of power that presents a risk in heating needs necessary during the winter.

Diagnostic Impressions

The client’s diagnosis is indicative of a generalized anxiety disorder based on the symptoms she presents. Glasofer (2021) states that, unlike other anxiety disorders, generalized anxiety disorder is not attributed to patients experiencing panic attacks. However, Suzana only presents signs of emotional distress subject to her existing family circumstances. The patient presented signs of excessive anxiety and worry, easily fatigued and had difficulty concentrating, her mind going blank. Glasofer (2021) concurs and indicates that excessive worry can be quantifiable on the criterias set in the DSM-5 to qualify the diagnosis of generalized anxiety disorder. The patient presented constant worry and emotional conflict, frequently crying during the session. Basic communication skills helped elicit the diagnosis by creating an environment that allows the client to open up. In addition, picking up on cues such as her emotional breakdowns that ended in tears during the session were indicative of distress.

Session Descriptions

The session with the client provided necessary insight that facilitates an objective and accurate understanding of the situation. Suzana, the client, disclosed the current emotional and financial abuse she was suffering. She presented signs of depression and worry subject to her lack of support at home and had minimal capacity to provide for herself and her two kids. The client’s worries were the basis on which the session was centered, attending the crisis to meet her basic needs; shelter, food, and utilities. Emotional support was provided, and the patient was reassured that all other issues could be discussed after her immediate needs were met.

Skills Competency Scale

Skills and competency are essential in facilitating my patient case counseling role. I presented myself with positive regard maintained adequate good eye contact. Eye contact is an integral component of non-verbal communication skills (Ezeh et al., 2021). Eye contact was used to assure the patient I was attentive and indulge the client in conversation, allowing the patient to open up and relay her worries. Furthermore, I exercised active listening skills and demonstrated empathy to the client’s circumstances and worries. Subsequently, I employed competence and skill by providing some reflection of feeling to create a therapeutic connection with the client. I was able to summarize well the issues she disclosed. I perceive that I adequately employed competent skills in working with the client on a goal around the crisis intervention first. Kanel (2019) defines a crisis as a factor or event that affects the steady-state of an individual. Kanel stipulates that psychological stabilization and preventing distress are essential strategies to conform to achieve crisis intervention. These steps of crisis intervention are expected to influence the client to think clearly and develop a solution objectively with a sound mind.

Assessment of Therapeutic Relationship

A therapeutic relationship is the expected outcome of the session that seeks to establish an environment of mutual feeling between the counselor and the client. An assessment of the session’s therapeutic relationship revealed some positive experiences and outcomes. A review of the sessions indicates that the client was very responsive and open to sharing her situation. The session developed a therapeutic connection with Suzana, who seemed to rely on me for support. She trusted me with her issues and expected me to unburden her from her emotional crisis.

Counselor Self-assessment

A personal assessment of the session revealed some skills that need improving to ensure effective counseling. Consequently, the counseling session presented some of the challenges that are bound to be experienced in facilitating my role as a counselor. A significant problem I encountered during the case example was nervousness. The role play with my supervisor was intimidating since I knew I was being assessed on my skills. In the actual session, I had to use a lot of attentive silence and provide lots of reflection of feelings.

On the other hand, counseling sessions presented a new reality that emotions are a common feature. The client expressed her emotions through crying, frequently breaking down into tears throughout the session. According to ‘T Lam et al. (2018), literature on therapy postulates that crying is a stress-relieving technique deemed to have cathartic properties for the patient in therapy. However, the discourse can be understood as a presentation of emotional instability in the client, facilitating diagnosis by detecting such non-verbal cues that display emotional wellbeing. ‘T Lam et al. (2018) reveals that mental health experts and scholars consider client crying vital to promoting positive therapeutic influence and connection. A counselor is expected to be empathetic, putting themselves in the client’s shoes to establish some understanding of such actions. It is essential that the counselor presents an environment where the client feels safe to express themselves and unburden.

In addition, the session took more time than expected, which meant that the counselor allowed the client to take her time expressing her issues. In some modern societies, therapy and counseling are professional and commercial discourses. Arguably sessions are timed, and expected rates are imposed depending on the time lapsed. Research by De Geest and Meganck (2019) reveals that healthcare systems have been under pressure globally to ensure optimization of sessions to be cost-effective, required to deliver effective results in short timeframes and expense. Consequently, the counselor is expected to be aware of the session duration to establish a balance, ensuring that the session doesn’t exceed time limits. This implies that I wasn’t time cautious and didn’t manage time effectively.

The skills of wrapping up and summarising are essential for the counselor to establish a conclusion to the session. The issue infers to deliberate cues such as referring to the time and queries of the activities to the next session. Potentially, the counselor presents the client with an incentive to come back for more counseling where necessary. It is essential to establish what the client needs and refer to them to ensure the session meets the needs.

I acknowledge my inefficiencies during the session in the manner I expressed myself physically through body language. Gestures and kinesics can be used positively to convey non-verbal communication assert confidence and attention of the client (Ezeh et al., 2021). However, some movements can be easily misconstrued and result in unwanted outcomes. I thought that I moved my hands a lot which I am aware can be disturbing during sessions. Effective communication skills require that a listener minimize body movements, such as fidgeting and excessive hand gestures that are distracting. This shows a problem on my part for creating an environment that may have been upsetting to the client. Therefore, the actions hindered my effectiveness in the session to support the client.

Overall Feeling About the Work in this Session

The work in this session was a significant experience that will improve my understanding of the professional field of counseling. The procedure revealed areas that I have deficiencies in and can be used as an opportunity to improve my skill competency. Arguably the case presentation is essential to create a suitable platform to put theories and ideologies into practice. The case was adequate in establishing areas I would be comfortable with and a clear framework of my capacity.

Class Feedback Helping Future Work with the Client

The question I pose to my classmates regards the possible ways to work with someone who seems to have lost all hope. The query seeks to elaborate on possible cues and skills to change the client’s mentality and spiritual wellbeing effectively. I acknowledge that this can be achieved through self-reflection and embracing her spirituality. Regardless, I question whether I can employ additional interventions or strategies to improve her hope and emotional mindfulness.


de Geest, R. M., & Meganck, R. (2019). How Do Time Limits Affect Our Psychotherapies? A Literature Review. Psychologica Belgica, 59(1), 206–226. Web.

Ezeh, N. G., Anidi, O. C., & Nwokolo, B. O. (2021). Body Language as a Communicative Aid amongst Language Impaired Students: Managing Disabilities. English Language Teaching, 14(6), 125. Web.

Glasofer, D. R. (2021). How Is Generalized Anxiety Disorder Diagnosed Using the DSM-5? Verywell Mind. Web.

Kanel, K. (2019). A Guide to Crisis Intervention (6th ed.) [E-book]. Cengage Learning. Web.

‘T Lam, C., Vingerhoets, A., & Bylsma, L. (2018). Tears in therapy: A pilot study about experiences and perceptions of therapist and client crying. European Journal of Psychotherapy & Counselling, 20(2), 199–219. Web.

Appendix A

Skills Competency Scale (SCS)

Basic Skills

Not Present Minimal Proficient Advanced
Eye contact, verbal tone, and attending skills

Facial expression and gestures

Appropriate Minimal Encouragers


Being non-judgmental/unconditional positive regard

Active listening

Open-ended questions

Reflection (feelings, meaning, content)



Attentive silence




Goal setting

Wrapping up the session