Psychology Note

Session Summary

The session reviewed the client’s work-related anxiety over the three weeks since the previous appointment. The client reported fewer late-night email checks after using an agreed boundary, but continued to worry after ambiguous feedback from their manager. The therapist completed a brief symptom review, mapped a maintaining cycle, and the client agreed to continue monitoring anxiety triggers before the next session.

Current Presentation

The client entered the session wanting to understand why neutral manager messages still felt threatening, with anticipatory anxiety before one-to-one meetings, reduced concentration after feedback messages, and two nights of disrupted sleep.

Session Content

The main therapeutic process was identifying how ambiguous feedback cues were rapidly appraised as threat. A recent manager message was used as a brief cue: the client interpreted it as possible criticism, reviewed their work repeatedly, and later felt frustrated when the meeting turned out to be about scheduling.

Obstacles, Setbacks and Progress

Progress included closing work email after 8pm on four evenings and noticing that anxiety usually reduced after twenty minutes when they did not check again. The main obstacle was the client’s fear that not checking could mean missing a serious problem. They worried they might not recognise early signs of performance difficulty unless they stayed vigilant.

Working Formulation / Therapeutic Understanding

The therapist and client developed a tentative cycle in which ambiguous feedback triggers an appraisal of being in trouble, leading to body tension, reviewing work, reassurance-seeking and delayed sleep. The client agreed this fitted the recent manager-message example. The therapist noted that the cause of the strong threat response remained uncertain and should not be assumed from one example.

Interventions

The therapist provided psychoeducation about threat appraisal and safety behaviours, then used guided questioning to compare the client’s feared outcome with what actually occurred. The client identified that checking emails late gives short-term relief but increases next-day fatigue and makes the workplace feel less predictable.

Exercises / Metaphors Used in Session

The therapist used a traffic-light metaphor to distinguish urgent work problems from ambiguous cues. The client placed recent examples into red, amber or green categories and identified the manager’s message as ambiguous rather than urgent. The client said this helped them see a possible pause point before starting a long review of their work.

Assessment / Measures

A brief symptom review covered sleep, concentration, panic symptoms, avoidance and reassurance-seeking over the previous three weeks. The client reported two nights of delayed sleep, no panic attacks, continued reassurance-seeking from one colleague, and no missed work days.

Risk Assessment and Management

The therapist directly asked about current suicidal thoughts, self-harm thoughts and thoughts of harming others. The client denied all three and said their distress was focused on work anxiety rather than safety concerns.

Next Steps

• Treatment direction / next-session focus: Jointly agreed to review the traffic-light categorisation and refine the maintaining cycle.

• Client between-session therapeutic work: The client agreed to record three anxiety episodes using trigger, thought, body response, behaviour and outcome.

• Therapist actions explicitly agreed: The therapist agreed to provide a one-page traffic-light worksheet.

• Booking, timing or frequency arrangements: The next appointment was kept for the usual fortnightly slot.