THERAPEUTIC ALLIANCE

Alex, a 16-year-old, struggles with anxiety before exams. Alex avoids talking about feelings with teachers and often isolates themselves at home.”

1- Perspective-Taking Patient (7–8 mins): if you are the client:

  • How do you feel about your situation?

    • I am constantly anxious when an exam is approaching

    • I am unable to focus on my daily tasks and finding the strength to do any task is hard when my whole body is being weighed down by my anxiety

    • My inability to focus makes it hard for me to focus on my revision, which in turn makes me more anxious, knowing that the less revision I do, the worse my experience will be when it come to answering questions

    • My mind always finds itself about the questions that may arise and what could go wrong during the exam, e.g. not being able to answer any questions

    • I don’t have anyone to talk to about this, no one understands my situation and the most I get is ‘it’ll be alright, don’t worry’

    • I even find it difficult to express my concerns so i keep it to myself because it makes me feel better than being misunderstood when I try to express how I feel

  • What worries you most coming to session?

    • My inability to express how I feel

    • I know that inability to verbalise what’s going on in my head will hinder the clinician from being able to help me, they can only work with what I give them

    • Also if the clinician invalidates the way i feel that would be heartbreaking for me

  • What do you hope the therapist would understand?

    • therapist I am not avoiding teachers because I don’t care but I just cant express how I feel

    • That it is hard for me to open up

    • That this anxiety is taking over life and I have no control

    • That I’m not just making excuses for my poor grades

  • What type of questions, you expect the therapist would ask?

    • How is the anxiety affecting your daily life?

    • My home and school life

    • My coping mechanisms for my anxiety

    • The first time I found myself anxious

    • Asking questions to find the root cause of my anxiety

    • How does the anxiety affect me physically, not just mentally

    • How does the anxiety affect the way I relate to others during that period


2- Perspective of therapist (7 -8 mins): switch role to therapist

• How would you respond to show understanding?

  • “Can you tell me what goes through your mind when you think about an upcoming exam?”

  • “When anxiety shows up, where do you notice it most in your body?”

  • “What has helped even a little in the past, even if it didn’t make the anxiety go away completely?”

  • “What would make these sessions feel safe or helpful for you?”

• What questions of reflection might you offer to build trust?

3- Reflection:

what was challenging for about seeing the situation from patient’s perspective?

How would this information help you to develop therapeutic alliance towards the client or what skills you would like to learn in terms of your CPD?