This client presented with intense anxiety associated with social interactions. They were unable to function in any 1:1 or group situations outside of the work environment. This resulted in almost total withdrawal from others barring requirements at work or essential commercial interactions to maintain personal comforts. Deep anxiety and a spiral of self-loathing hindered any healthy interpersonal contact or attempts by the client to remedy the situation on their own. Cognitive Behavioural Therapy (CBT) identified thought patterns focusing on low self-esteem which led to avoidance behaviours by which the client severely limited their exposure to others. They viewed social interplay as high risk of personal rejection. Intensive work to identify alternative thought patterns removing low self-esteem as the motivating cognitive pathway helped the client to change avoidance behaviours and become more comfortable in 1:1 and group circumstances.
The success of CBT was amplified by specific work on the client’s self-view (self-schema). This approach comprised three discrete steps: 1) identification of the client’s current, negative self-schema; 2) fashioning a positive self-schema representing how the client would like to present to the world; and 3) establishing a positive data base of the client’s personal characteristics demonstrating how far along they already were to achieving the positive self-schema. This new self-view led to improved self-confidence further enabling the client to engage in more social interaction.
The creation of alternative, more positive thought patterns and an enhanced sense of self was supported by a psychodynamic approach to therapy assisting the client to uncover root causes of low self-esteem and social anxiety. Negative experiences with peers early in life and complex parental relationships were identified among the root causes. The client was able to jettison the negativity of these experiences in light of a new self-schema and current contexts of social interplay which differ from the past.
An intense course of therapy comprised weekly sessions lasting over seven months greatly alleviated the client’s social anxiety. They are now able to comfortably move through healthy 1:1 and group interactions.