Psychological consultation case report

This case focuses on the moderate test anxiety and sleep disorder of Lin Xiao (pseudonym), a 17-year-old senior high school girl. After 8 sessions of cognitive behavioral + existential integrated consultation, the client's pre-test anxiety self-rating scale (SAS) score dropped from 68 to 42, the number of insomnia days per week dropped from 5 to 0, and the mock test ranking rose from 127th to 90th in grade. In the end, the college entrance examination exceeded expectations and was admitted to the Chinese language major of the target college. The intervention effect was significant.； In the process, the practical verification of two industry disputes: "whether adolescent anxiety intervention must prioritize childhood trauma" and "whether mild somatization requires drug intervention" has certain reference value for short-term clinical intervention of adolescent test anxiety.

The first time I met Lin Xiao was on a Saturday afternoon last winter. She was dragged into the consulting room by her mother. Her down jacket and hood were pulled down low, and the tips of her hair were still stained with snow particles falling outside. She bowed to me when she entered the door. After sitting down, she kept holding the seams on the side of her school uniform pants with her fingers until her knuckles turned white. After chatting for ten minutes, she shed tears. She said that during the mock test last week, she was holding a pen and her hand was shaking so hard that she couldn't fill in the admission ticket number. The day before, she lay with her eyes open until three o'clock, and all she could think about was "If I failed in the test, my mother would have spent all these years studying with her in vain." She was previously stable in the top 20 of her grade, but she fell directly to 127th in the last mock test. When she wiped her tears, she apologized hurriedly, saying, "Teacher, I'm sorry, I'm so useless, I can't bear the pressure."

After getting the evaluation results of SAS and sleep quality scale, I happened to have dinner with several colleagues from different schools, and there was a slight disagreement when talking about this case. A colleague with a psychoanalytic orientation said that she has received many similar cases, which are most likely due to unprocessed trauma in childhood. For example, Lin Xiao mentioned that when she was 3 years old, she could not recite ancient poems and was laughed at by her relatives, saying, "You look smart, but you are stupid." Since childhood, your parents have always said, "We are working so hard just for you." These deep-seated knots must be dug out first, otherwise the anxiety will easily recur. The cognitive-behavioral supervisor had a different opinion: At that time, there were only 5 months left before the college entrance examination, and Lin Xiao's core appeal was very clear - first solve the problem of hand shaking and insomnia in the examination room, so that she can perform normally. At this time, digging deeper into the trauma may destroy her emotions first, and the priority was completely wrong.

To be honest, both views are tenable, and their adaptability varies greatly in different cases. After discussing with Lin Xiao and her mother, I finally chose the option of focusing on the immediate problem first. After all, the person involved was already standing at the door of the examination room with the "bomb" in her arms. It was much more practical to put an explosion-proof mat on her first to overcome the obstacle in front of her than to squat down and study the year when the fuse was buried.

The first two consultations mainly focused on stabilization training, and taught her the "478 abdominal breathing method" and the 5-sensory landing technique in the examination room. The interesting thing is that she changed the technique herself. Originally she was asked to touch the tabletop and listen to the surrounding sounds. I put three mint candies in my pocket, corresponding to the three exams in Chinese, Mathematics, and English. When I enter the examination room, touch the corresponding candies and feel the cool touch, which can bring my attention back to the present moment from "What should I do if I fail the test?" It is much easier to use than the original version I taught. The third consultation encountered a stuck point. As soon as she got to the last big question in mathematics, her palms became sweaty. All she could think about was "This was the question she lost 20 points on last time." I didn't force her to correct her unreasonable belief. Instead, I asked her: "If you really can't solve this question, what do you think your life will be like?" ”She was very serious at first: she couldn't get into a good university, couldn't find a good job, and felt sorry for her parents. At the end of the conversation, she laughed and said, "I don't think I can. The worst thing I can do is read the Chinese language I like. I always get perfect marks in composition, right?"

When talking about the intervention plan, there was another controversial point: Lin Xiao had been to the neurology department before her first visit, and the doctor prescribed lorazepam. She did not dare to take it, fearing that it would make her brain duller and affect her ability to do questions. Friends from the psychiatry department said that if somatic reactions such as hand shaking and brain blanking have already occurred, short-term use of small doses will have very few side effects and will cause much less damage to the brain than anxiety attacks. ； However, seniors who provide consultation for children and adolescents also remind that minors should try to rely on psychological intervention to adjust first. Otherwise, it is easy to label them as "I need to take medicine because I am sick", which will increase the psychological burden. In the end, we did not choose a hard way. We just made an agreement with her: first have 3 consultations to see the effect. If the hand tremors are not relieved, try taking half a tablet without any psychological burden. After the third consultation, she said that her hands were no longer shaking during the recent mock test. The medicine has not been opened yet. When I saw her last time, she joked, "My three mints are more effective than the medicine."

At the end of eight consultations, she just caught up with the second model. She ranked 90th in her grade. Although she has not returned to the top 20 before, she was very satisfied. She said, "I was able to find time to go to the toilet during the exam. Before, I didn't even have the courage to look up." On the day when her college entrance examination scores were announced, she came to the consulting room with her admission notice and said she still hadn't solved the last big math question. But she touched the mints in her pocket and turned around to check the previous questions. In the end, her math score was 12 points higher than the mock test, which was just enough to get into the Chinese language major of the target college.

Of course, this case was not perfect. In the end, I didn’t even talk to her father, who worked outside all year round. She was afraid of delaying her father’s transportation work, so she said, “I don’t need to bother him if I can handle things myself.” If there had been a brief family intervention at that time, the effect might have been better. But after doing consultations for a long time, I know that there is no 100% perfect intervention. It can solve the client's most pressing problems at the moment and help her gain more courage to face the future. It is enough.