Counsellor Consult Note

Current Presentation

• Pt (Sipho Ndlovu, 34 yo M, ID: 900412 5112 08 4) presents with worsening generalised anxiety, occupational burnout, and initial insomnia over the past 3/52.
• Reports severe evening anxiety (7/10), irritability impacting marriage, and reduced concentration at work (missed two project deadlines this week). Sleep reduced to ~4.5 hrs/night; compliant with escitalopram (Cipralex®) 10 mg PO OD prescribed by GP.

Session Content

• Explored current occupational stressors following recent corporate restructuring and increased workload. Addressed maladaptive perfectionism, catastrophic thinking regarding job security, and resultant emotional withdrawal from his spouse.
• Pt expressed feeling "constantly on edge" and stated, "If I drop the ball at work, I'll lose everything." Reflected on deep-seated guilt regarding his lack of emotional availability for his wife and children.
• Recognised the link between his childhood high-achievement expectations and current inability to set boundaries with management. Noted a visible reduction in somatic tension after cognitive reframing of his workplace performance metrics.

Obstacles, Setbacks and Progress

• Unpredictable work hours, high baseline perfectionism, and reluctance to delegate tasks at home or work.
• Experienced a mild panic attack on Tuesday evening (14/05/2024) following a critical email from his line manager; initially coped via avoidance (working late into the night) before successfully utilising box breathing to de-escalate.
• Demonstrated strong self-awareness, consistent therapy attendance, and successfully initiated one boundary-setting conversation with his supervisor regarding weekend emails.

Session Summary

• Focused on identifying cognitive distortions (catastrophising, all-or-nothing thinking) related to occupational performance. Pt was highly engaged and receptive to CBT interventions (cognitive restructuring, Socratic questioning) and psychoeducation on the physiological stress response.
• Addressed recurring theme of conditional self-worth tied to productivity; pt is developing good insight into how avoidance behaviours maintain his anxiety cycle.
• Oriented x3, groomed. Mood reported as "anxious"; affect initially constricted and tense, becoming more reactive and congruent by session end. No SI/HI. Symptoms remain consistent with GAD and occupational burnout; prognosis good with continued boundary enforcement.

Next Steps

• Complete daily CBT thought record focusing on workplace triggers; practice progressive muscle relaxation (PMR) for 10 mins prior to bed; adhere to strict 18:00 digital cut-off from work emails.
• 28/05/2024 at 14:00 SAST.