Mental Health Therapy Session Record

Therapist's Note

Sarah presented today for her scheduled follow-up regarding worsening GAD symptoms and occupational burnout. Sarah reported increased sleep-onset insomnia, averaging 4 hours per night, and persistent somatic tension over the past two weeks due to a corporate restructuring at work. She noted adherence to escitalopram (Cipralex®) 10 mg PO OD with good tolerance, though morning anxiety remains elevated.

We discussed her tendency to catastrophize feedback from management and how this fuels her hypervigilance and overtime hours. Together, we examined the cognitive distortions driving her perfectionism and identified boundary-setting strategies, specifically logging off at 17:30 daily and delegating minor tasks.

Sarah has a history of childhood emotional neglect and high-achieving academic pressure, which predisposes her to fear of failure and rejection sensitivity in authority dynamics.

Interventions

Utilized CBT to challenge catastrophic automatic thoughts using a dysfunctional thought record. Incorporated ACT cognitive defusion techniques to help detach from the "I must not fail" narrative, alongside brief somatic grounding exercises (box breathing) in-session.

Goals

• Short-term: Improve sleep hygiene to achieve > 6 hours of uninterrupted sleep per night within 2 weeks; reduce daily overtime to < 30 minutes.
• Long-term: Remission of GAD symptoms (GAD-7 score < 5) and establishment of sustainable work-life boundaries without associated guilt.

Homework

• Complete a daily CBT thought record when experiencing workplace anticipatory anxiety.
• Practice 5 minutes of box breathing at 21:30 nightly prior to bed.
• Enforce a strict 17:30 work stop time on at least 3 days this week.

Safety Concerns

The client has not shared any safety-related concerns during the session. Continue ongoing assessment.

Next Steps

Continue current pharmacotherapy with escitalopram (Cipralex®) 10 mg PO OD. Follow-up appointment scheduled for 24/04/2026 at 14:00 to review thought records, assess sleep improvements, and continue ACT values clarification.

Optional Reflection Questions

• What is the actual cost to my physical and mental health when I say "yes" to late-evening work requests?
• Who am I outside of my professional productivity, and what personal values am I neglecting when work consumes my evenings?
• If a trusted colleague were in my exact position, what compassionate advice would I give them about their workload?