Ongoing Session Template

Content of Session

Mr Arthur Pendelton (DOB: 14/08/1982, NHS: 492 817 3049) attended his scheduled outpatient psychiatric psychotherapy review at 14:00. The session focused primarily on his ongoing occupational stress and the management of his recurrent depressive disorder and generalised anxiety disorder (GAD). We discussed his recent return to phased work duties and the anticipatory anxiety occurring on Sunday evenings, which has been triggering somatic symptoms including palpitations and initial insomnia. Medication adherence to sertraline 100 mg PO OD was also reviewed and confirmed to be consistent.

The patient demonstrated improved insight into the link between his perfectionistic cognitive distortions and his subsequent avoidance behaviours at work. He recognised that delaying tasks due to fear of failure directly exacerbates his baseline anxiety. Contextual factors shaping today's discussion included a recent minor conflict with his line manager, which initially destabilised his mood, though he managed to de-escalate his emotional response faster than in previous months.

Therapeutic Techniques and Interventions

• Cognitive restructuring was utilised to challenge catastrophic automatic thoughts regarding workplace performance and perceived criticism from management.
• Behavioural activation strategies were reviewed and refined to help re-establish a consistent evening routine and counter weekend social withdrawal.
• Socratic questioning was employed to explore the validity of his core belief regarding personal inadequacy.
• Grounding techniques, specifically paced box breathing, were practiced in-session to manage acute physiological symptoms of anxiety.

Progress Towards Goals

Mr Pendelton has made moderate progress toward his primary goal of returning to full occupational functioning without debilitating panic attacks. He successfully completed two weeks of phased return (working 20 hours per week) and utilised his thought record twice this past week, noting a subjective reduction in evening rumination.

Progress remains partially hindered by persistent sleep onset latency, which leaves him fatigued and more vulnerable to cognitive distortions during morning shifts. Additionally, he continues to avoid initiating conversations with senior colleagues, which limits his ability to advocate for reasonable workplace adjustments.

Risk Identified

The patient denied any active suicidal ideation, intent, or plans, and reported no history or current urges of deliberate self-harm. He identified his wife and sister as strong protective factors and confirmed he has Crisis Team contact numbers readily available. No dissociative episodes or signs of acute clinical deterioration were observed during the mental state examination.

No new acute risks to self or others were identified during today's session. However, there is a mild emerging risk of occupational burnout if he accelerates his phased return hours prematurely to appease his manager.

Overall clinical risk remains low and stable compared to the previous session on 10/03/2026. His fleeting passive thoughts of "wanting to disappear" reported a month ago have fully resolved following the titration of sertraline to 100 mg PO OD.

Plan for Next Session

• Continue sertraline 100 mg PO OD; no pharmacological adjustments required today.

• Complete a daily sleep diary and adhere to agreed sleep hygiene protocols to address initial insomnia.

• Complete at least three entries in the CBT thought record focusing specifically on interactions with senior colleagues.

• Introduce assertive communication role-play to prepare for his upcoming occupational health review.

• Review the completed sleep diary to determine if a short-term behavioral insomnia intervention (e.g., sleep restriction therapy) is warranted.

• Re-evaluate PHQ-9 and GAD-7 outcome measures at the start of the next appointment on 07/04/2026 at 14:00.

• The client expressed a preference to dedicate time in the next session to discussing boundary-setting with his line manager before his hours are scheduled to increase.

• He requested to continue focusing on practical cognitive strategies rather than exploring early developmental history at this stage.