188 ASSESSMENT AND INTERVENTION STRATEGIES
the actual outcome related to an anxious situation. The goal is to teach clients how
their initial thoughts and beliefs about vulnerability are a faulty representation of real-
ity that makes them more anxious and contributes to avoidance and ineffective coping
responses. The following clinical vignette illustrates how perceived vulnerability can be
challenged with a client suffering from generalized anxiety.
cL i e nT: I have been worried for a few days about my daughter’s visit. I am so concerned
that everything will go well. You know I haven’t seen her for so long. When she left
home a couple of years ago we had such a big argument. At that time she swore she
would never come back home again.
Th e r a p i sT: What’s the worst that could happen when she visits?
cL i e nT: Well, she could bring up the past and then we would get into a huge argument.
She would then storm out of the house and never return.
Th e r a p i sT: That would certainly be a terrible outcome for you. I know how much you
really love your daughter.
cL i e nT: Yeah, I’ve been trying to think how I can avoid an argument.
Th e r a p i sT: And what have you come up with?
cL i e nT: Basically nothing. Every time I try to visualize how it will go and what I will do
if she brings up the past, all I can see is anger, shouting, and her slamming the door
as she leaves the house. [low self- efficacy appraisals and beliefs]
Th e r a p i sT: Sounds like you feel pretty helpless. When you are thinking like this what
happens to your anxiety and worry?
cL i e nT: I just end up feeling more anxious and worried about the visit.
Th e r a p i sT: So one effect of thinking that you are incapable of handling this situation is
that your anxiety and worry escalate. How do you think all of this will affect your
interactions with your daughter?
cL i e nT: I don’t think it is helping me in any positive way. I end up feeling so scared and
confused, probably I will end up blurting out something stupid when she is with me
that will only make matters worse.
Th e r a p i sT: Okay, let me summarize. You’ve described worries over your daughter’s
visit next weekend. One of the themes running through this worry is “I’m helpless
to avoid a conflict” and this helplessness makes you feel even more anxious and less
prepared for your daughter’s visit. But I wonder if you are as helpless as you think.
I wonder if you as poor at coping with confrontation or your daughter’s anger as
you think. I would like to suggest a couple of things. First, let’s go over some of
your past experiences with people who are angry or confrontational and see how
you’ve managed. Are you as bad at dealing with these situations as you think?
And second, let’s take a problem- solving approach and write down, maybe even
role-play, some strategies you might use with your daughter when she visits. [The
therapeutic intervention seeks to contrast the client’s predicted self- efficacy with
actual outcomes in the past in order to highlight discrepancy and exaggeration of
low perceived self- efficacy.]
cL i e nT: This sounds like a good idea. I’m really worried about this visit.