CBT Session Example | Michalis Batakis Psychologist

Case Study

Case Study: How we map the problem in the first sessions

When we start together, our first step at People Forward is to bring order to the chaos of thoughts and symptoms.

As a CBT psychologist in Athens , through my office but also through online psychotherapy , I see every day how the first sessions aim to outline the picture and challenges faced by the patient. My name is Batakis Michalis and below I present a real, anonymous example of how I structure the initial assessment (reason for attendance, stressors and behavioral patterns), in order to design the appropriate, personalized action plan.

Physical symptoms of anxiety and angry outbursts - Psychological support

The Initial Mapping

Reason for Attendance The client comes to psychotherapy seeking a change in his life, in his daily life and in himself, as well as ways to derive more pleasure from it. He reports a strong difficulty in planning, disciplining and implementing the things he desires, feeling that he cannot remain focused. The following axes emerge from the discussion for subsequent anxiety treatment and depression treatment:

Main Stress Factors

• Work environment: Lack of motivation, feeling of monotony, mechanical performance of tasks and poor communication with colleagues (who work remotely and often do not respond).
• Difficulty asserting & expressing: Chronic anxiety of exposure to social/new environments (e.g. gym) and difficulty openly expressing one's "wants" and confronting.
• Procrastination and academic procrastination: Anxiety around studies/readings and exams, with a tendency to give up due to lack of motivation or discipline.
• Recent Burnout: Feeling of intense fatigue and a drop in mood/appetite, which leads him to reduce his efficiency in his current job.

Narrative Summary The patient describes himself as chronically passive and condescending, a person who simply “went with the flow of things” without making demands, motivated by an internal anxiety not to be exposed. In the past, the only time he has managed to function consistently is in a group program (Pilates), where he is helped by the good guidance of the teacher and the proximity of the space.

Currently, he feels trapped in a job that uses him only 20% of his potential. After a period where he is stripped of responsibilities (due to a delay in a project), his mood and appetite plummet. Now, because he is thinking about leaving the team, he adopts a defensive/denial attitude (“I do what I can, I don’t feel pressured”), which makes him feel calmer but not at all productive. At the same time, he recognizes a recent change in his relationship with his girlfriend, noticing that they have neglected themselves, gained weight, and reduced their activities.

Main Thematics

• Social anxiety and feelings of discomfort: Fear of how he will feel in new environments and social situations, which leads to avoidance (e.g. procrastination in starting a gym or reading).
• Delayed reaction (Ruminating thoughts): The client reports that during an argument or pressure at work, he "freezes" and the answers do not come to him at that moment. He processes them and gets angry hours later, after the conversation is over, resulting in internalized irritation.
• Isolation Mechanisms: Tendency to distance oneself and isolate oneself from one's friends, not because there are disagreements, but due to boredom or a need to keep one's distance.
• Desire for "ideal" relationships: Need to be surrounded by people he admires and with whom he can have meaningful and healthy communication, something he feels is lacking in his current work environment.
• Emotional connection through his partner: His girlfriend is his main support, as she is a person of dialogue and helps him express himself and open up, despite their shared difficulties at the given time.

What does office conversation look like? (Sample Session)

Here's an illustrative excerpt that highlights how I transform chaotic anxiety and passivity into practical, daily steps:

Patient: "...I feel like I want to do things, but I can't make them happen. I can't stay focused, I feel passive... At work I feel burned out, everything is done mechanically and communication with the team, which is remote, is non-existent. I look for them and they hide. Then I get stressed, I feel like it's my fault, I think about it for hours after the day is over..."

Therapist M.M.:

"This rumination is exhausting. I want us to try something practical to protect yourself and reduce guilt anxiety. Every time you try to contact a colleague, I want you to write it down in a notebook. 'I called at 10:00, no answer. I sent an email at 12:00.' That way, when your mind tells you at night, 'it's your fault,' you'll open your notes and see the facts objectively: You're doing the right thing. It's not your fault."

Patient: "That makes sense... It helps me to see it written down."

Therapist M.M.:

"Okay. And now let's move on to the topic of everyday life and the relationship, where you feel like you've fallen into a rut. I'd like to talk about how we can improve everyday life within your relationship... Are you okay with that?"

My Intervention Plan & Approach

My interventions focus on the transition from passive analysis to practical action and cognitive restructuring. My philosophy is based on the following axes:

Guiding and Practical Approach (Behavioral Activation) When a person is in a state of inactivity and low motivation, instead of being consumed only by analyzing the past, I work in the "here and now", proposing immediate, structured solutions:
• Schedule Introduction: I suggest using tools (like Google Calendar) to create a consistent but flexible weekly schedule (e.g. going out for coffee, going to the movies, going to the gym), combating procrastination. This approach is a key part of effective anxiety treatment, but also for depression treatment, where the person needs reactivation.
• Realistic Goal Setting: The goal is never perfection. My approach is: “Out of the 10 things you set, do 3... then 4.” This immediately reduces performance anxiety and feelings of failure.

Dealing with Work Stress (Objectification) To manage backlogs and poor communication in the work environment, I introduce tools such as Note Taking. By encouraging the client to objectively record their efforts, I achieve a dual purpose:

• Practical: The employee is professionally protected by having proof of his work.
• Psychological: It acts as an "antidote" to guilt. When anxiety returns later, looking back at the notes objectively proves that he did everything he could, stopping the destructive rumination.

Intervention in the Relationship Axis (Interpersonal Communication) When everyday life and burnout drag the couple's relationship into inactivity, my interventions take on the character applied in couples therapy. I suggest Establishing a Fixed Communication Time. By setting a specific day as an "appointment" for exclusive discussion about the feelings and needs of the relationship, I help the couple get off autopilot and encourage open expression.

Why do I work this way? I believe that psychotherapy should not just theoretically analyze a problem, but should actually give you tools to take control of your life back into your own hands. Whether we meet in person or take advantage of the advantages offered by online psychotherapy, change does not come passively, but through testing, action and the right support. And here is the point: CBT techniques seem simple on paper, but the objective perspective, personalized guidance and systematic feedback of a trained therapist are what guarantee that changes will take root and will not be abandoned at the first difficulty.

I use a direct, everyday and slightly confrontational but supportive discourse and I do not hesitate to use simple language to "wake up" the client from the passivity of the couch. I use empathy while simultaneously putting the client before his responsibilities, emphasizing that change will not come passively, but through testing and action, even if at first it is pressured.

Such interventions are considered effective and highly practical (Behavioral-Cognitive orientation). They manage to deconstruct the client's generalized and chaotic anxiety into small, manageable daily steps and by building a flexible and not rigid therapeutic plan. In the case of "unconscious resistance", I further use the Cognitive-Behavioral model to detect the client's automatic dysfunctional thoughts, emotions and behaviors and we shape his therapeutic plan. For example, in this specific case:

1. Automatic Thoughts

They are the immediate, spontaneous thoughts that pass through the patient's mind in specific situations (e.g. when colleagues do not respond) and trigger anxiety or guilt. Dysfunctional core beliefs may be triggered only at the moment of the event, that is, someone may consider themselves to be very confident, but the moment they face a specific situation, the patterns that prevent them from functioning as they would like to spontaneously emerge:

“It’s my fault for the poor communication / I did something wrong” (Self-blame).
"My colleagues are deliberately hiding from me."
"I'm not going to be able to finish what I start, so there's no point in trying" (Procrastination).
"Since I'm not 100% efficient, it's better not to push myself at all"

2.Intermediate Beliefs/ Rules & Assumptions

They are the deeper, rigid rules ("should") and assumptions ("if...then") that the patient has adopted to manage his life and protect himself:

Assumption: "If I expose myself or openly demand what I want, then I will fail or be judged negatively."
Rule: "I must always be condescending and avoid confrontations to stay safe."
Assumption: "If I can't do something perfectly and with absolute dedication, then it's not worth doing at all" (Extension of perfectionism that leads to inaction).
Core Belief that underlies: "I am inadequate/unable to control my life."

3. Coping Strategies

These are the behaviors that the patient employs to cope with (or avoid) the dysphoric feelings caused by the above beliefs:

Behavioral Avoidance & Procrastination: Delays or abandons activities (studies, gym) to avoid facing the anxiety of possible failure or social exposure.
Quiet Quitting: Adopts a “do whatever works, don’t push” attitude in his work. This acts as a defense mechanism to protect himself from burnout and feeling undervalued.
Mental Rumination: Thinks about the day's events for hours after it is over, ineffectively trying to analyze "what went wrong."
Passivity and Conformity: Follows the "flow of things" without risking speaking his mind or conflict, in order to maintain a superficial inner calm.

Breaking such a strong and deeply ingrained rule as “I must always be compliant and avoid confrontation to be safe” requires systematic work on both the cognitive and behavioral levels. The goal is not to make the person aggressive, but to move from passivity to assertiveness in a way that brings them closer to achieving their goals.

Do you want us to map your problem together?

As you saw in this case study, CBT is not about theories, but about immediate, everyday tools. If you are facing similar challenges, we can start your own plan. Sessions take place in my office in Athens, as well as through online sessions throughout Greece and Greek expats in the European Union. Book an introductory session today.