Background of the Client The client is a fifteen year old student called Joann. She has had trouble in school since her second grade. Joann reported class work problems and difficulties in test taking, as well. In earlier grades, she complained about difficulties in reading words and concentrating. However, as she grew older, the problems got worse; Joann experienced frequent headaches and reported occasional fainting spells. These symptoms started when Joann was just about to complete her fifth grade, and they have persisted to date. Her teachers also noticed that excessive panic during tests also characterizes her school days. This panic often manifested as a physical illness, and came about when Joan needed to do group assignments or quizzes. She also had a fear of classroom questions throughout her childhood. Joann’s academic performance seemed unaltered by these situations because her report cards were always above average, with A’s and B’s as her mean grades. Once in a while, Joann would get a C; furthermore, Joann attended school regularly, but she never enjoyed her experiences. Previously administered standardized tests also indicated that she had above average academic skills. Some of the tests that she did include: TerraNova and Metropolitan Achievement Tests. Presenting the problem This adolescent is a highly anxious one. The trait stems from Joann’s fear of tests, quizzes, and group assignments. She also has certain physical problems that include frequent headaches and occasional fainting episodes; they often manifest prior to these high-stress situations. Joan tends to react negatively to compliments on her performance. She tries to neutralize any of these compliments by cutting down her efforts. Joann has the same reaction when adults try to give her reinforcement or compliment her for her exceptional work. This individual enters into a state denial when another person comments about her high-quality performance in an activity. This adolescent feels isolated; she dislikes school and claims not have a favorite subject. However, she does relatively well in other non academic activities such as volleyball or basketball. Teachers and other instructors have not noticed any emotional distress in these areas. Joan continues to experience the same social and emotional problems that she had in the past; these include falling physically ill prior to: exams, group assignments and quizzes. Furthermore, she still suffers from frequent headaches and fainting spells. She also faces significant challenges with question-answering in class. Assessment or Diagnosis of the problem and justification of the assessment The adolescent under analysis suffers from performance anxiety that manifests as test anxiety and fear of classroom participation. This individual, therefore, possesses a social phobia, which the American Psychological Association (APA) recognizes in its DSM IV criteria (American Psychological Association, 2000). A person with performance anxiety, such as Joann, differs from others who experience universal fear because she experiences immense distress and disabling impairment in unrealistic dangers. Common manifestations of performance anxiety include the fear of theatrical performance, the fear of eating i