Increasing Sarah's self-efficacy: A case study

Sarah is a $21$‍-year old college student who is distressed by her inability to form relationships with others and feels that she is generally unsuccessful in school and in life. She experiences high levels of anxiety in social and academic situations, and has trouble sleeping because of her tendency to ruminate. Her stress levels become unbearable and she decides to reach out for help. When she visits her college’s counseling center she is assigned to a therapist, Dr. Becker, who interviews Sarah extensively in the hopes of finding and resolving key issues in her life. The following is an excerpt from Dr. Becker’s clinical notes on Sarah’s condition.

“Sarah describes never fully developing trust in others, and states that she struggled with trust from a very early age. She is very skeptical of other people’s intentions, which she says causes problems when she tries to make friends. She is very timid and reserved in social situations. Sarah recently gave a class presentation in front of a large group of her peers. She was incredibly nervous and bit her nails excessively beforehand, even more than she usually does on a regular basis. Sarah describes feeling as though she lacked the capacity to give a good presentation, despite extensive preparation. She states that she felt that her level of interest in the behaviors, comments, thoughts, and performance of others was unhealthy. She compares her performance to the performance of her peers, and states that they were so good that she lost confidence in herself. Despite her feelings, she says she was able to get through the presentation and received a good grade from her teacher. She earned a $94\mathrm{\%}$‍ but feels that this is because the teacher was too lenient in grading, and it was mere luck that she received an A.”

Based on the interview, Dr. Becker concludes that Sarah suffers from low self-esteem, which translates into negative self-efficacy. Dr. Becker focuses her therapeutic efforts on improving these qualities.

Imitation has been shown to be vital to our social development and self-identity formation. It has been studied in babies after birth as they exhibit imitation without a full concept of self-identity at that stage in their life. This may indicate that very early on, babies have a grasp of their bodies. What behavior would indicate something OTHER than true imitation?