how to write a counselling case study essay

Person-Centered Therapy Case Study: Examples and Analysis

Introduction

Welcome to The Knowledge Nest's in-depth exploration of person-centered therapy case study examples and analysis. We aim to provide you with comprehensive insights into the therapeutic approach, techniques, and outcomes associated with person-centered counseling. Through real-life case scenarios, we demonstrate the effectiveness of this humanistic and client-centered approach in fostering personal growth and facilitating positive change.

Understanding Person-Centered Therapy

Person-centered therapy, also known as client-centered therapy or Rogerian therapy, is a compassionate and empathetic therapeutic approach developed by the influential psychologist Carl Rogers. This person-centered approach recognizes the profound significance of the therapeutic relationship, placing the individual at the center of the therapeutic process.

Unlike traditional approaches that impose solutions or interpretations on clients, person-centered therapy emphasizes the innate human capacity to move towards growth and self-actualization. By providing a supportive and non-judgmental environment, therapists aim to enhance clients' self-awareness, self-acceptance, and self-discovery. This holistic approach has proven to be particularly effective in addressing a wide range of mental health concerns, empowering individuals to overcome challenges and achieve personal well-being.

Case Study Examples

Case study 1: overcoming social anxiety.

In this case study, we explore how person-centered therapy helped Sarah, a young woman struggling with severe social anxiety, regain her confidence and navigate social interactions. Through the establishment of a strong therapeutic alliance, her therapist cultivated a safe space for Sarah to explore her fears, challenge negative self-perceptions, and develop effective coping strategies. Through the person-centered approach, Sarah experienced significant improvements, enabling her to participate more actively in social situations and regain a sense of belonging.

Case Study 2: Healing from Trauma

John, a military veteran suffering from PTSD, found solace and healing through person-centered therapy. This case study delves into the profound transformation John experienced as he worked collaboratively with his therapist to process unresolved trauma. By providing unconditional positive regard, empathetic listening, and genuine empathy, the therapist created an environment where John felt safe to explore his traumatic experiences. With time, he was able to develop healthier coping mechanisms, embrace self-compassion, and rebuild a sense of purpose.

Case Study 3: Enhancing Self-Esteem

In this case study, we examine Lisa's journey towards building self-esteem and self-worth. Through person-centered therapy, her therapist empowered Lisa to identify and challenge deeply ingrained negative self-beliefs that inhibited her personal growth. By offering non-directive support, active listening, and reflective feedback, the therapist enabled Lisa to develop a more positive self-concept, fostering increased self-esteem, and self-empowerment.

Analysis of Person-Centered Therapy

The therapeutic relationship.

Person-centered therapy places profound importance on the therapeutic relationship as the foundation for positive change. The therapist cultivates an atmosphere of trust, respect, and authenticity, enabling the individual to feel heard and valued. By providing unconditional positive regard, therapists create a non-judgmental space where clients can freely explore their thoughts, emotions, and experiences.

Client-Centered Approach

The client-centered approach encourages individuals to take an active role in their therapeutic journey. The therapist acts as a facilitator, guiding clients towards self-discovery and personal growth. By allowing clients to set the agenda and directing the focus of sessions, the person-centered approach acknowledges the unique needs and perspectives of each individual.

Empowering Self-Awareness and Growth

Person-centered therapy seeks to unlock individuals' innate capacity for self-awareness and personal growth. Through empathic understanding, therapists support clients in gaining insight into their emotions, thoughts, and needs. This heightened self-awareness helps individuals develop healthier coping mechanisms, make meaningful choices, and move towards a more fulfilling life.

Person-centered therapy, as exemplified through the case studies presented, offers a powerful and transformative path towards holistic well-being and personal growth. The Knowledge Nest is committed to providing a platform for sharing knowledge, experiences, and resources related to person-centered counseling. Together, we strive to facilitate positive change, empower individuals, and create a more compassionate and understanding society.

Explore more case studies and resources on person-centered therapy at The Knowledge Nest to discover the profound impact of this therapeutic approach.

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How to Write a Case Conceptualization: 10 Examples (+ PDF)

Such understanding can be developed by reading relevant records, meeting with clients face to face, and using assessments such as a mental status examination.

As you proceed, you are forming a guiding concept of who this client is, how they became who they are, and where their personal journey might be heading.

Such a guiding concept, which will shape any needed interventions, is called a case conceptualization, and we will examine various examples in this article.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is a case conceptualization or formulation, 4 things to include in your case formulation, a helpful example & model, 3 samples of case formulations, 6 templates and worksheets for counselors, relevant resources from positivepsychology.com, a take-home message.

In psychology and related fields, a case conceptualization summarizes the key facts and findings from an evaluation to provide guidance for recommendations.

This is typically the evaluation of an individual, although you can extend the concept of case conceptualization to summarizing findings about a group or organization.

Based on the case conceptualization, recommendations can be made to improve a client’s self-care , mental status, job performance, etc (Sperry & Sperry, 2020).

• Summary of the client’s identifying information, referral questions, and timeline of important events or factors in their life . A timeline can be especially helpful in understanding how the client’s strengths and limitations have evolved.
• Statement of the client’s core strengths . Identifying core strengths in the client’s life should help guide any recommendations, including how strengths might be used to offset limitations.
• Statement concerning a client’s limitations or weaknesses . This will also help guide any recommendations. If a weakness is worth mentioning in a case conceptualization, it is worth writing a recommendation about it.

Note: As with mental status examinations , observations in this context concerning weaknesses are not value judgments, about whether the client is a good person, etc. The observations are clinical judgments meant to guide recommendations.

• A summary of how the strengths, limitations, and other key information about a client inform diagnosis and prognosis .

You should briefly clarify how you arrived at a given diagnosis. For example, why do you believe a personality disorder is primary, rather than a major depressive disorder?

Many clinicians provide diagnoses in formal psychiatric terms, per the International Classification of Diseases (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some clinicians will state a diagnosis in less formal terms that do not coincide exactly with ICD-10 or DSM-5 codes. What is arguably more important is that a diagnostic impression, formal or not, gives a clear sense of who the person is and the support they need to reach their goals.

Prognosis is a forecast about whether the client’s condition can be expected to improve, worsen, or remain stable. Prognosis can be difficult, as it often depends on unforeseeable factors. However, this should not keep you from offering a conservative opinion on a client’s expected course, provided treatment recommendations are followed.

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Based on the pointers for writing a case conceptualization above, an example for summarizing an adolescent case (in this instance, a counseling case for relieving depression and improving social skills) might read as follows.

Background and referral information

This is a 15-year-old Haitian–American youth, referred by his mother for concerns about self-isolation, depression, and poor social skills. He reportedly moved with his mother to the United States three years ago.

He reportedly misses his life and friends in Haiti. The mother states he has had difficulty adjusting socially in the United States, especially with peers. He has become increasingly self-isolating, appears sad and irritable, and has started to refuse to go to school.

His mother is very supportive and aware of his emotional–behavioral needs. The youth has been enrolled in a social skills group at school and has attended three sessions, with some reported benefit. He is agreeable to start individual counseling. He reportedly does well in school academically when he applies himself.

Limitations

Behavioral form completed by his mother shows elevated depression scale (T score = 80). There is a milder elevation on the inattention scale (T score = 60), which suggests depression is more acute than inattention and might drive it.

He is also elevated on a scale measuring social skills and involvement (T score = 65). Here too, it is reasonable to assume that depression is driving social isolation and difficulty relating to peers, especially since while living in Haiti, he was reportedly quite social with peers.

Diagnostic impressions, treatment guidance, prognosis

This youth’s history, presentation on interview, and results of emotional–behavioral forms suggest some difficulty with depression, likely contributing to social isolation. As he has no prior reported history of depression, this is most likely a reaction to missing his former home and difficulty adjusting to his new school and peers.

Treatments should include individual counseling with an evidence-based approach such as Cognitive-Behavioral Therapy (CBT). His counselor should consider emotional processing and social skills building as well.

Prognosis is favorable, with anticipated benefit apparent within 12 sessions of CBT.

How to write a case conceptualization: An outline

The following outline is necessarily general. It can be modified as needed, with points excluded or added, depending on the case.

• Client’s gender, age, level of education, vocational status, marital status
• Referred by whom, why, and for what type of service (e.g., testing, counseling, coaching)
• In the spirit of strengths-based assessment, consider listing the client’s strengths first, before any limitations.
• Consider the full range of positive factors supporting the client.
• Physical health
• Family support
• Financial resources
• Capacity to work
• Resilience or other positive personality traits
• Emotional stability
• Cognitive strengths, per history and testing
• The client’s limitations or relative weaknesses should be described in a way that highlights those most needing attention or treatment.
• Medical conditions affecting daily functioning
• Lack of family or other social support
• Limited financial resources
• Inability to find or hold suitable employment
• Substance abuse or dependence
• Proneness to interpersonal conflict
• Emotional–behavioral problems, including anxious or depressive symptoms
• Cognitive deficits, per history and testing
• Diagnoses that are warranted can be given in either DSM-5 or ICD-10 terms.
• There can be more than one diagnosis given. If that’s the case, consider describing these in terms of primary diagnosis, secondary diagnosis, etc.
• The primary diagnosis should best encompass the client’s key symptoms or traits, best explain their behavior, or most need treatment.
• Take care to avoid over-assigning multiple and potentially overlapping diagnoses.

When writing a case conceptualization, always keep in mind the timeline of significant events or factors in the examinee’s life.

• Decide which events or factors are significant enough to include in a case conceptualization.
• When these points are placed in a timeline, they help you understand how the person has evolved to become who they are now.
• A good timeline can also help you understand which factors in a person’s life might be causative for others. For example, if a person has suffered a frontal head injury in the past year, this might help explain their changeable moods, presence of depressive disorder, etc.

Sample #1: Conceptualization for CBT case

This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety.

Strengths/supports in his case include willingness to engage in treatment, high average intelligence per recent cognitive testing, supportive family, and regular physical exercise (running).

Limiting factors include relatively low stress coping skills, frequent migraines (likely stress related), and relative social isolation (partly due to some anxiety about social skills).

The client’s presentation on interview and review of medical/psychiatric records show a history of chronic worry, including frequent worries about his wife’s health and his finances. He meets criteria for DSM-5 generalized anxiety disorder. He has also described occasional panic-type episodes, which do not currently meet full criteria for panic disorder but could develop into such without preventive therapy.

Treatments should include CBT for generalized anxiety, including keeping a worry journal; regular assessment of anxiety levels with Penn State Worry Questionnaire and/or Beck Anxiety Inventory; cognitive restructuring around negative beliefs that reinforce anxiety; and practice of relaxation techniques, such as progressive muscle relaxation and diaphragmatic breathing .

Prognosis is good, given the evidence for efficacy of CBT for anxiety disorders generally (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).

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Sample #2: Conceptualization for DBT case

This 51-year-old Haitian–American woman is self-referred for depressive symptoms, including reported moods of “rage,” “sadness,” and “emptiness.” She says that many of her difficulties involve family, friends, and coworkers who regularly “disrespect” her and “plot against her behind her back.”

Her current psychiatrist has diagnosed her with personality disorder with borderline features, but she doubts the accuracy of this diagnosis.

Strengths/supports include a willingness to engage in treatment, highly developed and marketable computer programming skills, and engagement in leisure activities such as playing backgammon with friends.

Limiting factors include low stress coping skills, mild difficulties with attention and recent memory (likely due in part to depressive affect), and a tendency to self-medicate with alcohol when feeling depressed.

The client’s presentation on interview, review of medical/psychiatric records, and results of MMPI-2 personality inventory corroborate her psychiatrist’s diagnosis of borderline personality disorder.

The diagnosis is supported by a longstanding history of unstable identity, volatile personal relationships with fear of being abandoned, feelings of emptiness, reactive depressive disorder with suicidal gestures, and lack of insight into interpersonal difficulties that have resulted in her often stressed and depressive state.

Treatments should emphasize a DBT group that her psychiatrist has encouraged her to attend but to which she has not yet gone. There should also be regular individual counseling emphasizing DBT skills including mindfulness or present moment focus, building interpersonal skills, emotional regulation, and distress tolerance. There should be a counseling element for limiting alcohol use. Cognitive exercises are also recommended.

Of note, DBT is the only evidence-based treatment for borderline personality disorder (May, Richardi, & Barth, 2016). Prognosis is guardedly optimistic, provided she engages in both group and individual DBT treatments on a weekly basis, and these treatments continue without interruption for at least three months, with refresher sessions as needed.

Sample #3: Conceptualization in a family therapy case

This 45-year-old African-American woman was initially referred for individual therapy for “rapid mood swings” and a tendency to become embroiled in family conflicts. Several sessions of family therapy also appear indicated, and her psychiatrist concurs.

The client’s husband (50 years old) and son (25 years old, living with parents) were interviewed separately and together. When interviewed separately, her husband and son each indicated the client’s alcohol intake was “out of control,” and that she was consuming about six alcoholic beverages throughout the day, sometimes more.

Her husband and son each said the client was often too tired for household duties by the evening and often had rapid shifts in mood from happy to angry to “crying in her room.”

On individual interview, the client stated that her husband and son were each drinking about as much as she, that neither ever offered to help her with household duties, and that her son appeared unable to keep a job, which left him home most of the day, making demands on her for meals, etc.

On interview with the three family members, each acknowledged that the instances above were occurring at home, although father and son tended to blame most of the problems, including son’s difficulty maintaining employment, on the client and her drinking.

Strengths/supports in the family include a willingness of each member to engage in family sessions, awareness of supportive resources such as assistance for son’s job search, and a willingness by all to examine and reduce alcohol use by all family members as needed.

Limiting factors in this case include apparent tendency of all household members to drink to some excess, lack of insight by one or more family members as to how alcohol consumption is contributing to communication and other problems in the household, and a tendency by husband and son to make this client the family scapegoat.

The family dynamic can be conceptualized in this case through a DBT lens.

From this perspective, problems develop within the family when the environment is experienced by one or more members as invalidating and unsupportive. DBT skills with a nonjudgmental focus, active listening to others, reflecting each other’s feelings, and tolerance of distress in the moment should help to develop an environment that supports all family members and facilitates effective communication.

It appears that all family members in this case would benefit from engaging in the above DBT skills, to support and communicate with one another.

Prognosis is guardedly optimistic if family will engage in therapy with DBT elements for at least six sessions (with refresher sessions as needed).

Introduction to case conceptualization – Thomas Field

The following worksheets can be used for case conceptualization and planning.

• Case Conceptualization Worksheet: Individual Counseling helps counselors develop a case conceptualization for individual clients.
• Case Conceptualization Worksheet: Couples Counseling helps counselors develop a case conceptualization for couples.
• Case Conceptualization Worksheet: Family Counseling helps counselors develop a case conceptualization for families.
• Case Conceptualization and Action Plan: Individual Counseling helps clients facilitate conceptualization of their own case, at approximately six weeks into counseling and thereafter at appropriate intervals.
• Case Conceptualization and Action Plan: Couples Counseling helps couples facilitate conceptualization of their own case, at approximately six weeks into counseling and thereafter at appropriate intervals.
• Case Conceptualization and Action Plan: Family Counseling helps families facilitate conceptualization of their own case, at approximately six weeks into counseling and thereafter at appropriate intervals.

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Analyzing Strengths Use in Different Life Domains can help clients understand their notable strengths and which strengths can be used to more advantage in new contexts.

Family Strength Spotting is another relevant resource. Each family member fills out a worksheet detailing notable strengths of other family members. In reviewing all worksheets, each family member can gain a greater appreciation for other members’ strengths, note common or unique strengths, and determine how best to use these combined strengths to achieve family goals.

Four Front Assessment is another resource designed to help counselors conceptualize a case based on a client’s personal and environmental strengths and weaknesses. The idea behind this tool is that environmental factors in the broad sense, such as a supportive/unsupportive family, are too often overlooked in conceptualizing a case.

If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.

In helping professions, success in working with clients depends first and foremost on how well you understand them.

This understanding is crystallized in a case conceptualization.

Case conceptualization helps answer key questions. Who is this client? How did they become who they are? What supports do they need to reach their goals?

The conceptualization itself depends on gathering all pertinent data on a given case, through record review, interview, behavioral observation, questionnaires completed by the client, etc.

Once the data is assembled, the counselor, coach, or other involved professional can focus on enumerating the client’s strengths, weaknesses, and limitations.

It is also often helpful to put the client’s strengths and limitations in a timeline so you can see how they have evolved and which factors might have contributed to the emergence of others.

Based on this in-depth understanding of the client, you can then tailor specific recommendations for enhancing their strengths, overcoming their weaknesses, and reaching their particular goals.

We hope you have enjoyed this discussion of how to conceptualize cases in the helping professions and that you will find some tools for doing so useful.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research , 36 (5), 427–440.
• May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The Mental Health Clinician , 6 (2), 62–67.
• Sperry, L., & Sperry, J. (2020).  Case conceptualization: Mastering this competency with ease and confidence . Routledge.

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Person-Centered Therapy Case Study: Examples and Analysis

By: Tasha Kolesnikova

Person-centered therapy, also known as client-centered therapy or Rogerian therapy, is a form of psychotherapy developed by prominent American psychologist Carl Rogers throughout the 1940s to the 1980s. This type of therapy is a humanistic approach and was seen as revolutionary as most psychotherapies before its emergence was based on behaviorist and psychodynamic approaches. The humanistic approach directly contradicts and contrasts core techniques and models of other approaches that were commonly used at the time.

What Is Person-Centered Therapy?

5 characteristics of the fully functioning person, causes of incongruence, person-centered therapy in practice, person-centered case study, person-centered treatment plan.

Nowadays, the fundamental modalities of person-centered therapy are widely used in modern counseling practices in combination with other techniques and therapies. Rogers is often considered the father of all humanistic schools of therapy, as many new therapies have since stemmed from his work. 

Students can use this article as a resource to help them with an academic essay  about person-centered therapy. 

Person-centered therapy focuses on facilitating  self-actualization .  The therapy is built upon the fundamental ideology that human beings have an innate desire and ability to be the best they can be and live happy, fulfilling lives. An individual must set their own goals, and proceed to approach them in their own way. Once these goals have been met, self-actualization is also achieved and, as a result, they will become a  fully functioning person . 

It also promotes the notion that all individuals have the ability to cope with their problems and possess the potential for change. These abilities are unique to each individual, and therefore, everyone has the power to formulate appropriate solutions to help themselves navigate and manage their lives.

Positive growth can be achieved when an individual has positive regard for themselves and from others. Once optimal levels are reached, the individual will become fully functioning. Under this self-concept, it is believed that every individual has:

• the capacity for self-awareness
• the need for meaning in their life
• the need for balancing freedom and responsibility

The key part of the person-centered approach is to assist individuals in self-discovery and self-acceptance by providing sufficient conditions that help resolve incongruence between themselves and their experiences.

According to Rogers, a fully functioning person has the following five characteristics:

• They are  open to new experiences , both positive and negative. They accept that life can sometimes be painful, but they have healthy abilities to cope and learn from them.
• They are  mindful and focus on present  experiences without preconceptions from previous experiences. They do not dwell on the past or obsess about the future.
• They are  aware of and attentive to facts ,  feelings, and gut reactions . Unity of all three allows them to be true to themselves and thus have the confidence to make the right decisions. If the wrong choice is made, they will be able to accept it and learn from it.
• They are  willing to take risks and be adaptive . They will seize healthy and appropriate opportunities for growth.
• They  have a sense of contentment  and a desire for new challenges and experiences.

Each of these characteristics is achieved through congruence of the self.

An individual tends to struggle with becoming a fully functional person, mostly due to incongruence. Incongruence is usually caused by encountering conditional worth or conditional love at some point, often during childhood.

If love and worth are dependent on meeting specific expectations and withdrawn when these expectations were not met, the individual will suffer from anxiety. This anxiety leads to a feeling of the unified self-being under attack. To relieve this anxiety, the individual will engage in detrimental methods such as denial and defensiveness.

Another cause is frustrated basic impulses that lead to negative feelings and poor social skills.

Individuals receiving person-centered therapy are referred to as clients rather than patients. This is in line with the overall concept that therapy is a shared journey between two people rather than the therapist or counselor treating or giving the advice to solve problems. The client is regarded as the expert of themselves and has all the answers to their own problems required within them.

Sufficient core conditions required for therapeutic change under person-centered therapy are outlined as follows:

• Psychological contact  - a mutually respectful relationship between the counselor and patient must exist, where both parties feel equally important.
• Client incongruence  – the client must experience distress caused by incongruence between their experiences and awareness. They are vulnerable and or anxious.
• Therapist congruence or genuineness  – sometimes referred to as being authentic. The therapist must be aware of their active participation and be deeply involved, becoming congruent with the therapeutic relationship.
• Therapist unconditional positive regard  – the therapist or counselor must have a non-judgmental stance, so the counselor does not impose any conditions of worth.
• Therapist empathy  – the therapist or counselor must effectively and accurately communicate their empathic understanding of the client's frame of reference. Presenting problems from another perspective can also help the client gain a new point of view to solving them.
• Client perception  – the client must perceive and appreciate this empathy and acceptance from their therapist or counselor and develop positive self-regard to a minimal degree.

It is interesting to note that Rogers viewed both approval and disapproval shown towards an individual to be disruptive to therapeutic change. The role of the therapist is to provide a caring and accepting environment conducive to giving clients the freedom to explore areas of their lives in ways they were previously denied or distorted. 

Unlike other therapies, Person-centered therapy does not have many set techniques. This Is because therapy sessions are largely directed by the individual. The counselor's or therapist's job is to create a safe environment that facilitates congruence and form a therapeutic alliance with the individual.

Because of this, a defining technique used during person-centered therapy is  non-directiveness . This is achieved by:

• giving no advice
• asking no questions
• giving no interpretations
• allowing clients to set their own goals

Another technique used during therapy sessions is  active listening . This is achieved by:

• paraphrasing
• summarizing

It was theorized that the client will initially be closed, not open to experiences, and have little to no self-awareness. But once therapy is completed, all these obstacles will be addressed and reversed due to gaining positive self-regard.

There are many advantages in the techniques used during person-centered therapy. However, some concerns have also been raised about the approach:

• Non-directiveness  - idea of non-directiveness has been largely debated. Some have argued that therapy by nature will always be directed in some capacity. Furthermore, bias can never be completely eliminated. Therefore, unconscious or unintentional bias can cause direction.
• Inefficient  – person-centered therapy can take an unnecessarily long time due to the lack of structure and non-directiveness. For fear of intervening with progress, therapists may deliberately withhold solutions or advice from a client, and it may take longer than necessary to reach that solution, if at all.
• Frustration  – being non-direct can understandably cause frustration in some clients who may be seeking advice or opinions.
• Disorder specific  – Rogers originally claimed that Person-centered therapy could treat all mental health disorders, but research has shown this is not the case.

Jane's phenomenological worldview causes her to be incongruent with her true self and what she believed is expected of her. Expectations imposed upon her are unrealistically high, and fear of not meeting those standards has caused her incongruent distress. Subsequently, this has created a condition for her self-worth.

These expectations are a direct result of traumatic stress stemming from culture, religion, and loved ones. In her phenomenological world, she will never be good enough as a daughter, mother, wife, Catholic, or accountant. She feels she constantly lets everyone down and can never gain approval from those whose opinions she cares about.

Trying harder to please and meet everyone's expectations takes her further away from wholeness and true self-worth. She has lost confidence in her ability to make good decisions and constantly seeks outside direction on how she should act. This low self-esteem will hinder any feelings of success and satisfaction.

She is aware that how she handles situations as it stands is not working but fails to see the situation from another perspective or figure out new solutions.

This is a classic example of a client that may benefit from person-centered therapy. We can understand that although Jane feels these pressures of meeting rejection and disapproval, she still has the potential for self-actualization.

This is evidenced by her independent decisions of marrying a spouse outside her religion and studying accountancy against her family's wishes. The act of seeking therapy confirms her desire for growth and change for a better life.

Jane has risen above adversity on multiple occasions in life. She has achieved academically, personally, and professionally but the lack of caring relationships has distorted her ability to recognize and accept her success and potential. This has deterred her from achieving higher levels of self-actualization. Jane must take new risks to attain the growth she seeks. 

For treatment to be effective, the core conditions must be met. The formulation was as follows:

• Undertaking person-centered therapy, the therapist will provide an optimal therapeutic environment where her actualizing tendencies can flourish.
• Through active listening and empathy, the therapist and Jane will build a trusting therapeutic alliance and further clarify her thoughts and feelings. Being able to work out problems and breaking them down, Jane will no longer view them as insurmountable as she did before.
• Unconditional positive regard will install confidence in Jane as a competent person capable of making decisions and problem solving on her own. By increasing trust in herself, she reduces the control others have over her and will begin to believe in her own self-worth.
• Consistency and genuine rapport between Jane and the counselor will allow her to feel that the ideas and actions developed during sessions are authentic, dependable, and can be replicated outside in the real world.
• Jane's newfound view of the world will lead to her trying out new approaches to problems. She will continue to report back on her progress in integrating these new approaches. She will eventually come to recognize that she is capable of independently achieving success and overcoming failure.
• Jane will continue these practices until she has reached self-actualization and becomes a fully functional person.

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How to write counseling case studies

• Jan 31, 2021
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As a psychotherapy or counseling student, you are very likely to come across such written assignments as counseling case studies . As this is a very particular type of academic assignment, we created this guide to help you write psychotherapy case studies as a professional. 

A counseling case study is basically a simulation of your future work as a counselor. You have got a case about a person who has some psychological or mental challenges. You are provided with a description of the situation, the client’s complaints, behavior, some environmental factors like family, work, ethnic, cultural, and socio-economic factors, and you need to present your opinion about the situation and a tentative treatment plan. 

So essentially, you need to imagine yourself as a psychotherapist who works with this client and knows how to treat him. Therefore in your paper, you cannot just write irrelevant information such as definitions of mental diseases, history of counseling, or other side digressions just to fill up the required word count. This approach may work for many types of essays, but not for counseling case studies.  When writing case studies on psychotherapy, you need to be very on point. 

Your paper should contain three basic sections:

• Your analysis about the client’s situation;
• Diagnosis or summary/interpretation of the client’s problem from a particular theoretical standpoint or from an integrative perspective
• Interventions that might help the client based on your analysis. 

Your counseling case study should contain the analysis of the client's situation, assessment or diagnosis, and treatment plan containing proposed interventions and reflection on the therapeutic process. 

Keep in mind that the basic principle of academic paper writing is: KNOW WHAT YOU WRITE . That means know what you are required to write (make sure you understand the assignment and read the case carefully) and have the background knowledge about the theory and practice of psychotherapy, general counseling theories or a specific theory, and therapeutic techniques and interventions. 

For some people, such an assignment may seem overwhelming as you are not a working counselor yet and you are not sure how to tackle the client’s problem. But do not panic, just follow the steps below to produce a high-quality counseling case study. 

1.    Read your assignment and the case description carefully

Clarify all the terms you encounter in the case.  Make sure you know what theory of psychotherapy you are expected to follow in your diagnosis and treatment plan. If no theoretical approach is mentioned in your assignment, check if you have covered any particular theories in your classes.

If you are not sure what a theory of psychotherapy is, it’s a particular approach to interpret psychological and mental problems. The first theory of psychotherapy was psychoanalysis developed by Sigmund Freud. Its theoretical foundation relied on distinguishing three parts of the mind: ego, superego, and id; recognizing the role of the subconscious with its instincts and drives in psychological conflicts; interpreting maladaptive behavior through the lens of ego defenses; recognizing the role of early childhood experiences, particularly childhood traumas, in the pathophysiology of mental problems.  Later, many other theories of counseling were developed, such as Adlerian, existential, humanistic and person-centered, behavior (BT), cognitive-behavior therapy (CBT), Gestalt therapy, reality, feminist, narrative, solution-focused brief therapy, family systems therapy , and many others. So if earlier in the class, you covered humanistic counseling, you can use the humanistic theoretical approach in your case analysis (unless, of course, your assignment clearly states what theory you need to follow). 

2.    Review the textbook chapters on that theory paying attention to particular approaches to diagnosis and therapeutic techniques.

Theory is important as different theoretical frameworks interpret the same situation in a different way. For example, the same symptoms could be interpreted as defenses caused by childhood trauma in psychoanalysis, malfunctioning behavioral patterns in Behavior therapy, dysfunctional cognitive schemes in CBT, unfinished business in Gestalt, destructive environmental factors in feminist therapy, being stuck in a pattern of living a problem-saturated story in narrative therapy, and so on. 

3.    Re-read the case again paying attention to special terms

and see if you now understand the meaning of these terms after studying the literature. 

4.    Read additional resources (optional)

If you still have doubts about the case and how to proceed with it, you might need additional resources, either provided by your teacher or found on the Internet. If you have a specific psychotherapeutic theory to follow for your case, you can google “assessment and treatment in [your theory]” and search for books, worksheets, or articles. 

5.    Summarize the client’s situation in the case.

In this stage, we start writing up the draft of the case analysis. Describe the gist of the client’s problem as he sees it and as you can grasp from the description of his behavior, thoughts, and feelings in the case. If you can locate it in the case, summarize his family situation, relationships, the family of origins, and work relations . Also, note if any sociocultural factors, like race, religion, ethnicity, gender, income level, sexual orientation, or neighborhood , may have impacted the client and his significant relations. Note if the client has previously done efforts to deal with his problems and what these efforts were. 

6.    Formulate a diagnosis for the client.

This section will often require you to provide a diagnosis according to DSM diagnostic criteria or formulate a problem according to the conventions of your counseling theory. Some theoretical frameworks, like Narrative or Feminist therapy, do not make diagnoses in working with clients as they view clinical diagnosis as a pathologizing, discriminatory and condescending practice that skews power balance in favor of the therapist. So if you are writing the case study within one of these paradigms, you will not have to provide a diagnosis for the client. However, you will still have to make a sort of assessment. While diagnosis involves identifying specific mental disorders based on patterns of symptoms, for assessment , you need to point out the client’s main problem and identify the main factors of the client’s life that you think might be contributing to this problem.

If you need to provide the diagnosis according to DSM-V manual, pay attention to the Differential diagnosis section for each disorder description. If the client’s symptoms initially look like major depressive disorder, you can consult the differential diagnosis section in the major depressive disorder chapter to see if there are alternative explanations fitting the client’s symptoms. Thus, for major depressive disorder, the alternatives may be substance/medication-induced depressive or bipolar disorder, mood disorder due to another medical condition, ADHD, adjustment disorder with depressed mood, and sadness. Check the diagnostic criteria for all these disorders to find which one fits better. Some of the assignments will require you to spell out how many symptoms fit the criteria of the disorders, and name these symptoms.

7.    Outline the developmental context of the problem.

Write how the client’s problem developed over time. Consider if early childhood experiences, the family of origin, or family structure may have contributed to this problem. Has a similar problem been experienced by some family member before? Have environmental and socio-economic factors , like income level, race, ethnicity, religion, sex, sexual orientation, or any others, contributed to the development of the problem?  How do these developmental factors interact with the current stressors and conflicts to shape the client’s worldview? Does the client have social support or safety net to rely on? In some theoretical approaches, you will also have to identify the client’s pathogenic or irrational beliefs about himself (like BT and CBT), maladaptive styles of functioning (Gestalt, psychoanalysis), or internalized dysfunctional cultural narratives (narrative and feminist therapies). 

8.    Propose interventions and techniques that might benefit the client.

If you follow a specific theory, this assignment is not that hard. Just go to the textbook chapter of your theory, check the techniques and interventions, and choose the ones that are appropriate for your situation. But do not just mechanically copy the list of techniques from the textbook. Imagine yourself sitting with the client and having a counseling session with them. Where would you start? If you are at loss, remember that almost all theories start with establishing a contact, creating a therapeutic relationship with the client. You might start by explaining your role and responsibilities, the client’s rights and the process of therapy, and getting informed consent from the client. Listen to his story attentively and respectfully, learn reflective listening , suspend judgment about the client, show empathy . These are basic things that almost all therapists irrespective of their theoretical orientation and client’s problem, use. To these, you will add specific techniques from your theoretical approach or techniques that are normally used for similar problems. 

9.    Add reflections on the therapeutic process.

This section is not required in all case studies, but it’s often present since you need to be aware of this aspect as a future therapist. Here, write what you think about the client. Does she and her problems engage you emotionally? How might your feelings help or hinder the therapeutic process? Is there room for countertransference (when a client’s problem triggers an emotional response from you connected with your previous experience or your own problem). How might this client perceive you? How might her feelings help or hinder the therapeutic process? What challenges you might face while working with the client? What traits of your personality or any previous experience might help you establish trust and connection? 

Final thoughts

This is the general outline of all counseling case studies. The requirements might vary from case to case, but these steps are pretty much essential for a solid analysis of a client’s situation in a therapeutic setting. All these steps might seem overwhelming to you, but do not despair. To be successful, it is essential to understand the requirements and the case, have knowledge about your theory and counseling approach, and then use your brains to reflect on the given case using common sense, knowledge from the textbook, and your imagination of how you would work with a person presented in the case. As you see, in this paper there is not much room for paraphrasing or filling the space with irrelevant information. Everything must be very to the point. The only place where you can use some rewriting is the DSM diagnosis section, ONLY if the teacher asks you to note down all the symptoms that fit the diagnosis. Then you can take those symptoms from the diagnostic criteria of the disorder and slightly paraphrase them. The rest of the paper is your own reflection about the case, the client, and the ways to help him . If you feel intimidated, do not worry. Just start doing these cases, and you will get better with time. 

If you feel that you need professional help from a research assistant with good experience in counseling case studies, you’re at the right place. Check our prices for custom written counseling case studies and make your order here , it takes just a few minutes. 

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041 – Writing Case Studies – Carl Rogers’ 19 Propositions – Counselling Skills

In episode 41 of the Counselling Tutor Podcast, Rory Lees-Oakes and Ken Kelly describe how to write a case study. ‘Theory with Rory’ looks at how best to apply the 19 propositions when writing case studies and assignments. Last, the presenters talk about diversity in the counselling room.

Writing Case Studies (starts at 3.26 mins)

Ken and Rory offer a number of tips on writing case studies as a student:

• Always check the criteria set by your awarding body before you start writing.
• Open the case study with a ‘pen portrait’ of the client – e.g. age, gender and presenting issue.
• Continue by describing the client’s counselling journey, from start to finish.
• Depending on the criteria you are working to, there are various themes you can develop – for example, ethics , the theory of your modality, and your self-awareness during the work.
• It is always good to reflect on your own learning from your sessions with the client, and how you might approach things differently in future.

Carl Rogers’ 19 Propositions (starts at 13.51 mins)

The 19 propositions were developed by Carl Rogers, the founder of person-centred therapy. They describe his theory of personality, expressed in terms of how a human being perceives the world (i.e. phenomenology). This part of person-centred theory is often seen as particularly hard to ‘decode’. Rory has done so previously in Counselling Tutor Podcasts 13 and 14 . One key tip he offers when reading Rogers’ original wording is to swap the word ‘organism’ for ‘person’.

Rory offers three insights into how you can make maximum use of the 19 propositions when writing case studies and assignments. For example, you can use this theory to:

• evidence how clients engage with their incongruent selves
• describe how, in making sense of their reality, clients can transcend it (as the philosopher Edmund Husserl believed that once indivuduals understand their reality, they can then transcend it)
• explain how clients engage with their truth and what changes they make as a consequence of that.

Key to all these is to use client statements from counselling interactions to illustrate your points.

For more information, you can download Rory’s handout, ‘Three Positions in Phenomenology : The 19 Propositions’.

Free Handout Download

19 Propositions: Three Positions in Phenomenology

Counselling Skills (starts at 19.40 mins)

In counselling training, it is harder to demonstrate our use of skills than our understanding of theory (which can be written about in assignments). Because our work with clients is subject to confidentiality, we must showcase our grasp of skills through simulated sessions with peers. This can feel rather artificial, with a pressure to somehow slot in every skill in order to meet the criteria.

Ken’s new book, Basic Counselling Skills: A Student Guide is a great resource for skills development at all qualification levels. Uniquely, this includes links to online audio recordings of skills demonstrations. The effect of each skill is explored. As shown in research by Catherine Goldsmith at the University of Manchester, which led to the dodo bird conjecture , the key to effective therapy is primarily the relationship between the patient and therapist. Good counselling skills are key to building this relationship.

Rogers used to audio record client sessions and listen back to these for learning. Recording is really useful for student counsellors; Ken strongly recommends doing so as much as possible (with client consent). Voice recorders can be purchased inexpensively these days.

Links and Resources

Counselling Study Resource

Counselling Tutor Facebook group

Counselling Tutor website

Basic Counselling Skills: A Student Guide

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What Is a Case Study?

Weighing the pros and cons of this method of research

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Home > Blog > What is Case Conceptualization & How to Write it (With Examples)

What is Case Conceptualization & How to Write it (With Examples)

Courtney Gardner, MSW

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The Ultimate Guide to Case Conceptualization: Our Top Tips, Outlines, and Real-life Examples

As a mental health counselor, case conceptualization is one of the most essential skills you can develop to understand your clients and find the most effective treatment. But for new counselors, the process can be overwhelming. How do you synthesize all the information from your intake and assessment into a cohesive case conceptualization? Which theoretical orientation fits best? What should you include in your conceptualization? Let's dive in and discover the secrets to developing killer case conceptualization skills!

What Is Case Conceptualization?

Case conceptualization is the process of understanding and interpreting a client's presenting problems within the context of their individual history, personality, and current circumstances. It involves gathering and organizing information about the client, identifying patterns and themes, and formulating a comprehensive understanding of the factors contributing to their difficulties. This understanding serves as the foundation for developing a treatment plan and guiding the therapeutic process.

Why Is Case Conceptualization Important to Mental Health Professionals?

Constructing a case conceptualization is crucial for mental health professionals as it helps them better understand their clients' perspectives and needs. Professionals can develop effective therapy outcomes by analyzing clients' experiences, thoughts, behaviors, environment, and biology. This enables them to identify suitable treatment options and establish  tailored treatment goals and interventions. A comprehensive approach is vital for providing evidence-based, client-centered therapy, which can lead to profound results, including improved insight, self-esteem, and motivation to make positive changes in their lives.

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How to Write a Case Conceptualization

To provide personalized treatment plans to your clients, it is essential to have a well-developed case conceptualization that helps you understand their mental health needs. You should include the following components early in creating your case conceptualization.

Client Information

Gather essential client information, including age, gender, relationship status, occupation, presenting problem, and relevant family and medical history.

Theoretical Orientation

Determine which theoretical approach fits their needs. This approach will guide the therapist to understand the client's symptoms and experiences through a particular lens. For example, a psychodynamic approach may focus on uncovering unconscious drives or past traumas, while a cognitive-behavioral approach looks at maladaptive thought patterns and behaviors.

If applicable, use the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-5) to identify appropriate diagnoses and diagnostic codes based on your client's symptoms. Explain your conclusions.

The Eight P’s of Case Conceptualization Framework

If you aim to create a comprehensive case conceptualization, you can employ the 8 Ps framework. The Eight Ps framework helps you organize and structure your thoughts and ideas concisely and quickly. Utilizing this framework allows you to analyze and evaluate a case from multiple perspectives and develop a fully formed and well-rounded understanding of the issues at hand.

Take your time back! Get your progress notes done automatically.

Presentation.

What symptoms or life difficulties brought the client in? How do they view these problems?

• Describe the client's symptoms, concerns, and goals.  Identify the main issues to address, such as depression, anxiety, trauma, or relationship difficulties. Consider the duration and severity of problems.

Predisposing Factors

What makes the client vulnerable to these problems? Genetics? Trauma?

• Consider the historical or biological factors involved in the current issue. This may include discussing the individual's developmental experiences, family history, or medical conditions. It is also essential to examine the client's natural tendencies, traits, and vulnerabilities that may make specific problems more likely.

Precipitating Factors

What recent events triggered the current problems? Loss of a job? End of a relationship?

• Investigate recent events that may have caused or intensified the client's presenting problem. Identify any losses, changes, or stressors in the client's life. These could include health issues, the end of a relationship, or the loss of a loved one. It is also crucial to examine how the client responded to these events.

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Do they live an active or sedentary lifestyle? Is their personality naturally more dependent or independent?

• Identifying predictable patterns in a person's thinking, feeling, acting, and coping reflects their baseline tendencies in stressful and non-stressful situations.

Perpetuating Factors

What factors in their lives maintain their problems? Avoidance? Unhelpful thoughts?

• Pinpoint and explore the habits, beliefs, or dynamics that maintain the problem. This means looking into their unhealthy coping strategies, cognitive distortions, relationship patterns, lack of social support, unstable living situations, and any other factors that may be contributing to the issue.

Protective Factors and Strengths

What strengths does the client have? A robust support system? Coping skills?

• Note their strengths, resources, and supports that can aid in their healing process. This may include skills, talents, social connections, access to healthcare, spirituality, and other positive factors supporting their treatment and recovery.

How will you address the problems and build on your client's strengths? Treatment modalities? Strategies?

• Establish goals and strategies considering the factors that may have caused or contributed to their condition. Identifying any protective factors the client may already have and developing interventions that build on them is also essential.
• Discuss specific interventions, referrals, and approaches. The plan should be comprehensive, regularly reviewed, and modified to ensure that it effectively reduces the client's distress, helps them change unhealthy patterns, builds new skills, and improves overall functioning. You should also consider your clinical decision-making during the initial planning stages.

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What's the likelihood of improvement with treatment?

• Forecast the outcome of treatment for a client based on a combination of risk factors, protective factors, the client's strengths, and their readiness for change. It would help if you discussed your initial impressions regarding the severity of the problem, the client's motivation for change, their responsiveness to intervention, and other relevant factors. You should also estimate the number of sessions required for treatment.

Tips for Mastering Effective Case Conceptualizations

Creating an effective case conceptualization requires a comprehensive, adaptable, and multidimensional approach. It involves analyzing the client's situation, embracing various perspectives, focusing on their strengths, and evolving throughout therapy. Stay curious, keep an open mind, and be willing to learn. Your clients can benefit significantly from these qualities.

Remember the following essential tips to hone your skills and make a lasting impact on your clients:

Focus on the client's strengths.

When assessing problems and symptoms, it is essential to identify your client's strengths, resources, and abilities and build on what's working to motivate change.

Look for themes and patterns.

As you gather information from your client, look for connections between their thoughts, feelings, behaviors, experiences, and relationships. Themes will emerge that shape your conceptualization.

Consider multiple perspectives.

Various theoretical orientations can be applied to comprehend a client's situation better. Exploring different perspectives can offer alternative insights into a case.

Be flexible.

It is essential to regularly revisit and update your case conceptualization as new information arises and as your client progresses.

Paint the whole picture.

An effective case conceptualization should consider cultural context, family and social relationships, medical history, life experiences, environment, and more, not merely focus on the client's symptoms or problems.

Discuss your conceptualization with colleagues.

Bouncing ideas off  other therapists  or discussing cases during supervision can provide valuable feedback and input, strengthening your case conceptualization from different perspectives.

Continuously evaluate your conceptualization.

During therapy, regularly review how well your understanding of the situation accounts for any new issues or lack of progress and adjust your approach accordingly. A successful interpretation should always remain an evolving theory.

Review research and theory.

It's necessary to base your case conceptualization on established theory and research to give credibility to your formulations and interventions. Keep yourself updated with the latest developments in psychotherapy and counseling.

Case Conceptualization Template

An efficient case conceptualization template helps you structure the essential components of a client's situation and establish the foundation for a focused treatment plan. By following this framework, you can guarantee that you have considered all the relevant factors and gained a comprehensive comprehension of the client and their requirements.

• Presenting problem : Briefly summarize the client's presenting issues and symptoms.
• History : Summarize relevant information about the client's family, developmental, medical, and mental health history.
• Functional analysis : Analyze the environmental, cognitive, and interpersonal factors contributing to or maintaining the client's problems. This includes triggers, consequences, and coping strategies.
• Conceptualization : Explain your theoretical model and how it helps you understand the client's difficulties. Identify key themes, patterns, and underlying processes.
• Goals : Outline the client's objectives for therapy and your treatment goals based on your conceptualization.
• Plan : Propose a treatment plan with specific interventions and strategies that address your conceptualization and the client's goals. Monitor and revise the plan as needed.

Sample Case Conceptualization #1: John

John is a 45-year-old accountant who has struggled with social anxiety and depression for most of his life. He finds it difficult to connect with others and lives a relatively isolated existence. John's anxiety causes distress in work and social situations where interaction with others is required. His anxiety and depressive symptoms have been exacerbated by several major life stressors over the past year, including a breakup with his long-term girlfriend and downsizing at his company, where he was laid off.

John sought counseling to help improve his social skills, increase confidence in social and work settings, and learn strategies to manage anxiety and depression better. Initial treatment focused on cognitive techniques to identify and reframe negative thought patterns related to social situations. Role-playing and exposure techniques were also used to help build comfort in engaging with others. John showed gradual improvement over 12 sessions. He reported feeling less anxious in work meetings and social encounters. John also started dating again and joined a local recreational sports league to increase social interaction.

John felt he had made good progress at termination but would benefit from occasional "booster" sessions to help maintain gains. Recommendations were made for John to continue practicing cognitive and exposure techniques, engage in regular exercise and social activity, and follow up with medication management as needed. John left treatment with improved coping strategies, a more balanced perspective, increased confidence in social abilities, and an overall brighter outlook.

Example of John's Case Conceptualization

I.  Presenting Problem

• John sought counseling to address social anxiety, depression, and low self-confidence that had been impacting his work and social life.
• His symptoms had worsened due to recent life stressors, including a breakup and job loss.

II.  Background Information

• John has struggled with social anxiety and depression for most of his life.
• He has difficulty connecting with others and lives an isolated existence.
• His anxiety causes distress in social and work situations involving interaction with others.

III.  Psychosocial History

• John has a history of social anxiety dating back to childhood.
• He has few close relationships and limited social support.
• Recent life stressors have exacerbated his symptoms.

IV.  Diagnostic Considerations

• Social Anxiety Disorder
• Persistent Depressive Disorder

V.  Treatment Plan

• Cognitive techniques to identify and challenge negative thoughts
• Exposure exercises to build social skills and confidence
• Medication management as needed
• Recommend regular exercise, social activity, and booster sessions
• Help John develop coping strategies and a more balanced perspective

Sample Case Conceptualization #2: Jane

Jane is a 32-year-old married woman who presented with anxiety, depression, and relationship issues. She reports a lifelong struggle with feelings of inadequacy and low self-esteem. Jane's anxiety and negative self-image have contributed to difficulty asserting herself in her marriage and feeling disconnected from her husband.

Jane's symptoms worsened after the birth of her first child two years ago. She experienced postpartum depression and anxiety, which left her feeling overwhelmed as a new mother. Her husband, John, works long hours and takes on few childcare responsibilities. This has caused conflict and resentment in their relationship.

Jane sought therapy to address her depression, anxiety, and relationship problems. She wants to improve communication with her husband and negotiate a more balanced division of labor. Treatment initially focused on helping Jane identify and challenge negative automatic thoughts. Psychoeducation about assertiveness and conflict resolution strategies was provided. Role plays were used to practice effective communication and negotiation skills with her husband.

With therapy, Jane showed improvement in her mood and confidence. She was able to initiate difficult conversations with her husband about household responsibilities and childcare. Through gradual progress, Jane and her husband have found some compromise. Jane plans to continue working on assertiveness and negotiating skills to improve their relationship further. Medication may be considered in the future if symptoms do not continue to improve with therapy alone.

Example of Jane's Case Conceptualization

I.  Presenting Complaints

• Relationship issues with husband

II.  History of Presenting Issues

• Lifelong struggle with low self-esteem and negative self-image
• Symptoms worsened after the birth of the first child two years ago
• Experienced postpartum depression and anxiety
• Felt overwhelmed as a new mother
• Husband takes on few childcare responsibilities, causing conflict
• Married for five years, one child, age two
• Husband works long hours
• Limited social support

IV.  Conceptualization

• Negative automatic thoughts contribute to anxiety and depression
• Difficulty asserting needs and communicating effectively with her husband stems from low self-esteem
• Unequal division of labor at home breeds resentment and relationship issues
• Cognitive techniques to challenge negative thoughts
• Role plays and assertiveness training to improve communication skills with husband
• Negotiation strategies for dividing household responsibilities more equitably
• Consider medication if symptoms do not improve sufficiently with therapy

Sample Case Conceptualization #3: Sally

Sally is a 45-year-old woman who presented with symptoms of anxiety, depression, and substance abuse issues. She reports a history of trauma from an abusive relationship in her 20s, which left her with trust issues and anxiety in intimate relationships.

Sally currently lives alone and works as an accountant. She struggles with loneliness and social isolation. She copes by drinking alcohol, up to a bottle of wine per night. Sally's alcohol use has negatively impacted her work and personal relationships.

Sally sought therapy to address her depression, anxiety, substance abuse, and difficulty forming close relationships. Treatment focused on building coping skills to reduce alcohol cravings and manage anxiety. Psychoeducation about trauma and its impact on trust was provided. Sally participated in exposure therapy to help her overcome social anxiety and develop healthier social connections. With treatment, Sally was able to reduce her alcohol intake to a safer level. She made progress in confronting trauma-related thoughts and feelings that had previously prevented her from forming close relationships. Sally plans to continue working on coping skills, exposure exercises, and managing trauma symptoms to fully recover from substance abuse and build a more fulfilling social life.

Example of Sally's Case Conceptualization

• Sally presents with symptoms of anxiety, depression, and substance abuse issues stemming from a history of trauma from an abusive relationship.

II.  History of the Presenting Problem

• Sally has struggled with loneliness and social isolation for years since the trauma, coping with excessive alcohol use. Her drinking has negatively impacted her work and relationships.

III.  Relevant Background Information

• Sally lives alone and works as an accountant
• She has difficulty forming close relationships due to trust issues from her past trauma
• Sally drinks up to a bottle of wine per night to cope with anxiety and depression
• Sally's anxiety, depression, and substance abuse are all interconnected and rooted in her unresolved trauma from the abusive relationship. Her social isolation and lack of coping skills have led to unhealthy drinking patterns.
• Reduce alcohol cravings through coping skill-building
• Provide psychoeducation about trauma and its impact
• Exposure therapy to overcome social anxiety and form healthier relationships
• Continue working on managing trauma symptoms to recover from substance abuse fully

FAQs: Your Top Case Conceptualization Questions Answered

Case conceptualization is a critical first step but can also feel overwhelming. Here are answers to some of the most frequently asked questions to help put your mind at ease.

How do I get started?

Begin by collecting information from intake forms, interviews, observations, and assessments. Look for patterns and connections to the underlying factors influencing your client's symptoms and behaviors. Identify strengths, weaknesses, thought processes, core beliefs, relationships, environment, medical issues, and life events.

What should I include?

A good case conceptualization includes a description of symptoms, diagnosis (if applicable), developmental history, family and relationship dynamics, traumas, coping skills, motivation for change, and goals. It helps determine the factors perpetuating the issues and maintaining the status quo.

How often should I update it?

A case conceptualization is a living document. As you learn more about your client through sessions, revisit and revise your conceptualization. Note any changes in symptoms or life events and adjust treatment plans accordingly. Regular updates, even minor ones, help ensure you accurately understand your client and provide the best care.

Does software help?

Case conceptualization software and apps can help organize and identify patterns in information. They can also assist you in collaborating with colleagues. However, remember that technology should supplement your clinical judgment, not replace it. Software is not capable of determining causation or proposing an effective treatment plan.

You now have what it takes to craft an effective case conceptualization. Armed with the necessary tools and examples, you can begin by considering the eight Ps - problems, precipitating events, predisposing factors, perpetuating factors, protective factors, prognosis, plan, and progress. Infuse each section with rich details about your client, including quotes and observations that bring the case to life. Examine examples from others while ensuring your conceptualization reflects your unique client and therapeutic approach. With regular practice, case conceptualizations will come naturally and aid you in selecting the best interventions and outcomes. Now, get out there and start conceptualizing.

Remember to keep learning and enhancing your practice with Mentalyc. Stay updated on the latest techniques, strategies, and tools by subscribing to our email newsletter. You'll receive emails with actionable therapy advice delivered directly to your inbox. Take  advantage of our app's free trial,  automatically creating progress notes based on your therapy sessions. With  AI-drafted notes , you can quickly review and finalize, saving time and effort. Join our growing community of therapists and mental health professionals dedicated to practical, compassionate client care.

Biopsychosocial Model and Case Formulation . (2022, January 2). PsychDB.  https://www.psychdb.com/teaching/biopsychosocial-case-formulation

Jagpat, E. (n.d.).  Anatomy of a Clinical Case Conceptualization . Psychology Oral Exam Preparation, Study Materials, Consultation & more.  https://psychologyoralexam.com/anatomy-of-a-clinical-case-conceptualization-psychology-oral-exam/

Sperry, L., & Sperry, J. (2016).   Case Conceptualization: Mastering this Competency with Ease and Confidence . APA PsycNet.  https://psycnet.apa.org/record/2012-34298-000

Zaheer, G. J., & Farmer, R. L. (2020, July 30).   Science-Based Case Conceptualization . National Association of School Psychologists (NASP).  https://www.nasponline.org/professional-development/a-closer-look-blog/science-based-case-conceptualization

All examples of mental health documentation are fictional and for informational purposes only.

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Essay Writing in Counselling and Psychotherapy: Top Tips

I’m a liberal when it comes to most things—except (as my students will know) fonts, formatting, and grammar. So why am I a fully signed-up member of the Grammar Police (or should that be ‘grammar police’)? Well, aside from my various OCDs (yup, that’s Oxford Comma Disorder), it’s a way that you, as a writer, can make sure that your beautiful, brilliant, creative writing is seen in its best possible light—not detracted by missing apostrophes and torturously convoluted sentences. So here are over 25 top tips for those of you writing essays and dissertations—at all levels—based on years of marking and encountering the same issues time after time. All of these tips are aligned with the Publication Manual of the American Psychological Association (7th edition), which provides an essential set of guidelines and standards for writing papers in psychology-related fields. There’s also a checklist you can download from here to go through your draft assignments to check everything is covered. (And just to say, by way of disclaimer, listen to your tutors first and foremost: if they see things differently, do what they say—they’re going to be the ones marking your papers!)

Puncutation

Apostrophes. You just would not believe how many students working at graduate, Master's, and even doctoral level dont know when to put apostrophe's and when not to. Check out the rules on it—it takes two minute's on the web ( try this site )—and you'll never drive your marker's crazy again (whose this Roger’s bloke that students keep writing about?).

Single (‘ ’) or double (“ ”) quotation marks? For UK English it’s single; for US English it’s double. The only exception is when you give quotation marks within quotations marks, in which case you use the other type. So, for instance, in UK English you might write:

Charlie said, ‘I’ve often told myself, “buck up, don’t be stupid,” but I do find it hard.’ On the other hand, Sharon said…

And while we’re at it, make sure those are ‘curly marks’ (or ‘smart apostrophes’), and not the symbols for inches (") or feet ('), which are straight.

One space after a full stop . Not two. That’s for when we had typewriters.

Colon (:) before a list , not semi-colon (;), and definitely not colon-dash (:-).

Write out numbers as words if they are below 10 (except if they are to do with dates, times, or mathematical functions; or at the start of the sentence). So, for instance:

‘Across the three cohorts there were over 500 participants.’

‘In this study, six of the young people said…’

Think where you’re putting your commas . They’re not sprinkles: something you just liberally and randomly scatter over your text. So check where you’ve put them, and that they meaningfully separate out clauses, or items, in your writing .

And, while we’re at it, a comma before the last item in a list (after ‘and’). This is known as an ‘ Oxford comma ’, and is recommended by the American Psychological Association (APA) to improve clarity. So, for instance, you’d write that ‘Across the counselling, psychotherapy, and psychiatric literature…’ rather than ‘Across the counselling, psychotherapy and psychiatric literature…’

Watch out for over-capitalising words . In most cases, you don’t need to capitalise—you’re not writing German (unless, of course, you are). Most words don’t need capitalisation (e.g., ‘person-centred therapy’, not ‘Person-Centred Therapy’), unless they are ‘ proper nouns ’ (that is, names of specific one-of-a-kind items, like Fritz Perls or the University of Sussex).

Key terms should be italicised on first use . Say you’re writing an essay about phenomenology, or it’s a key term that you’re going to define subsequently. The first time you use the term, italicise it. For instance, ‘Person-centred therapy is based upon a phenomenological understanding of human being. Phenomenology was a philosophy developed by Husserl, and refers to…’. An exception to this is that, if you want to introduce a term but without any subsequent definition (perhaps it’s not that central to your essay), put it in quotation marks. For instance, ‘Transactional analysis is based on such concepts as “ego states” and “scripts”, while Gestalt therapy…’

Quotations AND CITATIONS

Reference your claims . Whenever you state how things are, or how things might be seen, reference where this is from. Typically, a paragraph might have four or more references in it. If you find that you have several paragraphs without any at all, check you’re not making claims without saying their source. If it’s your own opinion, that’s fine (particularly later on in essays, for instance in the discussion), but be clear that that’s the case.

If you give a direct quotation, give the page number of the text it’s from (as well as the author(s) and date).

If a quotation is more than 40 words (a ‘block quotation’), indent it .

Otherwise, treat direct quotations as you would other text . So you don’t need to italicise it, put it in font size 8 or 18, use a different font colour etc. The same for quotations from research participants: use quotation marks and treat as block quotations if over 40 words, but otherwise leave well enough alone.

The page number comes between the close quotation mark and the full stop (if the direct quote is in the text). For instance: Rogers (1957) said, ‘The greatest regret in my career is that I didn’t develop pluralistic thinking and practice’ (p. 23). The only exception to this is with block quotations, in which case the page number comes after the full stop. Stupid, I know, but there you go.

In text citations for papers with 3 or more authors only need the first author now from first citation onwards, with ‘et al.’: e.g., ‘Cooper et al. (2021) say…’

Paragraphs, Sentences, and Sections

One paragraph, one point . Don’t try and squeeze lots of different points and issues into one paragraph. Often, a good way to write paragraphs is with a first sentences that summarises what you are saying in it, then subsequent sentences that unpack it in more detail.

Keep sentences short. In most cases, it doesn’t need to be more than three lines or so. If it’s longer, check whether you can break the sentence down into simpler parts.

Keep sentences simple. You don’t normally need more than two or three ‘ clauses ’; and if you’ve got more, for instance, like this sentence has—with lots of commas, semi-colons, and dashes in it—you can see how it starts to get more difficult to follow, so try and simplify.

Make sure you give clear breaks between paragraphs . So that the reader can see where one ends and the other begins. For instance, have a line break, or else indent the first line of each paragraph.

Headings should stand out . That’s what they are there for, so make sure they are different from the rest of the text. For instance, do as bold and centred. Also, if you are using different levels of headings (for instance, headings, subheadings, and sub-subheadings), make it really clear which are which, with higher levels more prominent in the text.

Don’t forget page numbers . If you want your assessors to be able to give feedback, they need to be able to point to where things are.

General writing

Use acronyms sparingly . ‘The AG group felt that ACT was superior to CBB on the TF outcomes…’ Unless you’ve got the memory of a child genius they’re a nightmare. If you do use them, make sure you explain what they are on first use.

Avoid jargon/overly-casual terms . ‘The therapists in the study seemed quite chilled; but, for future research more groundedness and heart-centredness could possibly help.’ Enough said!

Avoid repetition. Saying something once is nearly always enough. You don’t need to repeat it again and again. It gets tedious. Especially when you say things over and over again.

Be consistent in the terminology that you use . For instance, if you are doing an interview study with young people, don’t switch randomly between calling your participants ‘young people’, ‘adolescents’, ‘teenagers’, ‘clients’, and ‘participants’. Choose one term and stick to it and; if you do use more than one term, be consistent in which one you use when.

Use footnotes/endnotes sparingly . It can be frustrating for a reader to jump between your main text and then subtexts written elsewhere. So try and include everything in your main text if you can (for instance in parenthesis).

Don’t assume your readers know what things mean . ‘When it comes to measures based on normative, formative indicators…’ What? You don’t know what ‘normative’ and ‘formative’ mean (and it’s not a music group, though the name ‘The Normative Formatives’ is pretty cool!). The point here, as above, is to spell things out so that the reader knows what you are talking about. If it’s brief you could do that in parenthesis in the sentence. If not, give it dedicated sentences.

Check the spell and grammar checkers . Those wiggly blue and red lines underneath your writing (on Microsoft Word) do mean something. Sometimes it’s just the software being over-sensitive, but it’s always worth checking and seeing what it’s picking up. If you’re software doesn’t do spell and grammar checks, it might be time to upgrade. You need something or someone else to give this a thorough check through before submitting any piece of work.

Make your file names meaningful . And finally, if you are sending out documents for assessments as digital files, give it a name that is going to mean something in someone else’s system. ‘Essay.doc’ or ‘Berne version 3 final’ is really not going to help your assessor know which is your submission—particularly in the midst of tens or hundreds of others. So make sure your surname is in the file title (unless the submission needs to be anonymised), and add a reference to the specific assignment: for instance, ‘Patel case study 1’. Adding a date of submission, or completion, is also very useful, though I would suggest always doing this in the format ‘year-month-day’ (rather than ‘day month year’), so that computers store more than one version of the file in the correct order (assuming the files are sorted alphabetically). So that gives you a file title like ‘Patel case study 1 2020-03-10’ and, with a name like that, it’s unlikely to get mixed up with anything else.

With many of these ‘rules’, the main thing is to be consistent. For instance, most markers won’t mind if you use double quotation marks rather than single, or italicising all your quotes, but the key thing is to do it all the way through. It’s when it’s changing that it gets confusing, because the reader thinks you might mean something by it, when in fact it just means you weren’t thinking about it. But how do we know?! Bear in mind, in particular, that your marker may have several assignments to work through, so anything that can help make their life easier is likely to be worth it. And the great thing is, once you get into these habits, they’ll stick with you for next time. As your academic level progresses, there will be more and more expectation that you’ll get these things ‘right’. So use the checklist to go through your first few assignments, and also ask a peer to scrutinise it using the checklist, and once you’re finding that you’re addressing the issues from the start you can stop using it.

Last thing, and I’ve already said this (so much for avoiding repetition!), but for a brilliantly concise and comprehensive guide to academic writing, go to the Publication Manual of the American Psychological Association (now in its seventh edition). Keep it by your writing desk, your bedside, your toilet…. it’s an invaluable investment in terms of getting through your assignments, because it gives you a consistent and clear set of guidelines on everything from referencing to headings to writing style.

Actually, sorry, really really last thing, and I couldn’t end this blog without saying it because my students won’t recognise me. Times New Roman 12 point. That’s all you need. No Comic Sans, no Bahnschrift Light SemiCondensed. Just one, nice, clear font all the way through.

Keep it simple and let the glorious light of your creative genius through. Good luck!

Acknowledgements

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Case Studies

Case studies, case studies and more case studies!

A Counselling Case Study Exploring Loss

Sue and Tom lost their child Jill to leukaemia approximately one year ago. Tom suggested that Sue attend Professional Counselling because she still doesn’t seem to be able to cope with everyday living. For ease of writing the Professional Counsellor is abbreviated to C. A précis of the session is as follows In the first […]

• September 17, 2010
• Case Studies , Relationship & Families

A Counselling Case Study Using CBT

Jocelyn works as a Human Resources Manager for a large international organisation. She is becoming more and more stressed at work as the company is constantly changing and evolving. It is a requirement of her job that she keeps up with this change by implementing new strategies as well as ensuring focus is kept on […]

• March 18, 2010
• Case Studies , Counselling Therapies , Workplace Issues

Drug Addictions and Group Work

A Support Group had been advertised on the display board of the local Drug and Alcohol Treatment Centre in the City where the Counsellor had been seeing each of the members for private counselling prior to the start of the programme. Ten clients enrolled in the group but by 7:15pm only 5 of the ten […]

• September 29, 2009
• Addictions , Case Studies , Group Work

Counselling Case Study: Using REBT

Thomas is a 33 year old married man, who has recently become a father. He explains that he feels his self-esteem has been gradually deteriorating ever since he was married. He says that he can’t find reasons to enjoy life with his wife due to feelings of inadequacy as a husband. In his new role […]

• September 7, 2009

Counselling Case Study: Managing Anxiety

Leah is a 24 year old woman who was recently discharged from the Army on medical grounds. During her four years in the Army, Leah experienced high levels of stress and anxiety which she coped with by drinking heavily. When she presented for counselling, Leah had been sober for 55 days and was seeking strategies […]

• June 5, 2009
• Addictions , Case Studies , Stress Management

Counselling Case Study: Learning to Let Go

Elizabeth came to counselling because she was experiencing intense anger, and was not coping with her life. She complained of failed relationships with her ex-husband, and with another man whom she left her husband to be with. Elizabeth cannot move on from the anger she feels about her failed relationships and she is feeling isolated […]

• June 26, 2008

Counselling Case Study: Social Anxiety

Sasha is a 60 year old woman who has recently retired from a career in teaching. Working for many years in a secondary school environment, Sasha was confident, motivated and dedicated to her work, but at the same time looking forward to retirement so she and her husband could travel and spend more time with […]

• February 11, 2008
• Case Studies , Clinical Mental Health , Stress Management

A Case of Using Logical Consequences

Richard is a 41-year-old plant operator in a heavy machinery company. He works long hours and must start very early each day. Twelve months ago he accepted a transfer from a country location to a capital city 250 kilometres away from his family. Due to financial obligations this was seen as a necessity. He travelled […]

• January 23, 2008

A Case of Using a Person-Centred and Cognitive-Behavioural Approach to Burnout

Brett is a 36 year old man who works as an accountant for a small family business. The business is failing and Brett will probably have to begin the process of “winding it up” in the near future. His commitment to the business and his friends, the business owners, has intensified the level of stress […]

• June 26, 2007
• Case Studies , Clinical Mental Health , Relationship & Families , Workplace Issues

Counselling Case Study: An Overwhelmed Client

Chris came to counselling because he was experiencing increasing feelings of being stressed, overwhelmed and weighed down by his commitments in life. He has been particularly concerned about his negative thoughts and attitude at work and at home and would like to change this. Chris has been seeing a Professional Counsellor for three sessions and […]

• June 1, 2007
• Case Studies , Relationship & Families , Stress Management

A Case of Mid-Life Difficulties

Fritz is 42 years of age and has been in Australia for the past 25 years. He migrated from Germany with his immediate family, comprising of his mother, father and two sisters. At the age of 17 Fritz was filled with great dreams and aspirations for his new life in a new country and until […]

• May 14, 2007
• Case Studies , Lifespan Development , Multicultural Issues , Relationship & Families

A Case of Stressful Life Change

Author: Jane Barry A précis of the sessions is as follows. For ease of writing the Professional Counsellor is abbreviated to “C”. In the first session, “C” asked some open questions to prompt Mary to start discussing her dilemmas. Mary was able to convey the events leading up to her problems clearly, although was reduced […]

• April 23, 2007
• Case Studies , Children & Adolescents , Disability Issues , Relationship & Families , Trauma & Disaster Mental Health

Counselling Case Study: Relationship Problems

Mark is 28 and has been married to Sarah for six years. He works for his uncle and they regularly stay back after work to chat. Sarah has threatened to leave him if he does not spend more time with her, but when they are together, they spend most of the time arguing, so he […]

• April 16, 2007

Counselling Case Study: Domestic Violence

The client, Gary, called to make his first appointment and said he was persuaded by “a mate” to attend counselling to control his anger. In short Gary was a perpetrator of physical abuse against his intimate female partner, Julie, who is 22 years of age. The couple have no children but his partner has recently […]

• March 27, 2007

A Case of Loss and Grief

Jim had come to counselling to seek help with dealing with the sale of his late mother’s estate. He was experiencing a lot of anger with the issue and also with his brother, Frank, who was joint inheritor. Frank was facing bankruptcy and needed the proceeds of the sale of the family home to save […]

• March 23, 2007
• Case Studies , Loss & Grief , Relationship & Families

Case Example: Jill, a 32-year-old Afghanistan War Veteran

This case example explains how Jill's therapist used a cognitive intervention with a written worksheet as a starting point for engaging in Socratic dialogue. 

About this Example

Jill's Story

Jill, a 32-year-old Afghanistan war veteran, had been experiencing PTSD symptoms for more than five years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED) while driving a combat supply truck. Over the years, Jill became increasingly depressed and began using alcohol on a daily basis to help assuage her PTSD symptoms. She had difficulties in her employment, missing many days of work, and she reported feeling disconnected and numb around her husband and children. In addition to a range of other PTSD symptoms, Jill had a recurring nightmare of the event in which she was the leader of a convoy and her lead truck broke down. She waved the second truck forward, the truck that hit the IED, while she and her fellow service members on the first truck worked feverishly to repair it. Consistent with the traumatic event, her nightmare included images of her and the service members on the first truck smiling and waving at those on the second truck, and the service members on the second truck making fun of the broken truck and their efforts to fix it — “Look at that piece of junk truck — good luck getting that clunker fixed.”

After a thorough assessment of her PTSD and comorbid symptoms, psychoeducation about PTSD symptoms, and a rationale for using trauma focused cognitive interventions, Jill received 10 sessions of cognitive therapy for PTSD. She was first assigned cognitive worksheets to begin self-monitoring events, her thoughts about these events, and consequent feelings. These worksheets were used to sensitize Jill to the types of cognitions that she was having about current day events and to appraisals that she had about the explosion. For example, one of the thoughts she recorded related to the explosion was, “I should have had them wait and not had them go on.” She recorded her related feeling to be guilt. Jill’s therapist used this worksheet as a starting point for engaging in Socratic dialogue, as shown in the following example:

Therapist: Jill, do you mind if I ask you a few questions about this thought that you noticed, “I should have had them wait and not had them go on?”

Client: Sure.

Therapist: Can you tell me what the protocol tells you to do in a situation in which a truck breaks down during a convoy?

Client: You want to get the truck repaired as soon as possible, because the point of a convoy is to keep the trucks moving so that you aren’t sitting ducks.

Therapist: The truck that broke down was the lead truck that you were on. What is the protocol in that case?

Client: The protocol says to wave the other trucks through and keep them moving so that you don’t have multiple trucks just sitting there together more vulnerable.

Therapist: Okay. That’s helpful for me to understand. In light of the protocol you just described and the reasons for it, why do you think you should have had the second truck wait and not had them go on?

Client: If I hadn’t have waved them through and told them to carry on, this wouldn’t have happened. It is my fault that they died. (Begins to cry)

Therapist: (Pause) It is certainly sad that they died. (Pause) However, I want us to think through the idea that you should have had them wait and not had them go on, and consequently that it was your fault. (Pause) If you think back about what you knew at the time — not what you know now 5 years after the outcome — did you see anything that looked like a possible explosive device when you were scanning the road as the original lead truck?

Client: No. Prior to the truck breaking down, there was nothing that we noticed. It was an area of Iraq that could be dangerous, but there hadn’t been much insurgent activity in the days and weeks prior to it happening.

Therapist: Okay. So, prior to the explosion, you hadn’t seen anything suspicious.

Client: No.

Therapist: When the second truck took over as the lead truck, what was their responsibility and what was your responsibility at that point?

Client: The next truck that Mike and my other friends were on essentially became the lead truck, and I was responsible for trying to get my truck moving again so that we weren’t in danger.

Therapist: Okay. In that scenario then, would it be Mike and the others’ jobs to be scanning the environment ahead for potential dangers?

Client: Yes, but I should have been able to see and warn them.

Therapist: Before we determine that, how far ahead of you were Mike and the others when the explosion occurred?

Client: Oh (pause), probably 200 yards?

Therapist: 200 yards—that’s two football fields’ worth of distance, right?

Client: Right.

Therapist: You’ll have to educate me. Are there explosive devices that you wouldn’t be able to detect 200 yards ahead?

Client: Absolutely.

Therapist: How about explosive devices that you might not see 10 yards ahead?

Client: Sure. If they are really good, you wouldn’t see them at all.

Therapist: So, in light of the facts that you didn’t see anything at the time when you waved them through at 200 yards behind and that they obviously didn’t see anything 10 yards ahead before they hit the explosion, and that protocol would call for you preventing another danger of being sitting ducks, help me understand why you wouldn’t have waved them through at that time? Again, based on what you knew at the time?

Client: (Quietly) I hadn’t thought about the fact that Mike and the others obviously didn’t see the device at 10 yards, as you say, or they would have probably done something else. (Pause) Also, when you say that we were trying to prevent another danger at the time of being “sitting ducks,” it makes me feel better about waving them through.

Therapist: Can you describe the type of emotion you have when you say, “It makes me feel better?”

Client: I guess I feel less guilty.

Therapist: That makes sense to me. As we go back and more accurately see the reality of what was really going on at the time of this explosion, it is important to notice that it makes you feel better emotionally. (Pause) In fact, I was wondering if you had ever considered that, in this situation, you actually did exactly what you were supposed to do and that something worse could have happened had you chosen to make them wait?

Client: No. I haven’t thought about that.

Therapist: Obviously this was an area that insurgents were active in if they were planting explosives. Is it possible that it could have gone down worse had you chosen not to follow protocol and send them through?

Client: Hmmm. I hadn’t thought about that either.

Therapist: That’s okay. Many people don’t think through what could have happened if they had chosen an alternative course of action at the time or they assume that there would have only been positive outcomes if they had done something different. I call it “happily ever after” thinking — assuming that a different action would have resulted in a positive outcome. (Pause) When you think, “I did a good job following protocol in a stressful situation that may have prevented more harm from happening,” how does that make you feel?

Client: It definitely makes me feel less guilty.

Therapist: I’m wondering if there is any pride that you might feel?

Client: Hmmm...I don’t know if I can go that far.

Therapist: What do you mean?

Client: It seems wrong to feel pride when my friends died.

Therapist: Is it possible to feel both pride and sadness in this situation? (Pause) Do you think Mike would hold it against you for feeling pride, as well as sadness for his and others’ losses?

Client: Mike wouldn’t hold it against me. In fact, he’d probably reassure me that I did a good job.

Therapist: (Pause) That seems really important for you to remember. It may be helpful to remind yourself of what you have discovered today, because you have some habits in thinking about this event in a particular way. We are also going to be doing some practice assignments that will help to walk you through your thoughts about what happened during this event, help you to remember what you knew at the time, and remind you how different thoughts can result in different feelings about what happened.

Client: I actually feel a bit better after this conversation. 

Another thought that Jill described in relation to the traumatic event was, “I should have seen the explosion was going to happen to prevent my friends from dying.” Her related feelings were guilt and self-directed anger. The therapist used this thought to introduce the cognitive intervention of "challenging thoughts" and provided a worksheet for practice. The therapist first provided education about the different types of thinking errors, including habitual thinking, all-or-none thinking, taking things out of context, overestimating probabilities, and emotional reasoning, as well as discussing other important factors, such as gathering evidence for and against the thought, evaluating the source of the information, and focusing on irrelevant factors. 

More specifically, Jill noted that she experienced 100 percent intensity of guilt and 75 percent intensity of anger at herself in relation to the thought "I should have seen the explosive device to prevent my friends from dying." She posed several challenging questions, including the notion that improvised explosive devices are meant to be concealed, that she is the source of the information (because others don't blame her), and that her feelings are not based on facts (i.e., she feels guilt and therefore must be guilty). She came up with the alternative thought, "The best explosive devices aren't seen and Mike (driver of the second truck) was a good soldier. If he saw something he would stopped or tried to evade it," which she rated as 90 percent confidence in believing. She consequently believed her original thought 10 percent, and re-rated her emotions as only 10 percent guilt and 5 percent anger at self.

Treating PTSD with cognitive-behavioral therapies: Interventions that work

This case example is reprinted with permission from: Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work . Washington, DC: American Psychological Association. 

Other Case Examples

• Cognitive Therapy Philip, a 60-year-old who was in a traffic accident (PDF, 294KB)
• Eye Movement Desensitization and Reprocessing Mike, a 32-year-old Iraq War Veteran
• Narrative Exposure Therapy Eric, a 24-year-old Rwandan refugee living in Uganda (PDF, 28KB)
• Prolonged Exposure Terry, a 42-year-old earthquake survivor

In this article, I use a fictitious case study to help to describe and demonstrate how CBT Therapy can be used to reduce depression and anxiety.

CBT Therapy – A Simple Case Study

Carol is a fictional character used to explain the ways in which I may work. She presented with anxiety and feelings of depression, and hopelessness. I helped her challenge her thinking and fear.

My Response

I can hear your emotional distress and the presentation seems impossible for you at the moment. Let’s see if we can break things down and work on a little at a time, to hopefully make things feel more positive and manageable for you.

Using the ABC model of CBT.

This is based on the premise that an Activating event (A)

• In your case, it is your presentation at work.

Leads to emotional and behavioural Consequences (C)

• Which you could avoid the presentation/ phone in sick, and others will not see how well you know your stuff. This is discounting the positive.

The consequences are seen as arising from your individual belief (B)

• You described self-doubt. It makes you feel nervous and afraid, you think you might feel humiliated in front of others, and they might think you are an idiot.

From past experience, you have shared some unpleasant physical symptoms: your heart racing, feeling tongue-tied, sweating.

• These inferences could be seen as jumping to conclusions, every situation is different, and you are also describing emotional reasoning. If you do your presentation, symptoms will happen because it did last time.

You have evaluated that you cannot do it, others will judge you, and others can do better. You are magnifying the negatives, discounting the positives.

Fact – You have explained that you know your subject thoroughly and the management seem to have faith in you as they have asked you to do this. Let’s focus on this and aim to achieve your presentation.

To make this more manageable, we break things down into small tasks. We work on these smaller tasks in our sessions and as homework.

• Practice your presentation in front of others, trust the feedback, work on this and practice as necessary.
• While you concentrate on your knowledge, projection, confidence, delivery, body language and professionalism, record as necessary and we can discuss.
• Tap into the emotions and physical sensations you are feeling; we could look at grading them compared to the last time you spoke publicly and each time you practiced.
• We can practice relaxation strategies and positive thinking to help with physical symptoms and nervousness. You can continue to practice alone when in times of need.
• We will look at your common cognitive errors, look for evidence of them and disregard those that do not fit.
• We can check into your self-esteem and confidence levels and record results as we go along. Assessing progress and exploring and working on sticking points.
• I would like you to list all of the facts why you can complete your presentation, and we will explore the results.

I will support you through this Carol. I have faith in this process and in you, and evidence says you can do it. We can make a plan for the sessions/homework for the time we have before your presentation.

CBT Techniques and behavioural techniques used:  The ABC Model

• Identifying faulty thoughts and feelings
• Identifying faulty thinking and looking at how it affects feelings and behaviour
• Challenging facts and focusing on positive
• Setting homework and goal and revisiting to look at progress
• Relaxation techniques
• Looking for evidence and Correcting distorted thinking
• Focusing on the client’s thoughts and feelings and underlying and irrational beliefs
• Looking at self-defeating beliefs and unrealistic beliefs
• Distinguishing between inferences and evaluations
• Teaching the client understanding and CBT method of change
• Triadic structure of CBT
• To help the client overcome blocks to change and independence
• To encourage positive thinking and change
• Looking at Schemata- underlying beliefs
• Applying distancing and decentring
• Using graded task performance
• Explaining and setting tasks/homework if the client agrees, and checking understanding.
• Explain and Test client commitment to tasks.
• Demonstrating how Carol might benefit from the sessions
• Reality testing
• Work on changing unhelpful work patterns
• Highlighting gaps between fears, experience and reality
• Review blocks and failure
• Empowering client to successfully take control
• Encouraging self-monitoring

So to summarise, for CBT therapy we work in manageable chunks. We identify the negatives and work on the fears you feel, finding strategies for you to cope and be calmer. We focus on you feeling confident and well equipped to deliver your presentation as we know you can.

About the Author:

I have many years of experience counselling individuals, young people and couples, supporting them through their struggles. I hope this article is of some help to you.

Please do get in touch through my “ Contact Me ” page to discuss your interest in CBT Therapy , or if you prefer, you are welcome to give me a call for a free introductory consultation.

Yours sincerely

BACP Accredited Counsellor Manchester

• Mental Health
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• Couples Counseling
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Counselling Case Study, Critique Of Counsellor Processes

This article was edited and approved for accuracy by adam szmerling on december 8, 2009.

The following article is intended as an educational resource for new counselling students and educators of various persuasions. You may link to this article as a resource and share on social media, but in terms of reproducing anything herein please See our Copyright Policy.

“There are a broad range of counselling micro skills that can be utilized effectively in therapy sessions. Within the context of their personal history, effective micro skill applications can encourage clients to tell their stories in colourful and extensive detail. Such effective implementation of micro skills facilitates the development of rapport and a positive therapeutic alliance thereby permitting clients to enrich their perspectives regarding problem and opportunity situations in their lives (Egan, 2007). Three important counseling techniques will be explored, all of which have been clinically demonstrated to be efficacious in a broad range of counseling settings (Egan). The skills of active listening, empathy and sharing empathic highlights will be discussed and analysed within the framework of a counselling case study. Accordingly, the purpose of this paper is to examine the use, efficacy and deficiencies of how these skills were employed within a counselling session with a mother, let’s call her Mary.

Mary presented to counselling with a five year history of frustrated attempts to get her daughter to sleep consistently in her own bed. On one hand, she had gone to extraordinary efforts to influence and sustain effective sleep patterns in her daughter. On the other, a feeling of being out of control permeated drained resourcefulness. Mary felt she was too compliant with her daughter’s unwilling behaviour and sought help from a counsellor.

The surface structure of Mary’s communication lingered around a circular logic of focusing on “how can I get her to sleep?”, using predominantly external resources. Her preference for externalization posed an initial challenge for the therapist as he was primarily operating from an internal locus of control. This was evident during his repeated suggestions to Mary to look within herself for solutions, and to value her internal self-sense and capabilities prior to relying on “externally determined reinforcement schedules” (Dr Berenson). This discrepancy of styles presented both a challenge and opportunity for the therapist to apply his counselling skills in a tactful yet flexible manner, while taking into account Mary’s cognitive preference and coping strategies (Egan, 2007).

The session commenced with proficient use of active listening skills. Active listening is a process by which the counsellor communicates verbally and non-verbally (Robertson, 2005) in a manner that allows the client to feel heard and understood and have their stories and emotions validated. It is proposed by many that the act of listening is the fundamental pillar of effective counselling (Graybar & Leonard, 2005). Active listening enhances and accelerates rapport building and is associated with increased client satisfaction with therapy (Duncan, Miller & Sharps, 2004). Littaeur, Sexton & Wynn (2005) found that clients reported higher levels of trust and satisfaction with counsellors who utilized effective active listening skills. It may also serve to differentiate the counseling relationship from other interpersonal relationships the client has. This distinction assists in creating counselling expectations of the client, which are important in client outcomes (Duncan et al). Active listening can also facilitate problem resolution and assist the client to experience further self-integration and understanding (Kensit, 2000).

Counsellor: “Mmm” Client: “Um. She did. She’d go off one night here, one night there, but most of it, most of the time she would sleep in her bed and carry right through. (Pause) She did well up until about two weeks ago and then completely turned around, and would not go..

This example indicates active listening through an objective acknowledgment, rather than a subjective comment by the counsellor and a pause, therein encouraging the client freedom to continue telling her story and possibly fostering increased rapport, as evidenced by the clients affirmative response.

However improper use of counselling skills can hinder the therapeutic alliance (Duncan et al., 2004) and may even be counterproductive for the client (Egan, 2007). An example of active listening being misused through interrupting:

Client: “Ok. So that’s what she’s sensing, is that…” Counsellor: (Interrupting) You have to learn to trust your heart as well as your head and when and, and, you’re going to feel more comfortable. You trust the intensity of the relationship. You trust the intensity of your experience.” Client: “Mmhum.”

Here the client responded incongruently, with a verbal affirmation but a contrasting tonality of uncertainty, suggesting a possible break of rapport due to the counsellor’s interruption. It should also be noted that since Mary presented with a loss of control over a situation, interruptions by the therapist may have reinforced her self-defeatist attitude that she needed to be compliant with external sources. In these instances, the cure can be worse than the disease (Egan, 2007), and accordingly such improper use of helping skills can hinder client progress and weaken the alliance (Duncan et al., 2004).

Additionally, the therapist provided advice to Mary, which may have invalidated her experience, as suggested by her tone of voice. It is widely recommended that the therapist continuously maintains congruency to enhance the value of active listening in the therapeutic alliance (Duncan et al., 2004). Congruent and consistent active listening, as opposed to interrupting, augments the therapeutic relationship and facilitates the development of empathy (Dryden & Mytton, 1999).

Another important counseling micro skill is empathy. Empathy, unlike sympathy, is the proximity of the counsellor to deeply enter and understand the micro and macro nuances of the client’s worldview, including their emotional state (Dryden & Mytton, 1999). In this way, the therapist is able to appreciate experiences and feelings from the perspective of their client (Graybar & Leonard, 2005), and communicate this accordingly. Additionally, according to Rogers (1980; cited in Robertson, 2005), when counselors suspend their prejudices and personal values, it makes room for empathy to more readily unfold. Furthermore, Patterson (1984; cited in Feller & Cottone, 2003, pp58) stated:

The magnitude of the evidence is nothing short of amazing. There are few things in the field of psychology which the evidence is so strong. The evidence for the necessity, if not the sufficiency, of the therapist conditions of accurate empathy, respect, or warmth, and genuineness is incontrovertible.

This point suggests that empathy may in fact be imperative, if not even the most significant factor in fostering helpful counselling relationships as it facilitates positive client outcomes and helps them to feel understood.

In the following example, the counsellor successfully demonstrates empathy, as indicated by the accurate, congruent match of the clients verbal and tonal affirmative response:

Counsellor: “You’re um, you’re really testing um, your own patience with the three days, four days, two weeks, then back.” Client: “Yes, Yes. I guess I am, but what, what can you do to, um, to make it be effective, and work, for a long period of time, and not, I mean, when this is ok, is going well you feel ‘ah’, I’ve reached the point and it’s ok, everything is wonderful, but…” Counsellor: “It’s a relief.” Client: “Yes, it certainly is. Um, but what about when maybe a month goes by and she decides that um, it’s time to test mother again, or what happens then?”

This example not only demonstrates the use of empathy, but indicates how its application assisted the client to continue telling her story in detail.

Notwithstanding, according to Rogers (1980; cited in Robertson, 2005) where the empathy of the counsellor is inaccurate, so long as unconditional positive regard is demonstrated, most clients will appreciate the therapist’s attempts to understand them. It is imperative that the counsellor correct their mistakes and subsequently re-establish empathy with their client to sustain a positive alliance. The following example shows how attempted empathy can go wrong:

Counsellor: “You’re looking for a strategy, but you’re looking outside of yourself and when you do that, you’re not listening to yourself and you have very strong feelings, ah, ah, very intense feelings, about a lot of things including your daughter.” Client: “Ah hum, um?” Counsellor: “You know what I want to say to you.” Client: “Yeah.”

Here the client responds with incongruity in her words and a questioning tonality. Therein the connection breaks. Additionally she does not continue telling her story at the length or depth as she had in the previous example of successful utilization of empathy. As Rogers (1980; cited in Robertson, 2005) suggests, it is preferable that the therapist consistently demonstrate unconditional positive regard for the client, rather than give advice. Had this been the done, Mary may have continued her story in detail and felt heard and understood. It is suggested that the counsellor ensures mindfulness of such responses from clients so as to adjust further communication accordingly, thereby making an effort to reestablish rapport and empathy. Heeding this could possibly allow not only the establishment of empathy in the relationship, but also a context for additional effective micro skills, such as sharing empathic highlights.

Another important counselling skill is sharing empathic highlights. This technique involves the counsellor highlighting verbally, non-verbally or tonally, the important key messages of the clients mood and story. This includes the counsellor demonstrating and conveying specific messages of empathic understanding to the client, as opposed to just summarizing what the client says verbally. When empathic highlights are used in conjunction with empathy and active listening, rapport is established between the counsellor and client, which in turn enhances the effectiveness of these and other appropriately applied counselling skills. Highlights are more productive when they are empathic, because through the reflective process the counsellor demonstrates real empathy and understanding that the client can sense and appreciate (Egan, 2007).

In a study of client perceptions of the counselling relationship, over half believed that a good counselling relationship was determined by respect, empathic understanding and attentive listening. Another 40 percent considered their counsellors clarification of their experience not only significant for the relationship, but also helpful for gaining enhanced self-understanding (Bachelor, 1995; cited in Duncan et al., 2004). Furthermore, Littauer et al (2005) found that clients who had counsellors that shared their key understandings, or empathic highlights, regarded the counselling process as helpful. A common response was “I must feel that people understand me before I can trust them.” (Littaur, et al, 2005, p29). Therefore these research findings suggest skills, such as active listening, are necessary but may not be effective until the client feels understood. Thus accurate use of empathic highlights may help to demonstrate understanding to clients, thereby building trust, alliance and improved outcomes.

Counsellor: “You’re really torn between reaching out to her..” Client: “Hmhmm” Counsellor: “And doing what your intellect tells you is best for her.” Client: “Right”

Wynn As suggested by the processing of the clients initial response in this example, she was given sufficient time to contemplate the therapists reflection. Her next affirmative response indicates that the counsellor had successfully reflected, and Mary had felt understood. This is in contrast to the following example where improper reflection was used:

Counsellor: “Because you’re not free.” Client: “Arhh?”

Here the counsellor selected a reflection which was inaccurate and inconsistent with the clients semantic and tonal descriptions of her presenting problem. In the above example the clients response indicated that she may have felt confused rather than understood. If the counsellor was mindful of such responses, his style of reflection could have been adjusted to build and maintain a relationship with the client. It is suggested that the counsellor identify and correct his mistake of inaccurate reflection so as to utilize a skill that more accurately fits with the clients emotional worldview.

In conclusion, the successful use of active listening, empathy and sharing highlights can facilitate the creation of a safe, supportive and constructive counselling relationship . These skills were explored in the context of a counselling session and the relevant research and literature was discussed. There is evidence suggesting that using a multitude of micro skills together creates more fulfilling counseling interactions and permits the counsellor to make mistakes without severely compromising the therapeutic relationship. It is, however, critically important for counsellors to self-reflect and identify their own errors in order to develop more polished, useful and congruent counselling skills for the benefit of their clients.”

Thanks for reading. If you have feedback feel free to leave us a comment. Also you can read our FAQ for more about our counselling services. We also provide links to other counselling resources.

Bayside Psychotherapy was founded by Adam Szmerling in Melbourne, offering counselling and psychotherapy for individuals and couples. Adam's experience with psychotherapy inspired him to help others improve their self-understanding, mental health and wellbeing.

• Adam Szmerling

Born and bred in Melbourne, I’m an Accredited Mental Health Social Worker (AASW) and clinical psychotherapist (PACFA). I work with individuals and couples, adult clients who want to speak and engage in psychotherapy.

• Natalie Szmerling

Natalie is a clinical psychologist with extensive experience in the health sector. She completed her Masters (Clinical Psychology) training at Swinburne University and wrote her masters thesis on multidimensional self-esteem in different problematic eating patterns.

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Content Some case study assignments may require you to provide a short summary of the case in your own words, especially if you have provided your own case study. This will help provide context for the rest of your analysis. The main part of the assignment will involve you applying the concepts and theories you have learnt about to the case study. This means that you will be referencing research and theory to support your ideas. A case study might also require you to provide examples of what you would say to a client or another person in the case, and what they might say. These are called verbatim examples. Structure Most case studies need to be structured in the same way as an essay, with an introduction, a series of body paragraphs and a conclusion. However, unlike essays, case studies usually have headings based on information in the task description or marking criteria. For example, a client case study assessment that asks students to identify the main issues and prepare a plan of action may have headings such as Summary of the case , Identification of main issues , Recommended action plan . Style Case studies require you to write in the third person (people’s names, he/she/they, the counsellor, the client, and so forth) when discussing the theories or research of authors, or the client, the professional or the organisation in the case. A case study might require you to use first person (‘I’, ‘my’ etc) to provide your own reflections about the case, its personal impact on you, or how you would apply theories and skills to the case. Check with your educator about whether you should use first person.

Make sure you have a good balance between describing your case study and analysing it. Many students fall into the trap of being too descriptive when writing about their case. Some ways to include analysis are:

• Explaining and giving reasons
• Comparing and contrasting
• Making suggestions and recommendations
• Supporting your ideas with information from sources

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How to cite ChatGPT

Use discount code STYLEBLOG15 for 15% off APA Style print products with free shipping in the United States.

We, the APA Style team, are not robots. We can all pass a CAPTCHA test , and we know our roles in a Turing test . And, like so many nonrobot human beings this year, we’ve spent a fair amount of time reading, learning, and thinking about issues related to large language models, artificial intelligence (AI), AI-generated text, and specifically ChatGPT . We’ve also been gathering opinions and feedback about the use and citation of ChatGPT. Thank you to everyone who has contributed and shared ideas, opinions, research, and feedback.

In this post, I discuss situations where students and researchers use ChatGPT to create text and to facilitate their research, not to write the full text of their paper or manuscript. We know instructors have differing opinions about how or even whether students should use ChatGPT, and we’ll be continuing to collect feedback about instructor and student questions. As always, defer to instructor guidelines when writing student papers. For more about guidelines and policies about student and author use of ChatGPT, see the last section of this post.

Quoting or reproducing the text created by ChatGPT in your paper

If you’ve used ChatGPT or other AI tools in your research, describe how you used the tool in your Method section or in a comparable section of your paper. For literature reviews or other types of essays or response or reaction papers, you might describe how you used the tool in your introduction. In your text, provide the prompt you used and then any portion of the relevant text that was generated in response.

Unfortunately, the results of a ChatGPT “chat” are not retrievable by other readers, and although nonretrievable data or quotations in APA Style papers are usually cited as personal communications , with ChatGPT-generated text there is no person communicating. Quoting ChatGPT’s text from a chat session is therefore more like sharing an algorithm’s output; thus, credit the author of the algorithm with a reference list entry and the corresponding in-text citation.

When prompted with “Is the left brain right brain divide real or a metaphor?” the ChatGPT-generated text indicated that although the two brain hemispheres are somewhat specialized, “the notation that people can be characterized as ‘left-brained’ or ‘right-brained’ is considered to be an oversimplification and a popular myth” (OpenAI, 2023).

OpenAI. (2023). ChatGPT (Mar 14 version) [Large language model]. https://chat.openai.com/chat

You may also put the full text of long responses from ChatGPT in an appendix of your paper or in online supplemental materials, so readers have access to the exact text that was generated. It is particularly important to document the exact text created because ChatGPT will generate a unique response in each chat session, even if given the same prompt. If you create appendices or supplemental materials, remember that each should be called out at least once in the body of your APA Style paper.

When given a follow-up prompt of “What is a more accurate representation?” the ChatGPT-generated text indicated that “different brain regions work together to support various cognitive processes” and “the functional specialization of different regions can change in response to experience and environmental factors” (OpenAI, 2023; see Appendix A for the full transcript).

Creating a reference to ChatGPT or other AI models and software

The in-text citations and references above are adapted from the reference template for software in Section 10.10 of the Publication Manual (American Psychological Association, 2020, Chapter 10). Although here we focus on ChatGPT, because these guidelines are based on the software template, they can be adapted to note the use of other large language models (e.g., Bard), algorithms, and similar software.

The reference and in-text citations for ChatGPT are formatted as follows:

• Parenthetical citation: (OpenAI, 2023)
• Narrative citation: OpenAI (2023)

Let’s break that reference down and look at the four elements (author, date, title, and source):

Author: The author of the model is OpenAI.

Date: The date is the year of the version you used. Following the template in Section 10.10, you need to include only the year, not the exact date. The version number provides the specific date information a reader might need.

Title: The name of the model is “ChatGPT,” so that serves as the title and is italicized in your reference, as shown in the template. Although OpenAI labels unique iterations (i.e., ChatGPT-3, ChatGPT-4), they are using “ChatGPT” as the general name of the model, with updates identified with version numbers.

The version number is included after the title in parentheses. The format for the version number in ChatGPT references includes the date because that is how OpenAI is labeling the versions. Different large language models or software might use different version numbering; use the version number in the format the author or publisher provides, which may be a numbering system (e.g., Version 2.0) or other methods.

Bracketed text is used in references for additional descriptions when they are needed to help a reader understand what’s being cited. References for a number of common sources, such as journal articles and books, do not include bracketed descriptions, but things outside of the typical peer-reviewed system often do. In the case of a reference for ChatGPT, provide the descriptor “Large language model” in square brackets. OpenAI describes ChatGPT-4 as a “large multimodal model,” so that description may be provided instead if you are using ChatGPT-4. Later versions and software or models from other companies may need different descriptions, based on how the publishers describe the model. The goal of the bracketed text is to briefly describe the kind of model to your reader.

Source: When the publisher name and the author name are the same, do not repeat the publisher name in the source element of the reference, and move directly to the URL. This is the case for ChatGPT. The URL for ChatGPT is https://chat.openai.com/chat . For other models or products for which you may create a reference, use the URL that links as directly as possible to the source (i.e., the page where you can access the model, not the publisher’s homepage).

Other questions about citing ChatGPT

You may have noticed the confidence with which ChatGPT described the ideas of brain lateralization and how the brain operates, without citing any sources. I asked for a list of sources to support those claims and ChatGPT provided five references—four of which I was able to find online. The fifth does not seem to be a real article; the digital object identifier given for that reference belongs to a different article, and I was not able to find any article with the authors, date, title, and source details that ChatGPT provided. Authors using ChatGPT or similar AI tools for research should consider making this scrutiny of the primary sources a standard process. If the sources are real, accurate, and relevant, it may be better to read those original sources to learn from that research and paraphrase or quote from those articles, as applicable, than to use the model’s interpretation of them.

We’ve also received a number of other questions about ChatGPT. Should students be allowed to use it? What guidelines should instructors create for students using AI? Does using AI-generated text constitute plagiarism? Should authors who use ChatGPT credit ChatGPT or OpenAI in their byline? What are the copyright implications ?

On these questions, researchers, editors, instructors, and others are actively debating and creating parameters and guidelines. Many of you have sent us feedback, and we encourage you to continue to do so in the comments below. We will also study the policies and procedures being established by instructors, publishers, and academic institutions, with a goal of creating guidelines that reflect the many real-world applications of AI-generated text.

For questions about manuscript byline credit, plagiarism, and related ChatGPT and AI topics, the APA Style team is seeking the recommendations of APA Journals editors. APA Style guidelines based on those recommendations will be posted on this blog and on the APA Style site later this year.

Update: APA Journals has published policies on the use of generative AI in scholarly materials .

We, the APA Style team humans, appreciate your patience as we navigate these unique challenges and new ways of thinking about how authors, researchers, and students learn, write, and work with new technologies.

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

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