how to write counselling case study

Writing a Counselling Case Study

As a counselling student, you may feel daunted when faced with writing your first counselling case study. Most training courses that qualify you as a counsellor or psychotherapist require you to complete case studies.

Before You Start Writing a Case Study

Writing a counselling case study - hands over a laptop keyboard

However good your case study, you won’t pass if you don’t meet the criteria set by your awarding body. So before you start writing, always check this, making sure that you have understood what is required.

For example, the ABC Level 4 Diploma in Therapeutic Counselling requires you to write two case studies as part of your external portfolio, to meet the following criteria:

4.2 Analyse the application of your own theoretical approach to your work with one client over a minimum of six sessions.
4.3 Evaluate the application of your own theoretical approach to your work with this client over a minimum of six sessions.
5.1 Analyse the learning gained from a minimum of two supervision sessions in relation to your work with one client.
5.2 Evaluate how this learning informed your work with this client over a minimum of two counselling sessions.

If you don’t meet these criteria exactly – for example, if you didn’t choose a client who you’d seen for enough sessions, if you described only one (rather than two) supervision sessions, or if you used the same client for both case studies – then you would get referred.

Check whether any more information is available on what your awarding body is looking for – e.g. ABC publishes regular ‘counselling exam summaries’ on its website; these provide valuable information on where recent students have gone wrong.

Selecting the Client

When you reflect on all the clients you have seen during training, you will no doubt realise that some clients are better suited to specific case studies than others. For example, you might have a client to whom you could easily apply your theoretical approach, and another where you gained real breakthroughs following your learning in supervision. These are good ones to choose.

Opening the Case Study

It’s usual to start your case study with a ‘pen portrait’ of the client – e.g. giving their age, gender and presenting issue. You might also like to describe how they seemed (in terms of both what they said and their body language) as they first entered the counselling room and during contracting.

Counselling case study - Selecting the right client for your case study

If your agency uses assessment tools (e.g. CORE-10, WEMWBS, GAD-7, PHQ-9 etc.), you could say what your client scored at the start of therapy.

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Writing a Case Study: 5 Tips

Describing the Client’s Counselling Journey

This is the part of the case study that varies greatly depending on what is required by the awarding body. Two common types of case study look at application of theory, and application of learning from supervision. Other possible types might examine ethics or self-awareness.

Theory-Based Case Studies

If you were doing the ABC Diploma mentioned above, then 4.1 would require you to break down the key concepts of the theoretical approach and examine each part in detail as it relates to practice. For example, in the case of congruence, you would need to explain why and how you used it with the client, and the result of this.

Meanwhile, 4.2 – the second part of this theory-based case study – would require you to assess the value and effectiveness of all the key concepts as you applied them to the same client, substantiating this with specific reasons. For example, you would continue with how effective and important congruence was in terms of the theoretical approach in practice, supporting this with reasoning.

In both, it would be important to structure the case study chronologically – that is, showing the flow of the counselling through at least six sessions rather than using the key concepts as headings.

Supervision-Based Case Studies

When writing supervision-based case studies (as required by ABC in their criteria 5.1 and 5.2, for example), it can be useful to use David Kolb’s learning cycle, which breaks down learning into four elements: concrete experience, reflective observation, abstract conceptualisation and active experimentation.

Rory Lees-Oakes has written a detailed guide on writing supervision case studies – entitled How to Analyse Supervision Case Studies. This is available to members of the Counselling Study Resource (CSR).

Closing Your Case Study

In conclusion, you could explain how the course of sessions ended, giving the client’s closing score (if applicable). You could also reflect on your own learning, and how you might approach things differently in future.

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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What Is a Case Study?

Weighing the pros and cons of this method of research

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

Cara Lustik is a fact-checker and copywriter.

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."

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How to write counseling case studies

Jan 31, 2021
Essay Writing Service

Guide on writing counseling case studies

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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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).

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.

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

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The following resources can be found in the Positive Psychology Toolkit© , and their full versions can be accessed by a subscription.

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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A case study example

A case study is an in-depth report on a single person, a small group or a process. A case study can tell a persuasive story about the impact and effectiveness of your service. Click here for more advice on how to write one.

Brief introduction (2 – 5 sentences)

Set the scene. Introduce the person who is the subject of the case study, which program or service they worked with and the presenting issue (the reason they contacted, or were referred to, your service).

eg: Susan contacted our counselling service asking for support to deal with anxiety and depression. She had been experiencing this problem for 10 months and felt its impact on her life was becoming ‘severe’.

Describe the client you are writing about, their general background and history. You would include a pseudonym (false name), their age, relationship or family status, occupation.

eg: Susan is a 35-year-old mother of three young children (aged 10, 8 and 4). She lives with her children and her partner in what she describes as a ‘good and supportive’ relationship. Prior to the birth of her youngest child Susan worked as a payroll officer for a charity. She had liked her work because she felt she was helping people, but she stopped working when she found herself too busy with the demands of three young children. She hopes to return to work when they are a little older. Susan’s mother died last year. Her father is in poor health but lives nearby and visits her often.

NOTE: Make sure you manage the confidentiality issues. Tasmania is a small place – too much information can make someone readily identifiable. It is common place to give someone a different name (a pseudonym) to ensure additional confidentiality.

The problem or issue

Describe the problem or issue which is the reason the person is using your service and then explain the impact the problem has had on their life. You might include details of the person’s history with the problem and any other attempts to get support to deal with it. This information should be given in chronological order.

eg: Susan contacted our service in April 2015 seeking support to deal with anxiety and depression which she described as ‘severe’. This problem had begun 12 months earlier after the death of her mother, whom she loved very much.

Since her mother died Susan says she has felt sad all the time, and has difficulty sleeping, no energy and no interest in the activities that normally give her pleasure, such as volunteering at her children’s school, shopping and spending time with her family and friends.

Susan is also experiencing anxiety. In November 2013 she realised that she was too anxious to leave the house and was increasingly fearful for the children’s safety when they were not at home. Susan says that this fear kept growing until by February she was ringing the children’s school three or four times a day to check they were safe.

Hint : While the description of the presenting problem might be quite recent, telling someone’s history takes you back in time. You can help the reader understand the sequence of events by doing three things:

After you have initially explained the problem that brought the client to your service), tell the history in the order in which it happened, starting with most distant past events.
Use grammar, especially tenses carefully. See, for example, Susan is experiencing anxiety…she was ringing the children’s school…
Use specific dates where you can.

The response to the problem or issue

Describe the services provided, or the approach that was used. You should also explain the short-term and long-term goals your service and the client were working towards.

Eg: Susan was offered six counselling sessions. The counsellor worked with her using cognitive behavioural therapy, through which they explored the thinking patterns which were underlying the emotions Susan was experiencing. Working with the counsellor Susan set goals for her sessions and for herself. Susan’s short term goals were to overcome her fear of leaving the house and get to the counselling service, and to be able to build on this with some small excursions into the community. Her long term goal was to experience a reduction in her sense of helplessness around the anxiety she was experiencing.

Describe the outcome of the work and the longer-term outlook for this person. Describe how this outcomes data was gathered (eg, interview, focus group, survey data, observation by staff members). You may wish to acknowledge the role played by other services, or other influences on the client’s life which also supported them to achieve these outcomes at this point in the case study. It is important to take credit where it is due but not to ‘over claim’.

Eg: in her final session Susan completed an assessment. It showed that she was feeling less anxious about her own and her children’s safety and more hopeful about her future. Susan also shared that she had successfully attended a number of social events away from her home. She was planning to volunteer to help at her children’s school to ‘get that back on its old footing’.

A very brief conclusion should sum up the information about the client, what the problem or issue was and the results arising from the services provided by your organisation.

Eg: Susan said she felt the counselling service had been helpful in dealing with anxiety and depression which she had felt was ‘severe’ and which was having a very negative affect on her life. Since overcoming these problems Susan said she felt able to ‘go back to her old life’.

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Counselling Case Study: Working with Grief

Grief is a complex and individual process. There are a number of well documented stages to the grief process such as numbness, guilt, despair, panic and acceptance to name a few. The order in which these stages are experienced and the intensity and duration of each stage will be different for each individual.

It is therefore understandable that an eclectic counselling approach to grief can be beneficial in allowing for the flexibility needed to work with individuals through various stages of the grief process. The following case study is a practical application of a variety of counselling approaches to one client and her experience of grief.

The client’s name is Joan. Joan sought counselling to deal with the unexpected loss of her daughter in a car accident. She received counselling about 2 weeks after her daughter’s death and continued with the counselling process over a period of 8 months.

The key features of Joan’s grief were her feelings of guilt and despair. In these areas, the counsellor worked mainly from a Person-Centered approach (PCT). The counsellor also utilised some techniques from Solution-Focussed Therapy (SFT) and Cognitive-Behaviour Therapy (CBT). A brief analysis of the case study and application of the various techniques are provided below.

Case Information

Joan is a semi-retired accountant, maintaining contract work with a few long-term clients to support herself in retirement. Joan is a divorcee, who lives on her own, in her family home. She is a mother of 2 children, Kirsten and Mathew, aged in their mid 20s. Joan has a supportive network of family and friends, including her sister, father, children, and friends from her gardening club.

Joan’s relatively steady life was overturned with the sudden death of her daughter, Kirsten. Kirsten was 24 when she died from head injuries caused during a car accident. She was admitted to hospital in a coma. Joan spent several anxious days with Kirsten, before she passed away.

In the days that followed, Joan arranged her daughter’s funeral and affairs and deferred her work commitments. Joan described this as a whirlwind period, where she operated in a mechanical way. She was completely absorbed in the organisation of Kirsten’s funeral and pushed aside her feelings of grief. Joan said that she found some security in the numbness that filled her during that time.

After a couple of weeks, however, Joan became concerned that she was not coping as she couldn’t move on from these feelings. People had commented that she should try to carry on as usual, however her numbness persisted and she couldn’t motivate herself to “carry on” as if nothing had happened.

Joan thought that there must have been something wrong with her and it was this fear that led her to counselling some weeks after her daughter’s funeral.

For ease of writing, the professional counsellor in this case will be referred to as “C”.

The Initial Stages

(Numbness) In the first session, Joan appeared somewhat vague and tired. She seemed focussed on describing the details of the funeral, the family members who attended and her concern about her daughter not having a will. “C” observed that Joan’s behaviour reflected a need to be in control of the situation and was a useful coping strategy for Joan at this time. “C” used PCT to build an empathetic understanding of Joan’s experience. She did not attempt to move Joan towards experiencing her grief, but trusted that Joan would reach this stage in her own time.

Joan began discussing the rapid way in which the whole event had occurred and the numbness that she was feeling. “C” used paraphrases and encouragers to assist Joan to express herself. “Everything has happened so quickly that you haven’t had time to absorb it all, is that right Joan?” “Yes”, Joan replied, “I’ve hardly had time to miss my little girl.” “You miss her,” responded “C”.

With this encourager, Joan began to cry and express her grief. Joan cried for some time whilst “C” sat with her in silence. At one point Joan apologised for her crying. “C” responded “It seems that you have a lot to cry about Joan. It shows me how much you loved your daughter.”

In the first session, Person-Centered therapy and Active Listening techniques enabled “C” to be guided by Joan’s readiness to express her feelings. The encouragers and reflection of feeling used, demonstrated to Joan that “C” understood her and allowed Joan to experience her feelings of grief, rather than to keep them at arms length.

Whilst “C” could have indicated to Joan that she was avoiding her grief, “C” instead trusted in Joan’s ability to express her grief in her own time. If Joan had not expressed her grief in this session, “C” would not have pressed the issue, although she may have encouraged Joan to have a further session within a few days.

(Grief and Despair) The following sessions were characterised by further experiences of grief and despair. Joan had found that her grief was no longer avoidable and her days were mostly filled with mourning. Joan abandoned her daily routines such as grooming, making meals and other basic self-care practices.

Joan’s disheveled appearance at the counselling sessions were concerning. At this point, “C” became more directive and suggested that Joan might have someone live-in with her for a while. Whilst “C” was encouraged by Joan’s regular adherence to the counselling sessions, she felt that Joan may need some extra support at home.

Joan contacted her sister Kerrie, who was available to stay with her for a month. Kerrie proved to be good support for Joan and provided her with gentle, yet insistent encouragement to face the everyday challenges.

Over several weeks of counselling, Joan had moved further into stages of despair and guilt. She described her life as being swallowed by a black hole and felt that she would never get over her daughter’s death. She felt that every day dragged by with no release from the pain. She had difficulty getting out of her bed in the morning and was constantly tired from lack of solid sleep.

“C” continued to employ PCT to allow Joan to explore and express her feelings and thoughts about her daughter’s death. Joan focussed heavily on her pain and seemed to stay with these feelings for a long time. “C” observed that Joan’s thoughts did not seem to be focused; she quickly moved from one topic to the next. “C” used summarising skills to help Joan highlight the key recurring issues from her thoughts.

“C” continued to trust that Joan would move through her feelings of grief in her own time. “C” did however experience some frustration with Joan’s continual despair. “C” sought the counsel of a colleague, who advised her to maintain her faith in Joan’s ability to grow and heal and reminded “C” of how the resolution of grief can often be a long-term process. The colleague also suggested some role-play techniques that “C” could use to work on Joan’s experience of her feelings.

(Guilt) Guilty feelings about her inability to prevent her daughter’s death were also of concern for Joan. “C” avoided telling Joan that she was not responsible for Kirsten’s car accident, and encouraged Joan to explore her guilt. In many instances grieving people feel guilt in relation to their loss. Often they will be told that they are not at fault, by well meaning people. The concern for counsellors is that grieving people are feeling guilty and will benefit more from expressing their guilt.

Dismissing guilty feelings won’t stop the grieving person from feeling blame and may lead to the increase of these feelings. “C” realised that Joan’s guilt was a means of expressing how fervently she wished to have her daughter with her still. “C” invited Joan to express her sorrow and guilt to Kirsten in a role play activity.

Afterwards, “C” encouraged Joan to debrief and talk about the effect of the activity. Joan was able to acknowledge the depth of her love and concern for Kirsten. “C” supported Joan by offering encouraging feedback. “C” was particularly taken with the extent of love and devotion that Joan displayed towards her daughter.

Joan left the session a little lighter for the experience. She said that she had been able to release some of her guilt and that she felt her despair ease a little. After two months of counselling, both Joan and “C” recognised this as a small breakthrough of acceptance.

Middle Stages

Joan’s grief and despair continued into the middle phase of the counselling sessions. Her emotions came in waves, rather than the constant fog of despair that had characterised her earlier sessions. “C” was continuing to utilise PCT with Joan to explore her issues. Joan expressed a readiness to establish goals during this stage. “C” implemented some CBT techniques for this purpose.

(Feelings of Panic) Kerrie had been encouraging Joan to take on small, everyday tasks such as walking to the shops, or posting the mail, in order to get out of the house for a while. Joan said she had done these tasks reluctantly as she was concerned about trying to “put on a brave face” in public.

Joan related a particular incident where she was at the local shop. She explained that when picking items from the shelves, she had selected her daughter’s favourite brand of biscuits. Feelings of panic had come over her as she realised that she no longer needed to buy the item, but she couldn’t bring herself to return the item to the shelf. In this state, she left all her purchases in the shop and walked straight home.

This incident had increased Joan’s anxiety about her ability to cope and accept her daughter’s death. In the session, “C” validated Joan’s experiences as being normal and a legitimate part of her grieving. As a part of the CBT process, “C” clarified and identified the causes and effects of Joan’s feelings of panic. These were as follows:

A realisation that her daughter was absent in her everyday life A rejection of awareness that her daughter was absent in her everyday life Conflicting emotions about acceptance of daughter’s absence

Causing anxiety
Causing a belief that she will never be able to accept her daughter’s loss
Causing a fear of losing control in public places

“C” and Joan discussed the nature of the anxious feelings, and Joan’s associated beliefs and fears. Together they devised a number of goals, including (1) the development of new beliefs, (2) relaxation and (3) taking it one step at a time – otherwise referred to as a graded-task assignment.

Joan’s new beliefs included:

It is normal to want my daughter back
I am normal to grieve for and miss my daughter
It doesn’t matter if I cry in public
Time will help me to heal

She kept notes in a personal journal about when she used these new beliefs. The journal writing was also a process that allowed her to identify other problematic beliefs and thoughts. Once identified, she developed more appropriate and accepting beliefs.

In preparation of taking it one step at a time, Joan and “C” devised some relaxation techniques for Joan to use when she felt a sudden onset of panicky or anxious emotions. Joan had used imagery before and found that an effective method of relaxation. Joan was to imagine a warm, white light surrounding her whenever she felt even slightly anxious. They also devised some imagery to help Joan continue to experience the overwhelming nature of her grief.

Joan often referred to her feelings as a fog, and so “C” encouraged her to imagine sitting in a fog, which was black, thick and impenetrable. Little by little, she suggested that Joan should try to make the fog thin out with her mind. (It is important to note that this imagery was to be used at times when Joan felt bogged down in despair, but not during her anxious moments).

Joan was to record her practice of her relaxing imagery (white light) and to note her responses to the technique. She also recorded the times she used her despairing imagery (black fog) and the extent to which she was able to thin the fog with her mind. The purpose of the exercise was to increase her relaxation and to give her an image of her despair and a means to control it as time went on.

The ‘one step at a time’ goal consisted of Joan taking small steps towards running errands and taking on more of her everyday responsibilities. Her tasks involved the following:

Plan meals for week
Write a grocery list
Go shopping with Kerrie.

Using her relaxation imagery, Joan completed the following graded tasks:

Imagine walking around the shops
Drive with Kerrie to the shop and stay in the car
Walk with Kerrie to the shop door
Walk with Kerrie around the shop for 10 minutes approximately
Start to purchase a small number of items
Complete an entire grocery shopping task

Each week, Joan completed a harder task. It took her only 4 weeks to complete a full shopping trip, although she experienced several occasions of feeling overwhelmed. Each time this occurred she gripped the shopping trolley and imagined the white light. Kerrie encouraged her to breathe deeply and relax. A couple of times, they left the shop (abandoned the trolley) when Joan felt she could not cope. They came back the following day to complete the shopping.

The important thing for Joan was to accept the times when she could not cope. Kerrie proved to be a supportive role model for Joan, helping her to accept her reduced ability to cope by offering encouraging comments and faith that Joan would heal.

Joan applied the graded-task technique to other areas of her life. “C” observed Joan’s increasing attention to self-care and other routines of everyday living.

Final Stages

(Acceptance) Joan’s increasing acceptance of the loss of Kirsten became more obvious with the passing of time. By dealing thoroughly with her despair and grief, she naturally moved on with her life and mourned less and less. After six months, the rewards for both “C” and Joan were evident in her long term improvement and growth.

Joan’s ability to develop goals for herself was greatly improved, as was her motivation. Joan was living independently again and without Kerrie around, she took on more responsibility and began to make plans for her life without Kirsten. Joan’s plans included a number of support mechanisms, as well as long-term goals for herself.

Joan had taken to visiting her daughter’s grave on a monthly basis. During her intense despair, she had been unwilling to venture to the cemetary. Due to her increasing acceptance, she was more inclined to visit and found the visits to be a sad, yet calming experience. The visits allowed her the opportunity to tell Kirsten the things she had left unsaid, and to update her daughter about her life, as she would have when Kirsten was alive. Joan found the visits kept Kirsten’s spirit and memory alive within her.

In these stages, “C” continued using PCT, and incorporated SFT to assist Joan to define her goals. “C” complemented Joan on her inventive ways of honoring her daughter’s memory. “C” was encouraged to see that Joan was actively seeking personal ways to express her grief.

Together, they worked to build Joan’s miracle picture. Joan expressed an interest to honor Kirsten’s life, by writing a book. Joan wanted to combine her own and Kirsten’s journals to recount the significance of her life and death. The process would also be a means to resolve her grief and offer a parting gift to her daughter.

Joan’s miracle picture included redefining her life goals to determine what was important for her. Kirsten’s death, whilst painful, had also brought growth and changes with it, and Joan was increasingly inclined to shed parts of her life that no longer held meaning for her. She threw out material things such as old furniture, files and boxes of junk and mentally discarded the maintenance of acquaintances that she no longer felt obliged to remain in contact with.

She renewed her bonds with close friends and family. Kirsten’s death allowed her family to grow closer to one another. Joan was buoyed by the love and support of these few, special people during her long months of despair.

Joan accepted that she would never completely ‘get over’ Kirsten’s death and that that was okay. Counselling assisted her to realise that her daughter would remain a part of her forever. She made a pledge to herself that she would continue to learn ways to live with Kirsten’s absence. Her journal writings and the possibility of publishing a book for Kirsten, would provide her with some therapeutic means of coping and expressing her grief. Joan would also draw from the support of her family and friends in times of need, particularly around the times of Kirsten’s birthday and the anniversary of her death.

End of Session

The case study has illustrated some of the stages that clients may experience due to the loss of a loved one. It has also attempted to demonstrate the way in which PCT lent itself to the complex and individual experience of Joan. The key issue from the PCT perspective was “C’s” respect for Joan to grieve and grow to acceptance in her own way and time.

CBT was applied to changing Joan’s negative thoughts about her ability to cope with her daughter’s loss and the fear of losing control of her emotions in public places. The imagery was a technique that Joan had prior experience with and was therefore ideal for her. Another client, may prefer other relaxation methods. It is important to identify strategies that the client is comfortable with.

Graded task assignments, journal writing, role plays, homework and other practical strategies such as developing support networks are also invaluable CBT techniques. Timing is important when introducing strategies, and the client should not be pushed into solutions before they are ready to accept them. Wherever possible, the counsellor should consult with the client about their ideas for, and their suitability to, particular techniques.

Once the client is ready to focus on solutions to their problems, SFT can be an invaluable tool for identifying the client’s goals through development of the miracle picture. The use of SFT has been briefly presented in the case of Joan, to illustrate its effectiveness in drawing out the plans and goals that Joan aspired to.

Author: Jane Barry

Related Case Studies: A Case of Grief and Loss , A Person Centred Approach to Grief and Loss , A Case of Acceptance and Letting Go

March 15, 2007
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Case Study , CBT , Person-centred , Solution-focused
Case Studies , Loss & Grief

Man or bear? Hypothetical question sparks conversation about women's safety

Women explain why they would feel safer encountering a bear in the forest than a man they didn't know. the hypothetical has sparked a broader discussion about why women fear men..

If you were alone in the woods, would you rather encounter a bear or a man? Answers to that hypothetical question have sparked a debate about why the vast majority say they would feel more comfortable choosing a bear.

The topic has been hotly discussed for weeks as men and women chimed in with their thoughts all over social media.

Screenshot HQ , a TikTok account, started the conversation, asking a group of women whether they would rather run into a man they didn't know or a bear in the forest. Out of the seven women interviewed for the piece, only one picked a man.

"Bear. Man is scary," one of the women responds.

A number of women echoed the responses given in the original video, writing in the comments that they, too, would pick a bear over a man. The hypothetical has people split, with some expressing their sadness over the state of the world and others cracking jokes. Some men were flabbergasted.

Here's what we know.

A bear is the safer choice, no doubt about it, many say

There were a lot of responses, more than 65,000, under the original post. Many wrote that they understood why the women would choose a bear.

"No one’s gonna ask me if I led the bear on or give me a pamphlet on bear attack prevention tips," @celestiallystunning wrote.

@Brennduhh wrote: "When I die leave my body in the woods, the wolves will be gentler than any man."

"I know a bear's intentions," another woman wrote. "I don't know a man's intentions. no matter how nice they are."

Other TikTok users took it one step further, posing the hypothetical question to loved ones. Meredith Steele, who goes by @babiesofsteele , asked her husband last week whether he would rather have their daughter encounter a bear or a man in the woods. Her husband said he "didn't like either option" but said he was leaning toward the bear.

"Maybe it's a friendly bear," he says.

Diana, another TikTok user , asked her sister-in-law what she would choose and was left speechless.

"I asked her the question, you know, just for giggles. She was like, 'You know, I would rather it be a bear because if the bear attacks me, and I make it out of the woods, everybody’s gonna believe me and have sympathy for me," she said. "But if a man attacks me and I make it out, I’m gonna spend my whole life trying to get people to believe me and have sympathy for me.'"

Bear vs. man debate stirs the pot, woman and some men at odds

The hypothetical has caused some tension, with some women arguing that men will never truly understand what it's like to be a woman or the inherent dangers at play.

Social media users answered this question for themselves, producing memes, spoken word poetry and skits in the days and weeks since.

So, what would you choose?

A truck is parked along a highway covered by floodwater.

Houston’s flood problems offer lessons for cities trying to adapt to a changing climate

Professor Emeritus of Climate and Space Sciences and Engineering, University of Michigan

Disclosure statement

Richard Rood receives funding from the National Oceanographic and Atmospheric Administration and the National Science Foundation. He is a co-principal investigator at the Great Lakes Integrated Sciences and Assessment Center at the University of Michigan.

University of Michigan provides funding as a founding partner of The Conversation US.

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Scenes from the Houston area looked like the aftermath of a hurricane in early May after a series of powerful storms flooded highways and neighborhoods and sent rivers over their banks north of the city.

Hundreds of people had to be rescued from homes, rooftops and cars, according to The Associated Press. Huntsville registered nearly 20 inches of rain from April 29 to May 4, 2024.

Floods are complex events, and they are about more than just heavy rain. Each community has its own unique geography and climate that can exacerbate flooding. On top of those risks, extreme downpours are becoming more common as global temperatures rise.

I work with a center at the University of Michigan that helps communities turn climate knowledge into projects that can reduce the harm of future climate disasters. Flooding events like the Houston area experienced provide case studies that can help cities everywhere manage the increasing risk.

A man works on the engine of a truck while standing in floodwater over his ankles outside a home.

Flood risks are rising

The first thing recent floods tell us is that the climate is changing.

In the past, it might have made sense to consider a flood a rare and random event – communities could just build back. But the statistical distribution of weather events and natural disasters is shifting.

What might have been a 1-in-500-years event may become a 1-in-100-years event , on the way to becoming a 1-in-50-years event. When Hurricane Harvey hit Texas in 2017, it delivered Houston’s third 500-year flood in the span of three years.

Basic physics points to the rising risks: Global greenhouse gas emissions are increasing global average temperatures. Warming leads to increasing precipitation and more intense downpours, and increased flood potential, particularly when storms hit on already saturated ground.

Communities aren’t prepared

Recent floods are also revealing vulnerabilities in how communities are designed and managed.

Pavement is a major contributor to urban flooding, because water cannot be absorbed and it runs off quickly. The Houston area’s frequent flooding illustrates the risks. Its impervious surfaces expanded by 386 square miles between 1997 and 2017, according to data collected by Rice University . More streets, parking lots and buildings meant more standing water with fewer places for rainwater to sink in.

If the infrastructure is well designed and maintained, flood damage can be greatly reduced. However, increasingly, researchers have found that the engineering specifications for drainage pipes and other infrastructure are no longer adequate to handle the increasing severity of storms and amounts of precipitation. This can lead to roads being washed out and communities being cut off . Failures in maintaining infrastructure, such as levees and storm drains, are a common contributor to flooding.

In the Houston area, reservoirs are also an essential part of flood management, and many were at capacity from persistent rain. This forced managers to release more water when the storms hit.

For a coastal metropolis such as the Houston-Galveston area, rapidly rising sea levels can also reduce the downstream capacity to manage water. These different factors compound to increase flooding risk and highlight the need to not only move water but to find safe places to store it.

Maps show how risk of extreme precipitation increased in some regions, particularly the Northeast and Southeast, and projections of increasing rainfall.

The increasing risks affect not only engineering standards, but zoning laws that govern where homes can be built and building codes that describe minimum standards for safety, as well as permitting and environmental regulations.

By addressing these issues now, communities can anticipate and avoid damage rather than only reacting when it’s too late.

Four lessons from case studies

The many effects associated with flooding show why a holistic approach to planning for climate change is necessary, and what communities can learn from one another. For example, case studies show that:

Floods can damage resources that are essential in flood recovery, such as roads, bridges and hospitals . Considering future risks when determining where and how to build these resources enhances the ability to recover from future disasters . Jackson, Mississippi’s water treatment plant was knocked offline by flooding in 2022, leaving people without safe running water. Houston’s Texas Medical Center famously prepared to manage future flooding by installing floodgates, elevating backup generators and taking other steps after heavy damage during Tropical Storm Allison in 2001.

Flood damage does not occur in isolation. Downpours can trigger mudslides , make sewers more vulnerable and turn manufacturing facilities into toxic contamination risks . These can become broad-scale dangers, extending far beyond individual communities.

A man in a boat peers under sheeting along a level. The river side is higher than the dry side across the levee.

It is difficult for an individual or a community to take on even the technical aspects of flood preparation alone – there is too much interconnectedness. Protective measures like levees or channels might protect one neighborhood but worsen the flood risk downstream . Planners should identify the appropriate regional scale, such as the entire drainage basin of a creek or river, and form important relationships early in the planning process.

Natural disasters and the ways communities respond to them can also amplify disparities in wealth and resources. Social justice and ethical considerations need to be brought into planning at the beginning.

Learning to manage complexity

In communities that my colleagues and I have worked with , we have found an increasing awareness of the challenges of climate change and rising flood risks.

In most cases, local officials’ initial instinct has been to protect property and persist without changing where people live. However, that might only buy time for some areas before people will have little option but to move .

When they examine their vulnerabilities, many of these communities have started to recognize the interconnectedness of zoning, storm drains and parks that can absorb runoff, for example. They also begin to see the importance of engaging regional stakeholders to avoid fragmented efforts to adapt that could worsen conditions for neighboring areas.

This is an updated version of an article originally published Aug. 25, 2022 .

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Writing a Counselling Case Study • Counselling Tutor
For example, the ABC Level 4 Diploma in Therapeutic Counselling requires you to write two case studies as part of your external portfolio, to meet the following criteria: 4.2 Analyse the application of your own theoretical approach to your work with one client over a minimum of six sessions. 4.3 Evaluate the application of your own theoretical ...
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Writing case studies for research, publication and professional development within the counselling professions Context This resource is one of a suite prepared by BACP to enable members to engage with the Ethical Framework for the Counselling Professions (BACP, 2018) in respect of writing case studies. Using Fact Sheet resources
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Get your FREE 5 Tips on writing a counselling case study PDF Handout HERE https://lynxshort.com/CasestudyWriting a Counselling Case StudyAs a counselling st...
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10.07.2022. 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 ...
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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.
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Writing a Counselling Case Study

Before You Start Writing a Case Study

Selecting the Client

Opening the Case Study

Free Handout Download

Describing the Client’s Counselling Journey

Theory-Based Case Studies

Supervision-Based Case Studies

Closing Your Case Study

Person-Centered Therapy Case Study: Examples and Analysis

Introduction

Understanding Person-Centered Therapy

Case Study Examples

Case Study 2: Healing from Trauma

Case Study 3: Enhancing Self-Esteem

Analysis of Person-Centered Therapy

Client-Centered Approach

Empowering Self-Awareness and Growth

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What Is a Case Study?

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At a Glance

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Case Study Examples

Section 1: A Case History

Section 2: Treatment Plan

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How to write counseling case studies

1. Read your assignment and the case description carefully

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

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

4. Read additional resources (optional)

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

6. Formulate a diagnosis for the client.

7. Outline the developmental context of the problem.

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

9. Add reflections on the therapeutic process.

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

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How to write a case conceptualization: An outline

Sample #1: Conceptualization for CBT case

Sample #2: Conceptualization for DBT case

Sample #3: Conceptualization in a family therapy case

Introduction to case conceptualization – Thomas Field

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Man or bear? Hypothetical question sparks conversation about women's safety

A bear is the safer choice, no doubt about it, many say

Bear vs. man debate stirs the pot, woman and some men at odds

Houston’s flood problems offer lessons for cities trying to adapt to a changing climate