Case Example: Jill, a 32-year-old Afghanistan War Veteran
This case example explains how Jill's therapist used a cognitive intervention with a written worksheet as a starting point for engaging in Socratic dialogue.
About this Example
Jill, a 32-year-old Afghanistan war veteran, had been experiencing PTSD symptoms for more than five years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED) while driving a combat supply truck. Over the years, Jill became increasingly depressed and began using alcohol on a daily basis to help assuage her PTSD symptoms. She had difficulties in her employment, missing many days of work, and she reported feeling disconnected and numb around her husband and children. In addition to a range of other PTSD symptoms, Jill had a recurring nightmare of the event in which she was the leader of a convoy and her lead truck broke down. She waved the second truck forward, the truck that hit the IED, while she and her fellow service members on the first truck worked feverishly to repair it. Consistent with the traumatic event, her nightmare included images of her and the service members on the first truck smiling and waving at those on the second truck, and the service members on the second truck making fun of the broken truck and their efforts to fix it — “Look at that piece of junk truck — good luck getting that clunker fixed.”
After a thorough assessment of her PTSD and comorbid symptoms, psychoeducation about PTSD symptoms, and a rationale for using trauma focused cognitive interventions, Jill received 10 sessions of cognitive therapy for PTSD. She was first assigned cognitive worksheets to begin self-monitoring events, her thoughts about these events, and consequent feelings. These worksheets were used to sensitize Jill to the types of cognitions that she was having about current day events and to appraisals that she had about the explosion. For example, one of the thoughts she recorded related to the explosion was, “I should have had them wait and not had them go on.” She recorded her related feeling to be guilt. Jill’s therapist used this worksheet as a starting point for engaging in Socratic dialogue, as shown in the following example:
Therapist: Jill, do you mind if I ask you a few questions about this thought that you noticed, “I should have had them wait and not had them go on?”
Therapist: Can you tell me what the protocol tells you to do in a situation in which a truck breaks down during a convoy?
Client: You want to get the truck repaired as soon as possible, because the point of a convoy is to keep the trucks moving so that you aren’t sitting ducks.
Therapist: The truck that broke down was the lead truck that you were on. What is the protocol in that case?
Client: The protocol says to wave the other trucks through and keep them moving so that you don’t have multiple trucks just sitting there together more vulnerable.
Therapist: Okay. That’s helpful for me to understand. In light of the protocol you just described and the reasons for it, why do you think you should have had the second truck wait and not had them go on?
Client: If I hadn’t have waved them through and told them to carry on, this wouldn’t have happened. It is my fault that they died. (Begins to cry)
Therapist: (Pause) It is certainly sad that they died. (Pause) However, I want us to think through the idea that you should have had them wait and not had them go on, and consequently that it was your fault. (Pause) If you think back about what you knew at the time — not what you know now 5 years after the outcome — did you see anything that looked like a possible explosive device when you were scanning the road as the original lead truck?
Client: No. Prior to the truck breaking down, there was nothing that we noticed. It was an area of Iraq that could be dangerous, but there hadn’t been much insurgent activity in the days and weeks prior to it happening.
Therapist: Okay. So, prior to the explosion, you hadn’t seen anything suspicious.
Therapist: When the second truck took over as the lead truck, what was their responsibility and what was your responsibility at that point?
Client: The next truck that Mike and my other friends were on essentially became the lead truck, and I was responsible for trying to get my truck moving again so that we weren’t in danger.
Therapist: Okay. In that scenario then, would it be Mike and the others’ jobs to be scanning the environment ahead for potential dangers?
Client: Yes, but I should have been able to see and warn them.
Therapist: Before we determine that, how far ahead of you were Mike and the others when the explosion occurred?
Client: Oh (pause), probably 200 yards?
Therapist: 200 yards—that’s two football fields’ worth of distance, right?
Therapist: You’ll have to educate me. Are there explosive devices that you wouldn’t be able to detect 200 yards ahead?
Therapist: How about explosive devices that you might not see 10 yards ahead?
Client: Sure. If they are really good, you wouldn’t see them at all.
Therapist: So, in light of the facts that you didn’t see anything at the time when you waved them through at 200 yards behind and that they obviously didn’t see anything 10 yards ahead before they hit the explosion, and that protocol would call for you preventing another danger of being sitting ducks, help me understand why you wouldn’t have waved them through at that time? Again, based on what you knew at the time?
Client: (Quietly) I hadn’t thought about the fact that Mike and the others obviously didn’t see the device at 10 yards, as you say, or they would have probably done something else. (Pause) Also, when you say that we were trying to prevent another danger at the time of being “sitting ducks,” it makes me feel better about waving them through.
Therapist: Can you describe the type of emotion you have when you say, “It makes me feel better?”
Client: I guess I feel less guilty.
Therapist: That makes sense to me. As we go back and more accurately see the reality of what was really going on at the time of this explosion, it is important to notice that it makes you feel better emotionally. (Pause) In fact, I was wondering if you had ever considered that, in this situation, you actually did exactly what you were supposed to do and that something worse could have happened had you chosen to make them wait?
Client: No. I haven’t thought about that.
Therapist: Obviously this was an area that insurgents were active in if they were planting explosives. Is it possible that it could have gone down worse had you chosen not to follow protocol and send them through?
Client: Hmmm. I hadn’t thought about that either.
Therapist: That’s okay. Many people don’t think through what could have happened if they had chosen an alternative course of action at the time or they assume that there would have only been positive outcomes if they had done something different. I call it “happily ever after” thinking — assuming that a different action would have resulted in a positive outcome. (Pause) When you think, “I did a good job following protocol in a stressful situation that may have prevented more harm from happening,” how does that make you feel?
Client: It definitely makes me feel less guilty.
Therapist: I’m wondering if there is any pride that you might feel?
Client: Hmmm...I don’t know if I can go that far.
Therapist: What do you mean?
Client: It seems wrong to feel pride when my friends died.
Therapist: Is it possible to feel both pride and sadness in this situation? (Pause) Do you think Mike would hold it against you for feeling pride, as well as sadness for his and others’ losses?
Client: Mike wouldn’t hold it against me. In fact, he’d probably reassure me that I did a good job.
Therapist: (Pause) That seems really important for you to remember. It may be helpful to remind yourself of what you have discovered today, because you have some habits in thinking about this event in a particular way. We are also going to be doing some practice assignments that will help to walk you through your thoughts about what happened during this event, help you to remember what you knew at the time, and remind you how different thoughts can result in different feelings about what happened.
Client: I actually feel a bit better after this conversation.
Another thought that Jill described in relation to the traumatic event was, “I should have seen the explosion was going to happen to prevent my friends from dying.” Her related feelings were guilt and self-directed anger. The therapist used this thought to introduce the cognitive intervention of "challenging thoughts" and provided a worksheet for practice. The therapist first provided education about the different types of thinking errors, including habitual thinking, all-or-none thinking, taking things out of context, overestimating probabilities, and emotional reasoning, as well as discussing other important factors, such as gathering evidence for and against the thought, evaluating the source of the information, and focusing on irrelevant factors.
More specifically, Jill noted that she experienced 100 percent intensity of guilt and 75 percent intensity of anger at herself in relation to the thought "I should have seen the explosive device to prevent my friends from dying." She posed several challenging questions, including the notion that improvised explosive devices are meant to be concealed, that she is the source of the information (because others don't blame her), and that her feelings are not based on facts (i.e., she feels guilt and therefore must be guilty). She came up with the alternative thought, "The best explosive devices aren't seen and Mike (driver of the second truck) was a good soldier. If he saw something he would stopped or tried to evade it," which she rated as 90 percent confidence in believing. She consequently believed her original thought 10 percent, and re-rated her emotions as only 10 percent guilt and 5 percent anger at self.
Treating PTSD with cognitive-behavioral therapies: Interventions that work
This case example is reprinted with permission from: Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive-behavioral therapies: Interventions that work . Washington, DC: American Psychological Association.
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What Is a Case Study?
An in-depth study of one person, group, or event
Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.
Cara Lustik is a fact-checker and copywriter.
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Benefits and Limitations
Types of case studies, how to write a 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 various fields, including psychology, medicine, education, anthropology, political science, and social work.
The purpose 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, it is important to follow the rules of APA format .
A case study can have both 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 to impossible to replicate in a lab. Some other benefits of a case study:
- Allows researchers to collect a great deal of information
- Give researchers the chance to collect information on rare or unusual cases
- Permits researchers to develop hypotheses that can be explored in experimental research
On the negative side, a case study:
- Cannot necessarily be generalized to the larger population
- Cannot demonstrate cause and effect
- May not be scientifically rigorous
- Can lead to bias
Researchers may choose to perform a case study if they are interested in exploring a unique or recently discovered phenomenon. The insights gained from such research can help the researchers develop additional ideas and study questions that might be explored in future studies.
However, it is important to remember that the insights gained 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 the use of 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 could be taught even after critical periods for language development had been missed. 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 had denied her the opportunity to learn language at critical points in her development.
This is clearly not something that researchers could ethically replicate, but conducting a case study on Genie allowed researchers the chance to study phenomena that are otherwise impossible to reproduce.
There are a few different types of case studies that psychologists and other researchers might utilize:
- 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 living 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 cast 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 utilize depends on the unique characteristics of the situation as well as the case itself.
There are also different methods that can be used to conduct a case study, including prospective and retrospective case study methods.
Prospective case study methods are those in which an individual or group of people is observed in order to determine outcomes. For example, a group of individuals might be watched over an extended period of time to observe the progression of a particular disease.
Retrospective case study methods involve looking at historical information. For example, researchers might start with an outcome, such as a disease, and then work their way backward to look at information about the individual's life to determine risk factors that may have contributed to the onset of the illness.
Where to Find Data
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.
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?
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, 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 .
A Word From Verywell
Case studies can be a useful research tool, but they need to be used wisely. In many cases, they are best utilized in situations where conducting an experiment would be difficult or impossible. They are helpful for looking at unique situations and allow researchers to gather a great deal of information about a specific individual or group of people.
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 that you are required to follow. If you are writing your case study for professional publication, be sure to check with the publisher for their specific guidelines for submitting a case study.
Simply Psychology. Case Study Method .
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 Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.
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I would not exchange or trade the honor and privilege I have had helping individuals, couples and families since 1987. Along this journey, I experienced many situations of success and seeing people grow and share their positive outcomes.
Below you will find a sample of cases where a client has given me permission to share their experience. Identifying information has been changed to protect confidentiality.
Dr. Chen is a good therapist. He has helped me clarify perceptions that have blocked my growth and development. I have been able to resolve the feelings that have grown from the misperceptions. In counseling, I have learned new attitudes and language to help improve my marriage and family relationships. The barriers I have built up over the years are being removed. This process takes a long time, but I think it has moved at an appropriate pace. Other counselors have taken much longer to help me even begin the healing process. I have made great progress while working with Dr. Chen.
Dear Dr. Chen,
I am writing to express my appreciation for your knowledge and understanding in helping us deal with our teenager’s issues. We were very distraught when we learned about our child’s problems. As with any parent, we were concerned for our child and feared for the worst. We didn’t know what to expect or how to help our child.
Your extensive knowledge and expertise helped us understand what was going on and provided comfort and reassurance. Your expertise and ability to relate to our situation helped us get through a very difficult time.
Thank you for the competence and calm demeanor you displayed as you helped reassure us during this critical time. I firmly believe that others facing similar problems would greatly benefit from your services.
Thanks again, Bruce L.
After suffering with trichotillomania for 15 years, I felt trapped by my constant urges to pull my hair. 3 weeks after seeking professional help from you, I was able to greatly reduce the amount I pulled my hair. By using the tools I learned in therapy, I can go several days at a time without pulling and am continually improving.
Thank you! Kelsey
Not long ago a client (Alan) came in seeking help for drug and alcohol abuse. He was in his mid 30’s and had been using marijuana, cocaine and methamphetamine since his late teenage years. He started drinking alcohol before he was a teenager.
Alan finished high school and began working in retail. He changed jobs or was fired every couple years but was able to work his way up into a manager position. He was married and had three children. His drinking had a negative impact on his family and occasionally he yelled at his wife and kids. Often he spent time by himself at home watching T.V. or surfing on the Internet.
He wasn’t very satisfied at work and occasionally got into arguments with his assistant manager. During therapy, it became evident that Alan used drugs and alcohol to cover up his feelings of anger, frustration and at times low self-esteem.
He was able to learn new coping skills and reduce his use of drugs and alcohol. His marriage improved and he enjoyed his kids more. Even his relationship with his assistant manager improved.
Cathy had been married for 14 years to her high school sweetheart. Things started out good but as their family grew to four children the first five years, their marital relationship gradually deteriorated. Her husband, a sales manager traveled almost every week. When he was home, he tended to ignore her and the kids.
Cathy would occupy herself with housework, church duties and helping neighbors and other relatives. Most people thought Cathy had a good marriage, but inside she felt empty and trapped.
Feelings of frustration and anger would occasionally rise to the surface, but most of the time she just kept it all inside.
When Cathy started therapy, she had just discovered her husband had an addiction to pornography. She was surprised, hurt, angry and didn’t know whether she wanted to stay in the marriage or leave. She was concerned about the kids.
The therapy focused on a pattern of behavior called co-dependency. Cathy discovered that her husband was in many ways like her father, who was an alcoholic. She tried to control her family growing up and now she was trying to control her husband.
Gradually Cathy developed a healthy mental separation from her husband and as she began to get healthy, her husband admitted he had a problem with pornography and decided to get help himself.
Ann was in her late 20’s and had been working in a secretarial position since graduating from high school. She was nervous and anxious most of the time. She rarely dated but desperately wanted to get married.
However, Ann was afraid to socialize and had few friends. Most evenings she would read a book at home or talk on the phone to her parents or other relatives.
By the time Ann came to therapy, she had begun to have panic attacks and at times she thought she might die. Therapy began by exploring why Ann was not dating. It was discovered that she had been sexually abused by a baby sitter when she was 7 years old. This abuse continued over a two year period. She had never told her parents. Later she was also sexually abused by an uncle.
Ann had strong feelings of anger toward men but also wanted to develop a relationship with a man and eventually get married. Her feelings of ambivalence had developed into anxiety which lead her to isolate and avoid men.
During therapy Ann was able to work through the trauma of the two different periods of sexual abuse. Her anxiety disappeared and then therapy focused on helping her develop appropriate social skills. Ann began dating and recently became engaged.
Donna was in her mid 40’s, a typical mother of 4 children, married for over 16 years and active in the community and church.}
She had her first depression with the birth of her first child, and her family doctor prescribed an anti-depressant.
Her husband was supportive and made a decent income, yet money always seemed tight. It was a challenge taking each of the four children to music lessons, dance, football practice and the like, not to mention all the church activities.
Donna never felt like there was any time for herself. In fact, if she did take time to do something she enjoyed, she felt guilty.
She tried to talk to her church leader once, but that didn’t seem to help. She knew there were other women who were depressed and taking medication, but she still felt like no one understood what she was going through.
When she finally came to therapy, she felt hopeless but wanted to change her life. In therapy, she learned to develop some positive thinking skills, not just think happy thoughts, but really challenge some of her long held beliefs that kept her from finding the peace and happiness she knew she had always sought.
She began to enjoy life more and her husband even commented how much happier she seemed. The best compliment was from one of her children who said “mommy, you don’t seem like you’re mad at me anymore”. Donna almost cried. The mixture of joy and sadness she had; joy that she could connect better to her husband and children, and sadness that she hadn’t sought help sooner.
Tom was in his late 40’s and ready for a new challenge in his life. He had worked in the computer industry for over 20 years and was recently let go from one of the major computer companies.
He first got into the computer industry because it was exciting and new developments were happening all the time. But over the years he became upset by the lack of loyalty that large companies showed their employees.
This was the third time he was a “victim” of a downsizing and he was ready to bail out of computers. But he didn’t have a clue what to do.
When Tom came to career counseling, the first question he asked was “What else am I good at?” He took a battery of assessments and found that he had natural abilities in the science and technology areas. The more he explored, the more interested he became in fixing scientific devices. He enrolled in a course designed to help technicians fix medical devices.
During this course he met another entrepreneur and together they developed a business plan. Tom had found a new challenge and was ready to move forward.
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Over the last fifty years the fabric of our society has been stretched, twisted and patched to the extent that not much remains of the organisational structure that defined the relationships of our parents and grandparents. When it comes to relationships- anything goes! »
Listening: The Key to Effective Communication
Communication breakdown in relationships has reached epidemic proportions. Couples are very busy. In most cases both partners work; they have children to raise; and family and friends to attend to. They are always in a hurry. In the Rush that has become their life, they find that they haven’t got the time to listen and to respond to each other. Before they know it they have stopped communicating a... »
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Counselling Client Case Study – Jamie
Presenting with anxiety, panic attacks and negative rumination.
In this counselling client case study we are discussing Jamie.
He presented experiencing several severe debilitating panic attacks.
This appears to have been triggered by entering a committed relationship with a man he really liked.
Triggering his fear around attachment.
He also presented with negative narratives around the future. Negative rumination around relationships and career.
As well as mild performance anxiety.
Counselling Client Case Study Client Details
Jamie is 30 years old.
He is a white gay male of Latino decent.
He is in a new intimate relationship that has been in play for roughly six months.
He lives with three other flatmates and works in the banking sector.
He enjoys travel, cycling and culture.
How Many Sessions with the Client
I completed six sessions with Jamie with no missed sessions. He was referred via his GP.
Jamie arrived on time, he was well presented and friendly.
He Stood tall and had an air of confidence about him.
English was not his first language, but his spoken English was of professional level and he articulated well.
He was out of breath and red faced due to cycling to the appointment.
Counselling Client Case Study Client’s Personal History
Jamie is originally of Latino decent.
He has one sister who is three years older than him.
He stated he had a close relationship with his family.
He went to an all-boys boarding school as a child and only returned home on weekends
He is an out homosexual male, and in a committed relationship for the past six months.
His experience of relationships has been quite negative and sees them as difficult to manage.
Several of his previous boyfriends have left him for another man.
Leading to fears this will happen again unless he understands why.
He said he is very image conscious and strives to look at his best always.
Ascetics are especially important to him he told me.
Counselling Client Case Study Modality and Relevance
During the counselling sessions I worked in an integrative way.
Drawing upon my modality of a person centred and psychodynamic therapeutic frameworks.
This meant attending to Jamie by using active listening skills.
As well as demonstrating my acceptance and approval of Jamie as a person regardless of his behaviour.
I strived to demonstrate this to him by using ongoing communication of respect, empathic understanding and genuineness.
My reactions all aimed at helping my client feel safe in our sessions.
These skills are central to the counselling relationship.
In our case this resulted in a strong therapeutic alliance developing.
More importantly they demonstrated the powerful use of the core conditions for self-actualisation throughout our therapy.
As Jamie presented with anxiety, panic attacks and fear based future projection.
Using an integrative approach that uses interventions such as exploring the presenting problems origins in the room.
Allowing Jamie’s past to pinpoint through exploration of his early developmental failures.
As well as uncover what was unconscious before therapy began.
Thereby enabling us to make them conscious again.
More importantly allowing us to challenge and revisit old traumas in the here and now.
This insight is vital to the therapeutic process and allowed me to help my client become consciously aware of the developmental failures he experienced as a child.
Then how they are still impacting upon him today.
By using an integrative approach this is beneficial as it is a framework as it focuses on stages and strategies
As well as the skills required skills to continue to work with what is being presented outside of the counselling room.
Counselling Client Case Study How did I work with the client?
Jamie attended six sessions of counselling and arrived on time for each session.
At the beginning of counselling he reported worry and anxiety around his relationship stemming from trust.
Most of this worry was future focused and mainly involved topics of his relationship, as well as work and career.
Many of his worries involved ruminations of his past relationships.
He was concerned with how his anxiety and fear of another panic attack were affecting his ability to concentrate at work.
As we entered the beginning stage of the counselling process.
I needed to establish a working relationship with Jamie.
To do this I needed to clarify his presenting problems as well as negotiate our contract together.
I clarified the presenting problem using exploration and active listening.
This meant helping Jamie to communicate his concerns.
Thus helping us both gain clarity and then arriving at a shared understanding of the nature of his dilemma.
As we only had six sessions together we needed to prioritise and focus the presenting problems.
Then work out what was more of a priority over the others.
I achieved this by encouraging Jamie to write down all the things that were worrying him.
Then together we explored each presenting problem, and gave it a priority number.
In our initial sessions our main aim was to develop a therapeutic alliance.
I did this by getting to know Jamie and attending to him.
Working in a integrative way we explored Jamie’s anxiety, and when he first remembered experiencing both anxiety and panic attacks.
Through exploration and self-awareness, we were able to isolate when in his past this anxiety began.
Jamie remembered this happening for the first time at school age, around 6 years old.
I was able to link this back to the developmental theories of Erik Erickson’s eight stages on man.
I believed that Jamie’s failure to navigate successfully through Erickson’s industry versus inferiority crisis stage.
This had a majorly impacted his self-worth today.
This was due to him feeling unable to connect with other children at school as he didn’t enjoy football.
Leading to isolation in the playground.
That combined with not feeling he could seek comfort from his mother, resulted in his anxious ambivalent attachment.
I believed it was very important that I worked in a reparative way, as when looking at Jamie’s past I understood this was something he felt was lacking from his mother.
I did this by offering him comforting energy and support when exploring these past unconscious memories.
There was some erotic transference at this stage of therapy.
However, I did not have time to explore that with Jamie or make use of this as our time together was too short.
Through my interventions I helped Jamie reveal some unconscious memories offering him the insight into his present condition.
It then became clear to him he was mostly operating from an external locus of evaluation.
His self-worth was based on his ability to be desirable to others and needed external validation.
As he had told me a few of his previous partners had left him for another man.
I helped him through conscious awareness to be able to connect those dots and become aware how this has impacted his self-worth considerably.
This being the main contributing factor to his fear based future projections, within his current relationship.
There were many times in our initials sessions that I observed confusion relating to his emotions as well as his emotional needs.
As this stood out, I used immediacy to relate this to Jamie so we agreed that a goal of our time together would be to work on his emotional awareness when making life choices moving forward.
I also observed Jamie repeatedly utilising the defence mechanism of intellectualisation as well as suppression to avoid vulnerability, Jamie was thinking his feelings rather than feeling his feelings.
We also agreed that some psycho education on defences would be incorporated into our time together.
Lastly to help counter Jamie’s future focused negative thinking we would incorporate mindfulness techniques to enable his to be more in touch with his present experiences and how he was feeling.
To enable me to work effectively with his defences.
I spend time additionally researching online effective therapeutic interventions, especially around the areas of intellectualisation.
As well as working with common mental health problems, along with some simple mindfulness techniques Jamie could adopt.
All of this would not have been possible without first developing our strong therapeutic alliance.
I did this through active listening and being non-judgmental, as well as demonstrating my acceptance of Jamie as a person through my communication of respect, empathic understanding and genuineness.
The skills required at the heart of the counselling relationship resulted in the effectiveness and therapeutic change.
As this was built on a foundation of trust, and containment, change was explored by Jamie.
Through this exploration, as well as challenging Jamie to look at different and more enabling perspectives on his future focused thinking, and ruminations of his past.
Jamie was able to bring into his conscious awareness how he had made some choices in his life to manage his emotions to avoid anxiety.
By seeing how those choices were in fact contradictory to what was important to him.
Plus they did not meet his emotional needs.
Counselling Client Case Stud y: Interventions
I introduced to him to the practice of mindfulness, that could help to increase his awareness of his internal experiences, as well as his reactions to those experiences.
We also conducted a value and emotional needs workshop.
Within this we listed on paper together Jamie’ core values, as well as how his current choices impact upon those values.
The goal of this task was to enable Jamie more awareness of his core values, as well as what his emotional needs.
Until now he intellectualised away from the importance of his needs to supress any anxiety, this defence was no longer supressing his emnotions and now leading to panic attacks.
As Jamie was an intellectual man I was able to introduce psycho education as an intervention around defence mechanisms.
This resonated well and achieved the goal of a higher awareness of his use of them.
Understanding further what was a healthy use of defence and what was seen as pathological.
As we entered the ending stage the main aims are to decide on appropriate change, and what change is possible, as well as the particular outcome Jamie wanted.
Jamie had set several goals for himself outside the therapy room, so we took time to evaluate.
For the actions that had been successful I celebrated those to reinforce Jamie’s sense of achievement.
A number of goals did go to plan.
So we used that as an opportunity for Jamie to identify what had gone wrong, and we were able to explore some minor adjustments that needed to be made,
We then reviewed our time together and I was sure to allow Jamie the full time of our last session to celebrate success, express any anxieties about change.
As well as any sadness or loss that our relationship was coming to an end.
A few of our session did go over time slightly as we were closing out.
As Jamie was my last client of the day this did not present any major challenges.
I observed that when this did happen it was mainly down to the fact; we were discussing sensitive material and I wanted to ensure Jamie was safe to leave the therapy room.
How did I make use of Supervision?
I used supervision to discuss the erotic transference, as well as Jamie’s resistance around being ambivalent in his previous relationships.
And if that had any role to play in those partners leaving him.
I was advised to allow the erotic transference to be in the room and to be mindful of giving Simon a positive ending experience of our therapeutic relationship.
This was to counter the past negative experiences he had encountered with his ex-partners.
After a number of discussions with my peers and supervisors.
It was deemed best to leave the challenge on his responsible role in those past relationship as I didn’t have enough time to really work through this with him.
Reflection on quality of the relationship
Seeing how Jamie progressed throughout our time together and the depth and authenticity I saw in our interactions, confirmed to me that we build a good working relationship.
The erotic transference worked as a positive as I was so aware of it.
I was always conscious to ensure I was not returning any erotic counter transference.
This would have shown Jamie that his value is not only around being desirable as that was not basis of our relationship.
I genuinely liked Jamie and had deep empathy for what he was experiencing.
We worked well together, and I was impressed with his ability to self-actualise within our short time together.
I would have liked to engage in a longer piece of work with Jamie. He still has work to do, but I am grateful I played a part in his journey.
Disclaimer: In the role of counsellor working within my BACP ethical framework, protecting my client’s identity, and maintaining confidentiality is paramount.
For the purpose of this case study.
Jamie, a fictitious name.
His ethnic background has also been changed to keep the identity anonymous.
Detailing only information that meets the requirements of this case study without breaching client confidentiality.
Read Janine’s counselling client case study next.
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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
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.
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.
Counseling Ethics Code: 10 Common Ethical Issues & Studies
Despite their potentially serious consequences, ethical issues are common, and without preparation and reflection, many might be violated unwittingly and with good intentions.
In this article, you’ll learn how to identify and approach a variety of frequently encountered counseling ethical issues, and how a counseling ethics code can be your moral compass.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
This Article Contains:
Counseling & psychotherapy ethics code explained, 7 interesting case studies, 3 common ethical issues & how to resolve them, ethical considerations for group counseling, a take-home message.
Most of us live by a certain set of values that guide our behavior and mark the difference between right and wrong. These values almost certainly influence how you approach your work as a counselor .
Following these values might feel natural and even intuitive, and it might feel as though they don’t warrant closer examination. However, when practicing counseling or psychotherapy, working without a defined counseling code of ethics is a bit like sailing a ship without using a compass. You might trust your intuitive sense of direction, but more often than not, you’ll end up miles off course.
Fortunately, there are a variety of professional organizations that have published frameworks to help counselors navigate the challenging and disorienting landscape of ethics.
Members of these organizations are often recommended or required to adhere to a framework, so if you belong to one of them and you’re not familiar with their respective code of ethics, this should be your first port of call. However, these ethical frameworks are also often available online for anyone to read, and so you don’t need to join an organization to adhere to its principles.
Each organization takes a slightly different approach to their code of ethics, so you may find it useful to view several to find one that resonates best with your practice. As an example, the British Association of Counselling and Psychotherapy (2018) has a framework that emphasizes aspiring to a variety of different values and personal moral qualities.
Those values include protecting clients, improving the wellbeing and relationships of others, appreciating the diversity of perspectives, and honoring personal integrity. Personal moral qualities include courage, empathy , humility, and respect.
These values and qualities are not meant to be strict criteria, and there is no wholly objective way to interpret them. For example, two counselors might display the same legitimate values and qualities while arriving at different conclusions to an ethical problem. Instead, they reflect a general approach to how a counselor should think about ethics.
Nevertheless, this approach to ethics may be overly prescriptive for you, in which case a looser and more general framework may be better suited to the nature of your practice. Most professional organizations recognize this, and there is a set of foundational principles that feature widely across different frameworks and refine the collection of different values and qualities described above into simpler terms.
These principles are autonomy , beneficence, non-maleficence, fidelity, justice, veracity, and self-respect (American Counseling Association, 2014; British Association for Counselling and Psychotherapy, 2018). They are largely consistent across frameworks aside from some minor variations.
- Autonomy is the respect for a client’s free will.
- Beneficence and non-maleficence are the commitment to improve a client’s wellbeing and avoid harming them, respectively.
- Fidelity is honoring professional commitments.
- Veracity is a commitment to the truth.
- Justice is a professional commitment to fair and egalitarian treatment of clients.
- Self-respect is fostering a sense that the counselor is also entitled to self-care and respect.
Putting these principles into practice doesn’t require a detailed framework. Instead, as the British Association for Counselling and Psychotherapy (2018) recommends, you can simply ask yourself, “ Is this decision supported by these principles without contradiction? ” If so, the decision is ethically sound. If not, there may be a potential ethical issue that warrants closer examination.
Regardless of whether you navigate using values, qualities, or principles, it’s important to be prepared for how they might be challenged in practice. As explained above, these are not intended to be strict criteria, and it’s good to foster a healthy amount of flexibility and intuition when applying your ethical framework to real-life situations.
You might also interpret challenges to other principles. There is no correct or incorrect interpretation to any of these cases (Cottone & Tarvydas, 2016; Zur, 2008).
For each, consider where you think the problem lies and how you would respond.
A counselor has been seeing their client for several months to work through substance use issues. A good rapport has been formed, but the client has not complied with meeting goals set during therapy and has not reduced their substance use.
The counselor feels they may benefit from referring the client to a trusted colleague who specializes in helping individuals with substance use issues who are struggling to engage with therapy. The counselor contacts the colleague and arranges an appointment within their client’s schedule.
When the client is informed, the client is upset and does not wish to be seen by the colleague. The counselor replies that rescheduling is not possible, and they should consider the appointment a necessary part of therapy.
A counselor working as part of a university service is assigned a client expressing issues with their body image. The counselor lacks any knowledge in working with these issues, but feels as though they may help the client, given the extent of their experience with other issues.
On reflection, the counselor decides to contact a colleague outside the university service who specializes in body image issues and asks for supervision and advice.
A counselor developing a new exposure-based form of anxiety therapy is working with a client with severe post-traumatic stress. There is promising evidence suggesting the therapy is effective for reducing mild anxiety, but it is unknown whether the therapy is effective in more extreme cases.
As a result, the counselor recognizes that this client in particular would provide a particularly valuable case study for developing the therapy. The counselor recommends this therapy to the client.
A client with a history of depression and suicidal ideation has been engaging successfully with therapy for the last year. However, recently they have experienced an unfortunate coincidence of extremely challenging life events because of their unstable living arrangement.
The counselor has noticed problematic behaviors and thought patterns emerging, and is seriously concerned about the client’s mental health given the history.
In order to have the client moved from their challenging living environment, they decide to recommend that the client be hospitalized for suicidal ideation, despite there being no actual sign of suicidal ideation and their client previously expressing the desire to avoid hospitalization.
A school counselor sees two students who are experiencing stress regarding their final exams. The first is a high-achieving and popular student who is likable, whereas the second is a student with a history of poor attendance and engagement with their education.
The counselor agrees that counseling is appropriate for the first student, but recommends the second student does not attend counseling, instead addressing the “transient” exam stress by directing their energy into “working harder.”
A counselor is assigned a teenage client after both the client and their family consent to therapy for issues with low mood. After the first session together, it is apparent that the client has been withholding information about their mental health from their family and is showing symptoms typical of clinical depression.
The counselor knows that their client is a high-performing student about to enter a prestigious school and that the client’s family has high hopes for the future. The counselor reassures the family that there is no cause for serious concern in order to protect them from facing the negative implications of the client’s condition.
A counselor is working with a client who is a professional massage therapist. The client offers a free massage therapy session to the counselor as a gesture of gratitude. The client explains that this is a completely platonic and professional gesture.
The counselor has issues with close contact and also feels as though the client’s gesture may not be entirely platonic. The counselor respectfully declines the offer and suggests they continue their relationship as usual. However, the client discontinues therapy abruptly in response.
Ethical issues do not occur randomly in a vacuum, but in particular situations where various factors make them more likely. As a result, although ethical issues can be challenging to navigate, they are not necessarily difficult to anticipate.
Learning to recognize and foresee common ethical issues may help you remain vigilant and not be taken unaware when encountering them.
Issues of consent are common in therapeutic contexts. The right to informed consent – to know all the pertinent information about a decision before it is made – is a foundational element of the relationship between a counselor and their client that allows the client to engage in their therapy with a sense of autonomy and trust.
In many ways, consent is not difficult at all. Ultimately, your client either does or does not consent. But informed consent can be deceptively difficult.
As a brief exercise, consider what “informed” means to you. What is the threshold for being informed? Is there a threshold? Is it more important to be informed about some aspects of a choice than others? These questions do not necessarily have a clearcut answer, but nevertheless it is important to consider them carefully. They may determine whether or not your client has given sufficient consent (West, 2002).
A related but distinct challenge to informed consent is that it is inherently subjective. For example, your client may have as much knowledge about a decision as you do and feel as though they fully understand what a decision entails. However, while you have both experience and knowledge of the decision, they only have knowledge.
That is to say, to some extent, it is not possible for your client to be informed about something they have not actually experienced, as their anticipated experience based on their knowledge may be wholly different from their actual experience.
The best resolution to these issues is to avoid treating informed consent like a checkbox that needs to be satisfied, where the client is required to ingest information and then give their consent.
Instead, encourage your client to appreciate the importance of their consent, reflect on their decision, and consider the limitations of their experience. In doing so, while they may not be able to become fully informed in an objective sense, they will achieve the nearest approximation.
Termination of therapy
Another time of friction when ethical issues can surface is at the conclusion of therapy , when the counselor and client go their separate ways. When this termination is premature or happens without a successful resolution of the client’s goals, it is understandable why this time is difficult.
This can be a challenging transition even when therapy is concluded after a successful result. Like any relationship, the one between a counselor and client can become strained when the time comes for it to end.
Your client may feel uncertain about their ability to continue independently or may feel rejected when reminded of the ultimately professional and transactional nature of the relationship (Etherington & Bridges, 2011).
A basic preemptive action that can be taken to reduce the friction between you and your client during this time is ‘pre-termination counseling,’ in which the topic of termination is explicitly addressed and discussed.
This can be anything from a brief conversation during one of the concluding appointments, to a more formal exploration of termination as a concept. Regardless, this can give your client the opportunity to acclimatize and highlight any challenges related to termination that may be important to explore before the conclusion of therapy.
These challenges may involve features of your client’s background such as their attachment history, which may predispose them toward feelings of abandonment, or their experience of anxiety, which may influence their perceived ability to cope independently after therapy.
If you already have knowledge of these features of your client’s background, it may be worth considering these potential challenges well in advance of the termination of therapy.
Remote forms of therapy are becoming increasingly common. This has many obvious benefits for clients and counselors alike; counseling is more accessible than ever, and counselors can offer their services to a broad and diverse audience. However, online counseling is also fraught with commonly encountered ethical issues (Finn & Barak, 2010).
As remote practice frequently takes place outside the structured contexts more typical of traditional counseling, ethical issues commonly encountered in online counseling are rooted in this relative informality.
Online counseling lacks the type of dedicated ethical frameworks described above, which means e-counselors may have no choice but to operate using their own ethical compass or apply ethical frameworks used in traditional counseling that may be less appropriate for remote practice.
Research suggests that some online counselors may not consider the unique challenges of working online (Finn & Barak, 2010). For example, online counselors may feel as though they do not have the same responsibility for mandatory reporting, as their relationship with their clients may not be as directly involved as in traditional counseling.
For online counselors who are aware of their duty to report safeguarding concerns, the inherent anonymity of online clients may present a barrier. Anonymity certainly has the benefit of improved discretion, but it also means a counselor may be unable to identify their client if they feel they are threatened or otherwise endangered.
Online counselors may also be unclear regarding the limits of their jurisdiction, as qualifications or professional memberships attained in one region may not be applicable in others. It can often seem like borders do not exist online, and while to some extent this is true, it is important to respect that jurisdictions exist for a reason, and it may be unethical to take on a client who you are not licensed to work with.
If you work as an e-counselor, the best way to resolve or preemptively prepare for these issues is to acknowledge they exist and engage with them. A good place to start may be to develop a personal framework for your practice that has a plan for issues of anonymity and confidentiality, and includes an indication of how you will report safeguarding concerns.
In a group setting, clients may no longer feel estranged from society or alone in their challenges, and instead view themselves as part of a community of people with shared experiences.
Clients may benefit from insights generated by other group members, and for some individuals, group counseling may literally amplify the benefits of a one-to-one approach.
However, group settings can also bring unique ethical issues. Just as some groups can bring out the best in us, and a therapeutic context can foster shared insights, other groups can become toxic and create a space in which counter-therapeutic behaviors are enabled by the implicit or explicit encouragement of other group members.
Similarly, just as some group leaders can inspire others and foster a productive community, it is also all too easy for group leaders to become victims of their status.
This is true for any relationship in which there is an inherent imbalance of power, such as traditional one-to-one practice, but in a group context, the counselor is naturally invested with a greater magnitude of influence and responsibility. This can lead to the judgment of the counselor becoming warped and increase the risk of overstepping ethical boundaries (Mashinter, 2020).
As a group counselor, first and foremost, you should foster a diligent practice of self-reflection to ensure you are mindful of the actions you take and remain alert to any blind spots in your judgment.
If possible, it may also be useful to examine ethical issues related to your authority by referring to another authority, in the form of supervision with one of your colleagues.
Finally, to prevent counter-therapeutic dynamics from developing within your group of clients, it may be useful to develop a clear code of conduct that emphasizes a commitment to group beneficence through mutual respect (Marson & McKinney, 2019).
Take a structured approach to preparing for and dealing with ethical issues, whether this is referring to a framework published by a professional organization or simply navigating by a set of core values.
Prepare for the most common types of ethical issues, while also keeping an open mind to the often complex nature of ethics in practice, as well as the specific ethical issues that may be unique to your practice. Case studies can be a useful tool for doing this.
If in doubt, refer to these five steps from Dhai and McQuiod-Mason (2010):
- Formulate the problem.
- Gather information.
- Consult authoritative sources.
- Consider the alternatives.
- Make an ethical assessment.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .
- American Counseling Association. (2014). Ethical & professional standards . Retrieved July 22, 2021, from https://www.counseling.org/knowledge-center/ethics
- British Association for Counselling and Psychotherapy. (2018). BACP ethical framework for the counselling professions . Retrieved from https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/
- Cottone, R., & Tarvydas, V. (2016). Ethics and decision making in counseling and psychotherapy . Springer.
- Dhai, A., & McQuoid-Mason, D. J. (2010). Bioethics, human rights and health law: Principles and practice . Juta and Company.
- Etherington, K., & Bridges, N. (2011). Narrative case study research: On endings and six session reviews. Counseling and Psychotherapy Research , 11 (1), 11–22.
- Finn, J., & Barak, A. (2010). A descriptive study of e-counselor attitudes, ethics, and practice. Counseling and Psychotherapy Research , 10 (4), 268–277.
- Marson, S. M., & McKinney, R. E. (2019). The Routledge handbook of social work ethics and values . Routledge.
- Mashinter, P. (2020). Is group therapy effective? BU Journal of Graduate Studies in Education , 12 (2), 33–36.
- West, W. (2002). Some ethical dilemmas in counseling and counseling research. British Journal of Guidance & Counselling , 30 (3), 261–268.
- Zur, O. (2008). Bartering in psychotherapy & counseling: Complexities, case studies and guidelines. New Therapist , 58 , 18–26.
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Person-Centered Therapy Case Study: Examples and Analysis
By: Tasha Kolesnikova
What Is Person-Centered Therapy?
5 characteristics of the fully functioning person, causes of incongruence, person-centered therapy in practice, person-centered case study, person-centered treatment plan.
Person-centered therapy, also known as client-centered therapy or Rogerian therapy, is a form of psychotherapy developed by prominent American psychologist Carl Rogers throughout the 1940s to the 1980s. This type of therapy is a humanistic approach and was seen as revolutionary as most psychotherapies before its emergence was based on behaviorist and psychodynamic approaches. The humanistic approach directly contradicts and contrasts core techniques and models of other approaches that were commonly used at the time.
Nowadays, the fundamental modalities of person-centered therapy are widely used in modern counseling practices in combination with other techniques and therapies. Rogers is often considered the father of all humanistic schools of therapy, as many new therapies have since stemmed from his work.
Students can use this article as a resource to help them with an academic essay about person-centered therapy.
Person-centered therapy focuses on facilitating self-actualization . The therapy is built upon the fundamental ideology that human beings have an innate desire and ability to be the best they can be and live happy, fulfilling lives. An individual must set their own goals, and proceed to approach them in their own way. Once these goals have been met, self-actualization is also achieved and, as a result, they will become a fully functioning person .
It also promotes the notion that all individuals have the ability to cope with their problems and possess the potential for change. These abilities are unique to each individual, and therefore, everyone has the power to formulate appropriate solutions to help themselves navigate and manage their lives.
Positive growth can be achieved when an individual has positive regard for themselves and from others. Once optimal levels are reached, the individual will become fully functioning. Under this self-concept, it is believed that every individual has:
- the capacity for self-awareness
- the need for meaning in their life
- the need for balancing freedom and responsibility
The key part of the person-centered approach is to assist individuals in self-discovery and self-acceptance by providing sufficient conditions that help resolve incongruence between themselves and their experiences.
According to Rogers, a fully functioning person has the following five characteristics:
- They are open to new experiences , both positive and negative. They accept that life can sometimes be painful, but they have healthy abilities to cope and learn from them.
- They are mindful and focus on present experiences without preconceptions from previous experiences. They do not dwell on the past or obsess about the future.
- They are aware of and attentive to facts , feelings, and gut reactions . Unity of all three allows them to be true to themselves and thus have the confidence to make the right decisions. If the wrong choice is made, they will be able to accept it and learn from it.
- They are willing to take risks and be adaptive . They will seize healthy and appropriate opportunities for growth.
- They have a sense of contentment and a desire for new challenges and experiences.
Each of these characteristics is achieved through congruence of the self.
An individual tends to struggle with becoming a fully functional person, mostly due to incongruence. Incongruence is usually caused by encountering conditional worth or conditional love at some point, often during childhood.
If love and worth are dependent on meeting specific expectations and withdrawn when these expectations were not met, the individual will suffer from anxiety. This anxiety leads to a feeling of the unified self-being under attack. To relieve this anxiety, the individual will engage in detrimental methods such as denial and defensiveness.
Another cause is frustrated basic impulses that lead to negative feelings and poor social skills.
Individuals receiving person-centered therapy are referred to as clients rather than patients. This is in line with the overall concept that therapy is a shared journey between two people rather than the therapist or counselor treating or giving the advice to solve problems. The client is regarded as the expert of themselves and has all the answers to their own problems required within them.
Sufficient core conditions required for therapeutic change under person-centered therapy are outlined as follows:
- Psychological contact - a mutually respectful relationship between the counselor and patient must exist, where both parties feel equally important.
- Client incongruence – the client must experience distress caused by incongruence between their experiences and awareness. They are vulnerable and or anxious.
- Therapist congruence or genuineness – sometimes referred to as being authentic. The therapist must be aware of their active participation and be deeply involved, becoming congruent with the therapeutic relationship.
- Therapist unconditional positive regard – the therapist or counselor must have a non-judgmental stance, so the counselor does not impose any conditions of worth.
- Therapist empathy – the therapist or counselor must effectively and accurately communicate their empathic understanding of the client's frame of reference. Presenting problems from another perspective can also help the client gain a new point of view to solving them.
- Client perception – the client must perceive and appreciate this empathy and acceptance from their therapist or counselor and develop positive self-regard to a minimal degree.
It is interesting to note that Rogers viewed both approval and disapproval shown towards an individual to be disruptive to therapeutic change. The role of the therapist is to provide a caring and accepting environment conducive to giving clients the freedom to explore areas of their lives in ways they were previously denied or distorted.
Unlike other therapies, Person-centered therapy does not have many set techniques. This Is because therapy sessions are largely directed by the individual. The counselor's or therapist's job is to create a safe environment that facilitates congruence and form a therapeutic alliance with the individual.
Because of this, a defining technique used during person-centered therapy is non-directiveness . This is achieved by:
- giving no advice
- asking no questions
- giving no interpretations
- allowing clients to set their own goals
Another technique used during therapy sessions is active listening . This is achieved by:
It was theorized that the client will initially be closed, not open to experiences, and have little to no self-awareness. But once therapy is completed, all these obstacles will be addressed and reversed due to gaining positive self-regard.
There are many advantages in the techniques used during person-centered therapy. However, some concerns have also been raised about the approach:
- Non-directiveness - idea of non-directiveness has been largely debated. Some have argued that therapy by nature will always be directed in some capacity. Furthermore, bias can never be completely eliminated. Therefore, unconscious or unintentional bias can cause direction.
- Inefficient – person-centered therapy can take an unnecessarily long time due to the lack of structure and non-directiveness. For fear of intervening with progress, therapists may deliberately withhold solutions or advice from a client, and it may take longer than necessary to reach that solution, if at all.
- Frustration – being non-direct can understandably cause frustration in some clients who may be seeking advice or opinions.
- Disorder specific – Rogers originally claimed that Person-centered therapy could treat all mental health disorders, but research has shown this is not the case.
Jane's phenomenological worldview causes her to be incongruent with her true self and what she believed is expected of her. Expectations imposed upon her are unrealistically high, and fear of not meeting those standards has caused her incongruent distress. Subsequently, this has created a condition for her self-worth.
These expectations are a direct result of traumatic stress stemming from culture, religion, and loved ones. In her phenomenological world, she will never be good enough as a daughter, mother, wife, Catholic, or accountant. She feels she constantly lets everyone down and can never gain approval from those whose opinions she cares about.
Trying harder to please and meet everyone's expectations takes her further away from wholeness and true self-worth. She has lost confidence in her ability to make good decisions and constantly seeks outside direction on how she should act. This low self-esteem will hinder any feelings of success and satisfaction.
She is aware that how she handles situations as it stands is not working but fails to see the situation from another perspective or figure out new solutions.
This is a classic example of a client that may benefit from person-centered therapy. We can understand that although Jane feels these pressures of meeting rejection and disapproval, she still has the potential for self-actualization.
This is evidenced by her independent decisions of marrying a spouse outside her religion and studying accountancy against her family's wishes. The act of seeking therapy confirms her desire for growth and change for a better life.
Jane has risen above adversity on multiple occasions in life. She has achieved academically, personally, and professionally but the lack of caring relationships has distorted her ability to recognize and accept her success and potential. This has deterred her from achieving higher levels of self-actualization. Jane must take new risks to attain the growth she seeks.
For treatment to be effective, the core conditions must be met. The formulation was as follows:
- Undertaking person-centered therapy, the therapist will provide an optimal therapeutic environment where her actualizing tendencies can flourish.
- Through active listening and empathy, the therapist and Jane will build a trusting therapeutic alliance and further clarify her thoughts and feelings. Being able to work out problems and breaking them down, Jane will no longer view them as insurmountable as she did before.
- Unconditional positive regard will install confidence in Jane as a competent person capable of making decisions and problem solving on her own. By increasing trust in herself, she reduces the control others have over her and will begin to believe in her own self-worth.
- Consistency and genuine rapport between Jane and the counselor will allow her to feel that the ideas and actions developed during sessions are authentic, dependable, and can be replicated outside in the real world.
- Jane's newfound view of the world will lead to her trying out new approaches to problems. She will continue to report back on her progress in integrating these new approaches. She will eventually come to recognize that she is capable of independently achieving success and overcoming failure.
- Jane will continue these practices until she has reached self-actualization and becomes a fully functional person.
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Therapy Case Studies Samples For Students
119 samples of this type
Do you feel the need to check out some previously written Case Studies on Therapy before you start writing an own piece? In this open-access directory of Therapy Case Study examples, you are provided with an exciting opportunity to explore meaningful topics, content structuring techniques, text flow, formatting styles, and other academically acclaimed writing practices. Using them while crafting your own Therapy Case Study will definitely allow you to finish the piece faster.
Presenting the finest samples isn't the only way our free essays service can help students in their writing endeavors – our experts can also compose from scratch a fully customized Case Study on Therapy that would make a strong foundation for your own academic work.
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Alberto, age 55, was brought to the emergency department of a regional medical center by his brother-in-law. Alberto is pacing, demanding, agitated, and speaking vociferously. “I did not wish to come here! My brother-in-law is simply jealous and he is trying to make me appear like I am suffering from some sort of insanity!” Alberto’s treatment is financially subsidized by his brother in law. Alberto will undergo a maximum of 8 sessions at 2 hours each session. The session will start on June 25, 2014.
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Insecurity is the evident point in this case study. The best way to address this issue is by using a comprehensive approach. The therapist should consider the multidimensional elements in the problem and should give emphasize to the wellness or quality of life by considering the spiritual, psychological and the emotional aspects of the patient.
Chronic Back Pain Case Study
This is a common type of musculoskeletal disorder that affects people at some stage in life. According to the medical researchers, it affects nearly 80% of all the people in their life time. Precisely, the chronic pain is that which lasts for more than 12 weeks. It has been scientifically found out that the chronic back pain is caused by the benign musculoskeletal problems which results from either the sprain or strain of the muscles or soft tissues of the body. This may cause pain to the spine particularly in cases where the back is physically downloaded.
Chronic pain is bad because it negatively affects people in many ways:
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Ben Sanderson (Cage) is a screenwriter with the Hollywood, a US Movie industry. He is overly dependent on the consumption of alcohol to an extent that it has adversely affected his social and work-related functions and his family life.
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There are different ways to handle medical, surgical and post surgical cases and especially when it comes to nursing, the application of concepts may remain the same however there is a lot of difference in the application of concepts from person to person. We will look at the case study related to endocrine/metabolic system, for Mr.Jenaro and will analyze the situation according to the data available.
Borderline Personality Disorder Case Study
Borderline personality disorder: case study.
Karen was admitted in the intensive care unit of West Raymond medical Center after she knowingly took an overdose of sedatives in addition to alcohol in a suicide attempt following a disagreement with her man.
Case Study On John Bio Psychosocial Profile 4
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Initial interview 4 Assessment formulation methods utilized 4 Assessment of John presenting problems and goals 5 Analysis and critique of MMT approach 6 Agreed goals 6 Treatment plan 6 CBT interventions 7 Intervention for cognitions-thoughts records 7 Benefits of the approach 7 Interventions for behavior- activity scheduling/diversion techniques 8 Benefits of the approach/ interaction 8 Interventions for imagery/interpersonal- imagery based exposure 8 Benefit of approach 9 Intervention for sensation- relaxation/ visualization 10 Conclusion 11
APPENDIX 1 13
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Questions: Describe how burn wounds are classified. Identify and describe Mr. Angelo’s burn injuries. Burn wounds are classified using four degrees that are based on the severity of how many layers of the dermis have been damaged; the higher the degree of burn classification, the more severe the burn injury and damage done to the patients skin and body. In the case of Mr. Angelo’s burn injuries, he sustains both 2nd and 1st degree burns covering approximately 40 percent of his body.
Explain the “rule of nines” used in assessment of burn injury.
Good case study on nutritional care plan for an older adult.
Nutrition is an indispensable component of care. It is from food intake that the body obtains the micro and macro nutrients needed to maintain and improve health. Diet is also an area of regulation for the management of chronic diseases such as diabetes. Care plans focused on nutrition necessarily must be individualized to take into account unique needs arising from specific medical conditions, the client’s developmental stage, and cultural preferences. Developing a care plan entails evaluating for nutritional risk, defining the goals of nutrition therapy, identifying interventions and expected outcomes, implementing the interventions, providing education, and promoting safety.
Evaluation of Nutritional Risk
Case study on clients background summary.
50 Years Old Widow and Its Effects on Her Well Being 50 Years Old Widow and Its Effects on Her Well Being
Introduction to the Theoretical Model
Epidemiology/ etiology case study example, case study on alteration in comfort pain.
Pain: State in which the individual experiences and communicates the presence of severe discomfort or an uncomfortable feeling.
Related factors: Pain resulting from musculoskeletal disorder; in this case, osteoarthritis; immobility
Features: Verbal communication of pain descriptors, level 8-9 pain reported by patient
Evidence: Mrs. Hardy experiences great knee pain when climbing stairs, a symptom associated with her osteoarthritis. Osteoarthritis cannot be cured, but pain can be controlled.
Sample Case Study On PTSD Research Paper
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Case Study On Nursing Cancer Care
Caner care and the complications of chemotherapy have always created concerns in the nursing profession. Arguments have been that these complications are preventable since evidence based research has discovered strategies to limit burns and other adverse effects of the treatment. The following pages of this document present a case study of a patient suffering from chemotherapy complication. A synthesis of evidence based research interventions that have been recommended as prophylactic measures will be advanced as an appropriate nursing care is designed for this patient.
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Her problem of Hypertension was diagnosed almost 6 years ago when her blood pressure remained consistently on the higher side on 4 consecutive visits to the clinic. It was consistently high in the range of 160/90 mmHg. Almost a year ago, she was also detected with microalbuminuria during her annual screening of urine. At that time, 1,943 mg/dl of microalbumin was detected in her urine sample.
She has come to the clinic today for her regular checkup and follows up visit for the diabetes and hypertension. She is a house wife. And has three children.
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Person Centred Counselling Case Study Example
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Description of the Presenting Problem
Intervention, roger’s core conditions.
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Egan’s Helping Model
- The Current Picture – where am I now?
- The Preferred Picture – where do I want to be?
- The Way Forward – how do I get there?
Improvements and Changes
- Corey, G. (2009). Theory and Practice of Counselling and Psychotherapy. Belmont: Thomson/Brooks Cole.
- Egan, G. (2007). The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping 8th ed. Pacific Grove: Brooks/Cole.
- Geldard, D. & Geldard, K. (2005). Basic Personal Counselling 5th ed. Frenchs Forest: Pearson Education Australia.
- Kottler, J.A. (2004). Introduction to Therapeutic Counselling 5th ed. Frenchs Forest: Pearson Education Australia.
- Myers, D. (1986). Psychology. New York: Worth Publishers Inc.
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Case Study Research: In Counselling and Psychotherapy
- By: John McLeod
- Publisher: SAGE Publications Ltd
- Publication year: 2010
- Online pub date: December 20, 2013
- Discipline: Counseling and Psychotherapy
- Methods: Case study research , Narrative research , Single cases
- DOI: https:// doi. org/10.4135/9781446287897
- Keywords: clients , counseling research , knowledge , outcomes , persons , psychotherapy , publications Show all Show less
- Print ISBN: 9781849208055
- Online ISBN: 9781446287897
- Buy the book icon link
Case-based knowledge forms an essential element of the evidence base for counselling and psychotherapy practice. This book provides the reader with a unique introduction to the conceptual and practical tools required to conduct high quality case study research that is grounded in their own therapy practice or training. Drawing on real-life cases at the heart of counselling and psychotherapy practice, John McLeod makes complex debates and concepts engaging and accessible for the trainees and practitioners at all levels, and from all theoretical orientations. Key topics covered in the book include: the role of case studies in the development of theory, practice and policy in counselling and psychotherapy; strategies for responding to moral and ethical issues in therapy case study research; practical tools for collecting case data; ‘how-to-do-it’ guides for carrying out different types of case study; team-based case study research for practitioners and students; questions, issues and challenges that may have been raised for readers through their study.
Concrete examples, points for reflection and discussion, and recommendations for further reading will enable readers to use the book as a basis for carrying out their own case investigation.
All trainees in counselling, psychotherapy and clinical psychology are required to complete case reports, and this is the only textbook to cover the topic in real depth. The book will also be valuable to people who intend to use existing case studies to inform their practice, and it will help experienced practitioners to generate publishable case reports.
- Praise for the Book
- Chapter 1 | The Role of Case Studies in the Development of Theory and Practice in Counselling and Psychotherapy
- Chapter 2 | The Development of Systematic Methods and Principles for Collecting and Analysing Case Material
- Chapter 3 | Justifying Case-Based Research: The Role of Systematic Case Studies in Building an Evidence Base for Therapy Policy and Practice
- Chapter 4 | Moral and Ethical Issues in Therapy Case Study Research
- Chapter 5 | Collecting and Analysing Case Material: A Practitioner and Student Toolkit
- Chapter 6 | Documenting Everyday Therapeutic Practice: Pragmatic Case Studies
- Chapter 7 | Evaluating the Effectiveness of Therapy: N=1 Time-Series Case Studies
- Chapter 8 | Using Multiple Judges in Evaluating the Effectiveness of Therapy: The Hermeneutic Single Case Efficacy Design (HSCED)
- Chapter 9 | Theory-Building Case Studies
- Chapter 10 | Exploring the Meaning of the Therapy Experience: Narrative Case Research
- Chapter 11 | Team-Based Case Study Research for Practitioners and Students
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Recent Client Work
Site: www.rezaahmadtherapy.com It was a pleasure to discuss my website with you, I felt you were very professional and a good listener. See full case study
Case Examples Examples of recommended interventions in the treatment of depression across the lifespan. Children/Adolescents Cognitive-behavioral therapy A 15-year-old Puerto Rican female The adolescent was previously diagnosed with major depressive disorder and treated intermittently with supportive psychotherapy and antidepressants.
Counselling Client Case Study - Assessment Janine seems unaware as to why her current issues with conflict anxiety and parental confidence come from. I believe this could be related to trauma from her parents fighting. And the latter is due to the lack of her own experiencing of a nurturing parent as a child.
The following samples can be taken as basic templates for case conceptualization, in the context of Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and family therapy. Sample #1: Conceptualization for CBT case This is a 35-year-old Caucasian man referred by his physician for treatment of generalized anxiety.
For example, one of the thoughts she recorded related to the explosion was, "I should have had them wait and not had them go on." She recorded her related feeling to be guilt. Jill's therapist used this worksheet as a starting point for engaging in Socratic dialogue, as shown in the following example:
Counselling Case Study: Using REBT Thomas is a 33 year old married man, who has recently become a father. He explains that he feels his self-esteem has been gradually deteriorating ever since he was married. He says that he can't find reasons to enjoy life with his wife due to feelings of inadequacy as a husband. In his new role […]
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.
NCMHCE Sample Case Study Part One Intake Client Age: 35 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: White Relationship Status: Single, Divorced Counseling Setting: Agency Types of Counseling: Individual Provisional Diagnosis: Major depressive disorder, Single episode, Moderate, With anxious distress, Mild: F32.1 Presenting Problem:
Below you will find a sample of cases where a client has given me permission to share their experience. Identifying information has been changed to protect confidentiality. Dr. Chen is a good therapist. He has helped me clarify perceptions that have blocked my growth and development.
Case Studies. A Case Using Brief Psychodynamic Therapy. November 27, 2014. Wendy is a 54 year old woman who has two adult children and has been married for twenty-nine years. Her husband, Steve, has recently and unexpectedly informed her that he no longer loves her and that he wants a divorce. ... Jenny has come to counselling due to strong ...
Counselling Client Case Study Client Details Jamie is 30 years old. He is a white gay male of Latino decent. He is in a new intimate relationship that has been in play for roughly six months. He lives with three other flatmates and works in the banking sector. He enjoys travel, cycling and culture. How Many Sessions with the Client
The case study involves Stephanie, a counseling student, who is currently working through her first internship at a small community agency. Her clinical supervisor, Amber, ... Examples of such potentially injurious information include minors disclosing that they are using controlled substances, engaging in sexual activity, breaking laws, or ...
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.
Case Studies are excellent training and professional development resources. They provide an overview of a 'real life' situation, merging theoretical knowledge and practical elements through a structured narrative. Writing a professional Case Study is not a simple task. It not only requires elevated
For example, two counselors might display the same legitimate values and qualities while arriving at different conclusions to an ethical problem. Instead, they reflect a general approach to how a counselor should think about ethics.
PDF | This is a sample of case presentation. | Find, read and cite all the research you need on ResearchGate
this book are described and illustrated through the case studies. Each case study is unique and distinctive, with each offering a rare opportunity for mental health prac-titioners to get a bird's-eye view of what happens around the world. Therefore, the study of these cases individually and collectively will yield a wealth of information
Person-Centered Case Study Jane's phenomenological worldview causes her to be incongruent with her true self and what she believed is expected of her. Expectations imposed upon her are unrealistically high, and fear of not meeting those standards has caused her incongruent distress. Subsequently, this has created a condition for her self-worth.
Good Example Of Case Study On Aspects Of Contract And Business Law Introduction In the day-to-day running of businesses, the parties that are involved are guided by some kind of law to ensure smooth running of the business. As such, there ought to be an agreement between the parties to the transaction, which in most cases, is binding.
Person Centred Counselling Case Study Example Reference this Share this: Facebook Twitter Reddit LinkedIn WhatsApp Background Information Rose, mother to five year old daughter, appears to be well spoken and articulate. No details in regards to Rose's marital status, work or family apart from her daughter were readily apparent from the session.
Case-based knowledge forms an essential element of the evidence base for counselling and psychotherapy practice. This book provides the reader with a unique introduction to the conceptual and practical tools required to conduct high quality case study research that is grounded in their own therapy practice or training.
At Change Psychology Services. Dr Carie Schuster is a chartered psychologist and EMDR Practitioner, who also uses Cognitive Behavioural Therapy and Mindfulness in clinical practice. She provides psychology services across Dorset, Somerset and Wiltshire. See full case study for this counselling client.