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What Is a Case Study?

Weighing the pros and cons of this method of research

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

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

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

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

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

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

At a Glance

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

What Are the Benefits and Limitations of Case Studies?

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

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

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

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

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

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

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

Case Study Examples

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

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

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

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

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

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

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

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

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

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

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

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

Section 1: A Case History

This section will have the following structure and content:

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

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

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

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

Section 2: Treatment Plan

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

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

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

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

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

Need More Tips?

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

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

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

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

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

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

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

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Case conceptualization: Key to highly effective counseling

By Jon Sperry and Len Sperry

December 2020

I n their first session, the counseling intern learned that Jane’s son had been diagnosed with brain cancer. The therapist then elicited the client’s thoughts and feelings about her son’s diagnosis. Jane expressed feelings of guilt and the thought that if she had done more about the early symptoms, this never would have happened to her son. Hearing this guilt producing thought, the intern spent much of the remaining session disputing it. As the session ended, the client was more despondent.  

After processing this session in supervision, the intern was no longer surprised that Jane had not kept a follow-up appointment. The initial session had occurred near the end of the intern’s second week, and she had been eager to practice cognitive disputation, which she believed was appropriate in this case. In answer to the supervisor’s question of why she had concluded this, the intern responded that “it felt right.”

The supervisor was not surprised by this response because the intern had not developed a case conceptualization. With one, the intern could have anticipated the importance of immediately establishing an effective and collaborative therapeutic alliance and gently processing Jane’s emotional distress sufficiently before dealing with her guilt-producing thought.

This failure to develop an adequate and appropriate case conceptualization is not just a shortcoming of trainees, however. It is also common enough among experienced counselors.

What is case conceptualization?

Basically, a case conceptualization is a process and cognitive map for understanding and explaining a client’s presenting issues and for guiding the counseling process. Case conceptualizations provide counselors with a coherent plan for focusing treatment interventions, including the therapeutic alliance, to increase the likelihood of achieving treatment goals.

We will use the definition from our integrated case conceptualization model to operationalize the term for the purposes of explaining how to utilize this process. Case conceptualization is a method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination.

We believe that case conceptualization is the most important counseling competency besides developing a strong therapeutic alliance. If our belief is correct, why is this competency taught so infrequently in graduate training programs, and why do counselors-in-training struggle to develop this skill? We think that case conceptualization can be taught in graduate training programs and that counselors in the field can develop this competency through ongoing training and deliberate practice.

This article will articulate one method for practicing case conceptualization.

The eight P’s

We use and teach the eight P’s format of case conceptualization because it is brief, quick to learn and easy to use. Students and counselors in the community who have taken our workshops say that the step-by-step format helps guide them in forming a mental picture — a cognitive map — of the client. They say that it also aids them in making decisions about treatment and writing an initial evaluation report.

The format is based on eight elements for articulating and explaining the nature and origins of the client’s presentation and subsequent treatment. These elements are described in terms of eight P’s: presentation, predisposition (including culture), precipitants, protective factors and strengths, pattern, perpetuants, (treatment) plan, and prognosis.

Presentation

Presentation refers to a description of the nature and severity of the client’s clinical presentation. Typically, this includes symptoms, personal concerns and interpersonal conflicts.

Four of the P’s — predisposition, precipitants, pattern and perpetuants — provide a clinically useful explanation for the client’s presenting concern.

Predisposition

Predisposition refers to all factors that render an individual vulnerable to a clinical condition. Predisposing factors usually involve biological, psychological, social and cultural factors.

This statement is influenced by the counselor’s theoretical orientation. The theoretical model espouses a system for understanding the cause of suffering, the development of personality traits, and a process for how change and healing can occur in counseling. We will use a biopsychosocial model in this article because it is the most common model used by mental health providers. The model incorporates a holistic understanding of the client.

Biological: Biological factors include genetic, familial, temperament and medical factors, such as family history of a mental or substance disorder, or a cardiovascular condition such as hypertension.

Psychological: Psychological factors might include dysfunctional beliefs involving inadequacy, perfectionism or overdependence, which further predispose the individual to a medical condition such as coronary artery disease. Psychological factors might also involve limited or exaggerated social skills such as a lack of friendship skills, unassertiveness or overaggressiveness.

Social: Social factors could include early childhood losses, inconsistent parenting style, an overly enmeshed or disengaged family environment, and family values such as competitiveness or criticalness. Financial stressors can further exacerbate a client’s clinical presentations. The “social” element in the biopsychosocial model includes cultural factors. We separate these factors out, however.

Cultural: Of the many cultural factors, three are particularly important in developing effective case conceptualizations: level of acculturation, acculturative stress and acculturation-specific stress. Acculturation is the process of adapting to a culture different from one’s initial culture. Adapting to another culture tends to be stressful, and this is called acculturative stress. Such adaptation is reflected in levels of acculturation that range from low to high.

Generally, clients with a lower level of acculturation experience more distress than those with a higher level of acculturation. Disparity in acculturation levels within a family is noted in conflicts over expectations for language usage, career plans, and adherence to the family’s food choices and rituals. Acculturative stress differs from acculturation-specific stresses such as discrimination, second-language competence and microaggressions.

Precipitants

Precipitants refer to physical, psychological and social stressors that may be causative or coincide with the onset of symptoms or relational conflict. These may include physical stressors such as trauma, pain, medication side effects or withdrawal from an addictive substance. Common psychological stressors involve losses, rejections or disappointments that undermine a sense of personal competence. Social stressors may involve losses or rejections that undermine an individual’s social support and status. Included are the illness, death or hospitalization of a significant other, job demotion, the loss of Social Security disability payments and so on.

Protective factors and strengths

Protective factors are factors that decrease the likelihood of developing a clinical condition. Examples include coping skills, a positive support system, a secure attachment style and the experience of leaving an abusive relationship. It is useful to think of protective factors as being the mirror opposite of risk factors (i.e., factors that increase the likelihood of developing a clinical condition). Some examples of risk factors are early trauma, self-defeating beliefs, abusive relationships, self-harm and suicidal ideation.

Related to protective factors are strengths. These are psychological processes that consistently enable individuals to think and act in ways that benefit themselves and others. Examples of strengths include mindfulness, self-control, resilience and self-confidence. Because professional counseling emphasizes strengths and protective factors, counselors should feel supported in identifying and incorporating these elements in their case conceptualizations.

Pattern (maladaptive)

Pattern refers to the predictable and consistent style or manner in which an individual thinks, feels, acts, copes, and defends the self both in stressful and nonstressful circumstances. It reflects the individual’s baseline functioning. Pattern has physical (e.g., a sedentary and coronary-prone lifestyle), psychological (e.g., dependent personality style or disorder) and social features (e.g., collusion in a relative’s marital problems). Pattern also includes the individual’s functional strengths, which counterbalance dysfunction.

Perpetuants

Perpetuants refer to processes through which an individual’s pattern is reinforced and confirmed by both the individual and the individual’s environment. These processes may be physical, such as impaired immunity or habituation to an addictive substance; psychological, such as losing hope or fearing the consequences of getting well; or social, such as colluding family members or agencies that foster constrained dysfunctional behavior rather than recovery and growth. Sometimes precipitating factors continue and become perpetuants.

Plan (treatment)

Plan refers to a planned treatment intervention, including treatment goals, strategy and methods. It includes clinical decision-making considerations and ethical considerations.

Prognosis refers to the individual’s expected response to treatment. This forecast is based on the mix of risk factors and protective factors, client strengths and readiness for change, and the counselor’s experience and expertise in effecting therapeutic change.  

Case example

To illustrate this process, we will provide a case vignette to help you practice and then apply the case to our eight P’s format. Ready? Let’s give it a shot.

Joyce is a 35-year-old Ph.D. student at an online university. She is white, identifies as heterosexual and reports that she has never been in a love relationship. She is self-referred and is seeking counseling to reduce her chronic anxiety and social anxiety. She recently started a new job at a bookstore — a stressor that brought her to counseling. She reports feeling very anxious when speaking in her online classes and in social settings. She is worried that she will not be able to manage her anxiety at her new job because she will be in a managerial role.

Joyce reports that she has been highly anxious since childhood. She denies past psychological or psychiatric treatment of any kind but reports that she has recently read several self-help books on anxiety. She also manages her stress by spending time with her close friend from class, spending time with her two dogs, drawing and painting. She appears to be highly motivated for counseling and states that her goals for therapy are “to manage and reduce my anxiety, increase my confidence and eventually get in a romantic relationship.”

Joyce describes her childhood as lonely and herself as “an introvert seeking to be an extrovert.” She states that her parents were successful lawyers who valued success, achievement and public recognition. They were highly critical of Joyce when she would struggle with academics or act shy in social situations. As an only child, she often played alone and would spend her free time reading or drawing by herself.

When asked how she views herself and others, Joyce says, “I often don’t feel like I’m good enough and don’t belong. I usually expect people to be self-centered, critical and judgmental.”

Case conceptualization outline

We suggest developing a case conceptualization with an outline of key phrases for each of the eight P’s. Here is what these phrases might look like for Joyce’s case. These phrases are then woven together into sentences that make up a case conceptualization statement that can be imported into your initial evaluation report.

Presentation: Generalized anxiety symptoms and social anxiety

Precipitant: New job and concerns about managing her anxiety

Pattern (maladaptive): Avoids cl oseness to avoid perceived harm

Predisposition:

• Biological: Paternal history of anxiety
• Psychological: Views herself as inadequate and others as critical; deficits in assertiveness skills, self-soothing skills and relational skills
• Social: Few friends, a history of social anxiety, and parents who were highly successful and critical
• Cultural: No acculturative stress or cultural stressors but from upper-middle-class socioeconomic status, so from privileged background — access to services and resources

Perpetuants: Small support system; believes that she is not competent at work

Protective factors/strengths: Compassionate, creative coping, determined, hardworking, has access to various resources, motivated for counseling

Plan (treatment): Supportive and strengths-based counseling, thought testing, self-monitoring, mindfulness practice, downward arrow technique, coping and relationship skills training, referral for group counseling

Prognosis: Good, given her motivation for treatment and the extent to which her strengths and protective factors are integrated into treatment

Case conceptualization statement

Joyce presents with generalized anxiety symptoms and social anxiety (presentation) . A recent triggering event includes her new job at a local bookstore — she is concerned that she will make errors and will have high levels of anxiety (precipitant) . She presents with an avoidant personality — or attachment — style and typically avoids close relationships. She has one close friend and has never been in a love relationship. She typically moves away from others to avoid being criticized, judged or rejected (pattern) . Some perpetuating factors include her small support system and her belief that she is not competent at work (perpetuants) .

Some of her protective factors and strengths include that she is compassionate, uses art and music to cope with stress, is determined and hardworking, and is collaborative in the therapeutic relationship. Protective factors include that she has a close friend from school, has access to university services such as counseling services and student clubs and organizations, is motivated to engage in counseling, and has health insurance (strengths & protective factors) .

The following biopsychosocial factors attempt to explain Joyce’s anxiety symptoms and avoidant personality style: a paternal history of anxiety (biological) ; she views herself as inadequate and others as critical and judgmental, and she struggles with deficits in assertiveness skills, self-soothing skills and relational skills (psychological) ; she has few friends, a history of social anxiety and parents who were highly successful and critical toward her (social) . Given Joyce’s upper-middle-class upbringing, she was born into a life of opportunity and privilege, so her entitlement of life going in a preferred and comfortable path may also explain her challenges with managing life stress (cultural) .

Besides facilitating a highly supportive, empathic and encouraging counseling relationship, treatment will include psychoeducation skills training to develop assertiveness skills, self-soothing skills and relational skills. These skills will be implemented through modeling, in-session rehearsal and role-play. Her challenges with relationship skills and interpersonal patterns will also be addressed with a referral to a therapy group at the university counseling center. Joyce’s negative self-talk, interpersonal avoidance and anxiety symptoms will be addressed with Socratic questioning, thought testing, self-monitoring, mindfulness practice and the downward arrow technique (plan-treatment) .

The outcome of therapy with Joyce is judged to be good, given her motivation for treatment, if her strengths and protective factors are integrated into the treatment process (prognosis) .

Notice how the treatment plan is targeted at the presenting symptoms and pattern dynamics of Joyce’s case. Each of the eight P’s was identified in the case conceptualization, and you can see the flow of each element and its interconnections to the other elements.

Tips for writing effective case conceptualizations

1) Seek consultation or supervision with a peer or supervisor for feedback on your case conceptualizations. Often, another perspective will help you understand the various elements (eight P’s) that you are trying to conceptualize.

2) Be flexible with your hypotheses and therapeutic guesses when piecing together case conceptualizations. Sometimes your hunches will be accurate, and sometimes you will be way off the mark.

3) Consider asking the client how they would explain their presenting problem. We begin with a question such as, “How might you explain the (symptoms, conflict, etc.) you are experiencing?” The client’s perspective may reveal important predisposing factors and cultural influences as well as their expectations for treatment.

4) Be OK with being imperfect or being completely wrong. This process takes practice, feedback and supervision.

5) After each initial intake or assessment, jot down the presenting dynamics and make some guesses of the cause or etiology of them.

6) Have a solid understanding of at least one theoretical model. Read some of the seminal textbooks or watch counseling theory videos to help you gain a comprehensive assessment of a specific theory. Knowing the foundational ideas of at least one theory will help with your conceptual map of piecing together the information that you’ve gathered about a client.

We realize that putting together case conceptualizations can be a challenge, particularly in the beginning. We hope you will find that this approach works for you. Best wishes!

For more information and ways of learning and using this approach to case conceptualization, check out the recently published second edition of our book, Case Conceptualization: Mastering This Competency With Ease and Confidence .

Jon Sperry is an associate professor of clinical mental health counseling at Lynn University in Florida. He teaches, writes about and researches case conceptualization and conducts workshops on it worldwide. Contact him at [email protected] or visit his website at drjonsperry.com .

Len Sperry is a professor of counselor education at Florida Atlantic University and a fellow of the American Counseling Association. He has long advocated for counselors learning and using case conceptualization, and his research team has completed eight studies on it. Contact him at [email protected] .

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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

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

Courtney Gardner, MSW

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

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

What Is Case Conceptualization?

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

Why Is Case Conceptualization Important to Mental Health Professionals?

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

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How to Write a Case Conceptualization

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

Client Information

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

Theoretical Orientation

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

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

The Eight P’s of Case Conceptualization Framework

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

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Presentation.

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

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

Predisposing Factors

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

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

Precipitating Factors

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

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

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

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

Perpetuating Factors

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

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

Protective Factors and Strengths

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

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

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

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

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What's the likelihood of improvement with treatment?

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

Tips for Mastering Effective Case Conceptualizations

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

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

Focus on the client's strengths.

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

Look for themes and patterns.

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

Consider multiple perspectives.

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

Be flexible.

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

Paint the whole picture.

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

Discuss your conceptualization with colleagues.

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

Continuously evaluate your conceptualization.

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

Review research and theory.

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

Case Conceptualization Template

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

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

Sample Case Conceptualization #1: John

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

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

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

Example of John's Case Conceptualization

I.  Presenting Problem

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

II.  Background Information

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

III.  Psychosocial History

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

IV.  Diagnostic Considerations

• Social Anxiety Disorder
• Persistent Depressive Disorder

V.  Treatment Plan

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

Sample Case Conceptualization #2: Jane

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

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

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

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

Example of Jane's Case Conceptualization

I.  Presenting Complaints

• Relationship issues with husband

II.  History of Presenting Issues

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

IV.  Conceptualization

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

Sample Case Conceptualization #3: Sally

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

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

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

Example of Sally's Case Conceptualization

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

II.  History of the Presenting Problem

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

III.  Relevant Background Information

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

FAQs: Your Top Case Conceptualization Questions Answered

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

How do I get started?

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

What should I include?

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

How often should I update it?

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

Does software help?

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

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

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

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

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

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

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

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

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Doing Research in Counselling and Psychotherapy

Student resources, carrying out a systematic case study.

The key messages of this chapter are:

• case study analysis makes a distinctive contribution to the evidence base for counselling and psychotherapy
• case studies are ethically sensitive, so need to be carried out with care and sensitivity
• it is important to be aware of how different types of research question require different case study approaches.

The following sources are intended to help you to explore issues covered in the chapter in more depth.

Methodological issues and challenges associated with case study research

Flyvbjerg, B. (2006). Five misunderstandings about case-study research . Qualitative Inquiry, 12 , 219 – 245. 

Essential reading – a highly influential paper that clarifies the value of case study methods

Fishman, D. B. (2005). Editor's Introduction to PCSP--From single case to database: a new method for enhancing psychotherapy practice.  Pragmatic Case Studies in Psychotherapy, 1(1), 1 – 50.

The rationale for the pragmatic case study approach

Foster, L.H. (2010). A best kept secret: single-subject research design in counseling.  Counseling Outcome Research and Evaluation,  1, 30 – 39

An accessible and informative introduction to n=1 single subject case study methodology  

McLeod, J. (2013). Increasing the rigor of case study evidence in therapy research.  Pragmatic Case Studies in Psychotherapy, 9 , 382 – 402

Explores further possibilities around the development of case study methodology

Different types of therapy case study

Bloch-Elkouby, S., Eubanks, C. F., Knopf, L., Gorman, B. S., & Muran, J. C. (2019). The difficult task of assessing and interpreting treatment deterioration: an evidence-based case study.  Frontiers in Psychology , 10, 1180. 

Systematic case study that combines qualitative and quantitative information to explore a theoretically-significant case of apparent client deterioration. Case was drawn from dataset of a larger study

Brezinka, V., Mailänder, V., & Walitza, S. (2020). Obsessive compulsive disorder in very young children–a case series from a specialized outpatient clinic.  BMC Psychiatry , 20(1), 1 – 8. 

Example of how a series of n=1 case studies can be used

Faber, J., & Lee, E. (2020). Cognitive-Behavioral Therapy for a refugee mother with depression and anxiety.  Clinical Case Studies , 19(4), 239 – 257.

A hybrid theory-building/pragmatic case study that seeks to develop new understanding of therapy in situations of client-therapist cultural difference. Clinical Case Studies is a major source of case study evidence – this study is a typical example of the kind of work that it publishes  

Gray, M.A. & Stiles, W.B. (2011). Employing a case study in building an Assimilation Theory account of Generalized Anxiety Disorder and its treatment with Cognitive-Behavioral Therapy. Pragmatic Case Studies in Psychotherapy , 7(4), 529 – 557

An example of a theory-building case study focused on the development of the assimilation model of change 

Kramer, U. (2009).  Between manualized treatments and principle-guided psychotherapy: illustration in the case of Caroline.  Pragmatic Case Studies in Psychotherapy , 5(2), 45 – 51

A pragmatic case study that also seeks to address important theoretical issues associated with the use of exposure techniques in CBT

McLeod, J. (2013). Transactional Analysis psychotherapy with a woman suffering from Multiple Sclerosis: a systematic case study.  Transactional Analysis Journal,  43 , 212 – 223.

A hybrid case study – mainly aims to develop a theory of therapy in long-term health conditions, but also includes elements of pragmatic, narrative and HSCED approaches. Good example of the use of the Client Change Interview in case study research

Powell, M.L. and Newgent, R.A. (2010) Improving the empirical credibility of cinematherapy: a single-subject interrupted time-series design.  Counseling Outcome Research  
 and Evaluation , 1, 40 – 49. 

Example of a series of n=1 case studies

Stige, S. H., & Halvorsen, M. S. (2018). From cumulative strain to available resources: a narrative case study of the potential effects of new trauma exposure on recovery.  Illness, Crisis & Loss , 26(4), 270 – 292. 

A narrative case study based on client interviews

Kellett, S., & Stockton, D. (2021). Treatment of obsessive morbid jealousy with cognitive analytic therapy: a mixed-methods quasi-experimental case study.  British Journal of Guidance & Counselling , 1 – 19. 

Example of an n=1 case study of a single case. Useful demonstration of how this approach can be used to study non-behavioural therapy

Wendt, D. C., & Gone, J. P. (2016). Integrating professional and indigenous therapies: An urban American Indian narrative clinical case study.  The Counseling Psychologist , 44(5), 695 – 729. 

A narrative case study based on client interviews 

Werbart, A., Annevall, A., & Hillblom, J. (2019). Successful and less successful psychotherapies compared: three therapists and their six contrasting cases. Frontiers in Psychology . DOI: 10.3389/fpsyg.2019.00816.                  

Combined narrative, theory-building and cross-case analysis, based on interviews with client and therapist dyads

Widdowson, M. (2012). TA treatment of depression: A hermeneutic single-case efficacy design study-case three: 'Tom'.  International Journal of Transactional Analysis Research , 3(2), 15 – 27. 

Example of an HSCED study that also includes elements of theory-building. Supplementary information on journal website includes full details of the Change Interview and judges’ case analyses. This open access journal has also published many other richly-described HSCED studies

Issues and possibilities associated with quasi-judicial methodology

Bohart, A.C., Tallman, K.L., Byock, G.and Mackrill, T. (2011). The “Research Jury” Method: The application of the jury trial model to evaluating the validity of descriptive and causal statements about psychotherapy process and outcome.  Pragmatic Case Studies in Psychotherapy, 7 (1) ,101 – 144. 

Miller, R.B. (2011). Real Clinical Trials (RCT) – Panels of Psychological Inquiry for Transforming anecdotal data into clinical facts and validated judgments: introduction to a pilot test with the Case of “Anna”.  Pragmatic Case Studies in Psychotherapy, 7(1), 6 – 36. 

Stephen, S. and Elliott, R. (2011). Developing the Adjudicated Case Study Method.  Pragmatic Case Studies in Psychotherapy, 7(1), 230 – 224.

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How to write counseling case studies

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

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

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

Your paper should contain three basic sections:

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

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

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

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

1.    Read your assignment and the case description carefully

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

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

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

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

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

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

4.    Read additional resources (optional)

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

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

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

6.    Formulate a diagnosis for the client.

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

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

7.    Outline the developmental context of the problem.

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

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

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

9.    Add reflections on the therapeutic process.

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

Final thoughts

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

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

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Person-Centered Therapy Case Study: Examples and Analysis

Introduction

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

Understanding Person-Centered Therapy

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

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

Case Study Examples

Case study 1: overcoming social anxiety.

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

Case Study 2: Healing from Trauma

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

Case Study 3: Enhancing Self-Esteem

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

Analysis of Person-Centered Therapy

The therapeutic relationship.

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

Client-Centered Approach

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

Empowering Self-Awareness and Growth

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

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

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

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How Do You Write A Client Case Study Counselling

Table of Contents

How do you write a client case study counselling?

Describe the client’s presenting problem and a background to this problem. Take the reader on the client’s therapeutic journey, from start to current status. Relate the case to your therapeutic modality. Identify any common themes and how these relate to the case and how you conducted therapy.

What is a counseling case study?

As this is a very particular type of academic assignment, we created this guide to help you write psychotherapy case studies as a professional. A counseling case study is basically a simulation of your future work as a counselor. You have got a case about a person who has some psychological or mental challenges.

How do you write a case report for counselling?

Writing a good report on a psychotherapy case calls for an integration of the following kinds of material: (1) background information about the case, including relevant case history, presenting problem and diagnosis, (2) the framework of research methodology that will serve as a basis for using the case material to …

What is an example of a case study?

Some famous examples of case studies are John Martin Marlow’s case study on Phineas Gage (the man who had a railway spike through his head) and Sigmund Freud’s case studies, Little Hans and The Rat Man. Case studies are widely used in psychology to provide insight into unusual conditions.

How do you start a case study in counselling?

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.

What is a client case study?

So, What is a Customer Case Study? Customer Case Study can be defined as: A marketing strategy to show the opinions of people that have actually purchased and used the product/service a company offers. It actually works because users will research the company they’re willing to buy the product.

What are the 5 P’s in counselling?

They conceptualized a way to look at clients and their problems, systematically and holistically taking into consideration the (1) Presenting problem, (2) Predisposing factors, (3) Precipitating factors, (4) Perpetuating factors, and (5) Protective factors.

What are the 4 types of case study?

• Descriptive case studies.
• Explanatory case studies.
• Exploratory case reports.
• Intrinsic case studies.
• Instrumental case studies.
• Collective case reports.

How to write a case study PDF?

Write a case study outline. You can use bullet points here. The problem section: In a couple of paragraphs, introduce your client and the challenge they faced. Include quotes if possible. The solution section: Explain why the client chose you, how you approached their problem, and how your service solved it.

What is the difference between counseling and case study?

In counseling, help is provided to the client without social services whereas in casework, administration of services in concrete forms is an essential component of the intervention strategy. An agency setting is not essentially necessary for counseling but casework is always practiced in an agency setting.

What is an example of a client presenting problem?

For example, a person with anxiety who seeks help only when he/she begins having panic attacks conveys to his/her treatment provider that the panic attacks are the most worrisome problem–in this case, panic attacks are the presenting problem.

How do you present a patient case study?

Case Presentation. The case report should be chronological and detail the history, physical findings, and investigations followed by the patient’s course. At this point, you may wish to include more details than you might have time to present, prioritizing the content later.

How to write a good case study?

• Identify your goal. Start by defining exactly who your case study will be designed to help. …
• Choose your client or subject. Who you highlight matters. …
• Conduct research and compile data. …
• Choose the right format. …
• Write your case study. …
• Promote your story.

How do you start a case study example?

• Start with a clear headline. This should be like a newspaper headline that gives the most important information. …
• Provide a snapshot. …
• Introduce the client. …
• State the problem, consequences, & hesitations. …
• Describe the solution. …
• Share the results & benefits. …
• Conclude with words of advice and a CTA.

How is case study written?

• Executive Summary/Synopsis. Introduce the topic area of the report. …
• Introduction. Summarise the your task. …
• Findings. Identify the key problems you have identified by: …
• Discussion. Summarise the major problem(s). …
• Conclusion. …
• Recommendations. …
• References. …
• Appendices (if any)

How do you write a good client case study?

Think of your case study like a story—it needs a beginning, a middle, and an end. Present your client’s problem at the beginning, and fill in the middle with the details of how you solved it. Cap things off with a description of how your client benefited from working with you.

How do you present a case study to a client?

• Introduction.
• Company overview.
• The problem/challenge.
• Your solution.
• Customer quotes/testimonials.
• Next steps.

What is the format of a patient case study?

In a case study, the discussion section should include discussion on the patient’s experience, clinical observations, the patient’s diagnoses (and why those diagnoses are accurate), therapy and treatments (along with an explanation of the pathophysiology of medications and treatments), and a reflection on the patient.

How do you write a case study format example?

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Problem Lists, Case Formulations and Treatment Plans

The basis of the therapeutic approach in CBT is known as ‘ collaborative empiricism ’. In this modality, the therapist is active-directive (in contrast to the non-directive nature of the person-centred approach, for example).

The therapist and the client together look at the client’s present life in a logical way, identifying their thoughts and underlying beliefs.

Socratic Questioning

This process of guided discovery is facilitated by the therapist using Socratic questioning , ‘which is characterised by questions and answers, by reasoning and deduction, and is aimed at discovering the truth’ (Feltham & Dryden, 1993: 179).

Typical questions that the CBT therapist might ask the client during the first (assessment) session include:

• What problem would you like to work on?
• How often do you experience this problem?
• How intense is the problem? (perhaps on a scale of 1 to 10, or 1 to 100)
• What situations/events trigger the problem?
• What effect does the problem have on your work/social/personal life?
• When the problem is triggered, what thoughts or images are you aware of running through your mind? And emotions? And physical sensations?
• What do you do to avoid doing to help you cope with the problem?
• What makes the problem worse? And better?
• What do you think might have initially caused the problem?
• What would you like to achieve through coming to therapy?

Formulations

Case formulation is a framework used by CBT therapists to identify and understand the client’s problems. Case formulations are often presented in a visual format that breaks down the client’s issue into manageable chunks.

The written formulation is shared with the client, so encouraging a solid working alliance and helping the client to feel hope through portraying the problem in context and concisely, with clear explanation of how change is possible.

Many CBT practitioners choose to display the formulation within visibility of both themselves and the client at each session, for easy reference by both.

Some clients might choose to photograph it using their mobile phone, so that they can refer to it between sessions – and possibly share it with loved ones if they wish to do so (so helping the latter to gain insight into the client’s problems – especially useful if the family or ‘system’ around the client is inadvertently helping to maintain the problem).

There is no hard or fast rule about formulations, and there is no rule that states how detailed or complex they should be. The simplest format looks at just three key areas: thoughts, feelings (emotions and physical sensations) and behaviours. Five additional elements are often added to this (referred to as ‘the five Ps’):

• presenting problem(s)
• predisposing factors
• precipitating factors
• perpetuating factors
• protective factors

Presenting Problems

This is what brings the client to therapy. Clients may have specific problems such as depression, low confidence, chronic worry, substance misuse issues, marital difficulties or stress. Other clients may have problems that are less well-defined, such as ‘just wanting to be happy’ or ‘wanting some peace and quiet’.

As clients often present with more than one problem, listing the problems they wish to work on helps to emphasise the importance of collaboration and ensure that the work focuses on areas likely to be clinically productive, and manageable in the time available. This is particularly important when working in a time-limited manner (e.g. with a maximum of six sessions).

It may be possible to reduce what appear to be multiple problems into one key theme – for example, with a client who is struggling with different relationships in their life, it may be possible to spot a key theme/pattern that characterises all these (such as a tendency to overextend themselves with those they love).

When a clear presenting problem has been identified, the therapist can move onto the next stage of the formulation.

Predisposing Factors

This part of the formulation looks at what has happened to the client during their lifetime that makes them susceptible to the problems they now face. For example, have they suffered abuse, trauma, family problems or relationship breakdowns?

Predisposing factors can often be traced back to childhood. These events can lead to negative core beliefs (also known as ‘schemas’) that can cause difficulties in adult life. The idea here is that nothing exists in a vacuum: people’s responses to problems have their roots in past events.

Precipitating Factors

What has happened to trigger the client’s mood state? This is often referred to as the ‘who, what, why, when and how’.

Context plays a pivotal role in behavioural choices, so it is important to understand all these elements in order to build a picture of the client’s problem. Triggers can be anything from family issues, money worries and health concerns.

CBT therapists will often ask clients to complete a mood diary in order to understand the context around any triggers of emotional disturbance.

Perpetuating Factors

What are the cognitive mechanisms and behaviours that are keeping the client locked in their problem?

An example might be a depressed client who avoids social interactions. This avoidance may lead to isolation and loneliness, which bring more depression and more resistance to socialising, and so on.

Are the client’s solutions short-term solutions to problems generating bigger problems long term? What is keeping the client stuck in the here and now?

Protective Factors

Therapists will ask what positives the client has in their lives. What can they draw on that can help them with their problem? Does the client have a good support network? Have they any hobbies or interests? Do they have a sense of humour? They may be asked to complete a wellbeing questionnaire to highlight what is going well for them and what areas they need to work on.

Clients may be asked about their previous coping strategies and how they might employ these to help them deal with current problems. Protective factors are important as they contribute to a client’s overall resilience to problems.

Importance of Flexibility

Beck (2018) states that formulations offer a roadmap to help treat a client’s problems. While roadmaps can get a person from A to B, they cannot tell us about events that may occur along the way, such as traffic jams, accidents or roadworks.

Therapy will present new information; this means that therapists need to be flexible and be constantly reassessing and adjusting the formulation to the individual needs of the client. For example, new insights may be discovered through the therapy sessions and homework.

Treatment Plans

Once a formulation has been developed, the therapist uses this to plan and write up a treatment plan – often in the form of a letter – which can then be presented to the client in their next session. Clients often really appreciate the personalised nature of this, being addressed to them in name and describing in narrative form (and with empathy and UPR) the agreed formulation.

It is important for the therapist to adopt a congruently hopeful tone in this, encouraging the client to see just how feasible it is for the client to effect change now that they are learning about CBT (including receiving psycho-education). This will enable them to become their own therapist over the course of the sessions, so empowering them not only to maintain but also to further build on the positive results.

Free Handout Download

Beck, A. (2018).  Applying the Generic Cognitive Model to Complex Case Formulation . [online] YouTube. Available at: https://www.youtube.com/watch?v=SJ2J9um-nMA [Accessed 16 March 2020]

Feltham C & Dryden W (1993) Dictionary of Counselling , Whurr Publishers

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Case Study Research in Counselling and Psychotherapy

• John McLeod - University of Oslo, Norway
• Description

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.

Comprehensive, passionate, right out at the growing edge of the psychotherapy research and even slightly beyond it, this book maps out where case study research has come from, what it looks like today, and what its future will look like.

Robert Elliott, Professor of Counselling, University of Strathclyde

This is an excellent book that has been needed by the counselling and psychotherapy profession for some considerable time. It has been worth the wait. John McLeod writes in a clearly accessible style easy to read and absorb and his comprehensive book both captures existing methods and identifies potential methods ripe for development.

Sue Wheeler, University of Leicester

This is an excellent book, and a very much needed addition to the case study methodology literature. It is very comprehensive and covers all aspects of case study methodology. The text addresses the issue intelligently, but is also an introduction for those engaging in case study research.

Mark Widdowson, Director of Training, CPTI Edinburgh

This book does an outstanding job in pulling together the crucially important literature on case studies in psychotherapy practice and research into a coherent, engaging and scholarly whole.

Daniel Fishman, Editor-in-Chief, Pragmatic Case Studies in Psychotherapy, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA

McLeod covers in real depth and high quality how to complete case study research, would definitely recommend.

Always have enjoyed John McLeod's writing style ever since I first started training and this book has not disapointed me. My students have said they also find him easy to read and digest, brilliant.

A good book in preparing students how to conduct case study research in counselling and psychotherapy

Very good book that highlights the focus of counselling and psychotherapy using detailed case studies.

John McLeod writes with his usual high level of insight and accessibility in this fascinating book, which is a must for everyone interested in counselling research. The examples provided give a new way of exploring ideas and concepts. Well written throughout, this is a vital book for anyone in the field - practitioners and students alike.

Essential of considering doing case study research - recommended for those who are not yet sure re the method to use for their research

John McLeod has provided an essential reference for training the new generation of research savvy psychotherapists. This book brings more than just the "what" and "how" - it reveals credibility, rigour and dignity in human ways of researching human process to develop more humane practice and research.

This book adds a useful source for students with a particular interest in case study methodology. In particular Counselling students, who struggle with positivistic approaches, welcome such a clear text that puts their own pratice into an evidence-based context.

This is an excellent addition to support students conducting their own research study as part of their higher education training. It clearly helps them to navigate their way through the research process and the use of case study research for further development of counselling practice.

Preview this book

Sample materials & chapters.

Foreword by Daniel B. Fishman, Ph.D., Rutgers University

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Defining the Counseling Process and Its Stages

The process begins with exploring the challenges a client faces before assisting them in resolving developmental and situational difficulties (Sajjad, 2017).

The counselor supports clients with physical, emotional, and mental health issues, helping them resolve crises, reduce feelings of distress, and improve their sense of wellbeing (American Psychological Association, 2008).

When successful, treatment can change how a client thinks, feels, and behaves regarding an upsetting experience or situation (Krishnan, n.d.).

This article explores what counseling is and is not, and the stages and steps involved in a successful outcome.

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This Article Contains

Defining the counseling process, the stages of the counseling process, 7 steps in the counseling process, real-life examples of the counseling phases, 12 valuable skills for each phase, a look at the process in group counseling, a take-home message, frequently asked questions.

All of us will, occasionally, take on the role of counselor. We informally offer family, friends, and colleagues advice regarding their relationships, finances, career, and education.

On the other hand, “a professional counselor is a highly trained individual who is able to use a different range of counseling approaches with their clients” (Krishnan, n.d., p. 5).

Counseling as a profession involves (Krishnan, n.d.):

• Dedicated time set aside to explore difficulties, stressful situations, or emotional upset faced by a client
• Helping that client see their situation and feelings from a different viewpoint, potentially to facilitate change
• Building a relationship based on trust and confidentiality

The counseling process should not include:

• Providing advice
• Being judgmental
• Pushing the counselor’s values
• Encouraging the client to behave as the counselor would in their own life
• Emotional attachment between the counselor and client

According to the American Psychological Association (2008), counseling psychologists “help people with physical, emotional and mental health issues improve their sense of wellbeing, alleviate feelings of distress and resolve crises.”

Counseling works with clients from childhood through to old age, focusing on “developmental (lifespan), environmental and cultural perspectives,” including (American Psychological Association, 2008):

• Issues and concerns in education and career
• Decisions regarding school, work, and retirement transitions
• Marital and family relationship difficulties
• Managing stressful life events
• Coping with ill health and physical disability
• Mental disorders
• Ongoing difficulties with getting along with people in general

While we often see counseling and psychotherapy as interchangeable, there are subtle distinctions. Counseling is typically short term, dealing with present issues and involving a helping approach that “highlights the emotional and intellectual experience of a client,” including how they feel and think about a problem or concern (Krishnan, n.d., p. 6).

Psychotherapy is often a longer term intensive treatment, helping the client overcome profound difficulties resulting from their psychological history and requiring them to return to earlier experiences (Krishnan, n.d.; Australia Counselling, n.d.).

The counseling process has been described as both an art and a science, helping to bring about changes in thought, emotion, and behavior in the client (Sajjad, 2017).

Counselors and clients must both be aware that the counseling process requires patience. There is rarely a quick fix, and things may need to get worse before they get better. In addition, the counseling process is collaborative. The counselor does not fix the client; the work requires interaction and commitment from both parties (Krishnan, n.d.).

The counseling process is a planned and structured dialogue between client and counselor. The counselor is a trained and qualified professional who helps the client identify the source of their concerns or difficulties; then, together, they find counseling approaches to help deal with the problems faced (Krishnan, n.d.).

Hackney and Cormier (2005) propose a five-stage model for defining the counseling process through which both counselor and client move (Krishnan, n.d.).

Stage one: (Initial disclosure) Relationship building

The counseling process begins with relationship building . This stage focuses on the counselor engaging with the client to explore the issues that directly affect them.

The vital first interview can set the scene for what is to come, with the client reading the counselor’s verbal and nonverbal signals to draw inferences about the counselor and the process. The counselor focuses on using good listening skills and building a positive relationship.

When successful, it ensures a strong foundation for future dialogue and the continuing counseling process.

Stage two: (In-depth exploration) Problem assessment

While the counselor and client continue to build a beneficial, collaborative relationship, another process is underway: problem assessment .

The counselor carefully listens and draws out information regarding the client’s situation (life, work, home, education, etc.) and the reason they have engaged in counseling.

Information crucial to subsequent stages of counseling includes identifying triggers, timing, environmental factors, stress levels, and other contributing factors.

Stage three: (Commitment to action) Goal setting

Effective counseling relies on setting appropriate and realistic goals, building on the previous stages. The goals must be identified and developed collaboratively, with the client committing to a set of steps leading to a particular outcome.

Stage four: Counseling intervention

This stage varies depending on the counselor and the theories they are familiar with, as well as the situation the client faces.

For example, a behavioral approach may suggest engaging in activities designed to help the client alter their behavior. In comparison, a person-centered approach  seeks to engage the client’s self-actualizing tendency.

Stage five: Evaluation, termination, or referral

Termination may not seem like a stage, but the art of ending the counseling is critical.

Drawing counseling to a close must be planned well in advance to ensure a positive conclusion is reached while avoiding anger, sadness, or anxiety (Fragkiadaki & Strauss, 2012).

Part of the process is to reach an early agreement on how the therapy will end and what success looks like. This may lead to a referral if required.

While there are clear stages to the typical counseling process, other than termination, each may be ongoing. For example, while setting goals, new information or understanding may surface that requires additional assessment of the problem.

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Many crucial steps go together to form the five stages of the counseling process. How well they are performed can affect the success of each stage and overall outcome of counseling (Krishnan, n.d.).

Key steps for the client

The client must take the following four steps for counseling to be successful (Krishnan, n.d.):

• Willingness Being willing to seek and attend counseling is a crucial step for any individual. It involves the recognition that they need to make changes and require help to do so. Taking the next action often involves overcoming the anxiety of moving out of the comfort zone and engaging in new thinking patterns and behaviors.
• Motivation Being willing to make changes and engage in them involves maintaining and sustaining motivation. Without it, the counseling process will falter when the real work begins.
• Commitment The client may be willing and motivated, but change will not happen without continued patience and commitment. Commitment may be a series of repeating decisions to persist and move forward.
• Faith Counseling is unlikely to succeed unless the client has faith in themselves, the counselor, and the process. Taking the step to begin and continue with counseling requires the belief that it can be successful.

Key steps for the counselor

Each step in the counseling process is vital to forming and maintaining an effective counselor–client relationship. Together they support what Carl Rogers (1957) describes as the core conditions for successful therapy:

• Unconditional positive regard Through acceptance and nonjudgmental behavior, the therapist makes space for the needs of the client and treats them with dignity. For more on developing this, we have these Unconditional Positive Regard worksheets , which may prove helpful.
• Empathy The counselor shows genuine understanding, even if they disagree with the client.
• Congruence The words, feelings, and actions of the counselor embody consistency.

Counselors often help clients make important and emotional decisions in their lives. To form empathy, they must intimately take part in the client’s inner realm or inscape .

Several well-performed steps can help the counselor engage with the client and ensure they listen openly, without judgment or expectation. The counselor must work on the following measures to build and maintain the relationship with the client (Krishnan, n.d.):

• Introduce themselves clearly and with warmth.
• Invite the client to take a seat.
• Address the client by the name they are most comfortable with.
• Engage in relaxed social conversation to reduce anxiety.
• Pay attention to nonverbal communication to identify the client’s emotional state.
• Invite the client using open questions to explain their reason for coming to counseling.
• Allow the client time to answer fully, without pressure.
• Show that they are interested in the client as a person.

Each of the above steps is important. Taken together, they can facilitate the formation of a valuable counseling relationship.

Ultimately, counseling is collaborative and requires a series of ongoing steps – some taken by the client, others by the counselor, and several jointly. For a successful outcome, appropriate resources, time, and focus must be given to each one, and every win must be recognized and used to support the next.

While there are guiding theories and principles, the counselor must make the counseling process specific to the individual.

The following two real-life examples provide a brief insight into the counseling process and richness of the scenarios counselors face.

Lost direction

‘Jenny’ arrived in counseling with little income, no sense of direction, and lacking a sense of control over her life (Fielding, 2014).

The counselor began by forming a picture of her situation and what had led her to that point.

Sessions then moved on to explore Jenny’s beliefs about herself: where they came from, how they affected her, and their appropriateness for current and future circumstances.

A series of brainstorming sessions were used to understand Jenny’s needs, family relationships, and past, and identify her irrational beliefs. Once Jenny uncovered her core beliefs, the counselor worked with her to replace them with more rational ones.

Jenny ended counseling overjoyed with her new preferred beliefs, along with a renewed sense of confidence and control over her life.

Saving a marriage

It is not just individuals who need help, but relationships too. When ‘John’ and ‘Sue-Anne’ attended counseling early on in their marriage, it was because, having lost their group of friends, they found themselves on their own with only each other’s company (Starak, 2010).

Early on in counseling, it became clear that they both needed time to ponder some serious questions, including:

Who am I? What values do I bring to this relationship?

The exercises helped John and Sue-Anne better understand their values, strengths, and what motivated their daily actions. By focusing on what each of them wanted their relationship to look like, they could clarify how much time they wanted to spend together and their roles within the marriage.

The counseling process enabled them to form a shared picture of how their marriage and life would look from now on.

Good communication is vital to all stages of counseling. Skills should ideally include (Krishnan, n.d.; Lesley University, n.d.; American Psychological Association, 2008):

• Active listening techniques
• Clarification
• Effective questioning

Beyond that, to build rapport with the client, counselors must also:

• Be able to experience and show empathy (rather than sympathy)
• See things from the client’s perspective
• Have a genuine interest in others’ wellbeing
• Use self-reflection to observe themselves and empathize with others
• Show accessibility and authenticity during counseling sessions
• Be flexible in their views and thinking regarding differing values and multicultural issues
• Be able to maintain a sense of humor
• Be resilient and able to bounce back from difficult situations

A mental health practitioner delivering positive outcomes in increasingly diverse populations benefits from developing theory, knowledge, and skills.

Partly due to its high degree of success, low cost, and wide availability, group therapy can be a good option for many clients.

It is essential to remember that group therapy is not the same as individual therapy performed within a group setting; it has specific and dedicated techniques and an additional skillset. Unfortunately, however, training has not always kept up with the specialist needs of group therapy (Novotney, 2019).

There are other, unique considerations and processes involved when offering and running group therapy, including being able to (Novotney, 2019):

• Get the right fit Not all clients are suitable for group therapy. They may be better placed in a one-to-one setting. High-quality screening is required to ensure the fit of the individual to the group and vice versa.

The Group Readiness Questionnaire has been designed to identify risk factors and the potential for dropout.

• Explain expectations upfront Individuals’ expectations of group therapy must be realistic. Change takes time, whether in a group or an individual setting. Also, the counselor must educate clients that group therapy is not about shouting and heated exchanges. Sessions can be fun and rewarding.
• Build cohesion quickly The issues being addressed can set the tone of the group and the speed at which it bonds. Grief groups, for example, often form cohesion quickly, while others can take more work and require splitting into smaller groups or pairs.
• Seek feedback Early and regular feedback can help assess how individuals and the group are functioning and whether dropout is likely.
• Identify and address ruptures Group work can lead to disagreements. Concerns and ruptures should be worked through early on, either bringing up issues directly with the members involved or more generally as a group.

17 Top-Rated Positive Psychology Exercises for Practitioners

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Counseling helps clients by bringing much-needed change to their lives (Sajjad, 2017).

While personal and theoretical approaches may vary, a professional counselor will typically begin by building a relationship with the client before understanding their situation and their reason for seeking help. They can then explore how to move forward and assist the client in changing their thinking, emotional responses, and behavior.

Whether performed individually or as a group, empathy and a collaborative approach are crucial to therapeutic success. The stronger the relationship and the more committed and motivated the client, the more likely a robust and appropriate outcome is reached.

When successful, counseling offers the client the opportunity to change by establishing specific goals, improving their coping skills, promoting decision making, and improving relationships across life domains (Sajjad, 2017).

Time spent gaining knowledge, training, and practicing is vital to gaining the required skills for this challenging yet rewarding profession. In return, mental health professionals have the potential to help people in a wide variety of situations live more productive and satisfying lives.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

The 10 principles of counseling are:

• Respect for client autonomy
• Empathy and understanding
• Non-judgmental attitude
• Confidentiality
• Cultural sensitivity and competence
• Trust and rapport
• Collaborative approach
• Professional boundaries
• Self-awareness and self-reflection
• Ethical and legal standards

The 5 C’s of counseling refer to the essential qualities that a counselor should possess:

• Competence: possessing the necessary knowledge and skills to effectively help clients
• Compassion: showing empathy and caring for clients
• Confidence: having confidence in oneself and one’s abilities as a counselor
• Connection: building a strong therapeutic relationship with clients
• Character: demonstrating ethical and professional behavior

The golden rule in counseling is to treat others how you would like to be treated. This means being respectful, empathetic, and non-judgmental with clients, and creating a safe and supportive environment for them to explore their issues and concerns. It also means adhering to ethical and professional standards and always acting in the best interest of the client.

• American Psychological Association. (2008). Counseling psychology. Retrieved June 17, 2021, from https://www.apa.org/ed/graduate/specialize/counseling
• Australia Counselling. (n.d.). What’s the difference between counselling and psychotherapy?  Retrieved June 17, 2021, from https://www.australiacounselling.com.au/whats-difference-between-counselling-and-psychotherapy/
• Fielding, L. (2014, November 25). A case of lost direction.  Australian Institute of Professional Counsellors.  Retrieved June 17, 2021, from https://www.aipc.net.au/articles/a-case-of-lost-direction/
• Fragkiadaki, E., & Strauss, S. M. (2012). Termination of psychotherapy: The journey of 10 psychoanalytic and psychodynamic therapists. Psychology and Psychotherapy: Theory, Research and Practice , 85 (3), 335–350.
• Hackney, H., & Cormier, L. S. (2005). The professional counselor: A process guide to helping . Pearson.
• Krishnan, S. (n.d.). The counselling process . Retrieved June 15, 2021, from http://www.dspmuranchi.ac.in/pdf/Blog/stages%20of%20counselling.pdf
• Lesley University. (n.d.). 6 critical skills every counselor should cultivate. Retrieved June 17, 2021, from https://lesley.edu/article/6-critical-skills-every-counselor-should-cultivate
• Novotney, A. (2019). Keys to great group therapy. Monitor on Psychology. Retrieved June 17, 2021, from https://www.apa.org/monitor/2019/04/group-therapy
• Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology , 21 , 95–103.
• Sajjad, K. S. M. (2017). Essentials of counseling . Abosar Prokashana Sangstha.
• Starak, Z. (2010, October 6). How to save your marriage by creating a relationship. Australian Institute of Professional Counsellors. Retrieved June 17, 2021, from https://www.aipc.net.au/articles/how-to-save-your-marriage-by-creating-a-relationship/

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Wow u have been helpful with these notes am grateful

I wish to thank you very much for this useful article, which throws more light on both the concept and process of counselling. I am a Guidance – Counsellor in a secondary school where students have a lot of behavioural issues. I believe this article has thrown more light that will help me figure out how best to journey with them.

I loved this article. So precise and to the point and so easy to understand. I am an undergraduate psychology student and needed to study this topic for my exam. From the examination point of view this is perfect.

The theme of Counseling explained in practical and easily understandable language.Respect to the client and unconstitutional positive regard, confidentiality and maintaining professional etiquette must be of prime concern. I am highly benefited.

I love the simplicity, directness and comprehensiveness of this well written article on Counselling. It contains all that’s needed to impart the knowledge and skills of this important and useful process that counselling is.

Well written article and simplest in all forms of understanding. Very useful in imparting knowledge to others

The articles here are very informative and relevant to my work. I am a counseling psychologist from Kenya. I would love to learn more.

This peice is carefully researched and clearly presented in a simple and clear term. I hope this is collectively applied in all areas to solve psychological problems.

Refugee needs counseling to reduce mental tension. I wish I could have such a book. Domestic conflict and violence are rampant in the community.Thanks.(Koboko Uganda)

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Couple Cases

Below you’ll find case studies of real clients that have attended couple’s counselling at All in the Family Counselling with our professional trained marriage expat counsellor. These cases do not represent all cases seen at our centre but rather are intended to give you insight into what makes for successful outcomes and the time and effort the clients choose to put in to make their relationship change. Each couple’s relationship is unique and has its own history which our therapist will attend to. But we hope you will find it helpful to see what successful clients choose to do and their outcomes.

Case Study 1

Profile : Professional couple married for 6 years but known each other for 10 years. The couple is in their early 30s.

Reason for Counselling : Couple came into counselling because of husband’s excessive use of pornography, a reduced sexual life and overall lower intimacy in the relationship. Wife was prepared to file for divorce if things didn’t improve rapidly. Wife had loss of trust due to pornography use.

Number of Sessions:   Couple had a total of 4 sessions with husband attending to 2 individual sessions. At the client’s initial session everyone agreed to the problem and what a positive marriage would look like for them.  They were taught basic relationship skills and given homework to practice. At their 2 nd  session, which was 10 days later, we reviewed their homework and both individuals had great revelations about themselves, each other and the relationship. They were taught additional relationship skills and given more homework to practice for 14 days.  The 3 rd  session we reviewed homework and refined skills and integrated new relationship concepts into the relationship including negotiating win-win for the relationship and managing perceptions in communication. Final session was 30 days later in which we reviewed their homework, revised some of their skills and gave them a framework to help identify and remedy problems if they were heading back into old relationship habits.

Success Factors:   This is an unusual case for a couple in crises to come to counselling and so dramatically turn their relationship around. The reason the couple experienced such dramatic success was that they had come into counselling early once the issue of intimacy and pornography were discovered. This couple was also highly motived to make counselling work and they energetically completed their homework in between sessions. The couple also had a lot of positive regard for each other and good personal insight into themselves and each other. The husband also attended a couple of individual sessions to work on stress management.

Case Study 2

Profile : Couple married for over 10 years in their mid 30s. Both have a college education and are professionally employed. Couple has no children.

Reason for Counselling : Counselling was initiated by the wife who had found out only 4 days prior to contacting our agency that her husband had an affair and both of them wanted to repair and improve the relationship.

Number of Sessions:   Couple had a total of 6 sessions over 3 months.  The first session was getting agreement that both couples wanted to repair and improve the relationship. Both parties agreed to not introduce punishment into the relationship as a result of the affair. The couples were given some new basic relationship skills and given homework to complete in between session including not discussing the affair.  Session 2 was 10 days later and the focus was on building a unified goal for the relationship. Four goals for the relationship were mutually identified and agreed to. Couples were given more relationship skills and homework to practice. The next 3 sessions were spread out over 2 months and focused on relationship skills that targeted communications, perceptions and internal control all with the couple doing homework in between sessions. The final session the clients evaluated how they did meeting their goals and they felt they got about 70–85% of each of their goals which was satisfactory for them. They felt confident with their new relationship skills. Trust had been restored, forgiveness was given and communication dramatically improved and the couple was established in their new and improved relationship behaviours.

Success Factors:   Couple came in quickly after finding out about the relationship. Both individuals in the relationship agreed to not introduce punishment into the relationship. This couple was focused on the present and building the future relationship.  The incident and issues of the past were only used as guidelines to help us know what worked and did not work. The couple was highly motivated to repair and improve their relationship and would complete their homework and came prepared to fully engage during the counselling sessions.

Case Study 3

Profile : Professional couple married for 7 years. The couple is in their late 30s. Had a history of infertility and infertility treatments that resulted in 2 children in last 3 years prior to treatment.

Reason for Counselling : Couple came into counselling because of dramatically reduced intimacy, increased fighting, difficulty communicating and negative perceptions of each other’s behaviours.

Number of Sessions:   Couple had a total of 12 sessions with each client engaging in 2 individual sessions within 5 months. The first session focused on stabilizing the relationship and providing them with basic relationship skills. The homework started to focus the couple on building positive regard towards each other.  Then next 2 sessions were focused on developing a new relationship base from which to make all decisions-shifting it away from the children as the base and back to the couple.  The next 4 sessions included reviewing the homework the clients were completing in between sessions, the lessons and observations they were learning as well as modifying and enhancing basic communication skills that included perception taking, learning to negotiate a win–win for the relationship and continuing to build positive regard.  The individual sessions were focused on personal issues that were affecting the relationship.  Individual sessions addressed some of the loss and trauma related to infertility treatments and stress and anxiety management.

Complicating & Success Factors:   This couple had a more complex prolonged history of infertility, stress and trauma that went on for a couple of years prior to entering counselling resulting in a more negative view of each other that reduced trust and positive regard for each other. This increased the number of sessions for the couple and individuals session were recommended.

However, the couple still had enough positive regard for each other and was committed to the counselling process because they really valued what they had earlier in their relationship. While the couple experienced some setbacks initially and was slower to implement their new relationship skills than the previous couples, they managed to keep coming to counselling and do most of the work.  As they start the client was successful because they gave counselling enough time to work and practice their new skills and continue to get feedback and guidance while working both on their relationship issues and individual issues. This couple needed more sessions because there were complicating factors and the issues had been developing for a longer period before coming for help.

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Case Studies

Case studies, case studies and more case studies!

A Counselling Case Study Exploring Loss

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

• September 17, 2010
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A Counselling Case Study Using CBT

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

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

Drug Addictions and Group Work

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

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

Counselling Case Study: Using REBT

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

• September 7, 2009

Counselling Case Study: Managing Anxiety

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

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

Counselling Case Study: Learning to Let Go

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

• June 26, 2008

Counselling Case Study: Social Anxiety

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

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

A Case of Using Logical Consequences

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

• January 23, 2008

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

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

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

Counselling Case Study: An Overwhelmed Client

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

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

A Case of Mid-Life Difficulties

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

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

A Case of Stressful Life Change

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

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

Counselling Case Study: Relationship Problems

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

• April 16, 2007

Counselling Case Study: Domestic Violence

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

• March 27, 2007

A Case of Loss and Grief

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

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