How to Write a Case Study

Note 1: For illustrative purposes the below is written for a therapy comprised of a single individual in the therapist role and a single individual in the client role. If you are writing a case study about a couple, family, or group, perhaps with a co-therapist, the structure as described below is the same, there is just an expansion of the individuals in the client role and/or the therapist role.

Note 2: Most of the case studies already published in PCSP have been written by the therapist in the case. However, an alternative is for others to join the therapist or for others alone to function as authors, using direct observations of the sessions, videotapes, transcripts, detailed clinical notes, and/or interviews with the therapist as the data for the case study. Two examples in PCSP of others joining the author to write the case study can be found at:
https://pcsp.nationalregister.org/index.php/pcsp/article/view/936/2334
https://pcsp.nationalregister.org/index.php/pcsp/article/view/1915/3340

Note 3: Almost all of the case studies already published in PCSP have been written about actual, although disguised, cases, and this is highly desirable. However, there have been instances in which for various reasons, such as special confidentiality concerns, a composite, hybrid case has been employed. Such an example can be found at:
https://pcsp.nationalregister.org/index.php/pcsp/article/view/2112/3511

Note 4: The below are guidelines -- not rigid rules -- for how to write a case study for PCSP.

CONCEPTUAL BACKGROUND OF A
PRAGMATIC CASE STUDY IN PSYCHOTHERAPY

The Pragmatic Case Studies in Psychotherapy (PCSP) journal was founded in 2005 on a vision of publishing psychotherapy case studies that is centered in Donald Peterson’s (1991) disciplined inquiry model of best practice across applied psychology, including psychotherapy (also see Fishman, 2013).

Figure 1 below presents an outline of Peterson’s model, with the different components translated into the generic headings of a PCSP case study manuscript.

In the Peterson model, the therapist begins with a focus on the Client and his or her presenting problems (component A). In this context, the therapist selects a general Guiding Conception (component B) with accompanying Clinical Experience and Research Support (component C). The therapist then conducts a comprehensive Assessment (component D), including history, personality, living situation, symptoms and other problems, diagnosis, and strengths. Applying the Guiding Conception to the Assessment data next yields an individualized Formulation and Treatment Plan (component E). The Case Formulation and Treatment Plan are thus a mini-version of the Guiding Conception as personalized for the individual client.

The Treatment Plan is implemented during the Course of Therapy (component F). This clinical process is consistently subjected to Therapy Monitoring (component G), generating feedback loops. If the therapy is not proceeding well possible changes in earlier steps (via component H) might be needed—e.g., reviewing the client’s characteristics and the “chemistry” between the Client and the therapist (component A); collecting more and/or reinterpreting the Assessment data (component D); and/or revising the Case Formulation and/or the Treatment Plan (component E).

If the Therapy Monitoring (component H) results in showing that the client has been successful and/or that the therapist and client agree that further therapy will not be productive, therapy is terminated and a Concluding Evaluation (component L) is conducted. This can yield feedback for either confirming—via assimilation—the original Guiding Conception (component J), or revising that theory through accommodation (component K).

The Narrative Nature of the Psychotherapy Case Study

Note that therapy involves the development of a highly emotionally and meaningful relationship and interactions over time between two persons, one in a therapist role providing help and one who in a client role receiving help. The resulting case study capturing these events should thus read in part like a richly detailed story about what happens when these two people meet.

Three Parts

As a summary, the therapy documented in Figure 1 proceeds in three parts:

(a) preparing for intervention (components A-E, headings 1-5);

(b) intervention (components F-I, headings 6 and 7); and

SPECIFIC GUIDELINES

In line with the above, PCSP is interested in manuscripts that describe the process and outcome of one or more clinical cases. Detailed description of the patient, presenting problem(s), conceptualization of the clinical challenges, and the course of treatment are necessary. PCSP expects a comprehensive presentation of all aspects of the case(s) reported, as reflected in headings 1-11 in Figure 1.

Note that deviations from the headings are allowed if they are conceptually based. An example is Shapiro’s (2023) case of “Keo,” in which sections 4, 5, and 6 are combined as they emerged from the initial contact with Keo because, in Shapiro’s words, “In the existential therapy model, the therapist approaches the client with a very open mind, not wanting to allow preconceptions to interfere with the process of relationship-building and the client telling their story in their own way.”
(https://pcsp.nationalregister.org/index.php/pcsp/article/view/2127/3524, p. 5).

Each of the eight main sections in a PCSP case study is addressed below, followed by three guidelines that apply to all eight sections.

1. Case Context and Method

This section is a short introduction to the reader about you, your background and clinical experience, and how you approach your clinical work. This should be brief and factual. Typical items include:

(a) Who you are;

(b) How long have you practiced;

(d) What training experiences and supervision have you had; and

(e) The way(s) in which you ensured confidentiality in your case study (required). This is typically done by disguising the client’s identity, in accordance with section 4.07 of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association:

4.07 Use of Confidential Information for Didactic or Other Purposes
Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so.
(https://www.apa.org/ethics/code).

2. The Client

This section should consist of a concise description of the client with selected details. The goal is to introduce the reader to the client as a person so they can keep this image of the person in mind as the reader continues through the case study. Some details about the client can include:

(a) cultural status,

(b) age,

(d) education/work background and status,

(e) marital status,

(f) parental status

(f) life circumstances, and

(g) presenting problems and, if relevant, diagnosis(es).

Note that this Client section is not a clinical assessment (this is below in section 4, Assessment). Rather, The Client section is a short description that places the patient in the context of their life, physical surrounds, and individuals with whom they must often interact.

3. Guiding Conception with Research and Clinical Experience Support

This section should inform the reader about:

(a) the type of clinical problem area(s) the client is presenting with and the relevant theoretical and clinical literature describing these problems. (The specific details and context of the client’s problems are presented in section 4, Assessment, described below.)

(b) your theoretical approach to understanding others in general and, more specifically, to the problem area(s) being addressed;

(d) your roadmap to the clinical work that needs to be done.

This Guiding Conception section provides the reader a context for understanding you as a therapist and how you work with the problem area(s) involved. This section should include references to important books and journal articles—including past case study articles—that you have found important over the years and have influenced how you approach and do psychotherapy. This section alerts the readers to general aspects of the client and their entire life that you will utilize in making your Assessment (section 4 below) of the client’s problems; your Case Formulation and Treatment Plan (section 5 below); and your conduct of Therapy (section 6 below).

4. Assessment of the Client’s Problems, Goals, Strengths, and History

This section should provide the reader with a systematic understanding of the client, including:

(a) their presenting problem(s);

(b) other problems and challenges;

(d) personality and character issues;

(e) their initial stated goals for treatment;

(f) previous therapy;

(g) relevant aspects of their life history (personal development, family issues and
events, and educational and work history);

(h) multicultural issues capturing the larger socio-cultural context of the case,
including information about the client’s gender, sexual orientation, race, ethnicity,
religion, socioeconomic class, etc.; and

(i) their strengths as well as limitations.

This section should present the methods and results of any quantitative assessment or other measurement tools you collected at intake, during therapy, at termination, and/or at follow-up.

5. Formulation and Treatment Plan

(a) This section should provide the reader with your conceptualization of what—in clinical theory terms—the client’s problems and issues are and how you planned to address them. Understanding of an individual, the conceptualization of their problems, and the goals of treatment can change over time.

(b) Provide the initial Case Formulation and Treatment Plan of the case in this section.

(c) In section 6 below, Course of Therapy, describe any changes that occurred in the Assessment, in the Case Formulation, and in the Treatment Plan as the treatment progressed.

6. Course of Therapy

This is the main section of the case study and should provide a detailed description of the process of the psychotherapy that occurred.

(a) Note that a very important way to capture the richness, subtlety, power, emotional and experiential nature, and relational dynamics of the therapy is through the use of selected transcript excerpts. Specifically, sample transcripts of the verbal exchange between patient and therapist should be utilized liberally to provide the concrete details of the clinical process, including at important points—such as points of client insight, of client obstacles, of client corrective emotional experiences, of ruptures and repairs in the therapeutic relationship, of therapist insight, crucial therapist choice points, and so forth.

(b) Descriptions of the therapy can be organized by: (i) by Session; (ii) by Blocks of Sessions; and/or (iii) by Phases (Sessions grouped into substantive Phases).

The goal is to provide the reader with a rich experiential sense of the client and the process of doing psychotherapy with this client. Some questions to think and write about:

(a) How did the client present themselves?

(b) What sort of therapeutic relationship was established?

(c) How did the client react to different comments or interventions you made?

(d) How did the therapeutic relationship change over time?

(e) How did you adjust your style or word choice in light of the client’s behavior or reactions?

(f) How did you bring up or introduce important issues that the client might have been avoiding?

Keep in mind the role and importance of other voices and influences in the therapy, such as a spouse, other family members, a boss, employees, colleagues, and friends.

7. Therapy Monitoring and Use of Feedback Information

This section should describe how the patient’s problems and behaviors were assessed over the course of therapy and how the process of therapy was monitored.

(a) Were quantitative treatment monitoring tools (such as the OQ-45 inventory
(https://www.oqmeasures.com/oq-45-2/) employed in each session, in selected sessions, and/or at the beginning and end of treatment and at follow-up?

(b) Were the psychotherapy sessions recorded or videotaped?

(d) How was the supervision of the therapy handled?

8. Concluding Evaluation of the Therapy's Process and Outcome

This section should be a summary of the process and outcome of the treatment, using both qualitative and, ideally, quantitative data.

(a) What changes, if any, occurred?

(b) Were the goals set in the treatment plan met?

(d) How, in general terms, did the process go?

(e) What comments and interventions seemed the most helpful? Least helpful?

Overall Guidelines Across the Eight Areas

(a) Be systematic, properly covering each of sections 1-8 and their interrelationships, ensuring a common structure with other pragmatic case studies.

(b) Clearly differentiate description from theory.

(c) Remember that the goal of a pragmatic case study is primarily to describe and interpret what happened in this particular case as a basic unit of knowledge in the field—not primarily to illustrate or confirm a theory, strategy, or procedure per se.

GENERAL GUIDELINES

Page Length

Manuscripts are to be typed double-spaced, following the APA Publication Manual. The format for pragmatic case studies allows a good deal of flexibility in page length. In terms of total pages independent of references, tables, figures, and appendices, PCSP manuscripts typically range between 35 and 90 pages. In terms of a 35-page manuscript, the first 8 sections might be distributed something like as follows (this is just an example, not a rigid requirement):

Case Context and Method, 1 ½ pages.
The client, ½ page.
Guiding Conception with Research and Clinical Experience Support, 4 pages.
Assessment of the Client’s Problems, Goals, Strengths, and History, 5 pages.
Formulation and Treatment Plan, 4 pages.
Course of the Therapy, 15 pages.
Therapy Monitoring and Use of Feedback Information, 1 page.
Concluding Evaluation of the Therapy’s Process and Outcome, 4 pages.

Note: Additional pages would be devoted to relevant references, tables, and figures.

Quantitative Data

The use of relevant quantitative data for assessment of problems, for monitoring therapy, and for outcome at termination and, if relevant, at follow-up is highly desirable. Almost all the case studies published in PCSP provide examples of the use of relevant quantitative data.

Note that if prospective quantitative measures are not collected, an option is to employ retrospective quantitative assessment. In this method, the client is asked at the end of therapy or at follow-up to complete quantitative measures a number of times with different mind sets, e.g., how they were feeling, thinking, and/or behaving at the beginning of therapy, at the end of therapy, and at follow-up. While not directly comparable to a prospective quantitative, such retrospective quantitative assessment can provide a useful additional perspective on the outcome of the therapy as subjctively viewed by client.

Description Versus Theory

Pay careful attention to the distinction between the description of clinical phenomena in ordinary language versus the interpretation of those phenomena in theoretical language, indicated by the use of technical theoretical jargon. Particularly, the Assessment and Course of therapy sections should contain a good deal of clinical description, such that the clinical phenomena of the client and the therapy could reasonably be interpreted from a different theoretical point of view. The use of technical, theoretical “jargon” terms when needed should be explained, knowing that not every reader is deeply knowledgeable about the theoretical orientation being employed by the author. Overall, the goal of a pragmatic case study is primarily to describe and interpret what happened in a particular case as a basic unit of knowledge in the field—not primarily to confirm a theory, strategy, and/or procedure per se. Rather the goal is to show how a theory, strategy, and/or procedure functioned in a particular case setting.

Scholarship

Present your material so as to include references to relevant books, journal articles, and web sites—including past case study articles—so that your work is connected to the relevant scholarly and research literature.

A Checklist of Questions to be Answered About Your PCSP Manuscript

Do you have separate sections with all the 8 headings in Figure 1?
Do each of the headings follow the Specific Guidelines associated with them?
Is the manuscript length between 35 and 90 pages (double-spaced; before references, tables, figures, and appendices)?
If there is quantitative data (which is desirable), is it fully presented?
Do you carefully distinguish between clinical description and clinical interpretation?
Are there references to the relevant scholarly and research literature?
Have you looked at sample cases from the journal as models?

Sample Cases

The published case studies in PCSP offer many examples of the variety of types of properly written case studies that, while varying in a number of ways, all follow the common structure outlined in Figure 1 and the specific and general guidelines outlined above. Sample cases can be found on the Home Page of this PCSP journal.

An instructive example of a case study published in PCSP is the case of “Caroline” by Ueli Kramer (2009; https://pcsp.nationalregister.org/index.php/pcsp/article/view/966/2366 ). An outline of the case illustrating the above headings is presented in Table 4 of Fishman (2013; https://pcsp.nationalregister.org/index.php/pcsp/article/view/1833/3256).

REFERENCES

Fishman, D.B. (2013). The pragmatic case study method for creating rigorous and systematic,
practitioner-friendly research. Pragmatic Case Studies in Psychotherapy, 9(4), Article 2, 403-425.
Available: https://pcsp.nationalregister.org/index.php/pcsp/article/view/1833

Kramer, U. (2009). Individualizing exposure therapy for PTSD: The case of Caroline. Pragmatic Case
Studies in Psychotherapy, 5(2), Article 1, 1-24. Available:
https://pcsp.nationalregister.org/index.php/pcsp/article/view/966/2366

Peterson, D.R. (1991). Connection and disconnection of research and practice in the education of
professional psychologists. American Psychologist, 46, 422-429.

Shapiro, J.L. (2023). Existential psychotherapy in a deep cultural context: The case of “Keo.” Pragmatic
Case Studies in Psychotherapy, 19(1), Article 1, 1-32. Available:
https://pcsp.nationalregister.org/index.php/pcsp/article/view/2127/3524

How to Write a Case Study

CONCEPTUAL BACKGROUND OF APRAGMATIC CASE STUDY IN PSYCHOTHERAPY

CONCEPTUAL BACKGROUND OF A
PRAGMATIC CASE STUDY IN PSYCHOTHERAPY