Person-Centered Therapy Case Study: Examples and Analysis

how to write a person centred case study

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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Case Report

Client assessment and formulation with person centered approach.

Arpita Ghosal*

Department of Psychology, University of Roehampton, London

Corresponding Author

Arpita ghosal, Department of Psychology, University of Roehampton, London.

Received Date: August 27, 2018;   Published Date: September 21, 2018

This paper is comprised of a case study on success of using psychotherapy for “Laura1” a client who experi-ences emotional disruption and executive difficulties. The primary approach of the issues of the client has been Person Centered Therapy, although some other problem-solving techniques such as pluralistic frame-work was also used. A report done previously of therapy with a client who experienced executive dysfunc-tion suggested that the client tend to perseverate on some specific negative thoughts inducing significant dis-tress to such clients. The case study of Laura has shown that this can be a risk, although there is possibility of working successfully with at least certain clients, and for doing so the Person-Centered approach is used.

Keywords: Person-Centered therapy; Emotional disruption; Executive dysfunction; Pluralistic framework

Abbreviations: FAQs: Frequently Ask Questions Sheet

  • Case Context

The case study of this paper is about Laura, 51yrs old lady, who has faced personal upheaval for which she is experiencing severe trauma. Laura had a head injury 10 years ago that led to her cognitive difficulties charac-terized by executive dysfunction including repetition, impulsiveness, poor planning, and disinhibition.

I completed the assessment for Laura. Based on a structured assessment form provided by the counselling service that lasted 50 minutes. I confirmed confidentiality of the sessions to the client. However, GP inter-vention can be requested with client approval if risk is identified. An agreement and frequently ask questions sheet (FAQs) including all these data is given to the client before the sessions begin.

Three months before the assessment, her husband left the marital home after giving her notice the previous night that he is walking away from her life. Subsequently, her husband has set up home with another woman. The proceedings of divorce are underway. This has impacted Laura very adversely. She felt alone and utterly abandoned leading to her inability to cope and a sense of hopelessness for the future. She recollected about her suicidal thoughts and the way she came close to initiate self-harm on many occasions.

Firstly, the case of Laura has had similarity to FS case as explained by King [1]. Both Laura and FS have had the experience of psychological distress along with trauma and a head injury related executive dysfunction. In the case of FS, the therapy turned out to be problematic as the client experienced his difficulties and trau-ma evoked repeatedly outside of sessions. The client was encouraged in accessing his perseverative difficul-ties and traumatic memories meant the inability of FS in disengaging from these when he is not inside the sessions. Therefore, King argued that there should be caution when therapy is conducted with such clients. Therefore, I decided following Laura in seeing if there is occurrence of similar issues as observed by King, and if possible, how to ameliorate them.

Secondly, Laura presents a platform in observing whether Person Centered Therapy to deal with her traumat-ic stress can be effective. The challenge in this case is whether extreme executive difficulties have the likeli-hood of impairing access to the processes of innate growth posited by the Person-Centered Therapy. At the outset, my prediction of this study has been that this could be an effective approach with a client of this type. I had experienced previously success with another type of neurological impairment client, which was related to myalgic encephalopathy with its interfering with their cognitive processing [2].

Assessment techniques and resources

This work deals with evaluation of efficacy of person centered, interactive therapy for Laura who also has head injury. The approach involves maintenance of respect for the client as implementation of therapeutic conditions was tried upon as advocated by Carl Rogers [3]. There would be openness to the goals and needs of the client who has the will of using approaches and techniques from other therapeutic modalities in the likes of cognitive behavioral therapy [4].

The model used widely, either on the basis of integration or in its own right, is the client centered approach [3]. The clients are allowed, with this model, in exploring their difficulties at their own pace and in their own time. This approach has also shown working well with neurological populations to help them coming in terms with their psychological distress and difficulties. For instance, Ward & Hogan, [2] have found effec-tiveness of this approach in a small trial that involved participants having myalgic encephalitis. These partic-ipants often had been coming in terms with severe personal loss. This has similarity with Laura as she faces neurological symptoms such as mental slowing, fatigue, lacking concentration.

Person Centered Approach offers a non-threatening and emphatic relationship to the client characterized by congruence, empathy, and unconditional positive regard. The involvement of emphatic understanding is with communication with the client that the counselor can understand and grasp in relation to the “frame of refer-ence” or the own perspective of the client. It should also be ensured that a genuine relationship is developed. The counselor must not hold opinions or attitudes about the client which he or she is unaware of and that can be detrimental to the relationship [5]. Finally, the counselor must have an “unconditional positive regard” to the client so as to avoid the communication of any negative attitude for the client. However, it should be not-ed that the counselor does not have to approve all behaviors of the client so long the counselor responds the client in a manner that is respectful and congruent with the therapeutic relationship.

Client in context and contextual information

Laura displayed considerable level of fear of her husband. She also feared physical consequences from her husband despite the fact that there has not been any history of physical abuse. Laura also experienced dis-tressing and recurrent recollection of the night when she got the announcement from her husband of his leav-ing her. This led her with a sense of a foreshortened future. She found it difficult to concentrate that had the lasting of over a month. Moreover, the distress started to impair her ability of functioning on a social level.

The emotional reaction of Laura to the fact that her husband left her was characterized by frequent recalling of the moment when he declared of his leaving. When Laura recollects this incident, she was overcome with intensely felt despair that drove her to tears. Her concerns involve that it would be very difficult for her to survive without her husband and the fact that she was dependent on him for last one decade. She has also given description that as she has been left alone, it would take a lot more time for her in completing a task.

Laura, for past many years has performed the homemaker’s role. From her account, it is clear that her need included considerable support and help from her husband in achieving certain daily tasks. Certain routine tasks like preparing meals for the family needed a lot of concentration and effort and can be taking several hours.

Laura’s executive functioning report was found in her medical record. There was administrating of two standard tasks from the version 3 of Wechsler Adult Intelligence Scale [6]. These are the digit span and block design tasks. The scaled scores have been four and seven respectively, which is suggestive of the scores being 63 and 70 respectively in the full-scale IQ. Contrastingly, on the vocabulary subtest, her scaled score has been 16. This suggests she had 134 overall full-scale IQ. This indicates that current level of executive func-tioning of Laura has been very low in comparison to a level of high pre-morbid ability.

Formulations

Laura suffered a head injury ten years ago. This led to her inability of pursuing her normal occupation and the experiences of certain difficulties in daily tasks to run her home. Her perception about herself was that she has become totally dependent on her husband. Her husband has taken responsibility for all complex affairs of the household.

Seemingly, a pattern was developing over the years where Laura’s perception about herself has been her de-pendence on her husband. She started to look at herself in way where she does not have the capability of any independent existence without the support of her husband. This culminated into a behavior where Laura found herself helpless on her own and therefore her views were self-perpetuated of her dependence on her husband. The relationship of Laura with her husband, in many respects, cannot be called as ideal, although she has been emotionally highly dependent on her husband. Therefore, the self structure of Laura came to be dominated by her thoughts of dependence on her husband along with her inability of copying or carrying out complex tasks without his help [7].

Treatment plan

The treatment plan for Laura has been formulated into two parts. Firstly, a Person Centered relationship will be given to her so as to enabling her to process her emotional reaction as her husband has left her. This would be allowing her to experience fully her feelings within the safety that the relationship provides her.

Secondly, it can be expected that her feelings’ intensity would subside over time and she would develop the ability of exploring other aspects of her feelings apart from her sense of overwhelming despair and loss. It can also be anticipated that with the unfolding of the sessions, it would be possible for Laura moving on to consider more practical ways of coping with her everyday challenges. Alongside this, the sessions will also help her in making use of both her loved ones and other community resources with the ability of moving forward towards an independent and a new existence.

These twin aims are expressible as two intervening goals, according to pluralistic framework. The first goal is not feeling emotionally overwhelmed because of the departure of her husband. The treatment of this goal is with Person Centered therapy. The second goal is working on some specific home management tasks in enabling Laura to be as independent as possible to carry out the task. The addressing of this goal is by the use of rehabilitation oriented, action focused and psycho-educational interventions.

Informed judgments

In the case of Laura, the question remains whether she dwells repetitively on her predicament’s negative as-pects and the ability of coping. I have taken the decision of recording and transcribing all our sessions, fol-lowed by the rating of the negative and positive coping statements that have had the occurrence and the in-stances of suicidal ideation. This would indicate whether the in-session behavior of Laura has seen augmen-tation of these dimensions. This would also have the repetition later as the therapy progresses to find if the proportions of the negative and positive coping statements have undergone any change.

These transcripts have allowed me in discussing the process of therapy and in ensuring the faithfulness of the sessions to the Rogerian Person-Centered way of working. As it has been mentioned before, the Person-Centered Therapy was chosen as the approach in dealing with Laura’s emotional difficulties. I have also in-tended in addressing Laura’s other concerns that involves practical issues of day to day life with the use of principles of rehabilitation in an integrative way.

Pluralistic approach

The approach of pluralistic has been a framework allowing the integrating of different theoretical approaches with the process of collaborating with the client. Cooper & McLeod [4] described the process of assessment of client and derive a set of goals agreed upon. These goals are the means to achieve them and the reviewing with the client throughout the therapy process.

The pluralistic framework allowed integration of Person- Centered Therapy with rehabilitation oriented, more action focused and psycho-educational interventions. The last component comprised of intervention in rela-tion to problem solving in helping Laura recognizing and dealing with and overcoming difficulties to remem-ber.

Monitoring of therapy and usage of feedback information

The scheduling of the supervision sessions has been on a weekly basis. The structuring of the supervision sessions in considering progress on work has been with the client and through exploration of any concerns or difficulties. The therapist would be noting the brief summaries that discussed issues and the points that are related to the future sessions are immediately recorded at the end of every session.

Critical exploration

Laura’s therapy was open ended and she had 43 sessions in total. The 43 sessions had frequency of once a week throughout the year.

Session 1-43: Works with Emotional Trauma and Phase it in Practical Difficulties

Emotional trauma

After the assessment initially, the counselor and Laura agreed that her most important goal initially was pro-cessing and coming to terms with trauma that has happened because of her divorce. The traditional Person-Centered approach was taken in helping Laura dealing with her trauma [8]. The counselor reflected carefully the narrative of Laura while facilitating her experience that had association with her mental states. The first eight weeks of therapy was dominated by this approach.

The statements of Laura in the early phase had the tendency of revolving around the initial trauma created by the separation, her enormous loss as perceived by her, and her fear related to what will happen to her in the future. For instance, when she had the initial shock that her husband announced that he will leave her, she said:

The first time I had panic attacks is when my husband told me this. It was terrible; he came after seeing his new lady that literally shattered me. In the morning, I was crying, but was trying to control the noise as he was sleeping and could have disturbed him.

My mind was full of fear as to how I will cope with the situation. Nay, I would not be able to cope. I knew that. I was even contemplating committing suicide but just in the nick of time he came to my room. The cli-ent’s narrative, by the fifth session, started to change. The therapist found that Laura’s emotional trauma has started to lose its raw edge as if she has started accepting and acknowledging these feelings. Laura heard her story’s other aspects being reflected back, which brought other feelings to the fore. Laura started to re-evaluate the relationship that she has gone through with her husband over the years and started to feel angry at some of ways her husband treated her [9].

These signs of her movement had been giving reassurances to the counselor, since it was suggestive that Laura would not experience the negative trauma outside the sessions. Moreover, Laura has been accessing processes of growth and going beyond blaming herself. For instance, she said: It was a life when I never had to go out. I would stay back home and do the household work. I felt I am Cinderella. It was by husband who would go out and brought things for me, whatever I wanted and the best that I wanted.

When her past relationship is reviewed and with the acknowledgement of the anger she felt now, Laura had been able to question a number of assumptions accepted by her over the years. She had the realization that there are a number of notions being planted by her husband by not giving her the opportunities in relearning certain previous skills of her. For instance, she said:

(My husband) told me that I can never have friends. I believed that when he told, but now I am seeing that there are many people who looks out for me and try to help me – amazing.

Unable dealing with housework

Following therapy for eight weeks, other issues started emerging in the narrative that have been worked with and taken up with the usage of other strategies by the counselor in collaboration with the client. The key is-sue, in particular, that have come up several times has been Laura’s inability of dealing with the household paperwork.

For instance, she said:It was half past eight when I found that I have to pick up two papers……it was terrible and was not at all feeling like doing it……still I did……and all the papers that I sorted the whole day……was behind me………I could not take any more. She referred here how the whole day was spent by her trying to sort out paperwork and realizing that in the end what she had done is laying behind her in a big trail.

Memory prompts

Laura was late frequently for sessions because of her difficulties with memory. This prompted a cell phone text system through SMS initiated in the 18th session reminding just ahead of each session each week. Thus, the number of sessions that she missed was reduced as compared to the sessions in the past.

Executive difficulties

During the therapy, it was evident that the executive difficulties of Laura impacted on the therapeutic dia-logue. The statements of Laura were significantly longer compared to what is experienced typically. Howev-er, her statements have a lot of repetition within specific utterances and within a session across the utteranc-es.

Assessment of progress within the process of therapy

I tried to make an objective assessment after the end of every 2 months in relation to whether progress has been made by Laura. I have also been concerned of whether the additional therapy would be undermining the potential of Laura in perseverating on her difficulties and expressing the negative perceptions about her abil-ity to cope. To be specific, as a baseline, I have recorded and transcribed sessions 1-5 with the counting of various verbal behaviors. To be specific negative and positive coping statements and idea of suicidal tenden-cy is notable. The positive coping statements expressed by Laura have shown some glimpses of positive out-look on her current situation. For instance, Laura has said: “but now I am seeing that there are many people who look out for me and try to help me – amazing”.

Contrastingly, she expressed negative coping statements of having negative outlook or not having the ability of doing things. For instance, “It was half past eight when I found that I have to pick up two papers……it was terrible and was not at all feeling like doing it……still I did……and all the papers that I sorted the whole day…… was behind me………I could not take any more.”, or “My mind was full of fear as to how I will cope with the situation”.

  • Concluding Evaluation of Outcome and Process of the Therapy

Laura, at the end of the therapy, have shown significant gains in positive coping statements in each session and decrease in the negative coping statements and reduction of statements showing suicidal tendency in each session. The therapeutic intervention outcome after the end of the therapy showed positive changes overtime. The changes that have been observed were the reflection of the fact that Laura experienced greater magnitude of wellbeing, was expressing lesser tendency towards self-harming impulses, having a feeling of greater ability for functioning, and was overwhelmed at a lesser degree by her problems [10]. Laura’s case has been the illustration of how a client having executive difficulties can be making use of fairly nondirective therapeutic strategy and being able to adjust and cope with emotional trauma. At the end of the therapy, Laura apparently was less emotionally distressed and more confident. Behaviorally, also, she was being able to cope much better with daily activities in the absence of her husband.

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  • DOI: 10.33552/ANN.2018.01.000506
  • Volume 1 - Issue 2, 2018
  • Open Access

Arpita G. The Effectiveness of Attentional Training on Stress AND Self-Esteem. Arch Neurol & Neurosci . 1(2): 2018. ANN.MS.ID.000506.

Person-Centered therapy, Emotional disruption, Executive dysfunction, Pluralistic framework, Psychological distress, Trauma, Head injury, Dysfunction, Neurological impairment client, Cognitive behavioral therapy, Neurological symptoms, Distress, Emotional reaction, Mental states, Memory prompts

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A Case Demonstrating Person Centred Therapy

Author: Jane Barry

Michael has made an appointment to see his School Counsellor. He is due to finish school this year and is undecided about what direction he should take once he leaves school. Michael is a high achiever and his parents want him to make the most of his opportunity to enter University and study Law or Medicine. Whilst Michael is interested in Medicine, he feels that his interests at the moment are directed towards working and travelling abroad. He wants to discuss his preferences with the School Counsellor and to talk about the pressure he has been experiencing.

For ease of writing, the Professional Counsellor is abbreviated to “C”.

Essential Case Information

“C” has known Michael for the last 18 months and has developed a rapport with him. Michael and his parents have visited “C” a few times to discuss Michael’s career options and the subjects that would benefit him the most. From these meetings, “C” has ascertained the following information. Michael’s parents would like him to achieve a high OP score and are encouraging him to pursue science and maths subjects to allow him access to University to study Law or Medicine. Michael’s father is a Barrister and would like to see his son follow on in his professional footsteps. Michael’s mother wishes for Michael to have a professional career, but she has also encouraged his interest in arts, history and travel.

Both parents have contributed considerable time and energy into Michael’s education and Michael is very grateful for their support. As he has a very close relationship with his parents, Michael feels a great deal of pressure to follow the goals that they have set for him. Whilst he would like to follow a career in Medicine, he is not sure that he has the life experience to make such an important decision. After the last meeting, Michael confided to “C” that he did not want to go into university straight after school. If he could have his own way, he would prefer to take some time off from study and travel for a while. He has a close group of friends who are interested in welfare work. Together they have plans to travel and work voluntarily. These dreams with his friends seem exciting and challenging to him and would allow him some time to come to a decision about his career.

Michael has talked to his parents about travelling, particularly to his mother. She is understanding of his need to see the world and to experience a different side to life, however she is also concerned that he is still very young and inexperienced. She would prefer to see him enter University first and travel when he gets a little older. Michael’s father is also concerned about Michael’s preferred directions. He fears that if Michael doesn’t undertake University at this age, he may spend his life wandering around the world, without any substantial training to fall back on. Michael’s older sister (Theresa) has dropped out of her studies and has spent the last 5 years travelling. Michael’s father does not want to see his son follow the same direction as his sister. He has offered to finance his son’s further education if he enters university directly after school.

“C” has previously administered a Personality Need Type Profile for Michael, and has found him to have moderate type C/D needs. After some discussion with Michael, “C” believes that he has fairly high need gratification through his school work and home life, however the disagreement with his parents has been causing him some discomfort, particularly because of his security needs.

Session Content

“C” has decided to use a person-centred approach with Michael. “C” believes that Michael has the resources to come to his own decision about his life. Because of the rapport that already exists between “C” and Michael, “C” suspects that Michael may look to him to acknowledge his right to choose his own path. Because of “C’s” respect for both Michael and his parents, “C” believes that a person centred approach would be of benefit, to ensure that the responsibility for the decision remains with Michael.

When Michael arrives, “C” begins the session by making him comfortable and asking some questions about his sports interests. Both “C” and Michael are interested in touch football, and it is a topic that they have discussed in some detail in the past. As this conversation draws to a close, “C” asks Michael about his reasons for making the appointment.

As Michael explains the difficult decision he has to make, “C” pays close attention to Michael’s body language and his description of feelings. “C” attempts to make Michael feel listened to by making eye contact with him and by sitting forwards, in a more active listening position.

“As you know, Mum and Dad are really keen for me to go to University next year, but I really don’t like the idea. I’m not looking forward to more years of study yet,” Michael explained. “I’m getting to the point where I don’t want to do any more study after this year, I’d rather hang out with Paul and Mica. Their parents don’t put the same pressures on them to study and they don’t mind if they travel after leaving school. Compared to them, I feel like I’m wrapped up in cotton wool.”

“C” paraphrased Michael’s comments, focussing on his feelings, “so your feeling that you haven’t got as much freedom as your friends do.” “Well, yeah,” replied Michael, “I’ve always gone along with what Mum and Dad wanted, and so I’ve never had any reason to really disagree with them, and I’ve always kinda wanted what they wanted anyway. But now I don’t. Sure it will be great to go to University one day, it’s not like I’m going to be like my sister and never come home, but Dad is really paranoid about it.”

“C” responded, “It sounds like you’ve got some plans of your own, that are different to your sister’s and your fathers, is that right?”

“Definitely,” Michael said with emphasis. “Definitely,” “C” replied, “you said that with a lot of conviction!” “Yeah,” Michael replied, “you know, I’ve got some really good ideas of where I want to go and what I could do with my life.” “That’s great,” responded “C”, “I’d really like to hear about them.”

As Michael describes his plans for the future, “C” listened carefully and felt proud of the goals Michael was setting himself. “C” appreciated the strength of character that Michael demonstrated, for someone of such a young age. “C” felt that Michael had both the conviction and determination to create meaningful goals for himself and to carry them through.

Michael felt excited and elated to talk about his plans so candidly with someone. He felt that “C” had a deep appreciation of his needs, which inspired confidence in himself and the goals that he dreamed about. Michael was surprised and heartened by the depth of his convictions and the strength of his belief in his goals. Having someone listen to him so intently made him feel special and worthwhile. He genuinely felt that his world was an exciting and challenging place to be.

“C” expressed some of his thoughts to Michael, so as to further convey his genuine concern for Michael. “You certainly seem to have some very clear goals for yourself. From what I know of you, you’re a very determined young man and you’ve achieved very well at the subjects that you’ve taken on. I am sure that you can achieve all of your goals if you keep your determination. It takes a lot of maturity, and a certain type of person to be able to identify your goals so clearly. I can imagine that it must be frustrating to experience some obstacles to reaching your dreams.”

“Yes…I’m not sure what to do about that,” replied Michael. “I know that my parents mean well and are worried for me, but, I think that I want them to support me in other ways now.” “How is their support of value to you,” inquired “C”.

“Probably more valuable than what I realise! You know, they’ve done a lot for me. I’ve always been into a lot of things and they seemed to have sensed that and tried to give me lots of opportunities. In some ways we’re a well suited family, you know? They want a son who achieves well, and I just want to achieve. Up until this point, we’ve mostly agreed about what I achieve at. My sister is different though, she is happier to just accept life as it comes along and she never used to like Dad pressuring her to do stuff. They used to argue a lot and sometimes I think she saw going overseas as a way to escape and be herself.”

“Dad was pretty upset when she went, I think he took it personally. I know he would just go crazy if he thought that I was going to do the same thing. I just wonder if I can ever get him to see that the decisions Theresa made and the ones I want to make have got nothing to do with him. I really don’t want him to think that I’m ungrateful or doing it to spite him.”

“C” reflected, “it sounds like your pretty grateful to your father and that you respect him. It also sounds like you are trying to find some ways to tell him about your plans, whilst still respecting him.”

“Yeah, though I’m still afraid that he won’t agree to my plans,” replied Michael.

“C” responded, focussing on his feelings, “can you tell me more about your fears?” “Well,” Michael replied, “I don’t know, I guess I fear that he’ll back off and not offer me any more chances to go to University.”

“How would you feel if that happened,” inquired “C”. “Really let down, and angry too. I mean, he’s got to let me make my own life now. I’m not just a kid any more,” Michael responded, frowning.

“C” reflected Michael’s meaning back to him. “You’re feeling angry about your lack of freedom and you want your father not to treat you like a kid any more. You want to go to University some day, but you’d like to have a break from study and travel with your friends. You’re afraid that your father will not accept your decisions and you will lose respect for each other. Does this sound right to you?”

Yeah, Michael sighed, “so what am I supposed to do? Why won’t Dad give me some credit for my own sense? Does he think that I’m going to be a kid for the rest of my life? I deserve to make my own plans,” complained Michael.

“C” nodded and responded, “they’re all important questions Michael, what do you think some of the answers might be?” “I don’t know,” replied Michael, “I thought that you could help me out there.” “Hmm,” said “C”, “that’s a tough one. I can see why you’re having such difficulty in making a decision. On the one hand, you’ve got some very exciting plans of your own that you want to fulfil. On the other hand, your trying to consider the plans that your parents are offering you, to get a tertiary education. I’m also wondering how you’ll make a decision.”

“Ultimately, I’d like to do both,” said Michael. “C” nodded and remained silent for a period. Michael also sat silently, thinking to himself. After a period, Michael replied, “I think I need to think about it some more. I need to talk to my parents some more too. I’ve been a bit afraid to talk about it directly, in case they definitely say ‘no’. I was thinking that I have to put in my selection for university soon, so perhaps I could apply for Medicine, but then defer for a year. It might be easier for Dad to accept, if I did this. What do you think about that?”

“C” replied, “discussing some of your options with your parents is a good idea. Perhaps you might think about how you would approach them. How might you feel if they still did not accept your proposals?”

“I’d feel let down and angry. I think I’d want to leave home if that happened. I wouldn’t want to make a scene, but I do want to live my own life. I think that I would have to leave.”

“C” replied, “that is a serious move, leaving home. Your goals must be very important to you indeed.”

“They are!” Michael exclaimed.

“C” probed further into Michael’s feelings about the choices he wanted to make. In particular he asked Michael about approaching his parents to discuss his goals. “C” focussed in on what Michael would say to his parents to let them know the seriousness of his intentions. “C” also asked Michael to consider how his parents might react to his news. From this, Michael developed some strategies for himself to use when telling his parents of his intentions.

In summary, “C” expressed his appreciation of Michael’s world and experiences. “C” validated Michael’s feelings and goals and complemented Michael on his mature strategies to explain his goals to his parents. Michael’s decisions included setting a time with his parents to discuss his goals, to suit everyone. He thought that they might go out for dinner one evening, to mark it as an important event. Michael would ask his parents to think about their goals for him and discuss these over dinner. In this way Michael would be allowing for his parents to contribute to his plans and hopefully influence them to listen to and respect his own ideas.

As a finishing point “C” asked Michael how he had felt about the session in general. Michael had appreciated the opportunity to talk about his issues and goals so completely to someone. He said he felt clearer about the direction he wanted to take in his life and was beginning to consider how to explain his goals to his parents. He thought that “C” had really appreciated him for who he was and it made him feel more mature in himself. He had hoped that “C” would have offered him some more direct advice about what to do, but understood that it was his own responsibility to decide.

End of Session

Some points to consider with Person Centred Therapy are as follows:

This therapy focuses on the quality of the client / counsellor relationship . It assumes that clients are basically trustworthy and have the inner resources to find solutions to their own problems. It is a less directive therapy on the counsellor’s behalf, meaning that clients are free to set their own goals and create the conditions that will allow themselves to explore their needs and behaviours.

Therapists themselves contribute to the client’s growth by providing a warm, positive, trusting, and open relationship with the client . The three important qualities the counsellor should possess are congruence (genuineness), unconditional positive regard (acceptance and caring) and accurate empathetic understanding (ability to deeply grasp the world of another person).

There are no fixed techniques that apply to Person Centred Therapy, rather there are a set of principles for counsellors to be guided by. Some of these are as follows:

  • The client is experiencing a discrepancy between the way they perceive themselves, the ideal picture of themselves and the reality of their situation. They may feel helpless and unable to make a decision, or direct their own life.
  • Whilst the client may look to the counsellor for direction, the emphasis will be upon the client to take responsibility for their own decisions and to learn to use the therapeutic relationship to increase their self-understanding.
  • The therapist should attempt to understand the client’s world through listening, empathising, respecting and accepting them; and in doing so, the counsellor will be integrating themself into the relationship with the client.
  • The therapist should try to experience genuine care and acceptance of their client, otherwise, the client may feel that the counsellor is feigning interest and will not fully disclose their feelings.
  • As clients experience the therapist listening to them and accepting them, they learn how to accept themselves. As they find the counsellor caring for them, they start to experience themselves as worthwhile and valuable. When they experience realness from the counsellor, the client is encouraged to shed their pretences with themselves and others.

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Case Conceptualization: Person Centered Therapy

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Person Centered Case Conceptualization

Humanistic case conceptualization: example treatments, person centered therapy conceptualization & spiritual application.

Person-centered therapy is a kind of treatment that gives clients an opportunity to figure out how their deeds and thoughts affect their health. The therapy is client-oriented. Therefore, clients assume the responsibility for their treatment course under the guidance of therapists.

Carl Rogers developed the treatment after realizing that the success of therapy depends on close interaction between therapist and client. For person-centered therapy to succeed, three conditions are necessary. These are empathy, congruence, and unconditional positive regard. Therapists should treat clients with utmost respect and not criticize or judge them.

Person-centered therapy can be used to treat clients suffering from depression, identity crisis, and alcohol disorders. Person-centered therapy is prone to ethical and cultural challenges. One of the ethical challenges is therapist’s attitude towards a client.

Therapists should not have a negative attitude towards their customers no matter their situation. Since person-centered therapy gives clients the liberty to decide on the treatment course to use, it might not work for clients who hail from cultures that value consultation. Person-centered therapy is to some extent compatible with Christian teachings. However, some of its practices and beliefs contradict Christian teachings.

Person-centered therapy (PCT) is also referred to as person-centered counseling. It is a kind of talk-psychotherapy established by Carl Rogers. The primary objective of person-centered therapy is to present clients with a chance to create a sense of character, where they can figure out how their actions, emotions and mindsets are being adversely affected (Cooper, O’Hara, Schmid & Wyatt, 2007).

Person-centered therapy gives much of the duty of healing course to the patient, with the therapist assuming a nondirective responsibility. Other objectives of person-centered therapy to clients are “greater openness to experience and increased self-esteem” (Cooper et al., 2007, p. 46). The therapy seeks to establish close conformity between clients’ idealized and real selves. It also aims to promote self-understanding and reduce cases of insecurity.

Rogers had a conviction that therapy should “take place in a supportive environment created by a close personal relationship between client and therapist” (Cooper et al., 2007, p. 53). Thus, he came up with the term client to demonstrate his rebuff of the conventionally hierarchical correlation between counselor and client and his perception of them as equals.

Rogers believed that therapist’s attitude plays a great role in helping a client. He asserted that congruence, empathy and unconditional positive regard are three correlated attitudes that are critical to person-centered therapy. Person-centered therapy seeks to boost self-esteem and help a client to interact with others.

Research in humanistic therapies has shown that individuals who are treated through person-centered therapy sustain steady changes over a long period. Besides, studies have shown that the changes exhibited by a patient treated through person-centered therapy are comparable to those exhibited by patients treated through other forms of treatment.

A five-year evaluation of the effectiveness of person-centered therapy in treating clients suffering from mental problems proved that the treatment is effective (Gibbrad & Hanley, 2008). Most of the clients evaluated showed significant improvement after therapy.

Rogers initially developed person-centered therapy to help in treating children. With time, therapists started to use PCT to treat even the adults. Person-centered therapy is mainly used to help individuals suffering from depression, cognitive dysfunction, alcohol disorders and anxiety (Cooper et al., 2007). In addition, the therapy can be used to treat any personality disorder.

Person-centered therapy helps in treating clients suffering from low self-esteem and those suffering from identity crisis. The therapy assists clients to come up with techniques to reconnect with themselves and attain self-actualization. Hence, person-centered therapy is the most appropriate treatment to use for my client because it will help him to gain inner locus of control and overcome anxiety and depression (Gibbrad & Hanley, 2008).

The therapy will allow my client to assume full responsibility for his treatment course. Hence, it will guarantee him a full recovery. One of the ethical issues that might arise when using person-centered therapy is therapist’s attitude towards a client. A therapist ought to treat a client as a person with dignity despite his or her situation.

Therapist ought to conduct themselves in a way that does not devaluate clients (Gibbrad & Hanley, 2008). Additionally, they should respect the client’s right to self-direction rather than imposing directions on the clients. In other words, therapists should make sure that they try as much as possible not to dominate their clients.

Rogers overlooked the concept of cultural diversity when coming up with person-centered therapy. One of the multicultural issues that might arise when using PCT with clients is a need for dependence on parents or relatives (MacDougall, 2002). The therapy encourages self-direction as the ultimate way to help clients overcome their challenges.

However, this approach may not work, especially when dealing with clients whose cultures require one to consult before making decision. In addition, it might be hard for the counselor to meet cultural expectations when helping a client to attain self-actualization. Person-centered therapy can be used in a crisis situation. The therapy is client-oriented.

Therefore, it contributes to establishing a calm environment for clients to come to terms with their challenges. Additionally, the therapy advocates genuineness on the side of a therapist (Kensit, 2002). A therapist identifies with client’s challenges and assists the client to come up with strategies to cope with the challenges. Thus, person-centered therapy can be helpful in a crisis situation since it begins by establishing a good rapport between a client and therapist.

Presenting Problems

John Cater is an African American, who presents himself as depressed after university administration thwarts his dream of becoming a civil engineer. John alleges that he was accused of orchestrating a strike in the university. In spite of him not being part of those who organized the strike, the school expelled him together with six other students.

After staying at home for two months, John secured a job with a local contractor. He was committed to his work, though his commitment earned him nothing but expulsion. He was accused of misappropriation of financial resources. The expulsion aggravated his depression.

As if this was not enough, John lost his childhood sweetheart after losing his job. He tried to plead with his wife to stay as he attempts to look for ways to sustain the family, but the wife was adamant to leave. All these incidences happened very fast such that it was hard for John to comprehend.

Goals for Counseling

John feels depressed after being unable to salvage his future and rescue his family. The first goal of seeking counseling is to help him change his attitude towards relationship. Even though John would like to marry again, he feels that he cannot keep a relationship because of his financial hardships. The second goal is to help John regain his self-esteem.

John claims that he developed low self-esteem after losing his work and wife. Hence, it is imperative to help him regain his self-worth. John’s predicament has made him irritable and hasty. The third goal of therapy is to assist him deal with his emotions, which are critical if he has to get another job and establish a family.

The three objectives aim to help John live a happy and confident life. John holds the key to solutions to his challenges. Person-centered therapy will help John to determine the direction of treatment that suits his objectives. As a result, he will assume control of the treatment course, thus being in a position to recover completely.

Interventions

Congruence. Kensit (2002) defines congruence as, “The willingness to relate to clients without hiding behind a professional façade” (p. 347). Therapists who demonstrate congruence in their counseling processes shares important sensational reactions with their patients. Congruence will be of significant help in helping John to accomplish his goals.

As a therapist, I will be open with John and establish a counseling environment that allows us to relate without fear of intimidation. Such an environment will make John disclose other challenges that he might not be comfortable revealing to people. In the process, I will help him to come up with a comprehensive treatment course that addresses all the challenges.

By being open, I will help John to cope with his emotions and come up with measures to shun anxiety. I will help John to learn that negative feelings keep him far from his loved ones and might deny him a chance to get a job in the future. I will do this by asking John to determine the number of friends he has made, or job applications he has tried since he lost his job and family. Such an exercise will help him to understand that his emotions may be one of the factors that frustrate his desire to live a happy life.

Unconditional Positive Regard. Unconditional positive regard implies that “The therapist accepts the client totally for who he or she is without evaluating or censoring, and without disapproving of particular feelings, actions, or characteristics” (Kensit, 2002, p. 350). Therapists exhibit unconditional positive regard through listening to clients’ stories without criticizing, disrupting or giving advice.

Positive regard establishes a non-threatening background, which allows a client to share freely sensational, aggressive, or atypical feelings without fear. Unconditional positive regard will help John to deal with his low self-esteem. I will allow John to give his side of the story without interruptions. Besides, I will make sure that I do not criticize John for his actions, feelings or decisions.

Showing unconditional positive attitude will help John to believe in himself and trust that he can still achieve his dreams regardless of the hardships he has gone through. I will assist John to identify fears and perceptions that make him develop low self-esteem and guide him on how to deal with the fears. Besides, I will help John to explore concerns and perceptions that are most critical to his dreams and guide him on how to work on the perceptions.

Empathy. Empathy refers to therapist’s attempt to understand client’s predicament from the client’s point of view. Empathy acts as a prelude step that determines if therapy session will proceed. One way that I will show empathy when helping John is by paying attention to his story (Blair, 2013).

Additionally, I will use reflection technique, which involves summarizing what John is saying. Such an approach will make John to feel that I am listening accurately, thus give him a chance to examine his thoughts and feelings. Through empathy, I will help John to deal with his attitude towards relationship (Walker, 2001).

I will request John to elaborate on his thoughts about relationship and assist him to change the views. I will endeavor to create an environment that will allow John to discern solutions to his challenges by himself.

Compatibilities

Person-centered therapy addresses matters that are often encountered in Christian teachings. First, person-centered therapy helps individuals to determine their identity. MacDougall (2002) argues that person-centered therapy helps clients to pursue pure conscience, which enables them to understand the meaning of their lives and to live as expected.

Christians are supposed to live as per their potential and meaning. Failure to achieve this leads to profound guilt. Person-centered therapy helps clients to focus on real conscience and budge forward. Second, Christianity encourages self-emptying. Christians regard self-emptying as “God’s way of being in the world” (Thorne, 2008, p. 87).

On the other hand, person-centered therapy encourages self-emptying as a way to understand oneself and seek solutions to challenges facing an individual. Third, person-centered therapy “offers a supportive bearing in relating to others” (Jones & Butman, 2011, p. 43). Undoubtedly, the Bible approves genuineness. Person-centered therapy requires therapists to be honest in all they do.

Besides, therapists are called to love and treat their clients with love. They are obliged to serve all clients diligently regardless of their social status. In person-centered therapy, therapists take their time to listen to clients without criticizing or interrupting them. It demonstrates the love, which Christianity advocates.

Incompatibilities

There are glaring inconsistencies between person-centered therapy and spiritual teachings. First, person-centered therapy assumes that mankind is innately provoked towards positive growth. Nevertheless, this is not the reality. We were created in God’s likeness, and we know that one benefits from being good.

However, we always find ourselves committing sins. Person-centered therapy holds that an individual can improve his or her life by striving to do well (Jones & Butman, 2011). However, Christianity teaches that man can only be made perfect through intercession of the Holy Spirit. Second, person-centered therapy encourages selfishness, which is against Christian teachings.

Person-centered therapy promotes self-actualization. Self-actualization involves, “Removing personal barriers, knowing ourselves and reaching our full potential” (Thorne, 2008, p. 91). In most cases, self-actualization makes individuals fail to discharge their duties to others and become self-centered.

Thorne (2008) alleges, “Person-centered therapy holds that human nature is intrinsically good and it supposes that self-actualization leads to goodness” (p. 95). However, the Bible encourages people to be selfless. Another incompatibility between person-centered therapy and Christianity is that person-centered therapy is phenomenological. The treatment “Uses subjective experience to determine a client’s concept of truth” (Thorne, 2008, p. 101).

It encourages therapists to accept a client no matter his or her situation. Therefore, it gives room for truth to be relative. Diverse clients may delineate ethics differently, and a counselor is required to acknowledge all the delineations. Christianity is very strict on the issue of morality, and it does not give room for morality to be relative. Thorne (2008) alleges, “In person-centered therapy, however, unconditional positive regard can be a trap” (p. 103).

Even though Christianity encourages people to love one another unconditionally, it emphasizes on the importance of truth. Christians are obliged to love one another. However, they are not forced to acknowledge everything their colleagues do. Christianity asserts that people should establish limits and encourage restraint in the lives of their loved ones.

With time, it is hoped that John will cope with his emotions and regain his self-esteem. It is also expected that John will understand how his emotions push him far from people and deprive him a chance to establish new relationships that might eventually lead to marriage. Besides, he will understand that it is hard for him to get a job without interacting with people.

It will be significant for John to know that it is possible for one to develop depression after going through hardships. However, one is not supposed to dwell on his past but to look for ways to overcome his or her challenges. It is hoped that John will gain the courage to apply for jobs and approach women in search of a suitable lady to marry.

One of the most challenging aspects of treatment will be helping John to regain self-esteem. He believes that he is worthless and spends most of his time alone. It will be challenging to convince him to start relating with people that he perceives to be in a high social status.

Blair, L. (2013). Ecopsychology: challenges for person-centered therapy. Person-centered & Experiential Psychotherapies, 12 (4), 368-381.

Cooper, M., O’Hara, M., Schmid, P., & Wyatt, G. (2007). The Handbook of person-centered psychotherapy and counseling . London: Palgrave MacMillan.

Gibbrad, I., & Hanley, T. (2008). A five-year evaluation of the effectiveness of person-centered counseling in routine clinical practice in primary care. Counseling and Psychotherapy Research, 8 (4), 215-222.

Jones, S., & Butman, R. (2011). Modern psychotherapies: A comprehensive Christian appraisal (2nd ed.). Downers Grove, IL: Intervarsity Press.

Kensit, D. (2002). Rogerian theory: a critique of the effectiveness of pure client-centered therapy. Counseling Psychology Quarterly, 13 (4), 345-351.

MacDougall, C. (2002). Rogers’s person-centered approach: consideration for use in multicultural counseling. Journal of Humanistic Psychology, 42 (2), 48-65.

Thorne, B. (2008). Person-Centered Counseling: Therapeutic and Spiritual Dimensions . New York: John Wiley & Sons.

Walker, M. (2001). Practical applications of the Rogerian perspective in postmodern psychotherapy. Journal of Systemic Therapies, 20 (2), 41-57.

  • Freud’s, Rogers’, Skinner’s Personality Theories
  • Rodgers' Person-Centered Theory in Women's Case
  • Client’s Responsibility in Person-Centered Therapy
  • Personality Assessment Inventory Test
  • Instructional Design, Constructivism, and Learning Sciences
  • Experience in Problem Solving
  • Critique of Jay E. Adams book How to Help People Change and Telling Yourself the Truth by William Backus
  • A Review and Comparison of the Personality Tests
  • Chicago (A-D)
  • Chicago (N-B)

IvyPanda. (2019, July 9). Case Conceptualization: Person Centered Therapy. https://ivypanda.com/essays/case-conceptualization-of-person-centered-therapy/

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IvyPanda . 2019. "Case Conceptualization: Person Centered Therapy." July 9, 2019. https://ivypanda.com/essays/case-conceptualization-of-person-centered-therapy/.

1. IvyPanda . "Case Conceptualization: Person Centered Therapy." July 9, 2019. https://ivypanda.com/essays/case-conceptualization-of-person-centered-therapy/.

Bibliography

IvyPanda . "Case Conceptualization: Person Centered Therapy." July 9, 2019. https://ivypanda.com/essays/case-conceptualization-of-person-centered-therapy/.

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A Person Centered Theory Approach, Case Study Example

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The person centered approach in counseling was established in 1942 by Carl Rogers, which contributed largely to the widespread use of humanistic psychology (Rogers, 1942). While humanistic psychology is traditionally thought of as psychoanalysis and behaviorism, certain approaches within the field are useful for making clients come to their own realizations as to what they need to fix in their lives through recurring therapy sessions. Therefore, instead of focusing on two these aspects of psychology, the person centered approach takes advantage of humanism, existentialism, and phenomenology. Using these three philosophical principles will help Kat understand more about her situation, why she has and is currently making certain life decisions, and give her the ability to change the course of her actions.

In order for the person centered approach to work effectively and help Kat, the proper therapist-patient relationship between myself and my client must be established. To do so, Rogers recommends six conditions; since Rogers established the person centered approach, these will be adhered to throughout the dialogues held with Kat. These principles state: the therapist and the patient must be in psychological contact, the patient should be in a state of incongruence where they are vulnerable or anxious, the therapist should be congruent or integrated in the relationship, the therapist should experience unconditional positive regard for the patient, the therapist must have an empathetic understanding of the patient’s situation and see things from the patient’s point of view, and the therapist should constantly communicate this understanding to the client (Rogers, 1957). Although all six of these conditions are important during discussions with the patient, this approach focuses mostly on the therapist’s understanding to promote growth in the patient; therefore, the conditions that apply directly to the therapist are considered the most important.

The person centered approach is ideal for Kat for several reasons. Firstly, she was not the one to recognize that she is suffering from a psychological problem; she was referred to me by her female doctor and seems to not realize that her situation is actually detrimental to her mental health. The best way to make Kat come to this realization is through talking to me about her life and coming to her own conclusions that the recurring behavior with her boyfriends is not typical behavior so that she will be able to make the changes to her life that she wants accordingly. In addition, this approach is ideal for who Kat is as a person; she seems to confide completely in her female doctor who she also considers a friend. It is difficult to tell whether Kat considers “friendship” as the ability to talk to and confide in a person or whether it refers to seeing the person frequently outside of the doctor-patient relationship; if the relation between Kat and the female doctor is the former, then it should be easy to generate the information required to help Kat because she should form a similar relationship with me as her therapist. Since Kat always feels the need to give out advice to other people and not take any herself, the person centered approach is also ideal because it will allow her the opportunity to finally have a conversation with someone about her life and her choices.

The recognition of the underlying concepts of existentialism, humanism, and phenomenology will greatly aid Kat during her conversations with me using the person centered approach. Firstly, the humanist philosophy states that each human being has dignity and worth. It also states that people are generally rational and have full capacity for goodness. Under this model, people are always striving to better themselves or become something more ideal. In Kat’s situation, this is her constant need to help charity organizations; while she doesn’t consciously realize the problems with her life, she does subconsciously and uses charity and religion as an attempt to atone for the things that she has done wrong. Although Kat didn’t explicitly state it during the interview, it is possible that is obsessively involved with charity work because of her regret for how she left her family. It is clear that her family are religious people because when she left they told her that she would “go to hell”; however, charity is an act that they would approve of. It is unclear of whether Kat has rekindled her relationship with her family, but a major goal in therapy should be getting her to realize that she should make an attempt to reconnect with them if she hasn’t. Kat’s way of thinking and acting may improve once she is shown that people believe in her and support her.

The existentialist philosophy deals with free will, choice, and personal responsibility. It states that “because we make choices based on our experiences, beliefs, and biases, those choices are unique to us – and made without an objective form of truth” (Casemore, 2011). In other words, there is no specific set of rules that any one of us must follow, we make our own rules and follow them accordingly. Kat has in part defined what these rules are for her, although they often lead to consequences that are not positive. Although the universe has no defined set of rules, it is important for her to understand that certain thoughts and actions will lead to either positive or negative consequences and that it is better to strive for the actions that lead to positivity in our lives. One of Kat’s major problems is that she seems to enter only relationships that are harmful to her; although her most recent ex-boyfriend hit her once, she seems to think this is okay and that it was her fault. This is a typical feeling of many women who are involved in abusive relationships, so it is important to make her understand this during the therapy session. In addition, it is important to note that even though this boyfriend only physically abused her this reported once time, Kat says that “I often tell him things he should know about himself and he gets furious”. Therefore, although Kat’s most recent ex-boyfriend was only physically abusive once, he seems to be verbally abusive quite frequently. Furthermore, he was emotionally abusive to her as well because he would have affairs with other women and make her aware of this. Even though Kat and her abusive ex-boyfriend are no longer together, Kat is dating a man who appears to be similar to him; he is also a substance abuser, and although not a lot of information was provided about him, he contrasts Kat’s “goody goody” nature based on the fact that he is a Nazi enthusiast. Therefore, a secondary goal of therapy should be to get Kat to realize why she is ending up with these men and turning down the others who are genuinely interested. Women are frequently unwilling to break off relationships with abusers because they feel that the abuse is either their own fault, they’re afraid to be independent, or they need to be needed. Based on the information provided about Kat, it is likely that she likes being with them because she things she can help change them; this is evident when she says that she told her ex-boyfriends “things he needed to know about himself” to motivate him. It is important for Kat to realize that she can be independent and the abuse was not her fault; she has many options available in life and if she “needs” to help people, there are many charity organizations she can get involved with to accomplish this.

Although the principles of existentialism aren’t necessarily positive, they are important for Kat to understand. In particular, the ideas that humans have free will, life has many choices and the decisions that people have to make create stress, some things are irrational and there is no reason for them, one must follow through with their decisions, and that the meaning of life is the one that we give it, can be helpful in enabling Kat to understand where she wants to go from here. The therapy sessions should be aimed to demonstrate that she is free to make her own choices, whatever they may be, and once she develops a plan of action she needs to stick with it. One of the major issues that is evident in Kat’s case is that she doesn’t seem to have an established life purpose. Although I was told of her past relationships with men, relationships in general, and briefly about her job, she doesn’t seem particularly driven in any of these areas. She excels at work because she feels a need to but there is no end goal in sight. Therefore, a third goal of these therapy sessions should be for Kat to define what she wants out of life; she should be allowed to discover what her idea job and relationships are and work towards those goals rather than focus exclusively on charity and the men she dates. There is a lot that Kat is missing out on in life because of her unique situation, and through counseling, she needs to teach herself that there is more to life than what is just happening right now. One of the most important ideas that existentialism teaches is that decisions cause us stress; this is inevitable and whether the decision is difficult or easy, it will still cause us some level of uncertainty. Therefore, Kat needs to make the best choice for her regardless of whether it is the easier choice because either way something could go wrong.

The philosophy of phenomenology teaches that “the events, feelings, experiences, behaviors, words, tones of voice and anything else that we see or hear, as they are in the moment” are important and we should avoid interpreting them out of the context of the situation (Casemore, 2011). Based on this principle, it is important to have many additional sessions with Kat because psychologists using the person centered approach are not able to apply information learned in one situation to a second. The important lies in the details of each unique situation and it is important to consider that the motivation behind each action or feeling differs with each detail. The ultimate goal of these therapy sessions is to guide Kat to stage seven of the “stages of becoming fully functional in counseling”. According to the provided interview, Kat is currently in stage 2; “the client becomes slightly less rigid and will talk about external events or other people” (Casemore, 2011). A patient who is in the final stage of this counseling scheme is “a fully-functioning, self-actualizing individual who is empathic and shows unconditional positive regard for others. This individual can relate their previous therapy to present-day real-life situations” (Casemore, 2011).

As mentioned above, the major goals that Kat should achieve through the person centered therapy sessions include the realization that her relationship with her family is broken and this is impacting her emotionally, that her relationship with men is detrimental to her emotional well-being, that her abuse was not her own fault and she is free to leave the situation, that she should work on building friendly relationships with her co-workers and other people around her, and that she should establish a long term life goal so that she is working towards something rather than just focusing on problems that exist in the moment. Since I am using the person centered approach of therapy, I cannot inform Kat that she needs to do this directly; rather I need to engage her in conversation about these topics and allow her to provide me with information about the subjects. When she is able to completely confide in me about these topics and has gone through them frequently and with enough detail, she will come to the conclusion that these are the changes she needs to make to be happy. I believe that this is the most effective way of counseling Kat because she may be resistant to these ideas if she doesn’t come to them on her own; it is important to note that based on Kat’s personality profile, she is resistant to change as evidenced by her tendency to repeat the same decisions a multitude of times. Once she realizes that she has these problems, she will be able to take the steps required to fix them; again, she needs to determine these solutions on her own, although I am able to guide her during the therapy sessions.

As mentioned earlier, it is also important to consider that a family/systems intervention may greatly help Kat in her road to discovering her issues and recreating her life. Before such an intervention could be put in place, it is important to determine whether Kat has any family members besides her immediate family whom she left and told her to “go to hell”. If she has any other relatives that she still speaks to or is closer to than her immediate family, this would be a good starting point for the family intervention. This systems framework would best address potential underlying family dynamics and relational aspects inherent in the presented case because it would allow Kat to first discuss the problems she is having with people other than her immediate family, who she should reconcile with. A family systems intervention would be helpful in this situation, because it would greatly reduce Kat’s level of stress knowing that she was first able to approach other members of her family. This would also make Kat feel less like she is the only one at fault for breaking the relationship between family members because everyone present will be able to contribute to this conversation in a positive way.

It is also possible that Kat does not have any family members other than her immediate family who she abandoned. If this is the case, it is important to set up the family systems intervention with them so that everyone in the family has a chance to speak about what’s on their minds about the falling out with Kat and how it impacts them. It is also a good chance for the family members to step up and take partial responsibility for Kat’s desire to leave home. Once this occurs, the family will hopefully reconcile and Kat’s family will become a part of her life again. This is a major breakthrough that will help Kat get the rest of her life together again; since her family knew her as a child, they will be able to offer her advice and guidance that no one else will be able to because they know her best and they knew her before she got into trouble. For an optimal result, the family interventions method can be combined with the person centered approach. Although the family members are not psychologists, they have an ideal capacity to listen to Kat’s problems and she will be more willing to open up to them over time. Eventually, they will help her come to the realization that she has problems that she needs to address and give her advice as to what potential solutions she can pursue.

In Kat’s specific situation, one of the major drawbacks of family systems intervention is that Kat’s family may not forgive her for leaving them or be understanding of her current situation. If Kat receives this kind of negativity from her family, it might cause her situation to get worse or not improve; she may continue to date abusive men, fail to establish relationships with people, and have a lack of drive in her life. In addition, this would be negative to the therapist-patient relationship because the advice to participate in the family systems intervention would damage Kat’s confidence and cause her stress. As a consequence, any individual counseling approach used after this point will not be as effective.

Casemore, R. (2011). Person-Centered Counseling in a Nutshell. SAGE Publications Ltd.

Rogers, C. (1942). Counseling and Psychotherapy. Retrieved from http://www.archive.org/details/counselingandpsy029048mbp

Rogers, C. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Retrieved from http://shoreline.edu/dchris/psych236/Documents/Rogers.pdf

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The empirical evidence underpinning the concept and practice of person-centred care for serious illness: a systematic review

Alessandra giusti.

1 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK

2 King's Global Health Institute, King's College London, London, UK

Kennedy Nkhoma

Ruwayda petrus.

3 School of Applied Human Sciences, University of KwaZulu-Natal College of Humanities, Durban, South Africa

Inge Petersen

Liz gwyther.

4 School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa

Lindsay Farrant

Sridhar venkatapuram, richard harding, associated data.

bmjgh-2020-003330supp001.pdf

bmjgh-2020-003330supp002.pdf

bmjgh-2020-003330supp003.pdf

Introduction

Person-centred care has become internationally recognised as a critical attribute of high-quality healthcare. However, the concept has been criticised for being poorly theorised and operationalised. Serious illness is especially aligned with the need for person-centredness, usually necessitating involvement of significant others, management of clinical uncertainty, high-quality communication and joint decision-making to deliver care concordant with patient preferences. This review aimed to identify and appraise the empirical evidence underpinning conceptualisations of ‘person-centredness’ for serious illness.

Search strategy conducted in May 2020. Databases: CINAHL, Embase, PubMed, Ovid Global Health, MEDLINE and PsycINFO. Free text search terms related to (1) person-centredness, (2) serious illness and (3) concept/practice. Tabulation, textual description and narrative synthesis were performed, and quality appraisal conducted using QualSyst tools. Santana et al ’s person-centred care model (2018) was used to structure analysis.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow data: n=12,446 studies screened by title/abstract, n=144 full articles assessed for eligibility, n=18 studies retained. All studies (n=18) are from high-income countries, and are largely of high quality (median score 0.82). The findings suggest that person-centred care encompasses the patient and family being respected, given complete information, involved in decision-making and supported in their physical, psychological, social and existential needs. The studies highlight the importance of involving and supporting family/friends, promoting continuation of normality and self-identity, and structuring service organisation to enable care continuity.

Person-centred healthcare must value the social network of patients, promote quality of life and reform structurally to improve patients’ experience interacting with the healthcare system. Staff must be supported to flexibly adapt skills, communication, routines or environments for individual patients. There remains a need for primary data investigating the meaning and practice of PCC in a greater diversity of diagnostic groups and settings, and a need to ground potential components of PCC within broader universal values and ethical theory.

Key questions

What is already known.

  • Person-centred care has become internationally recognised as a dimension of high-quality healthcare, promoted as a core competency of health workers, a key component of primary care and essential to achieving the Universal Health Coverage goals.
  • Ongoing conceptual debates are attempting to determine what constitutes ‘person-centredness’ and how this concept can be understood and implemented in a variety of settings.
  • Serious illness is especially aligned with the need for PCC; the complex clinical scenarios surrounding serious illness usually necessitate the involvement of significant others and depend on high-quality communication and joint decision-making to deliver care concordant with patient preferences, with recognition and management of clinical uncertainty.

What are the new findings?

  • Included studies largely support the Santana et al model of PCC and suggest that additional domains should be given visibility: family and friend involvement and support; promoting continuation of normality and self-identity; structuring service organisation to enable continuity of care and patient navigation.
  • The empirical data stresses the importance of patients and families being respected, listened to, understood, given honest, complete and comprehendible information and being engaged in all decisions that affect their daily life, care and treatment. Patients must be supported in their physical, psychological, social and spiritual needs.
  • All retained studies were conducted in high-income, Western countries.
  • Empirical studies present invaluable data on the meaning and practice of PCC, however none develop this evidence into a theorised framework for implementation of PCC for serious illnesses.

What do the new findings imply?

  • Person-centred healthcare must value the social network of each patient, promote quality of life and personal goals not only health status improvement, and implement structural reforms to improve patients’ experience of interacting with the healthcare system.
  • Health systems must be structured to enable sufficient availability and accessibility of health workers, and support staff to be able and willing to flexibly adapt skills, communication, routines or environments for individual patients.
  • There is a need for primary data investigating the meaning and practice of PCC in a greater diversity of diagnostic groups and settings, particularly non-Western, low- and middle-income settings.
  • There is a need to consider the theoretical underpinnings of PCC and to ground potential components within broader universal values and ethical theory.

Person-centred care has become internationally recognised as a dimension of high-quality healthcare. 1 The Institute of Medicine describes quality care as that which is: “safe, effective, patient-centred, efficient, timely and equitable”. 2 WHO policy on people‐centred healthcare highlights person‐centredness as a core competency of health workers, a key component of primary care, and essential to achieving the Universal Health Coverage goals. 3–6

A variety of terms have been used to denote person-centred approaches. ‘ Patient -centredness’ was first to gain prominence and aimed to challenge the reductionism of the biomedical model and stress the importance of psychosocial factors. 2 3 Many moved towards use of the term ‘ person -centredness’, suggesting this better articulates the holism of the ‘whole person’ and a broader conception of well-being. 7 8 In recent years, the term ‘ people -centredness’ has also gained prominence, emphasising a focus on “the whole person in their specific familial and community contexts”. 9 Person-centred, patient-centred and people-centred care (PCC) all embody an approach that consciously adopts the perspectives of individuals, families and communities, respects and responds to their needs, values and preferences and sees them as participants in their own healthcare rather than just beneficiaries. 2 10

Conceptual clarity is critical to the design, delivery and replication of successful innovations in care. 11 Despite the global prominence of PCC as a goal of health systems, the approach suffers from a lack of clarity. Ongoing conceptual debates are attempting to determine what constitutes ‘person-centredness’ and how this concept can be understood and applied in a variety of contexts. 7 12–14 While numerous conceptualisations of PCC are presented in existing literature, 8 15–21 most do not appear to offer empirical origins or practical guidance on the implementation of PCC. The WHO Global strategy on people-centred and integrated health services recognises that there is not a single model of PCC to be proposed, but rather that it should be context-specific and that each country should generate its own evidence to enable appropriate, acceptable, feasible practice of PCC. 10 It is currently unclear what evidence is available to model contextually-appropriate and culturally-appropriate PCC.

The need for a person-centred approach is particularly important in the context of serious illness. The complex clinical scenarios surrounding serious illness usually necessitate the involvement of significant others, high-quality communication and joint decision-making to deliver care concordant with patient preferences, with recognition and management of clinical uncertainty. 22–24 As populations age, as infectious disease is better managed, and multimorbidity becomes more prevalent, serious health-related suffering associated with conditions such as cancer, chronic lung disease and dementia is rising fastest in low- and middle-income countries (LMICs). 25 Serious illness is also a context in which delivering PCC can be more complex and may require more dimensions to a greater degree than for non-serious illness. Focussing specifically on serious illness is therefore a means of ‘stress testing’ generalist PCC theory and ensuring it captures ‘what matters’ in all diagnostic cases. A better understanding of PCC in the context of serious illness would have health-system-wide relevance for other less complex clinical scenarios.

This systematic review aims to aggregate and appraise the empirical evidence underpinning the concept and practice of PCC in the context of serious illness. Specifically, the objectives of the review are to answer the following questions:

  • What is the primary data underpinning conceptualisations and practice-based frameworks of ‘person-centredness’ in the context of serious illness?
  • What is the quality of this data?
  • What are the key constructs of PCC according to this data?

This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. 26 The review protocol was registered prospectively with PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139259 (registration number 139259).

Definition of terms

To structure this review, literature was considered in line with two frequently cited definitions of PCC, one policy-led (using the term ‘ people -centredness’) and one patient-led (using the term ‘ patient -centredness’):

  • “An approach to care that consciously adopts the perspectives of individuals, families and communities and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways.” (WHO, 2015) 10
  • “Care that is focussed and organised around people, rather than disease. Within this approach disease prevention and management are important but not enough to address the needs of person, family and community.” (International Alliance of Patients Organisations, 2007) 27

These definitions informed the broad review search strategy.

Numerous terms exist relating to person-centred care, including patient-centred, people-centred, patient-directed and so forth. We acknowledge that these various terms have differences in their origins and connotations. 28 However, as they overlap significantly and are often used interchangeably we chose to include all terms in the search strategy and analysis. When referring to this approach we chose to use the term ‘person-centred’. In agreement with Ekman et al 8 and The Health Foundation, 29 we take that view that the word ‘person’ avoids reducing the individual to a mere recipient of services and better highlights the whole human being with reason, preferences, needs and a social and cultural background.

The review focuses on serious illnesses in line with the following definition: “Serious illness carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments or caregiver stress. This includes conditions not advanced or high dependency/low function that carry a degree of clinical uncertainty” (Kelley et al , 2016). 30

According to Kelley et al ’s broadest definition of serious illness, serious medical conditions include: cancer (metastatic or hematological), renal failure, dementia, advanced liver disease or cirrhosis, diabetes with severe complications, amyotrophic lateral sclerosis, acquired immune deficiency syndrome, hip fracture, chronic obstructive pulmonary disease or interstitial lung disease if using home oxygen or hospitalised, and congestive heart failure if hospitalised for the condition. 30

Search strategy

The full search strategy is reported in online supplemental appendix A . The following databases were searched on 18 May 2020 with no date restrictions: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, MEDLINE, Ovid Global Health, PsycINFO and PubMed. Forward and backward reference chaining of included articles was performed.

Supplementary data

We included free text search terms (title, abstract and keyword search) related to (1) person-centred care/patient-centred care, (2) serious illness and (3) concept or practice (the meaning of PCC or way in which PCC is enacted). Search terms were adapted to each database subject headings and ‘exploded’ terms. The specific serious conditions included were those listed by Kelley et al 30 within their broad, operationalised definition of serious illness. Please see online supplemental appendix A for full list of search terms and example search strategy.

Data collection and extraction

All potential references identified were exported to EndNote reference manager and deduplicated. The primary reviewer (AG) assessed the titles and abstracts against the inclusion and exclusion criteria (detailed in online supplemental appendix A ). The full texts of remaining references were then similarly screened. Any reference for which inclusion was unclear was agreed through discussion with the secondary reviewer (KN) or adjudicated by a third reviewer (RH) if consensus was not reached. The following variables were extracted from retained studies into a common table: authors, year of publication, country, setting, aim and objectives, study design and methods, sample and main findings.

Quality assessment

We applied Kmet et al ’s Standard Quality Criteria 31 to the primary data. The checklists (quantitative data n=14-items, qualitative data 10-items) score each criterion ‘yes’=2, ‘partial’=1 and ‘no’=0. Items deemed not applicable are excluded from the summary score, which ranges from 1 (highest) to 0 (lowest). Online supplemental appendix A further details the method to calculate scores. We did not exclude studies based on quality score. The primary reviewer (AG) assessed the quality of each study. The secondary reviewer (KN) also assessed the quality of n=5 of the studies and met with the primary reviewer thereafter to compare assessments, resolve any discrepancies and enable reflections to be applied to all other studies’ quality assessments.

For quantitative studies, Kmet et al propose a cut-off score of 0.75 as the threshold for including a paper in a review. 31 As our goal was to assess data quality rather than exclude data failing to meet a quality threshold, we used Lee et al ’s 32 definitions for Kmet et al ’s quality scores; strong (summary score of >0.80), good (summary score of 0.71 to 0.79), adequate (summary score of 0.50 to 0.70) and limited (summary score of <0.50). For qualitative studies, Kmet et al use a threshold of 0.55 for inclusion of a study into their systematic review, 31 therefore we defined qualitative papers with scores of ≥0.55 as ‘adequate quality’ and ≤0.54 as ‘low quality’.

Data analysis

Retained studies were analysed using narrative synthesis in line with Guidance on the Conduct of Narrative Synthesis in Systematic reviews. 33 The preliminary synthesis was performed by tabulation, grouping and clustering.

To synthesise the extracted data the authors adopted a PCC model developed by Santana and colleagues 34 (hereafter referred to as Santana model). The Santana model was selected to structure the analysis of retained studies as it provides comprehensive, practical guidance for implementation of PCC, explicitly linking this guidance to the Donabedian model for assessing healthcare quality. 35 Santana et al ’s model was generated through a narrative review and synthesis of evidence, recommendations and best practice from implementation case studies, as well as existing frameworks. However, besides the consultation of a patient representative, there is limited voice of patients and families informing the model. The model’s authors suggest validation of the framework with additional diverse patient perspectives and to identify any necessary revisions or additions. 34

The components of the Santana model were used to construct an a priori coding frame for deductive analysis of the study findings retained in this systematic review (see online supplemental figure 1 for a priori coding frame). Findings that did not fit into the a priori frame were inductively coded into new codes. The primary reviewer (AG) coded the data using NVivo V.12 software, coding data that did not fit into the a priori frame into additional ‘Other’ nodes. The primary reviewer reviewed the contents of these ‘Other’ nodes throughout the analysis, generating new inductive codes where new themes appeared and revising or adding to these as more data was coded. New inductive codes were reviewed by the second and third reviewers (KN and RH), and discussed until consensus on new code meanings and labels was reached.

Patient and public involvement

Patient and public involvement was not conducted as part of this review.

The search summary flowchart following PRISMA guidelines is presented in figure 1 . The search yielded 12,446 references following deduplication, and 18 studies/n=19 papers 36–54 were retained and synthesised in this review. The characteristics of included studies are summarised in box 1 . Further detailed characteristics of each included study are presented in online supplemental table 1 , with Kmet et al ’s 31 data quality score.

Characteristics of included studies

Countries and settings.

All retained studies (n=18/18) reported data from high-income, Western countries.

  • The Netherlands (n=5/18) 36–40
  • Canada (n=3/18) 41–43
  • Australia (n=3/18) 44 45 49
  • USA (n=2/18) 46 50
  • UK (n=1/18) 47
  • Ireland (n=1/18) 53
  • Norway (n=1/18) 48
  • Sweden (n=1/18) 54
  • Germany (n=1/18 study reported in n=2/18 papers) 51 52

Healthcare settings

  • Hospital wards (n=5/18) 37 38 41 47 48
  • Residential aged care facilities (n=3/18) 44 45 54
  • Outpatient clinics (n=2/18) 36 50
  • Nursing homes (n=1/18) 53
  • Cancer centre (n=1/18) 42
  • Academic cancer institution (n=1/18) 43
  • Unknown/combination (n=5/18 studies reported in n=6/19 papers) 39 40 46 49 51 52

Diagnostic groups and healthcare professionals

  • Cancer (n=10/18 studies reported in n=11/17 papers) 36 38 39 41–43 48–52
  • Dementia (n=4/18) 44 45 53 54
  • End-stage renal disease (n=1/18) 37
  • Palliative or end-of-life care (n=2/18) 40 46
  • Mixed diagnostic groups experiencing acute care (n=1/18) 47

Participant groups included

  • Healthcare professionals (n=14/18 studies reported in n=15/18 papers) 37 39–47 49 51–54
  • Patients (n=10/18) 36–39 42 44 48–50 54
  • Caregivers (n=3/18) studies included 42 44 49
  • Volunteers working in palliative care (n=1/18) 40

Study designs

Qualitative designs (n=13/18):

  • Semi-structured interviews (n=11/18 studies reported in n=12/19 papers) 36 38 43–49 51–53
  • Focus groups (n=2/18) 43 47 50
  • Case studies (interview and observation) (n=1/18) 41
  • Mixed qualitative methods (posters and interviews, n=1/18) 42 interviews and focus groups, (n=1/18) 49

Quantitative design (n=1/18):

  • Survey (n=1/18) 54

Mixed-methodology designs (n=4/18):

  • Q methodology (n=2/18) 37 40
  • Questionnaire (n=1/18) 38
  • Delphi method (n=1/18) 39

Term used to refer to the PCC approach

  • Patient-centred care (n=8/18) 36–40 48–50
  • Person-centred care (n=7/18) 42 44 45 47 49 53 54
  • Patient-centred and family-centred care (n=1/18) 43
  • Client-centred care (n=1/18) 46
  • Individualised integrative care (n=1/18 reported in n=2/18 papers) 51 52
  • Interprofessional patient-centred care (n=1/18) 41

Kmet Data Quality Scores

Range=0.35 to 0.95 (possible range: 0 to 1)

Median=0.82

Qualitative studies and qualitative component of mixed-methods studies (n=17/18):

  • n=17 scored ≥0.55 (adequate quality)
  • n=1 scored ≤0.54 (low quality).

Quantitative studies and quantitative component of mixed-methods studies (n=5/18):

  • n=4 scored >0.80 (strong)
  • n=1 scored 0.71–0.79 (good)

Summary of aims and research questions of studies retained in this review

  • n=8/18 studies included an objective to investigate what is understood by the term PCC or what PCC should consist of in practice. 37 40 42 44–48
  • n=3/18 studies focused on patients’ experiences and expectations of care in relation to predetermined ideas of PCC components. 36 49 50
  • n=2/18 studies aimed to develop PCC indicators. 38 39
  • n=2/18 studies (reported in n=3/17 papers) aimed to investigate how teams that identify as providing PCC practice their care. 41 51 52
  • n=2/18 studies aimed to investigate clinicians’ knowledge and attitudes towards PCC. 43 53
  • n=1/18 study aimed to identify the organisational, environmental, resident and staff variables associated with aged care units with higher perceived levels of PCC. 54

An external file that holds a picture, illustration, etc.
Object name is bmjgh-2020-003330f01.jpg

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 flow diagram.

Synthesis of included studies’ findings

Patient-family-provider relationship.

Overall, the findings suggest that PCC encompasses empowerment of both the patient and their family by being respected, 40 41 48 50 53 listened to, 36 37 47 48 understood, 47 given honest, complete and comprehendible information 36 37 39–41 43 48 49 and by being engaged in treatment decisions and all decisions that affect their daily life and care. 36 37 42 46 48 50 51 This requires collaborative, trusting relationships to be developed between patients, families and clinicians, 40 47 49–51 which rely on clinicians’ communication skills, 39 43 49 attitude 41 and demonstrable compassion, 42 for example, by comforting nervous patients. 36 The studies highlighted specific patient information needs, for example, using diagrams or drawings to aid comprehension, using accessible language, providing information about the possible course of the disease and information about the treatment option of ‘no active therapy’. 38 49 It was also raised that patients should be given the necessary information, education and support to enable self-management. 39

A further dominant theme was the importance of involving and supporting the patient’s family, friends or significant others, 36 44 46 47 49 although some patients may deem this a lesser priority. 37 40

In addition to physical symptom control, the studies suggest patients must also be supported in their psychological, social and spiritual needs, 39 40 45 49 51 52 with great attention to all needs and aspects of care that are important to the person. 36 42 46 47 Sufficient time 51 52 and availability of staff 41 was identified as crucial to address these needs. 54 This also requires flexibility and willingness to adapt skills, routines or environments for individual patients. 44 46

Several studies’ findings placed weight on promoting autonomy, continuation of self and normality and enabling patients to participate in life. 44 45 52 53 This was particularly highlighted in studies focussed on dementia patients and nursing homes, 44 53 where a dementia-friendly physical environment was also deemed important. 54

Organisational level requirements

On an organisational level, PCC was reported to demand a shared philosophy of care, 54 satisfactory leadership, support from colleagues and continuing education and mentorship of staff. 54 PCC was seen as requiring interdisciplinary collaboration, 51 54 and consistency and regularity in collaboration of all members of a care team. 41 Furthermore, all staff (not only front-line) were deemed responsible for providing person-centred care. 42 Included studies highlighted the importance of the coordination and continuity of patient care 44 49 and of streamlining care delivery, 43 for example, by having nursing staff provide additional teaching following the physician visit, 43 or appointing each patient a care coordinator. 37 39 49 Studies also indicated the importance of enhancing accessibility of healthcare services and considering logistical barriers, such as lack of transport or financial resources. 49

Complementary findings across participant groups, across countries and across PCC terms

There were no clear discrepancies between the findings of studies incorporating patient participants, caregiver participants or healthcare professional participants. The heterogeneity of studies did not permit analysis to determine difference between countries or regions. However, the study conducted with indigenous Australian populations reported study-specific findings such as the high financial burden of accessing care and the importance of feeling ‘culturally safe’ within the healthcare system. 49 There was also no evidence of consistent differences between findings from studies using different terms within the PCC consortium, that is, patient-centred care, patient-centred and family-centred care, client-centred care and so on. Based on the WHO definition of ‘people-centredness’, we hypothesised that this term has conceptual differences to person-centredness and patient-centredness and wished to investigate what these may be. However, as none of the retained empirical studies used this term we did not have the opportunity to investigate this.

Domains of Santana model supported by included studies’ data

The data from included studies largely supported the Santana model components ( online supplemental table 2 ), providing more detail about the specific meanings of subdomains, and suggesting relationships between concepts. This is particularly the case for many of the model’s Process dimensions which saw numerous corresponding data codes, for example, Being responsive to preferences, needs and values; Sensitivity to emotional or psychosocial needs; Sharing information; Shared decision-making .

Understanding patient within his or her unique psychosocial or cultural context is an example of a Santana model domain that is better specified through the included studies’ findings. Findings related to this domain suggest that clinicians should show interest in the person as a whole and gain an understanding of their psychological and emotional health, spiritual and existential issues, living conditions, financial situation, social support system, culture, personal identity and daily routines and activities. This knowledge should then be translated into tailored care, perhaps providing emotional support from nurses, referring to appropriate specialists, considering patient convenience and resource availability when ordering investigations and initiating conversations and activities that may be meaningful to a particular patient. 36 38 39 42–47 49 51 52

Domains of Santana model left unpopulated by included studies’ data

Table 1 presents domains of the Santana model for which no corresponding study data was found. Predominantly, the Structure components of the Santana model were unpopulated by findings from the 16 studies. This includes domains such as “S3. Co-designing the development and implementation of health promotion and prevention programs”, and “Spiritual and religious spaces”. “P2b. Providing resources” was the only Process domain to be left unpopulated by the data. Outcome dimensions “O2b Patient-Reported Experiences (PREMs)” and “O2c. Patient-Reported Adverse Outcomes (PRAOs)” were left with no corresponding findings from included studies.

Santana model domains with no assigned codes from included studies:

Model adaptation: evidence additional to Santana model domains

Additional units of meaning arose from the included studies that are currently lacking in the Santana model: Family and friend involvement and support, Promoting continuation of normality and self-identity and Structuring service organisation to enable continuity of care and patient navigation . Table 2 presents these inductively-identified additional themes with examples of corresponding codes from supporting studies. Table 3 presents an adapted version of the Santana framework incorporating these additional themes.

Inductively-identified themes additional to Santana model with corresponding codes(see online supplemental table 2 for full table of studies’ findings deductively mapped onto Santana model and inductively mapped onto additional themes)

Adapted Santana framework incorporating additional themes from the empirical evidence (presented in bold text)

Specifically, Family and friend involvement and support was described as: inviting the patient to bring someone to appointments, 39 establishing conversation with family/friends; 42 involving family/friends in information-sharing and decisions regarding the patient’s care; 37 providing family/friends with opportunities to ask specialists and nurses questions; 38 respecting the opinions and worries of friends/family; 36 acknowledging family/friends in their role as carer for the patient; 37 44 and involving family/friends at all stages including long-term care, treatment and follow-up. 38 Being involved was deemed to avoid feelings of anxiety among family 44 49 and aid the patient emotionally, practically and in understanding and reflecting on information provided by clinicians. 49 51 This domain of PCC also requires healthcare professionals to pay attention to the needs of family/friends of the patient, 37 46 49 including providing accommodations in or near the hospital during treatment if possible, 37 49 and gathering information on the emotional health of family/friends and referring to specialists as appropriate. 39 It is worth noting that some patients and professionals may place this need as a low priority compared with other PCC domains. 37 40

Promoting continuation of normality and self-identity was discussed as requiring encouragement and enablement of persons with serious illness to participate in life despite the disease, and to regain a sense of control and self-efficacy. 51 52 This requires the clinician to consider a patient’s life goals and self-identity when discussing care and treatment options. 51 For long-term inpatients, particularly those with dementia, arranging and enabling meaningful activities was also viewed as a critical part of PCC. Creating individually targeted activities were described not only as providing a meaningful content to the day, but also as a means in reaffirming the residents as individual persons who were able to do the things they enjoyed. 44

Structuring service organisation to enable continuity of care and patient navigation encapsulates a collection of studies’ findings highlighting the importance of streamlining and easing patient navigation, ensuring continuity of care and simplifying the process of multi-specialist care. Suggestions for enabling this included appointing each patient a care coordinator or liaison officer, 37 41 49 ensuring patients see the same professionals over time 36 41 44 using multidisciplinary clinics to decrease wait times and patient anxiety between specialist referrals, 43 and arranging for nursing staff to provide additional information or education following a physician visit. 43

This review has revealed that a number of different constructs underpin the meaning and practice of PCC in the research evidence. These include patient and family empowerment and autonomy through respectful communication, appropriate information sharing and shared decision-making, addressing psychological, social, spiritual and cultural needs and enhancing coordination and continuity of care. The findings of this review indicate that person-centred healthcare must value the social network of each patient, and should promote quality of life and personal goals, not only health status improvement. This implies that person-centred health systems should be structured with flexible health workforce capacity and support staff to adapt skills, communication, routines or environments for individual patients and their families.

The studies’ findings largely validate the domains of the Santana framework of PCC, supporting their importance and providing more detail about specific meanings and subcomponents. The empirical findings of included studies also highlight new PCC themes additional to the Santana model. In focussing on serious illness, this review provides insights into the meaning of PCC that other, less severe conditions may not draw attention to.

The additional theme from included studies’ findings : Family and friend involvement and support , is in line with several other prominent conceptualisations of PCC. 2 16 55 It particularly aligns with conceptualisations that focus on ‘ people -centred’ care, such as that by the WHO, bringing attention to the health of people within their full social circles and communities. 56 57 The vast majority of everyday care is often undertaken by patient’s families and social networks. Enabling families and friends to be active participants in a patient’s healthcare should therefore rightly be a key goal of person-centred health systems reform.

Included studies also indicate PCC as enabling patients to continue to participate in daily life and meaningful activities, promoting continuation of self, personal identity and normality. This finding emphasises that patients’ highly value quality of life and continuation of their normal lives, not only health status improvement. This supports the idea that PCC involves striving to avoid damage to personal identities that the person values, 58 and ties into findings from research with frail populations showing patients value care that supports ‘getting back to normal’ or ‘finding a new normal’. 59 This finding also overlaps with a dimension of Mead and Bower’s patient-centredness framework: the ‘patient-as-person’, which places focus on the individual’s experience of illness and the impact of illness on the individual’s life or sense of self. 15

The third additional theme : Structuring service organisation to enable continuity of care and patient navigation, places particular weight on the organisational and structural reforms that are needed to enable person-centred, care-continuity processes. It highlights that PCC requires not only aspects of the clinician–patient interaction to reform, but also the experience the patient has in interacting with the wider healthcare system. Continuity of care has been presented within other prominent conceptualisations of PCC 17 17 18 55 55 however the specific structural features needed to enable this are rarely discussed. This review’s findings point towards some practical steps for achieving this, such as appointing each patient a care coordinator or arranging for nursing staff to provide additional teaching following a physician visit.

Strengths and limitations

The literature search conducted was comprehensive, considered numerous synonyms for PCC and involved no country or year of publication restrictions. This review also benefitted from interdisciplinary, multinational co-authors, allowing a range of perspectives and cultural viewpoints to inform the analysis and discussion. However, the review does suffer some limitations. First, only peer-reviewed studies published in English were included. Second, the review research questions and search strategy relating to ‘practice’ may have contributed to the lack of supporting data for structure and outcome domains of the Santana model. Third, only publications that included the term ‘person-centred’ (or synonym) were included. Research has certainly been conducted in non-Western LMICs that could inform models of PCC, for example, studies investigating ‘good communication skills’ or ‘empathetic care’. However, searching terms related to, in addition to near synonyms of, PCC would have deemed this review unfeasible. Our aim was to understand PCC as it is currently described.

Conclusions; implications for PCC research, policy and practice

This review indicates that there is a stark absence of theoretical models of PCC for serious illness that are grounded in empirical data. Future research should aim to generate theoretically-underpinned empirical frameworks for clinicians and policy makers on how to implement PCC through relevant, appropriate healthcare delivery.

It would also be insightful for future studies to further investigate the aforementioned PCC domains additional to the Satana model to validate whether these domains should constitute PCC components, and if so, what the specific, operationalisable actions within those components should be. One particular additional theme, Involving and supporting the patient’s family and friends , unsurprisingly surfaced most clearly in studies that included caregivers as participants (n=3). This highlights the importance of including this participant group in further empirical studies.

The included studies add depth and detail to existing Santana model domains, such as: Understanding patient within his or her unique psychosocial or cultural context . The findings related to this domain recognise that much of health is determined outside the clinic by social situations beyond the patient–clinician interaction, such as education, employment, income, housing, social support and gender. 60 Acknowledging and addressing these social determinants of health are critical to delivering PCC. Healthcare professionals must be given the support, tools and structures to actively engage with these social determinants of a person’s health and illness. However, this finding also raises the wider question of where the responsibility of PCC lies and how much of this rests with the individual clinic and clinician. Certain socially determined aspects of patient health can be positively influenced by a healthcare professional, others cannot. Consideration is needed about how and when clinicians should go beyond the clinic, and how to involve any external actors in contributing towards better patient health outcomes. 61 We must reflect on how a practice-based theory of PCC should sit within the broader socio-economic and cultural environment in which a health system operates.

Included studies also strongly support Santana model domains revolving around information sharing, shared decision-making and clinicians taking the time to properly understand each patient’s needs. This reaffirms the importance of in-depth holistic assessment of the patient and the need to empower patients and families through health literacy, equipping them with the knowledge to make informed decisions. 62

Several Outcome and Structure components of the Santana model were left unsupported by findings from the studies. This is not to say that those subdomains are unimportant, but that evidence to support them is lacking, and that patients, caregivers and professionals are most immediately exposed to, and concerned with, discussing processes. Future primary research with healthcare managers or policy makers should specify important structural and outcome domains. However, we could also perhaps infer that patients and caregivers facing serious illness are as, or even more, concerned with the quality of processes than with the outcomes which are most often the focus of healthcare improvement efforts. This suggests we should value process improvements as we value outcome improvements and should value the processes of person-centred care in and of themselves rather than just as a means to a series of outcomes. This supports ethical arguments that we should recognise the intrinsic, not just instrumental, value of PCC, and should pursue it as a valued quality and ethical domain in its own right. 13 58

The lack of study findings corresponding to some Structure components of the Santana model may also be a result of the lack of diversity in settings and diagnostic groups of included studies. The components left unpopulated by the studies’ findings appear to be those less relevant among the diagnostic groups and high-income settings of included studies. For example, Facility that prioritises the safety and security of its patients and staff is less likely to be voiced as a concern in high-income settings with lower rates of violent crime and civil unrest. Health promotion is an element of PCC that seems less poignant in cases of patients with end-of-life cancer and dementia; this topic may be of greater relevance in other serious conditions that are more responsive to lifestyle factors, such as chronic obstructive pulmonary disease. More empirical work is needed to confirm whether these components are of importance, what these components consist of and how they should be operationalised in day-to-day practice. This empirical investigation would be most insightful if conducted in a diverse range of contexts within which these components are likely to be more relevant.

PCC is an approach that evolved from high-income countries, and African theorists have questioned the relevance of Eurocentric conceptualisations and noted the absence of data to understand the meaning, feasibility and acceptability of PCC in non-Western LMICs. 63 This is unsurprising given existing biasses in healthcare research towards high-income countries, and limited resources and platforms for LMICs to conduct and promote this research. In the context of fewer resources, PCC may also be mistakenly perceived as a ‘nice-to-have luxury’ rather than a ‘need-to-have necessity’ and may be challenging to promote in settings with a history of disease-specific, vertical programmes. However, the lack of diversity in study countries raises questions about how both Santana model domains and additional themes could be conceptualised and operationalised globally, in a diversity of settings. Successful enactment of person-centred care would require a multitude of contextual and cultural factors to be considered and accommodated. For example, as Markus and Kitayama 64 discuss, the dominant construal of self differs between Western and other contexts. Western notions of the ‘self’ are that of an individual independent agent, while in most non-Western societies the ‘individual’ is more integrated with significant others. A patient with more interdependent views of self may be highly concerned with harmonising relationships and views. This has very real implications for the clinician–patient interaction and how to best practice involvement and support of a patient’s family and wider social network. Data from more individualistic cultures, such as that from the included Galekop et al study, 40 may suggest that ‘ there are some meetings involving the whole family, but ultimately, it is the patient who decides and not the family ’ . In a more collectivist culture, however, great importance may be placed on collective decision-making and the impacts of illness on a person’s network, 65 and thus, person-centred care would need to enable this. We must carefully consider the underlying values and determinants of culture in order to ensure cultural sensitivity in PCC theory. 58 66 A global theory of PCC and resulting policy would need to accommodate different beliefs and worldviews and centre around a common set of human values.

Handling editor: Seye Abimbola

Twitter: @KennedyNkhoma6, @sridhartweet

Contributors: AG planned, conducted, reported and submitted this systematic review, and is responsible for the overall content as guarantor. KN assessed the quality of a subselection of included studies and compared assessments with AG. KN and RH reviewed the work as required. RP, IP, LG, LF and SV contributed to design and interpretation. KN, RH, SV, RP, IP, LG and LF approved the manuscript.

Funding: This research was partly funded by the National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in sub-Saharan Africa, King’s College London (GHRU 16/136/54) using UK aid from the UK Government to support global health research.

Competing interests: None declared.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: All data relevant to the study are included in the article or uploaded as supplementary information. This paper is a systematic review and does not report novel primary data.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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How to write a case study

NHS Education for Scotland (NES)

Guidelines for writing a case study

Published: 27/07/2021

Publisher: NHS Education for Scotland (NES)

Type: Document

Audience: General audience

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Counselling Tutor

045 – Dialogue in Therapy – Development of the Person-Centred Approach – Choosing a Supervisor

Counselling Tutor Podcast 045: Dialogue in Therapy – Development of the Person-Centred Approach – Choosing a Supervisor

In episode 45 of the Counselling Tutor Podcast, Rory Lees-Oakes and Ken Kelly talk about how to avoid asking, ‘How does that make you feel?’ ‘Theory with Rory’ looks at three key phases in the development of person-centred counselling. Last, the presenters offer tips on finding a suitable counselling supervisor.

Dialogue in Therapy (starts at 3.50 mins)

‘How does that make you feel?’ has become a rather laughable question, often used to parody counsellors on TV etc. But since counselling is all about feelings, how do we avoid asking this stereotypical question?

Ken points out that in fact ‘How does that make you feel?’ distances us from the client, as it suggests we have no idea what emotions they might be experiencing. Listening to a client’s story, noticing their body language, using our intuition, and listening out for words that indicate underlying emotion can always enable us to have a go at saying what we think they might be feeling: they can then confirm this, or correct us.

Rory talks about the importance of getting the language right when we do this – using words that fit with the client’s own understanding and use of language. It’s important not to assume that everyone has the same breadth of vocabulary for emotions, and it may be hard for clients to find the right word to explain what they are feeling. As therapists, we can work on expanding our ‘ feelings vocabulary ’ by writing a regular journal in which we can work on finding just the right words to describe our experiences.

Development of the Person-Centred Approach (starts at 15.03 mins)

Since its beginning in the 1950s, person-centred counselling has developed considerably, and continues to do so today. There are many different branches of person-centred therapy, as described in The Tribes of the Person-Centred Nation (edited by Pete Sanders, PCCS books, 2012). However, all would agree on the key tenets of Carl Rogers’ approach:

  • the six necessary and sufficient conditions for therapeutic personality change
  • the seven stages of process (though some therapists believe these to be less linear than Rogers suggested)
  • phenomenology
  • the 19 propositions

Because Rogers did not prescribe any particular template, there are as many different styles of person-centred therapy as there are therapists themselves: we are all different, and it is important in this modality to be ourselves.

Rory describes three key stages in the development of person-centred counselling  over its first 30–40 years:

  • The first phase (1940–1950), when Carl Rogers first introduced his ideas, could be termed ‘non-directive psychotherapy’. This represented a big challenge to the two types of therapy that prevailed at that time, psychoanalysis and behaviourism, which were used to telling clients how they were and what they should do. In contrast, non-directive psychotherapists listened to and sought to understand the client’s experience.
  • In the second phase (1950–1957), ‘reflective psychotherapy’ (so-called as the therapist reflected the client’s feelings – the focus was on avoiding threat in the therapeutic relationship, by being congruent and real. This represented another step away from psychoanalysis and behaviourism.
  • The third phase (1957–1970) is known as ‘experiential psychotherapy’; it involved therapists becoming even more congruent in terms of expressing to clients how they were experiencing them. This can be a really useful form of feedback for clients on their process. This evolved into focusing, as developed by Eugene Gendlin, one of Rogers’ students.

Rory has prepared a handout on this topic, which you can download free of charge.

Free Handout Download

Three Periods in Person-Centred Therapy

Choosing a Supervisor (starts at 24.45 mins)

Ken and Rory provide tips on what to think about when choosing a counselling supervisor :

  • Check that the supervisor has sound knowledge and experience of your modality.
  • Choose carefully, as it’s not easy to change part-way through training (as you may need them to write both a 50-hour and 100-hour report).
  • Ask which professional body’s standards they work to: it may be useful to choose a supervisor who belongs to the same one as you.
  • If you will be working with a specific client group (e.g. bereavement), try to find a counsellor with an interest and experience in this field.
  • Ask how the supervisor will support you if you are ever feeling ‘less than’ – it is normal to have crises of confidence, and it’s important to have a supervisor who can support you at such times.
  • Visit three to four supervisors before deciding which one to go with.
  • When meeting possible supervisors, don’t get put off by transference. If you don’t like someone, try to work out why before making a final decision.
  • Make sure you can feel safe, in a threat-free environment. It is the stuff you are most ashamed of that is the most important to bring to supervision!
  • If your placement agency wants you to use a supervisor there, ask yourself whether you feel happy with this. Might you want an external supervisor too? If so, how would it work in practice using both?

Robert Shohet is a key figure in the development of supervision theory, having developed – with Peter Hawkins – the seven-eyed model.

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Counselling Case Study: Working with Grief

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

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

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

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

Case Information

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

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

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

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

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

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

The Initial Stages

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Middle Stages

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

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

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

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

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

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

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

Joan’s new beliefs included:

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

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

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

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

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

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

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

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

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

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

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

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

Final Stages

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

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

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

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

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

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

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

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

End of Session

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

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

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

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

Author: Jane Barry

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

  • March 15, 2007
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Power of Person-Centred Care: Putting Patients First for Better Outcomes

Blog Post | Power of Person-Centred Care: Putting Patients First for Better Outcomes

In health and social care, person-centred care moves away from a “one-size-fits-all” approach and focuses on the unique needs and individuality of each person. This leads to a better patient outcome, a happier experience for everyone, and in the end, a more caring and satisfying care system.

Imagine if every person at work got to have their say and feel valued for who they are. That is what we’re going to talk about – making work a place where everyone feels appreciated and understood, just like Emily in her journey to feeling happy and supported at work.

Emily is a young woman who has multiple sclerosis and has just moved into a place where people help her with daily things.

Even though Emily needs help sometimes, she likes to do things on her own and really loves music therapy.

But the place she is living has a strict timetable, and there are not many chances for her to do things she likes. Emily is struggling to feel happy and engaged in the activities she once loved.

This situation shows how important it is to care for people in a way that is all about them.

But what does that really mean?

What is Person-centred care

Person-centred care (or person-centred approach) is a philosophy of care that moves beyond routines and procedures. Person-centred care means looking after people in a way that is not just about following rules.

It focuses on understanding and respecting the unique needs, preferences, and values of each patient or resident. It is about really getting to know and respecting what each person likes and needs.

Instead of doing the same thing for everyone, person-centred care treats each person as someone special, with their own story, things they want to achieve, and things they like.

Why is a person centred approach important

It is important to look at the advantages and reasons why the person-centred approach is necessary. Not just for the person to be cared for, but also for the persons giving it.

With the story of Emily above, we will explain what the benefits of person-centred approach and ways to care for people.

The reasons here can be adjusted to fit other work instances beyond health and social care. The explanation can be used at any workplace by anybody.

The main idea is treating every as unique. John is different from James and both will have their individual needs and what they love. That is the whole concept of personal-centred care.

What is personal-centred care?

12 Benefits of Personal Centred Care?

So, here is why this way of caring is good for everyone:

  • Improved Patient/Resident Satisfaction and Well-being : When care is based on what each person likes and can do, they feel happier and more in charge. For Emily, having music therapy sessions or making a playlist for her room shows that her passion matters.
  • Gets Everyone Involved: People are more likely to join in with their care when they feel listened to and understood. Letting Emily help decide things like when she wakes up or who her physiotherapist is makes her feel important and lets her make choices.
  • Helps People Connect Better : Spending time getting to know someone makes them trust you more. This helps carers understand how Emily likes to talk – maybe she wants things explained clearly, or maybe she likes a joke now and then. This makes the relationship better and more supportive.
  • More Holistic Care that Addresses Individual Needs : Person-centred care goes beyond the body. There is more to well-being than just being healthy. This way of caring knows that being healthy is not just about the body. Think about how Emily might feel if she misses her music therapy – she might feel lonely. Carers who get this might help her meet other people who also love music, so she feels less alone.
  • Saves Time and Makes Everyone Less Stressed: When care is about what each person needs, it is easier to make plans that work. Instead of doing the same for everyone, carers can focus on what really helps Emily. This makes things less stressful for her and the people looking after her.
  • Treating Everyone with Respect: Person-centred care means treating each person with respect and kindness, no matter how old they are, what is going on with them, or where they are from. For example, letting Emily choose her clothes or using the words she prefers shows that we respect her as a person.
  • Getting People Interested: When care is about what each person likes, they are more likely to want to join in. Maybe Emily would be more likely to do her physiotherapy if it involved music or moving to a song she likes.
  • Making Pain Feel Better: Studies say that caring about each person can help with pain. Understanding what makes Emily’s pain worse and what helps her feel better, like doing something fun or relaxing, means we can help her feel less pain.
  • Supporting Families and Loved Ones : Person-centred care is not just for the person getting care – it is for their families too. Keeping Emily’s family in the loop about what’s happening with her care and letting them join in when they can makes them feel like they’re part of the team and less worried.
  • Making Work Better : Carers who can care in a way that is all about each person say they like their job more and feel less tired. Seeing Emily feeling better because of what we do makes everyone want to do a good job.
  • Always Learning: Caring about each person means always watching and learning. Seeing how Emily reacts to different ways of caring helps us get better at our job.
  • A Culture of Compassion : At its core, person-centred care is about compassion and empathy. This means being kind and understanding. By caring about Emily’s happiness and letting her be herself, the care place becomes a kinder, nicer place for everyone.

Getting Started:

The good news is that starting to care in a way that is all about each person does not mean changing everything. Here are some easy things to do:

  • Active Listening : Spend time talking to people, listening to their stories, what they like, and what they worry about.
  • Shared Decision-making: Let them help decide things about their care, explain what is happening, and respect their choices.
  • Do Things They Like: Try to do things they enjoy and are interested in.
  • Respect What They Want: Even small things matter, like letting them pick their breakfast or clothes.

By doing these things, nurses and carers can make their work better, being kinder and happier as they look after others.

Remember, it is all about thinking about the person first, just like Emily and her love for music.

Supporting Nurses and Carers:

Helping nurses and carers switch to caring in a way that is all about each person needs support too.

Here are some ways to help them:

  • Learn and Train: Teach them about how to care for each person in a way that is all about them.
  • Let Them Decide: Give them the power to make choices based on what each person needs. This makes them feel more in charge and happier at work.
  • Talk Openly: Encourage everyone to talk openly about what works well and what is hard. This helps everyone learn from each other and solve problems.
  • Say Well Done: When caring about each person leads to good things, make sure to say so. This makes everyone feel good and reminds them why caring this way matters.

Conclusion:

Caring about each person is not just a nice idea – it really works. By thinking about each person and what they need, nurses and carers can make care better for everyone. It is about being kind, doing a good job, and feeling happy at work.

Are you ready to care this way too? Share your thoughts and experiences!

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‘Being’ person-centred: a reflection from a personal and professional experience

In this week’s Evidence Based Nursing Blog, Andrew Cassidy (@mrandycassidy) brings his own personal lived experiences and professional thoughts from his years working in the NHS and other sectors on what being person-centred looks like. 

I’ve worked in the healthcare for nearly fifteen years, in the NHS, the third sector, and for a social enterprise. In spite of the differences in these roles, a main focus of each of them has been on the provision of person-centred care. But what is person-centred care, and how can one person be expected to say what is and what isn’t person centred for someone else? This question was brought into sharp relief in the early days of the pandemic. I have Crohn’s Disease, and take immunosuppressant medication to keep it under control. This placed me in the shielding group, and led to one of the most challenging conversations that I have ever had with my healthcare team. Early in the morning of March 23rd, my GP called to ask me how I would feel about having a DNR placed on my medical records. I have a good relationship with my GP, and her manner was sensitive and, I felt, pitched at a level I would respond to. We’ve always been candid in our conversations, and I appreciated this candour in our conversation, but it made me think. My conversation with my GP was structured around my level of understanding and my “expertise” of my own condition. However, I appreciate how difficult that conversation would have been for my GP to instigate, and I began to wonder how the conversations she had with other patients in my position were positioned. Were they all as “person-centred” as the conversation I had?

how to write a person centred case study

This made me think about my professional life, and the roles of my clinical colleagues. As nurses, they are expected to provide person-centred care in all circumstances. But how can “person-centred-ness” be quantified? Two people could look at the same interaction, and arrive at two polar opinions as to whether or not it was person-centred. Is there a universal definition, or is it nebulous and does that definition differ from person to person? Further, if there is no definitive definition – and, if the notion of what is and is not “person-centred” varies from person to person, then surely there cannot be? – how can we reasonably expect professionals themselves to determine whether their interactions are person-centred or not?  I decided to examine my own experiences of care, and to try to determine what factors were important in my appraisal of whether or not they were person-centred. My first thoughts ran to health literacy. For me, the first step of a person-centred approach is communicating at a level people are comfortable with. I’ve had Crohn’s for over twenty years, and conversations about antiemetics, 5-ASA’s, and terminal ilea do not faze me, but I can imagine the confusion these conversations would give rise to someone who has been newly diagnosed. But here’s the rub; that’s precisely what makes it person-centred for me. The very aspect that makes it person-centred to me could have completely the opposite effect on someone else. This leaves a very obvious question; can we truly expect professionals to know at first glance or interaction the approach that would suit every patient and pitch their interactions accordingly? And, if so, how can policies be made at Trust / Health Board / National levels when we have a virtual smorgasbord of opinions on what person-centred is and isn’t. For me, the essence of person-centred care comes down to ascertaining what is important to the person themselves. Recent initiatives have led the way on this, notably the Scottish Government’s What Matters to You , have shone a light on a way forward.  A system simply cannot decide what being person-centred looks like, but getting to the heart of what is important to the person can provide a starting point. What matters to the person should influence everything in a healthcare environment, from communications to potential treatment options and long-term support and care. Only once what matters to someone is identified and valued can systems begin to design a package of care that truly puts people at the centre.

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BMJ Journals

How context influences person-centred practice: A critical-creative case study examining the use of research evidence in occupational therapy with people living with dementia

Affiliations.

  • 1 Division of Occupational Therapy and Arts Therapies, Queen Margaret University, Musselburgh, Edinburgh, UK.
  • 2 Queen Margaret University, Edinburgh and The Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.
  • PMID: 36073249
  • DOI: 10.1080/11038128.2022.2119162

Background: Occupational therapists are encouraged to use research evidence to guide therapeutic interventions that holistically address the consequences of dementia. Recent efforts to use research evidence in practice have emphasized the challenges of doing so in ways aligned to person-centred and professional principles. Using research evidence is a complex process influenced by multiple contextual factors and layers. The influence of context in occupational therapy for dementia is currently unclear.

Aims: To explore the contextual complexities of using research evidence in practice with people with dementia, and to develop knowledge to improve the approach to using evidence in person-centred, occupation-focused practice.

Material & methods: A case study methodology was used, in which the contextual conditions of practice were clarified through the facilitation of critical and creative reflection using the following methods - Think Aloud, practice observation, creative expression and reflective dialogue.

Results: Cultural beliefs that affected evidence use included technically-orientated understandings of evidence-based practice. These were underpinned by apprehensions about losing professional identity and taking risks when processes derived from research evidence were adjusted to incorporate a persons' occupations. These cultural factors were perpetuated at the organizational layers of context, where systemic priorities and other team members' needs disproportionately influenced occupational therapists' decisions.

Conclusions & significance: Occupational therapists' potential to make reflexive and responsive decisions by adjusting evidence-based processes can be affected by their perceived freedom to address organizational tensions. Raising consciousness of the influence of the organizational context on decision-making about evidence use could adjust occupational therapists' perceptions of their freedom and ability to be person-centred. Intentionality in reflective processes in practice are required to foster reflexivity.

Keywords: Complexity; critical creativity; culture; evidence-based practice; occupation-focused; person-centred.

  • Occupational Therapists
  • Occupational Therapy* / methods
  • Occupations

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

case study

 Famous Case Studies

  • Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
  • Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
  • Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
  • Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
  • Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

  • Studying the effectiveness of psychotherapy approaches with an individual patient
  • Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
  • Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

  • Studying psychological development from birth through adolescence
  • Cases of learning disabilities, autism spectrum disorders, ADHD
  • Effects of trauma, abuse, deprivation on development

Types of Case Studies

  • Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
  • Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
  • Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
  • Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
  • Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
  • Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

  • Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
  • Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
  • Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

  • News/Media – News coverage of events related to the case study.
  • Academic articles – Journal articles, dissertations etc. that discuss the case.
  • Government reports – Official data and records related to the case context.
  • Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

  • Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
  • Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
  • School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

  • Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
  • Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

  • Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
  • Include client demographics like age and gender, information about social relationships, and mental health history.
  • Describe all physical, emotional, and/or sensory symptoms reported by the client.
  • Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
  • Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
  • Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

  • Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
  • Present the results of the intervention,including any quantitative or qualitative data collected.
  • For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

  • Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
  • Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
  • Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
  • Offer clinical implications, and suggest future research directions.

5. Additional Items

  • Thank specific assistants for writing support only. No patient acknowledgments.
  • References should directly support any key claims or quotes included.
  • Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
  • Provides detailed (rich qualitative) information.
  • Provides insight for further research.
  • Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

  • Lacking scientific rigor and providing little basis for generalization of results to the wider population.
  • Researchers’ own subjective feelings may influence the case study (researcher bias).
  • Difficult to replicate.
  • Time-consuming and expensive.
  • The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

  • Case Study Approach
  • Case Study Method
  • Enhancing the Quality of Case Studies in Health Services Research
  • “We do things together” A case study of “couplehood” in dementia
  • Using mixed methods for evaluating an integrative approach to cancer care: a case study

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