Systematic Case Study

Identify potential client/s

• In collaboration with your supervisor, consider all clients with whom you are embarking on a substantial (6+ sessions) piece of change-focused work, as a potential SCS case
• Review any information (referrals, triage notes, older records) you have access to which can help you anticipate your client’s needs (they may change in the room)

Identify potential clinical focus

• Using the information, you have access to, identify what the clinical focus of your work may be (e.g., reducing anxiety, depression, anger or improving regulation, quality of life)

Identify any relevant potential secondary treatment targets (STT)

• Clients often have multiple needs. You may want to identify potential STT (e.g., less self-criticism, improved relationships, getting back to work)

Review whether the client has completed measures before in the service

• Sometimes clients have not long been assessed, try to access any recent measurement as this could guide your choice of measure and act as a reference point in your work

Identify potential measures

• Consider standard measures used by the service and start to anticipate what you might add
• It may change in the room, but you can go to the first session prepared with some potential measures that may be relevant, based on what you know about the client already
• If you are unsure what the clinical focus may be, you may wish to choose a ‘global’ nomothetic distress measure which can capture a range of potential difficulties (e.g., CORE-OM, DASS, RCADS)
• Print an idiographic measure (see manual for different options) for use in the first session

Identify a shared treatment goal (your Primary Presenting Problem, PPP) and any viable secondary treatment targets (STT)

• Ask your client what they most would like to change when working with you (identify shared PPP)
• Take time to ensure the goal is Specific, Measurable, Achievable, Realistic and Time-Bound (SMART)
• When working with systems, consider who is/are your client and where the anticipated change is located (e.g., carer, nursing home team).
• If conducting an extended assessment, consider the service purpose and what you have capacity to change (e.g., insight, acceptance).
• Assess how feasible the STT are to achieve in the therapy, prioritise measurement of the PPP and any achievable STT

Gain consent to measure progress towards the goal in and outside of the therapy

• Speak to your client about the potential benefits of regular measurement (e.g., enrichens the therapy, measures and monitors impact, helps locate what is working and what is not)
• Seek verbal consent to incorporate regular measurement of the PPP and any achievable STT into the work

Administer your nomothetic measure for your PPP (at least)

• Identify and administer your nomothetic measure of the PPP before any intervention occurs (to get a true ‘starting point’)

If possible, devise your idiographic measure of PPP (at least) and any STT with your client

• Identify key shared goals/PPP/STT and how you plan to measure this in a person-centred (idiographic) way, see manual for options (e.g., GAS, Psychlops)
• Ask your client to rate themselves on the idiographic scale/s as they view things now (this is your ‘starting point’)

Consider measuring your therapeutic process

• Pick an appropriate process measure for your client and context

Agree the frequency of measurement

• Collaboratively agree the frequency of measurement. The more regular the measurement the more information you will have to work with in the room and in your assignment. But, balance this with client burden and the service context. Also consider that excessive measurement may perpetuate a PPP (can be common with presentations underpinned by excessive anxiety which manifest as adherence to routines).

Review understanding and adherence to measures

• Review client adherence to measures. If return is low, considering refining or reducing measurement
• It is common for the PPP to change during the course of therapy, try to identify this early and alter measurement plans. If possible, retain at least one measure you have a ‘starting point’ for
• The most important task in therapy is client change and experience, not your assignment. Try to notice any ethical dilemmas which arise within you as a result of your dual role (therapist/academic)

Utilise the incoming data in your therapy/work

• Use the data that is returned to you as valuable information in your work with your client. Not only does this make the purpose of measurement clear to the client which improves engagement/accuracy, it also engages them fully in the change process.

Discuss your potential cases with your academic tutor

• When you have an emerging data-set/s with your client/s it is best to talk to your academic tutor about what you have collected and which ‘case’ will best fulfil the SCS assignment requirements. The absolute minimum dataset requires an initial measurement of the PPP before intervention began, intermittent change measurement over the course of the work and PPP measurement at the end. We also encourage the collection of a ‘rich data set’ (Elliot, 2002) which includes idiographic and process measurement.

Discuss concept of your data being analysed as part of an academic assignment

• Nearing the end of your work, begin a conversation, if you haven’t already, with your client/s about whether they are happy for their anonymised data to be analysed as part of your academic course. Ensure the client has time to make an informed decision.

Re-administer key measures

• For PPP/STT you have a ‘starting point’ measure of, re-administer these measures again to enable you to assess change across time (you may also have daily/weekly/sessional measures too)

Consider conducting a Client Change Interview (CCI)

• To gain the perspective of the client on what change has/has not occurred and what contributed, consider conducting a CCI to enrichen your insights

Request and record consent

• Request and record your clients verbal consent that they are happy for their anonymised data to be analysed as part of your academic assignment in your relevant clinical system

Review your data with your academic tutor

• Once your work has concluded, it is useful to check in with your academic tutor in the dedicated SCS tutorial or separately about the data you have and how you intend to approach analysis.
• Write your assignment aligned to the SCS marking criteria
• Top top tip! Have a read of the Morley book, it will help situate your design within the broader single case methodology framework.