Comprehensive Case Study

Running head: THE CASE OF SALLY 1

Oral Comprehensive Report

The Case of Sally

Faheem Johnson

La Salle University

THE CASE OF SALLY 2

Tentative (5 Axis) Diagnosis & Goals Axis I: 311: Depressive Disorder NOS; 298.8: Brief Psychotic Disorder

(w/ marked stressor(s)); 313.82: Identity Problem Axis II: 799.9: Deferred Axis III: 556.9: Colitis, ulcerative Axis IV: Occupational – recent job loss; Economic – issues w/ family finances;

Other psychosocial/environmental problems – victim in a bank robbery Axis V: 60-65

For Sally’s Axis I diagnoses of clinical syndromes, utilizing all of the information provided in her

case narrative, several hypotheses were formulated leading to Sally having multiple diagnoses. The first

diagnosis is Depressive Disorder NOS. If this is the case, then some of Sally’s symptoms would include:

(1) an inability to think clearly or concentrate appropriately (2) exhibit variable symptoms that can cause

significant to severe distress or impairment in occupational, or other important areas of functioning, and

(3) exhibit episodic depressive features for at least 2 weeks.

To illustrate, Sally had recently been laid off from a job she worked for many years. And while

Sally was laid off from this job, a job in which she seemingly loathed, it can be assumed that Sally would

not only feel guilty about being laid off, but she would also experience a sense of devastation and

disconsolation, especially because she was one of the heads of the household with an income. As

indicated in the case description, Sally is definitively worried about her family’s finances. An

occupational disturbance such as losing a job can cause or increase debilitation of an individual’s mental

and emotional state, i.e. Sally’s professional identity is now in a bleak quandary. That is to say, if Sally

was at some point before all of this, quite stable and on the surface she appeared to be a well-adjusted

professional adult with little pervasive psychological stressors, then it is not unlikely to propose that

Sally’s variable depressive features were caused by or stem from a stressful life event such as losing her

job.

As for Sally’s secondary Axis I diagnosis of Brief Psychotic Disorder (w/ marked stressor(s)),

Sally reported experiencing seeing a vision of her late mother as she was falling asleep. After Sally had

been asleep for an unspecified period of time, she suddenly awoke to another vision, this one perhaps

more lucid than the first, of her mother standing in her bedroom gazing at her. In Sally’s own words, the

THE CASE OF SALLY 3

experience was “very real”. Following the event, Sally self-described herself as being “discombobulated”,

ultimately causing her to feel bewildered and incapable of performing normal parenting and household

duties. Even further, Sally reported feeling ill at ease and not herself for at least three consecutive days,

although each day appeared to get better with time.

Brief Psychotic Disorder (w/ marked stressor(s)) is a period of psychosis with a duration that is

typically shorter, non-re-occurring, and not caused by another condition. In preparing this secondary

diagnosis for Sally, it was assumed that Sally was not of a specific culture where symptomology of a brief

psychotic episode is considered culturally appropriate, sanctioned or otherwise normal. Because Sally

identified experiencing a pair of visions that her deceased mother was in her presence, describing such

experiences as “very real”, and following these experiences, she felt mentally disoriented for several days,

it is likely that Sally experienced hallucinations. Along with the presence of several other symptoms,

hallucinations are one of several symptoms that occur in those who suffer a brief psychotic period.

Namely, it is assumed that Sally experienced hallucinations of her mother because both of Sally’s visions

occurred while she was wakeful, and not while she was asleep and dreaming. For, dreams, while

somewhat related, occur while someone is not awake and typically do not involve an active distortion or

misinterpretation of reality and real perception. Additionally, Sally’s episode of experiencing

hallucinations, as well as exhibit grossly disorganized behavior for several days was brief and lasted less

than one month (3 days to be exact). More importantly, Sally described the entire experience, while

puzzling, as something that eventually got better with time, which is ultimately an eventful return to

premorbid levels of functioning.

And thirdly, Sally’s third and final Axis I diagnosis of Identity Problem was significant enough in

her case to receive clinical attention. This diagnosis stems not only from her recent job loss, but mainly

from her past history of unfinished business with her then, very strict mother. According to Sally’s case

description, her mother was a stringent parent who demanded and seemingly pushed Sally into choosing a

career that was more profitable and stable rather than support Sally in choosing any career that could

allow her both wealth and inner tranquility. Because of her past history, Sally, who is now unemployed is

THE CASE OF SALLY 4

a) anxious about looking for another job, especially because she was quite dissatisfied with accounting

work and b) at a crossroad of potentially never finding a job that suits, not only her financial needs, but

also suits her efficacious needs as well. Clearly, there is discord and uncertainty related to Sally’s overall

identity as a person, her career and professional identity as a social being, and her moral value(s) related

to what’s needed to be done both as a mother and as a wife to continue to support her family structure.

For Axis II; personality disorders and mental retardation, there was not enough information

provided in Sally’s case description to make any diagnostic judgment about an actual Axis II diagnosis;

thus, Sally was confidently given a deferred diagnosis on this axis. In contrast, on Axis III; general

medical condition(s), per the evidence detailed about Sally’s medical history, Sally’s colitis or more

formally, ulcerative colitis was recognized here. This specific medical condition is a form inflammatory

bowel disease that primarily affects an individual’s colon and rectum. According to medical literature,

there is seemingly no direct cause for colitis; however, stress and genetics are regular postulations formed

about the disease.

As for Axis IV and in accordance with the evidence in Sally’s case description, the psychosocial

and environmental factors that are likely catalysts in the ebb and flow of Sally’s diagnostic symptoms

include: recent job loss, issues with family finances, and her recent exposure to the violent and traumatic

event of being held at gunpoint in a bank robbery. Lastly, for Sally’s Axis V diagnosis (Global

Assessment of Functioning), Sally’s overall level of current functioning reflects that she falls in between

the ranges of 60-65. Despite Sally’s secondary Axis I diagnosis of Brief Psychotic Disorder, which

occurred nearly two months ago, Sally’s current level of functioning displays that she may exhibit some

mild symptoms of depressed mood, as well as display some difficulty occupationally due to her

joblessness. Conversely though, if it is assumed that Sally is generally functioning well and trying to

maintain some of her duties and commitments as both a wife and a mother balancing meaningful

interpersonal relationships, then her GAF score of 60-65 is appropriate for her current diagnoses.

As for confirming or rejecting Sally’s tentative multiaxial diagnosis, it is essential that the

therapist review current symptoms of depression using the DSM-IV-TR criteria, inquiring about each

THE CASE OF SALLY 5

symptom and about any past history of depression. It is also imperative for the therapist to take advantage

of peer consultation. It is also essential that Sally is referred to a psychiatrist for further medical and

diagnostic assessment. All the same, Sally and the therapist need to explore Sally’s family history as

extensively as possible to determine whether or not mental illness and/or addiction are unfortunate

contributors that have influenced Sally’s family generationally. One specific, as well as therapeutic

method to collect Sally’s familial history is to collaborate on completing a genogram. Unlike a

conventional family tree, completing a genogram with Sally provides a pictorial display of possible

hereditary patterns and psychological factors that have or still punctuate Sally’s family dynamic.

In preparing to work with Sally, it should be noted that the therapist’s approach would embody

several elements and characteristics to its method. To be general at best, the core or foundation of the

therapist’s aim is humanistic in nature and attempts to adopt a more holistic sense to Sally’s individual

experience as a human being. In essence, this approach would not be practiced in an attempt to solve any

one of Sally’s particular issues. Rather, the approach would more so identify with supporting Sally’s

individual growth so that she becomes better at managing both present and future issues in a more

integrative manner.

At the most basic level, the therapist’s overarching goal would be to facilitate empathic

engagement with Sally in order to establish, overtime, both a congruent and genuine therapeutic

relationship. That is also to say, with as much collaboration as possible, it would be important as Sally’s

therapist to reduce the potentiality of her having emotional discomfort in therapy, foster a general sense of

insight from Sally about herself, and encourage Sally to try and experience cathartic freedom or express

her emotions as freely as possible and as much as she can in session.

To illustrate, for Sally’s first Axis I diagnosis of Depressive Disorder NOS, because Sally (in

accordance with her condensed case description), does not appear to exhibit any one particular depressive

feature, one of the first goals in working with her would be to tap into her understanding of her diagnosis

phenomenologically or in the here-and-now so to speak. In other words, the therapist will not look to

disprove Sally’s own interpretation of her experience itself and the potential meaning it can have to her.

THE CASE OF SALLY 6

For, theoretical and behavioral interpretations cannot impugn first-hand experience(s) of any client

without first understanding a client’s subjective experience. Nevertheless, general psychoeducation and

providing new information about diagnoses can, and is, vital in working with any client, but specifically

speaking, in working with Sally, so that her self-awareness has a starting point in fostering what might or

might not be expected with having such diagnoses.

As for explaining why these general goals were selected or are preferred for Sally’s therapeutic

experience, the answer is rather simple: effective therapy requires healthy collaboration between the

client (Sally in this specific case), and the therapist. Essentially, there is a certain quality and strength to

allowing the therapeutic process be-come collaborative. An effective and empathic alliance between the

therapist and the client reliably shows that the process of therapy can maintain a healthy positive balance,

which in turn, can generate positive outcomes in therapy and promote the facilitation of therapeutic

change. As a result, the therapist and Sally will both facilitate an active role in her treatment process; thus,

prognostically, as a client, Sally will understand that her course of treatment with the therapist will most

centrally involve heightening her expectancy or capacity to change. Simply translated, this active

collaboration between Sally and the therapist will in no way guarantee that Sally will never experience

any of her diagnostic symptoms again, but rather, Sally and the therapist will work together to foster the

belief that the therapeutic process in and of itself promotes an expectancy of improvement upon Sally’s

major problems and issues she seems to be experiencing.

Theoretical Orientation & Case Conceptualization

Because there is no one fully acceptable or advantageous theoretical model of therapy and the

fundamentals of effective counseling seem to be proportionately similar (i.e. encouraging client catharsis,

presenting new knowledge and information to a client, and raising a client’s level of probability of

change), the therapist’s basic theoretical approach to counseling is to work from an eclectic model of

therapy. Subjectively, that is to say, certain types of psychotherapies are better suited for certain types of

individuals and issues. As well, despite preferring to work from an eclectic approach, generally speaking,

effective therapy from any discipline has more so to do with the connection between the client and the

THE CASE OF SALLY 7

therapist and the maturation of their therapeutic alliance than it has to do with subscribing to specific

theoretical orientations. Thus, in the same light of Arnold Lazarus’s unifying manner toward the overall

practice of counseling, the goal of therapy, then, is uniquely multidimensional and encompasses a holistic

influence on the individual client while working on a few problem areas of focus.

Specifically however, in the case of Sally, the two primary theoretical orientations that will be

presented to further conceptualize her issues are: Person-Centered Therapy and Gestalt Therapy. In

essence, both of these therapies, when integrated dynamically, yield the most congruence when it

specifically pertains to (1) the therapist’s views of human nature, (2) the influential roles of the client-

therapist relationship, (3) the development of maladaptive behavior, and (4) treatment goals of therapy.

For example, according to Rogers (1980a, p. 117), fully functioning persons are increasingly

open to experience, increasingly accepting of their own feelings, and capable of living in the present from

moment to moment. In other words, individuals are progressively free to make their own choices and act

on them as they please. As well, they are able to trust themselves and human nature while still being able

to balance sensible expressions of various emotions such as intimacy and aggression. Hence, one of the

main goals of person-centered therapy is to do the therapeutic work that promotes moving toward a truer

self, rather than move toward a self one is not.

In the same way, one of the primary tenets of Gestalt therapy is to assist clients to become more

fully aware, that is, achieve a healthy stability of satisfaction and balance. For, Gestaltists view humans as

having the capability to become fully aware in spite of their maladaptive behaviors and characteristics.

Moreover, awareness is what’s considered right for all individuals, especially clients. Consequently,

being fully aware allows for there to be a sense of inner direction and inspiration to being who we really

are. Therefore, according to Perls, all needs stem from, and are grounded in, this basic need to actualize

oneself, to become whole (Perls, 1969a). Even further, Gestalt therapy and person-centered therapy both

focus on the here-and-now approach and stress positive objectives and goals of living. Indeed, these two

unique modalities personify their own unique characteristics; however, like many of the broad therapeutic

orientations, some of their most general beliefs about effective therapy overlap with one another.

THE CASE OF SALLY 8

Again, because it is the therapist’s preferred methodology to utilize an eclectic approach to

counseling, Sally’s case will be conceptualized from both a Person-Centered modality and Gestalt

modality of psychotherapy. In the eyes of the therapist, both of these paradigms encompass the most

supportive and complementary evidence into the potential causes of and the current maintenance of some

of Sally’s issues.

To begin with, if the causes of Sally’s problems were to be looked at developmentally, it could be

said that Sally’s development, in relation to her early environment, was neither promoting nor

domestically satisfying. To explicate this developmental point more clearly, half of it will be discussed

from a Gestaltist view of early development and the other half will be framed from a Person-Centered

point of view. That is to say, in Sally’s social stage, her development in the infancy period included

depending on both of her parents for everything and having little to no awareness of herself, which is

considered normal. However, when it was time for Sally to move past the social stage of development to

the psychophysical stage of development where an individual becomes more aware of their self and self-

image through their relation to receiving acknowledgement and support, Sally was imperceptively

without a father in her life. This is critical to assume due to fact that Sally’s mother and father divorced

when Sally was 5 years-old. Even further, this critical assumption is also important to note due in part to

Sally’s mother being described as “very strict”. It is likely that Sally’s mother was more stoical than

warm in her emotional attendance and availability to her daughter. Therefore, Sally is likely to have gone

on in life adopting those same characteristics that her mother embodied, and unknowingly applied them to

her own life and interpersonal relationships. Because of this, Sally is at a current stage in life where she is

less than fulfilled existentially and is used to insecurely sheltering herself emotionally from others. Most

uniquely, it is mentioned by Kempler (1975) that very few people reach what Perls identified as the third

stage of development, which is the spiritual stage where one moves from awareness that is sensory

sensing to awareness that is extrasensory sensing. If this were the case, Sally’s recent episode of

experiencing a hallucinatory vision of seeing her deceased mother gaze at her one night can be looked at

as Sally’s inner self attempting to move from sensory-based awareness, which is (physical) to that of an

THE CASE OF SALLY 9

extrasensory awareness, which is more (mental). And while Sally experienced discombobulating after

effects of this episode, these experiences have brought Sally to therapy to find out what she experienced

and does this experience have any correlation to her lack of fulfillment career-wise; thus, further

exacerbating her anxiety about finding something new to do with her life.

By the same token, from a Rogerian or Person-Centered perspective, if it were the case that Sally

did not grow up in favorable conditions, then Sally is likely to have not been granted the chance to

flourish. In other words, after Sally’s parents divorced, Sally had to be raised by her mother, who

possessed the natural inability to promote and support Sally’s self-growth. Rogers recognized, of course,

that human beings can perpetuate great evil – that they are capable of deceit, hatred, and cruelty – but he

believed that these propensities are the result of negative “conditions of worth” imposed on children by

family and society (Moreiera, 1993). In summary, Sally’s dateless disposition of non-specific depressive

features has resulted in her becoming more externally preoccupied, rather than internally oriented. In

other words, if Sally is considered to have had a long-lasting lack of passion for herself and continuously

found herself tempted to distort her own feelings in order to meet the needs of others, it is clear to see

how Sally’s maladaptive behaviors could have manifested over time.

In beginning therapeutic work with Sally, some of the most fundamental elements of counseling

would be advocated as identified earlier in the Goals section of the paper such as: promoting an

expectancy for change to occur, utilize the nature of the therapeutic relationship to reduce Sally’s

potential for emotional discomfort, foster insight and self-examination, encourage catharsis, and provide

Sally with a different perspective of her issues so that they can be thought of as more solvable. However,

to speak in terms of technicality, the therapist would apply specific methods and techniques from the

Gestalt model, and if needed, attempt to support such therapeutic efforts utilizing fundamentals from the

Person-Centered approach to therapy.

To illustrate, the overarching goal in Sally’s case is to relinquish her potential psychological pain

and maladjustment (or resistances to contact), by becoming more aware; thus, helping Sally learn how to

enhance her entire self so that she can become more integrated internally rather than continue to

THE CASE OF SALLY 10

ineffectively preoccupy herself with external forces outside of her responsibility and control. Because the

Gestalt model functions primarily by using experiential work to help clients gain new insights while

improving their issues, it is vital that the therapist first prepare Sally for such therapeutic work. Hence,

Sally would have to first grant the therapist full permission to begin Gestalt therapy with her. As well, if it

were the case that Sally had any potential cultural concerns about the work, such concerns would be

explored and therefore treated sensitively by the therapist. As a result, the therapist and Sally will develop

a communicative partnership between equals – talk with, rather than at each other while remaining

centered in the here-and-now. Also, there will be resistance during the experiential process. Sally would

become more aware of that as therapy unfolds. It is predictable, especially provided Sally’s early

background and her current perpetuation of not being in the present moment, that certain elements of her

emotions will not be moved easily and that she may experience a fear of losing control; however,

provided that Sally wants to do the work, eventually, this resistance shall wane.

Furthermore, the nature of language during the sessions would be another central focus to

explore, as Sally would be encouraged to take more responsibility by phrasing what she means and how

she feels using “I” statements rather than “you” or “it” statements. Subsequently, in conjunction with the

experiential aspect of the Gestalt helping process, Sally would be encouraged to fully engage in

expression work, such as performing the internal dialogue exercise and therefore staying with the feeling

of this expression work in order to go deeper into her feelings that she tends to avoid. For example, the

therapist would encourage Sally to engage in Topdog vs. Underdog dialogue (in this case critical mother

vs. victim), either by using the empty-chair technique or by role playing with Sally and becoming her

mother in the present. If it were the case that Sally preferred the empty-chair method, with the guidance

of the therapist, Sally would be encouraged to take on both sides of the discussion; not only being herself,

but also being her mother as well. In general, this particular method allows Sally further exploration into

the nature of the relationship she had with her mother, while at the same time grant her some new insight

into herself. It can be predicted that this particular method will take place over the course of several

sessions due in part to Sally’s immediate inability to self-adjust to creative expression As well,


superimposed by deep feelings about her past (unfinished business), it is likely that a few sessions will

also have to transpire in order for Sally and the therapist to identify some of her specific defenses that

may resist engaging in such creative action.

This brief example of experiential work or rather, expression work is to again, promote the

maintenance of responsibility as therapy progresses. If Sally and the therapist are successful in their initial

attempts at promoting expression, Sally is likely to be able to engage in techniques that lead to the

differentiation and affirmation process of Gestalt therapy. To be clearer, Sally would be able to

differentiate the most unsettling parts of her inner conflict (e.g. working in a less than fulfilling industry

because of someone else’s desires) by, for example, exaggerating some of her body movements or facial

expressions in so doing, she may become more aware of the ‘sadder part’ (introjection) or ‘angrier part’

(retroflection) about herself. During the affirmation process of therapy, Sally would then be encouraged

to identify with or relate to all the emerging parts of herself that are now metamorphosing into her

awareness rather than maintain their resistances to contact. Namely, this process in therapy allows Sally

to finally experience a sense of catharsis, releasing pent-up emotions that have left her stuck for quite

some time. In what is to be considered the final process of Gestalt therapy, Sally and the therapist are left

to explore choice and integration. As Perls (1976, p. 79) put it, “responsibility is really response-ability,

the ability to choose one’s reactions.” This final process for Sally can only come about once she is able to

carefully abandon some her major defenses of being, and allow herself to be-come more aware of her true

feelings and potentially discover what some of her inner motivations are in life. Hence, acquiring internal

peace while undoing the past so that it is possible to live more fully in the present is the central goal here,

and for, Sally’s entire therapeutic journey.

Assessment & Ethnic and Gender Issues

As for the relevancy and role of assessment in Sally’s treatment, there are in fact several

assessment measures that would be utilized in this case. First, the therapist would administer the

Symptom Checklist-90-R or the (SCL-90-R). This relatively brief psychometric instrument is a self-report

questionnaire. The measure is designed to assess a broad range of psychological problems and symptoms


of psychopathology. By administering the assessment in session, both the therapist and Sally would gain

further insight into both of her major Axis I diagnoses of Depressive Disorder NOS and Brief Psychotic

Disorder. Therefore, the reliable results of Sally’s SCL-90-R will indicate the potential progress and

possible outcomes in therapy. Even further, the Career Beliefs Inventory (CBI) and the Strong Interest

Inventory (SII) are two complementary measures that the therapist would employ to further explore

Sally’s tertiary diagnosis of Identity Problem. Often used in career assessment, both measures are

counseling instruments used to provide measurable insight into a person’s interests, identifying beliefs,

and their potential career pursuits based on the data collected from the assessments. By administering

these three assessments, the therapist not only stays true to his eclectic dogma, but he also displays a

dynamic level of flexibility and resourcefulness in his counseling Sally, who is likely to appreciate the

therapist’s ability to tailor therapy specifically to her needs.

In considering possible ethnic issues, if it were the case that Sally distinctively identified herself

ethnically, it would be essential for the therapist to understand Sally’s meaning of ethnic identity.

Furthermore, even if Sally does not identify ethnicity as being an important influence on her life, as a

therapist, it is still obligatory that ethnic and cultural meanings are collected from Sally’s perspective.

Succinctly, it will be assumed that thus far in therapy, Sally has yet to openly present any one particular

issue in relation to her own ethnic identity or that of her therapist. However, if an ethnic issue or

conversation is presented during session, it can and will receive significant focus in relation to the course

of her treatment in therapy. As for some gender issues, more so than some ethnic issues, Sally is likely to

generate some discussion about her gender and what it means to her to be a woman in the world. Because

of this, the therapist could actively inquire about Sally’s thoughts and feelings regarding gender

membership or gender role in her family. It is easy to see how these particular constructs could have

meant something different to Sally, especially as a younger woman. Now that Sally is approaching 40

years old and is currently married with her own family, it is safe to assume that gender constructs are

indeed influential factors in Sally’s everyday cultural worldview. For instance, it is empirically reaffirmed

that typical patterns of psychopathology are likely to affect some women more than some men (e.g.


internalizing disorders such as anxiety and depression). Because of this, it is likely that at some point in

therapy, Sally may want to evaluate and discuss particular aspects about her gender in relation to her

diagnoses. In all, exploring such unique topics in therapy with Sally will not only potentially indicate her

progress therapeutically, but this type of exploration will also indicate that the therapist can be sensitive

and is willing to explore various cultural facets about Sally whether they are on a deeply personal level or

whether they are on a macro or more cultural level.

Consultation, Ethical Issues, & Assessing Outcomes

Putting the practical side of counseling to the forefront of one’s therapeutic thinking can be

difficult at times, especially while a therapist is actually conducting a therapy session. However, it is

imperative that a therapist seek regular consultation. In Sally’s case, as in most cases, the therapist here

would seek regular consultation in the form of peer consultation. For, an essential professional activity for

any wise counselor is regular consultation with peers or consultants. In general, consultation serves a

number of purposes, such as, but not limited to, reviewing cases, accepting advice, and discovering one’s

own potential blind spots.

As for ending or terminating therapy with Sally, the therapist would follow sound clinical

reasoning and abide by clear ethical standard when it became reasonably evident that Sally no longer

needed the service, while at the same time honoring the fact that Sally also has a say in her termination of

treatment and that the therapeutic relationship with her has always been, and still is, a mutual relationship.

As for how the therapist would terminate therapy with Sally, it would first be done face-to-face, as most

psychotherapy is done face-to-face. As well, in that final face-to-face interaction (maintaining the

assumption that Sally and the therapist have experienced a positive relationship), the therapist would not

only honor his therapeutic relationship with Sally, but the therapist would also acknowledge Sally’s

individual growth and recognize her vigorous determination to work through the majority of her issues in

order to achieve goals she might have only thought she could achieve and quite possibly discover things

about herself that she never knew were there. In general, terminating any type of relationship is difficult

to do. And although the word suggests an ending, termination is actually the start of a new beginning for


clients. After all, in Sally’s case, therapy was always about providing Sally a collaborative atmosphere

that promoted growth and self-awareness. Indeed, Sally’s final session marks another stage or transition

in her life that she is likely to embrace if she so chooses.

Perhaps the most ostensible ethical principle relevant in Sally’s particular case is ethical principle

2.01 Boundaries of Competence as identified in the American Psychological Association's (APA) Ethics

Code (2002). Because Sally has both the rights to be informed and provided access to alternative forms of

therapy, it is important that as Sally’s therapist, she is continuously provided services in areas only within

the boundaries of the therapist’s competence — based on education, training, supervised experience,

and/or consultation. Specifically speaking, because the therapist in Sally’s case prefers more of an

eclectic approach to counseling, and in this case, applied specific methods of the Gestalt discipline to help

treat and address Sally’s issues, for effective implementation of these services, it is assumed that the

therapist obtained the proper training, experience, consultation or supervision necessary to ensure

competence in such a therapeutic discipline of knowledge.

Because there seems to be a compulsory trend toward outcome measurement in psychotherapy,

and it is believed that measuring outcomes is likely to improve the connection between clinical research

and the effectiveness of actual clinical practice, the therapist in Sally’s case would track outcomes of

therapy by using the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Both of these

complementary outcome measures help Sally’s therapist (a) become a better therapist, (b) resist the push

towards accountability and embrace its many benefits, and (c) justify Sally’s right to know about the

treatment she is getting and if the treatment is or will ever help her.


References

American Psychological Association. (2002). Ethical principles of psychologists and code of

conduct. American Psychologist, 57, 1060-1073.

Kempler, W. (1973). Gestalt therapy. In R. Corsini (Ed.), Current psychotherapies (pp. 251-286).

Itasca, IL: F. E. Peacock.

Lazarus, A. A. (1981). The practice of multimodel therapy: Systemic, comprehensive, and

effective psychotherapy. New York: McGraw-Hill.

Moreira, V. (1993). Beyond the person: Merleau-Ponty’s concept of “flesh” as (re)defining Carl

Rogers’ person-centered theory. Humanistic Psychologist, 21, 138-157.

Perls, F. S. (1969a). Gestalt therapy verbatim. Moab, UT: Real People Press.

Perls, F. S. (1976). The Gestalt approach and eye witness to therapy. New York: Bantam Books.

Rogers, C.R. (1980a). A way of being. Boston: Houghton Mifflin.



Documents

Comprehensive Case Study