Psychotherapy termination is often conceptualized as a distinct clinical phase involving consolidation of gains, emotional closure, and preparation for posttreatment functioning. Despite its clinical importance, there is limited guidance on structured interventions to support this concluding phase. The present case study illustrates the use of the Conceptual Mapping Task (CMT), a semi-structured collaborative mapping procedure, as a structured approach to psychotherapy termination. CMT was implemented in the final session of outpatient psychotherapy with a 43-year-old woman in sustained recovery from substance use disorders and with a history of traumatic brain injury, traumatic loss, and chronic health sequelae. The mapping process allowed for reflection on treatment themes and the co-construction of a narrative of change. As the client described increased clarity about her growth, greater confidence in managing future challenges, and meaningful emotional processing of the therapy ending, the case illustrates how CMT may offer a clinically useful structure for supporting integration, meaning making, and continuity of therapeutic gains during termination. Implications for clinical practice as well as directions for future research on structured termination interventions are discussed.
Chronic pain poses a significant personal burden on individuals and their families, and a significant financial burden on the community. Research into the assessment and treatment of chronic pain indicates interdisciplinary approaches are most effective. This case study reports on the interdisciplinary treatment for chronic pain of a 58-year-old Anglo-Celtic Australian male who had experienced a workplace injury. The intervention was a high-intensity interdisciplinary group pain program of 90 hours duration over four weeks involving psychologists, physiotherapists, vocational rehabilitation providers and occupational therapists funded by his employer’s workers’ compensation insurance company. Individual psychological treatment for relapse prevention followed completion of the program. Risk factors evident in the development of the chronic pain for this client included high risk situations, failed treatments, new pain symptoms developing and depression. Treatment was effective in reducing the client’s anxiety regarding his pain, its interference in his activities and his depression. His self-efficacy to manage his pain particularly increased, despite his pain severity remaining the same and these gains were maintained at three-month follow-up. Given the frequent presentation of chronic pain as a comorbidity in psychology clients, psychologists are recommended to participate in and/or observe interdisciplinary group intervention for chronic pain.
This case report evaluated the effects of behavior analytic intervention on post-feeding rumination in a 10-year-old child with Phelan-McDermid Syndrome (PMS), a genetic disorder associated with intellectual and neurodevelopmental disabilities and co-occurring medical abnormalities. A preintervention functional analysis screening conducted with the child suggested that rumination was maintained by automatic reinforcement. Non-contingent reinforcement (NCR) consisting of fixed-time (FT) presentation of preferred foods was associated with decreased rumination within a concurrent multiple baseline design across lunch meals and snacks combined with a snack-only reversal design analysis. Low rumination rates continued during an intervention withdrawal phase (lunch) and a phase of systematic schedule fading (snack). Social validity measures reported by the child’s mother and therapists revealed positive acceptance and approval of the intervention plan.
Subclinical symptoms of anxiety and/or depression may negatively impact individuals’ lives, as they impair daily functioning and increase the risk of developing emotional disorders (e.g., depressive and anxiety disorders, and others related). Accordingly, preventive interventions targeting individuals with subclinical symptoms are essential. Among these, transdiagnostic approaches have proven to be particularly suitable, especially the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). The UP has recently been adapted for preventive contexts and has shown encouraging results, including significant reductions in negative affect. Despite these promising findings, existing adaptations are not specifically tailored to adults who present with subclinical symptoms of anxiety and/or depression. Thus, this study describes the implementation of a brief preventive version of the UP (UP-Prevent), which was delivered in a face-to-face group format across six two-hour sessions to three women with subclinical symptoms of anxiety and/or depression. Assessments were conducted at three time points (preprogram, postprogram, and three-month follow-up) and included measures of depressive and anxiety symptom severity, symptom-related impairment, emotion regulation difficulties, perceived functional impairment across domains (e.g., work, social activities, private leisure activities, interpersonal relationships), quality of life, positive emotions, and positive mental health. To evaluate changes, the reliable change index (RCI) was computed. Significant improvements were observed across participants in several variables, including anxiety symptoms and anxiety-related impairment, emotion regulation difficulties, and positive mental health. Participants reported high levels of satisfaction with the program, underscoring its acceptability and feasibility and highlighting the UP-Prevent as a promising intervention for individuals with subclinical symptoms.
This case study summarizes the assessment and treatment of a nine-year-old girl, Layla, with separation anxiety and school refusal. The initial assessment indicated that challenging behavior served both to access and avoid stimuli from the environment, rather than to escape or avoid an aversive stimulus. Treatment consisted of teaching and then differentially reinforcing the use of appropriate behaviors that serve the same function as the challenging behaviors for which the family was seeking treatment. These strategies included functional communication training and differential reinforcement of other and alternative behaviors using a cumulative duration schedule of reinforcement and a habituation paradigm. The treatment was successful in reducing school refusal and increasing compliance with adult directions. We discuss treatment- and assessment-related recommendations for clinicians and students.
Gaslighting within intimate relationships has received increasing public and scholarly attention; however, empirical research on clinical interventions remains limited, particularly in South Korea. This case study examines the effects of a cognitive behavioral therapy (CBT)-based intervention on cognitive confusion, depression, and guilt in a Korean woman experiencing gaslighting in an intimate partner violence (IPV) context. A mixed single-case design was employed, incorporating repeated in-session measures and a 12-month follow-up assessment. The intervention consisted of 12 sessions of structured CBT, including case formulation, a web-based Dysfunctional Thought Record (DTR), and cognitive restructuring using Socratic questioning. Results indicated reductions in self-doubt, depression, and guilt, with self-doubt demonstrating a sustained decline across treatment (NAP = .95; Tau-U = 1.00). Findings suggest that short-term CBT targeting self-doubt may reduce cognitive confusion and negative affect in individuals experiencing gaslighting. Additionally, a web-based DTR may support clients in validating their experiences and facilitating cognitive restructuring in contexts of repeated reality distortion. Despite limitations of a single-case design, this study highlights the clinical utility of short-term CBT-based interventions for gaslighting in IPV relationships.
Identical (monozygotic) twins represent a unique “natural experiment” for isolating the role of temperamental differences in psychotherapy processes, and controlling for genetic and environmental variables. This research presents a comparative case study of 20 sessions of Schema Therapy (ST) with 19-year-old twin sisters, both diagnosed with severe Social Anxiety Disorder and core schemas in the Disconnection and Rejection domain, specifically Defectiveness/Shame. Despite sharing an identical genetic background and a similar trauma history (adolescent illness and peer bullies), the clients exhibited distinct differences in temperament and ego strength. Client A (characterized by a “difficult” temperament and high emotional inhibition) displayed significant resistance to change, dominated by a rigid Punitive Parent mode. In contrast, Client B (characterized by an “easy” temperament and higher resilience) demonstrated rapid engagement with cognitive and experiential interventions. Results indicated that while both clients experienced significant symptom relief, their therapeutic trajectories diverged: whereas Client B successfully established an independent identity, Client A required a more intensive focus on Limited Reparenting to overcome emotional blockages. This study demonstrates that even when schema profiles are identical, temperament functions as a critical moderator, necessitating the tailoring of therapeutic strategies, specifically the balance between cognitive and experiential techniques, to the individual’s temperamental capacity.
Cervical cancer is the fourteenth most common cancer in the United Kingdom, with a national screening programme offered to women aged 25-64. Autistic women are significantly less likely than non-autistic women to engage in cervical screening, yet there is limited research examining psychological barriers to uptake. Illness Anxiety Disorder (IAD), characterised by excessive health-related worry alongside checking or avoidance of medical investigation, offers one possible explanatory mechanism. Despite a strong evidence base for cognitive behavioural therapy (CBT) in the treatment of IAD, there is minimal literature addressing its development, maintenance, or treatment in autistic adults, and none focused specifically on autistic women. This clinical case study describes the assessment, formulation, and treatment of an autistic woman presenting with gynecologically focused IAD centred on fears of cervical cancer. An adapted CBT intervention was delivered within a community post-diagnostic autism service over twelve sessions, incorporating structured visual formulation, imagery rescripting, integration of special interests, and targeted family involvement to address interpersonal reassurance processes. Change was monitored using the Short Health Anxiety Inventory alongside goal-based and behavioural indicators. Reliable improvement in health anxiety was observed, with marked reductions in checking behaviours, increased engagement in valued activities, and cessation of crisis service use, although health anxiety scores remained above clinical threshold at treatment end. The case highlights key adaptations required when delivering CBT for IAD in autistic women and discusses clinical implications, limitations, and directions for future research.
When cognitive analytic therapy (CAT) is used to help people that self-harm, then patients are typically allocated to the 24-session version. RELATE (relational approaches to self-harm) was a National Institute for Health Research (NIHR) funded feasibility randomised controlled trial; it evaluated delivering 8-session CAT compared to treatment as usual for patients that were self-harming. This is a co-produced case study with Jade who was a participant in the RELATE trial. The aims were: (a) to describe the treatment protocol, (b) demonstrate protocol fidelity, (c) index therapeutic competency, (d) evaluate nomothetic clinical outcomes, (e) evaluate of change in the idiographic target problems and (f) for Jade to provide a description of her experience of the tools, phases and approach of CAT. Results show that the CAT was competently delivered with high fidelity to the protocol. Self-harm reduced and non-overlap analyses found that improvements to recognition and revision of two of the three target problems occurred (and these would be coded as being evidence of a 'highly effective' intervention). Improvements were maintained at follow-up. Jade had low expectations before starting therapy, felt that the tools of CAT were helpful, building and maintaining trust in the therapeutic relationship was an important contributor to change and follow-up was useful. The conclusion is that it is possible to deliver brief CAT that is focal to self-harm with high treatment integrity. Guidance on how therapists can best utilise the brief CAT approach are provided.
This case study explores the first eleven sessions of a psychoanalytic therapy with Helen, an adult woman diagnosed with major depressive disorder. Our focus is on the complaint: Helen's plaintive narrative and the therapist's response to her words are closely examined. The therapist shows interpretative restraint, while clearly communicating his desire to work with Helen. The ambivalent and passionate dimension of the complaint at the beginning of the treatment is studied, together with the creation of an analytic space where the different psychological functions of the complaint can be heard and questioned. In the first session Helen portrays herself as (1) a lonely outsider, (2) a perpetual mourner, (3) a malnourished child and (4) a weeping woman. We study the stylistic characteristics of her colorful language and follow the development of these narratives throughout the subsequent sessions. During the preliminary analytic work Helen transforms the scope of her cries: from unaddressed wordless despair towards a grief put into words in the steady presence of the therapist.
This case provides a flat-footed model for how to conduct Queer-affirmative clinical work and achieve recovery, successfully treating PTSD, Queer traumas, and the commonly invisibilized stressors experienced by Queer people, including LGBTQ + Veterans. This is the case of a young gay solider, Felix, who presented for two rounds of trauma therapy: first for combat-related trauma and then second for a sexual assault and reactivated posttraumatic stress. The principal method deployed and adapted was Prolonged Exposure therapy (PE); intentionally considering the low reliability in defining reactivated trauma as well as in models for Queerly adapting this clinical method. PE here was overlayed with and fortified by a Queer-affirmative framework, largely architected by Queer Theory-driven understandings of identity and the social world as well as an empirical appreciation for chronic gender/minority stress. In both treatment episodes, this affirmative adaptation of this exposure therapy was successful in moving the client's PTSD into remission as well as increasing his self-actualizaiton and positive, compensated sexuality and gender identity. Several essential clinical implications and considerations for practitioners are provided, including instituting Queer trauma-informed and HIV-informed frameworks, increasing clinicians' self and social reflections as part of their Queer practice, drawing on the expertise of interdisciplinary approaches and methods in doing Queer work, purposefully deploying the power of language, and focusing on the shared foundational issue here that links, but synergizes, the psychological processes at play and on-going Queer experiences: in-/validation.
While Fetal Alcohol Spectrum Disorder (FASD) is a low-prevalence disorder, affecting less than 0.05% of the US population, children with FASD have high rates of comorbidity with other neurodevelopmental and mental health disorders. In addition, youth with FASD have high rates of disruptive behavior disorders, but they are underrepresented in the behavioral parenting intervention literature. This case study presents the treatment of a 4-year-old boy with FASD, IDD, and ASD using Parent-Child Interaction Therapy adapted for the boy's individual needs. Findings from this case report documented (a) child improvement in problem behaviors, but less improvement in intensity, (b) caregiver attainment of positive parenting skills, (c) caregiver satisfaction with intervention, (d) and maintenance of gains at 3-week follow-up. In addition, considerations are offered to clinicians and trainees who work with families with children with complex developmental profiles.
Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality and frequent relapse in adulthood. Although evidence-based treatments exist, their effectiveness remains limited, and few involve caregivers despite evidence supporting their role. This single-case study explored the feasibility and preliminary effectiveness of the ECHOMANTRA program-a brief, manualized, online intervention based on the cognitive-interpersonal model-as an adjunct to treatment-as-usual (TAU) for an adult woman with AN and her mother. The eight-session intervention included MANTRA-based modules for the patient and ECHO-based modules for the caregiver, supported by manuals and personalized workbooks. Assessments were conducted at pre-treatment, post-treatment, and three-month follow-up using validated self-report measures. Patient outcomes included eating disorder symptoms (EDE-Q), emotional distress (DASS-21), functional impairment (CIA 3.0), and quality of life. Carer outcomes included symptom accommodation (AESED), perceived illness impact (EDSIS), and caregiving skills (CASK). Results showed clinically meaningful reductions in eating disorder symptoms, emotional dysregulation, and functional impairment in the patient, with gains maintained at follow-up. A transient post-treatment increase in emotional distress likely reflected greater illness insight, which subsided by follow-up. The caregiver reported decreased accommodation, lower burden, and improved caregiving competence. Both participants adhered to and were highly satisfied with the intervention. Findings offer preliminary support for ECHOMANTRA as a feasible and potentially effective adjunct to standard care, highlighting the value of integrating caregiver-focused strategies into adult AN treatment.
Posttraumatic Stress Disorder (PTSD) remains one of the most debilitating anxiety disorders, with high prevalence, significant functional impairment, and disproportionate impact on minoritized groups. Although Prolonged Exposure Therapy (PET) is considered a gold-standard treatment, its effectiveness is limited by high dropout rates, particularly among Latine clients, who are historically underrepresented in PET research and implementation. Bilingualism influences emotional processing, with first language often eliciting heightened affective intensity during trauma recall. Building on this evidence, the present case study examines the integration of guided code-switching into PET (CS-PET) as a culturally responsive adaptation aimed at improving engagement and reducing distress among bilingual clients. "Julia," a bilingual Latina survivor of childhood sexual abuse, who presented with PTSD symptoms. Standardized assessments confirmed a diagnosis of PTSD with delayed expression. Treatment followed a modified PET protocol that incorporated structured language switching based on Subjective Units of Distress (SUDS). Spanish, the language of the traumatic events, elicited greater emotional activation, whereas English provided a regulatory function. Guided code-switching allowed for sustained exposure while modulating distress. Over six treatment sessions, Julia demonstrated substantial reductions in PTSD, anxiety, and depressive symptoms, ultimately no longer meeting diagnostic criteria for PTSD at termination. This case highlights the potential utility of code-switching as an arousal-modulation strategy within exposure-based treatments for bilingual clients. Clinical implications include the importance of assessing language-related emotional processing, collaboratively establishing code-switching thresholds, and monitoring language shifts to preserve therapeutic fidelity. Future research should evaluate the generalizability and mechanisms of CS-PET.
Young adults who have experienced cancer are at increased risk of mental health difficulties. Compassion-focused therapy (CFT) has a growing evidence base in cancer populations, yet research remains limited among young adults who are post-treatment. This case study describes a 12 session CFT intervention for a young woman with depression and anxiety, in the context of being post-treatment for skin cancer. Pre- to post-CFT improvements on measures of self-compassion, psychological distress, anxiety and depression, social dysfunction, and loss of confidence, as well as client-centred goals, were reported. Client feedback also supported the acceptability of the intervention and adapting for sociocultural factors was perceived as useful. This case study offers preliminary support for CFT in this population. Future high-quality intervention research is needed to help inform care pathways.
Non-suicidal self-injury encompasses several deliberately harmful behaviours used by some clients to manage distress. It has significant health risks, including accidental death. This single-case study explores the integration of temporary tattooing and a dialectical behaviour therapy (DBT) - informed skills-based intervention to treat non-suicidal self-injury in a female diagnosed with borderline personality disorder. The intervention was designed to redirect self-injurious behaviours toward self-expression through artistic temporary tattooing, conceptualised as a form of habit reversal training. Over 15 sessions, temporary tattooing was conceptualised as both a competing and reinforcing behaviour, aiming to promote mindfulness, self-expression, and affect regulation. Quantitative data from diary cards demonstrated increased use of DBT skills and temporary tattooing, accompanied by a reduction in the frequency of self-harm. Qualitative feedback suggested that the tattoos functioned as positive reinforcement, enhancing autonomy and positive identity formation. Findings support the therapeutic potential of temporary tattooing as a feasible adjunct to DBT skills in treating non suicidal self-injury. Implications for clinical practice, limitations, and recommendations for future research are discussed.
The present case details the use of Acceptance and Commitment Therapy (ACT) with "June," a 26-year-old biracial woman presenting with generalized anxiety disorder (GAD) and premenstrual dysphoric disorder (PMDD). Across 37 sessions in a community-based training clinic, treatment focused on reducing psychological inflexibility and strengthening flexibility processes, including acceptance, defusion, present-moment awareness, values clarity, and committed action. June entered treatment with severe anxiety, marked mood lability during her luteal phase, and significant relationship and occupational stress. The therapist tracked progress with standardized measures and qualitative reports. June showed clinically meaningful improvements in anxiety, psychological flexibility, wellbeing, and valued living. Though some of her premenstrual symptoms persisted, she no longer met criteria for PMDD at termination. This case highlights ACT's relevance as a transdiagnostic approach for clients managing both GAD and cyclical mood disturbances. It also underscores ACT's emphasis on relating flexibility to overarching values to help clients maintain motivation and consistent application of skills.
Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of developing eating disorders (EDs) compared to the general population. Methylphenidate is a common first-line pharmacological treatment for ADHD and has been explored for symptom interruption in bulimia nervosa (BN); however, its use and efficacy in individuals with comorbid ADHD and restrictive eating pathology, such as anorexia nervosa (AN), remain underexplored. This case study presents a 28-year-old female who initially presented to eating disorder services with BN, was later diagnosed with ADHD, and subsequently re-diagnosed with AN. The patient was treated with a combination of methylphenidate alongside outpatient psychological therapy and participation in a Day Services group programme. While in Day Services, the patient restored 2.2 kg (4lb 9oz); however, the patient remained medically underweight at discharge. EDE-Q scores demonstrated a downward trend in cognitive eating disorder symptoms; however, the patient felt this was not reflective of her mental state. The case examines the interaction between ADHD and co-occurring ED symptomatology, illustrating how pharmacological management of one condition may inadvertently maintain or exacerbate the other. The case highlights a divergence between psychological improvement on self-report measures and persistent underweight status and disordered behaviours, raising questions about the interaction between ADHD pharmacotherapy and eating disorder outcomes.
Autism spectrum disorder (ASD) frequently presents alongside emotional disorders (e.g., anxiety, depression) in youth. Existing treatments for youth with ASD most often focus on social communication, behavior management, and daily living skills, with generally less focus placed on emotional symptoms. This paper describes the theoretical rationale for and application of the Unified Protocol for Transdiagnostic Treatment for Emotional Disorders in Adolescents (UP-A) to youth with ASD. A case example is presented to highlight adaptations to the UP-A and illustrate the impact of these adaptations on treatment engagement, process, and outcomes. The case reviewed in this study features an adolescent male presenting with generalized anxiety disorder and persistent depressive disorder with a current major depressive episode. His comorbid ASD informed the adaptations to the UP-A that are discussed throughout. Considerations for case conceptualization, treatment planning, and progress monitoring during UP-A treatment are also reviewed.
Research suggests Cognitive Behavioural Therapy (CBT) is an effective intervention for tinnitus-related distress in typically developing adults. However, there is no specific evidence that CBT is effective for tinnitus distress in people with a learning disability (LD), or information regarding potential adaptations. This quasi-experimental single case study aimed to test the hypothesis that CBT would reduce tinnitus distress in a person with an LD. Quantitative and qualitative data showed significant reductions in self-reported tinnitus-related annoyance, sadness, interference with valued activities and sleep disturbance. All tinnitus distress-related measures except perceived loudness showed statistically significant improvement, with interference with valued activities showing the largest effect size, Ruscio's A = 0.99, 95% CI [0.91, 0.99], p = .0026. Adaptations included use of visual and sensory aids, and inclusion of parental thoughts, feelings and behaviours as treatment targets. This study offers support for the efficacy of CBT for treating tinnitus distress in people with LD, and for the efficacy of carer-supported CBT in this population.
