Case Study Scripts

Learning Objectives

Recognize therapist style and behaviours that support or hinder engagement.
Identify common relational elements that make psychotherapy effective.
Identify presenting problems described by a client.
Identify treatment targets from therapist–client interaction.

Materials

The two therapist–client scripts below.
A way for students to record observations for each interaction.

Overview

Students compare two short therapy interactions involving the same client. Their task is to identify the presenting problems, observe what the therapist does that appears helpful or unhelpful, and examine how the client’s openness and comfort change between the interactions.

Observation prompts

Ask students to focus on specific comments and behaviours from both the therapist and the client. They should keep their notes from the first interaction so that they can make a direct comparison.

What problems is the client experiencing?
What does the therapist do that seems helpful or unhelpful?
How does the client’s openness or comfort change?
Do you think the client would return to this therapist?

Small-group discussion

What did you notice about the therapist’s style in each interaction?
Which behaviours were helpful and which were not?
When did the client seem more or less engaged?
What are the client’s presenting problems?
What do you think treatment should focus on?

Whole-class debrief

Ask groups which interaction represented a more effective therapist and why. Common factors theory proposes that different approaches to psychotherapy are often similarly effective because they share underlying elements that support change.

Therapeutic alliance: a collaborative, trusting relationship between therapist and client.
Empathy, warmth, and acceptance.
Collaboration and shared goals.
Client expectations or hope for improvement.
Opportunity for emotional expression and meaning-making.
Therapist responsiveness and attunement.
Client characteristics, including motivation and resources.

Treatment targets

Students may identify anxiety, procrastination, feeling overwhelmed, and self-doubt as presenting concerns. Possible treatment goals include coping skills, reducing avoidance, changing thought patterns, increasing confidence, and improving emotional awareness.

Script B: The Not-so-Effective Therapist

Therapist: Hi. So last time you mentioned falling behind in your courses. Has that improved at all?
Client: Not really. I keep avoiding my readings and then I panic about deadlines.
Therapist: Okay. Avoidance can maintain anxiety. Have you tried setting a structured study schedule?
Client: I’ve made schedules before… I just don’t stick to them.
Therapist: Consistency is important with behaviour change. Sometimes it comes down to building discipline.
Client: Maybe. I just feel really overwhelmed when I think about everything I have to do….
Therapist: University is a big transition. Many students experience that.
Client: Yeah… I’ve also been having trouble sleeping because I stay up worrying.
Therapist: Sleep difficulties can worsen concentration and productivity. Some people find sleep hygiene strategies useful — things like limiting screen time or setting a fixed bedtime.
Client: I guess. I just feel exhausted most days….
Therapist That makes sense. Fatigue can make it harder to initiate tasks. What about your classes?
Client: When I go to lectures I’m distracted. I keep thinking maybe I shouldn’t even be here.
Therapist: Self-doubt is common in competitive academic environments. It’s important to focus on your performance goals.
Client: I don’t really talk about it with my friends. They all seem to be doing fine.
Therapist: Social comparison can increase stress. Try to stay focused on your own progress.
Client: Yeah… I end up avoiding work and then feeling worse.
Therapist: That reinforces the cycle. Breaking tasks into smaller pieces can improve task initiation.
Client: I’ve tried that a bit.
Therapist: What does a typical day look like?
Client: I wake up tired, go to class, then go home and plan to work… but I don’t.
Therapist: That suggests difficulty with follow-through. Behavioural activation strategies might be useful.
Client: Okay.
Therapist: For next week, I’d like you to create a prioritized task list and track how many hours you spend studying.
Client: Sure.
Therapist: Once we have that information we can evaluate what adjustments are needed.
Client: Alright.

Script A: The Effective Therapist

Therapist: Hi, it’s good to see you again. How have things been since our last session?
Client: Honestly… kind of rough. I keep falling behind on readings and then I just avoid thinking about it.
Therapist: Avoiding gives you a bit of relief in the moment?
Client: Yeah. I’ll watch videos or scroll on my phone for hours. Then later I feel worse because I’ve wasted time.
Therapist: So there’s some short-term relief, but it doesn’t last very long.
Client: Exactly. Then I start panicking about deadlines.
Therapist: What does that panic feel like for you?
Client: My chest gets tight. Sometimes I feel kind of nauseous. And I can’t focus on anything else.
Therapist: That sounds really uncomfortable.
Client: It is. And then I don’t sleep well. I stay up thinking about everything I have to do.
Therapist: So sleep has been affected too.
Client: Yeah… I’m exhausted most days.
Therapist: That must make it even harder to keep up with school.
Client: Definitely. I’ll go to lectures but I’m not really present. I just sit there worrying.
Therapist: Worrying about falling behind?
Client: Yeah… and also thinking maybe I shouldn’t even be here. Like everyone else seems to be managing.
Therapist: That sounds really discouraging — feeling like you’re the only one struggling.
Client: Yeah. I don’t really talk about it with anyone. My friends seem to have everything together.
Therapist: It feels risky to share this with them.
Client: I don’t want them to think I’m failing or… not smart enough.
Therapist: That’s a heavy thought to carry on your own.
Client: Yeah.
Therapist: What has a typical day looked like this week?
Client: I wake up tired, go to class, try to start work later… and then I just shut down. Sometimes I end up skipping meals because I feel so stressed.
Therapist: It sounds like stress is affecting a lot of areas — focus, sleep, even eating.
Client: I guess so. I hadn’t really thought about it like that.
Therapist: When you imagine starting your work, what seems to happen inside?
Client: I think about how much there is and then my brain just goes blank. It feels overwhelming.
Therapist: Almost like your system goes into overload.
Client: Yeah… that’s a really good way to describe it.
Therapist: Given how intense that feels, it makes sense that part of you wants to escape.
Client: I always thought it meant I was lazy.
Therapist: It sounds more like you’re overwhelmed than unmotivated. Would that fit your experience?
Client: Yeah… that actually feels kind of relieving to hear.
Therapist: I’m glad. If these meetings were helpful, what would you hope might be different in a few weeks?
Client: I’d like to not panic so much. And maybe feel like I actually belong here.
Therapist: Those sound like really important goals. We can take time to understand the anxiety and also experiment with small steps that feel manageable.
Client: That sounds good.
Therapist: For this week, maybe we could start by simply noticing when the overwhelm begins — what thoughts or sensations show up first. Not trying to change it yet, just getting curious.
Client: Yeah… I think I could try that.
Therapist: Great. We can talk about what you notice next time.