Writing a practice-based case study for publication
Information sheet written for the British Association for Counselling and
Psychotherapy
John McLeod
Tayside Institute for Health Studies
University of Abertay Dundee
February 2009
The aim of this information sheet is to offer practical guidelines for counsellors and
psychotherapists who are interested in contributing to the research literature by
publishing a case study based on their own work with a client. The information sheet
provides an introduction to the field of pragmatic case study research, ethical issues
involved in this kind of study, and what is involved in collecting, analysing and
writing-up case data. There are also recommendations for further reading, intended to
enable a deeper appreciation of the issues involved in this area of inquiry.
Introduction
There is a wide acceptance within the counselling and psychotherapy profession, and
in the organisations that commission and support therapy services, that it is essential
that practice should be informed by relevant research. On the whole, this requirement
has been interpreted to mean that the findings of large-scale randomised trials of the
efficacy of different approaches to counselling or psychotherapy, should be used as
the touchstone of whether an approach is effective or not. While it is clear that such
studies provide an invaluable source of evidence, it has also become apparent that,
within the field of counselling and psychotherapy, the method of randomised trials
has significant limitations (Rowland, 2007). In response to these limitations, and in an
attempt to establish a more broad-based knowledge base for counselling and
psychotherapy, Fishman (1999) and other have argued that it is necessary for the
profession to make a commitment to building a database of ‘pragmatic case studies’.
A pragmatic case study can be defined as a systematic, rigorous study of an individual
case, in which the available evidence is used to achieve a plausible account of the
process and outcome of the case, in a form that has pragmatic value in terms of
informing practice. The aim of the pragmatic case studies movement is to assemble
range of case reports that is extensive and detailed enough to allow generalisations to
be derived from it. Two journals have been established as an outlet for such case
reports: Clinical Case Studies, and Pragmatic Case Studies in Psychotherapy.
One of the key challenges that needs to be faced, by those who wish to carry out casebased research, is that of constructing a case report that will be accepted as having
scientific validity. Although it can be argued that the psychotherapy profession is
ultimately based on knowledge generated by the case studies carried out by Freud and
others, the current view is that the methods used at that time were necessarily
somewhat subjective, and open to many sources of bias, and that the contemporary
availability of recording equipment and measurement scales allows a higher degree of
rigour to be both expected and achieved. Another key challenge lies in the domain of
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ethics. Unlike large-scale studies, in which information about an individual client
exists only in numerical form embedded in a mass of other data, a case study
essentially seeks to tell the story of an episode in the life of a person seeking therapy
(and a person offering therapy). It is therefore important that published case studies do
everything possible to respect the confidentiality and well-being of the client and
therapist who are involved, and to adhere to all aspects of the BACP Ethical
Guidelines for practice (BACP, 2007) and research (Bond, 2004).
Many counsellors and psychotherapists have had an experience of writing one or
more case studies, during their training. While this information sheet is likely to be of
value to those involved in producing case reports for training purposes, it is necessary
to note that training establishments may have requirements that differ from the present
guidelines. The goal of these guidelines is to encourage practitioners (whether in
training or at a later stage of their career) to disseminate practical knowledge and
understanding, and facilitate constructive dialogue, by sharing examples of their work
across the professional community.
Conducting case study research in counselling and psychotherapy: practical
guidelines
This section of the information sheet summarises the main practical issues that are
associated with the process of carrying out a case study investigation. When preparing
to undertake case study research, it is valuable to undertake as much advance reading
as possible, to become familiar with the kinds of challenges and pitfalls that may
arise, and the potential solutions and strategies that can be applied to resolve them.
There is single, standard, ‘correct’ way to conduct a therapy case study – inevitably
each study reflects the specific circumstances in which it is carried out, and involves
the adaptation of methods in response to these circumstances.
1.
Deciding on the purpose of the case study
When planning any piece of research, it is necessary to be clear about what you are
trying to achieve, and the intended audience. There are different research aims that
can be pursued through case study investigations:
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Exploring and demonstrating the effectiveness of a particular approach to
therapy, or specific intervention. There are numerous examples, both in the
cognitive-behavioural therapy (CBT) literature (Turpin, 2001) and in studies
that have used the hermeneutic single case efficacy design develop by Elliott
(2001, 2002), of case studies that have provided credible evidence of
effectiveness. This kind of research is particularly influential when large-scale
studies of the approach or intervention do not exist. When a new approach is
first developed, it would be unethical to seek to apply it to a large sample of
clients in a randomised trial; the existence of case reports that carefully
exemplify the effectiveness of an approach or intervention supply part of the
rationale that is required in order to plan and justify larger-scale studies. The
role of case studies in effectiveness research is therefore mainly focused on
instances where the effectiveness of innovative approaches or interventions is
being assessed.
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The development of theory. Theories and models in counselling and
psychotherapy are designed to be applied to individual cases, and as a result,
case study data affords one of the best ways of testing and refining theory.
Further information on ‘theory-building’ case studies can be found in the
information sheet written by Stiles (2007).
Exploring and demonstrating the value of counselling/psychotherapy in
relation to a specific condition. There are many categories of problems for
which little research evidence is available concerning the effectiveness of
psychological therapy. It is unfortunately true, for example, that there are few
studies of how counselling or psychotherapy might help people who
experience various kinds of disability or illness. In such cases, what is of
interest is not so much whether a particular therapeutic approach is effective,
but the ways in which therapy methods might be adapted in order to respond
to the needs of particular clients, and the case report will focus primarily on
these aspects of the work.
Allowing the voice of the client to be heard. In the main, case study research in
counselling and psychotherapy has largely comprised stories told by therapists
and researchers. However, the case study format can also be used to enable the
client to tell his or her story. Examples of this use of case study inquiry can be
found in Etherington (2000) In this kind of report, the therapist may be
involved as co-author, or may involved merely at the level of encouraging the
client to write about his or her experience.
In order to construct a readable case report, it is necessary to decide on the
primary aim of the study, even if other secondary aims are also touched on. For
example, a case study that sought to highlight the effectiveness of an innovative
intervention, may also generate some interesting implications for theory.
However, given the complexity of the data that are typically collected in a case
investigation, there is a risk of confusing the reader by trying to address issues of
effectiveness, and theory, at the same time. In addition, the type of analysis that is
carried out may be different for each purpose.
2. Negotiating ethical consent
Case study research is highly ethically sensitive. The collection of papers edited by
Josselson (1996) provides multiple examples of situations where researchers did
everything possible to let their research participants know about that was involved in
taking part in a case study, and secured informed consent, and still ended up hurting
people. Reading about the intimate details of one’s own life, particularly in the
context of a formal publication, can be a highly exposing and threatening experience.
It is one thing to have a good relationship with a therapist or researcher, or to read
drafts of a manuscript – it is quite another thing to read these words between the
covers of a book. How can this difficult ethical issue be handled? There are a number
of basic procedures that should be followed:
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Writing a research protocol, that explains the aims of the research, what data
will be collected, how it will be analysed and disseminated, and the procedures
that will be followed to ensure confidentiality, avoidance of harm, and
informed consent. This protocol must be subjected to external scrutiny, for
example by an organisational ethics committee or research consultant;
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Providing the participant with a written information sheet, at the start of
therapy (preferably before therapy begins) and asking him or her to sign a
form that gives permission to collect research data, which specifically
mentions that these data may be used in future for case research, and that
further permission will be sought at the end of therapy if their material is to be
used for a case analysis;
At the end of therapy, or at follow-up, if it is decided that the case material is
to be used for research, it is necessary to secure further informed consent (if
the data is not used for research, it should be destroyed). At this stage, the
participant should be asked to indicate if there is specific information that he
or she would wish to be deleted from the case record, and to indicate how he
or she would like their identity details (e.g., job, location, ethnicity) to be
changed I order to preserve anonymity;
The participant should be offered an opportunity to read, comment on, and
edit, the final draft of the case report, in advance of publication;
It should be made clear to the participant that he or she can withdraw at any
time (including right at the end);
Application of the above procedures to the therapist, who is also a participant
in the study.
It is perfectly feasible to incorporate these procedures into everyday practice. Most
users of counselling and psychotherapy are aware of the structure of research that
supports the care that they receive, and are well able to refuse consent, or impose their
own conditions. Some clients are actively interested in research, eager to tell their
story, and find personal meaning in being asked to reflect on their experience (for
instance, when completing questionnaires or responding to interview questions).
One of the underlying themes in this discussion of ethical issues, is the idea that it is
wrong to pressurise clients to take part in research. From an ethical perspective, it is a
sign of success (of the transparency of the ethical procedures) every time a client
refuses consent. However, the withdrawal of a client from a case study can create a
difficult situation for a practitioner-researcher who may have invested a great deal of
time and effort in collecting a comprehensive data set on that client. For that reason, it
is valuable to try to collect data on more than one client – of someone drops out, there
are other possible case analysis contenders remaining. Another critical ethical issue
concerns the separation of the therapy from the research. The primary moral
responsibility of any counsellor or psychotherapist is to provide the best possible
therapy for their client. A desire on the part of the therapist to collect a certain type of
case data can compromise this primary responsibility. For instance, a therapist who
would like to publish a paper on a new theory of dream analysis may subtly (or not so
subtly) direct his or her clients in the direction of dream work. To avoid this situation,
it is necessary to include the clinical supervisor in the development of a research
protocol, and to charge him or her with the task of challenging the practitioner if the
therapy seems to be becoming ‘research-oriented’ to the detriment of the client.
3.
Collecting rich case data
The psychoanalytic write Donald Spence (1989), writing from within a therapy
tradition that has relied heavily on case studies that are drawn solely from the
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therapist’s memories of what happened during sessions, argues that such case studies
inevitably engage in ‘narrative smoothing’ – the complexity of the therapy process is
‘smoothed’ to conform to the theoretical presuppositions of the author. By contrast, a
defining characteristic of a good quality, systematic case study is that it is based on
rich set of data about what happened, and offers a ‘thick’ description of the process
and outcome of the therapy. There are a number of sources of data that can be
employed in counselling and psychotherapy case study investigations:
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Outcome measures completed by the client (e.g., the CORE questionnaire);
Process measures completed by the client (e.g., the Working Alliance
Inventory, a standard tool for assessing the strength of the counsellor-client
relationship);
Audio or video recordings of therapy sessions;
Therapist notes;
Recordings of supervision sessions where the therapist discussed the case;
Diary or personal journal entries kept by the client or therapist;
Creative works (e.g., paintings, music) arising from the therapy;
Email or letter correspondence between therapist and client;
End of therapy and follow-up interviews with the client and therapist;
Reports from significant others (e.g., spouse or work supervisor of the client).
Further information about how to access and use these methods is provided in a
section toward the end of this information sheet. In general, to construct a credible
case report, it is valuable to keep comprehensive notes, and to ask the client to
complete one or more outcome and process measures (preferably at each session). It is
also useful to conduct a post-therapy interview with the client, in order to collect
information about the client’s overall view of what was helpful or unhelpful in the
therapy, and the changes that he or she attributes to therapy. This interview may be
carried out by a colleague, to allow the client more space to be critical of the
treatment experience. It needs to be kept in mind that specific, written consent needs
to be secured for the research use of any of the sources of case data mentioned here.
4.
Analysing case material
The analysis of case data presents a major challenge for anyone intending to publish a
counselling/psychotherapy case study, because the process of data collection typically
generates a great deal of information, which may be complex, contradictory and
difficult to interpret. In order to bring some structure to the task of data analysis, it is
useful to consider the following strategies:
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Assemble the data (questionnaires, notes, transcripts or summaries of
recordings, etc) into a bound ‘case book’ that follows the course of the case
through from pre-therapy assessment to follow-up;
Score the questionnaires, and analyse qualitative data using standardised
guidelines, and insert this information into the appropriate sections of the case
book (so, for example, the reader can not only see the CORE questionnaire
completed by the client at each session, and also the score that has been
calculated). There exist a wide range of methods for analysing qualitative data
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– suggestions for further reading are provided at the end of this information
sheet;
Read through the case book, slowly, immersing yourself in the case and
making notes as you go. This stage of analysis is intended to capture first
impressions and emerging themes;
Write a summary of each session, and of the case as a whole;
Identify (if you have not done this already) the key aim of the case report – the
central issue that you wish to address (e.g., effectiveness, further articulation
of theory, etc);
Write down a summary of the evidence and conclusions relating to the main
points that you wish to make, in respect of the overall aim of the report. Go
back into the case book, and look for evidence that would challenge or
contradict these conclusions. Repeat this process until you have confidence in
the robustness of your evidence and conclusions. It can be useful to think of
case analysis in terms of a judicial process – in a courtroom, different
interpretations and explanations are offered for a set of events, and through
reasoned debate a consensus is reached regarding which view is more
supportable;
Start writing the report, using the headings suggested in the following section.
If you find that certain sections of the report are hard to write, it is probably
because your analysis is incomplete and requires further work. An analysis
that is ‘sorted’ and coherent tends to write itself!
Analysis of case material can be facilitated through the involvement of other people –
colleagues, fellow students, your clinical or research supervisor, the client. For
example, multiple copies of the case book can be created, so that a small team of three
or four people can read and interpret the material at the same time, and meet together
to engage in dialogue around their conclusions. Guidelines for this type of team
analysis can be found in Hill et al (1997), and in the extensive literature generated by
the ‘collaborative inquiry’ network (e.g., Reason, 1988). Alternatively, a case
researcher working mainly alone can ask someone else to audit their analysis of all, or
parts, of the data. Comments and feedback can be generated through written or oral
presentations to various audiences, including clients.
5.
Writing the final report
Although there are a range of different structures that can be used for case reports (see
Yin, 2003), it is sensible, in terms of meeting the requirements of counselling and
psychotherapy journal editors and reviewers, to follow the report structure that is
specified by the journal, Pragmatic Case Studies in Psychotherapy.. The website of
this journal includes examples of case reports written within this format, and detailed
instructions for authors that explain the rationale for the structure that the journal
requires. The main headings in a pragmatic case study are:
1. Case context and method. This section sets the scene for the case report, and
includes: (a) the aim of the report; (b) the rationale for selecting this particular client
for study; and (c) information about the different sources of data that have been used,
and how the data have been analysed; (d) the clinical setting in which the case took
place; (e) procedures that were used to ensure confidentiality and to secure the
consent of the client.
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2. The client. This section provides and outline who the client was, the social and
historical context of his/her life (although properly disguised); and their main
presenting problems.
3. Guiding conception. The term ‘guiding conception’ refers to a broad understanding
of the approach adopted by the therapist. This section includes a summary account of
the theoretical model(s) used by the therapist, the relevant research literature, and the
therapist’s previous training and experience in relation to this category of client
presenting problem.
4. Assessment of the client's presenting problems, goals, strengths, and history. This
section offers a more detailed account of the background to, and nature of, the
difficulties being experienced by the client. It is often valuable to contextualise this
information in relation to the developmental history and cultural background of the
client.
5. Formulation and treatment plan. A description of how the guiding formulation is
applied within this specific case, and how the case conceptualisation is negotiated
with, or conveyed to, the client.
6. Course of therapy. An account of the temporal course of therapy. It is particularly
valuable if verbatim transcripts can be used to document therapeutic process at critical
points in the therapy. The links between the guiding conception, and ongoing therapy
interventions and process should be explored and analyzed. Any difficulties or
impasses in the therapy should be described and discussed in relation to the guiding
conception.
7. Therapy monitoring and use of feedback information. Description of the therapist
process of self-reflection, supervision, client-completed quantitative questionnaires,
peer feedback, feedback from other professionals who have worked with the client.
This section should discuss the ways in which monitoring and feedback information
were used to influence the course of therapy.
8. Concluding evaluation of the process and outcome of therapy. This is a crucial
section, in terms of establishing the contribution to knowledge made by the case
study. Some of the issues that readers may want to know about here are: a) the
outcome of the therapy at termination and, ideally if possible, at follow-up; (b) the
ways in which the guiding conception played out within the case (i.e., implications for
theory); (c) comparisons to previously published cases (i.e., what does this case add to
the already existing knowledge base?); (d) implications for organisations and agencies
offering therapy services; (e) implications for practice – what is the message of this
case analysis, for fellow therapists and trainees?
When assembling a case report for publication, it is essential to be mindful of the
layout, referencing, and word length requirements of the specific journal to which the
paper is be submitted. It is always helpful to read articles already published in the
target journal, to gain a sense of its ‘house style’.
The criteria for a good case study
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When an article is sent to a journal, it undergoes an evaluation procedure that involves
reports being written by perhaps two or three reviewers. Typically, the editor of the
journal sends these commentaries directly to the author, with a covering letter
indicating the issues that he or she considers are most significant for revision. When
preparing a case study for publication, and when interpreting feedback from
reviewers, it can be helpful to be aware of the criteria that are used when assessing a
study of this type:
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Is the case significant? What is it that makes this case interesting, and worth
reading about?
Is the evidence of sufficient quality? Does the author supply enough
descriptive material, to give a sense of what happened in the therapy?
Is the case sufficiently contextualised? Is all relevant information provided
about the client, the therapist, and the therapy setting?
Have appropriate ethical procedures been followed?
Have the data been analysed in a systematic and rigorous fashion? Is it
possible to follow the clear line of argument between evidence and
conclusions?
Are multiple perspective and interpretations taken into account? For example,
has the views of the client, or other analysts of the case material, been taken
into account?
Does the author discuss what the present study adds to the existing literature
on the topic?
Is the report readable? Does it follow a clear structure?
A case study is a form of research report that depends a great deal on what has been
termed narrative knowing – advancing understanding by telling a story that
incoportates within it certain truths and insights. No matter how careful case data are
analysed, a case report stands or falls on its capacity to tell a good story.
Summary
The case study represents has an important role to play, within the range of
methodologies employed in contemporary counselling and psychotherapy research.
Case study investigations are particularly attuned to the needs and interests of
practitioners who are seeking to engage in research. Working on a systematic case
study can provide a practitioner with a unique opportunity for critically reflecting on
his or her own practice, and involving colleagues in that process as co-analysts. Case
studies also make it possible to share knowledge about innovative forms of practice.
While it is never possible to generalise from single cases, the existence of journals
willing to publish case study articles means that it is possible to build up a corpus of
case evidence. Carrying out case study research, and writing a case report for
publication, draws on a broad spectrum of skills and knowledge. The aim of this
information sheet had been to highlight the main elements of that body of skill and
knowledge, and to indicate sources for further learning.
References and suggestions for further reading
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The present information sheet is a best read in conjunction with Stiles, W. B. (2007).
Theory-building case study research. [Information sheet no. 55] Rugby: British
Association for Counselling and Psychotherapy.
1.
Examples of case studies.
In preparing to carry out a case study investigation, it is valuable to look at how other
case study researchers have handled the issues and challenges associated with this kind
of work. The best single source is the series of case studies in the Archive section of
Pragmatic Case Studies in Psychotherapy (http://pcsp.libraries.rutgers.edu/). Some other
interesting examples of systematic case studies include:
Etherington, K. (2000) Narrative approaches to working with adult male survivors of
child sexual abuse: the client's, the counsellor's and the researcher's story. London:
Jessica Kingsley.
Firth-Cozens, J. (1992) Why me? A case study of the process of perceived
occupational stress. Human Relations, 45: 131-142.
Hill, C.E. (1989) Therapist Techniques and Client Outcomes: Eight Cases of Brief
Psychotherapy. London: Sage.
Honos-Webb, L., Stiles, W. B., Greenberg, L. S. and Goldman, R. (2006). An
assimilation analysis of psychotherapy: Responsibility for “being there.” In C. T.
Fischer (Ed.), Qualitative research methods for psychologists: Introduction through
empirical studies. New York: Academic Press.
Strupp, H.H. (1980) Success and Failure in time-limited psychotherapy. A systematic
comparison of two cases : comparison 1. Archives of General Psychiatry 37: 595-603.
2.
Debates around methodological issues in case study research in counselling and
psychotherapy
The following sources provide a sense of how the counselling/psychotherapy profession
has engaged with the question of how best to carry out case study research, and the role
of case studies in terms of the general evidence base for therapy policy and practice:
Edwards, D.J.A.(1998) Types of case study work: A conceptual framework for casebased research. Journal of Humanistic Psychology. 38(3): 36-70.
Elliott, R. (2001) Hermeneutic single-case efficacy design: an overview. In K.J.
Schneider, J. Bugental and J.F. Pierson (eds) The Handbook of Humanistic
Psychology: Leading Edges in Theory, Research and Practice. Thousand Oaks, CA:
Sage.
Elliott, R. (2002). Hermeneutic Single Case Efficacy Design. Psychotherapy
Research, 12, 1-20.
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Fishman, D.B. (1999) The case for a pragmatic psychology. New York: NYU Press.
Fishman, D.B. (2006) Finding legitimacy for case study knowledge. Pragmatic Case
Studies in Psychotherapy, vol. 2, module 4, article 2.4.1, http://pcsp.libraries.rutgers.edu/
Hilliard, R.B. (1993) Single-case methodology in psychotherapy process and outcome
research. Journal of Consulting and Clinical Psychology, 61(3): 373-80.
Miller, R.B. (2004) Facing human suffering: psychology and psychotherapy as moral
engagement. Washington, DC: American Psychological Association.
Morley, S. (2007) Single case methodology in psychological therapy. In S.J.E.
Lindsay and G.E. Powell (Eds) A Handbook of Clinical Adult Psychology, 3rd edition.
London: Brunner Routledge.
Rowland N. (2007) BACP and NICE. Therapy Today, 18(5),: 27-30.
Schneider, K.J. (1999) Multiple-case depth research. Journal of Clinical Psychology,
55: 1531-40.
Spence, D.P. (1989) Rhetoric vs. evidence as a source of persuasion: a critique of the
case study genre. In M.J. Packer and R.B. Addison (eds) Entering the Circle:
Hermeneutic Investigation in Psychology. Albany, NY: State University of New York
Press.
Stiles, W. B. (2003). When is a case study scientific research? Psychotherapy
Bulletin, 38(1), 6-11
Stiles, W. B. (2005). Case studies. In J. C. Norcross, L. E. Beutler and R. F. Levant
(Eds.) Evidence-based practices in mental health: Debate and dialogue on the
fundamental questions. Washington, DC: American Psychological Association.
Stiles, W. B. (2007). Theory-building case studies of counselling and psychotherapy.
Counselling and Psychotherapy Research, 7, 122-127.
Turpin, G. (2001) Single case methodology and psychotherapy evaluation: From
research to practice. In C. Mace, S. Moorey and B. Roberts (eds) Evidence in the
psychological therapies: A critical guide for practitioners. London: BrunnerRoutledge.
3.
Case study research in psychology and social science: the broader context
Case study inquiry is carried out by researchers in many other fields – psychology,
sociology, education, management studies, etc. The items listed in this section offer an
introduction to some of the approaches to case research that are used in these disciplines.
Flybjerg, B. (2006) Five misunderstandings about case-study research. Qualitative
Inquiry, 12(2): 219-245.
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Runyan, W.M. (1981) Life histories and psychobiography: explorations in theory and
method. New York: Oxford University Press.
Stake, R.E. (2005) Qualitative case studies. In N.K. Denzin and Y.S. Lincoln(eds)
Handbook of qualitative research. 3rd edn. Thousand Oaks, CA: Sage.
Yin, R.K. (2003) Case study research: design and methods. 3rd edn. Thousand Oaks,
CA: Sage.
Yin, R.K. (2004) The case study anthology. Thousand Oaks, CA: Sage.
4.
Ethical issues
BACP (2007) Ethical framework for good practice in counselling and psychotherapy.
Revised edition. Rugby, UK: British Association for Counselling and Psychotherapy
Bond, T. (2004). Ethical guidelines for researching counselling and psychotherapy.
Rugby, UK: British Association for Counselling and Psychotherapy.
Josselson, R. (ed)(1996) Ethics and process in the narrative study of lives. Thousand
Oaks, CA: Sage.
5.
Working together as a team, to analyse case data
Hill, C.E., Thompson, B.J., Nutt-Williams, E. (1997) A guide to conducting consensual
qualitative research. Counseling Psychologist, 25: 517-572.
Hill, C.E., Knox, S., Thompson, B.J., Williams, E.N., Hess, S.A. and Ladany, N.
(2004) Consensual Qualitative research: an update. Journal of Counseling
Psychology, 52: 196-205.
Reason, P. (ed.) (1988) Human Inquiry in Action: Developments in New Paradigm
Research. London: Sage.
Schielke, H. J., Fishman, J. L., Osatuke, K., and Stiles, W. B. (in press). Creative
consensus on interpretations of qualitative data: The Ward method. Psychotherapy
Research.
6. Quality criteria the publication of case studies
Elliott, R., Fischer, T. C. and Rennie, L. D. (1999). Evolving guideline for publication
of qualitative research studies in psychology and related fields. British Journal of
Clinical Psychology, 38, 215-229.
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7. Sources of information about research tools and techniques that you might consider
applying in a case study investigation
Barker, C., Pistrang, N. and Elliott, R. (2002). Research methods in clinical
psychology: An introduction for students and practitioners (2nd ed.). Chichester:
Wiley.
Cone, J.D. (2001) Evaluating Outcomes: Empirical Tools for Effective Practice.
Washington, DC: American Psychological Association.
McLeod. J. (2003) Doing counselling research. 2nd edn. London: Sage.
Ogles, B., Lambert, M. and Fields, S. (2002) Essentials of outcome assessment. New
York: Wiley
Riding, N. and Lepper, G. (2005) Researching the Psychotherapy Process: A
Practical Guide to Transcript-Based Methods. London: Palgrave/Macmillan.
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