Eliza Case Study: Treatment Goals, Progress, and Closure
This paper presents a two-part clinical case study examining the treatment of a client named Eliza, who presents with anxiety, obsessive-compulsive disorder, trauma sensitivity, and an eating disorder. Part One addresses behavioral indicators of a healthy baseline, methods for monitoring treatment goals using the Outcome Rating Scale and Session Rating Scale, criteria for reevaluating or referring treatment, and the appropriateness of wraparound services. Part Two evaluates whether treatment goals were met, identifies factors that contributed to treatment success, discusses appropriate clinical communication strategies for conveying outcomes to the client, and outlines proper documentation practices for the final session. The paper draws on cognitive behavioral therapy research, collaborative planning principles, and established clinical documentation standards.
- Behavioral Indicators of a Healthy Baseline: CBT outcomes as markers of Eliza's stability
- Determining Whether Treatment Goals Were Met: Using ORS and SRS to monitor progress
- Criteria for Reevaluation, Extension, or Referral: When and how to reassess refractory anxiety treatment
- Wraparound, Outpatient, and Step-Down Services: Wraparound approach for Eliza's intensive needs
- Success Factors in the Treatment Plan: Collaborative planning and client-centered outcomes
- Communicating Outcomes and Documenting the Final Session: Language, documentation, and closure strategies
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The paper is clearly structured around distinct clinical questions, making it easy to follow the progression from assessment through closure.
- It grounds recommendations in specific, named tools — the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) — demonstrating practical clinical knowledge rather than vague generalizations.
- The use of cited evidence, including controlled study statistics and established frameworks such as wraparound services, adds credibility to each recommendation.
Key academic technique demonstrated
The paper demonstrates applied clinical reasoning: taking a specific client case and systematically working through assessment, monitoring, contingency planning, and closure. Rather than discussing therapy abstractly, each section ties general principles directly to Eliza's presenting symptoms and treatment context. This case-to-concept connection is a hallmark of effective graduate-level clinical writing.
Structure breakdown
The paper is divided into two parts. Part One addresses prospective treatment management — baseline indicators, goal monitoring, reevaluation criteria, and service needs. Part Two evaluates retrospective outcomes — goal attainment, contributing success factors, client communication language, and final documentation. Together, the two parts mirror the full arc of a clinical treatment episode from planning through termination.
Behavioral Indicators of a Healthy Baseline
The therapies described in Eliza's case will be instrumental in stabilizing her behavior, provided they are conducted regularly. Cognitive behavioral therapy (CBT) is effective in addressing several factors that contribute to Eliza's difficulties, including anxiety, obsessive-compulsive disorder, trauma sensitivity, and an eating disorder. Stability across these areas, as assessed through ongoing evaluation, can serve as a meaningful indication of Eliza's overall health.
CBT has demonstrated promising outcomes when applied early to forestall the development of mental disorders. The approach includes psychoeducation about trauma reactions, relaxation training, restructuring of fear-related beliefs, imaginal exposure to traumatic memories, and graduated exposure to avoided situations. A number of controlled studies have indicated that five sessions per week, each lasting one and a half hours, can reduce the six-month incidence of disorder from 67% to 15% (WHO, 2004).
Determining Whether Treatment Goals Were Met
Treatment goal attainment can be monitored using the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). These are standardized measures designed to track treatment progress and therapeutic alliance over time. The ORS is administered at the beginning of each therapy session, then reviewed and scored collaboratively with the client during the session. The SRS, by contrast, is reviewed only as needed in response to concerns that arise during or after a session.
Both the SRS and ORS utilize visual analogue scales, each comprising four items. Descriptive anchors appear at either end of a 10 cm line, and the client marks the point that best reflects their experience. The measurement from the left end of the line constitutes the score for that item. The ORS measures overall functioning — including individual, interpersonal, and social domains. The SRS assesses the client's feelings about the therapeutic process, including the approach, goals, and topics addressed, as well as the client's level of satisfaction with the session just completed (Goodman, McKay, & DePhilippis, 2013).
Criteria for Reevaluation, Extension, or Referral
When anxiety proves refractory to initial treatment, the first step is a thorough reevaluation of the patient. This evaluation should include diagnostic reassessment as well as an examination of the interplay among biological, stress-related, and cognitive factors. Inadequate coping strategies on the part of the patient and family members should be identified and revised. The dosages and duration of initial treatment must also be reviewed (Bystritsky, Khalsa, Cameron, & Schiffman, 2013).
At the outset of refractory treatment, intensive CBT in combination with an adequate trial of SSRIs or SNRIs — or both — may be warranted. If these measures are insufficient, treatment may progress to combining SSRIs with atypical neuroleptic or antiepileptic agents, particularly when psychotic disorder or bipolar disorder is suspected. Partial hospitalization in settings offering intensive CBT and medication management may also be recommended when clinically appropriate (Bystritsky, Khalsa, Cameron, & Schiffman, 2013).
Create your account
Always verify citation format against your institution’s current style guide requirements.