16-355, WC: 2990
Introduction
This case report describes a course of treatment provided to a client presenting with symptoms of
depression and highlights how I drew on both case management supervision (CMS) and clinical
skills supervision (CSS) to shape and guide my clinical decision-making at each stage of the
intervention.
Supervision is a core aspect of clinical training and practice, supporting the delivery of safe,
ethical, and evidence-based interventions. It offers a space for practitioners to reflect on their
decision-making, consolidate therapeutic skills, and maintain treatment fidelity (British
Psychological Society, 2024; NHS England, 2025). High-quality supervision has also been
associated with improvements in the therapeutic relationship, better clinical outcomes for clients,
and reduced risk of dropout (Alfonsson et al., 2018; Watkins, 2017).
In my service, I receive individual CMS weekly for one hour, as well as fortnightly group CSS
for one hour, in line with Talking Therapies guidance (NHS England, 2025). These structures
provide regular opportunities to review clinical risk, monitor treatment progress, and reflect on
therapeutic skills. This case report demonstrates how both forms of supervision supported my
clinical work and enabled me to engage with best practice guidance throughout treatment.
Assessment
Presenting Problem: This client (pseudonym Jorge) presented with low mood and reduced
motivation following a moderate hip injury sustained at work. Jorge had been recovering for
approximately six months, during which time he had been on medical leave. He described
himself as previously active and independent and reported that the injury and time away from
1
,16-355, WC: 2990
work had disrupted his routine and contributed to a sense of lost identity. Most days were spent
alone and unstructured, often watching television, something he described as “just letting the
days pass” and feeling like “a shell of my old self.” At the time of his problem-focused
assessment, his MDS scores were PHQ-9 = 17 and GAD-7 = 9, indicating moderately severe
depression and moderate anxiety.
Risk
Jorge denied any current suicidal thoughts, plans, or intent. He also denied any history of self-
harming behaviours. He identified protective factors including a close relationship with his
younger brother and spoke about his dog as a source of comfort. A collaborative risk
management plan was agreed, including access to crisis support if needed.
PSS
My main problem is feeling low and stuck. This started around six months ago after I injured my
hip and had to stop working. It happens most days now. Physically I feel tired and heavy, like I
don’t have much energy. Emotionally, I feel flat and withdrawn. My thoughts are things like
‘‘I’m wasting time’’, ‘‘I should be doing more.” Because of this, I tend to stay at home. I do walk
the dog, but that’s about it. Overall, it’s taken away the drive to do anything that feels enjoyable.
Goals
Get a bit of routine back so I’m not just spending all day on the couch.
Start working out with my brother again.
Feel ready to get back into dating when I’m in a better place.
2
, 16-355, WC: 2990
Intervention planning
Following Jorge’s problem-focused assessment, I brought this new case to CMS for intervention
planning, in line with Talking Therapies guidance (NHS England, 2025). Jorge’s presentation
met the criteria for a depressive episode, as outlined by the DSM-5 (APA, 2013), with symptoms
including low mood, reduced motivation, loss of interest in previously meaningful activities, and
disrupted routine. Given the functional nature of his difficulties and the absence of significant
risk or complexity, low-intensity (LI) treatment was considered appropriate.
Behavioural Activation (BA) was identified as a suitable intervention to support Jorge in
gradually re-engaging with valued activities and improving mood through increased positive
reinforcement (Martell et al., 2010; Papworth et al., 2018). NICE guidelines (2022) continue to
recommend BA as a first-line treatment for depression, particularly where inactivity and
withdrawal are key maintenance factors. It was therefore agreed in CMS to proceed with six
guided self-help (GSH) sessions based on the BA protocol.
Intervention process, use of supervision, and individual learning
Session 1
MDS: PHQ9 = 15 (q9 = 0) GAD-7=9 WSAS=14 Phobia=0
Content covered Homework set
COMPLETED FIVE AREAS MODEL; Read pages 1-10 of CEDAR Lift Your Low
INTRODUCED PSYCHOEDUCATION ON Mood (Farrand, Beech, & Boath, 2022)
3
Introduction
This case report describes a course of treatment provided to a client presenting with symptoms of
depression and highlights how I drew on both case management supervision (CMS) and clinical
skills supervision (CSS) to shape and guide my clinical decision-making at each stage of the
intervention.
Supervision is a core aspect of clinical training and practice, supporting the delivery of safe,
ethical, and evidence-based interventions. It offers a space for practitioners to reflect on their
decision-making, consolidate therapeutic skills, and maintain treatment fidelity (British
Psychological Society, 2024; NHS England, 2025). High-quality supervision has also been
associated with improvements in the therapeutic relationship, better clinical outcomes for clients,
and reduced risk of dropout (Alfonsson et al., 2018; Watkins, 2017).
In my service, I receive individual CMS weekly for one hour, as well as fortnightly group CSS
for one hour, in line with Talking Therapies guidance (NHS England, 2025). These structures
provide regular opportunities to review clinical risk, monitor treatment progress, and reflect on
therapeutic skills. This case report demonstrates how both forms of supervision supported my
clinical work and enabled me to engage with best practice guidance throughout treatment.
Assessment
Presenting Problem: This client (pseudonym Jorge) presented with low mood and reduced
motivation following a moderate hip injury sustained at work. Jorge had been recovering for
approximately six months, during which time he had been on medical leave. He described
himself as previously active and independent and reported that the injury and time away from
1
,16-355, WC: 2990
work had disrupted his routine and contributed to a sense of lost identity. Most days were spent
alone and unstructured, often watching television, something he described as “just letting the
days pass” and feeling like “a shell of my old self.” At the time of his problem-focused
assessment, his MDS scores were PHQ-9 = 17 and GAD-7 = 9, indicating moderately severe
depression and moderate anxiety.
Risk
Jorge denied any current suicidal thoughts, plans, or intent. He also denied any history of self-
harming behaviours. He identified protective factors including a close relationship with his
younger brother and spoke about his dog as a source of comfort. A collaborative risk
management plan was agreed, including access to crisis support if needed.
PSS
My main problem is feeling low and stuck. This started around six months ago after I injured my
hip and had to stop working. It happens most days now. Physically I feel tired and heavy, like I
don’t have much energy. Emotionally, I feel flat and withdrawn. My thoughts are things like
‘‘I’m wasting time’’, ‘‘I should be doing more.” Because of this, I tend to stay at home. I do walk
the dog, but that’s about it. Overall, it’s taken away the drive to do anything that feels enjoyable.
Goals
Get a bit of routine back so I’m not just spending all day on the couch.
Start working out with my brother again.
Feel ready to get back into dating when I’m in a better place.
2
, 16-355, WC: 2990
Intervention planning
Following Jorge’s problem-focused assessment, I brought this new case to CMS for intervention
planning, in line with Talking Therapies guidance (NHS England, 2025). Jorge’s presentation
met the criteria for a depressive episode, as outlined by the DSM-5 (APA, 2013), with symptoms
including low mood, reduced motivation, loss of interest in previously meaningful activities, and
disrupted routine. Given the functional nature of his difficulties and the absence of significant
risk or complexity, low-intensity (LI) treatment was considered appropriate.
Behavioural Activation (BA) was identified as a suitable intervention to support Jorge in
gradually re-engaging with valued activities and improving mood through increased positive
reinforcement (Martell et al., 2010; Papworth et al., 2018). NICE guidelines (2022) continue to
recommend BA as a first-line treatment for depression, particularly where inactivity and
withdrawal are key maintenance factors. It was therefore agreed in CMS to proceed with six
guided self-help (GSH) sessions based on the BA protocol.
Intervention process, use of supervision, and individual learning
Session 1
MDS: PHQ9 = 15 (q9 = 0) GAD-7=9 WSAS=14 Phobia=0
Content covered Homework set
COMPLETED FIVE AREAS MODEL; Read pages 1-10 of CEDAR Lift Your Low
INTRODUCED PSYCHOEDUCATION ON Mood (Farrand, Beech, & Boath, 2022)
3
