The document presents four case studies illustrating failures in data warehousing projects, each highlighting different issues such as lack of management support, insufficient user involvement, and technological challenges. The studies emphasize the critical importance of managing expectations, ensuring proper resources and involvement from end users, and adapting the project to organizational changes throughout its development. Ultimately, these examples provide valuable insights into common pitfalls in data warehousing and suggest strategies for improving success rates in future projects.

1. 1
HW#1: DW Case Study
Case Studies of Data Warehousing Failures
Four studies of data warehousing failures are presented. They
were written based on interviews with people who were
associated with the projects. The extent of the failure varies
with the organization, but in all cases, the project was at least a
disappointment.
Read the cases and prepare a report that provides a substantive
discussion on each of the following:
What’s the scope of what can be considered a data warehousing
failure?What do you find most interesting in the failure
stories?Do they provide any insights about how a failure might
be avoided?
Your discussion should be at least 2 pages in length with 1.5”
spacing & 1” margins.
Case Study 1: Auto Guys
Auto Guys initiated a data warehousing project four years ago
but it never achieved full usage. After initial support for the
project eroded, management revisited their motives for the
warehouse and decided to restart the project with a few changes.
One reason for the restructuring, according to the project
manager, was the complexity of the model initially employed by
Auto Guys.
At first, the planner for the data warehouse wanted to use a
dimensional model for tabular information. But political

2. pressure forced the system’s early use. Consequently,
mainframe data was largely replicated and these tables did not
work well with the managed query environment tools that were
acquired. The number of tables and joins, and subsequent
catalog growth, prevented Auto Guys from using data as it was
intended in a concise and coherent business format.
The project manager also indicated that the larger the data
warehouse, the greater the need for high-level management
support – something Auto Guys lacked on their first attempt at
setting up the warehouse. Another problem mentioned by the
project manager was that the technology Auto Guys chose for
the project was relatively new at the time, so it was not
accepted and did not garner the confidence that a project using
proven technology would have received. This is a risk inherent
in any “cutting edge” technology adoption. The initial
abandonment of the project was undoubtedly hastened by both
corporate discomfort with this new technology and the lack of
top management support.
A short time after dropping the project, top management felt
pressure to reestablish it. Because Auto Guys initially planned
an enterprise-wide warehouse, they had considerable computer
capacity. It was put to use on a much smaller project that
focused exclusively on a single subject area. Other subject areas
were due to be added once the initial subject area project was
completed. Auto Guys expects to grow the warehouse to two
terebytes within a year or two and eventually expand to their
projected enterprise-wide data warehouse. The biggest
difference between pre- and post-resurrection will be that the
project will evolve incrementally.
Given his experience with the warehouse, the project manager
made the following summary observations: (1) the management
of expectations is critical to any sizeable data warehousing
project; (2) proven technology, although not essential, does
make the project easier to explain and justify; and (3) the
construction of a sizeable data warehouse should be treated
more like and R&D effort instead of a typical

3. IT project because of the time it takes to complete the project,
the amount of money involved, and the short-term focus of top
management.
Case Study 2: Government Research Laboratory
The Government Research Laboratory (GRL) has a finance
department in each of the fifteen nearly identical laboratories
that report to its national home office. As a member of the
finance team, Bob was familiar with the monthly financial
reports required by the home office. Although the financial
reports themselves were not complicated, access to the
mainframe where the data was housed was necessary, and an
understanding of COBOL was needed to generate any report that
differed from the standard. Once a month, reports would be
distributed in paper form and each member of the finance team
would sort through them and file them away. If the reports
required any alteration, then someone from IS, or one of two
people from finance familiar with COBOL, was contacted.
Because of these reporting difficulties, an IS manager made the
suggestion that the company’s first data warehouse be
constructed, and that the finance department be the primary
beneficiary. Two people from IS began to work full-time on the
project and a financial analyst also joined the group. The IS
manager then offered a bonus to the IS technicians if they could
get the data warehouse up and running by the end of the fiscal
year which was just four month away.
Both the IS and the finance members of the team, firmly rooted
in reality, knew this would be a difficult if not impossible task.
But they resolved to give it their best shot and attempted a full
transfer of all available reports to the warehouse. When it
became clear that this was too ambitious, they cut out all of the
detailed reports and focused on just the summaries, assuming
the more detailed material could be integrated at some point

4. after the initial deadline.
The team was successful and had all summary reports
transferred to the data warehouse at the end of the fiscal year.
The fact that the necessary tables were up and functional,
however, was not an indicator of future success.
The first problem involved changes to the mainframe database
which were initiated at the same time, but uncoordinated with,
the data warehousing project. At the same time the foundation
for the data warehouse was being laid, the planning system on
the mainframe was undergoing modifications not captured in the
data warehouse. In particular, changes in cost accounting
standards within the organization changed the number of key
summary categories from the standard five used in the past to
seven, rendering the traditional five next to useless.
The second problem occurred when the goal to establish the
data warehouse became the end goal.
As the GRL financial analyst for the team describes it, the
feedback and modification period he had anticipated after
September never came. The preliminary fix became the
permanent solution. The analyst later learned that IS had always
intended to set the system up but only funded its basic
maintenance.
Modifications were not in the budget and the finance
department, only minimally included in the warehouse project,
never had a budget that would fund the inclusion of more data
and alterations to the system.
Essentially, GRL found itself with a data warehouse that
contained too little data and data that was outdated because of
format changes in GRL’s cost accounting standards. Also,
neither finance nor IS budgeted for changes necessary to create
a fully functional data warehouse. Those two problems alone
would have killed most data warehouse initiatives, but the
problems did not end there.
The data warehouse was supposed to solve two accessibility
problems. One involved the need for COBOL language expertise
whenever a report required alteration, and the other involved

5. the sheer mass of printed documents being disseminated and
archived. Instead of providing a solution, reports theoretically
available on a network were handled in much the same manner
as the old reports. For one
thing, the data access software installed on each user’s PC was
frequently incompatible with the mix of software already there.
Many end-users, therefore, found access to the data warehouse
difficult, and those who were able to access the data warehouse
had such bad experiences with the new system they just did not
use it. Also, the small minority that did not experience
accessibility problems simply printed hard copies of the reports,
which was no great change from how things had been done in
the past.
Additionally, the programming barriers in existence when
COBOL knowledge was necessary simply changed form.
PowerBuilder, very much a programmer’s tool, was selected to
build the user interfaces. Ironically, IS only had one individual
with PowerBuilder skills, thus creating more of a bottleneck
than had existed with COBOL.
The situation remained the same, if not worse, for three years
following the first warehousing initiative. Finally, another IS
project manager became interested in the idea of breathing life
into the old warehouse. He was motivated by the organization’s
solution to the Y2K problem, which involved abandoning the
old mainframe system and transferring the old reports to the
warehouse. Fortunately, his interest was accompanied by
funding that allowed the enhancements anticipated at the very
beginning of the first project to finally be realized. Also, all
users are able to access Web-based reports.
Several things should have been done differently at GRL: (1)
The warehousing initiative should have been in sync with
mainframe changes and other IT initiatives throughout the lab;
(2) Planning and resources should have been projected much
farther into the future; (3) A pilot should have been done which
probably would have identified a number of technical and fine
tuning problems; (4) Deadlines should have reasonable.

6. Still, given the most recent developments, GRL’s financial
analyst classifies his experience as a partial disappointment. “It
could have been so much better,” he explains. “It could have
been done right…for the right reasons.”
Case Study 3: Complicated Systems
The manager for Complicated Systems’ IT client information
center started her job three years ago. That was six months after
Complicated launched its data warehousing initiative that
started with initial interest from the chief financial officer but
shortly thereafter received its support from Complicated
headquarters. A small group of people from Complicated’s main
office, possessing no experience with data warehousing, decided
which data would be appropriate and which data access tools
would be utilized. This set limits on the future of the system
based primarily upon the types of reports corporate
headquarters assumed everybody needed and their arbitrary
selection of OLAP tools.
With corporate headquarters championing the effort and
supplying funds, the project had a lot going for it. However, end
users were not brought into the picture even though they were
the targeted beneficiaries. Information was immediately
accessible to sales, service, marketing, and finance divisions
around the world but it was not the right information.
Luckily for Complicated, certain things beyond strong corporate
championing and finding worked to Complicated’s advantage.
Extenuating circumstances included corporate’s initial design
decision, the appearance of new initiatives from the marketing
division, as well as top management, and the turnaround that the
data warehousing project manager bought to the IS division.
First, an initial decision was made to Web-enable the database.
This meant that although the information originally
disseminated by the organization was of little value to those

7. outside of top management, flexibility existed that would later
allow the system to be put to use.
Second, independent initiatives from marketing and top
management at headquarters, as well as more vocal end users
than had existed in the past, started the move toward making the
data more accessible and relevant to users. Specifically,
marketing wanted access to valuable data already gathered.
At the same time, corporate headquarters was experiencing
difficulties it thought might have solutions within the data
warehouse. This further fortified the commitment of central
management to their belief in the strategic benefit of the data
warehouse and elicited moral support that went beyond the
dollar commitment already made.
Third, and most difficult to assess, was the arrival of a new
project manager to the IT client information center. When she
arrived, the data warehouse, intended to support 140 branch
offices and averaging four users per office, was going nowhere.
The system contained data of little relevance to anyone outside
of Complicated headquarters and the end users identified by
management were unimpressed.
Turning the situation around required: (1) informing
management of the lack of practical application of the
warehouse; (2) obtaining adequate input from the end users to
build a more useful system; and (3) translating all the input
from marketing and central management into a technical
solution. The past three or four months, according to the project
manager, have seen the emergence of a system much more open
to the needs of users. They have opted out of OLAP, selected
tools more appropriate to a changing reporting structure, and
bridged the communication gap between central management
and the numerous branch offices.
Complicated was well on its way to a complete data
warehousing failure for two significant reasons -no user
involvement in determining information requirements and a
poor data warehousing tool selection process. The situation is
turning around, however, through the efforts of the data

8. warehousing project manager, the continuing need for a data
warehousing capability, and the fortuitous early decision to
Web-enable the warehouse.
Case Study 4: North American Federal Government
A real-estate and property management unit in the North
American Federal Government initiated and co-sponsored a data
warehouse with the IT department. The IT department wrote a
formal proposal. In it, an architectural plan was specified, costs
were estimated at $800,000, the project’s duration was
estimated to be eight months, and the responsibility for funding
and manpower was defined as the business unit’s. The IT
department never heard if the proposal was accepted but
proceeded with the project assuming that there had been no
problems with the proposal.
The project actually exceeded its eight-month schedule and
lasted almost two years. Several factors contributed to the extra
time. One was that the business unit stretched the detailed data
analysis from one and a half months to nine months. Another
was that the business unit kept expanding the planned user base.
Over a six-month period, the number of planned users grew
from 200 to 2,500. Also, to acquire the right technology for this
project, a formal approval process of the Federal government
took almost a year. Three weeks prior to technical delivery, the
project was canceled by the IT director. The rationale was that
the business unit was actually several months away from
accepting deliver. Yet, six weeks after cancellation, a new
interest in populating the warehouse emerged, but in the end,
nothing was ever delivered and this failed endeavor cost the
organization approximately $2.5 million.
There were three main reasons for the failure of this data
warehouse project. One was lack of focus. The business unit had
a difficult time identifying the scope of the project. It provided

9. an information architecture and data framework but the details
were defined very loosely. Also, the business unit kept pushing
back the milestone dates which gave the impression that the
project was neither urgent nor important.
Internal politics was another driving force behind this data
warehouse disappointment. First, the business unit leader
prevented analysts on the project from talking to the ultimate
end users, but the reason was uncertain. Second, the business
unit leader would go over the IT project leader’ head and
reassign staff to different tasks without informing the IT project
leader. This further led to ambiguity as to what was to be
accomplished and when. In the end, it was believed that the
cancellation of the project was primarily because the IT director
feared supporting a data warehouse. Staff and funding had
recently been cut, and such an endeavor would further drain IT
resources.
In hindsight, the IT project leader would have done two things
differently. First, he would not have allowed the politics and
overriding of authority to prevent inopportune and incorrect
decisions as well as lack of direction. Second, the original plan
for this data warehouse was to build a warehouse framework
with a common language and then spin off subject area data
from it. The manager believes that a better approach would have
been to start with data marts and them work toward a full-blown
data warehouse.
warehousing project was not represented. Project supporters
assumed that the project would survive any budget cuts based
upon the project’s past success and its relatively small budget,
but they did not sit at the negotiating table. Additionally,
Integrated Health’s central management knew very little about
the project and political tension between the two hospitals still
greatly influenced behaviors and attitudes. The decision was
made to discontinue funding of the data warehousing initiative.

10. The project manager made the observation that many things
occurring in concert brought a halt to Integrated Health’s data
warehousing project. The first set of difficulties were corporate-
based and rooted in past practices and personnel. Mistrust and
suspicion at the hospitals added difficulty to the data
integration project. Significant disconnect existed between the
two hospitals and Integrated’s central management. Also, the
lack of a champion at a level directly involved in the budgeting
process eroded the effectiveness of the champion that did exist.
Timing was a difficulty for Integrated Health since the project
was too old in the sense that it threatened certain parties but too
young in the sense that it had not yet proven itself. Had the
project been either a year younger or a year older, guesses the
project manager, it would have survived the budget cuts. Data
warehouses are also more prone to failure, says the project
manager, because they require a lot of funding and take multiple
years to fully realize their potential. This is a stark contrast to
corporate memory, which is short.
Volume 39/Number 3/July 2017/Pages 18 1-194/doi: 10
.17744/mehc.39.3.01
THEORY
Case Conceptualization: Improving

11. Understanding and Treatment with the
Temporal/Contextual Model
Lynn Zubernis, Matthew Snyder, and Cheryl Neale-McFall
Case conceptualization is a critical component o f diagnosis and
treatment. This article intro-
duces a comprehensive, holistic model of case conceptualization
called the temporal!contextual
model. This model aims to improve the accuracy, efficiency,
and effectiveness of the case con-
ceptualization process. The temporal/contextual model is
applied to a case example, illustrating
its efficacy in helping a client with an eating disorder.
Before counselors can decide on interventions and set goals
with clients,
they must have a thorough understanding of who the client is
and the context
within which that individual has developed and is currently
living. Case con-
ceptualization is the process by which counselors come to this
understanding,
by eliciting and organizing information, developing and testing
hypotheses,
and working collaboratively with the client toward an integrated
concept of
the client’s life. Case conceptualization is a core competency
for counselors
and considered as integral to counseling effectiveness (Betan &
Binder, 2010;
Sperry, 2010).
Case conceptualization includes diagnosis, but this is only the
beginning
of the process. Once the client’s presenting problem and

12. symptoms are known,
the counselor and client together begin to explore the etiology
and construct
a framework that allows them both to understand the nature of
the symptoms
and what is maintaining them. Case conceptualization gives the
counselor
a blueprint for how to interact with, listen to, and ultimately
help the client
(Seligman, 2004). Neukrug and Schwitzer (2006) define case
conceptualiza-
tion as a tool that helps the counselor observe, understand, and
integrate a
client’s behaviors, emotions, and thinking. When a thorough
case conceptu-
alization is constructed, the counselor can better understand
both the client’s
needs and their strengths and support systems. Thus,
interventions are likely to
Lynn Zubernis, Department o f Counselor Education, West
Chester University o f Pennsylvania; Matthew
Snyder, Department o f Counselor Education, West Chester
University o f Pennsylvania; Cheryl Neale-
McFall, Department o f Counselor Education, West Chester
University o f Pennsylvania.
Correspondence concerning this article should be addressed to
Lynn Zubernis, Department o f Counselor
Education, West Chester University, 1160 McDermott Drive,
Suite 102, West Chester, PA 19383.
E-mail: [email protected]
0 Jojrnal of Mental Health Counseling 181
mailto:[email protected]

13. be more appropriate and effective, which is a benefit in today’s
managed care
climate, with its focus on timeliness and efficacy.
The case conceptualization developed by a counselor
subsequently
impacts the way in which the counseling relationship proceeds.
The concep-
tualization guides the counselor’s choice of theoretical
perspective, suggests
which questions need to be asked, and frames interpretation of
the client’s
answers. By employing an organized model of case
conceptualization, the
counselor can more easily see clearly where the client has been,
where they
are now, and where it is possible for them to go.
Case conceptualization includes assessment and evaluation —
observing
current symptoms and assessing the context within which those
symptoms
developed. The process also includes gathering background
information —
family history, relationships, identity, culture, sexual
orientation, educational
background, past trauma, and a plethora of other variables that
together create
the context of the client’s life. Background information includes
not only data
on the challenges facing the client, but also the strengths,
coping skills, and
support systems that have enabled them to be in the counselor’s
office and will
inform treatment interventions. In addition, the client’s
readiness for change

14. must be assessed, as this impacts the ways in which the
counselor can most
effectively encounter the client. Finally, the precipitating
factors that brought
the client to treatment are part of the evaluation phase.
Once the information is gathered, the organizational phase of
case con-
ceptualization begins. Case conceptualization is far from a
passive process; the
counselor actively organizes data and observations in order to
make inferences
and identify themes and patterns. Once the client’s core issues
become clear,
the counselor can develop hypotheses about the etiology and
maintenance of
the presenting problem and begin to set goals for change along
with the client.
The amount of information a client may divulge can seem
overwhelming for
the counselor who is hearing it; an articulated model of case
conceptualization
helps the counselor organize and make sense of this information
and deter-
mine which is relevant and which may not be. This helps the
counselor focus
subsequent sessions, again enabling effective and timely
treatment outcomes.
During the organizational phase, the counselor begins to piece
together
an explanatory framework for the client’s issues, creating a
“map” of the client’s
life story, which can then guide treatment decisions. This
framework is based
on culture and environment as well as on internal personality

15. constructs (IPCs)
and physiological factors. The counselor’s understanding of hew
the client’s
problems developed and what is sustaining them is also
informed by the theo-
retical perspective adopted. As the case conceptualization
process unfolds, the
counselor selects and draws from relevant theories of change,
which also guides
hypotheses and intervention possibilities. Research has not
demonstrated the
relative efficacy of any one theoretical model; rather, case
conceptualization
allows the counselor to choose the theoretical approach that fits
their emerging
understanding of the client’s issues.
182 0 Journal of Mental Health Counseling
Case Conceptualization
CASE CONCEPTUALIZATION USING THE
TEMPORAL/CONTEXTUAL MODEL
The importance of case conceptualization is well recognized by
counsel-
ors. However, the process is often not explicitly taught in
training programs.
In addition, many models of case conceptualization are specific
to a particular
theoretical orientation, limiting their usefulness. The
temporal/contextual
model (T/C model; Zubernis & Snyder, 2015), in contrast, is a
holistic and

16. atheoretical model that can be used with a wide variety of
clients and pre-
senting problems. A visual flowchart and worksheet demystify
the process and
make the model well suited for collaborative work with clients.
The model’s
developmental approach encourages an accurate reflection of
the complexity
of the client’s experience, while helping the counselor identify
specific targets
for change.
The T/C model provides a framework for gathering information
and
making sense of the client’s often complex history; assessing a
wide range of
internal and external influences; and explicitly reminding
counselors to gather
information on strengths, resources, coping skills, and supports.
This emphasis
on strengths is particularly important when working with clients
with long-
standing issues who may feel hopeless and helpless after years
of struggle.
Finally, the model includes a timeline, which allows a focus on
past experi-
ences and future goals and reminds the counselor of the
importance of the
here-and-now experience. While the incorporation of a timeline
is not unique
to the T/C model (see Bronfenbrenner’s [1981] chronosysrem,
for example),
the inclusion of the timeline in the graphic model encourages
the counselor to
“go backwards” if needed and always to keep the client’s
imagined future in mind.

17. THE TEMPORAL/CONTEXTUAL MODEL
The Triangle
In the T/C model, a triangle represents the three major elements
of human
experience and expression: behavior, cognition, and affect
(Greenberger &
Padesky, 1995). The triangle can be viewed as the client’s
experienced world,
both psychological and physiological. The client’s personality
is part of the
triangle, including the IPCs that form the client’s values,
beliefs, self-concept,
worldview, attachment style, sense of self-efficacy, and self-
esteem (see Figure
1). IPCs influence how the client perceives their environment
and how well
they cope, which connects to the client’s readiness for change
(Prochaska &
DiClemente, 1982, 1986).
Behavior, cognition, and affect are the points of the triangle and
also
connect to the client’s external world. Behavior is what clients
do, including
eating, sleeping, and level of activity, and the counselor’s
observations of the
client during a session. Cognition includes the client’s beliefs
about self and
others, the way in which the client perceives and interprets
information, their
attachment status, and the customary ways in which they relate
to others.
These beliefs and interaction patterns are developed over time

18. through inter-
$ Journal o f Mental Health Counseling 183
TEMPORAL CONTEXTUAL ( T/C ) MODEL OF CASE
CONCEPTUALIZATION
Internal Personality
Characteristics
• ATTITUDES
• VALUES
• BELIEFS
• SELF-ESTEEM
• SELF-EFFICACY
• ATTACHMENT
STYLE
COGNITION
CLIENTS INTERNAL
WORLD
'S MIMOMOI OC,
►I PCs
Biology
Physiology
COPING'

19. SKILLS AND
.STRENGTHS
READINESS
FOR |
CHANCE
CLIENT'S OUTSIDE
WORLD /
ENVIRONMENT:
• CULTURE
• RELATIONSHIPS
• SOCIETAL INFLUENCES
• COUNSELING
RELATIONSHIP
CLIENT’S INTERACTION WITH
THE OUTSIDE WORLD
Past <— - Present Future
F igure I . Th e te m p o ra l/c o n te x tu a l m odel o f case
co n cep tu a liza tion . F rom Case Conceptualization and
Effective Interventions: Assessing and Treating Mental,
Emotional, and Behavioral Disorders,
by L. Z u be rn is and M . Snyder, 2015, Thousand O aks, C A :
SAGE (p . 55). C o p y r ig h t 2016 by
SAGE P ublica tions, Inc. R ep rin ted w ith perm iss ion .
action with the outside world. Affect includes the client’s
emotional awareness,
expression, and regulation. All three have a reciprocal influence

20. that is clearly
seen in the model. The client’s beliefs and emotions impact
their behavior, and
their emotions are tied to thoughts and experience. The client’s
perceptions
of biological and environmental experience influence the
client’s thinking
(Bronfenbrenner, 1981). The T/C model allows counselors to be
effective by
illustrating the interrelationships between these constructs,
which helps the
counselor understand and thus empathize with clients.
The components of physiology and biology include clients’
strengths, vul-
nerabilities, physical health, genetic predispositions,
temperament, reactions to
stress, biochemical differences in neurotransmitter function, and
other brain
chemistry factors. Once again, these factors have reciprocal
influence. Genetic
and physiological factors impact the client’s thoughts,
emotions, and behavior,
the points of the triangle. For example, the client’s beliefs,
which have devel-
oped from the interaction of personality, biology, and
experience (environ-
ment), create hot thoughts that are directly connected to affect
(Beck, 2011).
A hot thought is a thought that causes an emotional reaction,
usually based on
both the current environmental stimulus and the individual’s
attitudes, values,
and beliefs regarding the meaning of that stimulus.
184 (ji Journal o f Mental Health Counseling

21. Case Conceptualization
The Inner Circle
The inner circle represents the boundary between the client’s
internal
and external worlds; the client interacts with the environment,
and the environ-
ment is in turn impacted by the client (Bronfenbrenner, 1981).
Both somatic
symptoms and psychological symptoms are included, along with
the client’s
coping skills, strengths, and readiness for change (Prochaska •&
DiClemente,
1982, 1986).
The client’s life roles represent another important factor within
the inner
circle. All of us play many roles throughout our lives —for
example, mother,
daughter, sister, coworker, physician, friend. Each role that we
play influences
our behavior and self-concept (Clark, 2000). Life roles are
influenced by the
values and beliefs the client has learned, and the roles taken on
in turn impact
the way the client responds to environmental events. The
client’s negotiation
of multiple and sometimes conflicting roles has an impact on
identity develop-
ment, self-esteem, and stress level.
The Outer Circle

22. Environmental influences that impact the client (and are in turn
impacted by the client) are included on the outer circle. These
include inter-
personal relationships (whether family, oeer, romantic, or
client/counselor),
cultural norms and values, and socioeconomic status
(Bronfenbrenner, 1981;
Clark, 2000). There is again an interrelationship between
constructs; factors in
the client's environment have an effect on the client’s
developing IPCs at each
stage of development (Greenberger & Padesky, 1995). Stressors
in the external
environment are often what trigger a client to ask for help,
combined with
preexisting vulnerabilities, which together exceed the client’s
coping skills, cre-
ating symptoms. Thus, symptomatology is located at the
intersection between
person and environment.
The Timeline
The timeline is used in several ways during case
conceptualization. For
example, there are times when a consideration of past events is
warranted.
Relationships and events that happened in the past shape IPCs;
we all learn
irrational beliefs and maladaptive behaviors as we develop. The
model helps
client and counselor explore early experiences to gain insight
into which pat-
terns of thinking are distorted and which are healthy. It serves
as a reminder

23. that events that happened in the past can he interpreted
differently in the
present. The timeline also allows an examination of the client’s
identity across
time and is a reminder to set goals for the future, which will
contribute to the
client’s motivation for change.
APPLICATION OF THE TEMPORAL/CONTEXTUAL MODEL
One of the strengths of the T/C model is its emphasis on client
thoughts,
feelings, and behavior as embedded in cultural contexts. This
makes the model
particularly useful in treating complex disorders such as eating
disorders. In the
$ Journal o f Mental Health Counseling 185
next section, we briefly review the research on eating disorders,
focusing on the
complex etiology and symptom variability that make case
conceptualization
and effective treatment challenging. Finally, we demonstrate the
utilization
of the T/C model in helping counselors understand and treat
eating disorders
more effectively.
Eating Disorders
According to the National Eating Disorders Association, one-
third of the
30 million Americans who develop an eating disorder will be

24. men (as cited in
Birli, Zhang & McCoy, 2012). In addition, research shows that
43% of men
are dissatisfied with their bodies. Concerns may focus on
bulking up as well as
being thin, and men may be reluctant to seek help due to shame
(Birli et al.,
2012).
Eating disorders also cut across age groups. A recent study in
the
International Journal of Eating Disorders reported that 13% of
women over 50
had some disordered eating characteristics (Shallcross, 2013).
Mid-life stresses
including physiological changes, environmental transitions such
as children
launching, stressors related to caring for aging parents, and loss
from death or
divorce may trigger the disorder. Eating disorders can be
especially dangerous
for older women, because their health may be more fragile.
Research also shows that the rates of eating disorders do not
differ between
white women and women of color, though minority clients may
be under-
diagnosed (Shallcross, 2013). Therefore, when working with
minority clients,
the impact of prejudice, racism, acculturation, and body
concerns specific to
each cultural group should be considered, as these may have an
effect on body
and self-image. The comprehensive nature of the T/C model,
showcasing an
emphasis on cultural influences and societal roles, is helpful in

25. reminding
counselors to take all of these considerations into account.
Eating disorders also have a complex etiology, which
encompasses
multiple influences; thus, a comprehensive way of organizing
and making
sense of information, as with the T/C model, is particularly
useful (American
Psychiatric Association [APA], 2013). Environmental pressure
related to body
image and appearance is a key risk factor, as well as holding
unrealistic ideals
of thinness from an early age. In a recent study, 40% to 60% of
girls ages 6 to
12 expressed concern about their weight or about becoming
overweight (Cash
& Smolak, 2011). Environmental stressors are not, however, the
entire story.
More recently, genetics and biology have been found to play a
larger role in
the development of eating disorders than originally considered
(Collier &
Treasure, 2004). Eating disorders cannot be traced back to one
single causal
factor, but rather they develop when both internal and external
environmental
influences combine, including genetic vulnerabilities, family
standards, cul-
tural pressures, and stressful life events (Birmingham, 2015).
For example, losses such as death or divorce or a traumatic
event can
lead to a sense of loss of control, which motivates individuals to
attempt to
regain control through restricted eating. Transitions such as

26. reaching puberty,
186 <f! Journal of Mental Health Counseling
Cose Conceptualization
pursuing autonomy, leaving home, or having children leave
home are also
risk factors for developing an eating disorder (Fairburn &
Harrison, 2003).
Therefore, it is critical that an assessment of risk factors
include both envi-
ronmental and interpersonal factors. This could include
information about
the client’s family of origin, since people learn values and
norms regarding
appearance and benavior within the family. Certain personality
traits are also
risk factors, including perfectionism, high need for approval,
and obsessive
traits (APA, 2013).
Case Conceptualization for Eating Disorders Using the
Temporal/
Contextual Model
The multifaceted etiology and complex symptomatology of
eating disor-
ders make thorough assessment and comprehensive case
conceptualization
critical. Complicating the assessment process is the fact that
clients are often
ashamed about their disordered eating and therefore may come
to counseling

27. with presenting problems that focus on other issues. The
organized, compre-
hensive nature of the T/C model, which emphasizes a wide
range of both
internal and external influences, makes a thorough assessment
more likely as
well as more time efficient.
For example, because most treatment approaches consider
eating disorder
behaviors as a coping strategy for dealing with overwhelming
emotion or loss
of control, the case conceptualization should include the client’s
ability for
emotional regulation and stress management. Cognitive factors
include per-
fectionism, low self-esteem and self-efficacy, obsessive
thoughts, a strong sense
of shame, and distorted beliefs and perceptions. A thorough
understanding of
the behaviors surrounding the client’s eating disorder is also
necessary, as is
an assessment of findings from a medical exam, current
physiological symp-
toms, and weight, as eating disorders can have serious physical
consequences.
Utilizing a comprehensive, organized case conceptualization
such as the T/C
model prompts assessment of all these domains. Once the case
conceptualiza-
tion is complete, it also provides a road map to enable effective
intervention.
Treatment interventions for eating disorders are often
multidisciplinary in
approach, involving additional health care professionals in a
treatment team;

28. the comprehensive information included in the case
conceptualization can
be utilized by a team to improve treatment efficacy (Costin,
2006; Grilo &
Mitchell, 2010).
The T/C model includes information about the specific targets
for inter-
vention recommended during treatment. When a client with
anorexia nervosa
(AN) is medically stable, for example, counseling interventions
can focus on
the client’s experience of their illness, distorted thoughts, body
image issues,
emotional regulation, and coping skills, which have been
assessed with the T/C
model. Many interventions for AN challenge irrational beliefs
(encompassed
in the T/C model as IPCs) in an attempt to modify the distorted
thoughts that
trigger restrictive and controlling behaviors. If the individual
can change the
0 Journal o f Mental Health Counseling 187
way they see themselves, then the motivation for these
behaviors will diminish
(National Institute for Clinical Excellence, 2004; Petrucelli,
2004).
The T/C model illustrates how both past events and present
environmen-
tal cues impact the disorder. Because issues related to body
image, self-efficacy,

29. and self-esteem may be connected to early childhood
experiences, the T/C
model’s timeline reminds the counselor to explore the past, as
well as to take a
here-and-now focus on the current goal of helping the
individual gain insight
into how their beliefs and values are affecting their behavior
and health.
The Intersection of Case Conceptualization, Theory, and
Intervention
One of the strengths of the T/C model is its ability to be used in
conjunc-
tion with multiple theoretical approaches. For example,
cognitive behavioral
therapy (CBT) interventions that focus on a client’s irrational
beliefs, negative
self-image and worldview, and associated maladaptive
behaviors are often used
to treat eating disorders (Hsu, 1990; Murphy, Straebler, Cooper,
& Fairburn,
2010; Waller et ah, 2007; Wilson, Grilo, & Vitousek, 2007).
The use of the
T/C model facilitates thorough assessment of the client’s
thoughts and think-
ing patterns and the origin of these thoughts. A newer variant,
enhanced CBT
(CBT-E; Fursland et ah, 2012), is a collaborative modality that
helps the client
recognize their own cognitions and behaviors (Fairburn, 2008;
Poulsen et ah,
2014). The T/C model is an effective tool for collaborative
methods such as
CBT-E, intentionally organized and visually presented so that
counselors can

30. share the model with clients to increase understanding and
motivation.
Family therapy interventions are also used for treatment of AN,
espe-
cially for adolescents or young adults who are still living at
home (Hay, 2013).
Family therapy focuses on the family system, exploring the
client’s position
in the family and the role the client’s disorder maintains in the
family system
(Lock, Couturier, & Agras, 2006; Lock & Le Grange, 2013).
The T/C model’s
emphasis on relational roles as well as family norms and beliefs
creates a solid
foundation for these interventions. The client and family can
also utilize the
visual depiction of the model as a way of recognizing the roles
they are playing
in sustaining the client’s problem behaviors.
From a psychodynamic perspective, internal psychological
conflict and
problematic family dynamics are the underlying cause of eating
disorders. For
example, insecure attachment may lead to ambivalence about
independence,
which can then contribute to eating disorders (Milan & Acker,
2014; Tasca
& Balfour, 2014; Thompson-Brenner, 2014). If the client’s
internal struggles
are identified and processed, the need for the symptom is
reduced (Gilbert &
Miles, 2014). Treatment focuses on assisting the client in
understanding the
impact of past experiences on present symptoms and how

31. disordered eating
functions as a coping mechanism, both of which are facilitated
by the T/C
model (Haase et ah, 2008; Leichsenring & Klein, 2014).
Interpersonal therapy has also been effective by focusing on
improving
the client’s interpersonal relationships instead of focusing
directly on eating
behaviors. Once relationships are strengthened, emotional needs
can be met
188 0 Journal o f Mental Health Counseling
Case Conceptualization
through those relationships instead of through disordered eating
(Murphy,
Straehler, Basden, Cooper, & Fairburn, 2012). The T/C model
facilitates this
work with an exploration of the client’s relationships, both past
and present,
including the client/counselor relationship. Motivational
interviewing (MI) is
also used with clients in the early stages of AN who may be
ambivalent about
change (Price-Evans & Treasure, 2011; Treasure & Schmidt,
2008). The use
of the T/C model specifically assesses the client’s stage of
change, helping the
counselor to be more effective in determining when an MI
approach might be
helpful.

32. Recently, mindfulness-based interventions have also shown
some efficacy
in treating behaviors such as binge eating (O’Reilly, Cook,
Spruijt-Metz, &
Black, 2014). These approaches incorporate awareness of
physiological cues,
which are assessed with the T/C model. Finally, feminist models
emphasize
a systemic basis for eating disorders, from resistance to a
culture that does not
support female development and maturity (Steiner-Adair, 1991).
An eating dis-
order may be a way for women and girls to be heard and noticed
in a culture
that does not routinely hear them (Wastell, 1996). The T/C
model's assessment
of contextual, familial, and cultural factors provides a thorough
understanding
of these contributing factors.
The following section introduces a client named Jessica and
utilizes the
T/C model to develop a case conceptualization, which will
guide subsequent
treatment.
THE CASE OF JESSICA
Jessica is a freshman in college. She came to the counseling
center
because she became concerned about episodes of purging
behavior. Jessica says
she started binge eating in high school around the time of her
parents’ divorce
and a breakup with her boyfriend. Jessica is doing well
academically and is very

33. achievement oriented; however, she reports feelings of anxiety
and depression
and says she never feels “good enough for anyone.”
Jessica attended a single-sex private high school, which placed
a great deal
of emphasis on appearance and achievement. She was successful
there both
athletically and academically and was considered popular and
good-looking.
However, Jessica did not feel good about herself and felt a
strong sense of
shame and embarrassment about her parents’ alcohol-fueled
screaming fights,
some of which spilled out onto the lawn of her otherwise
pristine, quiet neigh-
borhood. Her parents eventually divorced, but Jessica’s
externally perfect image
is in part a defense against this deeply held shame. After the
divorce, Jessica
became a surrogate parent for her younger sister, whom she had
always tried to
protect from their parents’ fights.
Jessica finds her feelings for her parents confusing and
upsetting. When
they’re sober, they are warm and loving, but when they drink,
they are angry
and verbally abusive. Jessica grew up being hypervigilant,
constantly worrying
that her household would erupt in rage and violence.
Journal of Mental Health Counseling 189

34. She started binge eating after her high school boyfriend broke
up with
her to date a friend of hers, right around the time of her parents’
divorce. She
also tried to be there for her boyfriend and take care of him, but
felt that her
boyfriend saw too much of her “true self’ and that “it was too
much for him.”
She was especially worried about her litde sister’s emotional
well-being during
that time.
Jessica tends to engage in binge eating when she is
overwhelmed by strong
emotions. She describes her eating as being out of control and
expresses shame
over her lack of control. Jessica also talks about being hopeless.
“I’m just like
my parents. Nobody will ever stay with me. They’ll leave, just
like my boyfriend
did.”
The college environment, which does not have a strict schedule
like
Jessica had in high school, has resulted in an increase in
Jessica's binge eating.
She kept busy with sports practice and studying in high school,
and having so
much unscheduled free time makes her anxious. Jessica says she
has gained
“a few pounds,” and consequently, she has begun purging after
eating. This
worried her enough that she made an appointment at the
counseling center.
TEMPORAL/CONTEXTUAL MODEL CASE

35. CONCEPTUALIZATION
The initial case conceptualization for Jessica follows. An
asterisk (*)
denotes areas that require more information and exploration.
Presenting Problem: Disordered eating, anxiety, depression,
relationship
conflict
Internal Personality Constructs and Behavior:
• Self-Efficacy: Low, perfectionistic tendencies, lack of
awareness of past
successes
• Self-Esteem: Low, negatively impacted by sense of shame
regarding
parents’ rages and perceived inability to “control” her binge
eating
behaviors
• Attitudes/Values/Beliefs: Exaggerated importance of
appearance;
achievement oriented; high valuation on what others think and
how
perceived by others
• Attachment Style: Possibility of insecure attachment
Biology/Physiology/Heredity: College-age young adult; female;
family history
of substance use and difficulties with emotional regulation;
mecical history*
Affect: Depressed, anxious, difficulty with emotional regulation
Cognition: Perfectionistic thinking; she must take care of
others; she is emo-
tionally overwhelming to others. Hot Thoughts: “I have to do

36. everything right”;
“If people truly knew who I was, they wouldn’t love me”;
“Nobody will ever
stay with me.”
Behavior: Binge eating; restricted eating; hypervigilance;
perfectionism
Symptomatology: Binge eating; restricting; weight gain;
emotional dysregula-
tion
190 V Journal o f Mental Health Counseling
Case Conceptualization
Coping Skills and Strengths: Academic success; athletic ability;
intelligence;
sought treatment
Readiness for Change: Entering action stage/aware of need for
change and
motivated
Life Roles: Caretaker for sister, ex-boyfriend; Adult Child of
Alcoholics; stu-
dent; athlete
Environment:
• Relationships: Conflict with father/mother; protective cf
younger sister;
breakup with boyfriend; past relationship history*
• Culture: Family background;* parents economically
successful; high
socioeconomic status; single-sex school
• Family Norms and Values: high parental expectations;

37. academic and
athletic success highly valued; appearance highly valued
• Religious or Spiritual Beliefs:*
Timeline:
• Past Influences: Parental pressures, parents’ alcoholism;
parents’ divorce;
breakup
• Present Influences: Escalating binge eating and restricting
behavior: aca-
demic motivation; transition to college; concern about younger
sister
• Future Goals: Healthier eating; college graduation; romantic
relation-
ship;* career goals*
With the initial case conceptualization in place, the next step is
to think
about what other information is needed before counseling can
move forward.
The counselor fills in missing information and develops a
hypothesis about the
presenting problem. In the case of Jessica, the case
conceptualization highlights
areas of possible intervention. For examp.e, because there are a
number of dys-
functional thoughts and beliefs associated with Jessica’s
disordered eating, as
well as problematic behaviors, a cognitive behavioral approach
might be most
effective. Jessica’s interpersonal difficulties seem to stem from
growing up in a

38. family struggling with alcoholism and have led her to develop
certain beliefs
about her life roles, which need to be explored and challenged
as well. At the
same time, Jessica’s strengths and resources are clear in the
formulation and
can be used to challenge her current depression and irrational
thoughts and
create motivation and optimism for a brighter future. As
treatment proceeds,
the counselor will add to the case conceptualization, further
refining his or her
understanding of Jessica and developing intervention strategies
accordingly.
CONCLUSION
Case conceptualization is the cornerstone to counselors’ ability
to under-
stand a client’s lived experience and the key to effective
treatment. Clients
with complex conditions such as eating disorders can present a
challenge for
$ Journal o f Mental Health Counseling 191
counselors. A thorough understanding of internal and
environmental factors
contributing to the development and maintenance of such
disorders is critical
for gaining an understanding of the client’s problems. The T/C
model provides
a powerful tool for developing such an understanding, allowing
for the com-

39. plexity of symptoms while streamlining the assessment process.
By utilizing the
model, the counselor is not overwhelmed by information, and
the client feels
both heard and understood. Thus, use of the model also
contributes to a strong
therapeutic alliance, as the counselor helps the client begin to
recover.
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