Case Clinic

Purpose

The Case Clinic is a structured peer-coaching format from Otto Scharmer's deep-sensing change process. A case giver presents a real challenge to a small group of peers who listen deeply, reflect back what they sense, and offer images and perspectives — not advice. The process accesses collective intelligence through empathic listening rather than problem-solving.

At a glance

How to run

1. Intention (3 min). One minute of silence. Each person connects to their intention for this session.
2. Case presentation (10 min). The case giver shares the challenge: the situation, the question they are sitting with, and where they feel stuck. No interruptions.
3. Clarifying questions (5 min). Coaches ask brief, genuine questions to understand — not to steer or advise.
4. Stillness (2 min). Silence. Coaches let go of analytical thinking and listen to what arises within them.
5. Mirroring (10 min). Each coach shares: "What I noticed..." "The image that came to me..." "What I felt in my body when you spoke about..." This is sensing, not advising.
6. Generative dialogue (15 min). Open conversation among coaches in the presence of the case giver. They speak to and build on each other's reflections. Case giver listens.
7. Case giver reflects (10 min). The case giver shares what resonated, what shifted, and what they will take forward.
8. Closing (5 min). Each person shares one word capturing the session. Appreciation.

Materials needed

• Chairs in a circle (no tables)
• Timer
• Optional: journal for each participant
• Bell or singing bowl for transitions

Pitfalls & common mistakes

• Coaches giving advice. The hardest discipline. Redirect: "Share what you sense, not what you think they should do."
• Case giver not being vulnerable enough. Surface-level cases produce surface-level insights. Encourage the case giver to share the real stuckness.
• Skipping silence. The stillness phase is where the shift from analytical to generative listening happens.
• Too many coaches. More than 5 coaches dilutes depth. Keep it intimate.

Inclusion & accessibility

• The format naturally equalizes power — everyone listens and speaks in turn.
• Offer the option to share reflections in writing if speaking feels too exposed.
• Be mindful that vulnerability levels vary across cultures — frame the exercise with care.
• Ensure the room is quiet and free from interruptions to support deep listening.

Variations

• Virtual Case Clinic: Use video with cameras on, muted during listening phases, unmuted in sequence.
• Extended Case Clinic: Add a follow-up session 2–4 weeks later to hear what the case giver did.
• Trio Case Clinic: Stripped-down version with 1 case giver and 2 coaches, 30 minutes total.

When NOT to use this

• When the case giver wants concrete expert advice on a technical problem.
• When trust in the group is too low for vulnerability.
• When time is extremely limited — rushing a Case Clinic destroys its value.

Source & further reading

• Scharmer, C. O. (2016). *Theory U: Leading from the Future as It Emerges*. 2nd ed. Berrett-Koehler.
• Presencing Institute. Case Clinic Tool. https://www.presencing.org/resource/tools/case-clinic-desc
• Hayashi, A. (2021). *Social Presencing Theater: The Art of Making a True Move*. PI Press.