I would ask several cognitive questions to discover the root of Maria's automatic thoughts.
This will enable me to know what makes her have that feeling of failure, and from there I will be able to know how to frame my questions.
Another approach to Maria's automatic thoughts is by CBT thought records. In this approach, I will help Maria break down her problem into thoughts, feelings, and actions. This will be accomplished in the following procedural questions;
1. At what instance does the thought of you being a failure occur?
2. What comes to your mind at that time?
3. What are your emotions and how intense are they (on a scale of 0 to 100) at that point?
What cognitive distortion did you have? In short, what were negative thoughts at that time?
After gathering the information, I would use it to change Marias thought by devising a new thought. This will only be by looking at the situation in another perspective. For instance, when the thought comes find a way to distract yourself and relax your muscles. Again you have a counter thought that your parents wanted you to have an education and you did. So they would be very proud of you Maria.
Maria should practice this routine on a daily basis and I would look at the progress during our sessions.
1. Feeling hopeless, responsible and worthless- thoughts;
i) my mother and father sacrificed everything so that I can have a decent education and now they are gone I have nothing to show for it.
ii) my father died because of stress caused by me failing to date a decent Mexican guy. He pictured me as a failure.
iii) If my mother did not have to work for me, she would have saved her money and had her medical check-up and probably be alive right now.
iv) God has seen my doings and is punishing me, so I accept.
Core beliefs: I should be having a good job because I am educated, God is angry at me, the society does not love me.
Activating situations: Loss of job, the death of parents, break-up with American boyfriend, Connor.
Assumptions: I deserve what I am getting since I never listened to my father.
Strengths and Assets: Willingness to see a therapist and need to change.
Maria's core beliefs include can be categorized into;
Worthless core beliefs: I am worthless, I am a disappointment.
Helpless core beliefs: I could have saved my mother, I led to my fathers death.
One of Maria's negative opinion is that she is a disappointment to her parents.
Modifying the belief: I would modify this belief by Socratic questioning. I would ask Maria why she thinks she is a disappointment, what if she had done the course she wanted, would her parents be happy if they were alive? Looking at her situation from another perspective, what would she tell someone else in her situation to encourage him/her?
Maria should first know that God does not rejoice in the pain of His people and thus doesnt punish. Moreover, I would help Maria restructure her old memories. For instance, they moved to the USA simply because her parents wanted her to have a different background while growing; her father died a happy man and proud of her because she had a degree, cancer is a disease that you can only control, and her mother would eventually die and leave her. Nevertheless, I would help her come up with a counter automatic thought when she feels depressed about being a disappointment like you have an education, and thats all your parents wanted.
Why do you think you are a failure? Are you a failure? What do you think is a big cause of your failure? At what times do you feel that you are a failure? How would you feel if you did the course of your liking? And would your parents be happy for you? Why do you think they would be happy for you?
I would provide Maria with few Socratic questions and teach her Socratic questioning techniques. When she has been able to do it under my guidance, I will give her the rest of the questions. Moreover, I would select the questions that are based on her thought of being a failure and guide her as she undertakes them by helping her where she is not successful and waiting for her improvement on our next session.
If some of Marias beliefs were true, I would create strife on solving the problem even if its to some degree. Again I would investigate the validity of her belief to the situation she is in and the conclusion that she has drawn so far. Lastly, I would encourage her to accept the outcomes and focus on the future.
Maria feels guilty because of the life that her parents had led. She thinks she is responsible for her parents deaths and putting her mother in danger as she went to work. First I would teach her how to use thought record to evaluate her thoughts. I would encourage Maria to engage in the problem-solving process i.e. Socratic questioning. Moreover, I would encourage her to employ relaxation techniques and distractions when the automatic thought occurs.
List of Problems
Feeling guilty and responsible
- My father died because of my neglect of Mexican roots.
- My mothers death was preventable)
(emotions and behavior
- Grief and hopelessness)
Feeling like a failure and rejected
- I am not acceptable and lovable.
- I dont have a job, and yet my parents struggled for me to be educated)
(emotions and behavior
-sad; I am a reject)
- My father would be happy if I had not dated Connor and he would probably be around.
- If my mother did not have to work for my well-being, she would still be around.
- God is punishing me, and I deserve it.
-Death of father
-Rejection by Connors family
-Loss of job
Marias core beliefs in their categories are:
- Worthless core beliefs: I am not lovable, I am a disappointment, I am being punished, and I deserve it.
- Helpless core beliefs: I could have saved my mother, I led to my fathers death.
Maria believes that she is a disappointment even to her absent parents. This is a negative thought since her parents only wanted her to have a decent education of which she already has. Therefore, she is not a disappointment because she does not have a job. To modify this belief, I would have to ask Maria how much does she believe this belief to be true (scale of 0 to 100), then why she thinks it true and what would be the case if she used the degree she acquired to have a better job? I would also encourage her to write notes during our thought so as to be revisiting the beliefs that she has already examined.
Developing a new core belief for Maria. This would only be possible by restructuring Marias old beliefs and in their place putting something positive.
You are not a failure just because you are educated and your parents wouldnt be disappointed because of that. They educated you. That was their part, and now you have to do your part to look for a job. Again, it is not guaranteed you have the same life as other people at your age. Everybodys blessings are at different times because God doesnt punish you. Instead, He wants you to work hard and look for a job.
I would encourage Maria to revisit this belief every morning when she wakes up.
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