Cognitive Behavior Therapy: Carol Case

CAROL CASE STUDY:
Im to blame for all the problems in my family
As the oldest of three children, Carol (who is 29) berates herself for her familys tension and dissension. Her father is depressed most of the time (which Carol feels responsible for); her mother feels overburdened and ineffectual (Carol feels she contributes to this); and both her sisters are doing poorly in school and having other personal problems (Carol also assumes responsibility for this). Somehow she is convinced that if she were different and did what she should do, most of these problems would greatly diminish. Assume, as you listen to her, that you hear her saying some of the following things:

My father looks to me to be the strong one in the family. I must be strong if Im to gain his approval, which I feel I must have.

Since my mother is overworked, I should take on more of the responsibility for taking care of my younger sisters. I ought to be able to talk with them and help them with their problems.

My sisters both expect me to do their chores for them, to help them at school, and to live up to the image they have of me. I ought to meet their ideals, and it would be absolutely horrible of me to fail in this regard. Then if they grow up with problems, Ill have only myself to blame for the rest of my life.

1. One of the things a rational emotive behavior therapist would do is teach Carol that her thinking and her evaluation of events are causing her problems (feelings of inadequacy, anxiety, and insecurity). What do you hear her saying to herself that is irrational?

2. Discuss in greater length which of the above techniques you would expect to rely on the most. What might you expect to occur through the use of these procedures? What outcomes would you hope for?

3. Assume that Carol holds steadfastly to her beliefs and tries to convince you that they are not irrational? For example, she tells you: I just know that if I were more adequate as a daughter, my father wouldnt be depressed.
Its because Ive let him down so that he feels useless as a father. How would you respond?

4. If Carol seems to hang on to the idea that she must have the approval of her father in order to feel adequate as a person, what direction might you take?

5. What value do you see in asking Carol to do a written REBT Self-Help Form?

6. Apply the technique of rational-emotive imagery in Carols case. How would you help her imagine herself thinking, feeling, and behaving in the way she would ideally like to?

Please answer each question separately.