Notes:
- Melinda is 34 years old.
- She has been drinking heavily since she was 28 after a traumatic break up of a long term relationship.
- Melinda finds drinking relaxes her in social situations and reduces her feelings of anxiety and worthlessness. Drinking also helps her forget how lonely she’s been feeling.
- Over this period Melinda has become increasingly socially and emotionally withdrawn to the concern of her close friends.
- Melinda’s drinking and depressed mood have worsened and she reports increasingly feeling like an idiot in many social situations.
- Her early childhood experiences included neglect from an emotionally cold and very strict father that has led to strong beliefs about her being worthless and that it’s not safe to open up to anyone as she believes this will always result in pain.
- Melinda can see the connection between her increased drinking and feelings of depression and how both are maintained.
- Presenting problem: Drinking heavily, feelings of depression and anxiety, becoming increasingly withdrawn.
- Pattern and onset: Past 6 years drinking has increased from social situations to managing feelings of anxiety and worthlessness.
- Predisposing factors: Feelings of neglect by emotionally cold father.
- Precipitating factors: Traumatic ending of long term relationship.
- Perpetuating factors: Increasingly debilitating feelings of depression and anxiety in social situations.
- Protective factors: Close friends; has had periods of feeling well and managing social situations in the past without alcohol use.
- Prognosis: Melinda recognises the connection between her alcohol use and her feelings of depression and anxiety.
Melinda is a 34 year old single woman. Her early childhood experiences included neglect from an emotionally cold and very strict father. This has led to strong beliefs about herself that she is worthless and that it is better not to open up emotionally to anyone because the likely outcome is emotional pain. After she experienced a a traumatic break-up of a long-term relationship in her early 20s, her negative beliefs were activated and began more strongly influencing how she interpreted situations. These beliefs gave rise to other problems including relationship difficulties, social and emotional withdrawal, which have led to feelings of depression and have, in turn, reinforced her negative beliefs. Melinda started drinking because it helped her relax in social situations by managing her feelings of worthlessness, and helped her to forget her loneliness. However, this has led to further problems and exacerbated her depressed mood, anxiety in social situations and the need for alcohol to cope. As a result, Melinda's drinking and depressed mood have continued to worsen. She reports multiple active cognitive distortions mainly centred on feeling like 'an idiot' especially in social situations. Melinda recognises that her drinking is exacerbating her depressed mood and that her feelings of depression are maintaining her drinking.
