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 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 with life. 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.

What I think is happening, Melinda, is when you were young, not having your dad pay you much attention made you feel unloved and you've carried this feeling with you into adult life. It's also made you wary of opening up to anyone in case you get hurt. Wind forward to your break-up, and all these beliefs that are, in a sense, unconscious, are triggered. You've had some thoughts like 'no-one will love me' and 'I'm a loser' that you told me about and probably a lot more negative thoughts that you aren't always aware of. Is this sounding okay so far? As a result of these beliefs you've been carrying from childhood and then the negative thoughts you have - probably every day - you start to feel sad and lonely. Sounds like drinking puts you at ease when you are feeling like this, especially in social situations, but then also later makes these feelings even worse. Does this sound reasonable? Is it making sense to you? Anything you would like to add or change?