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A cognitive-behavioral counselor would begin with a thorough assessment of Maria and then implement one of the cognitive-behavioral intervention strategies. Using Persons and Davidson's (2001) case conceptualization model as the basis of this discussion, I begin with a problem list. The case study provides bits and pieces of the kind of information necessary to understand the problems faced by Maria. It would be best to have the client explain the problem, which she does not do in this case description, at least not directly.

Maria's Problem List

1. Depression, evidenced by difficulty sleeping, crying, weight loss, and suicidal ideation. A Beck Depression Inventory score would be a useful bit of information. Depression is evidenced by sad affect, sleep disturbances, and disturbing dreams. Maria's words, "I have nothing to live for. No one cares about me. I've ruined my life and the lives of two families, and I am currently hurting my children," are indicative of her depressed affect and sense of hopelessness.

2. Interpersonal difficulties, especially with her children and other family members. Maria is also unable to sustain a relationship with potential future mates.

3. Problems at work, which include difficulty concentrating and more absences than are acceptable to her employer.

4. Acculturation issues, including that Maria is Hispanic and grew up in a culturally encapsulated neighborhood.

Working Hypothesis

Maria's thoughts about self, others, the world, and the future include the following:

1. "I am inadequate, irresponsible, inferior, ashamed, and guilty."

2. "Others are demanding and don't understand me."

3. "The future is hopeless."

Precipitating and Activating Situations

The onset of the problems appears related to the abuse Maria suffered at the hands of her ex-husband, the end of their marriage, and the lack of support from her own family when this occurred. Her coping mechanism, putting energy into work, led to problems arising with her children.

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