PSY 315 Project Two Case Vignette: Evaluating Ms. Z Using a Counseling Theory (CBT)

Choosing a counseling theory for Ms. Z

A counseling theory is a lens. It tells the counselor what causes and maintains a client’s distress, what to focus on in sessions, and which interventions to use. Several theories could explain Ms. Z’s case, but this guide uses cognitive behavioral therapy (CBT), based on Aaron Beck’s cognitive model of depression, as the primary theory. CBT is a strong fit for three reasons:

• Strong evidence: CBT is one of the most researched treatments for major depressive disorder (MDD), and cognitive therapy specifically reduced repeat suicide attempts by about half in a randomized trial (Brown et al., 2005).
• Safety focus: because Ms. Z recently reported suicidal ideation, she needs a structured, present-focused approach that addresses risk from the first session.
• Practical and time-limited: as a single mother of two young children, Ms. Z benefits from a goal-oriented outpatient treatment with skills she can use at home.

Where useful, this evaluation also draws on attachment theory to understand how Ms. Z’s early relationships shaped the beliefs CBT targets.

Overview of the CBT model

Beck’s cognitive model holds that it is not events themselves that cause depression, but the way a person interprets them (Beck et al., 1979; Beck, 2021). Early experiences shape core beliefs about the self, others and the future. When a stressful event activates those beliefs, the person experiences automatic negative thoughts that lead to depressed mood and behaviors such as withdrawal, which in turn reinforce the beliefs. Beck called the depressive pattern the cognitive triad: a negative view of the self, the world and the future.

The beliefs and thoughts above are hypotheses for illustration. In real practice, the counselor confirms them collaboratively with the client.

Evaluating the case through the CBT lens

1. Presenting problem

Ms. Z was assessed at a crisis center for suicidal ideation and recommended for outpatient treatment for MDD. Her symptoms have been present in some form since age 10 and have worsened over the past three years. A long course of depressed mood with recent worsening suggests the counselor should assess for recurrent MDD and for persistent depressive disorder using the DSM-5-TR criteria (American Psychiatric Association [APA], 2022), and screen symptoms with a standardized tool such as the PHQ-9 or the Beck Depression Inventory-II.

2. Early experiences and core beliefs

Ms. Z was raised by a single mother who worked long hours and was often absent, and she describes the relationship as “distant.” From an attachment perspective, an emotionally unavailable caregiver can lead to an insecure attachment style, in which a child learns that others are not reliably there and that needs will not be met (Bowlby, 1988). In CBT terms, these experiences may have formed core beliefs such as “I am not important enough” or “I cannot depend on anyone.” Reporting depressed mood as early as age 10 supports the idea that these beliefs developed early.

3. Triggering event: the divorce

The divorce, and her ex-husband’s complete absence from the family, likely activated these dormant beliefs. Being left echoes her childhood experience of a parent who “wasn’t home often,” which can confirm the belief that people she loves will leave. Becoming the sole parent of two young children adds stress, fatigue and possibly financial strain, which can intensify hopelessness.

4. Maintaining factors

• Cognitive distortions: likely patterns include personalization (“the divorce was my fault”), overgeneralization (“every relationship I have fails”), all-or-nothing thinking and catastrophizing about the future.
• Behavioral withdrawal: rarely speaking with her mother suggests a small support network. Isolation reduces positive experiences and reinforces depressed mood.
• Hopelessness: in Beck’s model, hopelessness about the future is one of the strongest predictors of suicidal behavior, so it is a priority target.
• Life stressors: single parenting, limited time for self-care and possible financial or practical barriers to treatment.

5. Strengths

A strengths-based evaluation is essential. Ms. Z reached out for help at a crisis center, which shows help-seeking and a desire to live. She has long experience with mental health services, so she may be familiar with therapy. She is raising two children on her own, which shows resilience and responsibility, and her children may be a powerful reason for living to build on in treatment.

Treatment plan using CBT

Example of cognitive restructuring

Multicultural considerations

Ethical and effective counseling requires attention to Ms. Z’s identity and context (Sue et al., 2022). The counselor should:

• Explore Ms. Z’s cultural identity and values rather than making assumptions about her. Ask what being an African American woman and a single mother in Baltimore means to her, and what role family, community and faith play in her life.
• Consider stigma and mistrust: some Black clients report stigma about mental illness and mistrust of healthcare systems rooted in historical and ongoing discrimination. Discuss these openly to build trust.
• Explore the “Strong Black Woman” schema if relevant: expectations to be strong, self-reliant and to suppress emotions have been linked to psychological distress and less perceived emotional support (Watson-Singleton, 2017). This connects directly with the CBT belief “I must handle everything alone.”
• Adapt CBT to her context: validate real stressors, such as racism, financial pressure or the demands of single parenting, rather than labeling every negative thought as a distortion. Use her own words, values and examples in sessions.
• Address practical barriers: flexible scheduling, telehealth, childcare options and insurance or sliding-scale fees can make attendance possible.
• Practice counselor self-awareness: reflect on personal biases, and use broaching to openly invite discussion of race and culture in the counseling relationship.

Ethical and legal considerations

• Duty to protect and safety: suicidal ideation requires ongoing risk assessment, documentation and a safety plan. Confidentiality has limits when there is serious and foreseeable harm, and Ms. Z must understand these limits during informed consent (American Counseling Association [ACA], 2014).
• Informed consent: explain CBT, its goals, the expected number of sessions, homework, and the limits of confidentiality, in clear language.
• Child welfare: the counselor should assess how Ms. Z’s depression affects her ability to care for her children, and know state reporting laws, while supporting her role as a parent rather than assuming harm.
• Competence and referral: refer for a psychiatric medication evaluation if symptoms are severe, and coordinate care with the crisis center and her primary care provider, with her consent.
• Cultural competence: the ACA Code of Ethics requires counselors to respect diversity and avoid imposing their own values.

Strengths and limitations of CBT for Ms. Z

Alternative theories could complement CBT. Attachment-based or psychodynamic therapy would explore her relationship with her mother and the grief of the divorce in more depth. Interpersonal therapy (IPT) targets role transitions, such as becoming a single parent. Person-centered therapy (Rogers) would emphasize empathy and unconditional positive regard, which may help a client who felt emotionally neglected. Many counselors integrate these elements into a CBT framework (Corey, 2017).

Tips for writing your Project Two paper

• Name one theory clearly and explain its key concepts before applying them.
• Link every claim to the vignette: quote specific details, such as “distant” mother, divorce and depressed mood since age 10.
• Cover the whole picture: presenting problem, contributing factors, strengths, treatment goals and interventions, cultural and ethical considerations, and limitations of the theory.
• Use scholarly sources and your course textbook, and cite in APA 7th edition.
• Avoid stereotypes. Describe how culture may influence the client, and how the counselor would explore it with her.

Related reading: Depression and the DSM-5-TR and our psychology theories study guide.

Conclusion

Through a CBT lens, Ms. Z’s depression can be understood as the result of early experiences with an emotionally distant caregiver that may have formed core beliefs of being unlovable and alone, which the divorce reactivated and which are maintained by hopelessness, self-blame and isolation. A culturally responsive CBT plan would start with suicide risk assessment and safety planning, then use behavioral activation, cognitive restructuring and core belief work, while strengthening her support network and addressing practical barriers. Combined with attention to her cultural identity, ethical safeguards and her clear strengths as a help-seeking and devoted mother, CBT offers Ms. Z a structured, evidence-based path toward recovery.

If you or someone you know is struggling or having thoughts of suicide, call or text 988 (Suicide & Crisis Lifeline, U.S.) or contact local emergency services.

References

American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.

Beck, J. S. (2021). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial. JAMA, 294(5), 563–570. https://doi.org/10.1001/jama.294.5.563

Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning.

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001

Sue, D. W., Sue, D., Neville, H. A., & Smith, L. (2022). Counseling the culturally diverse: Theory and practice (9th ed.). Wiley.

Watson-Singleton, N. N. (2017). Strong Black woman schema and psychological distress: The mediating role of perceived emotional support. Journal of Black Psychology, 43(8), 778–788. https://doi.org/10.1177/0095798417732414