Within CBT/REBT, the processes occurring within a client's mind are considered most important to locating the source of the problem(s). These two approaches differ in the way thought processes are conceptualized, however, with REBT focusing on irrational

Rebecca

Rebecca is a 46-year-old Jewish female who recently lost her husband. She comes into your office crying, “I can’t go on.” She is very distraught, disheveled, and dressed in all black. Her clothing appears more suitable for someone younger than her age. She had been married to her husband for less than a year.

Rebecca met her husband Joseph, a Roman Catholic who was 17 years her junior, when she was on vacation in the Bahamas. Rebecca likes to take vacations in the Caribbean in January and vacations in Europe in the summer when school is out. Joseph is a Marine who served in the first Gulf War and currently works as a corrections officer. He reported having numerous physical problems. She explained that Joseph “was always in pain . . . his back . . . He had flashbacks from his military service . . . He was bitten by a snake once . . . He had kidney stones.”

Rebecca tells you that she was “madly in love” with Joseph. “We had the perfect marriage. I loved him so. He was wonderful . . . He would wake me up every morning with coffee. He wrote me love letters. How many men do you know who write their wives love letters?” She begins sobbing. “I’m sorry. I was thinking about our wedding . . . We had a fairytale wedding . . . really . . . we found a place like Disney . . . it was held in King Arthur’s Court . . . I was a princess.”

Rebecca comes from an intact Jewish home. Both of her parents still live in San Diego, where she grew up. Rebecca is the oldest daughter in the family. She was and still is considered the “good girl.” She has an older brother (a Cantor), a younger sister (who is considered the “bad girl”) and a younger adopted brother (working in construction). None of her siblings live near her. Her parents consider themselves observant Conservative Jews.

Rebecca did well in school, earned a master’s degree in special education, and is currently a supervisor of special education services in a local school district. She is very proud of her work and enjoys it. She is somewhat concerned, as the school district is cutting back due to increasing needs and limited resources and she is being forced to go back into the classroom. She is very unhappy about this. She states she loves being a supervisor, and that she “will have no place to put all of the stuff from my office.”

Rebecca reports that since her husband’s death (three weeks ago) that she has had financial difficulty. She explains that Joseph had a $100,000 life insurance policy and that “he was supposed to make me his beneficiary” and that “he told me he made the change of beneficiary, but he didn’t.” She says his parents received the insurance money, but they won’t talk to her. “They want nothing to do with me. They think it’s my fault he’s dead.” She continues, “I have two cars and two houses to keep.” She and Joseph had a condo, which they planned to sell, and they had just purchased a single family home. She reports that the corrections officers were good to her after Joseph’s death. “They gave me $800. I got $700 from friends of my parents, and my coworkers at school gave me $500, but I still will have trouble making ends meet.”

You ask about the circumstances of Joseph’s death. Rebecca tells you that Joseph was always in a lot of pain because of his physical ailments, and that he was always on a lot of pain medication. He recently changed doctors and went to see a doctor at the Veterans Administration. The VA doctor prescribed several pain pills and methadone. “It’s the VA doctor who killed him,” she says. “He should have never prescribed those medications. I’m getting a lawyer, and I’m going to file suit.”

Joseph was at work one day and started experiencing flashbacks. He took his medication. The flashbacks became so bad that his coworkers told him to go home. He went home, and when Rebecca saw him, she thought “he looked awful. He was unsteady on his feet. I asked if he was okay, and he said he was having flashbacks.” He went into the bathroom and didn’t come out. Rebecca went into the bathroom and found him passed out on the floor. “I shook him and screamed, and he woke up. He said he was fine and that he just wanted to sleep, so I helped him get in bed.”

Rebecca finishes the story: “That night, he was snoring very loudly. He always snores, but this time it was much louder than usual — so loud that I couldn’t sleep. When it gets that loud, you just can’t sleep in the same room . . . how could he expect me to sleep in the same room? So I went to sleep in the other bedroom. I still couldn’t fall asleep. His snoring became louder and wheezy. Eventually, the snoring stopped, so I went back to our bed and fell asleep. The next morning, he was dead . . . blood everywhere . . . eyes, ears, nose, mouth. I called the ambulance and the police. My cousin and his brother-in-law cleaned the bed, the sheets, and the bedroom so I could sleep in there. I know it’s weird to sleep in the bed the next night, but I really loved him. Do you think you can help me?”