Cognitive therapy is based on the foundation that a person's emotional state is not determined by what happens to him, but rather his understanding of what happens. In other words, your psychology is based on your perception of your world, not the world itself. For example, when a student gets a B+ on her exam, that in and of itself cannot create happiness, sadness, anxiety or any other emotion. The student, at varying levels of consciousness, decides how she feels by interpreting what a "B+" means to her.
Cognitive therapists spend most of their time helping clients to see if their thoughts/perceptions are both accurate and adaptive. Achieving a B+ on an exam could pose a problem for a student who is seeking to make the Dean's List. A cognitive therapist would strive for a natural and healthy emotion such as concern or disappointment, ideally leading to a plan to work harder to get a better grade in the future. By contrast, a student who beats herself up over this and perceives this as complete failure because it wasn't the grade she wanted would be encouraged to look more closely to see if this set of beliefs was causing excessive distress. Finally, a student who has struggled in that class and is elated at getting a B+ due to hard work would likely be pleased and not require any intervention on the part of her therapist.
One common error in perception that many of us make is known as Fortune Telling or simply "jumping to conclusions." Like Catastrophizing, I happen to be an expert at making myself miserable in this fashion. Consider my work with Max, a bright 14 year-old boy with anxiety difficulties. Common areas of anxiety in this age group include peer acceptance, budding sexuality, friends and family's welfare, forging through the early stages of independence, academics, and so forth. On one particular session, however, Max expressed a fear about aliens and their attack on Earth.
"Dr. Rob, I'm afraid they'll come down and kill us."
"Do you mean aliens like the ones in the movies?"
"Yeah, like in Independence Day."
I shuddered at the thought of having to sit through two hours of that filth again. "You know, some people believe that there are other living beings in outer space, but I don't think the aliens in the movie you are talking about are real."
"They're not? Are you sure? One kid at school said that they are real and that Will Smith couldn't kill all of them on his own, that even though they died in the movie, they'll come back."
Quietly praying that Independence Day 2 was not in the works, I said "Right, he probably couldn't do that on his own, but I'm pretty sure you don't need to worry about that. Those aliens are made up. Like Santa Claus."
"I said that they are made up."
"No, what about Santa Claus? He's made up?!"
"Yes, he's simply a...um...oh dear."
"Oh my God!" Max yelled.
I immediately began to feel panic set in. This was not because I told an adolescent that there is no Santa Claus. That reality in and of itself cannot cause extreme anxiety. It was my perception of that event and the accompanying Fortune Telling that generated my distress:
I've shattered his beliefs. His parents are going to be furious. This is just like what happened with A.J. and Jack. Max won't want to come back to therapy. I'm a failure as a therapist and will never be successful in life and my mother will agree with every one of these thoughts which will simply lower my self-esteem and confirm my inferiority as a person. No one will ever love me.
"Santa's not real?" Max asked, panicky himself now.
Therapist Rule: Do not lie, yet do not blatantly go against a parent's value system.
"Well, there once was a man named St. Nicholas and...Max, would it be alright if I got mom and we talked about this together?"
"Yes, get her!"
Using a shaky hand to prompt Mrs. Max into the office from the waiting room, I tried to gather myself for what could be an ugly scene. The thoughts were still racing through my mind, and as my heart rate was accelerating, I'm sure beads of sweat became visible. Max is 14. If he were 6, I wouldn't have dreamed of saying something like that. How could I have known he still believed in Santa Claus?
"Mom! Dr. Rob told me there is no Santa Claus!"
Rather than getting angry at me for exposing the jolly fat man as a sham, she seemed a bit sad. "Well, I suppose we all knew this day would come," she said, lowering her head as if her son inadvertently found out he was adopted.
"I'm very sorry," I said. "I had no idea this was an issue at his age."
"Why wouldn't it be?" Mrs. Max asked, seemingly confused.
"Well most children don't believe in Santa Claus at 14," I said, feeling a bit more stable, like I could impart some actual wisdom instead of being simply a glorified Myth Buster. "That is generally reserved for much younger children, at least in my experience. I also wonder if this could be in some remote way connected to Max's anxiety."
"Max, do you ever talk to your classmates about Santa?"
"Sometimes. No one else believes in him. They tell me that it's baby stuff and they make fun of me, so I just assumed that they would rot in hell."
"See Mrs. Max," I said. "It can be very taxing for an adolescent to have these kinds of social difficulties. If Max is brought up to speed with things like Santa Claus..."
"And the Tooth Fairy!" Max said.
"Right, and the Tooth Fairy, then maybe he can relate a bit better with his peers. This might help with his anxiety."
"His father believed in the Easter Bunny until he was 15," Mrs. Max said, "so I don't know what is normal. You seem to know your stuff, just please do right by Max."
The moral of the story: do not assume that whatever is going on in your head is patently true. I created a veritable panic attack for myself based on thoughts and predictions that could have come true, but proved not to. That's the essence of Fortune Telling, taking what is technically possible and turning it into a definitive. More importantly though my gaffe created a great therapeutic opening for Max. After a few months dispelling myths and teaching him interpersonal skills, he began to interact with his 14 year-old peers in a more traditional manner, discussing video games and getting to 2nd base rather than elves from the South Pole and pixies who take your molars and leave a dirty nickel on your sheets. This did, in fact, lower his anxiety.
My therapist was glad to know what I learned about misperception. She then spent two weeks psychoanalyzing why I need to bash Independence Day at every opportunity I get.