Juan, or the glass you look through

Juan, fifty years old, is for most of those close to him a man who has succeeded. He has a family, a job, friends. Only last year he was promoted and his first grandson was born. His wife does not understand how, faced with situations they had both so wished for, Juan can appear uninterested and sad. His friends, disconcerted by his conduct, do not know how to help him. When he speaks about it, Juan lets slip phrases such as: “… what good is a promotion if the money is not enough for us to live better anyway”, “some are born and others die”, “I am turning into an old man who is of less and less use”.

One might say that, in Juan’s case as in anyone else’s, what largely influences his emotional state, his ideas and his conduct is not the events of life in themselves, but the interpretation one makes of them. The same events that provoke sadness in Juan may provoke joy in his wife or admiration in his friends, since each of them would surely see them in a different way. Taking into account the fact that “it all depends on the glass you look through”, that is, on the particular vision each person has of the world, of themselves and of the future, is one of the fundamental premises of cognitive therapy.

If Juan were to consult a professional in search of help, it would be fundamental for the therapist to listen to the account he gives of his situation, seeking to understand the particular meanings he attributes to the facts. These personal meanings that people grant to events are what we call constructions. The cognitive therapist tries to assemble — in the manner of a jigsaw puzzle — the particular construction of reality made by the client. In a cognitive approach, the key pieces that guide the puzzle are what are called cognitions, which include thoughts and images.

Other important pieces, directly linked to cognitions, are the emotional reactions and the conduct that goes with them. Let us suppose, the better to understand these concepts, that Juan develops a chain of thoughts of this kind: “There are people who are born — like my grandson — and others who grow old — like me; if I grow old, death draws near; and if I do not die soon, I shall be old and good for nothing anyway, so there is no point in their promoting me at work, since they do it for my seniority and not for what my work is worth; and on top of that I shall not even have an old age with a little economic well-being, and I do not deserve to be given a higher salary since I am of less and less use anyway.”

Let us further suppose that certain images accompany these thoughts: for example, picturing an old Juan making bigger and bigger mistakes in his work, and imagining the expression of an angry boss. He might also carry on his chain of images and picture a situation at home in which his wife tries to console him in a tone of pity. At this point it is not hard to understand, from Juan’s vision, both his uninterested conduct and the sadness that overwhelms him.

The reader will not have failed to notice, at this point, a certain alteration in the logic of Juan’s associative chain of thoughts and images. These inadequate interpretations are called cognitive distortions, and they are held to be largely responsible for emotional and behavioural alterations, sometimes mild, sometimes severe.

We all have, in our personal history, situations in which an associative chain of this kind has been able to engender a feeling of hopelessness, of pain, of resignation, and so on. It is also likely that, in certain cases, we have been able to reverse that feeling: by looking at the problem from another angle, by seeking in our surroundings evidence for our assertions, thanks to a friend’s questioning of our way of seeing the facts, and so on. But very often the suffering settles in with greater force and duration, and we feel shut inside a vicious circle of ideas, feelings and conducts.

This is the moment when one feels the need for professional help. Many psychotherapeutic approaches can help, but the client has the right to choose the one they identify with most and that gives them an answer or a solution to their concern. In the same way, the therapist can choose, for the patient who consults them, the therapeutic alternative they judge most likely to succeed.

The purpose of this article (the first in a series) is to offer the reader an overview of cognitive therapy: what its characteristics are, how it is developing in other countries, and in which kinds of difficulty it constitutes a valid psychotherapeutic alternative.

What the cognitive model puts forward is a correlation between cognitive variables (what we think and imagine) and emotional states. For example: to the extent that one thinks one is incompetent, that no one understands one and that there is no hope in the future, this will be associated with a feeling of dejection, of sadness or of loneliness. Another characteristic of cognitive therapy is that, for the “affective disorders” that do not involve severe alterations of the personality, a brief treatment is used (some twenty sessions).

Two voices on cognitive therapy