From the author: Cognitive therapy. Case from practice. Published with the client's consent. All names are fictitious. Last fall, a client, Ivan, came to see me. He said that he had panic attacks that he could not explain. At first glance, he could be seen as an above-average person. He was a lively, talkative, well-read and highly educated young man. But continuous severe panic attacks made him unhappy. Sometimes they were so unbearable that he had to quit work and spend the rest of the day in bed. The attacks continued for many years. They consumed his life and destroyed his happiness. He lost close relationships, took jobs far below his abilities, alienated people until he was left alone, hiding from the whole world. In vain Ivan tried to find an explanation for his misfortune. Every week he constructed a new theory in his imagination. At first he decided that he was not cool enough, so he watched many films in search of a hero to emulate. The following week he accused himself of extreme passivity. At one point, he even bought himself a self-analysis textbook and tried to dig up deeply repressed memories. Another time he came to the conclusion that he was not spiritually developed enough, so he read Genesis of the Saints and prayed five hours a day, trying his best to become righteous. Neither approach worked. He gave up each new attempt after a couple of weeks. His neighbors had their own explanations, and they liked to tell him their favorite theories. One woman who studied macrobiotic diets proclaimed, “It's all the fat you eat, the processed foods. If you followed the diet from the book I am reading now, you would gain weight immediately.” Another neighbor suggested that Ivan take up taekwondo to become more courageous. The third, a local amateur biochemist, determined that Ivan had hypoglycemia. In search of an explanation for his suffering and panic, Ivan turned to therapy. His first counselor told him that he was repressing his sexual impulses. The attacks continued, and the therapist suggested that he must be suppressing aggression. When the attacks still did not stop, the therapist continued to look for what else Ivan could suppress. The second therapist hypnotized Ivan and, after hypnosis, instilled in him a feeling of importance and security. Ivan felt better for a couple of hours, but when the trance dissipated, he quickly returned to his original state. The third consultant did not give any explanations; he simply reflected Ivan’s feelings. The fourth gave him two tapes - one for relaxation and the other for becoming more self-confident. The records contradicted each other, and that was the end of the matter. The last therapist simply handed Ivan some medicine, after which he felt like he was floating in the clouds all day. The panic did not stop, but only the box of medicine rattled in his head. When he came to see me for a consultation, he looked as pathetic as ever. I also didn’t know what was causing his attacks, and decided to study his past. Ivan described all the significant events of his childhood. According to him, it was happy. His family never cared about money, but his parents did not spoil him and forced him to earn pocket money himself. He did well in school, played several sports, and had several friends. In general, his past seemed more rosy than that of most people. We carefully looked for some critical event, some clue that could explain what was happening to him. But we found nothing remarkable—no unusual disorders, no major traumatic events, no overwhelming disappointments or melancholy. His losses and experiences were typical of most people. So what is the cause of his panic attacks? At first I thought there must be somethingFreudian, some unconscious cause, or perhaps some biological, hereditary imbalance. But none of this came to light. In the end, I decided to take one last look at Ivan’s past and look for more likely explanations. Even though the client's life experiences were favorable and unremarkable, there was something unusual in his voice when he described certain events. I decided to explore his past again, this time focusing on Ivan's beliefs, and asked him to focus more on what he thought about the event rather than what happened. Ivan highlighted two episodes from his past: the time when he felt rejected at school and when his first girlfriend left him for another man. The following text is a reproduction of the sessions from my working notes. Session 1Ivan: When I went to school, some guys didn’t really like me. I didn't seem to fit in. My usual response to such statements was, “That must be offensive,” or some other sympathetic remark. But now, since we had already returned to the same thing many times, I decided to try something different. E.E.: So what if they didn’t like you? What was so terrible about this? Due to the fact that standard methods did not work, I decided to turn to something different. Ivan: What is this! You must be kidding! It’s terrible for a child to not fit in. Since I abandoned the empathic approach, I decided to follow this path to the end. E.E.: Why? Ivan: You’re a psychologist. What are you doing? What are you talking about? Children need to be liked by others. E.E.: That's what you say. But what's so bad about them not liking you? Did they beat you, throw stones at you or what? Ivan: No, of course not. They just didn’t like me like other children. E.E.: Okay. Of course it's unpleasant, but you said you had several friends. So what did it really mean to you not to be super popular for everyone? Ivan: It meant that I’m not like all the boys. E.E.: Sorry! How do you think you were different? Ivan: I felt like some kind of weirdo, or a blockhead, or something like that. E.E.: Just a minute. Over the course of several sessions, you told me that you felt different from other guys. Okay, maybe that was it. But now you claim that you were different for the worse. You believe that because you were different, there was something wrong with you, that this difference proves that you are inferior. Why? Why couldn't being different indicate your superiority? Ivan: Well, if I were better, I would be popular. Right? E.E.: Wrong! Children reject anyone who is not like them. They make no difference between those who are different for the better and those who are for the worse. The most popular person in school is the one who adapts the best. Mozart and Einstein will be rejected just like a loser. And perhaps even more, because the other children will be jealous. Ivan: I’m not Einstein or Mozart! E.E.: No. However, you don’t have to be too different to be rejected. A teenager's need to fit in is so strong that peers identify even the slightest difference and attack those who refuse to accept the will of the teenage subculture. Groups of teenagers can take pride in not being subservient to the adult world. But within the group itself, its members are very conformist. No other human association has stricter rules or is more intolerant of nonconformists than a group of teenage peers. They can be very cruel. They can't stand boys or girls who don't suit them, they simply kick them out of the group. There are no exceptions here. There is no forgiveness here. Ivan: But how could I be different for the better? E.E.: You already told me. You were much smarter than the other children. While they were reading comics, you were reading your sister's astronomy and philosophy textbooks and classic novels, right? Their comics made you sad. Programs seemed stupid to you and.