Bernice has issues, and sure we all do, but hers are getting out of hand. At times she
goes through bouts of depression that make it hard for her to even get out of bed. Sometimes
she suffers from serious anxiety around things like test taking, flying, lots of things.
All of which are brutalizing her self-worth and affecting her performance in work and life.
She's ready to get professional help and, lucky for Bernice, she has a lot of options.
Psychotherapy, perhaps the predominant type of psychological treatment, involves a therapist
using a range of techniques to help a patient overcome troubles, gain insight, and achieve personal growth.
Now you know by now that there are kinds of perspectives on the human mind and lots of
different philosophies on how to approach it. So it may not come as a surprise that
there's also a variety of ways that experts analyze and treat ailments of the mind.
They each create their own kind of experience for a person seeking help and to be honest
some approaches are better suited for treating certain psychological conditions than others.
But with Bernice as our guide we can see how each of these techniques works and maybe in
the end we can get her out of bed, feeling more calm and confident, and back in the swing of things.
He's back!
If we're going to talk about psychotherapy, we've got to start with Freud, right? Psychotherapy,
you will recall, is commonly grouped into four major schools or orientations. The psychodynamic,
existential-humanistic, behavioral, and cognitive therapies. Freud's famous lay on the couch
and talk psychoanalysis is just one of several related therapies in the psychodynamic family
and it was basically the first.
In essence, Freud assumed that we didn't really know or at least fully understand ourselves
or our motivations. So psychoanalysis served as a kind of historical reconstruction that
helped patients access repressed feelings and memories and unconscious thoughts, by
using free association and dream analysis with helpful interpretations from the therapist
until they gained some self-insight.
As you free associate, talk about your past and answer questions, your psychoanalyst picks
up on sensitive subjects around which you appear to show resistance. Mental blocks that
keep you from your consciousness because they cause you anxiety. The psychoanalyst notes
these resistances and offers interpretations of what might be going on to help promote insight.
So if Bernice was visiting a psychoanalyst, talking about her day, the therapist might
say "Tell me more about that dream with the birds with the broken wings." Or he might
point out resistance, like, "I noticed that when you mentioned your fear of flying, you
tend to bring up your childhood, but you never talk about your mother. Why might that be?"
The therapist points out what may be unconscious themes to coax them into the light. Maybe
Bernice needs to deal with a traumatic childhood memory or the fact that her mom ran away with
a pilot or something to understand the roots of her fear.
Today, traditional psychoanalysis is less common. Critics have pointed out that psychoanalytic
interpretations aren't easy to prove or disprove, which is a problem when you're trying to take
the scientific approach. Plus, psychoanalysis tends to involve many sessions, sometimes
4 or 5 a week over a long period of time, and health insurance just won't cover that anymore.
Therapists who have branched off from the psychoanalytic school fall into the psychodynamic
family, which includes not just Freudian, theory, but also ideas from Karl Jung, Alfred
Adler, Karen Horney, and others.
The terms psychoanalytic and psychodynamic are often confused, but you can think of psychoanalysis
as Freud's particular baby, while psychodynamic theory is really the family descended from
that baby. Similar to psychoanalysis, psychodynamic therapy focuses on helping people gain insight
on the impact of unconscious internal forces, early relationships, and critical childhood
experiences. But these therapies don't dwell on the id and the ego and superego or all
the sex stuff, at least not like traditional psychoanalysis does.
And not all psychologists are interested in rooting through your deep unconscious recesses
like it was your underwear drawer. Some therapies focus more on conscious material and believe
the present and future are worth more attention than the past. These include the existential-humanistic
therapies, championed by Carl Rogers, Viktor Frankl, Fritz Perls, and others, who emphasized
people's inherent capacity for making rational choices, achieving self-acceptance, and attaining
their maximum potential.
Like the psychodynamic school, existential-humanistic therapy is still insight oriented, but it's
much more about promoting growth rather than curing illness. Instead of calling folks patients,
humanistic therapies refer to those they help as clients or just, ya know, people.
In the mid 1900s, Rogers developed a humanistic technique called client-centered therapy.
He encouraged therapists to help their client by providing an empathetic, genuine, and accepting
environment and using active listening where the therapist echoes and clarifies what their
clients are saying and feeling. Rogers believed these techniques helped to provide a safe,
non-judgmental place where clients could accept themselves, feel valued, and work towards
self-actualization. But other therapists in this school brought in more somber topics.
Perls, Frankl, and others incorporated the existentialist perspective, understanding
anxiety and limits to personal growth is driven by the human impulse to deny the fact that,
let's face it, we're all going to die. Sounds a little grim, but much like the existentialist
philosophers, these theorists thought to maximize human potential and meaning in life in the
face of those existential fears, helping people access their genuine selves.
So let's say Bernice sees an existentialist-humanistic therapist and talks about her depression and
how it's keeping her from living a full life. By focusing on the present, this therapist
might suggest that Bernice is afraid and avoidant of her true emotions, the bad and scary ones
as well as the good ones, which is why she feels emotionally lifeless and drained. So
her therapist might say, "Say more about the feelings that you're having right now, in this
moment, as you talk about your depression." The therapist would listen without interpreting,
at least at first, and help Bernice understand that she was being heard and accepted, which
hopefully would give her comfort and strength to begin dealing with the tough
emotions that she's been avoiding.
Now if Bernice were to make her appointments with a behavior therapist, she'd experience
quite a different session. Behavior therapists argue that simply knowing that you're afraid
of flying, for example, won't help you from freaking out at the thought of getting on
a plane. Instead these therapists suggest that the problem behavior is the actual issue
and the best way to get rid of unwanted automatic behavior is to replace it with more functional
behavior through new learning and conditioning. In other words, behavior therapy aims to change
behavior in order to change emotions and moods. Behavior therapy is rooted in the experiments
of Ivan Pavlov and his classically conditioned dogs that drooled at the sound of a bell and
work by E L Thorndike and B F Skinner on operant conditioning or changing behavior by using
positive or negative reinforcement.
So say Bernice is seeing a behavior therapist because of an intense fear of flying. We know
her fear is keeping her from personal and career goals like going to conferences and
vacationing to Baja. But sometimes it even effects her ability to look up at a blue sky
or flip through a travel magazine. Her therapist might use counter-conditioning to evoke new
responses to the stimuli that trigger this unwanted behavior or she may use other behavior
therapy methods like exposure, systematic desensitization, and aversive conditioning
to help Bernice modify her reactions and behavior. So she doesn't dwell on having Bernice relive
old memories or helping her self-actualize, she just wants to fix the problem behavior.
Aversive conditioning is less common and usually involves pairing an unpleasant stimulus with
the targeted behavior. A classic example is giving someone with an alcohol problem a pill
that makes them puke when they drink.
Far more common and better studied, the exposure therapies treat an anxiety by having a person
face their fears by exposing them to real or imagined situations that they typically
avoid. Systematic desensitization is a type of exposure therapy that associates a relaxed
state of mind with gradually increasing anxiety-inducing stimuli. Taking Bernice from, say, just thinking
about flying, to looking at photos of planes in the air to sitting on a grounded plane,
to eventually soaring in the skies for reals.
Behavior therapy works pretty well in treating specific fears and problems like phobias and
it can also work for people with generalized anxiety disorder or major depression, but
it often needs a boost. And we can get that boost from the cognitive therapies, the kind
that teach people new, more adaptive ways of thinking. Cognitive therapy focuses more
on what people think rather than what they do, assuming that if you can change a self-defeating
thought, you can change the related behavior.
This is the approach used by founding American cognitive therapist Aaron Beck. He and his
colleagues pioneered the Socratic questioning method to help clients reverse destructive
and catastrophic beliefs about themselves, the world, or the future at large, such as
everything that could possibly go wrong will go wrong.
Say Bernice has a big test coming up, like a really big, all or nothing, end of the year
exam. She's freaking out and her anxiety around the test already has her depressed, imagining
that she'll fail. If she bombs the test, she fears that her dreams of getting into the
graduate programs she wants will be dashed and her life will be over. Classic catastrophic
thinking. A cognitive therapist would actively discuss all of this with her, challenging
her thinking along the way and, in the end, help Bernice reexamine her assumptions about
what's going to happen if she does fail like the world will not end and she will not utterly
fail at life. Helping her work toward thinking more positive thoughts about herself and her future.
The cognitive therapist helps patients understand that changing what we say to ourselves is
a very effective way to cope with our anxieties and modify our behavior. In other words, it
really is the thought that counts. Not surprisingly, the cognitive and behavioral schools have
joined forces frequently enough that cognitive-behavior therapies are typically considered a single
school, and a lot of therapists use integrative approaches that try to use the best elements
of all of these schools of thought.
But all of these different psychotherapies don't always mean being alone with your therapist
and your thoughts. Most of them can be done in groups, too. Group therapy fosters the
therapeutic benefits you get from interacting with other people. Not only does it help with
the social aspects of mental health, but it also may remind clients that they're not alone.
In a similar way, family therapy treats a family as a system, and views an individual's
problem behaviors as being influenced by, or directed at, other family members. Family
therapists work with multiple family members to heal relationships, improve insight and
communication, and mobilize communal resources.
So, the big question remains. Does psychotherapy work? You're going to have to wait until next
time to find out because that is what we will be taking about, along with a look at the
biomedical approach to therapy.
For now, you've learned about the major types of psychotherapy. These include psychodynamic
therapy and Freud's famous psychoanalysis, existential-humanist therapy and Roger's
client-centered focus, and behavior and cognitive therapies.
We also took a quick look at group and family therapy.
Thanks for watching, especially to all of our Subbable subscribers who make Crash Course
free for everyone who can't pay for it. To find out how you can become a supporter, just
go to subbable.com/crashcourse.
This episode was written by Kathleen Yale, edited by Blake de Pastino and our consultant
is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins. The script supervisor
is Michael Aranda who is also our sound designer, and the graphics team is Thought Cafe.