Getting Help – Psychotherapy: Crash Course Psychology #35


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


This post was previously published on YouTube.

Photo credit: Screenshot from video.