Okay. So now that you have a, a sense of at least some of the various mental illnesses, what we're going to talk about in the last three lectures this week are some of the therapeutic approaches that are brought to bear. one of the things I think you'll realize early on is that, some forms of therapy would work better with some mental disorders than others will, and in fact, many therapists, when you go and see them, they're actually experts in a number of different kinds of therapies. and they will often spend some time trying to understand which therapy is best-suited for any issues that you might have. So we're going to go through some of that, and in, in this lecture I'm going to give you a taste of history, a little bit of an overview of what we're going to cover, and then we're going to focus on one class of therapy something that's called insight therapies. Let's do it. Alright. So week seven, lecture six, insight therapies, finally changed the thing on the bottom here. yeah these are also called talk therapies. And, this is that stereotypical notion of going and sitting on a couch or laying on a couch or talking to a therapist. But you see, even within that, there are different approaches. Before we go there, though, let me just mention an important transition that, that happened. So of course, mental illness has been around for a long, long time. in the earliest of days, it was often seen as some form of possession, that some spirit had gotten within a person and had taken over their body, in a sense. And so one of the earliest treatments involved something called trephining, basically drilling a hole in a person's head. the idea being that once there was a hole in the head, the spirit could leave. and so it would take this door, and it would be out, and the person would be better. I don't think it worked very well. And I'm not sure why the nose or mouth wouldn't have worked as a, as a perfectly [LAUGH] fine door as well. I, I suspect they killed more people than they helped with this method. But it is a good example of, of that approach. Because, you know, even that mind set, it took a long time to change. When we're into the, even 1600s, 1700s, there was still the notion that somebody who is mentally ill had lost their human capacities. They, they essentially became beasts. And they were treated, to some extent, as though they were beasts. They were often, you know, all put together within an asylum, that was often filthy. They weren't cared for very well. If they showed any violent tendencies, like this gentlemen perhaps. they were typically constrained perhaps to a chair. Perhaps tied to a wall, chained to a wall there was no, of course, therapy of any sort really given. So these places, in fact, one of the famous ones was called Bedlam, and we use that term now, which, we describe something being Bedlam when we mean, you know, it's just absolutely crazy. There's, there's like, a lot of activity and a lot of strange stuff going on. Well, that's what asylums were. and it took awhile for that to change. But, eventually it did start to change. People began to think of, mental illness as just that. As an illness like other forms of illness. and as one that perhaps, could be treated, and the individual could be brought back to mental health. so that's, I'm going give you a taste of some of these therapies. There's obviously a, a long detailed story behind all this, but we're going to, in the next three lectures, touch on three therapies. Today we'll talk about insight therapies, then we'll talk about cognitive behavior therapy. which is very common. And of course drug therapies, which are also very common. so we're going to talk with these as separate classes, but again, I'll try to bring them together a little bit at the end. Insight therapies then. Okay, so this is really the kind of clinical psychology that Freud began. the notion that underlies it is that the symptomology you see, the behaviors that somebody is showing are, you know, really reflective of some inner, much deeper, problem. And the notion is usually, certainly within the psychoanalytic tradition, Freud's tradition. The notion is that often the patient doesn't know what the real problem is. And they don't know very specifically, because there are cognitive mechanisms that are preventing that problem from getting into awareness. So that literally, like let's imagine somebody was perhaps abused as a child, sexually abused as a child, perhaps by a family member, somebody they really love and care for. You know, we talked about this in terms of the multiple personality situation, but just generally, let's say somebody doesn't develop a multiple personality, but they still eh, if they were abused maybe once or twice, maybe their mind has come up with a way of blocking that from their conscious awareness, suppressing that, putting that away. And so they literally do not remember that event. but, it's there. and it's causing all sorts of psychological stress. All sorts of psychological angst and that energy is coming through. That stress is coming through in terms of problematic behaviors. Maybe in, in a case like that, maybe a real problem with close relationships and intimacy. Etc. and so now the therapist has a challenge ahead of themselves. Because if you accept the psychoanalytic view, you can't just, if you were a therapist and you began to think, well, maybe this client was sexually abused. What you cannot do is just say that. I think you were sexually abused, because doing that a direct confrontational approach, would just bring up all those defenses, and kind of alert them. And, you will get nowhere, you will be fighting with the person's mind as it were. And so, often the psychoanalytic approach is to try to get at the issues in a much more indirect way. A much more, kind of a, like you're trying to sneak around the defenses. and get out what's going on. So you've probably heard of some of these things. a psycho analytic person may ask someone to free associate. I'm going to give you words, and when I give you a word. What I want you to do is don't think about it too much. Just tell me the first word that comes to mind. Spit it out. I'm going to give you another one. Spit it out. but let's say, you know, I'm. I'm a therapist and I'm thinking sexual abuse. I'm, and, and, and I'm thinking a family member, perhaps. And so, what I might do is during my free association, I might throw out some random words. Storm. Table. but, but I might throw in something like uncle or or father, or you know, any, anybody that I suspect may be relevant. And I may be very interested in the words the person gives back. If I say something like uncle, do they give, do they say something like Fear? Or scary. Or anxiety. Or, you know, anything that might suggest some association between that figure and an underlying emotional state. and if they do, I would probably go some other direction right away. I'd probably say lamp. Table, you know kind of ease the defense mechanism. But then I might try to come at it in other ways. Or, you know, I maybe show them a picture of a family having dinner and ask them to recount some family dinner they have and talk about the people around the table. And again, be very sensitive to how they describe people, and how they react when they are describing people. Of course Freud was a big fan for many years of dreams. He felt that when you were dreaming, your defense mechanism wasn't as vigilant. and so that things, these underlying issues would come through in your dreams not exactly. So it's not like this person would have dreams of the sexual abuse. But they would have content within the dreams it would all be disguised but there would be something in the dreams that if you could decode the symbolism, you could figure out the underlying cause. Okay, now often this would take a lot of time you would have to go to a therapist over and over. there are issues within the therapeutic setting that were really interesting, so from, so Freud said, first of all, there would be this resistance to finding the true cause, because the person kind of doesn't want to know. They've been hiding it. There are issues like transference, so the patient might have feelings for somebody else, like, say, the abuser. That they transfer to the therapist at some point, so they might be starting to talk to the therapist as though the therapist were the abuser. And the therapist had to be on guard for that. And in fact, Freud said that there might also be counter transference, that occasionally the therapist themself has issues. And maybe the therapist might in this, in this highly personal interaction. Might start to transfer some of their issues onto the patient. and so Freud actually claimed that every good therapist needs a good therapist. That they actually should be going through therapy as well. And he would look deeply at this therapeutic interaction. Remember that for Freud it was often, the underlying things often were with, were with respect to sex and aggression, so these therapies would tend to be talking about those issues. So they would tend to be very intimate, and you know, therefore people, both the therapist and the patient had to be on guard, especially the therapist obviously. with respect to ethical practices and things like that. Here, here's a statement from Freud. We are what we are because we have been what we have been, and what is needed for solving the problems of human life and motives is not moral estimates, but more knowledge. So he's saying you know, I'm not about judging, but I need knowledge. I need more information to understand what's going on. And so does the patient, in that, that will ultimately be the cure, and so the whole purpose of the therapy is mining this knowledge, while trying to avoid the resistance of defense mechanisms. Okay, there's a lot that can be said about psychoanalysis, but I have some videos for that. [SOUND] I want to move, I want to give you a contrast. So I, I'm really going to highlight two insight therapies. Psychoanalysis on the one hand, and again psychoanalysis often focused on finding that underlying problem, versus client centered therapy, or humanist therapy. Associated with Carl Rogers, it's a very different perspective. In fact, I often like to describe it in the following way. You might go to a money manager if you, if you currently had real money issues. And you wish, you know, there's a certain goal you wish to attain. You wish you were financially stable. You wish you were maybe fluent. Certain level of money, and so you talk to a financial adviser who says okay, you're here now, you want to be here. Let's work through how you can get there. 'Kay? That's the same concept of Humanistic Therapy. In fact, they talk about patients not as patients, but as clients. They don't kind of say there's anything wrong with you. What they do say, though, is that people usually end up in therapy when, the person they are is not the person they would like to be. 'Kay, there is some what's called incongruence. And, the idea of the therapist is to try to help this, help the client minimize this incongruence. but it's a really a supportive role, it's very what's called non-directive. I'm going to give you a taste of it in a second, but the idea is that the therapist does not tell the patient what to do. The therapist does not really have any deep theory. the therapist is in fact helping the client to figure things out for themselves... So they, they say things but they kind of reflect so that the, the client themselves kind of works through something. Let me, let me just give you an example. because this is the best way to do it. I'll come back to this. [COUGH] This is an online version of humanistic therapy called Eliza, so, so I'm going to act like I'm, I'm talking to Eliza, and I will say something, and she will say something back, but notice that what she says do you believe it is normal to be feeling depressed today? No, I don't, no, I do not. notice that's she's not really saying anything. Well, maybe some people are depressed. What she's really doing is prompting me to think. You don't seem quite certain. I only really know my own life. [LAUGH] So I'm not going to, I'm not going to continue, but I'm going to give you the link to Eliza so you could. [LAUGH] You can continue this. I'm not going to continue this. but you could continue this as, as you want, but notice the way she's responding when you do. let me go back to where we were. it's very much about just kind of allowing the patient to go through, so you can imagine a patient saying something like, you know, I had a bad day yesterday. I was with my spouse and we got into a big fight. And the therapist might say, tell me about the fight. And you say, well, you know I think it kind of started when I, I told my spouse that I didn't like when they did x. And the therapist might say, well do you think you shouldn't have said that then? and the person might say, well, I don't know. It seemed like the right thing to do at the time. And the therapist might say, well, were there other options? And you might say, well, I guess I could have, instead, just done this. And then the therapist might say, well, what do you think would have happened if you did that? and so the therapist, again, is just kind of being a sounding board, maybe steering the conversation a little, but they're largely allowing the client to explore the space and maybe the client would say, geez, you know what, now that I think about it, that would be the right path to go. And then the therapist might say, well, maybe you should try that next time you're in that situation. So that's the idea of the humanist therapy. It's not about finding some negative and uncovering it, it's about allowing a client to figure out behaviors that can bring them closer to being the person they want to be. So it's a much more positive mindset, a much more supportive. And a much less directive approach to therapy. and many people really like it. Kay, so it's a, it's a good counter-point to psychoanalysis. Now for all of these insight therapies it's important to understand limitations, you're not going to do much with a schizophrenic. Within psych therapy. You're not going to do much with the psychopath. The psychopath thinks they're perfectly fine. They don't need therapy. this is going to work with people, first of all, who feel they have some issue they want to resolve. Okay, they have to feel they have a problem, and they kind of have to be intelligent, articulate. Motivated, and I say, and rich enough to spend a lot of time exploring this stuff with a therapist. So if somebody's not very intelligent, or not very articulate, then this deep discussion is never going to happen, and you're not going to get anywhere. in terms of whether it actually works. There are some scientific studies. not a, not many. But those that, have been done suggest, yes, it's, it's better than nothing. and in fact humanistic therapies, a lot of people really end up, liking. They come out of humanistic therapy, feeling better about themselves. In fact, you know, in a way humanistic therapy's a good model of how to be a, great friend. You know, don't tell your friends what to do. Listen, and explore with them, but allow them to figure out their lives. So, humanistic therapy tends to do okay. But neither virtually any insight therapy they're not as good as cognitive behavior therapy. The therapy we're going to talk about next. but again, for, in some situations, maybe this is the best approach, so it depends a little bit on the actual context, the actual problem the person is, is feeling. Alright, so, I'm going to leave this in your hands now. Here are a few things, this is a whole channel about insight therapies, a YouTube channel, so a few different videos related to different insight therapies. This is a short little animation on psychoanalysis. This is about humanistic therapy. so On Becoming a Person, on becoming that person you want to be. so a nice little video on that to give you a better sense of humanistic therapy. over on the readings side, yeah, again an overview of insight-oriented therapies. This is actually from a UFT page. I wanted to give you this to give you a sense of, this is the sort of therapy we offer to our students as well here, if they're interested. Here's that link to Eliza, if you want to play with that computer program, [LAUGH] and have a free therapy session. It will give you a good sense of humanistic, she's not as intelligent obviously as a, as a real therapist would be, so some of the comebacks are kind of weird, but it gives you a feel for the style... and this last page describes psychoanalysis as it was, but also what it is today, so a little bit more updated view on psychoanalysis. So check that stuff out, and next time, we're going to talk about cognitive behavior therapy. See you there. Change the way you think. Bye Bye. [BLANK_AUDIO]
