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.