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New Methods of Psychotherapy

The three forms of psychotherapy are psychodynamic: thatís kind of like the tell-me-about-your-childhood kind of thing, which weíll talk about. Cognitive behavioral: thatís sort of like, "Look, your thoughts are all messed up. Every time you get in the car you have a panic attack. Letís do a stop-think here. Letís do some exercises, some deep breathing and maybe that will get rid of the panic attacks." Then finally, supportive psychotherapy: thatís what you do with schizophrenics or sometimes with people with dementia.

Traditionally there has been some conflict between supporters of psychodynamic therapy and CBT. At present Ö this was like back when Freud was kind of going out, like in the 60ís or the 70ís. There were sort of a lot of people who said Freud is it and everything that came from Freud is it, and other people said no, heís not it. Cognitive behavioral therapy is it.

Psychodynamic psychotherapy: this is basically what came from Freud, Freudís legacy. Freudís structural model consisted of the id - thatís sort of like the inner child, just wants to have fun, have a good time - the superego, thatís kind of like the stern parent, and the ego - thatís balances the two and lives in the real world. Freud came up with another model for the mind, the topographical model. Thatís the conscious, the preconscious and unconscious. The conscious is, "Yeah, I know Iím talking to a group of people right now." The unconscious is, "Well, Iím breathing, Iím blinking, Iím maybe adjusting my tie and Iím not realizing it." The preconscious is that tip of the tongue thing.

Psychodynamic therapy can be seen as a revised and evolved form of Freud psychoanalysis. Freud did the couch thing. Freudís thing was this, "Look, you sit on a couch, I sit there and take notes." Itís the basis for all those New Yorker cartoons. You know, youíve got the psychiatrist sitting there, "Tell me about your childhood." Freud would say, "Free associate and tell me whatís been going on." And then heíd say, "Youíve got oedipal complex" or whatever.

The basis of psychodynamic therapy is that you had difficulties earlier in life and youíve got these unconscious conflicts which are rooted in past experiences. What we do is have therapy. That brings the unconscious into the conscious and now you are not going to do it anymore. Iím not a big fan of this. I really have a lot of problems with it, actually, but this is what itís about. Traditionally the therapist interprets the meaning of the patientís symptoms. If the patient is, "Gee, Iím building a lot of bird houses."

Defense mechanisms: these I really would not put them on the Boards if I wrote the Boards, but we are going to talk about them because they can still show up on the Boards. Hereís the thing. Whoís ever heard of "forced normalization"? Thatís a neurologic concept. Forced normalization. I donít think it really exists. I donít think there is the literature to support it. Why do I bring it up? So that neurologists could relate to it.

So letís go through the specific defense mechanisms. Repression basically underlies the other defense mechanisms, and like the others, itís supposedly a way of relieving anxiety. You see something or experience something bad and then the mechanism takes the memory and puts it into your unconscious to be retrieved later.

Denial: is not accepting the truth. "My goldfish isnít dead, heís just resting." Splitting: those with borderline personality, which we will talk about, tend to see people as oscillating between all good and all bad. Splitting is, thereís no area of gray. We all like to split to an extent. Thatís why football games, basketball games are so great.

Projection: one theory behind paranoia is that a person unconsciously dislikes himself and deals with the anxiety by saying, "You hate me and you are out to get me."

Dissociation: the person sort of checks out during the incident. You would actually see this like in combat, people in car accidents will say, "You know, I was in a car accident. I donít remember getting out of the car. I was behind the wheel and then I was on the curb, but I donít remember getting out." People in Vietnam would say, "Hey, whereís Bob?" you know where Bob is.

Undoing: repeated actions to relieve anxiety. Classic Shakespeare, Lady MacBeth, "Out out damn spot." Remember the story of MacBeth. Lady MacBeth gets her husband to commit these murders and what does she do for the rest of the play? She washes her hands. That sort of undoing, you are trying to undo the crime.