The Myth of Psychodynamic Therapy

Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud) To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug. That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David’s answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem! Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.  Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.  So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.  This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!  For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.  Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.  What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.  So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.  I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.  Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.  A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM. Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds? David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks! Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause of anxiety is problematic because it may lead to a kind of therapeutic ‘tunnel-vision’ and delayed recovery, as time is wasted, trying the same approach, repeatedly, expecting different results. For example, assuming that ‘early attachment wounds’ are the ‘cause’ of anxiety may trigger the false belief that the most effective treatment would be many years, even decades, of Psychoanalysis.  This has been disproven, scientifically, yet it lingers in our minds, as a kind of mythology, passed down from our past.  Rather than subjecting our patients to decades on the couch, talking about their childhoods, it’s far more effective to ‘fail our way to success’, using multiple methods and measuring outcomes after each one, to discover what is actually effective for them.  Once you find the method(s) that are helpful, these will continue to be helpful, for that individual, throughout their lifespan, and it’s just a matter of practice. Another question about the Hidden Emotion model: when do you consider it “niceness” in anxious people and when is it the fear/anxiety to upset others due to the anxiety? David's answer. That can happen, but not usually in my experience. The “niceness” typically results from automatic suppression of uncomfortable feelings and problems. When they hidden problem or feeling is brought to conscious awareness, in most cases the anxious individual deals with it or expresses the feelings, and that’s when the anxiety typically disappears completely. As a part of my anxiety disorder, at times, I feel flat, emotionless and disconnected from everything around me. How do you treat that? David's answer. I use T E A M, not formulas! I do not treat symptoms, I teat humans. Matt’s Answer:  You could start with a Daily Mood Log, writing down the details of what was happening, in one specific moment in time, when you felt this way.  Include what you were thinking and feeling, including ‘flat’, ‘emotionless’ and ‘disconnected’.  For example, let’s imagine you had thoughts like, ‘nothing will ever change’, ‘this is pointless’, ‘I’ll never feel better’ and/or, ‘I shouldn’t be feeling so disconnected and flat’ or ‘I should be more in-touch with my emotions’ and/or ‘I need to be more up-beat’ or ‘people will reject me if I’m not more enthusiastic’.  You’d have to identify your particular thoughts, these are just guesses. After this, you could decide what, if anything you wanted to change.  If some change is desired, you might imagine a ‘magic button’ that would achieve that change, without any effort on your part.  For example, the button might eliminate all the upsetting feelings on your Daily Mood Log.  However, everything else in your life would remain the same.  Can you identify any reasons NOT to press that button?  Are there any positive values you have, related to these thoughts?  Would there be any down-side to pressing that button?  This represents your ‘Outcome Resistance’.  Typically, there will be many pieces of resistance that would need to be acknowledged or addressed before methods will be effective in helping you.  You can read in one of David’s many excellent books, like ‘Feeling Great’ and ‘When Panic Attacks’ how to make the most of this approach and what the next steps are. Thanks for listening today. MANY more cool questions on the best treatment techniques for anxiety next week. Matt, Rhonda, and David