Psychotherapy Saves: Dr. Norman Doidge - Full Interview

when we're thinking of doing intensive psychotherapy we're looking at a complex picture it's a person who could have depression or anxiety or psychosomatic problems or sexual problems or sleep problems or any number of kinds of problems but they're usually chronic they don't go away easily they're usually based on psychological conflict so the person is torn in two different ways you want something badly like a relationship but every time you start to get close you just totally panic and are fearful so the person has a conflict and it's usually a conflict that's caused by something that went awry in development so we're not machines you know we're not Hardware in software and it's not a matter of just changing the software and thinking differently we we grow when we develop we're more like plants than we are like machines and in the course of our development sometimes things go awry development can be blocked certain capacities don't develop there can be trauma which is the commonest thing we see in patients who need intensive psychotherapy and they tend when we've studied them here in Ontario and throughout the world to be people who have multiple psychiatric disorders if you're just doing that checklist they're depressed they're anxious they often have somatic complaints bodily complaints sleep problems sexual problems and also personality issues problems relating in certain kinds of situations so that's really typical and it's a class of people whose problems won't get better with less intensive interventions or if they had less intensive interventions it just prolongs the pain and doesn't resolve it or perhaps gives them a temporary relief so when we look at the kinds of people in Ontario for instance who've been in intensive psychotherapy the psychoanalytic psychotherapy is the interpersonal kinds of psychotherapy so what we find is 82% of them have already tried less intensive forms of therapy and one way to think about it is this like do you need a shorter term intervention or a longer term or more intensive intervention if you've had a pretty good baseline up here throughout your life and then some event happens some you know a death or some major disappointment something didn't materialize and your baseline functioning goes down here often with a short number of sessions we can get a person back up here but there are many many people who've never been up here they've had a sector of their personal functioning that's down here and those things aren't changed with a handful of sessions and often what we find when we look at it is there was something that didn't happen in development and so one of the things that's happening in these intensive forms of psychotherapy is we're sort of getting to the bottom of where development went awry and we help it resume and then when it resumes what you find is people can sometimes not only go up to a good baseline sometimes they can go beyond what they dreamed possible for themselves now this is a therapy that understands something really really important about human beings that we really are all different we've all had different histories and so it's not a therapy that goes by a manual and says if the patient says this you say that if patients were machines that would work every time perhaps but they're not and so because everybody's different what the intensive psychotherapists does is they ask a lot of open-ended questions and they don't immediately assume they know what's best for the patient what we do is we look for the blocks we look for the ways they get in their own way we look for where their insight starts to break down we pointed out to them we help them to see it and this always has to happen in the context of earned trust you have to take time with the patient to earn their trust and that doesn't happen overnight and it actually it doesn't happen in a couple of sessions either even if you're really be good when people's development have gone awry they're really sensitive to being misunderstood by others so as the trust is earned what you find is the person starts to spontaneously feel that they can with you their look into the aspects of themselves they don't understand and that's really really important you know when people come to treatment they often say how does talking help and it's not just talking it's talking with someone who's listening who's been trained to listen for these kinds of blocks if people like to make a lot of jokes about therapists just listening but actually if you ask Canadians what bothers the most about their experience with health care providers they'll say we don't have enough psychotherapeutic counseling we don't have people who are listening everybody's rushed on to the next thing now if you think everybody is the same or everyone with depression is the same why listen you hear the symptoms you think about the medication or the treatment and and you give it to the person you send them off or you tell them how their thinking is all messed up but if you don't think that everybody's the same each encounter with a patient is is very very different you know the kinds of people in therapy that I've treated over the years it's a full spectrum some of the stories are so awful you just can't sleep at night some of the stories yes they don't sound that awful but when you sort of look into the patient's conundrum you realize they're really stuck for a good reason look over the years I've dealt with people who have been forced to have sex with their mother their father a sibling I've developed a kind of expertise in dealing with patients who had very good parents but they lost them their parents died when they were very very young but people discover siblings who had committed suicide I've had people sent away for various reasons sometimes because of war sometimes because of illness from parents you know at an age when people need their parents the most I've had patients who have been viciously beaten by parents or caregivers people have been kidnapped people have had terrible disabling accidents but you know there are a lot of people who suffer terribly who haven't had these dramatic traumas that are easy to describe and suffering a suffering and they're very very blocked you know lovely people who for instance had subtle learning disorders growing up and they're always this close to accomplishing their goals and never can and they don't even know it's because of a learning disorder and when you start to figure that out sometimes we can send them for interventions for the learning disorder but having had a childhood learning disorder that wasn't wasn't known which is very very common by the way it can be very traumatic you can be traumatized by your own brain I've treated you know patients who've had psychosis and bipolar illness over the years and people would say well isn't that a chemical imbalance and there is a chemical imbalance in those but it's traumatic to basically not be able to discern what's real and what isn't real that's really traumatic this idea that if a person is either schizophrenic or bipolar or something like that that they don't deserve psychotherapy they just require medication it's absurd when particularly when the medications are somewhat helpful they can really use the psychotherapy and then there are people who have what's often demeaned as neuroses so here's what a neurosis is a neurosis is a situation where you're going in two directions at once your reason tells you that it's actually safer to take an airplane than it is to go in a car but you're much much more worried about the airplane or you swear you're not going to provoke your boss it's the day before he's deciding your raise and every time that comes up you go in there and you hear very annoying we can all chuckle about that but some people's lives are ruined by these kinds of things or there's someone you love and cherish and feel the most tender feelings about but you can't have any sexual excitement with that person so all of those things are in the class of things that are called neuroses and we like to make fun of them you know maybe that's the worried well except if it's you it destroys your potential perhaps for a marriage or for success at work so psychotherapy can also deal with those kinds of conditions and they're really really common and they're really really important to deal with you know there's another misconception out there we should look at the treatments and see which treatments cure people and which don't and not use the ones that don't that makes sense right except nowhere else in medicine do we talk like that here's what I mean by that you know in medicine what we've learned over the years is that we can cure sometimes we try to relieve often and we comfort always and there are certain people with mental illnesses that are really really severe and if we're honest we're not curing them but psychotherapy it's called supportive psychotherapy can be the thing between a schizophrenic person or someone who has an illness like that who's had just a life you couldn't even begin to imagine it's it's been so bad and they've lost the genetic lottery those people need someone to talk to sometimes that psychotherapy supportive psychotherapy goes on a long time but it's a very very humane undertaking and it's always been a medical kind of undertaking medicine is understood at times we comfort people and sometimes that psychotherapy these people have no one in their lives is keeping that person from killing themselves or just from a life of desperate isolation in a total abyss you know people who don't understand psychotherapy like to say it's talked their therapy which it is and that it's just talk but we've been doing psychotherapy for about a hundred years now and it's not just any old talk and actually when it's done properly we now have studies we have brain scans done that shows that it actually changes the wiring of the brain and that includes psychoanalytic psychotherapy that's a study by a bhoot kind that was done where people had tried previous forms of treatment didn't get better and then they were given intensive psychotherapy their brains were scanned before and after and when they had this intensive psychoanalytic psychotherapy as they got better their brain scans normalized and we know the parts of the brain that was firing abnormally at first and we know how it normalized and in recent years there has just been this incredible breakthrough this discovery that the brain is neural plastic so neuro is for neuron the nerve cells in the brain and plastic means changeable or modifiable or adaptable and neuroplasticity is that property of the brain that allows it to change its structure and its function in response to mental experience so that's thinking imagining perceiving reflecting on yourself all of those things when done properly in a professional way can actually change the structure and function of the brain in a positive direction and this is actually one of the ways that psychotherapy works so psychotherapy is working at a biological level it's affecting biological systems it's affecting chemicals we know this also from you know millennia of meditation when we study meditators they change their brain wiring and they also can change the chemical baths in which the brain is bathed so psychotherapy not only clearly intervenes at a biological level it can do so in a positive way and in some ways it does it in a way that's with higher resolution than medications do so look I recommend medications for some patients but not all patients and you know as much as it's necessary and no more and sometimes they are not necessary the over-reliance and medication I think it every sensible person knows can be a problem because when medications enter your body they bathe your entire body and they bathe your entire brain so even though the target of the medication may be one small part of your right when you take that medication for your issue you get all sorts of other effects they're called side effects but they're really just the medication doing what it does to parts of the brain that we don't want we don't want to influence so I don't actually think they're side effects they're actually just effects so medication thank God we have it for some conditions but using it when we shouldn't that's a problem so psychotherapy a particular one we're dealing with trauma what we can do is we can literally get the person to think about the trigger for their trauma and that activates those brain circuits involved in that trauma and then while they're activated if we've created a safe environment for the patient which is a lot of what we do as psychotherapists they can actually rewire it one of the things that happens in trauma is this you're in the midst of a terrible terrible attack and perhaps you think you're going to be killed murdered and you might stare up at the ceiling tiles and what your brain does is at a certain point it's when it literally cannot cope with that it fractures consciousness and it stops the perceptions from Co hearing free and you knowing the meaning of it that man his you know his raspy beard the fact that I'm being pinned down the knife that I'm seeing all means he's probably gonna try to slit my throat so it's probably a protective thing for you know when animals are about to be eaten by predators they go into what's called a dissociated state now the parallel or of the dissociated state in the brain is we stop putting our perceptions together so that we understand their meaning and so the person who's traumatized now after the trauma is over if they're lucky enough to survive never took that event though the which they their brain knew is perceptions if you will and put them into a memory because the the brain kind of froze in the midst of the trauma so what they do is if there's anything that is similar to the event let's say there is an there was a knife involved and then they see a knife at a restaurant with the chef is chopping something they could be retreat or if there was a loud noise involved in a war and then a car backfires so what happens is those perceptions which were never filed away as memory are reactivated and they reactivate your your stress center and it's like it's happening all over again in fact that's not the way to put it it's just happening because there's no sense of the past and what we do with these new traumas psychotherapies which are great they're one of the greatest breakthroughs in modern medicine as far as I'm concerned is we learn how to put a person in a particular state where they can trigger that memory and very very quickly in using different techniques that make them feel safe allow them to desensitize and so on they can actually file them away as memories and the patients always say the same thing when you work all of that through that's a term Freud used working through they say I don't feel like it's happening now I feel it's over I can move on it's like it was a really bad thing I feel really badly for myself as that child who experienced that but it's actually over now in many many ways in psychotherapy when we're working with trauma and I'm talking about it a lot because that's one of my specialties is we do that over and over in many ways we help people turn the page and experience bad things that happened as something that's over and now you can actually think about it because once it's a memory and you're not Reaper sieving it you've got all of your capacities to use to bring to bear on it so a lot of traumas can be healed and by the way can every trauma be healed that's just extrapolation I don't know I mean some things can be so bad life can be so hard that not always the case but sometimes we're surprised at things we thought couldn't be helped and they can be helped so it's always worth the effort Canadians made a covenant when doctors were asked to join the public system the promise was that we are going to insure everybody for - treatments of which psychotherapy is one of the most established treatments that we have and that would enable all levels of society to sign on to this and it would of course make it available for people who were of average income or less in fact when we look at who's in psychotherapy they basically make an average income in Ontario which is exactly what you would expect if it was distributed you know just according to medical need and but it's it's not cheap because it's intensive like most medical treatments where a person has a chronic illness most middle-class people would be completely wiped out if they had to pay for their chronic care you know we have taxes in Canada and to support these things and people have paid their tax dollars for these things and interestingly when we look at the psychotherapy that's done in Ontario what we find is that it's not over prescribed at all and the people who are in it need it and they're coming back because in general they're feeling they're benefiting people often say you know psychotherapy that's for the worried well you know that's for people from Hollywood or you know blabbing away about trivialities and it's for the rich and well if the government cuts out intensive psychotherapy it will be for the rich you

Channel: Psychotherapy Saves

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Id: 0Qc8EcPxixU

Length: 19min 13sec (1153 seconds)

Published: Fri Oct 30 2020