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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now, we continue our WNYC Centennial series, 100 Years of 100 Things. Today, it's Thing No. 61, 100 years of psychoanalysis and psychotherapy. Sigmund Freud was in his heyday of influence in 1925. He published a book that year called The Resistance to Psycho-Analysis. Over the last century, of course, the field of study and of practice that Freud set in motion has undergone many changes, including repudiation of some of Freud's own ideas.

Today, a variety of kinds of talk therapy are widely in use. The American Psychological Association lists psychoanalysis and psychodynamic therapies as one category, also behavior therapy, cognitive therapy, humanistic, Gestalt, holistic, integrative, and existential therapy as various primary examples. Let's talk about 100 years of psychoanalysis and psychotherapy with Paul Bloom, professor of psychology at the University of Toronto, professor emeritus of psychology at Yale.

He's the author or editor of eight books, including, most relevant to this segment, Psych: The Story of the Human Mind, which came out in 2023. He deals not only with individual psychotherapy but also the field's relationship to understanding some of today's social and political concerns. Of course, we live at a time when mental health crises of various kinds are considered widespread reflections of today's world. Professor Bloom, thanks for joining us for this. Welcome back to WNYC.

Paul Bloom: Thanks so much for having me back.

Brian Lehrer: Listeners, as we like to do in these 100-year segments, we invite your oral history calls. We would love to hear from people for this one who practice psychotherapy of any kind. How does the history of the field influence how you practice today? Did you come up through school learning about the history? Share some of that with us. Have there been schools of psychological thought from the last 100 years that you've mostly embraced or mostly rejected for your own practice? How do you use tools for more than one of those schools of thought if you do to create the best-practice practice in your practice? 212-433-WNYC, 212-433-9692.

Again, we'd love to hear from people who practice psychotherapy of any kind. How does the history of the field influence how you practice today? Have there been schools of psychological thought from the last 100 years that you've mostly embrace or mostly rejected or use a few of them in conjunction with each other for a best-practice practice of your own? 212-433-WNYC, 212-433-9692. Now, Professor Bloom, I'm going to play a clip of Freud speaking on the BBC in 1938. The audio is really bad, but just so people can hear his voice for a few seconds, he says here, "I discovered some important and new facts about the unconscious in psychic life, the role of instinctual urges, and so on.

Sigmund Freud: I discovered some important and new facts about the unconscious in psychic life, the role of instinctual urges, and so on.

Brian Lehrer: A rare audio clip of Sigmund Freud on the BBC in 1938. Give us that part of the history as you understand it, Professor. How much did Freud discover, as he put it, some important and new facts about the unconscious and psychic life and create a 20th-century science that didn't previously exist?

Paul Bloom: It's a great question. I think a lot of people listening to this are going to be surprised to hear that from the standpoint of the science of psychology, and I'm a research scientist, not a therapist, Freud is mostly seen as an embarrassment. A lot of his ideas are seen as ridiculous and I think rightfully so. Just about all of his specific claims about mental illness, about development, about sexuality are seen as just entirely mistaken and sometimes silly and embarrassing.

Brian Lehrer: Things like the Oedipal complex?

Paul Bloom: Yes, exactly. Penis envy.

Brian Lehrer: Okay, I was going to say it in a whitewashed way, but yes, so things like that, but go ahead.

Paul Bloom: Yes, and there's very little evidence for these things, but I actually am somewhat of a defender of Freud. I think it's an overreaction. I think that although the specifics were wrong, there's a core idea he had, which persists. I think it's right. I think it's important. This is the idea that we have unconscious motivations and desires that when it comes to even the most important decisions of our lives like who we love and what we do for a living and what pursuits we take on, we're driven by forces that we're not often conscious of.

You might think you love somebody for such and so reason. You might just be wrong. You might be wrong in your guesses as to why you vote the way you do and why you chose the job that you do. We owe a lot to Freud here. He's not the first to think about the unconscious, but he turned it into a science. I think there's an unacknowledged debt to Freud and modern psychology.

Brian Lehrer: What kinds of unhappinesses, if that's the right word, was Freud dealing with in his time, let's say, I know he started before 1925, but let's say around the time 100 years ago? In relation to what we discuss today, if today we use terms like "anxiety" and "depression" and things like that as being fairly widespread or terms that people would have a basic understanding of and recognize, what was it then?

Paul Bloom: The terms were different. He talked in terms of neuroses, which is a term that I think people still use, but it isn't used much by professional psychologists. To some extent, if you hear the stories of Freud's patients and the people he worked with, they'll sound familiar to you. We wouldn't use the same language described and we wouldn't say they suffer from depression or anxiety disorder. He would use different language.

They talked about troubles with everyday life, problems with relationships, often obsessions, often weird phobias. Freud's approach to dealing with this was what he called a "talking cure," which is he talked to them and tried to figure out what the underlying nature of their problems was. With the idea that if they understand what's up with them, if they understand the hidden forces that gave rise to the problems, the problems would pretty much go away.

I think many psychologists, as you say, still talk to patients. If you're seeing somebody right now, there's probably a lot of talking going on. It tends not to be focused that much on hidden realms of unconscious. Often psychologists now do, as you say, cognitive behavioral therapy. They focus on how to improve your life in concrete ways, techniques, and ways to deal with your problems. Still, there's some continuity from how Freud dealt with his patients to how people deal with their patients right now.

Brian Lehrer: Psychoanalysis, as we call it. Maybe you can define that psychoanalysis as he might have used the term 100 years ago. If the book that he released exactly 100 years ago in 1925 was called Resistance to Psycho-Analysis, what was psychoanalysis and what came next?

Paul Bloom: You probably know for psychoanalysis from old movies. Psychoanalysis, your patient comes in. They lie on the couch. They talk. The therapist goes, "Uh-huh, Uh-huh," takes down notes, occasionally says something wise. In orthodox psychoanalysis, you might go five days a week, an hour a day. The idea is you totally get your mind worked out. You figure out unconscious dynamics that are ruling you. I think there's still some psychoanalysis today. I used to live in New Haven. There were a couple of psychoanalysts or many psychoanalysts in Manhattan now. It is not a popular movement. It's not popular because it's time-consuming. It's difficult. It's expensive. It may not be as useful or at least not as quickly useful as other techniques.

Brian Lehrer: Let's take a phone call from a nurse practitioner, who does a type of psychotherapy. It's going to relate to some of this history as we go through a 100-year timeline. Shannon in Park Slope, you're on WNYC. Hi, Shannon, thanks for calling in.

Shannon Carroll: Hi. Amazing. Thank you so much for having me. Yes, my name is Shannon Carroll and I do Rogerian therapy, which is based on the work by Carl Rogers. Their belief is that you need unconditional positive regard, empathy, and presence in each session that you offer. That's what I try to do. The idea is that people will heal themselves if they experience that type of environment. I've seen it work obviously with guidance and safety measures and understanding of how the work goes.

It's an unbelievable technique and it's really good for people who are new to therapy because they come in and they're automatically liked. I know that all therapists automatically like their patients. In Rogerian therapy it's an extra emphasis in my opinion. Also like to say that in-person is a different experience than virtual therapy. I would love to encourage anyone who has access to, to go in person because we're supposed to be getting out of our houses and into third spaces. That's a great way to start.

Brian Lehrer: Thank you very much.

Shannon Carroll: Thank you.

Brian Lehrer: He mentions Carl Rogers. Where does Rogers come in? Was Rogers a disciple of Freud in any way?

Paul Bloom: Well, Rogers ended up very different from Freud. The approval and love and warmth associated with the Carl Rogerian school of therapy is very antithetical to Freud. This call is a nice illustration of how there's now many, many different types of therapy and some which are incredibly divergent from what Freud started off with. One of the surprising things is that we could be critical about therapy.

I think the study of how to cure mental disorders has not been a pure success story to say the least. Still, therapies tend to be better than not going for therapy. Strangely, just about all therapies have their successes. Some people think it suggests that it's not due to the specific techniques of the therapy, but just having a sympathetic person listen to you, what's sometimes called a therapeutic alliance. Some concern, some hope, some optimism.

Brian Lehrer: Roger's heyday was not that long after Freud's, right? 1940s, 1950s, around there?

Paul Bloom: That sounds about right.

Brian Lehrer: The caller talked about empathy. You just mentioned empathy. I think you wrote a book called Against Empathy, didn't you?

Paul Bloom: I did, I did. We talked about it a while ago.

Brian Lehrer: What does that mean?

Paul Bloom: In the clinical setting, actually, it means we should make certain distinctions. I argued in the book, backed up by a lot of therapists, that it's extremely important for a therapist working with you to understand what's going on with you. Empathy in a sense of understanding. It's extremely important that they want you to be better. They feel for you. They feel compassion for you.

The argument I made against empathy is that too much connection, where the therapist feels your pain too much, experiences what you feel, can get in the way of the helping process. There's a lot of evidence that if you're too empathic in that sense, if the patient comes to you and they're anxious and they're sobbing and you're anxious and you're sobbing, you're not going to be a good shrink. You need some sort of clinical distance to do your job well.

Brian Lehrer: Interesting. Another listener writes, "Good morning. When you start with Sigmund Freud, don't forget to mention Carl Gustav Jung." People do talk about Jungian psychotherapy, if that's the right word, or Jungian analysis or research as deriving from Freud but taking a next step, right?

Paul Bloom: Yes, people do. The Jungian movement hit popularity. He was Freud's most famous student. There was this wonderful, interesting dynamic between the two. I think it's fair to say that as this form of therapy right now, it's extremely rare. I never heard of anybody who currently does it. I've seen it. I've read about it in novels. I saw a movie where they had it in. If you go to a therapist, you're not going to throw some Jungian stuff at you.

Brian Lehrer: How would you describe it or define it, Jungian stuff?

Paul Bloom: All I connect with Jung is the idea of archetypes. The idea that they're fundamental, universal themes that emerge over and over again in the human mind and within each patient. Part of the therapeutic process is wrestling with these archetypes.

Brian Lehrer: Let's take another call. Here's Ellen in Nyack. You're on WNYC. Hi, Ellen.

Ellen: Oh, good morning. Thank you so much for doing this. Yes, I just wanted to comment. I'm a psychotherapist in Nyack in New York City. I employ, which I know many other therapists employ, what's called an eclectic approach, where you evaluate your client and see what they need. That could include cognitive behavior therapy, which can be very helpful, combined with medication, and also sometimes psychodynamic therapy, vocational therapy, art therapy, Rogerian, somatic. I do EMDR. There are many varieties of therapy that can be effectively used rather than being very rigid with one and not bending to what the client might need.

The other comment I wanted to make about Freud, which I feel very strongly about, I did go and get certified as a psychoanalyst at one time. I feel that Freud's worldview was very much of his time in protecting the men of his time, the males, the responsible burghers of Vienna, Austria, and wherever he practiced in that. I've worked a lot with child sexual abuse.

At the time, child sexual abuse, especially from parental figures and caretakers, was taken to be Oedipal complex where the child was projecting their own fantasies. I think at that time, it was definitely to protect a lot of actual sexual abuse that was going on to protect the people who were doing it, who might have been very respected or responsible members of that society. I feel that for 100 years, that's done a lot of damage to children who are not always believed they are actually being sexually abused.

Brian Lehrer: Ellen, thank you very much for your call. In fact, Professor Bloom, I saw you say in a KCRW interview that, to some extent, modern psychologists see Freud as if he were some sort of pharmaceutical company that got its start by selling meth. That's some quote.

Paul Bloom: Yes, so your caller raises a good point. Freud is in for a lot of criticism. Some has to do with his ideas themselves. Some has to do with his personal style, which was often. He can be very cruel and very ambitious and not entirely honest. The caller's right that one of the issues about Freud is that he heard many stories of sexual abuse. He chose, for whatever reason, to see them as fantasies of the patients and not things that actually happened. That's one of the indictments against Freud. I think it's fair to say that his views about men and women, about sexuality would not export well to modern times. He was very much a man of his time.

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Brian Lehrer: Go ahead.

Paul Bloom: By the way, the emphasis on eclecticism, which is a really good point. We're talking about different schools of therapy, but it's not like there's a psychoanalyst and Rogerians and behavior therapists. Most therapists take an eclectic approach where they use whatever works. At least the best therapists use whatever works. You might go to a psychiatrist and be given some SSRIs for depression but also talk about your problems and talk about your feelings and also get some advice and everyday techniques to make yourself better. The best people in the business use many different tools.

Brian Lehrer: Claudia in Manhattan, you're on WNYC. Hi, Claudia.

Claudia: Hi, how are you? Thanks so much for doing this. I'm a guide in the world of psychoanalyst. I've actually written a textbook about becoming a psychoanalyst. I think we have to remember that Freud talked about the unconscious and that CBT and all of the other mindfulness therapies don't help us get to know the parts of our brain that are reflexive. I think what Freud offered us, as misguided as he was in his methods and the way he treated people, was that he gave us theories of the mind so that we understood that we have defenses that keep us from feeling pain.

He understood that maybe there was an ego, superego, id, although we don't use that anymore. That was a metatheory of the mind. When we deal with mental disorders, we need these metatheories. Where are the patient's energies going? What are they defending against? How do they experience reality that we want to help them discover? What we've learned since Freud is that interpretations and insights don't work. You can know everything about yourself and it just won't help.

We've replaced interpretation with what's called "emotional communication." Instead of falling into the trap of caring too much for the patient or telling them where to go or giving them an attitude adjustment, we want to give them a new experience in the session where we listen, where we help them see a new way of looking at their own maladies and scratch beneath the surface and look under the hood so they can start to understand their own mind. This is what we preserved from Freud and the greatest gift that he gave us.

Brian Lehrer: How interventionist does that leave you, Claudia, as a psychoanalyst? I think the stereotype of the original model is the analyst doesn't say anything, doesn't necessarily give advice, for example, as opposed to just asking some questions that draws out the inner thoughts or an expression of the subconscious, if that's the right way to put it, from the client.

Claudia: Well, Freud believed and we don't want to have empathy. He believed we had to get out of our patient's way and that was his way of doing it. If we do that today, we're getting in the patient's way because it's too frustrating. We want to have a real relationship with our patients. We want to get in there so that we're no longer strangers to them.

That's why psychoanalysis takes so long because it's not an intellectual process. We become soul-to-soul connections like family, and then we can get inside, look under the hood. The methods are perhaps how psychoanalysis has become most revolutionized. Freud used to hypnotize people. He'd put his hands on people. He told them they wanted to screw their mother. [laughs] He had a lot of misguided methods, so that's changed a lot.

Brian Lehrer: Yes, so it's--

Claudia: We are no longer the tabula rasa. We get in there with our patient, but we have to make sure that it's not about us.

Brian Lehrer: Are you proud of your field for having evolved so much over 100 years?

Claudia: What's that?

Brian Lehrer: Are you proud of your field for having evolved so much over 100 years?

Claudia: I'm so glad you picked that up because we need somebody that helps us understand our unconscious. Usually, people just react to us the way we induce them to. They get annoyed with us if we're unreasonable, when we're exaggerated. They give us attitude adjustments when we're twisted. We do need practitioners who can enter into the world of a patient non-judgmentally and help the patient get to know themselves. It's really the highest form of love in some ways to have this clinical experience.

Brian Lehrer: Claudia, thank you so much for your call. Let's keep going. Here's another licensed psychoanalyst, he says. Tom in Manhattan. Hi, Tom, you're on WNYC.

Tom: Hello. I trained in analysis. I've been a licensed psychoanalyst for a number of years, but I've seen a sea change in the field from seeing the human being from an objectivist point of view to understanding that we have something called intersubjectivity, which is you are not an object of my observation, but you are a subjective person in your own right. Therefore, the best we can do is have a relationship in which we acknowledge the subjectivity of the other and see what emerges.

One of Freud's closest followers was a man named Ferenczi, who believed that Freud was wrong in giving up the seduction theory that, in fact, many of our patients are subject to sexual abuse. For taking that position, Ferenczi was exiled for 50 years. Now, he's become an icon. There's a Ferenczi school at The New School. All of those years where patients were told that their experience of being sexually abused was fantasy was a great injustice. For one, I actually was in an encounter group with Carl Rogers. I also did training in Gestalt therapy that there is no formula for understanding how to cure mental illness. We have to depend on what emerges unbidden from the relationship rather than to impose a dogma onto our patients.

Brian Lehrer: Tom, thank you so much. One more in this set. Meryl in Brooklyn calling in, I think, to say, "Unlike has been stated before, Jungian therapy is not dead." Meryl, you're on WNYC. Did I get your gist right?

Meryl: You sure did, Brian. Thank you so much. Yes, I was pretty surprised to hear your guest say that for many reasons. One, there are two very active Jungian training programs in the city, including the C.G. Jung Institute. The C.G. Jung Institute has a low-fee referral service that is busier than ever. I really don't understand how that could be. My husband is a Jungian psychoanalyst. I'm a creative arts therapist. I use Jungian techniques within my space. It's just it's a really shocking thing. Actually, anecdotally, we--

Brian Lehrer: What's an example, the Jungian technique?

Meryl: Oh, like dream work, dream analysis. Your guest mentioned archetypes, but parts work. There's a lot of conversation now in the therapy space about internal family systems that all evolved from Carl Jung's work with parts, which is considering all the different ways in which your different aspects of you that are protected or subconscious.

Brian Lehrer: Meryl, let me ask you a question since you're connected to the field in the ways you describe. From a listener, I'll throw this to you. Listener writes in a text message, "How can people figure out what style of therapy is best for them without having to hop from therapist to therapist?"

Meryl: Sure. Well, first, you should speak to different therapists to get a sense of, first, if there is the possibility of a therapeutic alliance. Also, it's understanding what your goals are going into the space. People go into therapy for a variety of different reasons. One of your other callers talked about the shorter long-term goals. There's plenty of people who are going in to address particular anxiety or what have you. Certainly, CBT or DBT and those kind of things, that can be useful. To go deeper, you want to be working with someone who does more depth work.

Brian Lehrer: Meryl, thank you very much. Anything to add on that question, Professor Bloom?

Paul Bloom: All of these callers seem like great therapists. I could tell a certain compassion, interest in other people, an ability to listen and be constructive. To go back to something, I'm not myself as proud of the progress for the last 100 years. One of the reasons is that all these specific claims are being made. I'm not sure that the claims that are rooted in Freudian ideas are actually true. A lot of people are skeptical. One of your callers talked about getting at repression and unconscious drives and all that when it comes to treating somebody.

I think there's reason to doubt that that's the best technique. If you're suffering some severe depression or anxiety attacks or panic attacks, it might be your problem doesn't have anything to do with defense mechanisms and hidden conflict. It might have to do with neurochemical imbalances. It might have to do with maladaptive ways of living. It might have to do with a terrible life circumstance. These things are addressed in better ways than the talk therapy that we've been going over.

Brian Lehrer: When did medications to treat emotional or mental conditions get introduced in this 100-year history?

Paul Bloom: I think medications started to get used from the get-go. Pretty soon after Freud, there were various attempts to treat people with different drugs. It hit its stride with the development of SSRIs, drugs that influenced neurotransmitters like serotonin and dopamine. I think these medications do good, do well. I think that they help people some of the time. I also think, to be fair and maybe here I'm on the side of the Freudians, that their efficacy is often really overstated.

Anybody who's gone to a psychiatrist for help and been prescribed medications will know sometimes they work, sometimes they don't. Sometimes they have awful side effects. Sometimes you have to try one and try another and so on. It's not like antibiotics or something, a success story. You would hope that in the next decade or so, we'll come up with something better. Honestly, over the last 25 years, there hasn't been significant progress. Medications work so-so. That's the way they were 25 years ago.

Brian Lehrer: We'll continue in a minute and finish up on this 100 Years of 100 Things segment on 100 years of psychoanalysis and other psychotherapy with Paul Bloom, professor emeritus of psychology at Yale and author of Psych: The Story of the Human Mind and more of your calls and texts. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC. A few more minutes in our 100 Years of 100 Things segment for today on 100 years of psychoanalysis and other psychotherapy. Another landmark researcher of the mind from the last century who I haven't mentioned yet, also very controversial in retrospect and maybe in his day, was B.F. Skinner, who's credited with developing theories of behaviorism. Here's a clip of Skinner in 1971. He's explaining the idea of operant conditioning to produce and reinforce certain behaviors. We pick it up as he's about to demonstrate reinforcement of a desired behavior on pigeons.

B.F. Skinner: The consequences of behavior are as important as its antecedents. Things happen to an organism after it behaves and have a very important effect on it. The effect is to make it more likely that the organism will behave in the same way again. That is what is called "operant conditioning." Food to a hungry organism, hungry pigeon is what we call a reinforcer. All I can do with this switch is to make that reinforcer occur at the proper time.

Brian Lehrer: We only have a few minutes left in the segment, Professor Bloom. Was there a social or political or cultural context to B.F. Skinner? I know that one of the things with respect to your book is that you try to place it not just in the realm of individual pursuit of happiness, but also what's going on in the culture.

Paul Bloom: Yes, so Skinner is a fascinating figure. He was, to some extent, a reaction to Freud. Freud said we have all this crazy stuff in our heads, these weird sexual desires, these complicated feelings, dreams, and all of that. Skinner rejected all of that, went to the other extreme, said there's nothing in the head. We just talk in terms of reinforcement and punishment. A human is no more complicated, no more interesting than a pigeon.

Skinner developed his theory of operant conditioning and use it as a way to make people's lives better, he argued. Also, he had a social program. He wanted to use his techniques to make society better, figure out ways to reinforce good behavior and punish bad behavior. He wrote a book, Walden Two, where he sketched a utopian society based on these principles. I think, in some ways, Skinner has done worse in history than Freud. At least we still respect a lot of Freud's core ideas.

The idea that there's no such thing as thoughts, no such thing as ideas that you do with psychology that doesn't take those into account is something, I think, nobody takes seriously now. A lot of the techniques that Skinner developed, developed in terms of training animals and very low-level techniques involving reward and punishment, are still used. They call it cognitive behavioral therapy. The cognitive part, Skinner would have hated. The behavioral part, he would have got behind. The idea is that we should encourage adaptive behaviors, discourage maladaptive ones. In some way that while a theory of Skinner isn't that worth taking seriously, his techniques have lived on.

Brian Lehrer: Interesting. Here's our last listener comment. Listener writes, "I'm 44 years old and have been in therapies since I was 19. I love the fact that your guest touched on how the field hasn't progressed much, especially in the way of meds." In our last minute or so, you have said that the field has been stagnant for about the last 30 years. You've called it a young science. Can you reflect on that and then we're out of time?

Paul Bloom: Yes, I think a lot of clinicians might disagree with me, but I've talked to people and I've talked to experts. The progress has been limited. We have made progress actually in areas such as making therapy more available to people. I think in-person might be better than virtual as somebody said. Still, the accessibility of therapy online makes therapy available to so many people who wouldn't otherwise get it.

There are certain treatments for psychosis that we have that we didn't have before. Still, if you come in and you're sad and you're anxious and you're miserable and you go to a therapist, what you'll be exposed to will not be substantially different from what you've been exposed to 25 years ago. I think that's worrying. I think it would be nice if we had a revolution around the corner.

Brian Lehrer: Paul Bloom, professor of psychology associated with the University of Toronto and Yale and author of the 2023 book, Psych: The Story of the Human Mind. Thank you so much for sharing some of the contents of your mind with us and talking to our callers in this 100-year segment.

Paul Bloom: Thanks so much for having me on.

Brian Lehrer: That's The Brian Lehrer Show for today, produced by Mary Croak, Lisa Allison, Amina Srna, Carl Boisrond, and Esperanza Rosenbaum. Zach Gottehrer-Cohen produces our Daily Politics Podcast. Alison next.

 

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