S2E23 The Problem with Freud

Without further ado, Dr. Rubin and Dr. Pete bring you the first episode regarding the differences between behaviorism and traditional psychoanalysis as developed by Sigmund Freud. They highlight how the practices are similar and how behavioral health providers are often implementing more similar interventions than different, but how eastern traditions are nonjudgmental and likely more applicable across groups when compared to traditional Freudian theory. Tune in to learn more.




Nikki: Pete, this is an episode we've teased for a long time, that you and I, we've been really interested in talking about. And today got a little bit of a provocative title here for any psychodynamic clinicians out there listening, which is we're going to talk about the problem with Freud today.

Pete: It’s about time,

Nikki: It's about time, we're also going to talk a lot about we owe thanks, we owe a lot of like gratitude to Freud and his contributions to the field. But we thought it was really important to talk about this, because I would say, if just average listeners out there that aren't clinicians, most people, when they're thinking about anything related to psychology, or psychotherapy, really tend to think about stuff that's Freudian based. And our job, and one of the reasons we wanted to do this podcast was to disseminate information about the most current methods in behavioral science and then of course, in eastern spiritual traditions that we use quite a bit of. So yeah, I don't know, anything you want to add before we kind of dive into some of the little bit of the history here and a little info.

Pete: Well, you and I are not experts in psychodynamic or psychoanalytic theory, we're going to break that down a little bit for our listeners. Because I think when we think when our listeners see a therapist on television, they're often a, like Freudian type therapist, that's portrayed in a lot of like media,

Nikki: Or like ‘In Treatment', that new season just came out.

Pete: That's still alive?

Nikki: They just have a new season.

Pete: I can’t imagine that.

Nikki: Yeah, a new season. So yeah, no, that's right on TV. It's almost always

Pete: Almost always, yeah.

Nikki: Oh, psychoanalyst. Yeah.

Pete: Yeah, so… yeah, go ahead. Sorry.

Nikki: No, you please. We're like “No, no”.

Pete: Well, so we're thankful for like a lot of the theory because what we're going to say for at least for like modern psychotherapy, if it weren't for some of the Freudian stuff that maybe we wouldn't, I always joke and say, like, “Freud also gave us cocaine”. Which, because there was he, yeah. Did you know that?

Nikki: No, I didn't know that.

Pete: I'm not sure. Like, I remember reading the he, I don't think he like developed it. But I think he studied it as like a treatment modality for some folks.

Nikki: Interesting.

Pete: I would be very interesting, because if you think about some of his theory, like it's, I mean, cocaine is an upper. Perhaps that was like how he got, maybe that's why all his theories were just so sexualized. I don't know,

Nikki: Well, maybe. I was going to say cocaine, it's almost like, it mirrors like a manic episode.

Pete: That's right.

Nikki: So there's like, that's very, wow, that's fascinating. See guys, I learned stuff in real time.

Pete: Well, I'll break that down a little bit. Because that's also, I came from a program that trained more in psychodynamic theory than you did. Because I don't think you really got much, if any?

Nikki: No, I did get some

Pete: Oh, you did. Okay.

Nikki: I did get some but the difference, and we have mentioned this a little bit on the podcast before that, Pete, obviously trained in the New York metropolitan area.

Pete: On the east coast.

Nikki: On the East Coast, which, and New York itself is really like a hub of psychoanalysis and on the west coast, it's just not the dominant theory and practice and there some reasons for that, which obviously, we're going to talk about today. So maybe let's just start with a little bit of history and also just explaining why we do owe a debt of gratitude to Dr. Freud. So psychoanalysis, he really sort of like coined it or was like, officially sort of came into the mental health world in 1896, he was in Vienna. And Freud, he's the first person to really do psychotherapy and the way that we do it today. And again, listeners will be familiar with sort of the imagery of like, a patient lying on the couch. That is specifically psychoanalytic. So other types of therapies don't do that. So just, if anyways, if you're listening and you’ve been in therapy, when Pete and I see patients in person,

Pete: There's no laying down.

Nikki: There's no laying down,

Pete: Although sometimes I do lay down for like [inaudible 4:34], but alright.

Nikki: Well, sure, but not for the treatment.

Pete: Not for the treatment.

Nikki: It's like…No, the person's sitting on a couch, and we do have a couch but we're speaking face to face. So he started this process of creating a space to begin to explore, I think the word you probably use is the psyche. And honestly, Freud had a lot of theories related to like exploring the unconscious, so like dreams and dream analysis. And there's a lot of overlap, I would say, we humans evolved. I mean, I don't know, with any kind of, some spiritual traditions honestly just like exploring the depths of the mind. So it was, at the time, very cutting edge.

Pete: It was very cutting edge. And that's really where the couch came in, because it was free association was the technique they use. And so the providers…

Nikki: Say what that is for people,

Pete: So free association was just this idea of like, that was getting into consciousness. So whatever came up, whatever arose during the conversation is what he would say we'd get deeper down into the unconscious. That's why the couch often faced away from the provider, because they didn't want to have anything that was like interfering. And I think there's even a research, psychoanalysis were trained, I think, I'm forgetting now. But I think the couch either faces the window, or vice versa. So even in terms of the office, there's like the angle in which the provider is, versus the window is also really relevant.

Nikki: I also don't remember what the direction is. But yes, you are, right. There's like a certain orientation in terms of the office. And it also has to do with the transference and countertransference.

Pete: So break that down for us,

Nikki: Yeah, let's talk a little bit about that. So another part of Freud's theory is that what's going to happen in the room between the relationship between the patient and the therapist is that the patient's brain, I guess we could say it that way, is going to in the moment, kind of like, how do I want to say it, re experience or reenact,

Pete: Reenact,

Nikki: Reenact what they experienced with other people and put that on to the therapist, which is called transference. So it might be like, let's say the patient has a difficult relationship with their father and,

Pete: I become their father,

Nikki: You become their father. And the idea is for the therapist to be as blank a slate as possible. So that they're not influencing the transference in any way that they want. They want the reenactments, so to speak to…

Pete: So say more about the being blank as possible.

Nikki: Yeah. So it's not…

Pete: Because you had fluorescent pink nails. There's nothing blank about that.

Nikki: Truth, that's right, yeah. Different schools of thought here. So it's being a blank slate, not reacting, being sort of, again, as blank as possible. So that would include like, in the way someone dresses as well. And then countertransference is the way that the clinician feels towards the patient. That's a term, actually, we still use across the different types of psychological theory of modalities today. So we use that as cognitive behavioral therapists as well.

Pete: I love how you just said that, it's across therapeutic modalities, because it's not an ‘us and them',

Nikki: Thank you for saying that, that's right.

Pete: Yeah. Because a lot of times, especially like, East West, even in the practice of psychoanalysis, it's cognitive therapy versus psychoanalysis, and it's not.

Nikki: It's not, no, and that's where, Pete and I, especially, Pete's obviously still on the east coast. And I definitely had this practice when I was living there. Our interest is in doing what is effective, and what's evidence based, and not disregarding anything that's come before. And of course, keeping things that are still working, though also recognizing when there are some things that are not working or don't work as well. So this is like the practice of flexibility. And this us versus them, so glad you're bringing that up, not only, and it doesn't matter who, it could be CBT versus psychoanalysis, or it could be anything, like humanistic existential versus, I don't know, family systems or something, whatever. That shuts down curiosity, openness, and to me, it always sort of boggles my mind, I find extremely perplexing. So I’m like, our commitment as clinicians is to help people evolve and grow in ways that are most effective, and how are we going to do that if we're focused on judging what works and what doesn't. Like I have said, actually, Dr. Danielle Keenan-Miller, who we had on for our disordered eating episode, she actually mentioned this the other day, she said when she was interviewing me, she's like, “I don't know if you remember this, Nikki”, she go, “but when I was interviewing you to work at UCLA” she said, I said to her, “if a bunch of research came out tomorrow and said, CBT doesn't work at all, I would stop doing it”.

Pete: That's right.

Nikki: And she said, “I just was like, I love you”. And I said, “I don't remember saying that to you but I say that all the time”. And I mean it because we want to keep evolving and so,

Pete: Keep evolving for what works.

Nikki: So if we go back to our title here of like, the problem with Freud, is that there has been an attachment in our field to aspects of Freudian theory that don't work that well.

Pete: And we're going to talk about some evidence base Freudian theories. I'm going to break it down, I want to break it down a little bit, just I'm going to have you go to that one. Because we've been talking about psychoanalysis, and just for listeners, what's important in psychoanalysis, Howard Stern famously will talk about psychoanalysis and has been a patient of psychoanalysis for a long time. And that requires, A, a lot of money, and B, like three days a week, going in to see your therapist.

Nikki: Three to five,

Pete: Three to five days a week to go see your therapist. So that's not something that most people can afford. And however those that offer psychoanalysis have gone through psychoanalysis themselves. So that's where that's also a commonality with mindfulness, because as a mindfulness provider, you want to also have your own practice. The other psychodynamic is Freudian informed and so that would be more of borrowing a lot of the theory, but a typical kind of one day a week, an hour a week, every week, the difference also there is that it's every week for an unidentified amount of time. And oftentimes, it could be for like, one's entire life, where in CBT, we tend to kind of be more solution focused. So I quickly want to talk about the theory of like, one of the theories, so Nikki countertransference, transfer is really important. One of the things that again, we're not experts, but id, ego and super ego, you may have heard of, and that's a big piece of any kind of Freudian based therapy, thinking about ID as this like, pleasure principle, like instinct, which is like someone's desire to either like, have sex or to kill, whereas the ego is like reality. So ego would come in and be like, “Well, you can't really kill that person, because it's against the law”. And super ego is also morality there of like, “well, it's also like, not good to do that to people, because that's a mean thing to do”. So I just wanted to make space for that.

Nikki: Yeah absolutely. And we can also say, like those concepts, also, those probably resonate with people because like, those are aspects of how humans orient, we don't use that language in behavioral therapy.

Pete: Like ID, ego, superego.

Nikki: Yeah, we don't. And yet, those concepts we absolutely talk about. We talk about, like, what are the biological drives? We talked about that all the time.

Pete: A dialectic,

Nikki: Right, dialectic, we talk about seeing reality as it is, that's part of mindfulness. And we also talk about, like, the morality piece, we kind of link that a little bit to values,  frankly. Though, I think, if I'm remembering correctly, the super ego gets actually kind of judgy, actually, super ego can get a little bit rules oriented, which, again, humans do that,

Pete: The brain likes that.

Nikki: The brain likes that.

Pete: So what would you say about the sexuality part of it?

Nikki: That to me, personally, is what I find the most problematic. I don't know if you agree with that.

Pete: I do.

Nikki: Yeah, so Freud's theory relied pretty heavily on kind of viewing humans as, I mean look, we are sexual being, but again, some people are asexual, many humans are sexual, but I think well, that's important, too. So there's an assumption that everybody is sexual, number one, and two, he really characterize different stages of development. And I would say many behaviors as somehow linking back to sex. And this is where I also want to mention, just and maybe we'll do another episode on this, but there is some, I can't get too deep into it today, but there are power dynamics related to men and women that existed at that time that Freud, obviously, he was a doctor, he saw a lot of female patients and then I just want listeners to think about, and then what that must be like, that there's an assumption that everything has to do with sex. And he would also talk about, there's also things about talking about like, in childhood, that sex is a big,

Pete: Well name those,

Nikki: There's like this, I just wanted to forget some of them. But it's like the anal stage, for example, like that. This is, my apologies, listeners [inaudible 14:26]

Pete: Well, no, I’m sorry. I was thinking more of like the Oedipus complex.

Nikki: Well yes, those too. So will you actually share a little bit about that.

Pete: Okay, there's the Oedipus complex, or like the, I don't think it's, based on that was like the Electra complex. So essentially, sort of like a child wanted to have sex with their parent or idolize their parent. So, again, we're not experts in this we're probably saying this wrong. Certainly someone who has like gone through analysis or is a writer would discuss this differently. But the underlying theory there, is that there's like orange envy or like primary sex organ envy.

Nikki: Well actually, say what it is, specifically, he said penis envy,

Pete: Penis envy,

Nikki: That women envy like having that men have penises. And the Oedipus complex really was specifically saying that young boys do you want to have sex with their mother and then get rid of the father by killing him. He believed that that was like a natural biological, like inborn urge. Which…

Pete: Sounds kind of nuts and psychotic.

Nikki: Yeah, so I mean, and so I think we can use this as a segue to say, look, theories, any kind of theory is just that, like people make, we make hypotheses based on the information available. And so like we said, a lot of Freud's theories at the time were very cutting edge, they were provocative, this is like in the Victorian era, to be talking about sex at all. Even this, he started to say, there's an unconscious and like, what's going on behind the scenes in our brain that we're not paying attention to. So theories are hypotheses.

Pete: And I think sometimes they take these as facts, like, I think,

Nikki: Yes, so that's where we're sort of coming up on where I think, that there's the problems here. Is that, we want to be able to as, and as clinical scientists to be willing to acknowledge what do we know, and what don't we know. And look, there hasn't been any data to suggest that young boys want to have sex with their mothers and kill their fathers, haven't been able to conclude that yet. Though, look, we do have plenty of data that people have biological drives, for example. And so I think that where Freudian approaches can get really sticky, is that yes, that there's often, and this has been my experience that I was consulting with folks that have, and I've had some really, I should say, I had some wonderful psychoanalyst colleagues in New York,

Pete: Sure, we still do.

Nikki: Still do, had some great conversations and talk a lot about stuff like the conceptual

Pete: Well, actually…go ahead, I’m sorry. I was going to say maybe you could talk about like the evidence based psychodynamic therapy, because that's what I also hear you saying is like, the data that is there is like ADP.

Nikki: Right. Well, let me say this part first, and then we can talk about that. Because those therapies are focusing on what do we know. So people that are focusing on what, like being attached to some of the older stuff, like what Pete was just saying is that, what I've often noticed is that, because the psychodynamic… or I'm sorry, my apologies, psychoanalytic approaches often rely on an intervention called interpretation, interpreting what the patient is saying. And I say to people, and especially when I'm trying students, I'm like, therapists, we certainly make interpretations, which are just guesses about what we think is going on. However, I would say my experiences from Freudian approach, interpretations are talked about as truth, as facts, which we've talked about. We have an episode on judgments, and interpretations are just opinions, they're just judgments. So when I've talked to somebody, I might make, I say it's a guess. I'm going like, “I don't know, this is what I think”. But then I asked the patient, “what do you think, does that resonate with you?” As opposed to, ‘this is what's happening’.

Pete: Like, “your dream means this”.

Nikki: Right, it's like, and I see visions all the time, people will talk to me about dreams, and I'll go, they're like, “what does this mean?” I'm like, “I don't think it takes being a psychologist to know what a dream is”. I was like, “sounds like you're scared. I don't know, what do you think?” So I think it's this concept of like, being willing to let go of saying we know everything, and so yes, there are a number of evidence based psychodynamic excellent treatments, emotion focus therapy, accelerated experiential, dynamic psychotherapy. I think there's one also called brief short term psychodynamic therapy,

Pete: There is, yes,

Nikki:  There is transfer focused psychotherapy, which borderline personality disorder. There's a lot of excellent ones out there, though again, why I love behavioral science, it's like, I'm just really interested in like, what's the data say. You know what I'm saying? Would you add anything to that?

Pete: No, because, so on one hand what I hear, it's like, it's nice, beautiful dialectic. On one hand, we're saying like, there's a lot of similarity. Any kind of behaviorism is born out of this, especially in the Western world. But that there's, if tomorrow I learned that CBT wasn't good for panic, I wouldn't start doing CBT with panic.

Nikki: Right. And you know, what I want to add on too is that, so behavioral science is the study of human behavior. And so there's, actually one of my favorite behavioral science books is called ‘Learning RFT’, relational frame theory, which we've mentioned on here before. And in that book, there's a great example where it's saying, you can apply behavioral science to literally anything, even to psychoanalysis, because you're two humans in a room doing behavior. And so what I would say is, I want to have, the more knowledge we have, the more we can help people. So yeah, again, to me, I'm, like, I talked about countertransference, and I would like to keep adding knowledge and using behavioral science to continue to help people change and improve their lives. And so yeah, obviously Freud's not my guy. He's not, and I'm grateful for his contributions to the field.

Pete: And before you wrap it up, there's not much to add from the east for this, because this is really just that kind of Western theory, but what I will say is, I do think Eastern practices are a bit more like accessible, so they're really more global, that really any culture, any person can. Whereas, something like a Freudian type-based therapy is really, maybe more Western based, and certainly more privileged base. And that's a lot of the criticism where it's really white man base too.

Nikki: That's right. And it's straight up from Europe. So that's such an important point. But I think also, some of the Eastern approach that we're taking is to just practice this mindful, non judgmental approach and this openness to like, let's take in data, let's take in things that are effective, and also being willing to let go or evolve past things that maybe no longer fit this moment. So listeners, hopefully, you've learned a little something about what's helpful about Freud and what's not so helpful. And maybe you what you can take with you is a model to say that if we're willing to grow, we're willing to evolve, it also means sometimes letting go of something that was helpful at one time.

Nikki: This has been When East Meets West. I'm Dr. Nikki Rubin,

Pete: And I'm Dr. Pete Economou. Be present. Be brave.

Pete: This has been When East Meets West, all material is based on opinion and educational training of doctors Pete Economou, and Nikki Rubin.

Nikki: Content is for informational and educational purposes only.