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PSYCH 179: Intensive Short-Term Psychodynamic Psychotherapies · Clinical Deep Dives

• 0:00
  SPEAKER_00: If I ask you to picture psychoanalysis,
• 0:03
  SPEAKER_00: I can almost guarantee the exact image that pops into your head.
• 0:07
  SPEAKER_01: Right. It's the classic dim room.
• 0:09
  SPEAKER_00: Yeah, exactly.
• 0:10
  SPEAKER_00: A dimly lit room, a patient lying flat on this like heavy leather couch,
• 0:15
  SPEAKER_00: just staring aimlessly at the ceiling,
• 0:18
  SPEAKER_00: rambling about a dream they had involving a train and a tunnel.
• 0:22
  SPEAKER_01: And behind them completely out of view is the therapist scribbling on a notepad
• 0:26
  SPEAKER_01: and muttering, hmm, maybe twice an hour.
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  SPEAKER_00: Yes, precisely.
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  SPEAKER_00: And you picture this going on for, what, five days a week?
• 0:33
  SPEAKER_00: For ten years?
• 0:35
  SPEAKER_01: That's the stereotype, yeah.
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  SPEAKER_00: The ultimate cliché of the endless couch.
• 0:39
  SPEAKER_00: But what if I told you that in 1908, Sigmund Freud,
• 0:43
  SPEAKER_00: the literal architect of this entire field,
• 0:46
  SPEAKER_00: treated the world-famous composer Gustav Mahler for, well,
• 0:50
  SPEAKER_00: for severe psychogenic impotence?
• 0:53
  SPEAKER_01: Quite a significant issue for him at the time.
• 0:54
  SPEAKER_00: To say the least.
• 0:56
  SPEAKER_00: And Freud cured him in a single four hour walk through the woods of Vienna.
• 1:01
  SPEAKER_01: It really is one of the most striking and honestly most often ignored anecdotes
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  SPEAKER_01: in the whole history of psychiatry.
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  SPEAKER_00: Just a four hour walk.
• 1:09
  SPEAKER_01: A four hour walk.
• 1:11
  SPEAKER_01: Side by side, actively engaged in a really dynamic, highly focused conversation.
• 1:16
  SPEAKER_01: I mean, it shatters our modern assumptions completely.
• 1:19
  SPEAKER_00: It fundamentally breaks the stereotype.
• 1:22
  SPEAKER_00: And it serves as the perfect entry point for what we are tackling today in this deep dive.
• 1:26
  SPEAKER_01: Absolutely. We're looking at intensive short-term psychodynamic psychotherapies.
• 1:31
  SPEAKER_00: Right. And our structural spine today is chapter 32.5 of Kaplan
• 1:36
  SPEAKER_00: and Sadak's comprehensive textbook of psychiatry.
• 1:38
  SPEAKER_01: Classic.
• 1:39
  SPEAKER_00: But to truly understand these highly accelerated therapies, we really need a mental model.
• 1:45
  SPEAKER_00: And the text provides this rather brilliant framing device.
• 1:50
  SPEAKER_01: It reads almost like a psychological thriller.
• 1:53
  SPEAKER_00: It really does.
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  SPEAKER_00: So imagine a telegram arriving at Baker Street shortly after midnight.
• 1:57
  SPEAKER_00: It reads, a man is imprisoned within his own mind.
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  SPEAKER_00: The doors are open, yet he cannot leave.
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  SPEAKER_01: Very dramatic.
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  SPEAKER_00: Right. So you travel to this peculiar Victorian mansion,
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  SPEAKER_00: known locally as the House of Unspoken Feelings.
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  SPEAKER_00: And inside, you find the owner.
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  SPEAKER_01: And he's a highly successful barrister.
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  SPEAKER_01: Brilliant by all accounts.
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  SPEAKER_00: But completely crippled.
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  SPEAKER_00: By relentless anxiety, inexplicable bouts of sadness,
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  SPEAKER_00: and just this long succession of failed relationships.
• 2:26
  SPEAKER_01: And every physician in the city has examined his symptoms.
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  SPEAKER_00: Every single one.
• 2:30
  SPEAKER_01: And none have discovered their source.
• 2:31
  SPEAKER_00: Because, well, the mystery isn't biological in the traditional sense.
• 2:35
  SPEAKER_00: It's not something a standard physical exam is ever going to uncover.
• 2:38
  SPEAKER_01: Right. It is the ultimate locked room mystery.
• 2:43
  SPEAKER_01: And the locks in this house, they weren't fashioned out of malice.
• 2:46
  SPEAKER_00: No, they were built by the barrister himself.
• 2:48
  SPEAKER_01: Exactly.
• 2:49
  SPEAKER_01: Decades ago, they served a vital purpose.
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  SPEAKER_01: They protected him from emotions that were just, you know, too overwhelming,
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  SPEAKER_01: too dangerous for a child's nervous system to endure.
• 2:58
  SPEAKER_00: But now as an adult, those same protective locks have basically become his prison.
• 3:03
  SPEAKER_00: Spot on.
• 3:04
  SPEAKER_00: So as we stand in the entrance hall of this metaphorical mansion,
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  SPEAKER_00: we notice three distinct portraits hanging on the wall.
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  SPEAKER_00: Three master detectives of the human psyche,
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  SPEAKER_00: each proposing a radically different route to catch this hidden culprit.
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  SPEAKER_01: The first portrait is Peter Sifneos.
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  SPEAKER_00: And his method is like a narrow, brilliantly lit corridor, right?
• 3:24
  SPEAKER_01: Yes. Highly focused, incredibly direct.
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  SPEAKER_01: It's designed for a suspect whose conflicts are quite specific and crucially,
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  SPEAKER_01: whose willingness to confess is strong.
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  SPEAKER_00: Then the second portrait is David Milan,
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  SPEAKER_00: and he's constructed these two elaborate triangular staircases in the house.
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  SPEAKER_01: Right. One staircase connects feelings, anxiety, and defenses.
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  SPEAKER_01: And the other connects past relationships, present relationships,
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  SPEAKER_01: and the relationship happening right now in the room.
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  SPEAKER_00: Which leaves the deepest chamber.
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  SPEAKER_01: And that belongs to Habib Davanlu.
• 3:56
  SPEAKER_00: Yes.
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  SPEAKER_01: And its iron door is protected by massive, elaborate, really rusted locks.
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  SPEAKER_00: The heavy-duty stuff.
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  SPEAKER_01: Exactly. Exactly.
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  SPEAKER_01: We call those locks intellectualization, avoidance, detachment, and resistance.
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  SPEAKER_01: To get in there, I mean, you cannot just pick the lock.
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  SPEAKER_01: You have to confront the barrier directly.
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  SPEAKER_00: But there is also a fourth portrait added a bit more recently, I suppose.
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  SPEAKER_00: Diana Foscia.
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  SPEAKER_01: Yeah, she offers a different room altogether.
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  SPEAKER_01: It's a room of distorted mirrors where the man sees himself as entirely unworthy.
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  SPEAKER_00: And her key isn't a battering ram, is it?
• 4:32
  SPEAKER_01: No, not at all.
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  SPEAKER_01: It is the key of profound empathic connection.
• 4:36
  SPEAKER_00: So I want to be really clear about our mission for this deep dive
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  SPEAKER_00: because this is not just a regurgitation of a textbook.
• 4:42
  SPEAKER_01: No, certainly not.
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  SPEAKER_00: This is a conceptual synthesis.
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  SPEAKER_00: We want to build your mental models, clarify the underlying mechanisms,
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  SPEAKER_00: and ultimately strengthen your clinical reasoning.
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  SPEAKER_01: Because whether you're a psychiatry registrar, a seasoned clinician,
• 4:54
  SPEAKER_01: or just a fiercely curious learner,
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  SPEAKER_01: you really need to understand how psychiatrists actually think
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  SPEAKER_01: when they are sitting opposite profound human suffering.
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  SPEAKER_00: Because psychiatry fundamentally is the study of how the brain, the mind,
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  SPEAKER_00: and human experience interact.
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  SPEAKER_01: And how that magnificent, incredibly complex process can go wrong.
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  SPEAKER_00: Right.
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  SPEAKER_00: We are looking at how these clinicians act as navigators,
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  SPEAKER_00: basically mapping the intricate and sometimes, quite frankly,
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  SPEAKER_00: terrifying architecture of the human mind.
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  SPEAKER_01: It's a brilliant way to frame it.
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  SPEAKER_00: So let's start with the history,
• 5:26
  SPEAKER_00: because we really have to understand how we lost that four hour walk energy
• 5:30
  SPEAKER_00: and how we eventually sort of clawed it back.
• 5:33
  SPEAKER_01: Yeah, the timeline is fascinating.
• 5:35
  SPEAKER_01: Freud's early treatments were actually incredibly brief,
• 5:37
  SPEAKER_01: ranging from just a few hours to a few months.
• 5:40
  SPEAKER_00: But over the decades, the timeline just stretched out to years.
• 5:44
  SPEAKER_00: It's as if, well, think of it like software.
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  SPEAKER_00: The original software was designed to be a quick, highly effective patch.
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  SPEAKER_00: But over time, the developers just added so much background processing,
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  SPEAKER_00: so many diagnostic scans, that the software took five years just to boot up.
• 5:58
  SPEAKER_00: What actually caused that bloat?
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  SPEAKER_01: The bloat was really the result of a shifting technical focus.
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  SPEAKER_01: You see, the early psychoanalytic pioneers developed a very specific technical triad.
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  SPEAKER_00: Okay, let's break that down.
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  SPEAKER_01: First, there was a heavy reliance on free association,
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  SPEAKER_01: just letting the patient's mind wander wherever it pleased without any interruption.
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  SPEAKER_00: No steering at all.
• 6:21
  SPEAKER_01: Exactly.
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  SPEAKER_01: Second, a deliberate, almost extreme reduction in the therapist's activity.
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  SPEAKER_01: The therapist essentially became a blank screen.
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  SPEAKER_00: Just sitting there in silence?
• 6:33
  SPEAKER_01: Mostly, yes.
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  SPEAKER_01: And third, the slow, deliberate cultivation of what they call the transference neurosis.
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  SPEAKER_00: Which is the phenomenon where the patient slowly, over years really,
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  SPEAKER_00: transfers their unresolved childhood conflicts onto that passive therapist.
• 6:49
  SPEAKER_01: That's the one.
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  SPEAKER_00: I mean, it sounds incredibly inefficient.
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  SPEAKER_00: If I go to a doctor with a broken arm,
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  SPEAKER_00: I don't want them to stare at me silently for three years
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  SPEAKER_00: until I project my childhood relationship with my father onto them.
• 7:02
  SPEAKER_01: No, you definitely don't.
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  SPEAKER_00: I want them to set the bone.
• 7:05
  SPEAKER_01: You're touching on the exact frustration that eventually splintered the field.
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  SPEAKER_01: But to be fair to those early analysts, this incredibly slow,
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  SPEAKER_01: passive process did yield substantial heuristic fruits.
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  SPEAKER_00: What do you mean by that?
• 7:18
  SPEAKER_01: Well, by letting the mind wander endlessly, they were able to build this vast,
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  SPEAKER_01: really quite beautiful theoretical edifice, psychoanalytic metapsychology.
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  SPEAKER_00: Ah, right, the mapping of the mind.
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  SPEAKER_01: Exactly.
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  SPEAKER_01: They mapped the unconscious mind, the ego, the id, the superego,
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  SPEAKER_01: the specific defense mechanisms in just unprecedented detail.
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  SPEAKER_01: They were basically explorers mapping a totally new continent.
• 7:45
  SPEAKER_00: But...
• 7:46
  SPEAKER_00: Mapping the continent isn't the same as curing the plague that's sweeping across it.
• 7:50
  SPEAKER_01: Precisely. That is spot on.
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  SPEAKER_01: The price they paid for that beautiful map was a severe loss of therapeutic potency,
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  SPEAKER_01: especially for patients with highly resistant,
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  SPEAKER_01: deeply entrenched character pathology.
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  SPEAKER_00: Even Freud noticed this, didn't he?
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  SPEAKER_01: He did.
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  SPEAKER_01: Freud himself became increasingly pessimistic about the power of free association
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  SPEAKER_01: to actually overcome these massive superego resistances.
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  SPEAKER_00: Because what happens with a resistant patient is that they basically figure out how
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  SPEAKER_00: to game the system, right?
• 8:19
  SPEAKER_01: Yes. They use free association not to reveal their unconscious, but to hide it.
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  SPEAKER_00: They intellectualize endlessly.
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  SPEAKER_01: Exactly. They will spend 50 minutes giving you this brilliant,
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  SPEAKER_01: entirely detached philosophical analysis of their childhood trauma.
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  SPEAKER_00: Without ever actually feeling a single drop of the raw motion attached to it.
• 8:39
  SPEAKER_01: Not a drop.
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  SPEAKER_01: The intellect just becomes the ultimate defense mechanism.
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  SPEAKER_00: So how did the field correct course?
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  SPEAKER_00: I mean, how did we move from this intellectual archaeology back to active, brief healing?
• 8:51
  SPEAKER_01: The paradigm shift really gathered momentum in the middle of the 20th century.
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  SPEAKER_01: Practitioners like Sandor Ferenczi and Otto Rank began to strongly rebel against the passivity.
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  SPEAKER_00: They realized that just knowing about your problems isn't enough.
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  SPEAKER_01: Right. If a patient only acquires intellectual insight without integrated affect,
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  SPEAKER_01: meaning without physically feeling the emotion in the room,
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  SPEAKER_01: that knowledge is practically useless.
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  SPEAKER_00: It just becomes another sophisticated way to avoid feeling pain.
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  SPEAKER_01: Exactly. So they proposed a new triad to counter the old one.
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  SPEAKER_01: Enhanced therapist activity, an active therapeutic focus, and crucially,
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  SPEAKER_01: setting strict non-negotiable time limits.
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  SPEAKER_00: Because a deadline forces action.
• 9:36
  SPEAKER_01: Yeah.
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  SPEAKER_00: If you know you only have 20 sessions,
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  SPEAKER_00: you really can't afford to spend three of them talking about the weather.
• 9:41
  SPEAKER_01: You certainly can't.
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  SPEAKER_01: But the real conceptual leap, according to the text,
• 9:46
  SPEAKER_01: came in the 1930s and 40s with Franz Alexander in Chicago.
• 9:51
  SPEAKER_00: Ah, yes.
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  SPEAKER_00: He introduced a phrase that feels like, well, the holy grail of modern therapy.
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  SPEAKER_00: The corrective emotional experience.
• 10:00
  SPEAKER_01: Alexander's insight was revolutionary.
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  SPEAKER_01: He argued that the goal of therapy isn't to intellectually explain the past just
• 10:07
  SPEAKER_01: to satisfy the therapist's curiosity.
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  SPEAKER_00: Right.
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  SPEAKER_01: The goal is to give the patient a live,
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  SPEAKER_01: visceral opportunity to relive the original childhood trauma in a safe,
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  SPEAKER_01: supportive present.
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  SPEAKER_01: It is entirely about affect.
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  SPEAKER_00: OK, let's break down the actual mechanics of that.
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  SPEAKER_00: How does an emotion correct something?
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  SPEAKER_01: Think of it procedurally.
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  SPEAKER_01: Imagine a patient who grew up with a fiercely punitive, highly critical parent.
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  SPEAKER_00: Okay.
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  SPEAKER_01: Their entire nervous system is wired to expect punishment
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  SPEAKER_01: the exact moment they show any vulnerability.
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  SPEAKER_01: So they walk into the therapy room and their unconscious mind just assumes
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  SPEAKER_01: the therapist is going to be just as punitive.
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  SPEAKER_00: They're waiting for the other shoe to drop.
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  SPEAKER_01: Always.
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  SPEAKER_01: And when they begin to express a forbidden emotion, say anger or deep shame,
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  SPEAKER_01: they brace for the attack.
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  SPEAKER_01: But the attack never comes.
• 11:00
  SPEAKER_01: Instead, the therapist actively supports, understands,
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  SPEAKER_01: and just holds space for them while they experience that terror.
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  SPEAKER_01: The emotional memory is literally neurologically corrected in that specific moment.
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  SPEAKER_00: They learn viscerally that the world is no longer the childhood prison they grew up in.
• 11:16
  SPEAKER_01: Exactly.
• 11:17
  SPEAKER_00: Okay, I want to pause here for a second and play devil's advocate because we live
• 11:21
  SPEAKER_00: in an era of rapid psychopharmacology
• 11:23
  SPEAKER_00: and highly manualized cognitive behavioral therapy.
• 11:26
  SPEAKER_01: We do.
• 11:27
  SPEAKER_00: Medication is often viewed as the quick, measurable biological fix.
• 11:30
  SPEAKER_00: If I have a patient with crippling anxiety,
• 11:32
  SPEAKER_00: I can just write a prescription for a daily SSRI and see results in a few weeks.
• 11:37
  SPEAKER_00: So how does a 20-session talking therapy compete on a biological or long-term level
• 11:43
  SPEAKER_00: with modern psychopharmacology?
• 11:44
  SPEAKER_00: I mean, aren't these dynamic therapies just an expensive luxury?
• 11:49
  SPEAKER_01: That is definitely the dominant critique in modern managed care.
• 11:53
  SPEAKER_01: But the evidence base provided in Kaplan and SADAC answers it definitively.
• 11:57
  SPEAKER_00: What does the data say?
• 11:58
  SPEAKER_01: Well, look at the 2013 American Psychological Association Council Review,
• 12:02
  SPEAKER_01: or even go back to the classic 1970s Smith & Glass meta-analysis.
• 12:07
  SPEAKER_01: The data consistently shows that the effects
• 12:09
  SPEAKER_01: of these short-term dynamic psychotherapies are significant, large,
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  SPEAKER_01: and constant across a really wide variety of diagnostic conditions.
• 12:17
  SPEAKER_00: Okay, but how does it compare to the pills long-term?
• 12:21
  SPEAKER_01: That's the critical difference, the mechanism of long-term change.
• 12:25
  SPEAKER_01: Within SSRI, the medication is suppressing the symptom.
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  SPEAKER_01: When you stop taking the pill, the mechanism of action stops,
• 12:32
  SPEAKER_01: and the vulnerability completely remains.
• 12:35
  SPEAKER_00: It's like the structural foundation of the house is still rotting.
• 12:38
  SPEAKER_00: You've just put a really nice coat of paint over the mold.
• 12:41
  SPEAKER_01: That's exactly it.
• 12:42
  SPEAKER_01: But with short-term dynamic psychotherapies, or STDPs,
• 12:45
  SPEAKER_01: patients acquire psychological skills and emotional capacities that they take
• 12:49
  SPEAKER_01: with them after termination.
• 12:51
  SPEAKER_00: They've rewired the foundation.
• 12:52
  SPEAKER_01: They've literally rewired their relational expectations.
• 12:55
  SPEAKER_01: The research shows a fascinating phenomenon.
• 12:58
  SPEAKER_01: Patients treated with dynamic psychotherapy often continue to improve
• 13:02
  SPEAKER_01: after the sessions have ended.
• 13:04
  SPEAKER_00: Wow. So the upward trajectory continues without the therapist.
• 13:08
  SPEAKER_01: Yes. Their results tend to last longer,
• 13:11
  SPEAKER_01: and they are significantly less likely
• 13:12
  SPEAKER_01: to require additional treatment courses compared to those managed
• 13:15
  SPEAKER_01: with psychopharmacology alone.
• 13:17
  SPEAKER_01: You are treating the actual root of the vulnerability.
• 13:21
  SPEAKER_00: That makes perfect sense.
• 13:23
  SPEAKER_00: So let's step into the shoes of the clinician now.
• 13:25
  SPEAKER_00: We have our theoretical grounding,
• 13:27
  SPEAKER_00: but how do we actually choose the right tool for the patient sitting in front of us?
• 13:31
  SPEAKER_01: Well, the textbook outlines a spectrum of these brief therapies.
• 13:34
  SPEAKER_01: They scale and complexity, and a psychiatrist has to choose their model based
• 13:38
  SPEAKER_01: on the severity and nature of the patient's pathology.
• 13:41
  SPEAKER_00: Right. Let's start with our first detective, Peter Sifnios, and his model,
• 13:45
  SPEAKER_00: short-term anxiety-provoking psychotherapy, or STAPP.
• 13:50
  SPEAKER_01: Syphonius occupies the relatively less complex end of the pathological spectrum.
• 13:55
  SPEAKER_01: SDAPP is a highly specific mechanism designed for a very specific type of patient,
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  SPEAKER_01: those suffering from an Oedipal conflict.
• 14:02
  SPEAKER_00: Okay. Oedipal conflict.
• 14:03
  SPEAKER_00: That's a term that carries a lot of pop culture baggage. It does.
• 14:07
  SPEAKER_00: Let's define what that actually means in a modern clinical setting,
• 14:10
  SPEAKER_00: totally independent of Greek tragedy.
• 14:12
  SPEAKER_01: Good idea.
• 14:13
  SPEAKER_01: In clinical terms, an edible conflict refers to the psychological aftermath
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  SPEAKER_01: of unresolved competition, affection,
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  SPEAKER_01: and triangulation with parents during early childhood.
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  SPEAKER_00: And how does that show up in adulthood?
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  SPEAKER_01: It usually manifests as intense guilt over success, really deep fear of intimacy,
• 14:30
  SPEAKER_01: or repeated self-sabotaging conflicts with authority figures.
• 14:35
  SPEAKER_00: But crucially, for Siphnios to even accept a patient for STAP,
• 14:38
  SPEAKER_00: they must meet strict criteria, right?
• 14:40
  SPEAKER_01: Very strict.
• 14:41
  SPEAKER_01: They must have high motivation.
• 14:43
  SPEAKER_01: They must have had at least one meaningful reciprocal give and take relationship in their past.
• 14:48
  SPEAKER_00: Meaning they are capable of healthy attachment.
• 14:50
  SPEAKER_01: Exactly. And they must have very minimal character pathology.
• 14:54
  SPEAKER_00: So we are not dealing with severe personality disorders here
• 14:57
  SPEAKER_00: or profound early attachment trauma.
• 14:59
  SPEAKER_01: No, not at all.
• 15:00
  SPEAKER_01: We are dealing with fundamentally healthy people who are trapped in a specific neurotic loop.
• 15:05
  SPEAKER_00: They have a solid ego structure, but a localized glitch in their software.
• 15:09
  SPEAKER_01: That's a great way to put it.
• 15:10
  SPEAKER_00: Now, the technique itself is literally in the name.
• 15:13
  SPEAKER_00: Anxiety provoking. Yes.
• 15:15
  SPEAKER_00: Which sounds incredibly counterintuitive.
• 15:17
  SPEAKER_00: If a patient comes to me complaining of severe anxiety,
• 15:20
  SPEAKER_00: my instinct as a physician is to calm them down, you know,
• 15:22
  SPEAKER_00: to soothe the nervous system.
• 15:24
  SPEAKER_00: Why on earth would Sifneos want to make them more anxious?
• 15:27
  SPEAKER_01: It is the defining paradox of his whole approach.
• 15:31
  SPEAKER_01: Sifneos understood that for these highly functioning,
• 15:34
  SPEAKER_01: neurotically defended patients, anxiety is not the enemy.
• 15:38
  SPEAKER_01: Anxiety is the fuel for change.
• 15:40
  SPEAKER_00: So if you soothe them?
• 15:42
  SPEAKER_01: If you soothe them, they will just settle quite comfortably back
• 15:45
  SPEAKER_01: into their intellectual defenses.
• 15:47
  SPEAKER_01: They'll talk your ear off and change nothing.
• 15:50
  SPEAKER_01: So the therapist actively provokes anxiety through relentless confrontation
• 15:54
  SPEAKER_01: and clarification of the patient's avoidant behaviors.
• 15:57
  SPEAKER_00: But how does the patient not just walk out of the room?
• 15:59
  SPEAKER_00: I mean, if someone is just provoking me when I'm already anxious, I'd leave.
• 16:04
  SPEAKER_01: They stay because of the therapeutic alliance.
• 16:07
  SPEAKER_01: The therapist heavily relies on a very strong positive transference,
• 16:11
  SPEAKER_01: meaning the patient genuinely likes, respects, and trusts the therapist.
• 16:15
  SPEAKER_00: Ah, so that bond acts as an anchor.
• 16:17
  SPEAKER_01: Exactly. It holds them steady while their defenses are ruthlessly challenged.
• 16:23
  SPEAKER_01: Furthermore, the therapist absolutely refuses to let the patient regress.
• 16:27
  SPEAKER_00: What does regression look like in this context?
• 16:30
  SPEAKER_01: If the patient tries to become passive, if they try to act helpless,
• 16:33
  SPEAKER_01: or if they engage in what we call pre-genital behaviors,
• 16:36
  SPEAKER_01: like whining or demanding to be told what to do,
• 16:39
  SPEAKER_01: the therapist blocks it immediately.
• 16:42
  SPEAKER_00: They force the patient to stay focused on the adult conflict.
• 16:44
  SPEAKER_01: Yes. Full stop.
• 16:47
  SPEAKER_00: Now, to navigate this highly charged environment,
• 16:49
  SPEAKER_00: Sifnios uses a fascinating mental model to guide his clinical reasoning.
• 16:54
  SPEAKER_00: He calls it the dynamic hologram.
• 16:56
  SPEAKER_01: It's a wonderful construct.
• 16:58
  SPEAKER_00: I really love this visual because it explains the exact architecture of a psychiatric symptom.
• 17:03
  SPEAKER_00: Can you walk us through the mechanics of the three layers?
• 17:06
  SPEAKER_01: Willingly.
• 17:07
  SPEAKER_01: So visualize a three-layered hologram suspended in the air.
• 17:12
  SPEAKER_00: Okay, got it.
• 17:13
  SPEAKER_01: At the very bottom, the deepest, most obscured level,
• 17:18
  SPEAKER_01: you have the genetic pathogenic foci.
• 17:22
  SPEAKER_00: Which means?
• 17:23
  SPEAKER_01: These are the deep, original, unconscious impulses or feelings.
• 17:28
  SPEAKER_01: Perhaps a repressed loss of a caregiver's exclusive attention
• 17:33
  SPEAKER_01: or some forbidden anger from early childhood.
• 17:36
  SPEAKER_00: Okay.
• 17:36
  SPEAKER_01: That deep feeling is intolerable to the child, so it radiates upward,
• 17:42
  SPEAKER_01: distorting the personality to create the second layer, dynamic forces.
• 17:47
  SPEAKER_00: Now, these dynamic forces, those are the broad, habitual, maladaptive behaviors, right?
• 17:52
  SPEAKER_00: Like a personality trait?
• 17:53
  SPEAKER_01: Exactly.
• 17:54
  SPEAKER_01: It's the character armor.
• 17:57
  SPEAKER_01: Like an automatic simmering hostility toward all authority figures.
• 18:02
  SPEAKER_01: Or a compulsion to push romantic partners away the absolute moment things get serious.
• 18:07
  SPEAKER_00: But the patient rarely comes to therapy complaining about their dynamic forces.
• 18:12
  SPEAKER_01: No, they don't say, doctor, I have a maladaptive dynamic force of hostility.
• 18:16
  SPEAKER_00: Right.
• 18:16
  SPEAKER_00: They come in complaining about the third layer, the surface layer, conscious life problems.
• 18:21
  SPEAKER_01: Which is the top of the hologram.
• 18:23
  SPEAKER_00: It's the immediate crisis.
• 18:25
  SPEAKER_00: Like they just got fired from their third job in a row
• 18:27
  SPEAKER_00: or they are having panic attacks right before their wedding
• 18:30
  SPEAKER_00: or their marriage is actively failing.
• 18:32
  SPEAKER_01: Exactly.
• 18:33
  SPEAKER_01: So the goal of STAB is to shine a light through all three layers simultaneously.
• 18:38
  SPEAKER_00: So the therapist forces the patient to see
• 18:41
  SPEAKER_00: in real time how their surface level panic attack is a direct holographic projection
• 18:47
  SPEAKER_00: of their maladaptive dynamic trait.
• 18:49
  SPEAKER_01: Yes.
• 18:49
  SPEAKER_00: Which itself is just a cover for that deep hidden genetic childhood trauma at the bottom.
• 18:55
  SPEAKER_01: And when the patient sees the whole hologram illuminated at once, the symptom loses its mystery.
• 19:00
  SPEAKER_01: It loses its power.
• 19:02
  SPEAKER_00: It's brilliant.
• 19:03
  SPEAKER_00: Let's see how this manifests in human reality.
• 19:05
  SPEAKER_00: Let's look at the case of Chris from the text.
• 19:08
  SPEAKER_01: Chris is a classic Sifneos patient.
• 19:11
  SPEAKER_00: Right.
• 19:11
  SPEAKER_00: So Chris is a 31-year-old man presenting with recurrent relationship failures.
• 19:15
  SPEAKER_00: He has a severe fear of commitment,
• 19:17
  SPEAKER_00: suffers from acute panic attacks whenever conflicts arise with his girlfriends,
• 19:21
  SPEAKER_00: and has a history of clashing aggressively with older male figures at work.
• 19:25
  SPEAKER_01: Chris perfectly fits the criteria.
• 19:28
  SPEAKER_01: He has a circumscribed set of complaints.
• 19:30
  SPEAKER_01: He has a history of some functional relationships.
• 19:33
  SPEAKER_01: And his issues have a very clear Oedipal flavor.
• 19:36
  SPEAKER_01: Trouble with intimacy and conflict with male authority.
• 19:39
  SPEAKER_00: So applying Sifnios' mechanism,
• 19:41
  SPEAKER_00: the therapist doesn't spend months listening to Chris complain
• 19:44
  SPEAKER_00: about his terrible boss. No.
• 19:46
  SPEAKER_01: Instead, the therapist uses active,
• 19:48
  SPEAKER_01: anxiety-provoking inquiry to hunt down that bottom layer of the hologram,
• 19:53
  SPEAKER_01: the genetic focus.
• 19:54
  SPEAKER_00: And through this rigorous questioning, they locate it.
• 19:57
  SPEAKER_00: Chris suffered a profound loss of his exclusive maternal bond when his younger brother was born.
• 20:02
  SPEAKER_00: Chris was two years old at the time.
• 20:05
  SPEAKER_01: But as we discussed with Franz Alexander,
• 20:07
  SPEAKER_01: merely telling Chris you're afraid of commitment because you felt replaced
• 20:10
  SPEAKER_01: by your brother achieves absolutely nothing.
• 20:13
  SPEAKER_00: It's just an intellectual exercise.
• 20:15
  SPEAKER_01: Quite.
• 20:16
  SPEAKER_01: The therapist pushes Chris to actively explore his feelings about his mother in the room.
• 20:21
  SPEAKER_01: And during this intense, anxiety-provoking inquiry,
• 20:24
  SPEAKER_01: Chris experiences a massive psychological breakthrough.
• 20:28
  SPEAKER_00: He vividly recalls a very specific memory.
• 20:31
  SPEAKER_01: He does.
• 20:32
  SPEAKER_01: He remembers being a toddler, being held in his mother's arms in a dark closet.
• 20:37
  SPEAKER_01: He can smell her perfume, feel the warmth of her skin, hear her heartbeat.
• 20:42
  SPEAKER_00: And in the therapy session, Chris is so entirely absorbed in reliving this memory
• 20:47
  SPEAKER_00: that his physiology actually changes.
• 20:49
  SPEAKER_01: He physically blushes.
• 20:51
  SPEAKER_01: He giggles with delight.
• 20:53
  SPEAKER_00: He's reliving the ultimate Oedipal victory.
• 20:55
  SPEAKER_00: He has exclusive, uninterrupted possession of the mother.
• 20:58
  SPEAKER_01: Yes.
• 21:00
  SPEAKER_01: But then the memory shifts.
• 21:02
  SPEAKER_00: Right.
• 21:03
  SPEAKER_01: The closet door is suddenly violently yanked open by his angry father.
• 21:07
  SPEAKER_01: Blinding light floods in, completely shattering the sanctuary.
• 21:10
  SPEAKER_00: And in the therapy room, sitting opposite the therapist, Chris's joy instantly evaporates.
• 21:16
  SPEAKER_01: It's replaced by profound, devastating grief and intense rage.
• 21:21
  SPEAKER_01: He experiences viscerally the primal loss of that exclusive bond,
• 21:26
  SPEAKER_01: a loss that was permanently cemented when his brother was born shortly after.
• 21:30
  SPEAKER_00: That is the corrective emotional experience and action.
• 21:33
  SPEAKER_00: By feeling the terror and rage of that memory while sitting safely
• 21:36
  SPEAKER_00: with a supportive therapist, the spell is broken.
• 21:39
  SPEAKER_01: Exactly.
• 21:40
  SPEAKER_01: Chris realizes that his current inability to commit to women
• 21:43
  SPEAKER_01: and its constant antagonism toward male bosses are just elaborate,
• 21:48
  SPEAKER_01: exhausting defenses.
• 21:49
  SPEAKER_00: He's been pushing women away to protect himself from ever experiencing that primal,
• 21:53
  SPEAKER_00: devastating loss of the mother again.
• 21:56
  SPEAKER_01: And he's been fighting bosses to preemptively fight off the angry father yanking the door open.
• 22:01
  SPEAKER_00: Once the hologram is visible, Chris can choose to stop projecting it.
• 22:06
  SPEAKER_01: It is a brilliant, elegant mechanism.
• 22:08
  SPEAKER_01: But Saphneos' approach does have a glaring limitation. Which is?
• 22:13
  SPEAKER_01: It requires a patient who is robust enough to handle the anxiety
• 22:16
  SPEAKER_01: and whose trauma is relatively circumscribed.
• 22:20
  SPEAKER_01: What happens when the patient doesn't have a neat, oedipal conflict?
• 22:23
  SPEAKER_00: What happens when they are fundamentally crippled by a pervasive fear of abandonment
• 22:28
  SPEAKER_00: and their defenses are far more rigid?
• 22:30
  SPEAKER_01: Exactly.
• 22:30
  SPEAKER_00: That brings us to our second detective.
• 22:32
  SPEAKER_01: David Mallon. Right.
• 22:34
  SPEAKER_01: If Sifnios is dealing with neurotics who need a push, Mallon is dealing with deeper waters.
• 22:40
  SPEAKER_01: Mallon targets patients struggling with unresolved interpersonal conflicts,
• 22:45
  SPEAKER_01: profound issues of abandonment, and deeper, more heavily suppressed impulses.
• 22:50
  SPEAKER_00: Mallon gives us perhaps the most enduring and practical mental models in all
• 22:54
  SPEAKER_00: of psychodynamic reasoning.
• 22:56
  SPEAKER_00: He gives us two foundational triangles.
• 22:58
  SPEAKER_01: I love these.
• 22:59
  SPEAKER_00: If you are listening, genuinely try to visualize these two triangles suspended in front of you.
• 23:04
  SPEAKER_01: The first is the triangle of conflict.
• 23:06
  SPEAKER_01: It essentially maps the internal plumbing of the human mind.
• 23:10
  SPEAKER_01: At the bottom point of the triangle, pointing downwards, you have the hidden impulse or feeling.
• 23:15
  SPEAKER_00: Okay, impulse at the bottom.
• 23:17
  SPEAKER_01: At the top left corner, you have anxiety.
• 23:20
  SPEAKER_01: And at the top right corner, you have the defense.
• 23:23
  SPEAKER_00: So how does this machinery actually operate in practice?
• 23:26
  SPEAKER_01: It works in a very specific sequence.
• 23:29
  SPEAKER_01: The patient experiences an unacceptable impulse.
• 23:32
  SPEAKER_01: Let's say intense murderous rage at a neglectful parent.
• 23:36
  SPEAKER_00: Right.
• 23:36
  SPEAKER_01: But experiencing that rage feels deeply unsafe.
• 23:39
  SPEAKER_01: It threatens their core attachment.
• 23:41
  SPEAKER_01: So that impulse immediately triggers severe anxiety.
• 23:44
  SPEAKER_00: The alarm bells go off.
• 23:45
  SPEAKER_01: Exactly. And to avoid the pain of the anxiety, the mind instantly deploys a defense.
• 23:51
  SPEAKER_01: The defense could be anything.
• 23:53
  SPEAKER_01: Sudden depression, emotional withdrawal, hypercompliance, or even physical pain.
• 23:58
  SPEAKER_00: So when a patient walks in looking severely depressed,
• 24:01
  SPEAKER_00: the depression isn't necessarily the core illness.
• 24:04
  SPEAKER_00: The depression is the defense mechanism at the top right of the triangle,
• 24:08
  SPEAKER_00: covering up the anxiety, which is covering up the hidden rage at the bottom.
• 24:13
  SPEAKER_01: Spot on.
• 24:15
  SPEAKER_01: And Malin's clinical reasoning dictates a very specific order of operations.
• 24:19
  SPEAKER_01: You cannot just jump to the bottom of the triangle and tell the patient they are angry.
• 24:22
  SPEAKER_00: Why not?
• 24:23
  SPEAKER_01: Because they will deny it.
• 24:25
  SPEAKER_01: The anxiety is too high.
• 24:27
  SPEAKER_01: The therapist must first clarify the defense.
• 24:30
  SPEAKER_01: You gently, persistently point out how the patient is defending themselves.
• 24:34
  SPEAKER_00: Like saying, notice how every time we talk about your mother,
• 24:36
  SPEAKER_00: you suddenly change the subject to how tired you are.
• 24:39
  SPEAKER_01: Exactly.
• 24:40
  SPEAKER_01: By bringing the defense into conscious awareness without judging it, you lower the anxiety.
• 24:46
  SPEAKER_00: Ah, and once the anxiety is modulated.
• 24:48
  SPEAKER_01: The hidden impulse at the bottom of the triangle can finally rise to the surface
• 24:52
  SPEAKER_01: and be safely experienced.
• 24:54
  SPEAKER_00: But Malin's true genius is that he doesn't stop with just the internal plumbing.
• 24:58
  SPEAKER_00: He links that triangle of conflict to a second triangle, the triangle of the person.
• 25:03
  SPEAKER_01: Yes.
• 25:04
  SPEAKER_00: And the three points of this second triangle are the past,
• 25:07
  SPEAKER_00: usually childhood figures, the present,
• 25:09
  SPEAKER_00: meaning current relationships like a spouse or boss, and the transference,
• 25:13
  SPEAKER_00: which is the immediate relationship with a therapist in the room.
• 25:17
  SPEAKER_01: And Malin was not just a theoretician.
• 25:19
  SPEAKER_01: He was a meticulous empirical researcher.
• 25:21
  SPEAKER_01: He recorded and analyzed thousands of session transcripts to figure out exactly
• 25:26
  SPEAKER_01: which interventions actually cured people.
• 25:29
  SPEAKER_00: What did he find?
• 25:31
  SPEAKER_01: He discovered a highly reliable predictor of success.
• 25:34
  SPEAKER_01: He found that the most effective interventions are what he called TCP interpretations.
• 25:39
  SPEAKER_00: TCP standing for transference, current, past.
• 25:43
  SPEAKER_01: Yes.
• 25:44
  SPEAKER_01: A TCP interpretation is when the therapist links a specific defensive pattern
• 25:48
  SPEAKER_01: across all three points of the triangle of the person simultaneously.
• 25:53
  SPEAKER_00: I always think of this like a game of 3D chess.
• 25:56
  SPEAKER_00: The therapist is looking at three different clear acrylic boards stacked on top of each other.
• 26:00
  SPEAKER_01: That's a great visual.
• 26:02
  SPEAKER_00: The patient makes a move on the middle board, their present life.
• 26:05
  SPEAKER_00: The therapist stops the game and says, look at what you just did.
• 26:09
  SPEAKER_00: The defensive move you are making right now on the present life board
• 26:12
  SPEAKER_00: with your husband by giving him the silent treatment is the exact same move you made
• 26:17
  SPEAKER_00: on the bottom past board when you were a teenager dealing with your father.
• 26:22
  SPEAKER_01: And here is where the insight really lands.
• 26:26
  SPEAKER_01: It is the exact same move you are actively making on the top therapy room board
• 26:31
  SPEAKER_01: with me right now by refusing to answer my question.
• 26:35
  SPEAKER_00: Wow. When a patient sees that pattern align perfectly across all three dimensions
• 26:40
  SPEAKER_00: of their life, it completely shatters the illusion that their behavior is just
• 26:44
  SPEAKER_00: a rational, random reaction to current events.
• 26:47
  SPEAKER_01: It makes the unconscious architecture of their life completely visible.
• 26:50
  SPEAKER_01: And because the interpretation includes the transference,
• 26:53
  SPEAKER_01: the here and now relationship with the therapist,
• 26:56
  SPEAKER_01: it is felt with intense visceral emotion.
• 26:59
  SPEAKER_00: It bypasses intellectualization entirely.
• 27:01
  SPEAKER_01: Completely.
• 27:03
  SPEAKER_00: To see the power of Malan's triangles, let's look at the case of Anna.
• 27:07
  SPEAKER_00: Anna is 60 years old.
• 27:08
  SPEAKER_00: She presents with severe, treatment-resistant depression.
• 27:12
  SPEAKER_01: And for 15 years of that, she has tried SSRIs, like every SSRI you could imagine.
• 27:17
  SPEAKER_01: And she is plagued by profound, unrelenting, almost toxic hatred for her mother,
• 27:23
  SPEAKER_01: who abandoned Anna in a desolate orphanage when she was just five years old.
• 27:28
  SPEAKER_00: Anna is a perfect candidate for Milan's SDDP.
• 27:31
  SPEAKER_00: She is dealing with catastrophic early abandonment, and she has built very intense,
• 27:37
  SPEAKER_00: rigid resistances to survive it.
• 27:39
  SPEAKER_01: Right.
• 27:40
  SPEAKER_01: In her triangle of conflict,
• 27:42
  SPEAKER_01: the hatred and the depression are actually massive defenses against the unbearable,
• 27:47
  SPEAKER_01: annihilating pain of the abandonment.
• 27:49
  SPEAKER_00: Working through Milan's triangles, the therapist doesn't do what a layperson might expect.
• 27:54
  SPEAKER_00: The therapist doesn't try to talk Anna out of her anger.
• 27:57
  SPEAKER_00: They don't try to convince her that her mother had a hard life.
• 27:59
  SPEAKER_01: No, they don't try to make her forgive.
• 28:02
  SPEAKER_01: Doing so would be entirely counterproductive.
• 28:04
  SPEAKER_01: It would just be arguing with the defense.
• 28:06
  SPEAKER_00: Right.
• 28:07
  SPEAKER_01: Instead, the therapy forces Anna to fully physically experience the terrifying depth
• 28:12
  SPEAKER_01: of her destructive anger toward her mother within the safety of the transference.
• 28:16
  SPEAKER_01: The therapist helps her navigate the anxiety so she can plunge to the bottom of the triangle.
• 28:21
  SPEAKER_00: Because the rule of the psyche is that until you feel the absolute bottom
• 28:25
  SPEAKER_00: of that well of rage, you literally can't move past it.
• 28:29
  SPEAKER_01: Precisely. The anger was acting as a heavy iron shield.
• 28:33
  SPEAKER_01: By safely experiencing the absolute full intensity of her rage,
• 28:37
  SPEAKER_01: without being destroyed by it, and crucially without the therapist abandoning her,
• 28:42
  SPEAKER_01: the anger eventually exhausts itself.
• 28:44
  SPEAKER_00: It just burns out.
• 28:45
  SPEAKER_01: It burns out.
• 28:46
  SPEAKER_01: And underneath that burned out rage, something miraculous and deeply human emerges.
• 28:51
  SPEAKER_01: Profound grief.
• 28:53
  SPEAKER_00: She finally cries for the five-year-old girl who was left behind.
• 28:56
  SPEAKER_01: Yes.
• 28:57
  SPEAKER_01: And once she can genuinely grieve the loss
• 29:00
  SPEAKER_01: of the mother she desperately wished she had,
• 29:02
  SPEAKER_01: A modicum of genuine empathy for her actual mothers.
• 29:06
  SPEAKER_01: Desperate historical situation begins to appear spontaneously.
• 29:11
  SPEAKER_00: And the depression lifts entirely.
• 29:13
  SPEAKER_01: It does. Why?
• 29:14
  SPEAKER_01: Because the massive daily expenditure of psychic energy required to suppress
• 29:18
  SPEAKER_01: that raging grief is finally freed up.
• 29:21
  SPEAKER_01: She has her energy back for living.
• 29:23
  SPEAKER_00: It's an incredible mechanism.
• 29:24
  SPEAKER_01: It is.
• 29:25
  SPEAKER_00: But as we know, even Malin has limits.
• 29:28
  SPEAKER_01: He does.
• 29:29
  SPEAKER_00: Ana was highly resistant, but she was still accessible through interpretation.
• 29:33
  SPEAKER_00: What happens when the locks on the doors are rusted shut?
• 29:36
  SPEAKER_00: What happens when the patient is so heavily defended,
• 29:39
  SPEAKER_00: so entrenched in their character pathology that they cannot even engage
• 29:43
  SPEAKER_00: with the triangles?
• 29:44
  SPEAKER_01: This brings us to our third and undoubtedly most intense detective, Habib Davin Liu,
• 29:50
  SPEAKER_01: and Intensive Short-Term Dynamic Psychotherapy, or ISDTP.
• 29:54
  SPEAKER_00: We are in the absolute deepest chamber of the mansion now.
• 29:58
  SPEAKER_00: Who exactly is behind this heavily locked door?
• 30:02
  SPEAKER_01: Davon Liu built his clinical model specifically
• 30:05
  SPEAKER_01: for the most severe treatment resistant patients.
• 30:08
  SPEAKER_01: These are individuals who have failed multiple other therapies.
• 30:12
  SPEAKER_00: The tough cases.
• 30:13
  SPEAKER_01: The toughest. They present with massive entrenched character defenses
• 30:18
  SPEAKER_01: and pervasive diffuse symptoms, chronic anxiety, profound depression,
• 30:23
  SPEAKER_01: widespread somatic pain that has no medical cause. Right.
• 30:27
  SPEAKER_01: These are patients whose core attachment bonds were severely traumatized, Now,
• 30:33
  SPEAKER_00: the textbook is very specific about their underlying pathology.
• 30:36
  SPEAKER_00: It states that at their core, these patients harbor highly primitive unconscious rage.
• 30:41
  SPEAKER_00: I mean, that's a terrifying phrase.
• 30:43
  SPEAKER_00: Let's unpack the etiology of that rage.
• 30:45
  SPEAKER_01: Well, when a child's core attachments are traumatized,
• 30:48
  SPEAKER_01: whether through physical abuse, severe emotional neglect,
• 30:52
  SPEAKER_01: or repeated unpredictable abandonment, it mobilizes an incredibly primitive,
• 30:58
  SPEAKER_01: almost murderous rage within the child.
• 31:00
  SPEAKER_00: It is a biological survival response.
• 31:03
  SPEAKER_01: Exactly. But here is the tragic paradox.
• 31:06
  SPEAKER_01: A child cannot express rage at the caregiver they depend on for food, shelter, and survival.
• 31:12
  SPEAKER_00: To attack the parent is to risk total abandonment and death.
• 31:15
  SPEAKER_01: Precisely.
• 31:16
  SPEAKER_01: So the child executes a desperate psychological maneuver.
• 31:20
  SPEAKER_01: They turn that primitive rage entirely inward upon themselves.
• 31:24
  SPEAKER_00: They protect the abuser to protect their own survival.
• 31:27
  SPEAKER_01: Exactly. They bury the rage under immense, suffocating layers of guilt, grief,
• 31:33
  SPEAKER_01: and masochistic, self-sabotaging character defenses.
• 31:36
  SPEAKER_01: They dedicate their lives to punishing themselves in order to protect
• 31:40
  SPEAKER_01: the idealized image of the parent.
• 31:42
  SPEAKER_00: Wow.
• 31:43
  SPEAKER_00: So to break through these massive calcified locks,
• 31:48
  SPEAKER_00: Davenloo developed a highly structured,
• 31:50
  SPEAKER_00: highly aggressive eight step process called the central dynamic sequence.
• 31:54
  SPEAKER_01: It is a formidable technique.
• 31:56
  SPEAKER_00: I want to walk through the mechanics of this because it is just unlike anything else
• 32:00
  SPEAKER_00: in psychiatry.
• 32:01
  SPEAKER_00: It starts with step one, inquiry, and step two, defense identification,
• 32:06
  SPEAKER_00: where the therapist points out the patient's evasiveness.
• 32:09
  SPEAKER_01: Standard so far.
• 32:10
  SPEAKER_00: But it escalates rapidly at step three, the head on collision with the patient's resistance.
• 32:16
  SPEAKER_00: I have to stop here.
• 32:18
  SPEAKER_00: A head on collision sounds incredibly violent for a therapeutic setting.
• 32:22
  SPEAKER_01: It does sound that way. Yes.
• 32:23
  SPEAKER_00: How does a psychiatrist justify this safely?
• 32:26
  SPEAKER_00: Isn't there a massive risk of re-traumatizing a deeply fragile patient?
• 32:30
  SPEAKER_01: It is a vital question, and understanding the answer is really the key to Davenloo's genius.
• 32:36
  SPEAKER_01: The head-on collision is a relentless, unyielding challenge to the defense,
• 32:42
  SPEAKER_01: never an attack on the patient.
• 32:43
  SPEAKER_00: Okay, distinguish those for me.
• 32:45
  SPEAKER_01: The therapist essentially corners the defensive structure.
• 32:48
  SPEAKER_01: They point out over and over, with increasing pressure,
• 32:52
  SPEAKER_01: how the patient's detachment, their intellectualization,
• 32:55
  SPEAKER_01: or their stubborn passivity is destroying their life out in the real world.
• 32:59
  SPEAKER_00: And how it's actively destroying the therapy in this very room.
• 33:03
  SPEAKER_01: Exactly. Your refusal to look at me and answer
• 33:05
  SPEAKER_01: the question is exactly how you isolate yourself from your wife.
• 33:09
  SPEAKER_00: Ah, I see.
• 33:10
  SPEAKER_01: By relentlessly pressuring this resistance, the therapist makes the defense ego alien.
• 33:15
  SPEAKER_00: Ego alien.
• 33:17
  SPEAKER_01: Meaning the patient stops identifying with the defense.
• 33:19
  SPEAKER_01: They stop saying, I'm just a quiet, passive person.
• 33:22
  SPEAKER_01: And they start seeing the passivity as this alien parasite that is ruining their life.
• 33:27
  SPEAKER_00: Yes, it separates the true self from the pathological defense.
• 33:30
  SPEAKER_01: And once the defense is ego alien, we reach step four, the breakthrough.
• 33:35
  SPEAKER_00: Because the therapist has blocked every conversational exit.
• 33:38
  SPEAKER_01: Exactly. The resistance finally collapses under the pressure,
• 33:42
  SPEAKER_01: which leads directly to step five and six,
• 33:45
  SPEAKER_01: the mobilization of the unconscious therapeutic alliance and direct access
• 33:49
  SPEAKER_01: to the unconscious.
• 33:50
  SPEAKER_00: What does that actually look like in the room when they break through?
• 33:55
  SPEAKER_01: It manifests as a sudden visceral volcanic eruption of that primal rage and grief
• 34:00
  SPEAKER_01: that has been buried for decades.
• 34:02
  SPEAKER_01: The patient might physically shake, sob uncontrollably, or express intense,
• 34:06
  SPEAKER_01: previously unthinkable anger toward the traumatizing figures of their past.
• 34:11
  SPEAKER_00: It sounds exhausting.
• 34:12
  SPEAKER_01: It is.
• 34:13
  SPEAKER_01: But as that emotional storm breaks, a profound alliance forms.
• 34:18
  SPEAKER_01: The healthy, buried part of the patient,
• 34:20
  SPEAKER_01: which has been trapped behind the iron door for a lifetime,
• 34:23
  SPEAKER_01: finally joins forces with the therapist.
• 34:26
  SPEAKER_00: And then the final steps, seven and eight,
• 34:28
  SPEAKER_00: involve systematically analyzing the transference and consolidating
• 34:31
  SPEAKER_00: the newly uncovered history.
• 34:33
  SPEAKER_01: Precisely.
• 34:34
  SPEAKER_00: Let's ground this in a clinical manifestation.
• 34:37
  SPEAKER_00: The textbook provides the case of John demonstrating ISTDP.
• 34:41
  SPEAKER_00: John is a 35 year old professional.
• 34:43
  SPEAKER_00: He is objectively brilliant,
• 34:46
  SPEAKER_00: but he suffers from an almost delusional conviction that he is destined
• 34:49
  SPEAKER_00: for catastrophic failure.
• 34:51
  SPEAKER_01: A very common presentation in these severe cases.
• 34:54
  SPEAKER_00: He deliberately suppresses his own ambitions, sabotages his own promotions,
• 34:58
  SPEAKER_00: and remains severely lonely.
• 35:00
  SPEAKER_00: He claims he does this because he is terrified of being perceived as arrogant.
• 35:04
  SPEAKER_01: John represents the exact type of massive character resistance Davenloo targets.
• 35:09
  SPEAKER_01: John's self-sabotage, his false humility, his conviction of failure.
• 35:13
  SPEAKER_01: These aren't just symptoms of low self-esteem.
• 35:16
  SPEAKER_00: They are an iron door.
• 35:17
  SPEAKER_01: Yes.
• 35:18
  SPEAKER_01: They are a massive, masochistic character defense covering up deep, unconscious,
• 35:22
  SPEAKER_01: aggressive conflicts.
• 35:24
  SPEAKER_01: A therapist using a gentler method might spend years trying to build John's self-esteem.
• 35:29
  SPEAKER_00: Which John would just endlessly deflect.
• 35:30
  SPEAKER_01: Endlessly. So the ISDTP therapist goes for the head-on collision.
• 35:35
  SPEAKER_01: They meet John's self-deprecating resistance with intense pressure.
• 35:39
  SPEAKER_00: They challenge his pathological need to neuter his own brilliance.
• 35:42
  SPEAKER_01: They relentlessly point out that his humility is actually
• 35:45
  SPEAKER_01: a destructive weapon he is using against himself and the therapy.
• 35:49
  SPEAKER_01: And they maintain this pressure until the underlying rage.
• 35:52
  SPEAKER_01: The rage at whoever originally demanded his submission and punished his vitality
• 35:56
  SPEAKER_01: when he was a child finally bursts through the defense.
• 36:00
  SPEAKER_00: And John realizes his failure is a punishment inflicted on himself to protect
• 36:04
  SPEAKER_00: the memory of a tyrant.
• 36:05
  SPEAKER_01: Spot on.
• 36:06
  SPEAKER_00: It is exhausting just thinking about the sheer emotional energy happening in these rooms.
• 36:11
  SPEAKER_00: But psychiatry is not a static field.
• 36:13
  SPEAKER_00: We are constantly evolving, constantly learning.
• 36:16
  SPEAKER_01: We have to be.
• 36:16
  SPEAKER_00: And a major critique of Davenlu's ISDTP is that while it is effective,
• 36:21
  SPEAKER_00: it is incredibly grueling.
• 36:23
  SPEAKER_00: So what happens when the lock on the chamber isn't made of hardened anger,
• 36:27
  SPEAKER_00: but is made of fragile, crumbling shame?
• 36:30
  SPEAKER_01: Or what happens when the primary symptom isn't depression, but acute, terrifying panic attacks?
• 36:35
  SPEAKER_00: Exactly.
• 36:36
  SPEAKER_00: Let's transition to the emerging frontiers of brief dynamic therapy.
• 36:40
  SPEAKER_01: This is where we look at how the next generation of clinicians adapted the core mechanisms.
• 36:45
  SPEAKER_01: Let's examine the fourth portrait in our mansion,
• 36:48
  SPEAKER_01: Diana Foscia and Accelerated Experiential Dynamic Psychotherapy, or AEDP.
• 36:54
  SPEAKER_00: Foscia builds heavily in the short-term tradition of focusing on affect
• 36:57
  SPEAKER_00: and the body, but she completely inverts Daven Liu's approach to resistance,
• 37:02
  SPEAKER_00: doesn't she?
• 37:02
  SPEAKER_01: She does completely.
• 37:04
  SPEAKER_00: I love the contrast here.
• 37:05
  SPEAKER_00: If Davenloo uses a heavy battering ram to break down the iron door of defenses,
• 37:09
  SPEAKER_00: Fosha builds a warm glowing hearth in the hallway that makes you actually want
• 37:13
  SPEAKER_00: to open the door and take your heavy armor off voluntarily.
• 37:17
  SPEAKER_01: That is exactly the mechanism.
• 37:19
  SPEAKER_01: Fosha roots her theory deeply in the modern neurobiology of attachment.
• 37:24
  SPEAKER_01: She posits that affects, our deep core emotions,
• 37:28
  SPEAKER_01: are biologically meant to be sources of vitality, connection, and authenticity.
• 37:32
  SPEAKER_00: But if a child grows up with rejecting highly critical or emotionally absent parents...
• 37:38
  SPEAKER_01: Experiencing those core emotions becomes deeply unsafe.
• 37:42
  SPEAKER_01: So the child builds defenses to survive.
• 37:45
  SPEAKER_00: So Davenlu sees the defense as an enemy to be crushed,
• 37:48
  SPEAKER_00: but Fosha sees the defense as a tragedy to be mourned.
• 37:51
  SPEAKER_01: Exactly.
• 37:52
  SPEAKER_01: Instead of aggressively confronting the defense,
• 37:55
  SPEAKER_01: the AEDP therapist adopts a highly supportive, explicitly affirming,
• 38:00
  SPEAKER_01: and emotionally engaged stance from the very first minute of the very first session.
• 38:05
  SPEAKER_00: They don't wait for a therapeutic alliance to form.
• 38:08
  SPEAKER_01: No, they actively construct it.
• 38:10
  SPEAKER_01: They create such an overwhelming sense of emotional safety and connectedness
• 38:13
  SPEAKER_01: in the here and now that the patient's nervous system registers a new reality.
• 38:18
  SPEAKER_01: The threat is gone.
• 38:19
  SPEAKER_00: The defenses are no longer necessary for survival.
• 38:22
  SPEAKER_01: Right. The mutative agent in AEDP isn't breaking resistance.
• 38:26
  SPEAKER_01: It is the visceral experience of processing core emotions within a safe,
• 38:31
  SPEAKER_01: emotionally engaged, responsive dyad.
• 38:34
  SPEAKER_00: It's a profound shift from a conflict-based model of therapy
• 38:38
  SPEAKER_00: to an attachment-based model of healing.
• 38:41
  SPEAKER_00: Now let's look at another frontier, panic disorder.
• 38:44
  SPEAKER_01: A vital area of adaptation.
• 38:46
  SPEAKER_00: For a very long time, panic was viewed by the psychiatric establishment
• 38:49
  SPEAKER_00: as a purely biological or cognitive misfiring.
• 38:52
  SPEAKER_00: You know, a random chemical imbalance or a catastrophic misinterpretation of a racing heartbeat.
• 38:57
  SPEAKER_01: That was the prevailing wisdom, yes.
• 38:59
  SPEAKER_00: But Barbara Milrod and her group at Cornell developed PFPP,
• 39:03
  SPEAKER_00: Panic-Focused Psychoanalytic Psychotherapy.
• 39:06
  SPEAKER_00: They brought the dynamic lens to an AXIS-1 disorder.
• 39:09
  SPEAKER_01: Milrod's brilliant clinical insight is that panic attacks are not random.
• 39:13
  SPEAKER_01: They have profound unconscious meaning.
• 39:16
  SPEAKER_01: In her framework, a panic attack often represents a sudden catastrophic failure
• 39:20
  SPEAKER_01: of an overburdened system of psychological defenses.
• 39:23
  SPEAKER_00: The levy breaks.
• 39:24
  SPEAKER_01: Precisely.
• 39:26
  SPEAKER_01: These patients frequently harbor deep, unacknowledged rage or profound,
• 39:30
  SPEAKER_01: terrifying separation anxiety.
• 39:32
  SPEAKER_01: They spend enormous energy keeping these feelings repressed.
• 39:35
  SPEAKER_00: And then what happens?
• 39:36
  SPEAKER_01: When an event in their adult life triggers that hidden anger or threatens
• 39:40
  SPEAKER_01: a separation, like a spouse traveling for work or an argument with a boss,
• 39:45
  SPEAKER_01: their fragile defenses get completely overwhelmed
• 39:47
  SPEAKER_01: and the entire psychic system crashes into acute physical panic.
• 39:51
  SPEAKER_00: Wow.
• 39:52
  SPEAKER_00: The textbook details Milrod's specific three-phase structure for PFPP.
• 39:56
  SPEAKER_00: It is highly organized.
• 39:58
  SPEAKER_00: Phase one is dealing with the acute panic itself, mapping out the personal,
• 40:02
  SPEAKER_00: highly specific architecture of the unconscious conflicts triggering the attacks.
• 40:07
  SPEAKER_01: You have to identify the exact nature of the compromised defense first.
• 40:11
  SPEAKER_00: Right.
• 40:11
  SPEAKER_01: Then phase two is where the deep work happens, targeting the core conflicts.
• 40:17
  SPEAKER_01: This involves actively desensitizing the patient to the fear of their own anger
• 40:22
  SPEAKER_01: and desensitizing them to their fear of autonomy.
• 40:25
  SPEAKER_00: You help them understand that experiencing anger will not destroy them.
• 40:29
  SPEAKER_01: And being independent will not result in abandonment.
• 40:33
  SPEAKER_00: In phase three, termination is fascinating from a clinical reasoning perspective.
• 40:37
  SPEAKER_00: Usually termination is just saying goodbye, wrapping things up.
• 40:40
  SPEAKER_00: But in PFPP, ending the therapy is actually the final, most crucial therapeutic intervention.
• 40:46
  SPEAKER_01: Because ending the therapy forces the patient
• 40:49
  SPEAKER_01: to directly experience their core separation conflict with the therapist
• 40:53
  SPEAKER_01: in real time.
• 40:55
  SPEAKER_01: The patient has to face the anxiety of losing the therapist.
• 40:58
  SPEAKER_01: And by successfully surviving that separation without panicking, the cure is consolidated.
• 41:04
  SPEAKER_00: Before we move to the brain itself, we must mention Heinz Kohut and self-psychology,
• 41:08
  SPEAKER_00: which the textbook highlights as crucial for patients suffering
• 41:11
  SPEAKER_00: from narcissistic vulnerabilities.
• 41:13
  SPEAKER_01: Yes, very important.
• 41:15
  SPEAKER_00: I want to clarify immediately, though,
• 41:16
  SPEAKER_00: when we say narcissism in a clinical psychodynamic context,
• 41:20
  SPEAKER_00: we absolutely do not mean the pop culture definition of a vain person taking selfies
• 41:25
  SPEAKER_00: on Instagram.
• 41:26
  SPEAKER_01: Not at all. In Kohut's framework, narcissistic vulnerability is a profound,
• 41:31
  SPEAKER_01: tragic failure to integrate a cohesive sense of self.
• 41:34
  SPEAKER_00: And what causes that?
• 41:36
  SPEAKER_01: It is caused by chronically unempathetic parental responses during childhood,
• 41:41
  SPEAKER_01: what Kohut calls a severe lack of mirroring.
• 41:45
  SPEAKER_01: If a child's early environment doesn't accurately mirror their value, their joy,
• 41:49
  SPEAKER_01: and their worth, they're developing ego fractures.
• 41:52
  SPEAKER_01: They experience cognitive-affective dissociation.
• 41:56
  SPEAKER_00: So they swing wildly between extreme, haughty, distancing, and intense,
• 42:01
  SPEAKER_00: desperate neediness, plagued by a pervasive,
• 42:04
  SPEAKER_00: agonizing sense of shame or internal emptiness.
• 42:06
  SPEAKER_01: Exactly.
• 42:08
  SPEAKER_01: To math this specific pathology, Cohut offers the triangle of the self.
• 42:12
  SPEAKER_00: Visualize this one.
• 42:13
  SPEAKER_00: Defenses and dissociation at one corner,
• 42:16
  SPEAKER_00: anxieties like shame in the psychic fragmentation at the other.
• 42:20
  SPEAKER_01: And at the base, the core feelings,
• 42:22
  SPEAKER_01: specifically the wildly fluctuating valued or devalued representations of the self.
• 42:28
  SPEAKER_00: And how does the therapist treat a fractured self?
• 42:31
  SPEAKER_00: Because you obviously can't use Davenloo's head-on collision on someone
• 42:34
  SPEAKER_00: who was already fragmenting from shame.
• 42:36
  SPEAKER_01: Exactly. That would be disastrous.
• 42:38
  SPEAKER_01: The primary tool here isn't confrontation, but profound, sustained empathy.
• 42:43
  SPEAKER_01: Kohut introduces a brilliant technique called imaginary reconstruction.
• 42:47
  SPEAKER_00: What does that entail?
• 42:49
  SPEAKER_01: The therapist actively helps the patient vividly imagine an optimum,
• 42:52
  SPEAKER_01: non-wounding version of a painful past failure or rejection.
• 42:56
  SPEAKER_01: It acts as a soothing psychological balsam to deep narcissistic wounds,
• 43:01
  SPEAKER_01: allowing the fragmented, dissociated parts of the self to slowly,
• 43:04
  SPEAKER_01: safely reintegrate.
• 43:06
  SPEAKER_00: It's beautiful, really.
• 43:08
  SPEAKER_00: Well, this brings us to the ultimate synthesis.
• 43:11
  SPEAKER_00: We have spent, you know, over an hour talking about metaphors, triangles, holograms,
• 43:15
  SPEAKER_00: and repressed childhood memories.
• 43:17
  SPEAKER_01: The intangible stuff.
• 43:18
  SPEAKER_00: Right. It is easy for skeptics to dismiss this as poetic, unscientific theorizing.
• 43:24
  SPEAKER_00: But the textbook's final section on neurobiology proves
• 43:27
  SPEAKER_00: that we are not just engaging in philosophy.
• 43:29
  SPEAKER_00: We are talking about hard biology.
• 43:32
  SPEAKER_01: We aren't just debugging invisible software.
• 43:34
  SPEAKER_01: We are literally physically rewiring the metabolic hardware of the human brain.
• 43:39
  SPEAKER_00: The neurobiology section of chapter 32.5 is where a century
• 43:43
  SPEAKER_00: of metapsychology finally meets the modern fMRI scanner.
• 43:48
  SPEAKER_01: And the neuroimaging data confirms what psychodynamic therapists have theorized since Freud.
• 43:53
  SPEAKER_01: We have evidence that in obsessive compulsive disorder,
• 43:56
  SPEAKER_01: effective behavioral and dynamic therapy literally uncouples
• 44:00
  SPEAKER_01: the runaway corticostriatothalamic loop in the brain.
• 44:03
  SPEAKER_00: The physical circuit of obsession is actually broken.
• 44:06
  SPEAKER_01: Yes.
• 44:07
  SPEAKER_01: And in major depression, the textbook highlights studies showing
• 44:11
  SPEAKER_01: that psychotherapy actually increases prefrontal activation
• 44:14
  SPEAKER_01: and decreases limbic activation.
• 44:17
  SPEAKER_01: It Physically reverses the baseline depressive metabolic state of the brain.
• 44:21
  SPEAKER_00: And the data on panic disorder is perhaps the most striking.
• 44:25
  SPEAKER_01: Beudel's fMRI studies show
• 44:27
  SPEAKER_01: that successful psychodynamic therapy demonstrably decreases hyperactivity
• 44:32
  SPEAKER_01: in the amygdala and hippocampus.
• 44:33
  SPEAKER_00: The brain's primitive fear and memory centers.
• 44:36
  SPEAKER_01: Simultaneously, it increases activity in the prefrontal cortex.
• 44:41
  SPEAKER_00: Let's translate that mechanism for a second.
• 44:43
  SPEAKER_00: The process of memory reappraisal The act of sitting in a room feeling safe
• 44:48
  SPEAKER_00: with a therapist and finally allowing yourself to fully experience old rage
• 44:52
  SPEAKER_00: and grief literally changes the metabolic rate of the fear centers in your brain.
• 44:57
  SPEAKER_01: You are physically building top-down cortical control over runaway limbic fear.
• 45:02
  SPEAKER_01: You are using the power of a safe therapeutic relationship to alter cellular activity.
• 45:07
  SPEAKER_00: It is the ultimate, undeniable vindication of Alexander's corrective emotional experience.
• 45:14
  SPEAKER_00: These implicit procedural memories of terror that were hard-coded
• 45:18
  SPEAKER_00: into our early attachments are physically, metabolically overwritten by the new,
• 45:24
  SPEAKER_00: safe attachment formed with the clinician.
• 45:27
  SPEAKER_01: It's quite phenomenal when you look at it that way.
• 45:29
  SPEAKER_00: So as we step out of the house of unspoken feelings and look back at the portraits
• 45:33
  SPEAKER_00: of Siphneos, Milan, Davenloo, and Fauchat,
• 45:37
  SPEAKER_00: The overarching lesson becomes incredibly clear.
• 45:41
  SPEAKER_01: The object of brief dynamic psychotherapy is never merely an intellectual exercise.
• 45:46
  SPEAKER_00: It is not just about explaining the past to satisfy our curiosity or to assign blame.
• 45:52
  SPEAKER_01: It is far more profound and far more active.
• 45:55
  SPEAKER_01: The goal is to recognize the maladaptive pattern,
• 45:59
  SPEAKER_01: to physically and emotionally experience the forbidden feeling that drives it.
• 46:04
  SPEAKER_01: To loosen the suffocating grip of the defense mechanism.
• 46:07
  SPEAKER_01: And ultimately, to free up the psychic energy required to live differently.
• 46:11
  SPEAKER_00: Spot on. Now, before we wrap up, I want to ensure we consolidate
• 46:15
  SPEAKER_00: the clinical reasoning we've built today.
• 46:17
  SPEAKER_00: Let's do a rapid-fire conceptual synthesis of the core mysteries we've unlocked.
• 46:22
  SPEAKER_01: Excellent idea.
• 46:23
  SPEAKER_00: I'll ask the question, pause for a moment so you, the listener, can think,
• 46:27
  SPEAKER_00: and then our expert will break down the answer.
• 46:29
  SPEAKER_00: If you want to go deeper on any of these, pull up Chapter 32.5 of Kaplan and Sadak.
• 46:33
  SPEAKER_00: All right. Question one, concepts.
• 46:36
  SPEAKER_00: Which early psychoanalytic pioneer is credited with emphasizing
• 46:39
  SPEAKER_00: the corrective emotional experience and focusing
• 46:42
  SPEAKER_00: on the patient's emotional experience in the here and now,
• 46:45
  SPEAKER_00: moving away from purely intellectual insight?
• 46:48
  SPEAKER_01: That would be Franz Alexander.
• 46:50
  SPEAKER_01: He realized that intellectual knowledge without affect serves as a resistance.
• 46:55
  SPEAKER_00: Right. Question two, mechanisms.
• 46:58
  SPEAKER_00: In David Mallon's short-term dynamic psychotherapy,
• 47:00
  SPEAKER_00: what are the three points of the triangle of conflict?
• 47:04
  SPEAKER_01: Impulse or feeling at the bottom and defense and anxiety at the top corners.
• 47:10
  SPEAKER_01: The therapist works to clarify the defense to lower anxiety and access the hidden impulse.
• 47:16
  SPEAKER_00: Question three, clinical reasoning.
• 47:19
  SPEAKER_00: You are evaluating a patient who suffers from severe pervasive symptoms,
• 47:23
  SPEAKER_00: highly primitive unconscious rage and massive entrenched character resistance.
• 47:28
  SPEAKER_00: According to the text, which model is specifically designed to handle this level
• 47:32
  SPEAKER_00: of pathology through a head-on collision with resistance?
• 47:36
  SPEAKER_01: Habib Devonlu's Intensive Short-Term Dynamic Psychotherapy, or ISTDP.
• 47:41
  SPEAKER_00: Moving on to question four, concepts.
• 47:44
  SPEAKER_00: Ensephoneosis is STAPP.
• 47:46
  SPEAKER_00: What is the specific term used to describe the visual or conceptual map linking
• 47:51
  SPEAKER_00: a patient's deep genetic impulses to their broad dynamic forces
• 47:55
  SPEAKER_00: to their surface conscious life problems?
• 47:58
  SPEAKER_01: That is the dynamic hologram.
• 48:01
  SPEAKER_00: Question five, mechanisms.
• 48:03
  SPEAKER_00: Diana Fosha's AEDP differs from Dan of Law's ISDTP in how it approaches patient defenses.
• 48:11
  SPEAKER_00: What is the primary mutative mechanism AEDP uses to encourage patients to drop their defenses?
• 48:17
  SPEAKER_01: Fostering emotional safety and an emotionally engaged empathic bond in the here
• 48:22
  SPEAKER_01: and now rather than actively breaking through defenses via confrontation.
• 48:27
  SPEAKER_00: Finally, question six, clinical reasoning.
• 48:30
  SPEAKER_00: Based on the neuroimaging studies discussed in the text,
• 48:33
  SPEAKER_00: successful psychodynamic psychotherapy for panic disorder is most likely to show
• 48:38
  SPEAKER_00: which specific changes in brain activation on an fMRI.
• 48:42
  SPEAKER_01: Decreased activity in the amygdala and hippocampus with increased prefrontal activity.
• 48:48
  SPEAKER_01: This is the physical manifestation of gaining cognitive control over runaway limbic fear.
• 48:53
  SPEAKER_00: Fantastic.
• 48:54
  SPEAKER_00: Which leaves me with a final provocative thought for you to mull over as you go out your week.
• 48:59
  SPEAKER_00: We've just established that 20 to 40 sessions of highly focused,
• 49:03
  SPEAKER_00: emotionally engaged, honest conversation can permanently alter
• 49:07
  SPEAKER_00: the metabolic activity of our amygdala.
• 49:09
  SPEAKER_01: It can literally rewire the brain's fear network.
• 49:13
  SPEAKER_00: So if structured conversation is that biologically powerful,
• 49:16
  SPEAKER_00: what does that say about the everyday conversations we have with the people we love?
• 49:20
  SPEAKER_00: Or perhaps even more importantly,
• 49:22
  SPEAKER_00: what does it say about the silent stories we repeatedly tell ourselves in the quiet
• 49:26
  SPEAKER_00: of our own minds?
• 49:27
  SPEAKER_01: That is a staggering realization.
• 49:30
  SPEAKER_01: We are constantly shaping our own neurobiology through our emotional interactions.
• 49:36
  SPEAKER_00: Thank you so much for joining us on this deep dive into Chapter 32.5.
• 49:40
  SPEAKER_00: Keep questioning your assumptions, keep connecting the clinical dots,
• 49:43
  SPEAKER_00: and keep exploring that magnificent, complex interaction between the brain,
• 49:47
  SPEAKER_00: the mind, and human experience.
• 49:49
  SPEAKER_00: We will see you next time.