Psychotherapy: (yet another context and form of learning)

There are many forms of learning and learning environments. In many instances the process underlying learring and the representation of the knowledge acquired from each of them is somewhat different. For example the mechanisms involved in motor learning (like learning to hold a fork or ride a bike) have features that are different from learning a language or acquiring math skills. Some learning is very rapid and some knowedge acquisition is painfully slow. Some learning remains largely incomplete throughout a life time.

How do we learn about who we are, what we are made of, what is our essence, what drives us and stops us from being successful. Naturally one would invoke life experiences as being our most informative teacher. Some have also considered psychotherapy as yet another context for learning knew life skills based on getting a chance to look at and review what we have already learned, personal knowledge that frequently is outside of our awareness. What are the features of a psychotherapy learning environment? In this posting I consider the value of applying some of the methods typically used in psychotherapy to how we learn, acquire new knowledge, reevaluate what we already know.

Many clichés reflect what is true. We are our history, individually and collectively. We are the sum total of what we know, which includes what we know that is in as well as outside of awareness. We also have archives of false and irrational knowledge that we often use to guide us (in the wrong direction. We have persuasive biases, beliefs and attitudes that are not based on any sort of evidence, facts, rational concepts, skills and so on. At any moment in time our reactions to ongoing events are based on our history, knowledge that is overt or hiding under the covers.

I guess when it comes to identifying the our knowledge we should also include information that is stored and expressed as our genetic history. Obviously  genetic information is a kind of knowledge that guides features of our lives.

Our brains are plastic.  As life-long learners we are constantly acquiring new knowledge and massaging what we already know. Learning occurs in many different forms. While most learning is not ‘deliberate’ but rather occurs incidental to strolls through each day’s experiences, some learning is deliberate such as when we study physics or auto mechanics, or when children learn to hold a pencil or become toilet trained.

Are some of the processes that are typically used in psychotherapy useful when applied under conditions in which we are deliberately learning new knowledge and skills? I would answer the question with maybe and that depends on the type of knowledge that is being learned.

The highpoints of the history of psychotherapy (as applied to mental disorders and the discomforts of lives lived) are well known as described in scientific and clinical journals, in books on the subject, in ‘translations’ of the what psychotherapy (talk therapy) in films, novels, biographies, autobiographies, and confessionals.

A very brief superficial overview of psychotherapy: It was late in the 19th century Freud and many others drifted away from accounts of mental disorders based on damaged brain tissue and instead considered symptoms as the byproduct of events in a patient’s life particularly those that originated early in development. What was proposed, in various forms, is talk therapy, the treatment of mental symtoms  by uncovering, interpreting, reinterpreting the wellspring of significant early psychological ‘trauma’. Along the way other talking points were developed such as dream analysis, free association, the dynamics of the relationship of therapist and patient.

The constant in all of the methods was the idea that talking about and exploring the past could lead to an understanding of current experiences, new insights about personal history, which would then translate into neutralizing psychological traumas and that in turn would be reflected in improved mental health.

For all sorts of reasons the value of talking therapy has been questioned both in terms of effectiveness and also based on practical considerations and this has accelerated with the use of all sorts of drug therapies. With the rapid developments in psychopharmacology one-on-one talking treatments became used less and less. Cost in time, money and effiency have also hastened the demise of, for example, classical psychoanalysis which takes a huge amount of time and is therefore neither affordable nor available for most patients. Psychoactive drugs used to treat mental disorders were seen as more reliable and effective although this may have been and still may be an overly generous conclusion.

Regardless of therapeutic value patients often conclude that therapy was for them a powerful learning experience. Patients often acknowledge that they developed new knowledge about themselves, uncovered all sorts of knowledge about significant figures in their lives. It was also not uncommon for patients to appreciate new cognitive skills they had learned in the course of therapy such as being able to listen more acutely, to withhold judgment, to experiment with new ways of approaching all kinds of scenarios in their lives. They often seemed to be saying that they learned a great deal and also learned something about how to learn new things.

What elements of psychotherapy are ripe for application to enhance how we learn? The listing that follows will be elaborated later.

1. Learning to free associate: ‘Uncontrolled’ retrieval of all sorts of knowledge including historical biographical information that is ordinarily outside of awareness. All sorts of cognitive operations (such as making decisions, problem solving) require the use of what we know. Some of the search for relevant knowledge is accomplished in a controlled fashion but this can be enhanced by having access to ‘unconscious’ knowledge.
2. Second and third looks at what we already know: Reviewing, reexamining what we already ‘know’ can alter how that knowledge is represented in our brains and its accessibility for cognitive functions. We are often surprised that what we thought we knew is both more, less and different from what we imagined is in memory.
3. Thinking in a new context: Therapists often encourage clients to ‘experiment with how we might behave in all sorts of situations. So the suggestion of ‘why don’t you try…..” are the conditions for changing the context for what we retrieve from both conscious and unconscious memory. This often involves conditions for altering what we learn about our own behavior and stretches how we might respond in familiar situations and therefore is the conditions for new learning to occur. Applied to new learning conditions changing the context for thinking about some to-be-learned information might involve deliberately choosing an atypical mindset to operate when processing new information. Altering the context in solving complex problems is often the very conditions that promote solutions.
4. Developing realistic goals for learning and changing behavior: successful learning starts at the beginning, before learning takes place. Successful learning, problem solving, decision-making is dependent on what knowledge is currently available and accessible and how that knowledge is put to use. However accessible useful knowledge is dependent on the form of questions we ask. It is understood that in the world of scientific research the most important ingredient is asking the right questions. Asking poorly designed questions will inevitably lead to failure even if there is a great deal of knowledge and powerful tools available for use.
5. Investing time to reflect and reevaluate our own cognitive performance: Self-reflection is a cornerstone of psychotherapy. In cognitive term this would be considered a meta-cognitive function and as such is an important ingredient of monitoring ones own behavior and progress to solving all sorts of problems. Meta-cognitive skills can also be seen as part of executive functions (a prefrontal lobe function) and these functions are learned starting in early development. A good deal of a client’s beliefs about self and significant others.
6. The ‘outside observer who can challenge your beliefs and knowledge: Most people who work out in a gym appreciate the value of having a trainer (at least for some of the time they work out). Skilled trainers know you well enough to know your workout limits. They know how to push but also when to back off. Then are also trained to know when you are doing an exercise correctly and when you are ‘cheating’. Skilled therapists are capable of providing an outsiders view of what you are doing, what you can try to do better, and when you are cheating yourself via distorted self-perceptions.
7. Learning that is safe from recrimination and over critical judgment: Therapists often refer to their working ‘space’ with a client as non-judgmental. Similarly, in problem solving, decision-making learning we too often limit our ability to perform by applying self-critical breaks on our performance. Having the freedom to do as well as possible at any given moment is likely to result in more effective cognitive functioning.
8. Learning in a safe relaxed environment but with enough ‘tension and arousal’ for motivated performance: The therapeutic environment is optimum when there is some arousal, stress, tension present but not so much that it is toxic to performance. For example, a deadline, a commitment to complete a goal energizing performance.
9. Impulsive in contrast to deliberate decsion-making: There is a huge literature on how we make decisions, the conditions that promote effective evidence-driven conition in contrast to impulsive irrational responses to environmental stimuli. In parallel, at the same time, therapists have developed interventions that get patients to think before they act, to slow down the process of responding so that decisions being made are reasonable and helpful.. For example, if a patient over responds (emotionally) to a verbal assault they can be taught to slow down responding to allow reflection to take the place of reflexive responding that can be both ineffective and self destrtuctive. Similar methods of slowing down responding to block reflexive responded can be taught students (especially young stiudents) so that they might think before rapeidly responding as they learn or their learning is tested.
10. Altering ‘toxic’ beliefs: I suppose cognitive therapists have for decades developed some of the techniques that can challenge and then change ‘cherished’ beliefs of their patients. So for example, notions about worthlessness, helplessness, unrealistic threats and so on have been the target for change in cognitive therapy (using reflection, thought exercises, feedback from therapists). In many learning situations ‘students’ also begin with strong beliefs that are difficult to change but can be altered through exposure to carefully planned exercises (such as experiements in physics showing that a bullet fired from a gun reaches the ground at the same time as one dropped from the muzzle of the gun).
11. Teachers, mentors, therapist have powerful (influence) roles in our lives: What we value, what we want to learn, how we live our lives is for us to decide. At the same time we choose to use all sorts of experts to help us meet OUR goals. There are a wide range of people in helper roles such as financial advisors, all sorts of teachers-mentors, physicians, and so on including psychotherapists. We choose to go to a therapist because we are uncomfortable or see ourselves as unsuccessful and use the expertise of the  therapest to promote positive change.  Starting with out parents we are guided, helped taught by many who fill the role of our ‘helpers’. This is the case whether we are taught how to become researchers, learn arithmetic or are working with a therapist in order to comphrend and change facets of our inner and outer life. These are powerful roles filled by people that are real and not some ideal and have their own values and biases which are part of what is ‘tqaught’ those being helped. They are not objective. This is a topic that has often been written about and is well accepted as one of the limitations (and strengths) of the therapist in the expert helper role. We all have limitations in how we apply our expertise. We certainly accept that as a limitation in, for example, financial advisors. Likewise, the expertise of psychotherapists, our teachers and mentors must be used with our active participation as critical reflective students. Once again we are warned ‘buyer beware’.
12. Guided imagery: This is a tool used in therapy that may be useful in providing alterative perspectives in learning environment….needs some additional thoughts and exploration