Question: Is Freud dead?
Dr. Katherine Shear: Oh, that's a hard question. I would have to say in my case personally, I don't think a lot about this, I have to say. But I'm quite sure that there – Freud was an incredible observer. He was a very, very good observer and what he wrote about, the clinical phenomenon, were very insightful. And also things like his ideas about the concept of transference – how people basically bring to a new relationship the expectations and predictions they have gleaned from other earlier relationships, especially attachment relationships. That's my background. And I'm sure it still informs what I do.
Question: Will one-on-one therapy always be part of psychiatry?
Dr. Katherine Shear: Yes, I think. I absolutely think and very much hope, but I mean, I think it's an essential part of healing people and we know this, regardless of what other ways we develop and whether they be neurobiological methods. And now we're talking not only about psychopharmacology but a lot of other kinds of brain stimulation, for example, and even some kinds of very focused neurosurgeries seem to be things that have promise for certain people in certain situations. So I do very much see psychiatry developing in the direction of neuroscience and neurobiology. I think we've made some great leaps in that direction and I think we will and we should continue to work in that area.
At the same time, one of the things about psychotherapies is that the more focused psychotherapies actually are better able to target specific behavioral syndromes than any kind of somatic treatment that we have so far. So I definitely think that there's a role for very focused kind of technical interpersonal interventions that are, so to say, psychological interventions. I don't think that will ever go away. But I think we're learning more and more about those kinds of interventions and again, specific techniques. Like there's a very interesting recent report of using training in attention in attentional processes in some anxiety disorders and social phobia and generalized anxiety – probably for any of the anxiety disorders. Because one of the things that you do when you have an anxiety disorder is you over-focus on certain kinds of cues like we were talking about with panic. You know, if you're a socially anxious person, you're going to do that with social cues. You're going to be overly sensitive to social cues. And you can train people apparently away from that by training their attention. And so that's one kind of thing I see happening in the future. But for many of the – I would say virtually all of the conditions we treat – there's always going to be some way in which the person who has the problem will need to kind of get close to – really close – to very distressing emotions and thoughts. And to do that, I think you really need to feel safe. And to feel safe in any treatment, you need another person. You need a person who can be there for you. So I think that will always be there.
Recorded on November 3, 2009
Interviewed by Austin Allen