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Segal discusses how psychotherapy works in NYC lecture

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Blaine Friedlander

Imagine a crash course in major methods of psychotherapy, conducted in 50 minutes -- ironically, the length of a psychotherapy session.

That was clinical psychologist Harry Segal's task as he lectured some 800 people Jan. 22 on "What Is Psychotherapy (and how does it work)?" at One Day University in New York City.

Segal, senior lecturer in psychology at Cornell and at Weill Cornell Medical College, used the case of "Joe," a fictional Cornell freshman who is doing well socially but is struggling with his studies, to walk his audience through four models of therapy.

Joe had been a star in high school, but at Cornell, family issues were kicking in. Mom idealizes Joe and is impatient with Dad, who has his own self-worth issues. No matter how hard Joe tries, he can't focus on his schoolwork.

"First, I take Joe through generic counseling," such as discussing whether homesickness or lack of a quiet place to study were issues. "A lot of people aren't comfortable being in psychotherapy, but 'counseling' is okay," Segal said. "Then I take him to a psychopharmacologist and talk a bit about the neurobiology of anxiety disorders and how you would treat it with medication.

"Assuming that doesn't work, I take him through cognitive-behavioral therapy, which targets distorted thinking about the future, the theory being that we don't have an emotional response to events, we have emotional responses to our interpretations of events." Cognitive-behavioral therapy assumes that depressed people attribute the cause and the consequence of events in negative ways that assume a negative outcome will always happen, Segal said.

"Lastly, I take them through a psychodynamic treatment of Joe, which assumes there is a conflict. Consciously, he wants to succeed. But unconsciously, he might be anxious about surpassing his dad and being his mom's favorite, and something about embarking on a college career is stirring up this conflict," Segal said. "If you make that conflict conscious, Joe has a chance to reorganize his experience and work through his studying block."

Does psychotherapy work? "The empirical evidence has been definitive for about 25 years that psychotherapy works quite effectively for different symptoms for different issues," said Segal, the only clinical psychologist in Cornell's psychology department. "In the lecture I wasn't presenting empirical evidence. I was only trying to explain what it is and how it works."

After the talk, several people approached Segal with questions about someone they were worried about -- a child, a grandparent, a spouse. He said Cornell students who register for his introductory psychopathology course raise many of the same questions. "There's always a percentage that take it because of a difficult time they've had or someone in their family has had," Segal said.

One Day University brings highly rated faculty members from elite universities to deliver lectures in their fields to a largely lay audience. "I liked the audience very much," said Segal. "In a lecture you're establishing an ongoing relationship with a group, but in this case you only have an hour."

"My sense is that people's relationship to the idea of psychotherapy is fraught, because it involves acknowledging that you might need help," Segal said. "Or that you want to be stronger, or better at what you do, or happier in your life. Americans, I think, have very complicated relationship to that idea."

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