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Psychoanalytic Psychotherapy
by Mark Sichel, LCSW and Alicia L. Cervini

Psychoanalytic psychotherapy, based largely on Freud's early discoveries about child development, is the most practiced form of therapy in the U.S. Often therapists use a mixture of psychoanalytic and cognitive techniques in their treatment (To review the role of cognitive therapy in battling panic, read Cognitive and Behavioral Therapy, then return to this page).

The theory behind psychoanalytic psychotherapy is that if you are able to verbalize your thoughts and feelings, you will not need to act them out with symptoms such as panic. Most psychodynamic therapy centers around addressing issues of dependence vs. independence.

A person having a panic attack wants to be in a safe place where their need to be taken care of can be safely and assuredly met. They do not feel independent and capable of handling a given situation, rather they want to be taken care of. They have reverted into a state of dependence.

Being able to vocalize your feelings about a stressful situation -- what psychotherapy trains you to do -- is an act of independence; being unable to express your emotions during a time of stress is a sign of dependence. Dependence is a facet of regression (Read Regression if you need to be reminded about how the phenomenon of returning to more primitive forms of thinking sets the stage for panic attacks). Being raised to be dependent, rather than independent, can profoundly and negatively effect your ability to cope with stress as an adult.

A new-born baby is completely and totally dependent on his or her mother. As the child grows, the parents either support and highlight the child's attempts at independence, or else they encourage and reward the child for displays of dependency. Fostering dependency in children causes a child to grow up without developing healthy coping mechanisms of their own. A child such as this will be prone to panic attacks as they age, as well as a host of other psychological maladies. The good news, however, is that with practice and with an understanding of where a feeling of independence comes from, any adult can develop and nurture their own ability to be independent, regardless of their upbringing.

The process of learning independence is related to a person's ability to master, psychologically, separation from the family. As a child, each act of independence is an act of separation from the family. Every time we successfully act independently as children, we are getting closer to achieving a healthy sense of self, separate from our families. Without successful and healthy separation from our families, we cannot grow naturally into healthy and independent adults.

The reason some people have greater difficulty mastering independence is related to parental mixed messages. Some parents naturally have a great deal of confidence about their children's ability to be independent, and others are quite fearful. Often these same parents who are fearful are also reluctant to allow their children to separate from the family. These parents feel, somehow, that their children's dependence creates a safe haven not only for their children, but also for themselves. Thus they unconsciously reward dependence and punish independence in subtle ways in order to maintain the status quo.

Much of what we've already covered in these Panic Disorder lessons is based on theories of childhood development within a family. A psychoanalytic interpretation of panic would revolve around the idea that a person's panic is caused by the difficulty they are having accepting their fears about independence and autonomy. These fears are known collectively as separation anxiety.

The psychoanalytic way of thinking would say that if you are having panic attacks, you are having trouble accepting and verbalizing your desire to have someone take care of you, because of lingering feelings of separation anxiety and a lack of independence. This phenomenon manifests itself in people essentially for two reasons:

  • Your family had difficulty rewarding your successful acts of independence, whereas they gave you LOTS of attention for acts of dependence.

  • At the same time, your family encouraged you to feel shameful about your wishes to let someone else take care of you.

    The treatment, in this case, would be to help you to understand your difficulties with independence, and reduce your fears about your abilities to be independent. At the same time, we would normalize your wishes to have someone take care of you by explaining that they are universal feelings and that they are, in fact, only wishes. It is not pathological to want to be taken care of, it is normal. It is only when your desire to be taken care of cripples you that you have a problem.

    Panic attacks are often triggered by separations from the family. This is why college students are particularly vulnerable to panic attacks. Separating from a spouse, losing a parent, or moving to a different state are all external stimuli that could trigger panic attacks for a person that previously had never experienced anything of the kind. Panic attacks force someone -- whoever is there -- to take care of the afflicted person, thus simulating the "safe" and dependable environment of the family the afflicted person has been separated from.

    Sometimes, however, the panic attack is brought on by a less literal separation. Developmental and situational changes in life -- new jobs, new babies, new boyfriends -- mean the end of an old way of doing things. This natural movement from one situation in life to the next can also cause feelings of separation anxiety.

    If you would like to continue the Panic Disorder lessons and find out if you have a problem with separation anxiety, please read Are you Susceptible to Separation Anxiety?.

    If you would like to start at the beginning of the Panic Disorder lessons, please read What to Expect When You are Diagnosed with a Panic Disorder.

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