The Different Anxiety Disorders - Admission/Application Essay Example

Psychodynamic Theoretical Approach to Treating Anxiety Panic disorder is a prominent problem in society and its prevalence manifests with or devoid of agoraphobia (averting of exposed situation owing to fear of panic or incapability to escape) range between 3-5.6% for panic attacks and 1.5-5% for panic disorders. Abrupt and repetitive panic attacks can be regarded as the hallmark symptoms of panic disorder; however, the context in which the symptoms manifest is very essential when one is making a diagnosis. The persistent and unexpected panic attacks symptoms that the client exhibits can be the outcome of traumatic experiences during his childhood. Initially, panic attacks emanate from stressful episodes, but steadily the attacks become dissociated and arise “out of nowhere.” The paper explores psychodynamic theoretical approach to treating anxiety and describes how a therapist can understand and treat a client diagnosed with panic disorder. Psychodynamic Theoretical Approach to Treating Anxiety Introduction Both cognitive-behavioral and pharmacologic treatments of panic disorder have been proved to be effective within the short-term treatment of panic disorder; nevertheless, patients usually fail to tolerate or respond to the treatments. Moreover, the probability of relapse is frequent, especially in cases where medication is discontinued. The psychodynamic approach comprises of four core therapies, namely: psychoanalytic, object relations, Adlerian, and Jungian. Psychodynamic psychotherapy carries value in the treatment of panic disorder informed by the notion that, panic patients manifest psychological vulnerability to the disorder linked to “relationship problems, personality disturbances, unconscious conflicts relating to anger, separation and sexuality, and difficulties defining or tolerating inner emotional experiences (Shedler, 2010). Discussion Psychotherapy can be regarded as one of the general treatment options to aid a client in overcoming the difficult symptoms of panic disorder. Panic-focused psychodynamic psychotherapy can be cited as one of the approaches to treat panic attacks. This approach derives from psychoanalytic theory and concepts based on the notion that panic disorder manifests in response to fantasies, unconscious feelings, and conflicts. The approach also stipulates that an individual establishes defenses in an attempt to deal with complex emotions as the client struggles with core conflicts based on loss, autonomy, and anger. The approach is unique from other forms of psychotherapy in the sense that it is not employed in the treatment of a broad array of conditions, but rather focuses entirely on the treatment of the symptoms of panic disorder (Levy, Ablon, & Kächele, 2012). The psychodynamic approach encompasses all the theories within psychology that view social functioning as based on the interaction of forces and drivers in the person, especially unconscious, as well as between the varying structures of personality (Starcevic, 2005). The psychodynamic approach derives from the assumptions that human behavior and emotions are strongly influenced by unconscious motives. The approach also assumes that human behavior and the feelings that people have been grounded in their childhood experiences. Psychodynamic approach also assumes that, parts of the unconscious mind (superego and id) are in perpetual clash with the conscious element of the mind, and that personality takes shape as the drives modified by diverse conflicts at diverse times in childhood, especially during psychosexual development (Milrod et al., 2007). The psychoanalytic theory outlines that symptoms are grounded, in part, in unconscious fantasies, affects, and fantasies. The therapist should focus on personality reconstruction, deriving insight to unconscious motivations, and repressed materials principally relating to early childhood. In assuming the role of the therapist, the therapist should pay considerations on the client’s character since this determines the efficacy of outcome, timeframe, and application strength for every technique employed. The psychodynamic approach to anxiety view anxiety as a pointer that ego is finding it difficult to mediate between the id, reality, and superego (Milrod et al., 2007). The different anxiety disorders are perceived as the outcome of diverse defense mechanisms used to cope. Largely, defense mechanisms are activated so as to preclude the threat out of awareness to ensure that it does not become overly traumatic. In his attachment theory, Bowlby viewed disturbances in parent-child bond yielding to “anxious attachment” and disorder later in life. Other psychodynamic theorists focused on the influence of human interpersonal relations on psychological growth. For instance, Horney (1950) argued that relationships that impeded psychological growth in children take the form of guardians who are indifferent, overprotective, or dominating yielding to a lack of confidence in oneself and others, which in turn, triggers feelings of isolation and helpless. Sullivan (1953), on the other hand, argued that anticipated disapproval from caregivers during childhood is a contributing factor to anxiety. Other theorists have postulated that anxiety-generating conflict manifests between a child’s feelings of dependence on the parent, and the fear of being overwhelmed and lose identity may be a source of anxiety since the child can no longer evoke the parent when needed. Use of Psychodynamic Theoretical Approach to treating Anxiety Psychodynamic therapies can be broadly utilized in treating a wide range of psychological disorder with a focus on uncovering unconscious motives, defenses, and conflicts. Psychodynamic therapists mainly sit face-to-face with clients and hold sessions with the clients once or twice every week, but the treatment does not last as long relative to psychoanalysis. Psychodynamic therapy mainly focuses on unconscious drives as they manifest within the individual’s present behavior, and seeks to help clients to become aware and experience their feelings, which have excluded them from conscious awareness (Shedler, 2010). This is guided by the premise that an individual holds and harbors vulnerable and painful feelings that are too hard for the subject to be consciously aware of the suppressed feelings. The objectives of psychodynamic therapy center on a client’s self-awareness and appreciating the influence of the past and present behavior. This aids the client to scrutinize unresolved conflicts and symptoms, which emanate from past dysfunctional relationships. During the therapy, the therapist can opt for psychodynamic psychotherapy approach in an attempt to understand the client’s problem. The client, in this case, may exhibit a certain set of qualities including curiosity regarding origins of his symptoms, while at the same time addressing the symptom that arose from the maladaptive behavior. The exposure of the the underlying drives should be followed by initiatives directed at helping the client to inventing and constructing elements of change, which can be implemented (Shedler, 2010). The therapist is free to exploit various methods during the therapy sessions detail free association, resistance and transference, and addressing complex and challenging issues, memories, and functions so as to institute cohesively and supportive therapeutic relationship. The use of person-centered approach therapy as a form of psychodynamic therapy necessitates that the therapist makes the client the catalysts for their own healing, which makes the approach less structured. The function of the therapist centers on extending constant, affectionate, unreserved positive regard towards the clients. In the therapy sessions, one can utilize supportive expressive model of psychodynamic therapy, which is guided by the premise that, a set of dangerous or traumatic interpersonal experiences yields to several basic desires/wishes, beliefs, expectations, and feelings regarding self and other people (Busch, Milrod, & Singer, 1999). In most cases, the wishes relate to gain of stability, love, or protection from other people and are linked to fear that other people may abandon, disappoint, abuse, or criticize. The anxiety generated by the interpersonal beliefs and desires is powerful to the extent that the subjects opt to cease thinking about the beliefs, desires, and memories, which have a hand in the manifestation of the fears. One means of forestalling thinking about the feelings, desires, and memories centers on becoming excessively cognitively concerned (worried) by certain events in life. The supportive expressive psychodynamic model does not limit the development of anxiety disorders to early childhood events since it presumes that interpersonal stresses and traumas can manifest at any phase of life; however, an extended period of insecure attachment in childhood is mainly to blame for the manifestation of powerful expectations about others that remain even at adulthood. Once entrenched, the collection of interpersonal beliefs, desires, and feelings make up cyclical feedback system by recreating the form of perceived circumstances, which initially generated anxiety (Shedler, 2010). The core expressive task during the treatment centers on the formulation of conflictual relationship theme (CCRT) for the patient and exploiting the formulation to inform interventions, which necessitates establishment and maintenance of a constructive therapeutic alliance. Symptoms of Panic Disorder Panic disorder represents an anxiety disorder typified by recurrent fears and panic attacks. This condition can have significant influences on an individual’s career, relationships, and the quality of life. Some of the symptoms of panic disorder, which can be distressing and frightening, entail numbness, shivering, trembling, dizziness, nausea, chest pain, and uncontrolled sweating. The unpleasant physical symptoms were accompanied by feelings of terror and fear. This generated a vicious cycle of panic attack in which the each panic attack triggers the other. The symptoms felt can be so intense and uncontrollable to the extent that the client feels detached from the circumstances, his body, and the environment (Klein, Milrod, Busch, Levy, & Shapiro, 2003). Panic attacks comprise of physical symptoms during which the client experience feelings of de realization and depersonalization, which makes them feel that the situation is unreal. The depersonalization made the experiences highly disorienting and confusing. During the session, the therapist can realize that the client had difficulty when handling emotions of anger and fantasies, especially toward close attachments figures. The wishes can be conceived to represent a threat to attachment figures that stimulate overwhelming anxiety. Largely, the client may not fully appreciate the intensity of the feelings, or the vengeful fantasies that accompany such feelings. The main goal of the therapist during the psychodynamic psychotherapy centers on ensuring that, the client is conscious of the feelings and ensuring that the feelings are less threatening. Fantasies, which are experienced as dangerous, can be averted through the triggering of the defense mechanisms, which represent unconscious mental processes that mask the fantasies or make them inaccessible to consciousness. The client may employ certain defenses including undoing, denial, and reaction formation. Undoing and reaction formation play a central for panic patients to the extent that the client unconsciously seeks to convert angry outbursts to affiliative ones, in an attempt to dwarf the threat to the attachment figure. During reaction formation, a threatening feeling is usually substituted by its opposite; indeed, the panic client manifested negative feelings substituted by concern. Denial is a form of non-recognition of the presence of a certain feeling, fantasy, and conflict. The client may also employ some form of denial when he or she alludes that, he or she was not angry even in instances in which the relative had done something hurtful to him or her. The treatment in this case can pay focus on gaining insight regarding the perceived danger to ensure that the patient can view the danger as not significant, as what he imagined. This aligns with acceptance based treatment in which the removal of strategies utilized to avert feelings paves way for a reduction on anxiety. Nevertheless, a psychodynamic approach on anxiety goes beyond the avoidance (defense) and explores other determinants of extreme levels of anxiety (Stein, Hollander, & Rothbaum, 2010). Case Scenario The client, a 30-year old male with panic disorder, lived with continuous fantasy. Mr. Jones realized that her unassertiveness was structured around a number of central developmental experiences detailing fear of his temperamental father, fear of an older brother who was very aggressive, and identification with his mother, who was lacked self-confidence and was unable to confront his father about problems. Each of the outlined formative developmental circumstances aided me to illuminate the client’s worry that, asserting self would yield to disruptions within her relationships (Heimberg, Turk, & Mennin, 2004). In his childhood, Jones felt that being a “nice boy” sustained others’ interest in his and was the sole means to keep her attachments secure. As Mr. Jones grew more aware of some of the fantasies that he harbored, and which underpinned his fears, Mr. Jones became highly active in “examining” her behaviors and concerns with others. The client had fearful temperament, which in turn, predisposed him to anxiety paving way for the onset of panic disorder. I helped to change Mr. Joness attitude so that he does not perceive therapists as merely “provider” whose work is to dispense diverse interventions and techniques. I was also keen to invite Mr. Jones to explain his understanding of his anxiety, in an effort to capture his own viewpoints regarding what could be making him suffer panic attacks. The notion that his anxiety could carry some meaning provided something to reflect on and understand. Mr. Jones revealed his private thoughts and was hypercritical of almost all people, where he could hone in on some fault, then revile the person for no apparent reason. This explains why he viewed himself through the same lens based on the inclination to revile and constantly attack self. Some of the anxiety that some clients experience arise from the perceived rejection or unavailability, or the narcissistic injury of dependency, which makes the client angry at the attachment figures. The anger that the client experienced, and the associated fantasies played a big role in severing the relationship with his parents, especially the father, which further heightens the threat of loss and a fearful dependence. The treatment followed the overall course of first appreciating the interpretation of the manifest symptoms while simultaneously drawing attention to defense mechanisms that impede consciousness of panic-specific disowned feelings, fantasies, and conflicts (Klein, Milrod, Busch, Levy, & Shapiro, 2003). After making the feelings conscious, the next step centers on making the feelings less threatening. This necessitates utilization of psychoanalytic techniques of confrontation, clarification, and interpretation; however, the three stages are not necessarily sequential and can take up varying time between clients. Phase I The first phase of the treatment centered on the identification of meanings and content of the panic episodes that the client regularly experienced. Furthermore, it was essential that I probe the stressors and feelings enveloping the start and persistence of the panic attacks. During the therapy session, my role centered on reviewing the client’s developmental history so as to delineate vulnerabilities carrying the possibility of leading to the panic such as having difficulty in managing and expressing angry feelings. In the course of the therapy, I had to adopt a nonjudgmental stance so as to aid the client articulate his feelings and fantasies, which might have been unconscious or hard to tolerate such as abandonment fears or vengeful wishes. The information obtained during the session proved useful in identifying the presence of intrapsychic conflicts enveloping the anger, based on the objective of minimizing panic symptoms. Phase II The second phase centers on addressing the dynamics, which make the client vulnerable to panic attacks. This relates to the conflicts enveloping anger management and recognition, fears of abandonment or loss (separation anxiety), and ambivalence regarding autonomy. The outlined dynamics were addressed as they arose within the client’s feelings and fantasies on relationships within their present and past. Consequently, the meanings of the registered symptoms and the utilization of defenses also play a central function in recognizing underpinning dynamism. Good understanding of the outlined conflicts can help to interrupt the vicious cycle and minimize panic recurrence. Phase III The last phase, the termination phase, avails a chance to work with the client conflicts relating to anger and autonomy as they rise within the context of terminating treatment. Efforts were made to help the client to focus on the experience and freely articulate their feelings regarding anxiety with the therapist. The client manifested enhanced awareness and understanding, which is critical to the management of feelings and avoidance of development of severe panic states. Towards the end of the phase, the client exhibited enhanced capability to express anger in ways that can be regarded as less threatening which is the fundamental part of treatment. The client exhibited enhanced assertiveness and capacity to communicate on conflicts within relationships, which in turn, enhances psychosocial function and minimize vulnerability to panic. Conclusion Psychodynamic psychotherapy approach theorizes that the panic derives from psychological causes at its origin, whereby clients are expected to examine their pasts. The patients will have to acknowledge ideas and feelings that they have previous regarded as unacceptable, rather than invalidating their thought and feelings, which triggers panic. The driving principles of psychodynamic therapy centers on the examination and resolution of inner conflicts that most individuals hold, which in turn, aid the client to gain insight so as to appreciate the character traits, responses, actions, and behaviors in need of transformation. In the therapy sessions, the therapist should seek to uncover the underpinning conflicts that catalyze the unhealthy and disturbing symptoms that the client exhibited. References Busch, F. N.,Milrod, B. L., & Singer, M. B. (1999). Theory and technique in psychodynamic treatment of panic disorder. The Journal of Psychotherapy Practice and Research, 8 (3): 234-242. Heimberg, R. G., Turk, C. L., & Mennin, D. S. (2004). Generalized anxiety disorder: Advances in research and practice. New York, NY: Guilford Press. Horney, K. (1950). Neurosis and human growth: The struggle toward self-realization. New York, NY: Norton. Klein, C., Milrod, B. L., Busch, F. N., Levy, K. N., & Shapiro, T. (2003). A Preliminary Study of Clinical Process in Relation to Outcome in Psychodynamic Psychotherapy for Panic Disorder. Psychoanalytic Inquiry, 23 (1): 308-331. Levy, R. A., Ablon, J. S., & Kächele, H. (2012). Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence. New York, NY: Humana Press. Milrod, B. L., et al. (2007). A Randomized Controlled Clinical Trial of Psychoanalytic Psychotherapy for Panic Disorder. The American Journal of Psychiatry, 16: 265-272. Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 63 (2): 98-109. Starcevic, V. (2005). Anxiety disorders in adults: A clinical guide. Oxford, UK: Oxford University Press. Stein, D. J., Hollander, E., & Rothbaum, B. O. (2010). Textbook of anxiety disorders. Washington, DC: American Psychiatric Pub. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York, NY: Norton. Read More