SPECIFICS OF UTILIZING PSYCHOANALYTIC PSYCHOTHERAPY FOR PANIC ATTACKS: ANALYSIS OF A CLINICAL CASE

Abstract

The paper is devoted to the analysis of the possibilities and limitations of psychoanalytic psychotherapy in the treatment of panic attacks in patients with narcissistic-depressive personality organization. Panic attacks are a common symptom, particularly in anxiety disorders. In Ukraine, this problem is exacerbated by the effects of chronic stress. It is emphasized that psychodynamic therapy has proven its effectiveness in a number of randomized controlled trials for the treatment of panic attacks, demonstrating a significant reduction in their frequency and improvement in overall functioning. This article aimed to illustrate the dynamics of transference/countertransference and the transformation of defenses over a two-year treatment period, using a qualitative analysis of a clinical case of a patient with panic attacks. The theoretical review of the article covers the classical psychoanalytic understanding of anxiety as a signal of ego overload in the conflict between impulses and reality. In the Kleinian tradition, panic attacks are associated with regression to persecutory anxiety of the paranoid-schizoid position and the functioning of primitive defenses (splitting, projective identification), as well as a consequence of the object’s inability to perform a containing function, which hinders the subject’s ability to comprehend their own affects. The following clinical case of a 38-year-old patient illustrates this typical cycle: persecutory anxiety – regressive defenses – somatization – increased control. The dynamics of the therapeutic process, which took place face-to-face twice a week, showed a shift from total control and expectation of a punitive/omniscient therapist to the ability to endure pause and ambivalence. The key mechanisms of therapeutic change are: (a) the containing functions of the setting, (b) the interpretation of primitive defenses and focus on microprocesses of relationships, (c) the gradual internalization of a “good enough object.” This contributed to the maintenance of a depressive position, which manifested itself in a decrease in the frequency of panic attacks, a strengthening of the reflective function, and the ability to endure guilt without self-deprecation.