Psychodynamic Insight Therapy

What is it?
Psychodynamic therapy, also known as insight-oriented therapy, focuses on unconscious processes as they are manifested in a person’s present behavior. The goals of psychodynamic therapy are a client’s self-awareness and understanding of the influence of the past on present behavior. In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances.

Insight therapy is the traditional form of psychotherapy that explores ones personal history, family history, relationships, major life events and their impact. The personal history includes medical, mental, legal, educational and employment history. The purpose is to better understand how you have come to be the person you are – how you have been influenced by this history. This is the form of therapy most people are familiar with and is invaluable to understanding oneself and why you are who you are. It is important to note that while we are influenced by our history – nurture – we are also influenced by our genetics – nature. Anxiety disorders can be significantly influenced by both nature and nurture, especially OCD. There is clear evidence of a genetic influence in many with an anxiety disorder in addition to nurture – the role modeling of their parents, how they were parented and the influence of peer relationships.

I have come to fully appreciate the value and need for Insight Therapy (IT) in addition to Cognitive-Behavioral therapy (CBT). There is a school of thought that CBT alone can be effective in resolving anxiety disorders as well as other mood disorders. My experience indicates that is not realistic. Exploring history helps clarify the origin of ones issues with anxiety or depression and the reason for particular anxieties and issues. If nothing else, it satisfied our normal desire to understand origins – why things are the way things are. But the value of understanding origins is far more than meeting simple curiosity. Identifying the root of an issue clarifies the nature of the issue, how it may best be resolved or even reveal the original issue that is now camouflaged by a secondary, perhaps even surrogate issue. Often times, especially with anxiety, identifying the root cause of the anxiety can point to another underlying issue that is hidden under the anxiety. Other times an original event may have by numerous routes turned into anxiety; or caused anxiety; or was mistaken to be anxiety. In other words, original events unidentified and unresolved can become replaced with anxiety that becomes the identified issue and focus of attention.

Examples can help to clarify and simplify what I am describing as to how an event or issue may morph into anxiety.

— One client began to experience panic attacks when at his cottage in the town where he grew up and now had a cottage, children and grandchildren. His panics triggered the fight or flight response and he felt urgent need to get back to his home residence on the other side of the state. He experienced similar panic upon a return visit, and then panics upon later attempts to drive across state to his cottage and children. The result was several years of not driving to that area with an increasing fear of driving much out of his range of familiarity near his home. He wanted to resolve the issue to return to his town of birth and visit his children and grandchildren. They had also sold their cottage as he had been unable to visit anymore. Shortly into therapy I began to – in an Insight Therapy manner – explore the origin of his panics in his town of birth. He disclosed that his father had died some months prior to his 1st panic there and it became evident the cause was tremendous grief that he was not able to properly identify, process and express. That intense suppressed emotional energy began to morph into anxiety which quickly escalated into a panic attack. That panic attack was a traumatic event – a trauma – that effectively triggered post-traumatic stress disorder, which is how I view panic disorder – a form of PTSD which I elaborate on elsewhere.

(note: the “elsewhere” can be a link to further explanation of panic as ptsd that follows)

So his panic began a downward spiral where he had tremendous anxiety returning to the place where he was so traumatized “the scene of the crime” so to speak. Everything about the place was now a reminder of and cue, or potential trigger, for more anxiety which is very much PTSD. He not only feared that specific place but months later began to experience acute anticipatory anxiety in beginning the drive there so he quit those attempts. His circle of comfort shrunk – what is considered a manifestation of agoraphobia. So this cycle of fear and avoidance went on for years until he had enough with being so limited and fearful. Him coming to understand the reason for the first panic attack and unresolved grief helped him further process and reduce his grief and also helped him better identify the important issue of greater self-awareness of his feelings and their causes. He was also more confident to gradually travel further outside his comfort zone and has since been returning to his hometown and feeling like a normal – complete – person again. He is now in control of his anxiety instead of his anxiety controlling him. His progress was the result of IT and the CBT process of identifying & modifying fearful thoughts and working on making gradual behavior changes.

There are several common events and issues that are revealed in IT that can trigger anxiety or an anxiety disorder. These include:

•LOSS – a death, a job, financial security, a relationship;

•INSECURITY – financial, relationship, status, employment, safety;

•ANGER – from a recent event or old and chronic – in either case the anger is largely or completely unrecognized (this can include chronic repressed anger since childhood);

•OTHER UNIDENTIFIED NEGATIVE EMOTIONS – hurt, humiliation or grief such as illustrated above;

•STRESSORS – increased current life stressors can exacerbate anxiety symptoms as they compound distress but can also mitigate anxiety as they serve as a distraction.

LIFELINE EXERCISE:

This is an exercise I have many of my clients do as a part of IT which anybody can do on their own with much benefit. A Lifeline is simply a chronology of significant life events and their emotional impact. It is not a life story narrative but a bullet point listing of life experiences. This allows people to see cause and effect between events and emotional impact. It can stimulate recall of events that had been overlooked, forgotten or suppressed. It is often very helpful to have a parent, sibling, friend or mate help in the compilation of events, their time frame and impact. Most people find it revealing because we all can loose sight of our lives – not seeing the forest for the trees.

PANIC DISORDER AS A FORM OF PTSD

Everyone who has had a panic attack, especially their first one, heartily nods in agreement and verbally agrees with me when I say that their first, or even subsequent panics, was a traumatic event. They recognize it but usually hadn’t conceptualized it as such. Because it was a traumatic event, it is likely to manifest as a form of PTSD, involving many of its symptoms:

•Preoccupation with the event;

• emotional and physical distress when reminded of it

•disturbance of emotions or sleep

•avoidance of places or activities associated with it

•chronic fear of another panic.

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