Psychotherapy for anxiety: Dr Jan Resnick

Transcript

Hello, I’m Jan Resnick, I work as a senior psychotherapist and supervisor based in Perth at the Claremont Medical Centre. My practice there is called Amygdala Consulting. Before that, I was Director of Training of The Churchill Clinic where I ran psychotherapy trainings for 18 years and was also the Founding President of The Psychotherapists & Counsellors Association of WA. Currently, I serve as an Advisory Board Member of ASCA (Adults Surviving Child Abuse) and since 2011 I’ve been an Editorial Board member of Virtual Medical Centre and Virtual Psychiatry Centre.

What is psychotherapy?

Generally, the term psychotherapy can refer to any type of formal, professional counselling process where the focus is usually upon the patient’s personal issues, mental disorders or emotional suffering. It is a difficult term to define because there are over 400 different types of psychotherapy practices. The dominant practice is psychoanalytical or psychodynamic and that is what I am referring to here. Psychoanalytic Psychotherapy has come a very long way since Freud created it over 100 years ago.

As a contemporary practice, this type of psychotherapy creates a safe, non-judgemental environment and makes use of the professional relationship to address issues in depth. Psychotherapy works through reflection, detailed discussion, paying attention to language and developing communication skills, interpretation and the skilful navigation of emotional suffering. Psychotherapy cultivates understanding of the meaning of our experience of the world, how we act and what happens to us and how this leads to painful problems. Psychotherapy is not only about explaining our experience, however, it is also a personal development program that builds our capacities to deal with the difficulties in our lives, adjust to changes, develop a more authentic sense of self, create better relationships, and feel well.

How does psychotherapy differ from psychology and psychiatry?

To become a psychiatrist, you become a medical doctor first and then undertake specialist training in psychiatry. That training includes some limited training in both psychology and psychotherapy. Of the many different types of mental health professionals, only doctors and psychiatrists can prescribe medications.

Psychologists are university-trained, and the term psychology usually refers to Cognitive Behavioural Therapy (CBT). Psychology is based on research and research determines general trends or ways that people are the same. Therefore, psychology is a one-size-fits-all method. Its usual focus is trying to change the way we think and behave.

The training for Psychotherapy is different and the practice operates in a different way. One difference is that psychotherapy trainees are required to have therapy for themselves. This is essential for working with people with mental/emotional issues to be safe and effective. Psychotherapy practice is based on individual difference and focusses on each person’s unique way of experiencing their world and themselves in it. We pay particular attention to feelings and to each patient’s history and how that affects their present situation. We also focus upon the dynamics of interpersonal relationships, on family of origin experiences and on recurring patterns. Psychoanalytic Psychotherapy makes use of the professional relationship that is known to be a primary agent of healing and of change.

What is anxiety? What are the signs and symptoms?

Anxiety refers to nervousness, worry, apprehension, arousal of the nervous system, it is a fearful state characterized by mental preoccupations, agitation, angst, edginess, tension, trepidation or foreboding – people often speak of ‘what ifs’ – what if this happens or that happens, what if I hurt someone? – there can be stress and suspense, I sometimes refer to anxiety as a feeling as if your finger was plugged into the electric socket.

There can also be corresponding physical sensations such as hot and cold flushes, tingling sensations, racing heart or palpitations, tightness in the chest, difficulty breathing and when anxiety amps up to panic, people have wondered if they are having a heart attack.

There is a range of intensity in feeling anxious but at its worst, it is a highly distressing mental and physical state. And it is very difficult to get on with things, to concentrate, to focus and to think about anything else.

How is it diagnosed?

The need to diagnose is more important for psychiatry and practices that have to answer to insurance companies or that follow the traditional medical model where diagnosis determines treatment. As psychotherapy is more concerned with experience, the focus is on how a patient feels and people usually know when they are anxious. I don’t use scales or questionnaires because they don’t take into account essential variables, personal differences, or properly consider how the way we feel changes over time. It is more personal to ask questions and discuss issues during consultations. Patients may well be anxious one day and not the next or with established anxiety disorders, then anxiety may dominate for years. So, psychotherapy works with what is happening at the time.

How can psychotherapy help in the management and treatment of anxiety?

Psychotherapy addresses the underlying reasons for anxiety. Other practices try to manage anxiety with techniques or exercises to help people to relax and feel better. There are breathing exercises, mindfulness and meditation practices that all can help. Similarly, there are anxiolytics, that is anti-anxiety medications that lower arousal and help to feel better.

The limitation of these approaches is that they do not gain an understanding of why someone gets anxious in the first place, what causes anxiety. This is where psychotherapy can be effective and also help to prevent anxiety returning down the track.

Anxiety often happens because there is something we cannot bear to think about or to feel, perhaps to suffer. Anxiety acts like a blanket covering over our experience so that we cannot focus on what makes us uncomfortable. It is a psychological avoidance device.

So, for example, one 20 year old patient who I will call Jo, had a lifelong anxiety disorder. She would check her phone constantly, be looking around, feeling nervous, agitated and distracted, she couldn’t concentrate of her studies and also needed to self-medicate with alcohol and other substances just to relax and to sleep. Psychotherapy explored her childhood and also current relationship with her parents. Her mother was often extremely critical of her and she could be in trouble sometimes for nothing at all. She said to me that she felt she was always in trouble, always in the wrong, and about to be punished. She was checking her phone for an angry spray from her mum that she had grown accustomed to.

While it helps to know what you are anxious about and to develop a capacity to deal with it, psychotherapy also helps to separate out the past from the present. Jo needed to develop a greater sense of separateness from her mother. She needed help to grow up into herself and reduce her sensitivity to scolding and disapproval. She had an identification with naughtiness and so she had to develop a sense of herself as not automatically ‘bad’ or in the wrong.

She worked well in psychotherapy and could understand these dynamics and she grew to feel more solid and stronger in herself. She could take responsibility for what she did that was wrong but also stand up for herself and feel clear of conscience and not so worried. Her anxiety dissipated and when it was triggered she could assess whether or not there was a valid reason for it. Then she could deal with that more directly.

My top three tips for anxiety

1. Anxiety is often misunderstood as being free-floating or existing for no reason. This is a mistake. Pay special attention to what is going on when anxiety is triggered. Identifying triggers for anxiety helps to understand what is affecting you and this is the first step to overcoming it.
2. The function of anxiety is most often to avoid thinking about something or feeling something. Usually, the nature of these thoughts or feelings is that they are uncomfortable, unacceptable, embarrassing or unbearable. Sometimes, something has happened earlier on in our lives before we were ready to process it, so it gets blocked by anxiety. When you can, think about what this could refer to. Try to face what is most painful or uncomfortable for you. The more you can do this, the less anxious you will feel.
3. The first two points come under the heading of ‘the analysis of anxiety’. This third point is purely about feeling better. Try to find what gives you comfort. This differs greatly from one anxiety sufferer to the next. It could be to have a heart-to-heart with a friend, a walk on the beach, listening to your favourite music, playing sport, deep breathing, mediation, or exercise. At the same time, develop self-soothing; this is a reassuring internal voice that calms you and helps to settle your nerves. Try to ground yourself. Remember: you may feel like you’re tied to a railway track with a train speeding toward you but actually, you’re not. There are no tracks, no rope, no train. You will be okay. This is the voice of self-soothing.

Lastly, my take home message

My take home message is that help is possible. I do psychotherapy because I believe it is the best approach to deal with anxiety and most forms of mental disorder and emotional pain. Therapy is work and it is work worth doing. After nearly 40 years of practice, I have seen many people improve by working through their anxiety in therapy.

Medications and techniques can be useful but psychotherapy works to resolve the underlying reasons for anxiety and the psychological susceptibilities to anxiety for long-term improvement.

Thank you for watching.

 

Kindly written and reviewed by:

Jan Resnick, PhD (Psychology) Senior Psychotherapist and Supervisor at Amygdala Consulting (Claremont), Advisory Board Member of ASCA (Adults Surviving Child Abuse, Sydney), Editorial Advisory Board Member of Psychotherapy in Australia, and of Virtual Medical Centre & Virtual Psychiatry Centre.

Useful resource

The MindSpot Clinic is a free telephone and online service for Australian adults troubled by symptoms of anxiety or depression. The service is run by a team of health professionals and provides free Online Screening Assessments, free Treatment Courses and can assist in finding local services that can help. To speak to one of the team call 1800 614 434 between 8am -8pm AEST Monday to Friday and 8am – 6pm AEST on Saturday or visit MindSpot Clinic.

More information

For more information on the risk factors, symptoms and treatment of anxiety, see Generalised Anxiety Disorder (GAD)