Marija Vaštakė (Lithuania) Existential principles of psychotherapeutic work with clients with panic disorders

Quite a few clients seek psychotherapeutic help due to complaints of increased anxiety, fear and panic attacks, and numbers of such clients are growing. Clients who suffer panic attacks make up for the greatest part of the psychotherapeutic practice of the author.

A panic attack, to put it simple, is the highest point of anxiety. Ontological anxiety is one of the most interesting and complicated phenomena and one of the basic concepts of existential psychotherapy. Such anxiety is rooted in the existence as such, and its inherent threat to a person’s being and values. The question of anxiety is the centre of many important problems.

Existential philosophers and thinkers – Kierkegaard, Heidegger, Freud, Tillich, May, Frankl – were the first to turn their attention towards the problem of anxiety. The problem of increased anxiety (in existential therapy – pathological anxiety) is viewed in several psychological paradigms, each offering different understanding and specific ways of working with clients.

Panic attacks are characterised by fear that is often accompanied by a sense of inevitable destruction or anxiety and/or a feeling of inner tension in combination with 4 or more of these symptoms:

1. Pulsation, strong palpitations, abrupt pulse, increased blood pressure.
2. Sweating, heat or cold waves.
3. Shivers, quivering, an inner sense of chills.
4. A feeling of lack of air, shortness of breath, a feeling that you cannot breathe deeply, a choking feeling in the chest, pain or discomfort in the breast area.
5. Pain or discomfort in the left side of the chest.
6. Nausea or abdominal discomfort, gastric spasming.
7. Dizziness, a feeling of loss of balance, light-headedness or a state before fainting.
8. A feeling of de-realization, de-personalization. A feeling of being separated from oneself, a feeling of unreality of one’s own body or the surrounding events.
9. A fear of losing one’s mind or acting uncontrollably.
10. A fear of death.
11. A feeling of loss of sense or prickliness (paresthesia) in limbs.

Most often clients emphasize the fear of losing control over themselves, the fear of dying or the fear of fainting.

What are the psychological reasons behind panic attacks?

Psychological conflicts that have been pushed away are seen as the main reason for panic disorders. In existential psychology these are conflicts with the existential givens of being, and in connection to it – repressed feelings, desires, that have no way out, which a person cannot cognize and solve for different reasons. This is when a symptom appears.

Similarly, sometimes an inner conflict that is connected to repressed hate towards the mother can be observed in clients with panic attacks. Clients feel negative emotions towards their mothers, but do not express them in any way, do not even let them exist, as it is “wrong”, “rude”, “not allowed”.

And finally, psychological traumas experienced in childhood also influence development of increased anxiety and panic attacks.

Practical experience proves that panic attacks appear in border-line situations – divorce, loss, illness. When working with clients who experience panic attacks, it is important to return their true, human Being to them.

Existential therapy is a deep psychological approach with the goal of reviewing the symptom’s cause and solving a deep psychological conflict. The symptom is just a reflection of the client’s inner world and hardships. When working with clients that have panic attacks, the therapist must be the client’s companion from the physical dimension and the symptom to other dimensions. The symptom limits the client’s view of his own life, and the therapist must help him widen this perspective.

Through long-term existential therapy clients with panic attacks not only free themselves from the symptom that they had been suffering, but also become more aware of its causes, which allows them to change their lives.

Yet an existential therapist does not work with symptoms. A symptom is viewed only in the whole context of the client’s life. Disappearance of a symptom is a side-effect of therapy. However, sometimes significant attention is paid to the symptom, and a unique way of coping with the symptom is found together with the client, as it can be an obstacle of the client’s progress.

Working with clients that have panic attacks does not differ from working with other clients. Here, too, the relationship of the client and the therapist, curiosity, empathy and the therapist’s support hold great significance.

The therapist needs to know what panic attacks are, yet at the same time he needs to stay neutral, not assume an expert role. Practice shows that the openness of the therapist is vital when working with clients that suffer from panic attacks. This creates a sense of safety for the client.

The therapist’s creative approach in searching for ways of progress is important when working with clients that are subjected to panic attacks. The therapist needs to help the client set realistic goals, taking into account all the client’s possibilities and limitations.

Working with clients that have panic attacks is not easy. It requires a creative approach, does not bring immediate results; yet it is interesting. From the therapist this kind of work demands patience, instead of hurry. As Benjamin Franklin said, “Only the patient one will succeed, but the hasty one will fall.”