Typically I find that when people worry about the future they are projecting something forward that has already happened. So if s/he says, "I am afraid someone will be critical" (or whatever), I ask, "So when has that happened?" They always come up with something and then we deal with the unacknowledged feelings toward the person who already humiliated them. Hope that's helpful.
This was really helpful. There is so much to consider in psychodynamic literature that it can feel quite disorienting. Malans triangles and your clear explanation of this one really help the neophyte therapist find a little bit of firm technique from which to start growing clinical skills
I am an energy psychology practitioner for over 15 years, and you are correct. What people refer to as anxiety is a physiological reaction in the body - head, heart, gut area typically. Therapists should learn techniques that help their clients regulate their nervous systems. I suggest Emotional Freedom Techniques, hypnotherapy and a less well-known approach such as Visual Release Technique.
It's also important to get to the memories, feelings and fantasies that are triggering the anxiety rather than just trying to manage anxiety once it is evoked. People do not have to live with anxiety and depression. It's possible to get to the source and heal it. I am sure you agree.
@@patriciacoughlinphd1852 I agree it is important to get to the root causes. I am fairly certain you're not familiar with the late Dr. William Baldwin, or Dr. Edith Fiore. But with regards to anxiety, I always find the condition is based in trauma from early childhood, and then other events simply pile on as they say. I was a traditional talk therapist for many years. But for me, regression therapy, working with the subconscious, has been key in identifying the reason for anxiety and depression, as two examples. And EFT really helps release the trapped emotions, for lack of a better word, from the nervous systems. In some cases, I have had to resort to something called Spirit Release Therapy.
Thanks for the video! I think it would be very interesting to hear you refer to how to manage our own anxiety (as therapists) when interacting and confronting our patients. Many thanks!
I may be the wrong person to ask, as I don't experience anxiety when I'm treating patients. I am clear about my therapeutic stance, and know why I am doing what I am doing. Even if it is difficult, I always have the patient's best interest at heart. If you are clear that you are helping and not hurting, your anxiety should not be a problem. What is it that you are anxious about?
Patricia, sorry for the delay, I hadn't noticed your reply. What you say makes a lot of sense to me. I think that I have felt nervous with some patients when I felt a little lost and without knowing where to turn or question what I am doing and why (which has been enhanced at times when trying to mix models such as CC and psychodynamic, which is complex since they have different theories and ways of intervening). Very anxious patients who ask for specific techniques or tools to manage that anxiety and not being able to offer them have also generated a little anxiety in me (since I tried at times to work in a more behavioral way and the truth has not given me results)... for That's why I leaned back to psychoanalysis :)
@@Pedro-ew1dj This also gets back to the goal of therapy - whether you and the patient have agreed to simply manage symptoms or to get to the bottom of - to discover the underlying cause of the symptoms.
@@Pedro-ew1dj This also depends on the agreement between patient and therapist about the goals of treatment - are you there to manage symptoms or to the get to the bottom of it?
I’d love to hear you elaborate on IBS and bowel symptoms - I have suffered for years with IBS , could it all be anxiety related? Where could I read up a bit on this? Thanks
Hello! I have a very specific question... could the tachycardia be a manifestation of the second channel? And the blushing, shaking of the voice and stuttering? Thank you so much!
These are all symptoms of anxiety. To do something like pulling out hair is a defense against the feelings and impulses that are generating the anxiety. Examine the symptoms generating situation to discover the underlying conflict.
Perfect, thanks for your quick response. My question is which channel do these symptoms correspond to? It is difficult for me to identify those impulses/feelings in patients who have a lot of social anxiety when speaking in public... Have you been able to identify some recurring conflicts in these patients?
Hi Patricia, I'd love it if you can do a post on severe punitive superego pathology (PSE); how it creates and maintains depressive symptoms/anxiety? Specifically, I have a patient in his late 40's that's suffered from depressive sxs "since childhood" and presents as very dysthymic/detached/passive + severely self-loathing and self-critical (prone to privately criticizing others at times too). When I recently applied pressure and even challenge to his suicidal ideation he smiled at the notion he was doing "such a good job punishing myself." He has mixed feelings about his self-punishment and expressed some pain/sadness about how critical he can be, but relates to his need to be self-critical like an alcoholic, "I suppose I'll never really be free of the need to criticize myself..." I've repeated HOC with his need to punish and reject himself/ his emotional life, but it seems his PSE is so syntonic my efforts fall flat. I've also put pressure to his RAEC, followed by a HOC in the Transference, with some movement, but again, his PSE is so entrenched it feels like progress is slow, if not negligible. I realise without seeing my tape there's not much you can say that's specific to this case, but perhaps a post about making severe PSE more dystonic. Thanks!
The danger here is that you join him in being too harsh. Why does he need to suffer is the primary question. Is he trying to spare others by taking the hit? What did he do to warrant such a harsh sentence? Without a clear case conceptualization and understanding o the driving force behind the symptoms and suffering, you are stuck with just trying one technique after another. Put on your Columbo hat and start inquiring. Another case comes to mind. A woman in her mid 40 started cutting herself and didn't understand why her family, friends and providers were so upset about this. "It helps me with anxiety - what 's the big deal?" As long as this defense is syntonic, pressure and challenge have no place. She would feel personally attacked by such interventions, since she is identified with this defense. She was the mother of 4, so I said to her, "You are saying that cutting is an effective way to regulate anxiety. So if one of your children was obviously anxious, would take a razor blade and cut them to reduce the anxiety?" She was appalled by the idea - "Never! That would be abusive!". She had no real observing ego when it came to herself. When I externalized this by bringing in her children, she saw the behavior for what it was and started to wonder why she treated herself in a way she would never dream of treating anyone else. It was a start.
What about ruling out POTS? Patients with POTS are commonly misdiagnosed with an anxiety disorder when in fact, their heart races and they get lightheaded and pass out simply due to a postural change and the body’s inability to maintain blood pressure. Do you have a way of distinguishing between orthostatic hypotensive issues and psychological phenomena?
I don't know a lot about POTS, but my understanding is that it is typically triggered by standing up quickly. In any event, we assess via response to intervention. If the patient's anxiety plummets following the direct experience of feelings and fantasies he has been avoiding, we have gotten to the source.
Hi, Great video, always very helpful! I have a patient that struggles with anxiety and specifically reports increased anxiety when speaking in front of others and when interacting with others. The patient can identify some fear, but I have a sense there’s other emotions driving this anxiety. Do you have any suggestions how you might explore his subconscious feelings that might be driving The situation specific anxiety? Thanks, Alex
It's also important to distinguish between fear and anxiety and to help your patients do the same. Fear is a response to an external threat to life and limb. Speaking in front of people may be uncomfortable but it won't kill you! That is anxiety - a response to some sort of emotional threat.
@@patriciacoughlinphd1852 This is a good point, some patients verbalize fear but may be describing anxiety. Gives me a good area to explore. Thanks again, much appreciated!
Very helpful, thankyou so much.I have a client with the third kind you mentioned(cognitive perceptual realm) and I feel stuck with her. Any suggestions on which approach to use will be greatly appreciated.
If the patient cognitively disrupts they are not present and wont' benefit from therapy. You must help her pay attention to anxiety so it can be regulated. Your first goal is to get her in striated anxiety.
@@patriciacoughlinphd1852 Maybe something like How to build up a client so they are better able to experience the conscious awareness of anxiety when they are feeling in in their smooth muscles. I seem to see clients who will shift back and forth between the states you describe. Sometimes get stuck in the smooth muscle experience of a headache or bowel disturbance etc. I currently use something like undulations.
@@jandumond4711 Will do. Sometime a headache is a manifestation of smooth muscle anxiety but, in my experience, it is more likely a tension headache. Make sure to check so you don't mistake started tension with smooth muscle anxiety. It is also often their result of instant repression of a forbidden impulse - the patient is doing to themselves what they want to do to the other. Davanloo discovered there is often a one to one correspondence between the suppressed impulse and the paint's symptoms.
At different levels of anxiety, different channels get activated. At a tolerable level, it sounds like you patient can tense up and sign and have striated muscle activation. If they go over threshold, it then goes to smooth muscle? Like what? Migraine? IBS? In any case, you want to keep the patient in striated, which is the optimal level of activation.
@@patriciacoughlinphd1852 Thank you for your reply. I was actually referring to myself as the patient, I’m not a therapist. It feels as though I experience both at the same time but perhaps I’m just not consciously aware of it going from voluntary to smooth muscle. The smooth muscle symptoms are best described as IBS in my case. I raised the issue of anxiety last session but clearly there is still work to be done in this area. I still have a lot of issues trusting my therapist and I suspect much of my anxiety stems from that.
Most therapists know nothing about the channels of anxiety. This was one of Davanloo's contributions, but it not widely known. Make sure that you and your therapist work to keep you in the optimal zone of striated. If you feel your stomach cramp up, notice that and slow down. Identify the triggers that evoke that level of anxiety. Best of luck to you.
@@patriciacoughlinphd1852 Thanks again. After doing some more reading on this subject, it was interesting to learn there is a correlation between self-criticism, mixed feelings towards attachment figures and smooth muscle anxiety. These are all things I struggle with a lot so these symptoms make a lot more sense to me now.
Hi, I’m thinking about another patient who is experiencing significant anxiety related to relationship problems that might result in ending the romantic relationship. This patient struggles experiencing emotions, yet was able to identify some sadness around the situation. He physically becomes nervous fidgety and can identify that he feels anxious. However he has difficulty experiencing sadness that can be driving this anxiety related to these relationship problems. There may also be some anger as well, yet he has trouble identifying experience of these emotions. Do you have any thoughts on how to help the patient that can cognitively identify that a situation might make him sad or angry, yet struggles to actually experience that sadness or anger when he discuss this issue. His affect stays pretty flat, although cognitively he says You would expect to be sad about this. Thanks again for all your thoughts!
In a sense, the anxiety is like a blanket, covering up other emotions. So he "knows" he is sad and angry but only feels anxiety. That's pretty torturous wouldn't you say? Bad enough your girlfriend is leavening you, but this adds insult to injury, doesn't it? The patient needs to see that he uses the anxiety defensively to avoid other emotions and that doing so is cruel. Hope that helps.
@@patriciacoughlinphd1852 That helps, his girlfriend has dismissed his needs so he feels he may need to end the relationship, and feels solely responsible for managing a healthy relationship, I could see how the anxiety can be a Defence against his emotions. Thanks so much! Wish you the best,
@@alexguerrero8900 I would also make sure he is not coming from a victim position. He doesn't have to do anything. Can he own his choice in the matter.
@@patriciacoughlinphd1852 Excellent point, he may be conflicted about ending the relationship even though logically it makes sense for his own happiness. They’ve been together for five years so he definitely realizes he cares a lot about her, even though she has not been able to acknowledge his needs. So, do you think helping him except his choice well help him experience his emotions, so I can help him process these emotions and reduce his anxiety?
What need is there to understand G anxiety and Major Depressive Disorder, when IV Ketamine infusion therapy washes them away in just two or three sessions? Far cheaper, FAR more efficacious than psychotherapy, much less time, longer lasting according to clinical trials. Four infusions over a two week period have done more for me, than over a year of psychotherapy with a mental health professional. 70-85 percent efficacious. Check the Yale ketamine studies...
It might have worked for you for whatever reason, but you're making your feelings empty and meaningless by suggesting they can just be washed away and everything is fine again. Sure biological depression exists but generally our feelings tell us something. That's why they exist. Don't wash them away .
@@jackdawcaw4514 Well ... fortunately or unfortunately depending on ones perspective, any form of mental health counseling is no longer an option - for me. That ship has sailed forever in my life, due to the frustration, hurt and pain two horrible therapists dropped into my lap due to multiple ethics violations over a several year period - mainly, causing a break up with my significant other, via therapist attempting to do couples counseling on me/us by proxy and mucking up my relationship with my love and destroying trust and communication. Too long of a story now... In short, that is unfortunate because I for many years I was a proponent of talk therapy. There have been many situations in my life, that it could have helped. After being abused by two horrible social workers however, even the thought of seeing another talk therapist brings up a tremendous amount of anger. It would be like asking an abuser for help after being abused, for mitigating the psycological pain caused by abusive therapists - mainly the pain of losing the most important person in my life. So for someone like me, treatments like Ketamine infusions are an excellent alternative, and I have felt no need what so ever for any kind of talk therapy. As a matter of fact, I feel that were I to do both simultaneously, talk therapy would be counter productive to the good results that Ketamine infusions have provided. And long term, if one can find a good clinic - ketamine infusions are far more cost effective, better data to back up efficacy compared to talk therapy, and far less baloney and psychobabble. I would even go so far to say that Ketamine infusions are a good treatment to mitigate botched up talk therapy. And the benefit is such that, a patient can determine after just two or three treatments if it is effective for the individual. Try comparing that to talk therapy, which is a 50 - 50 efficacy proposition and can take MONTHS or even YEARS to determine if it is helping one.
@@modelo61 What frustration? I am just stating the facts based on efficacy results of randomized controlled trials of ketamine infusions for MDD, and comparing those results to efficacy results of randomized controlled trials that use psychotherapy to treat MDD. From the PubMed database. So just show me a “Randomized Controlled Trial” of “Psychotherapy”, and we can compare the two. The original post was a factual consumer issue, and I am just stating the facts. Since you asked me a question - I'll ask you one. Do you think Psychotherapists in general would be willing to compare and discuss openly any efficacy results from a randomized controlled trial with proper placebo, for Ketamine infusions to mitigate MDD, and compare those efficacy results to a Randomized Controlled Trial of Psychotherapy treating same? Using the same ethical and clinical trial method? Just a simple question Yes or No will suffice - then explain your answer. Yes or No first, then elaborate. The only true way to compare the two, is to not add pharmacology to the psychotherapy treatment during trials. In other words, any test clients would have to NOT be on any psych meds while undergoing psychotherapy, to truly and ethically compare Ketamine to talk therapy, as far as efficacy is concerned. When researchers or therapists start throwing both drugs and talk therapy into the mix during clinical trials, it is not an accurate, honest or ethical way way to determine (or promote) efficacy, since no one is sure if it’s the drug, or the talk, is helping people, and what percentage is due to the drug(s) compared to talk.
@@jackdawcaw4514 I did not ever state above that my feelings are empty and meaningless, and that they can just be washed away with Ketamine, and that everything is fine again; your assertion is completely false. I also did not state that our feelings do not tell us something. I also never said I was washing away feelings with Ketamine - actually, the infusions bring my feelings to the surface, so they can be better dealt with in a more meaningful, positive manner, without the MDD and Anxiety. You seem to be confusing MDD diagnosis with feelings and thoughts. Not apples to apples. Are you suggesting that MDD = feelings 100%? If so, where is your clinical trial substantiation, other than semantics, to back up that statement? You are making a lot of assumptions here. Have you ever experienced a Ketamine infusion by the way? I have had 27 in the past 13 months. Ketamine infusions for MDD have been shown in Randomized, Controlled trials, to have an efficacy of anywhere from 70 - 80% in treating MDD. Show me a Randomized Controlled Trial using psychotherapy, that has a PROPER PLACEBO on par with the drug companies, that shows equal or better trial data. Do you know of any such trials? If so please post a link so we can all take a look at it, thank you.
