Symptoms of Anxiety and Panic Disorders in the Context of the World We Live in

Anxiety and panic disorders are getting increasingly common among young adults. This is a phenomenon observed and mentioned by mental health professionals who work in Europe, Asia and America. There are several hypothesis to this observation. The logic that resonates most with me is the one by a psychiatrist colleague from Italy, Gianni Francesetti.

Francesetti attributes panic disorder to “an acute attack on solitude (loneliness)”. This actually implies that the symptoms of panic and anxiety attacks, while observed to be affecting an individual person, is in fact contributed by this person’s relationship to the world around him/her. Why? Because we cannot be lonely if we are in contact with some other persons in the environment. Hence to be lonely is to be left in the cold with on one for company.

The word panic is descriptive of the state of being left exposed in the wilderness. It is said to have been derived from the name of the Greek god, Pan. Reading the characteristics of Pan one would derive the keywords, all-encompassing, wilderness, solitude, rejection, stomach-churning cry and death. The word panorama describes the wide open field space. A young animal separated suddenly from its mother and exposed to the cold environment would panic. In its panic it would cry out.

Neuroscientist Panksepp’s lecture explains to us how the panic pathway in the brain is wired up. He also tells us in the video below that the baby animal in panic would be quiet again once it is held warmly. If it were not held, it cries would ultimately stop, and the animal would fall into a state of what looks like depression in humans. The panic system generates loneliness and sadness, and it is observed to be the gateway to depression.

The panic system is related in mammals (including humans) to separation distress and over exposure. Human suffers experience the onset of panic disorder usually as young adults, the age when one leaves the parental home.

Most clients who complain of panic attacks are independent and forward-looking people. Feelings of being exposed or separated are not part of their conscious awareness. These experiences belong to the client as toddlers or babies, and are overwhelming. Many clients manage to uncover this hidden past experience after months of psychotherapy.

Psychotherapy for Anxiety or Panic Attacks – A case study

Clarise, 26 years old, a student who holds also a job as a medical receptionist. She had her first panic attack when she was 20 and had just left her family home and moved to another country, Vienna. She explained that the onset of subsequent panic attacks happen when she is about to leave the family home when she is on holiday there. Strangely, this is also related to her leaving her younger brother, Mike.

Proud of being an independent worker, she came to therapy often talking dryly about happenings at work, talking about panic attacks and medication, and avoiding topics about her relationships. I could perceive her avoiding experiencing her emotions, and her intense fear of going there. Sessions in the first 4 months felt slow. I soon had difficulty remembering her among the other clients.

The slow, almost deadening atmosphere in the sessions soon became clear to me. I felt like I was in conversation with someone who was trying to make herself invisible to me. Yet I felt a longing between us for contact. Clarise came every week for therapy faithfully. I decided on several experiments during the sessions. The most useful of which was very simple: to walk around the room as we spoke. Clarise, while walking, became more animated. It seemed as if in order to make herself invisible, she kept her body still. When she had to walk around, her energy flowed. She appeared then more alive and open to being in conversation with me.

Over time, Clarise was able to talk about her childhood. Keywords were: Unwanted child. Emotionally abusive mother who was devaluing, abandoning, de-validating of her feelings, denying, contradicting. Her mother favors her younger half-brothers. As a child she had to look after the boys. She was also competitive with mother with regard to the brothers. She became overtly responsible for Mike.

Her childhood memories were fragmented, indicating a kind of trauma, perhaps from neglect. Only mother’s feelings of those days could be recalled by Clarise. In the therapy room, it felt to me as if her mother always present. Sometimes I would use the mother’s “presence” as an intervention.

Clarise admits to be constantly yearning for attention. This is a paradox, because of the way she unconsciously makes herself invisible. She admits to flattening her voice to control emotions. Clarise has little body awareness, which she became aware of as we walked around the room.

Gestalt Psychotherapeutic intervention for panic attack symptoms

Clarise’s case shed light on the polarities that emerged during our work.

Polarities are:

  • Fear vs. Curiosity,
  • Attention yearning vs. Self-hiding
  • Being forgettable vs. Forgetting

“I must be afraid so that mother can feel good about herself.”

“When my boyfriend is not at home, I am not in danger of having a panic attack.”

“I make my breathing shallow to press against my chest, so that I won’t cry here.”

Clarise also exhibited tendency for Self-ISOLATION, even if it were unconscious to her. One of her strategies was to dissociate. To disappear. To forget. She admitted that as a child, it was “Safer to be unseen.” If her mother was at home, she would not be able to predict if she would be treated with kindness or anger.

Clarise realised that she could use illness and lately the panic symptoms to garner support from people around her. “When I’m in dire straits, people will come to me and they won’t harm me.”

Looking at PSYCHOPATHOLOGY from the perspective of the relationship between client and therapist.

In the therapeutic alliance, suffering is not located only within the client, but is an emergent phenomenon. This means that we as therapist can feel, perceive ourselves as being part of the symptom. We are impacted by the symptom.

When I am able to acknowledge how being with this client impacts me– in this case the feeling of stagnating stillness and forgetting– I am able to adjust my being with her. In so doing, the atmosphere changes. In gestalt therapy we acknowledge this the as the field.

3 levels of observing anxiety disorder symptoms based on this case study
Single person LevelDyadic Interaction Level Aesthetic Field Level
“My client has panic attacks.” “I forget the client. I overlook her. She seems to make herself invisible to me.” “There is stillness and monotony in the air. I can hear the clock tick. The room feels empty. I feel tingly. There is a sense of longing.”

Conclusion

What I attempt to present here is a cutting-edge perspective of treating symptoms of panic disorder in a patient in the clearest way possible in a blog. Medication and quick therapies have not managed to effect lasting relief for most patients of anxiety. This is why we, as gestalt therapists, look to the broader field. We look beyond the person. We have found useful to see the client in context of the socio-cultural environment. We use this field during the session. We move ourselves in the field. We allow ourselves to be impacted. In this way we make small adjustments. These work as tender changes within the psyche of the client.

Remembering the hypothesis that panic is an acute attack of loneliness, the work with Clarise revealed it to be so. Although Clarise never admitted that she was lonely, she revealed her natural tendency for self-isolation. In making herself forgettable, it was I who ended up feeling left alone in the therapy room. Noticing this and sensing our longing for contact, I could affect the field around us. When the field changed, the client eventually changed. Clarise learned to cry. This was a relief to her. It was a relief to feel safe and be vulnerable. It was a relief to her that she did not have to go into a state of panic to afford company.

Bibliography

Francesetti, G. (Ed.). (2007). Panic Attacks and Postmodernity. Gestalt therapy between clinical and social perspectives. FrancoAngeli.

Invitation to Participate in Group Sessions: FREE-TO-BE-ME

Starting soon in Singapore. 90-min group therapy sessions themed “Free to be me”.

Join this series of experiential group sessions of self-expression.
Feel what it is like to really be yourself in the presence of others.
Experience what it is like to move, talk and laugh like yourself.
Discover the different aspects of your personality.
Uncover your sensuality.
Express yourself creatively.
Be in contact with like-minded others.

Why you need this?

Maybe you don’t. You’re fine. You work hard and play hard. You wear many hats in your life. You’re a parent, a child, a sibling, a colleague, a lover, a friend, a spouse… the list goes on. As you tune into yourself, who is that person you are meeting?

What happens in these sessions?

We work relationally. We make contact with one another. We make contact with ourselves. We do this through dialogue. We communicate verbally and and also non-verbally. We move. We create art.

Who is invited to join?

Interested persons of any gender, marital status or cultural background, age 22 and above.

What is the benefit of participating?

I am bringing this powerful self enrichment sessions to Singapore which is common in some cities in Europe for an affordable fee. Participants who attend this group regularly benefit from attainment of self agency, ability to build better relationships, better health. All this is possible through the connection to a professionally guided, self-supporting group to face challenges life throws at you.

How much does it cost?

Price per session is SGD 48 per person.

Where? When?

At Nicole’s practice in #08-14 Peninsula Plaza, Singapore, and various clubs in SG. You can expect bi-monthly sessions for each group. Places are limited to 12 per group. Group and placement availability will be advised on registration.

Please contact me for registration and information.

gestalt group psychotherapy session singapore

About me

Nicole Chew-Helbig (Mag. pth.) is Singaporean (b.1969) and is a Austria-licensed gestalt psychotherapist and counselor in Singapore. 

Bob and Rita Resnick: Gestalt Couples Therapy

In this video, we learn what couples therapy can look like, what gestalt couples therapy is focussed on. Here is an interview with the Resnicks on their perspective on couples therapy in the psychotherapeutic practice.

Couples Therapy Films – with Rita F. Resnick, Ph.D. and Robert W. Resnick, Ph.D. from GATLA Videos on Vimeo.

Experiential psychotherapy sessions bring lasting effect

I mentioned in the first page of my website that clients can expect motivating, fun and experiential psychotherapy sessions. While it is for most clients the road to therapy is wrought with painful experiences and difficulties, being in therapy is about learning. The learning one gets from gestalt psychotherapy is not the kind of cognitive learning one expects to get at school. Rather, in experiential sessions, one learns procedurally. The experiments and role playing enables the clients to embody new ways of being. This kind of learning takes no effort. This kind of learning is integrated and permanent. The road to this kind of learning is also playful, touching and motivating.

Corporate Counseling: What is the difference between a group and a team?

“A group is any number of individuals who form a recognizable unit, cluster, or aggregation. Teams are specific groups of people with (it is hoped) complementary skills and abilities who join together to collaborate.” Kets de Vries

Within a team are people with different and complementary function. Their unique functions serve the team’s goals. These individuals are highly inter-dependent.   Each team player is also an individual.

The team is considered “merely” group if people are dependent on being in the group, or have to be in this group (as in families), and conform to groupthink. Groups usually form a leadership that decides unilaterally on how the group exists.

Organizations are groups that may or may not be teams. In a team, its members have each a function. This function serve to support the goals of the team.  The collective functionality of all the members of a team is more than the sum of its members. This means that putting the people together alone does not lead to performance unless the potential function of each individual within the group is realized.

Organizations that have healthy functioning teams experience smoother paths towards performance outcomes.

Read also: What motivates people to work and stay in teams?

How do I know if I’m working in a Team?

  • The people you work with have a high degree of interdependence.
  • The group is geared towards a common goal.
  • The members hold themselves accountable for the outcome.
  • The individuals have unique and complementary skills which make them interdependent.
  • Each member and the team as a whole will be affected by the outcome of the work.

Source:

De Vries, M. F. K. (2011). The hedgehog effect: The secrets of building high performance teams. John Wiley & Sons.

Corporate Counseling : What motivates people to work and stay in teams

The motivation to work in a team is often a personal one. Motivation to work in a team is different from simply working for the money.

Being in a team brings along with it a sense of belonging and social interaction. Being identified with a team brings along with it a sense of pride. While teams are formed so as to fulfill tasks for the organization, teams also meet the needs of its members.

The members in a team function together to produce what is much greater than the sum of the number of people in it.

A well functioning team performs. Within this group are unique individuals. A group comprising of unique individuals who have specified tasks which are crucial to their goal is a team. In order for the team to thrive, the authenticity of each member of the team needs to be respected. This means that oftentimes, each member is met with the difference of the other. Sensing differences from oneself is a cause of fear that leads to inter-personal conflict.

Addressing individual needs and fears may well contribute to motivating team membership and performance. Most people have a powerful desire to be part of a group in which they feel recognized and understood. Belonging—being part of a social context—is essential for the development of self-esteem and self-confidence.

It is therefore useful for teams to have the space to reflect on these differences. This is best done with group reflection counseling, best with a professional that is outside the team.

Corporate Counseling: Strengthening Teams within Organizations

A group of people working together does not make a team. Teams are built to perform tasks and fulfill their goals. Teams are also made up of unique individual who are mutually dependent. Each member in a team have a stake in the outcome of the task.

Setting clear, well defined goals

Strengthening the team is like oiling and maintaining a machine. Sometimes the parts need to be serviced, sometimes replaced. However, a machine is not useful if it does not in the first place have a well defined function. If your team suffers from fuzzy goals, and if priorities keep fluctuating, it is time to get this cleared up.

Resolving Conflicts

Conflicts exist. If team members are to stay the long haul, they would need to feel free to be their authentic selves while in the team. However individual differences do rub against each other. These feelings of differences cause anxiety in the members. Anxiety is usually the root of conflicts. Overt conflicts in team is damaging to the persons involved and hurt team function.

Getting a professional from outside the team is instrumental in identifying the conflicts and resolving them.

Attaining real consensus among members

To avoid conflicts, members of the team tend to fake their positions, giving opinions that they do not believe in. False consensus are damaging to the team. In many cases, this leads to bad decisions resulting in losses.

Providing a safe space for members to come clean with their expert views without fear of getting into conflict is a way for avoiding losses due to faulty team decision making. This space can be provided by an external counselor.

Identifying and resolving stalemate in decision making

Since individuals are different, these different point of views may lead to stalemate in decision making. When this happens, it is a sign that people have a stake in what is going on and are interested in the outcome. This reaches stalemates and slow dow the decision making process. Providing a safe space for dialogue is the way to overcome stalemates.

Enquiring non-Participation or passivity of members

When individual differences are not perceived as being appreciated or accepted, the underlying need is for the individual to disappear from the scene. Disgruntled or disillusioned members of the team may lose interest in what is going on. This will not be explicitly said, but acted out. People become passive and/or simply not show up.

Non activity of members in a team holds up the work process. Providing space for communication about the cause of disgruntlement and disillusionment is a way to improve member morale. It is also an opportunity for open dialogue about the participation of the member.

Leveling out uneven attribute of importance

Hierarchy is a part of organization. In a team, even though there is hierarchy, the members share equal importance to each other. If there is imbalance or discrepancy in the attitude of the team to individual members, this would lead to conflict and passivity mentioned above.

Member feedback and communication with each other are curative ways of dealing with imbalance of appreciation of the importance felt by members to each other.

Looking out for lack of mutual accountability

A functioning team is made up of members, all of whom are responsible individually for the outcome of the tasks. Members who fail to be accountable can hold back the work flow. Usually people have a reason for not feeling accountable or not wanting to be accountable for their parts. This is worth working through during counseling sessions.

Team Maintenance

Like any machine, the team needs care and maintenance. This comes in the form of taking care of the humanity that is involved in the team. Providing a space and time for counseling by a professional outside the organization is an effective way of achieving this.

AuthornikhPosted onMay 5, 2019Tagscorporate counselingworking with teams

Coming off Psychiatric Medications

Taking psychiatric medications is not the same as taking over-the-counter flu medication. When one gets a flu, one simply takes a pill and stops when the symptoms subside. With psychiatric medications, however, this is different. Having started on a course of psychiatric pharmaceuticals for mental health symptoms like depression, anxiety or psychosis, one must follow carefully the directions of the physician, and to consume the right dosage at the prescribed intervals. When the symptoms subside, or when one feels that the meds do not help, the patient should not simply stop taking the medication. He/she should first consult the psychiatrist who would advice the patient on how the dosage can be reduced.

This controlled reduction of psychiatric medication is an important measure of harm reduction. Why harm reduction? Psychiatric drugs are chemicals that alter the balance of one’s brain biochemistry. On consumption of these drugs, the body and brain cells adapt to the drugs. This adaption process does not happen spontaneously, but take weeks. Genes are switched on and off. A hormonal and a neurobiochemical balancing act takes place. When you decide to stop taking the drugs, you’d need to allow time for your balancing neurobiological system to adapt back to life without these medications.

Measures to take before thinking about coming off antidepressants:

  • Find support from the people around you. Going off these meds can be an unpredictable process. One my feel moderate to severe swings of mood, disordered sleep, anxiety and even rage.
  • Plan beforehand to take up some wellness and coping skills. Some of the most effective are body-based activities that require controlled breathing, like weight-training, yoga, swimming, dancing and meditation. Different people have different preferences.
  • Get support from a psychotherapist at least 6 months before you decide to reduce your medication. This will help you resolve internal conflictual issues that triggered the symptoms in the first place.

In the video below, Will Hall, a former psychiatric patient turned psychotherapist and harm reduction educator explains how and why coming off psychiatric drugs need special attention.

Download Will Hall’s free booklet on coming off psychiatric drugs.

How to Contact Me for Psychotherapy in Singapore

Poem: the Sense of an Ending

 The world spun increasingly slow
Days felt like months
Hours felt like days
Minutes felt like hours
Volcanoes spurted their larvae
All together
They wanted me to feel their inner heat
I didn't want to miss it
I felt hot, very very hot
I smoldered, I cringed,
I felt as if I were turning to ash
Instead I turned into glass
Thick glass
I refracted the glow of the molten larvae
The larvae felt like tears
Tears that would have otherwise remained retroflected,
Flowed in hot fury
I am thankful for the heat that changed me
I have turned into a solid, transparent, reflective, smooth, supportive material
This is a gift
As the end drew near
The volcanoes emptied out
Heat turned to warmth
It is now summer
The sense of an ending
There is sadness
It is not grief because there is no loss
Only gain
As the last milliseconds crept by
I felt the here-and-now like never before
How long does the here-and-now last anyway?
3 seconds? 3 milliseconds?
At the very end
As we say our goodbyes for the last time at the door
as we turn to look each other for the last time eye to eye
The here-and-now is eternity.

Nicole Chew-Helbig, Vienna, 26.6.2019