The Psychodynamics of Performance Anxiety: Psychoanalytic Psychotherapy in the Treatment of Social Phobia/Social Anxiety Disorder

  • Thomas HoffmanEmail author
Original Paper


The optimal treatment for Social Phobia/Social Anxiety Disorder (SP/SAD) remains an open question despite the existence of a variety of controlled studies, including randomized trials of cognitive behavioral and psychodynamic therapies. Moreover, individuals with Performance Anxiety, a colloquial term for SP/SAD, are typically treated by lay coaches and unlicensed practitioners, who focus on managing the symptoms of “stage fright.” This paper describes the psychodynamic (psychoanalytic psychotherapy) treatment of an individual with manifestations of SP/SAD in the realms of public speaking, musical performance, and professional accomplishments. The narrative identified contributions of childhood abuse, gender concept confusion, mismatched parent–child interactions, and conflicts concerning aggression and entitlement. It became clear that strong feelings associated with anxiety concerning self-worth were at play that left the patient no possible alternatives to wishes for idealized perfection. These findings served as the basis for a therapeutic approach from a self-psychology perspective that focused on empathy, shared emotional experiences, attunement, and being known. Psychoanalytic psychotherapy is a robust and potentially valuable option for individuals willing to undertake a more intensive therapy whose benefits extend beyond symptomatic relief.


Anxiety disorders Psychodynamic therapy Self-psychology Gender concept 



I wish to thank Richard Geist, Larry Hirschhorn, Judith K. Hoffman, Frank Lachmann, Michael Lavin, Joseph Lichtenberg, and Monica Leonie Meerbaum, for editorial comments. “Dr. Conrad” (a pseudonym) approved all aspects of this project, including modifications to profession, institutions, workplaces, and family names to protect confidentiality. He reviewed the complete text prior to authorizing its publication, giving his full assent to its entire content, including the degree of masking of his identity.

Compliance with Ethical Standards

Conflict of interest

Author declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institute for Contemporary Psychoanalysis and Psychotherapy and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from the individual included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute for Contemporary Psychotherapy & PsychoanalysisWashingtonUSA
  2. 2.BethesdaUSA

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