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

  • Thomas Hoffman
Original Paper
  • 13 Downloads

Abstract

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.

Keywords

Anxiety disorders Psychodynamic therapy Self-psychology Gender concept 

Notes

Acknowledgements

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.

References

  1. Bandelow, B., Torrente, A. C., Wedekind, D., Broocks, A., Hajak, G., & Rüther, E. (2004). Early traumatic life events, parental rearing styles, family history of mental disorders, and birth risk factors in patients with social anxiety disorder. European Archives of Psychiatry and Clinical Neuroscience, 254(6), 397–405.CrossRefPubMedGoogle Scholar
  2. Bishop, M., Rosenstein, D., Bakelaar, S., & Seedat, S. (2014). An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder. Annals of General Psychiatry, 13, 16.  https://doi.org/10.1186/1744-859X-13-16.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Bögels, S. M., Wijts, P., Oort, F. J., & Sallaerts, S. J. (2014). Psychodynamic psychotherapy versus cognitive behavior therapy for social anxiety disorder: An efficacy and partial effectiveness trial. Depression and Anxiety, 31(5), 363–373.CrossRefPubMedGoogle Scholar
  4. Dodes, L. M., & Dodes, J. (2017). The case study method in psychodynamic psychology: Focus on addiction. Clinical Social Work Journal, 45(3), 215–222.CrossRefGoogle Scholar
  5. Fenichel, O. (1934). Outline of clinical psychoanalysis. Psychoanalytic Quarterly, 3, 223–302.CrossRefGoogle Scholar
  6. Fosshage, J. L. (2002). A relational self psychological perspective. Journal of Analytical Psychology, 47(1), 67–82.CrossRefPubMedGoogle Scholar
  7. Freud, S. (1936). The problem of anxiety (1926). In Trans. HA Bunker. New York: WW Norton & Co.Google Scholar
  8. Freud, S. (1916/1957). Some character-types met with in psycho-analytic work. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914–1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works (pp. 309–333), 1957. (Original work published in 1916).Google Scholar
  9. Geist, R. (2016). From self protection to relational protectiveness: The modification of defensive structures. International Journal of Psychoanalytic Self Psychology, 11(4), 368–380.  https://doi.org/10.1080/15551024.2016.1213102.CrossRefGoogle Scholar
  10. Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., Huesing, J., Joraschky, P., Nolting, B., Poelmann, K., Ritter, V., Stangler, U., Straus, B., Stuhldreher, N., Tefikow, L., & Leibing, E. (2014). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: A multicenter randomized controlled trial. American Journal of Psychiatry, 171(10), 1074–1082.CrossRefPubMedGoogle Scholar
  11. Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., & Leibing, E. (2014). Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. American Journal of Psychiatry, 170(7), 759–767.CrossRefGoogle Scholar
  12. Levy, S. T., Seelig, B. J., & Inderbitzin, L. B. (1995). On those wrecked by success: A clinical inquiry. The Psychoanalytic Quarterly, 64, 639–657.CrossRefPubMedGoogle Scholar
  13. Lipsitz, J. D., Markowitz, J. C., Cherry, S., & Fyer, A. J. (2014). Open trial of interpersonal psychotherapy for the treatment of social phobia. American Journal of Psychiatry, 156(11), 1814–1816.Google Scholar
  14. Macdonald, H. (2016). H is for Hawk. New York: Grove Press.Google Scholar
  15. Magee, W. J. (1999). Effects of negative life experiences on phobia onset. Social Psychiatry and Psychiatric Epidemiology, 34(7), 343–351.CrossRefPubMedGoogle Scholar
  16. Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368–376.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Nagel, J. J. (2018). Memory slip: Stage fright and performing musicians. Journal of the American Psychoanalytic Association, 66(4), 679–700.CrossRefPubMedGoogle Scholar
  18. NIMH (2014) Social Anxiety Disorder. http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed November 10, 2018.
  19. Solovitch, S. (2015). Playing scared: A history and memoir of stage fright. New York: Bloomsbury Publishing USA.Google Scholar

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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