I saw this 34 year old man for 17 sessions. Jim was from an Italian immigrant family, worked as a corrections officer, and was in no way comfortable with psychology or psychotherapy. Very much a "manís man", he was not someone who reflected on his feelings or behavior, and he was a firm believer in the philosophy of "deal with it". Unfortunately, his symptoms had progressed to the point that they were interfering with his job performance, so he reluctantly sought help.
Jim had always been an energetic, wary, and tense person, and in the two years before coming to see me, these qualities had escalated into panic attacks. They occurred when he was driving, especially long distances for his job (transporting inmates to other jails), but lately even when traveling 20 minutes from his home town to the next. Hardly a coward in other areas of his life, he could not at all understand this symptom.
In sessions, Jim was friendly and responsive, but very tense, with a kind of fixed smile and constant shoulder shrug, as if always reminding himself, "hey, no problem, Iíll deal with it". We tried some relaxation, some breathing exercises, and some of Albert Ellisí cognitive therapy. We had some success but it never lasted. Heíd have one uneventful drive, but then the next attack would be all the worse.
Gradually Jim relaxed enough to stop shrugging and really describe the details of the attacks. In session 8, he was especially vivid in his recollection of panicking on the way to my office. He described a sense of being in some old "Twilight Zone" episode, on a road to and from no-where, stranded forever in a car, cut off from everyone and everything.
Jim was quite astounded that after this session his attacks became far less frequent and intense. Just identifying and beginning to flesh out the whole experience of panic -- feeling and remembering it consciously and out loud -- kicked him out of the pattern. He stopped treatment after another 9 sessions. By then heíd had no attacks for a month.
What happened? There are several possibilities, all of which may have contributed. Jim came from a rather violent and intolerant family. He greatly minimized any effect this may have had on him. He shrugged off any suggestion on my part that it sounded rough, but all his stories confirmed this impression. Sure enough, what we donít feel we are doomed to enact, and it became clear that his panic and other symptoms were the expression of this unfelt reaction to home.
As he described it in session 8, the panic was associated with feeling helpless, lonely, and isolated. All of these feelings were ripe in the stories Jim told me about his past and present family life, but he was conscious of none of them. Apparently it took panic attacks to awaken him to the possibility that he harbored such feelings. In that eighth session, he finally managed to stop shugging them off as "I donít know, itís weird". He began to put them into words, to understand some of their nuances -- for example not just "I start shaking", but "I get panicked, afraid, like Iím lost somewhere...". As we know, when we feel what weíve been avoiding, we feel better and function better.
At a somewhat deeper level, what may also have happened to Jim in our sessions was what analysts call a "tranference cure". His panic attacks had to do with feelings of isoIation, helplessness, loneliness. It makes sense that having someone he can talk to about these feelings in itself alleviates them. With me in his life heís not so alone. Sounds rather straightforward, but I refer to it as "deeper" because Jim remained oblivious to all such feelings. He simply could not consider the idea that he felt anything other than "fine" in any area but the moments of panic attacks.
Jim stopped treatment after 17 sessions. He got the symptom relief he wanted was not inclined to continue. But over the years, Jim has returned to treatment several times, for brief periods, always with a recurrence of his anxiety symptoms. There was never a particular cause of these relapses. I believe the relapses are evidence that there is more treatment warranted. Calming him down so he can drive again or reminding him that he is not alone (the transference cure) seem to be temporary palliatives, band-aids. The symptoms recur because other feelings are bursting to get out. Oblivious to any sense of helplessness , isolation, being lost, etc. in his conscious and daily life, these feelings are bottled up and leak out in his panic attacks. You could say itís the only way he tolerates them.