Panic-focused psychodynamic psychotherapy

Domain I · Psychodynamic & depth psychology · Milrod, Busch, Cooper · 1997

What it is

PFPP is a time-limited psychoanalytic psychotherapy for panic disorder with or without agoraphobia. Its premise is that panic attacks are not "out of the blue." They carry psychological meaning. They are a compromise formation between unacceptable wishes (most often anger and wishes for…

Format

• Format. Individual sessions of 45–50 minutes, twice weekly. The full course is 24 sessions over 12 weeks; trials allowed up to 14–16 weeks to fit in all sessions. Concurrent medication may continue. The manual gives no session-by-session protocol. It sets out the focus for each phase and expects…
• Phase I — Treatment of acute panic (roughly sessions 1–8; boundaries are approximate)

Who practises it, and how they are trained or regulated

• Trained psychodynamic clinicians: in 2007, psychiatrists or psychologists with psychoanalytic training. They took a 10–12-hour PFPP course plus a supervised pilot case, then had monthly group supervision.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• over-questioning that turns into interrogation. It's working when the patient begins to clarify on their own.
• history-taking that drifts away from panic. Keep linking it back. It's working when the patient sees parallels between past and present without being told.
• repetition that becomes rote. Each repetition should be tied to fresh feeling. It's working when the patient generalises the insight to new situations without prompting.
• genuine withdrawal or medical causes. Those belong to the prescriber or physician. It's working when the patient can talk about attachment to the medication or prescriber.
• vague, purely physical accounts. Gently ask for the interpersonal context. It's working when the patient starts adding details unprompted and wonders aloud what was going on.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.