When a person reports panic, how can we most effectively help?
I am grateful to have had the opportunity to learn from Dr. Elvin Semrad, the most influential teacher of the art of psychotherapy of his and subsequent generations. Semrad’s manner was calm, his words simple. One of the valuable bits of wisdom I learned from him:
Panic is a sign that something in your life needs attention.
The expanding balloon of urgency that accompanies a patient’s report of panic dependably deflates when we attentively begin to investigate just what in his or her life “needs attention.” In fact, reframing panic as simply “a sign that something in your life needs attention” is an effectively calming way to initiate the work.
This practical approach to panic is calming both for the patient and for the therapist.
Our work is clear. Sometimes the way to hone in on what is generating the experience of panic may be to inquire as to when the patient last felt more relaxed, and then carefully and in detail to trace the experiences and accompanying feelings that followed the period of more comfortable feeling. My most recent work of this kind occurred with a patient reporting panic one day on awakening. Looking closely at the details of the previous day’s events in this case brought to light feelings of conflict and frustration that the patient had not fully acknowledged, and which had evolved to the panic she experienced on awakening the following day.
Other times, panic on awakening may be related to something that occurred in a dream and which resonates with unresolved conflict in waking life.
Panic, like other symptoms, is a sign that the patient is not adequately in touch with the uncomfortable and painful feelings that need attention. As with all of the work of psychotherapy, when we are effective, we help the patient to trade neurotic pain for existential pain — conflict, frustration, anger, sadness, whatever.
While this doesn’t sound like progress, as long as we try to avoid facing and feeling the pain of life — existential pain — symptoms like panic can continue without resolution. However, what is true about existential pain is that facing it and feeling it can lead to its abatement.
No therapy is comfortable, because it involves dealing with pain. But there’s one comfortable thought: that two people sharing pain can bear it easier than one. — Semrad.
In today’s psychopharmacology-driven culture, when a patient reports panic, the temptation for the therapist is to reach for the prescription pad. Doing the work of helping patients to investigate their lives, to acknowledge and bear their feelings, and finally to put them into perspective, that is the work of psychotherapy. That is what Semrad helped many of us to learn to do. That is the work to which I am committed.