Unlocking Panic’s Roots: A Guide to Psychodynamic Therapy
Panic attacks can feel like a sudden, terrifying ambush from within your own body. One moment you are fine, the next your heart is pounding, you cannot breathe, and an overwhelming sense of dread or impending doom washes over you. When these attacks become recurrent, and you begin to live in fear of the next one, it becomes panic disorder, a condition that can shrink your world until it feels like a prison. While many therapies focus on managing these symptoms in the moment, psychodynamic therapy asks a deeper, more profound question: what is your panic trying to tell you?
This approach offers a different kind of hope. It suggests that your panic is not a random malfunction but a meaningful, albeit painful, signal from the deeper parts of your mind. It is a distress flare, illuminating unresolved conflicts and unspoken emotions that have been buried long ago. By exploring this hidden landscape, psychodynamic therapy aims not just to stop the attacks, but to heal the underlying wounds that cause them, leading to a more profound and lasting sense of peace and self-understanding.
What Exactly Is Panic Disorder?
Panic disorder is an anxiety condition characterised by recurring, unexpected panic attacks. These are not just feelings of intense anxiety, they are overwhelming episodes of fear that trigger severe physical reactions when there is no real danger or apparent cause.
A panic attack is a sudden surge of intense discomfort or fear that peaks within minutes. During this time, you might experience a pounding heart, sweating, trembling, shortness of breath, a choking sensation, chest pain, nausea, dizziness, or a feeling of being detached from reality. Because these symptoms are so physical and so terrifying, many people who experience their first panic attack believe they are having a heart attack or dying.
The disorder itself develops when the fear of having another attack becomes a central focus of your life. This persistent worry can lead you to avoid places or situations where you fear a panic attack might occur, a condition known as agoraphobia. This avoidance can severely limit your ability to work, socialise, or even perform daily tasks like grocery shopping, trapping you in a cycle of fear and isolation.
How Does Psychodynamic Therapy View Panic?
Psychodynamic therapy views panic attacks as symptoms with a deep, personal meaning, not as random biological events. From this perspective, a panic attack is the result of powerful emotions, memories, or conflicts that have been pushed out of your conscious awareness but are now forcefully breaking through.
This approach is built on the foundational idea that our unconscious mind holds a vast reservoir of experiences, desires, and fears that profoundly influence our daily lives. When certain feelings, like anger, grief, or even intense excitement, are deemed unacceptable or too threatening to acknowledge, we unconsciously repress them. Panic, in this framework, is what happens when this dam of repression begins to crack, and the immense pressure of these buried feelings erupts into the conscious mind in a disguised, terrifying form.
The physical sensations of a panic attack, the racing heart and shortness of breath, are seen as symbolic. They are the body’s desperate language for a psychological crisis that has no words. The goal of psychodynamic therapy is to learn to translate this language, to understand what unconscious conflict is fuelling the fire, and to address it directly so that the alarm system can finally be turned off.
What Are the Core Principles of This Approach?
The central principle of psychodynamic therapy is to make the unconscious conscious. It operates on the belief that bringing hidden conflicts, repressed emotions, and unresolved past experiences into the light of awareness is the key to resolving current symptoms like panic.
This exploration happens within the context of a unique and powerful therapeutic relationship. The therapist provides a safe, non-judgmental, and confidential space where you can feel secure enough to explore the most vulnerable parts of yourself. This relationship itself becomes a crucial tool for healing, allowing you to experience a new, healthier way of relating to another person.
Therapists use techniques like free association, where you are encouraged to speak whatever comes to mind without censoring yourself, to bypass the conscious mind’s filters. They also pay close attention to dreams, slips of the tongue, and recurring patterns in your behaviour and relationships. These are all seen as valuable clues, windows into the unconscious dynamics that are driving your panic. The ultimate aim is to increase your insight, helping you understand the ‘why’ behind your fear.
Why Look to the Past for a Present Problem?
Looking to the past is essential because our earliest relationships and experiences create the fundamental blueprint for how we navigate the world emotionally. Our first attachments with caregivers teach us what to expect from others, how to manage distress, and whether it is safe to express our needs and feelings.
If these early experiences were marked by insecurity, unpredictability, neglect, or trauma, we may develop coping mechanisms that, while helpful at the time, become problematic in adulthood. For example, a child who learned to suppress their anger to keep a volatile parent calm might grow into an adult who is completely disconnected from their own anger. This repressed emotion does not simply disappear, it can build up pressure internally until it bursts forth in the chaotic, undifferentiated form of a panic attack.
The purpose of exploring the past is not to assign blame or to dwell on old hurts indefinitely. It is to understand how these formative experiences shaped your internal world and continue to influence your reactions in the present. By connecting the dots between past and present, you can begin to grieve old wounds, challenge outdated beliefs about yourself and the world, and develop a more flexible and resilient way of being that is no longer held hostage by old fears.
How Does a Psychodynamic Session for Panic Actually Work?
A psychodynamic therapy session is fundamentally a deep and collaborative conversation. It is not a highly structured meeting with worksheets or pre-planned exercises, instead, it is a fluid exploration of your inner world, guided by your own thoughts and feelings.
You are encouraged to speak as freely as possible about whatever is on your mind. This could be the details of a recent panic attack, a dream you had, a conflict at work, a memory from childhood, or a feeling you are having right there in the room. The therapist’s role is not to give direct advice or simple solutions, but to listen with a unique kind of attention. They listen for the patterns, the underlying themes, the emotional currents running beneath the surface of your words.
The therapist will gently intervene with questions, observations, or interpretations. An interpretation is a hypothesis that connects a current feeling or behaviour to a potential unconscious meaning or past experience. For example, they might notice that your panic attacks often occur after you have felt unappreciated by an authority figure, and then gently wonder with you if this connects to older feelings about a critical parent. This process is slow, careful, and always collaborative, aimed at building your own capacity for self-reflection and insight.
What is Transference and How Does It Help?
Transference is an unconscious process where you begin to project feelings, expectations, and relational patterns from significant past relationships, usually with parents or early caregivers, onto your therapist. You might, for example, find yourself feeling intensely afraid of the therapist’s judgment, or worried about disappointing them, mirroring feelings you once had toward a parent.
While this might sound strange, in psychodynamic therapy, transference is not seen as a problem, it is one of the most powerful tools for healing. It brings your old, ingrained relationship dynamics right into the therapy room, creating a living laboratory where they can be safely examined and understood in real-time. It moves the problem from a historical story to a present-day, felt experience.
By exploring these transference feelings together, you and your therapist can gain incredible insight into your core relational patterns. You can see, firsthand, how you automatically react to perceived authority, dependency, or intimacy. The therapist can help you see that these reactions belong to the past, not the present, allowing you to untangle yourself from these old scripts and develop new, healthier ways of relating to both the therapist and, by extension, to others in your life.
What is the Goal of Exploring Defenses?
The goal of exploring psychological defenses is to understand the unconscious strategies you use to protect yourself from painful or threatening emotions. Defenses are not inherently bad, they are creative and necessary ways our minds cope with overwhelming anxiety, but they can become rigid and maladaptive over time.
Common defenses include repression, which is pushing unwanted thoughts into the unconscious, denial, which is refusing to acknowledge reality, and projection, which is attributing your own unacceptable feelings to someone else. For someone with panic disorder, a panic attack can be understood as a moment when these defenses are failing. The anxiety that was being held back is so immense that it breaks through the defensive wall.
In therapy, the therapist helps you gently identify your go-to defenses. The aim is not to tear them down aggressively, which would leave you feeling exposed and vulnerable. Instead, the goal is to understand what purpose each defense has served, to appreciate why it was needed, and to gradually build stronger, more flexible, and more conscious ways of managing difficult emotions. As you develop a greater capacity to tolerate your feelings, the need for these primitive defenses, and the risk of them failing and leading to panic, diminishes.
Is Psychodynamic Therapy Effective for Panic Disorder?
Yes, a growing body of research demonstrates that psychodynamic therapy is an effective treatment for panic disorder, offering deep and long-lasting benefits. While other therapies may produce faster initial symptom reduction, psychodynamic approaches are associated with continued improvement even after therapy has ended.
The effectiveness lies in its ambitious goal. It does not just aim to eliminate the symptom of panic, it aims for what is sometimes called "psychic restructuring." This means fostering a fundamental change in your personality structure, making you more resilient, more self-aware, and better able to navigate life’s emotional challenges. The focus is on building your internal capacities rather than just teaching you techniques.
It is often contrasted with Cognitive Behavioural Therapy (CBT), which is a highly effective, evidence-based treatment that focuses on changing the thoughts and behaviours that trigger and maintain panic. While CBT provides invaluable tools for managing acute symptoms, psychodynamic therapy delves into the ‘why’ behind those thoughts and behaviours. For many people, a combination of the two approaches can be ideal, using CBT for immediate relief and psychodynamic therapy for resolving the core, underlying vulnerabilities.
How is Success Measured in This Type of Therapy?
Success in psychodynamic therapy is measured by much more than just a reduction in the frequency or intensity of panic attacks. While symptom relief is a crucial goal, it is seen as a natural byproduct of a much deeper healing process.
True success is marked by an increase in your overall psychological freedom and resilience. This includes a greater capacity to recognise, tolerate, and express a full range of emotions, both positive and negative, without becoming overwhelmed. It means having more fulfilling and authentic relationships, as you are no longer playing out old, unconscious scripts with the people in your life.
Another key measure is a more stable and cohesive sense of self. You may feel less fragmented, more integrated, and have a stronger core identity. Ultimately, success is about moving from a position of being a victim of your symptoms to becoming an expert on your own inner world, able to understand your emotional life with curiosity and compassion rather than terror. It is the shift from asking "Why is this happening to me?" to understanding "What is this feeling telling me about myself?"
Who is a Good Candidate for This Approach?
A good candidate for psychodynamic therapy is someone who is motivated by more than just the desire for a quick fix. It is for the individual who has a sense of curiosity about themselves and a feeling that their panic attacks are connected to something deeper within them.
This approach is well-suited for people who have noticed recurring, self-defeating patterns in their lives, whether in relationships, work, or their own emotional states. If you have tried other therapies that focused only on symptoms and felt that something was still missing, or if you suspect that past experiences or traumas are playing a role in your present distress, psychodynamic therapy could be a very good fit.
It does require a willingness to be patient with the process and a commitment to self-exploration. The journey can be challenging at times, as it involves confronting difficult feelings and memories. However, for those who are ready to look beyond the surface and do the work of understanding their own story, the rewards can be transformative, leading not just to an end of panic, but to a richer, more meaningful life.
Frequently Asked Questions
How long does psychodynamic therapy take?
The duration of psychodynamic therapy varies greatly from person to person because it is tailored to the individual’s unique needs and goals. It is generally not considered a brief therapy, as the focus is on depth and lasting change rather than speed. Some may find significant relief in a matter of months, while others may choose to continue for a year or longer to work through more complex, deep-seated issues. The length is determined collaboratively between you and your therapist.
Is it just about talking about my childhood?
No, while your past is important, psychodynamic therapy is not solely focused on excavating your childhood. The primary focus is always on your present-day life and your current struggles, including your panic. The past is explored only in so far as it illuminates and helps you understand the roots of your present feelings, behaviours, and relational patterns. The goal is to see how the past lives on within you now, and to free you from its unhelpful influences.
Will I have to lie on a couch?
The image of a patient lying on a couch is a classic stereotype largely from the early days of psychoanalysis. While a few traditional psychoanalysts still use the couch, the vast majority of modern psychodynamic therapists conduct sessions sitting face-to-face in chairs, just like in any other form of talk therapy. The focus is on creating a comfortable and collaborative environment, and for most, that means direct, face-to-face interaction.
Is it different from psychoanalysis?
Yes, psychodynamic therapy is a direct descendant of psychoanalysis, but it has evolved significantly. Psychoanalysis is the most intensive form, traditionally involving sessions three to five times a week and often using the couch. Psychodynamic therapy is a broader term that encompasses a range of therapies based on psychoanalytic principles but adapted for a modern context. It is typically less frequent, usually once or twice a week, and is more focused on relieving specific problems like panic disorder by exploring their connection to a person’s inner world.
At Counselling-uk, we understand that panic is more than just a symptom, it is a profound and distressing experience that speaks to deeper challenges. Our mission is to provide a safe, confidential, and professional space where you can do more than just manage your fear, you can begin to understand its story. We believe in supporting you through all of life’s challenges, offering the expert guidance needed to explore your inner world, heal past wounds, and build a more resilient future. If you are ready to look beyond the panic and discover the strength within, we are here to help you on your journey.
During psychodynamic therapy for panic disorder, you can expect to explore your thoughts, feelings, beliefs, and behaviors related to the disorder. Your therapist may ask questions about your past experiences or relationships in order to gain insight into how they may be influencing your current condition. In addition, they may help you identify patterns in your thinking or behavior that could be contributing to your panic attacks. You may also be encouraged to explore how certain events or people in your life have impacted you emotionally.
What are some goals of treatment?