Manual of Panic Focused Psychodynamic Psychotherapy: eXtended Range

Empirical research in psychodynamic psychotherapy has been delayed in its development relative to research for other modes of psychotherapy, but clinician/researchers have emerged both nationally and internationally over the past decades to demonstrate the efficacy of the treatment (1). Among psychodynamic treatments, psychotherapy for panic disorder and other anxiety disorders, the topic of this excellent volume, has been the most thoroughly studied and researched. We benefit from the depth of knowledge and empirical approach that are demonstrated in this follow-up to the authors' 1997 edition (2).

The treatment described adds to the evidence-based cognitive-behavioral treatments already available to clinicians. Having multiple efficacious treatments for panic disorder reflects psychotherapy's version of the trend toward personalized medicine. As researchers and clinicians, our responsibility is to find “the right treatment for the right patient.” A psychodynamic approach offers patients with curiosity about the source of their panic symptoms, psychological avoidance, and inhibitions an empirical model rich in opportunity for exploration of the psychological meaning of their difficulties. The authors describe the extensive pilot work that resulted in this manual. Multiple clinical trials, funded by the National Institute of Mental Health, over the past decade have demonstrated that their panic-focused psychodynamic psychotherapy treatment decreases symptoms and improves general patient functioning.

What distinguishes this book from the previous volume is the extension of the treatment principles beyond symptoms of panic disorder to a broader range of anxiety disorders. In addition, as the authors explain, the volume presents “a more clearly articulated description of panic-focused psychodynamic psychotherapy as it has been practiced in our successful efficacy studies.” Researchers and clinicians alike will benefit from these refinements that are evident in this current edition. It is important to note, however, that while the authors express confidence in panic-focused psychodynamic psychotherapy as an effective treatment for patients with a variety of anxiety disorders, the treatment has not been formally studied in these contexts using randomized trials like the ones completed with panic disorder patients. It is this extension of treatment approaches beyond panic disorder that accounts for the subtitle of this volume—eXtended Range.

The explanation of the treatment protocol itself proceeds from an exploration of psychodynamic theory and formulation to the clearly outlined three-phase treatment model: initial evaluation, interpretation of central conflicts and defense mechanisms, and termination. There is an emphasis on the description of the patient's relationship to the therapist and its possible connection to anxiety and panic symptoms. The authors' research has identified patterns of conflicts around separation, anger, development of independence, and sexuality that guide the focus of the treatment process. This information alone is useful to clinicians pursuing a psychodynamic approach to the treatment of patients with anxiety disorders and represents a wonderful example of how treatments can be designed around change processes that have been identified empirically (3).

The empirically based manualized treatment described stops short of a session-by-session protocol because the authors recognize that patients bring their individual differences to treatment despite their common diagnoses. The authors also recognize that psychodynamic treatment principles and interventions may need to be used flexibly depending on the hour-to-hour complexities of the patient. Our own psychotherapy process research has suggested that it is truly impossible to fully control the process of psychotherapy as it is, and it should be a cocreated narrative between the patient and therapist (4, 5). Yet as this volume proves, suggested treatment focus and principles can be clearly articulated in a manner that helps therapists provide effective care for specific clinical problems without constricting or limiting the therapeutic process or detracting from the development of an effective therapeutic alliance.

Completed after years of hard work in the demanding world of empirical research, this manual will be valuable to both experienced and newer psychodynamic psychotherapists. The value of the principles extends beyond panic disorder and the other anxiety disorders discussed. However, to the authors' credit, they make certain to state that their treatment approach should only be used by experienced clinicians because they recognize the need to make complex clinical adjustments based on a patient's course in any given psychotherapy. They ask less experienced clinicians to be supervised when utilizing the treatment.

It is hard not to say that this manual, developed after years of clinical trials, experimentation, teaching, and revisions, represents the most fully developed and useful empirically based treatment that the world of psychodynamic psychotherapy has produced. We are all enriched by the ideas, principles, and manualized treatment offered in this important and excellent volume.