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One of the reasons this blog came into being was to give young people a chance to orient themselves in the varied field of psychotherapies and psychiatric treatment in general. We have always avoided flaunting the defense of one theory over others in order to encourage calm reflection on the content without expiring into sterile questions of affiliation that almost always lead to aprioristic closure preventing confrontation.

It is already very difficult for a young person to arrive at the decision to seek outside help

but he is often unaware that psychotherapy is by no means one-size-fits-all. Whereas in organic medicine there is a defined protocol, whereby a certain diagnosis corresponds to a certain therapy, this is not the case in psychotherapy. I am not going to dwell here on why it has come to such a situation, I only mention that treatment has been given up and the word healing has become forbidden. In its place we now speak of support, containment, which obviously widens the mesh of intervention. Cure forces the search for a cause, an etiopathogenesis and a diagnosis, while support can be done in so many ways. Even the word “mental illness” has disappeared from the radar to make way for the certainly more vague word “disorder.” Consequently, one is now concerned only with manifest behavior while disinterested in the internal dynamics that determine it. Then there are also a few white flies who think that there is a cure and that, to be such, one must deal with the deep, unconscious dynamics, but these are now a minority. 

Today, however, I would like to leave aside these reflections, which are in danger of appearing abstract, to offer a glimpse of a session because perhaps we understand each other better that way.

Many years ago a girl of almost 19 years came to me. She was very worried because she had been having sudden panic attacks. It had never happened to her before and they had arisen in seemingly calm situations, while she was taking driving school lessons. 

A beautiful girl, intelligent, very well-groomed in appearance, she had just graduated from high school. In short, a good girl, maybe too much so….

She tells me a little of her story: she had been with a boy for five years, a stable, quiet relationship. With her father she had never been able to really open up while with her mother she was more intimate. She tells me that her parents got together when her mother was 14 years old and had been together ever since. 

She had been having panic attacks while taking driving lessons. I ask her if she was always taking lessons with the same instructor and she says no but with the other one she had no problems. So I tell her to tell me about the offending instructor, and after some hesitation, blushing a little, she finally comes out of the good girl’s cage and tells me that he is a beautiful, wonderful guy…in short I could tell that she really liked him!

What can we understand from this excerpt of the session? That the girl had the more or less conscious idea that she would follow in her mother’s footsteps. Identification with her mother had completely enveloped her underlying identity, adhering to it like a glove until it was hidden, and led her to believe that her destiny was already written: she would get with the boy at 14 (like her mother), then she would marry him, children…and they would all live happily ever after! In short, a normal life, already mapped out, with no major shakeups, until the encounter with the instructor happens that threatens to shatter the gilded cage of identification and the forbidden idea of seeking her own fulfillment peeps out. Hence the panic attacks. She feels she is dying because she no longer distinguishes her identification with her mother from her true identity, and the death of her identification, which would finally allow her to realize herself, is experienced as her own death. The suffocation experience is the suffocation of that residual shred of identity that cannot make it to rebel. 

So we could say that in this case the panic attacks, as unpleasant and distressing as they were, represented perhaps the only chance for the girl to have a healthy crisis, certainly not an easy one, to then pave the way for a radical change in her life. Therein lies the importance of dealing in psychotherapy with the deep dynamics underlying behavior. In our case it also allowed us to make the symptom comprehensible, thus eliminating that anguish of the looming threat of something inexplicable, something foreign, which could manifest itself at any moment and from which one can never completely free oneself.

Conversely, if one is behaviorally oriented, as unfortunately now seems to be the norm, the only intervention will be to try to find the right technique and/or the right medication (often the two go hand in hand) to chase away that distressing symptom as soon as possible. I don’t know and don’t care what it is due to-say the psychotherapist or psychiatrist on duty-I am interested in getting the patient back in a position to lead a “normal” life as soon as possible. Maliciously, I would be inclined to say that then, in the course of time, from anxiolytics we will move on to antidepressants!

I think it is permissible to choose a reassuring path, delegating to the expert on duty to rid us of that unbearable symptom, but I think it is equally permissible for us to know that there are completely different ways of dealing with the same problem.

Marco Michelini


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