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A psychodynamic approach to anxiety is not disorder specific; anxiety can and usually is present to varying degrees in all patients that are seen for psychodynamic psychotherapy. This chapter aims to shed some light on some psychodynamic approaches to thinking about anxieties. Using theory and clinical examples we think about how difficulties in containing processes between caregiver and infant early in the infant’s life may predispose to the persistence of archaic anxieties. We go on to explore the nature of separation and loss in relation to anxiety and finally, we reflect on how internal conflict and the role of a critical internal object can bring about anxiety. The clinical examples illustrate how wider variation in anxieties may present in therapy and the last section focuses on how the therapist may experience and respond to these different anxieties.
Anxiety is both an innate and a constructed response to perceived and anticipated threat. This chapter explores anxiety as signal, symptom and syndrome, and describes the evolution of the major psychodynamic models of signal anxiety. The major psychodynamic models of signal anxiety posit anxiety as a signal of unconscious, intrapsychic danger. Neurobiological factors also contribute to the development and expression of anxiety symptoms and syndromes. Imaging techniques have been used to illustrate the presence of unconscious processes that to date have only been hypothesized; specifically that unconscious affects are a crucial determinant of behavior. Many symptomatic patients were forced to make adaptations to internal and external threats in early childhood. Ironically, the treatment of symptomatic anxiety may create an anxiety of its own, the anxiety about change. Many patients present with the acute onset of anxiety symptoms but do not meet the criteria for an Axis I anxiety disorder.
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