Dear Therapist

This past summer, I had an anxiety attack. It came as a surprise, because while last year I was depressed, at the beginning of the summer I made it my business to get out of the rut. Since then, I’ve been very busy going to classes and running a small business that allows me to express myself. I’ve been in therapy for about a year now and I really feel like I’m on the road to recovery. I feel emotionally aware and stable. How is it that at this point I suffered from an anxiety attack? I’ve had four since the summer. Maybe I need a different form of therapy. How do I know if and when it’s time to change tactics or therapists? I can’t go on like this. I feel like
my anxiety attacks are holding me back tremendously.

Response

I’m not sure what you mean when you refer to an anxiety attack.  Although this is a commonly used term, there are many different forms of anxiety and levels of severity.  A “panic attack” is a sense of terror, along with a physical reaction, which leads to yet higher anxiety.  Physical symptoms can include profuse sweating, weakness, dizziness, tingling, numbness, heart palpitations, fear of having a heart attack, and subsequent fear of another panic attack.  Panic attacks can be frightening in the extreme.  If you are having panic attacks, a therapist can help, but you will likely want to see a psychiatrist who can prescribe something to alleviate the symptoms until you learn to decrease the frequency and severity.  Educating yourself about panic attacks can help to decrease the fear associated with the attacks.

Often, however, when people speak of anxiety attacks, they simply mean that they have a constant level of anxiety that began at a particular point, or that they experience waves of anxiety.  These can range from a general feeling of concern to many specific fears, and can fluctuate or remain at one basic level of severity.  It sounds like you may be having waves of recurring anxiety without a specific identifiable cause or fear.

One thing to bear in mind is that the very lack of an identifiable fear often exacerbates the anxiety.  This may be part of what is causing your anxiety.  Learning to acknowledge possible underlying fears—even if they make no logical sense—can help to change this dynamic.

There are a number of forms of therapy that can help to address this form of anxiety.  An eclectic therapist is capable of utilizing various therapy modalities either individually or concurrently to achieve the maximum benefit.  If your therapist mostly uses only one modality (i.e. cognitive therapy or psychoanalysis), and you are no longer seeing gains, this should be discussed with the therapist in order to ascertain whether she can continue to help you with the particular issue that you’re experiencing.

Sometimes, the therapist-client relationship becomes stagnant and, if not addressed, the therapy process can get stuck in a continuous loop.  This can be due to many factors.  If this issue is addressed, an honest and competent therapist can help you to decide whether she is the proper professional to help you achieve your goals.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  author of Self-Esteem: A Primer

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