Psychotherapeutic approaches to the treatment of panic attacks, hypochondriasis and agoraphobia

Various theoretical orientations suggest different treatment approaches to the agoraphobic syndrome. In this paper a self-psychology formulation is applied to the treatment of panic attacks, hypochondriasis and agoraphobia. When these symptoms are viewed as manifestations of self-fragmentation, their treatment can be conceptualized as a process of improving self-cohesiveness. The initial management of symptoms sets in motion a self-object transference which is the foundation of treatment. As therapy proceeds, the defences against affect which are associated with a primary defect in anxiety regulation can be understood in the light of childhood reconstruction and worked through in the transference. The resultant restructuring of defences promotes an increased capacity to tolerate affects without the threat of self-fragmentation. Through this path a more durable self-cohesiveness is achieved.