Strubbe Glenn, Vanheule Stijn
J Am Psychoanal Assoc. 2014 Apr;62(2):237-66. doi: 10.1177/0003065114527616. Epub 2014 Mar 20.
From Jacques Lacan's theory of anxiety, principles are deduced for a Lacanian-oriented treatment of panic disorder. This Lacanian approach is related to Freud's theory of the actual neuroses, and is comparable in some ways with the approach taken in Panic-Focused Psychodynamic Psychotherapy (PFPP). The Lacanian conceptualization of panic retains the idea that both repressed material and unsymbolized mental states lie at its basis. People suffering from panic attacks are overwhelmed by signifiers, aspects of corporeal excitation, and/or existential questions that remain too Real. Psychoanalytic therapy aims to create a name for such Real elements. The three registers that Lacan situates at the basis of his psychoanalytic approach (the Symbolic, the Imaginary, and the Real) are discussed, as well as the treatment principles for conducting this clinical work. The case study of a young woman with panic disorder is presented to illustrate how a brief, Lacanian-oriented treatment (forty-eight sessions) progressed, and where the patient managed to both name and find a symbolic place for psychic experiences that were too Real. During this treatment, the patient overcame her avoidant-defensive mode of functioning and her persistent difficulties related to separation.
从雅克·拉康的焦虑理论中，推导出了以拉康理论为导向治疗惊恐障碍的原则。这种拉康式方法与弗洛伊德的现实神经症理论相关，在某些方面与聚焦惊恐的心理动力心理治疗（PFPP）所采用的方法类似。拉康对惊恐的概念化保留了这样一种观点，即被压抑的材料和未被象征化的心理状态都是其基础。患有惊恐发作的人被能指、身体兴奋的方面和/或仍然过于真实的生存问题所淹没。精神分析治疗旨在为这些真实元素创造一个名称。讨论了拉康在其精神分析方法基础上所设定的三个界域（象征界、想象界和实在界），以及开展这项临床工作的治疗原则。呈现了一位患有惊恐障碍的年轻女性的案例研究，以说明一种简短的、以拉康理论为导向的治疗（48次疗程）是如何进展的，以及患者如何成功地为过于真实的心理体验命名并找到一个象征位置。在这次治疗过程中，患者克服了她的回避防御功能模式以及与分离相关的持续困难。
