Uncharted waters: psychodynamic considerations in the diagnosis and treatment of social phobia.

Despite the prevalence and psychological toll of social phobia, it has only recently been systematically studied. Although major advances in pharmacotherapy and cognitive-behavioral therapies have added to treatment options available for these patients, social phobia still goes unrecognized and untreated. The author examines how particular countertransference reactions to patients may interfere with the recognition and subsequent treatment of social phobia. She notes that the psychodynamic literature has also neglected this topic, although aspects of social phobia are imbedded in previously described neurotic or characterologically disturbed patients. Two case examples are presented that explore psychodynamic issues related to shame, aggression, trauma, and unresolved grief in the etiology of social phobia. The author believes that treatments that more fully integrate psychodynamic principles with pharmacological treatment and cognitive-behavioral methods will be efficacious in treating this diverse group of patients.