Anxiety denotes a whole range of affects and phenomenon. Those include panic attacks, vertigo, a general sense of worry, uncertainty and doubts regarding which direction to take in life. Bodily phenomena often include breathlessness, palpitations, muscle tension, fatigue, dizziness, sweating and tremor. If we can never be sure of the reasons behind our feeling, say, happy or sad (happiness can cause sadness or guilt) anxiety has an overwhelming certitude attached to it – it is real, something in front of which all words and categories fail. Anxiety happens when our place in the world and how we used to see ourselves in it suddenly changes, when we can no longer rely on the Other and use his desire as a compass to orient ourselves in relation to it. Instead, we are left suspended in a moment where we no longer know where our place is, and a future where we will never be able to refind ourselves. For the existentialist philosopher Jean-Paul Sartre, anxiety is evidence of our freedom. For Jacques Lacan there exists a relationship between anxiety and desire. Anxiety is a way of sustaining desire when the object is missing and, conversely, desire is a remedy for anxiety, something easier to bear than anxiety itself. Psychoanalytic Psychotherapy approaches it from the fundamental notion of an absolute loss, a ‘lack of a lack’ and sees desire as its remedy.
Do you find yourself eating or sleeping too much or too little? That you are pulling away from people and activities because of low or no energy? Some of us may feel like nothing matters anymore. We are left confused, isolated, angry, worried or scared, perhaps even having suicidal thoughts. In those cases where all seems well and ‘perfect’ this feeling of disillusionment is quite baffling to understand. One way of looking at depression is as a force or movement driving our lives. Like a heart that has stopped beating, depression marks a stop to this vital movement. Given the set of circumstances and how long things have been kept this way unaddressed, it may be challenging for some to regard this issue as worth investigating. Often placated by feelings of shame we tend to fall back on the basic assumption that us alone can change our situation. Unsurprisingly, questions of anger, frustration and isolation are often central to the experience of depression. With online therapy I will approach this issue with the view to reintroducing a movement using the element of surprise.
Relationship fall-outs are expressions of a toxic form of aggressivity between partners. Typical signs include living in tension and mutual rejection, jealousy, passive aggressivity, denial and in some instances verbal or even physical abuse.
For example in the act of blaming the other personal criticism is expelled by projecting it onto the other. Referring himself to the master-slave dialectic by the German philosopher Hegel (1807) Lacan argues that a fraught relationship is ‘imaginary‘ in nature, a life and death struggle for ‘pure prestige‘. In this context the other is seen as a rival, whose elimination seems to be the safest option. Generally speaking, aggressive attacks are a form of response indicating that one’s defense mechanism is somehow stuck in overdrive. The ego is felt to be under constant attacks and threatens to collapse. Those are moment of great vulnerability and risk in which retaliation is seen as an attempt to protect oneself against the anxiety that the threat of disintegration immediately poses.
Jealousy is experienced when the ego concludes that the other with whom one is competing has the advantage. Feelings of jealousy reflect the desire to have this advantageous position for oneself, and the wish to eradicate this frustrating other.
Psychoanalytic Psychotherapy sees working with issues in relationships as one of ‘un-knotting’ the multiple threads that have led to this situation. Its goal is to try and dislodge the frozen and stereotyped perceptions and evaluations at play.
One avenue of exploration may for instance include exploring those significant previous relationships in the patient’s life.
Anger may be categorised as any forms of violence expressed towards others or oneself in self-harm. In the former, symptoms of anger include bullying, threatening people, persecuting, insulting, pushing or shoving, using power to oppress, shouting or playing on people’s weaknesses.
Psychoanalysis regards anger as a ‘passage à l’acte’: a form of ‘acting out’ with no control. We become violent when the Real has come to possess such a grip on us that the fictional character we had created of ourselves to contain it breaks down. However paradoxical this may sound, Psychoanalysis Psychotherapy understands anger as a form of ‘deadly enjoyment‘ which, in its final analysis, expresses nothing other than a rejection of what is felt to be a threat to one’s sense of integrity. For Freud, hate and anger are more ancient feelings than love. In this context, the clinical work consists of using language as a way to make something of this anger. The exercise of symbolisation realised in therapy may well be initially experienced as somehow exacerbating this feeling further, but should in due time transform itself into some useful and creative productions.
In certain situations we may find it almost impossible to act, and instead react as if feeling self-conscious and unable to act in a natural way. Symptoms of inhibition include reticence, procrastination (delaying), reserve, wariness, reluctance, discomfort, hesitancy, nerves, nervousness.
The experience of inhibition can be transitory, for instance in a surprise accident from which we eventually recover, or last some extended period of time while bringing with it feelings of isolation and anger. From another person’s perspective, it may look as if nothing is really going on. In fact, being quiet may even be encouraged and seen as a positive personality trait (especially for men), that is, until eventually some violence is done and personal ties are cut. Symptoms of inhibition include fear; being hyper sensitive to the other’s reactions; feelings of being disconnected or dissociation. In therapy, it may be useful to invoke the place and presence of the Other with its omnipotence. Using online therapy I will encourage patients to try and remember anything that could have been felt as particularly traumatic. It may also be useful to explore the various relationships the patient had with this so-called ‘omnipotent Other’.
Issues of self-confidence and/or self-esteem include shyness, embarrassment, unease, reserve, apprehension and feelings of insecurity.
As a derivative of the experience of inhibition, issues of self-confidence can be usefully regarded in therapy as revolving around the notion of power, the perceived lack of which is based on an image (the ego) which is in fact deceptive. This is not to say that feeling of low self-confidence is not real. This ‘hole in the mirror‘ can have a significant impact on one’s life if left unattended. The society we live in demands that we continuously show self-confidence. The work undertaken using online therapy will include helping patients describe their significant relationships and identify those specific descriptions that have an alienating influence in their lives. The aim in therapy is also to help patients identify with what works for them; the Sinthome.
Addictions are usually recognised in experiences of dependency, craving, habit, weakness, compulsion, fixation or enslavement.
From a psychoanalytical perspective addictions are regarded as a type of ‘self-medication’: a method used to evade everyday suffering. Intoxication affords not just an immediate relief from pain, it also provides a feeling of independence from the external world. At any time the addict can withdraw from the pressure of reality and find refuge in a world of his own.
Addiction with intoxicating substances may draw to it an enormous amount of resources, physical and financial, potentially leaving the sufferer totally depleted or, as popular language would have it, ‘wasted’.
The looming danger with addictions of this sort, besides the obvious risks to one’s health, include some potentially long-lasting changes in the person’s view of himself or herself. “I would no longer be ‘me’ without it”; “I am expected to keep achieving and could not do this without it” are only a few typical accounts therapists hear in their clinic. The combination of using substances as painkillers or as a means to sustain a particular lifestyle in which one is trapped makes it a formidable symptom to treat. The work may seem arduous, if not impossible at first, but this would be to underestimate the power of words. The patient’s understanding of the notion of ‘belief’, as well as what may have been seen and heard at the time in the past, are essential avenues to explore using online therapy.
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