The Psychodynamics of Performance Anxiety: Psychoanalytic Psychotherapy in the Treatment of Social Phobia/Social Anxiety Disorder.

The optimal treatment for Social Phobia/Social Anxiety Disorder (SP/SAD) remains an open question despite the existence of a variety of controlled studies, including randomized trials of cognitive behavioral and psychodynamic therapies. Moreover, individuals with Performance Anxiety, a colloquial term for SP/SAD, are typically treated by lay coaches and unlicensed practitioners, who focus on managing the symptoms of "stage fright." This paper describes the psychodynamic (psychoanalytic psychotherapy) treatment of an individual with manifestations of SP/SAD in the realms of public speaking, musical performance, and professional accomplishments. The narrative identified contributions of childhood abuse, gender concept confusion, mismatched parent–child interactions, and conflicts concerning aggression and entitlement. It became clear that strong feelings associated with anxiety concerning self-worth were at play that left the patient no possible alternatives to wishes for idealized perfection. These findings served as the basis for a therapeutic approach from a self-psychology perspective that focused on empathy, shared emotional experiences, attunement, and being known. Psychoanalytic psychotherapy is a robust and potentially valuable option for individuals willing to undertake a more intensive therapy whose benefits extend beyond symptomatic relief. [ABSTRACT FROM AUTHOR]