Nr 22  2010 sid. 29–46

THE STRANGER IN YOU – THE STRANGER IN ME
THE GROUP ANALYTIC APPROACH
TO SOCIAL PHOBIA

Rudolf Balmer

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Rudolf Balmer, Basel, Switzerland, Psychiatrist and Psychoanalytic Psychotherapist at the University of Basel and the Psychoanalytic Seminar of Basel, graduation as Group Analyst at the Seminar of Group Analysis Zurich (SGAZ). He is Teaching Group Analyst of SGAZ and of DAGG/Germany and Teaching Group Analyst of the Group Analytic Seminar GRAS/Bonn. He works in private practice in Basel with main scopes in psychotherapy, social psychiatry and group analysis (therapeutic groups and team supervision). He is member of working parties of the organisation of psychiatric health care in the area of Basel and of the EFPP Executive Committee (1987-2005). This paper was presented at the EFPP group-conference in Prague, 2009.

Introduction

Social phobia is a disorder which is due to certain individual and social conditions. In my paper I would like to illustrate both as-pects of this, without treating either aspect systematically. After-wards I would like to discuss the therapy and group analysis. As in psychoanalysis, it is not customary in group analytic psycho-therapy for us to concentrate on disorder-specific treatments. We focus on the psychodynamic aspect. For some years, however, we have been confronted with the trend towards disorder-specific forms of treatment. We are required to see and show our work from this angle.

Diagnosis of social phobia

Since Freud differentiated anxiety neuroses from anxiety hysterias, a change has taken place in the classification of anxiety disorders. A new classification was introduced in the context of the rearrangements of DSM-III and ICD-10 in 1980. Freud was already guided by symptoms in his diagnosis but nevertheless gave his dynamic considerations pride of place. The more recent classifications, however, have a different structure. They are based on an analysis of symptom-orientated factors which have been obtained in detailed interviews of patients. (See the synoptic tables: classification of anxiety disorders – table 1 – and diagnos-tic criteria according to the ICD – table 2).

Table 1: Classification of anxiety disorders according to Hoffmann (2008)

Non-directed anxieties
  Panic disorder
    - Subtype: cardiac anxiety disorder
  Generalized anxiety disorder

Directed anxieties
  Phobias Agoraphobia, Social phobias, Specific phobias
  Hypochondria
  Environmental phobias

Table 2: Diagnostic criteria of social phobia (ICD 10 F40.1)

1. Anxiety of being in the centre of attention or showing embarras- sing or humiliating behaviour – or avoidance of such situations

2. Minimal two symptoms: blushing or trembling, fear of vomiting, urge to defecate or urinate

3. Clear emotional burden of symptoms and realization that they are exaggerated and irrational

4. Symptoms are restricted to feared situation or thoughts of the situation

5. Exclusion of schizophrenia, affective disorders, compulsive disorders, organic psychic disorders

The diagnosis centres on the fear of making oneself look foolish and exposing oneself to ridicule or humiliation in public. Social phobia is a chronic and incapacitating fear of social interactions in which patients are afraid of being judged unfavourably by others (Hoffmann 2003).

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2011-10-29

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