Dr. Sandi, Sarajevo www.drsandic.com.

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The following text is a translated excerpt of a case study of psychoanalytic psychotherapy performed with a panic disorder with Ivan B. It is originally published as a chapter in a book How To Help Yourself And Your Child by M. Sandi i A. Sandi. Thus copyright belongs to the authors. If data concerning the original publication are needed, such in a case of intended citation or any other, you may send an inquiry e-mail to: ordinacijasandic@gmail.com

Ivan B.

Sitting opposite me in the psychotherapy office is a man of about thirty, of medium height, and respectably dressed. He is an electrical engineer, but he is not working in that profession. He works as a shopkeeper, with his own store, buying and selling drinks. He is unmarried, and lives with his parents in a two-roomed flat.

Ivan B. sits huddled in his chair, hunched up, his hands trembling. He gives the impression of being tied in a knot of fear and insecurity. He is preoccupied with himself and his body, occasionally glancing at the psychotherapist. He tries to ease his anxiety, the unease that grips him, cracking his fingers and crossing and re-crossing his legs. He breathes deeply in his attempt to get enough air into his lungs. At the same time, he is trying to weigh up the psychotherapist, this woman sitting opposite him. He hopes, although he has been gnawed by doubt for a long time, that she will finally understand him and maybe even cure him. Ivan B. is silent, squirming on his chair, listening attentively, and then suddenly begins to speak, prompted by his own agitation:

My heart is pounding. Im afraid. I feel dizzy. I feel as though I might pass out any minute. Ive seen every doctor in Banja Luka about these problems. Ive had countless blood tests, urine tests, ECGs. Every time they tell me that the results are fine, that Im in good health. I cant even count the number of doctors whove given me check-ups. They all say Im in good health. Healthy. Healthy? he repeats, in tones of resignation and disbelief. They say all the results are fine, but I feel worse every day. I cant remember when I last felt well. Two weeks ago an internist gave me a thorough check-up, and after a long talk with me he convinced me that my problems were psychological. He referred me to you.

He fell silent for a while, musing, then continued. How can I describe to you everything that happens to me so you will understand me? The question was uttered in a tone and accompanied by a facial grimace that reflected doubt that he would meet with understanding on the part of the psychotherapist. But at the same time his open expression and the gleam in his eyes betrayed a trace of the hope that had brought him here.

We have plenty of time, I said encouragingly. Tell me, feel free to tell me whats bothering you. Im sick, but I dont know what with, he replied immediately. Even as we speak, my ears are buzzing, my hands are shaking, Im pouring with sweat. My heart is pounding so hard it feels as though it will jump right out of my chest. The first time I felt like this it was right out 1

Dr. Sandi, Sarajevo www.drsandic.com.ba/en of the blue. It was four months ago. All of a sudden everything went black. I felt anxious, and a kind of trembling in my belly. A sense of fear came over me. The fear and trembling spread from my belly to the whole of my body. I grabbed the back of the chair and clung to it hard, with all my strength. If I hadnt, Im sure I would have passed out. Ever since then Im afraid I might pass out in the street, in a caf, anywhere. Sometimes Im seized with panic. When that happens I shake and Im afraid Ill go mad.

Ivan B. fell silent. Head bowed, body hunched up, he waited for the psychotherapist to say something. Can you tell me what situations you are usually in when this happens to you? I asked. What situations? When? I feel the same problems in the street, in my shop, everywhere. At times panic takes hold of me while Im doing deals with business partners, so I quickly go home and lie town. Sometimes I feel like Im passing out while Im at the wheel of the car. When that happens I have to pull off the road, stop, take a bensedin and wait half an hour until it starts to take effect. I feel safest at home. I get home tired from the day, and thank God, there at least I find some relief. I tell myself: There, youve got through another day. Youve forced yourself through it in fear and anxiety, and nothings happened to you. But how can I live if I only feel safe between four walls? Im only thirty years old! I want to work. I want to go out with friends. My father is retired, but his life has more meaning than mine. Hes in good health. The moment hes drunk his morning coffee with my mother, he goes off to the caf. And my mother too, despite all shes lived through, poor thing, she goes to the hairdresser, believe me. She goes to her neighbours for coffee, and shes not afraid. She often dresses up and goes out for a walk in town, with a friend or even alone. Im the only one of the three of us whos sick. I feel best when Im looking after the house. Its as if Ive become accustomed to living in fear, he lamented, bemoaning his own fate and at the same time displaying envy and jealousy, and even a hint of fierce anger against his parents. Tell me, where were you the first time you felt as though you might pass out, or that you might go mad? I asked him.

Nowhere special, he said waspishly. I was in the caf. I drop in there during the day. On that occasion a friend of mine and I had gone for coffee, he continued, controlling his sarcasm. Other doctors have asked me that too. I didnt have any kind of shock. On the contrary, I was feeling good. I was sitting in a caf with my best friend. Weve been friends since early childhood. I was in a really good mood. We were reminiscing over our childhood pranks and having a good laugh. Then all of a sudden, right out of the blue, I felt terrible. I began to shake, to choke. I was gripped by fear. I was afraid Id go mad or pass out. That same evening I ended up in Emergency.

Try to remember what you were talking about, I urged him. I used a tone of voice in which he could recognize both friendly good intentions and interest in everything that had been happening to him.

Dr. Sandi, Sarajevo www.drsandic.com.ba/en Ivan B. settled himself more comfortably in his chair. He smiled, took out a cigarette and asked me:

May I? Can one smoke here? It would be easier if I could have a cigarette. We dont smoke while were talking. Smoking distracts the attention, reduces tension, I explained. In the psychotherapeutic process we need total concentration. Its a written rule that neither the psychotherapist nor the patient may smoke during the session.

Maintaining his composure, he put the cigarette back in his pocket and continued: My best friend, Milorad, the one I was in the caf with that day, lives in Switzerland. When it happened it was the first time since hed gone abroad that hed come to Banja Luka to visit his parents and friends. Until he went to Switzerland we were inseparable. We grew up in the same street, in next-door houses. Weve always been friends. We played together when we were still little kids, in his yard. We were the same age, we went to school together. We even went to university together. I dont have any brothers. I have an older sister, who married fifteen years ago and went to live in Germany. I love Milorad like a brother. Until he left, we shared everything: our successes, our good moments and our bad ones. We trusted one another. If I ever had a problem, and there were plenty, Id ask his advice. Ever since I can remember my fathers been short-tempered and unapproachable. He drinks! He likes a glass or too; he never leaves the caf. I remember there were times, when I was a child, when my father used to come home in the evening dead drunk. He could drink a lot them. Its different now. Hes getting older. After hes had two or three glasses, hes dead drunk. He staggers back home. Hes old and he doesnt have the strength for scandals any more. He sneaks in quietly, gets past me and mother, and goes straight to bed. He makes me sick. He used to lord it over us, too. He ruined my childhood. He ruined my youth, too. I remember him, while I was still in pre-school, hed come home drunk and in a fury. Hed be yelling as he came in through the door. Hed latch on to some little thing that bothered him right then, or hed think up something nonexistent, simply to find an excuse to yell. My mother would go up to him all submissive, and help him, drunk as he was, to take his coat and shoes off. And while she was taking care of him hed be thrashing about with his arms and legs, hitting out and kicking. I hated him them. It was because of him I was shy of the neighbours and the kids in the neighbourhood. His shouting would echo around the house and you could even hear it outside. He became suddenly thoughtful, paused for a while, and then continued his story. As a child I felt sorry for my mother. I used to try to persuade her to divorce my father. Shed say it was impossible. She was a housewife. She hadnt even gone to secondary school. My father worked he was the breadwinner. Mothers family lived in the country. If she divorced my father, she wouldnt be able to live in town. Shed have had to go back to the village, with me and my sister. And how would my sister and I get an education, if we did that? So our family life went on in the same old way until I was sixteen. Then I stopped my father in his tracks. I remember it to this day. I was waiting for him at the door as he returned, drunk as usual. I grabbed him by the coat. Look! My hands are clenching! said Ivan B., gripped by fear and showing me his fists.

After a brief silence I noted:

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You began with your conversation with friend whod come from Switzerland. Yes, said Ivan B., with a confused expression on his face, recalling the subject we had begun with. After a moment he went on with the story about his friend. It was my idea that we should go and live abroad. Although Milorad was hesitant at first, he agreed. But when he finished high school he didnt know whether to study Law or Economics. What do you mean, Law or Economics! I said, surprised he should think like that. You can only work in Yugoslavia with a law or economics degree, I said. Lets enrol at the Faculty of Electrical Engineering. You can be an engineer anywhere, in Germany, in America, and here too, I persuaded him. So Milorad and I enrolled in the Faculty of Electrical Engineering. We both graduated in the same year. After graduating and doing our military service, we planned to go abroad. Where would you rather live? I used to ask him. His idea was that we should go to Slovenia. Hed explain that Slovenia wasnt far away, and that one could live well there. Whats this about Slovenia? Id jeer, in a kind of brotherly way. If were going abroad, lets go to Switzerland. Engineers earn a good living there. Weve only one life! Lets make the most of it! When weve earned good money we can come back to Yugoslavia. So, thanks to me, Milorad found jobs for both of us in Switzerland through an aunt of his. We got all the papers we needed to leave the country. Oh, I was so full of enthusiasm. . . but I didnt get to go anywhere! Milorad left, and I even spent the entire war here. I spent all four years on the battlefield. Its better I dont talk about that. But when I came back from the front as a veteran and needed a job, I couldnt find one. An engineer here, hmmm. . . and he fell silent. After a brief pause he continued: Im mortified, and yet at the same time happy, that Ive got my own shop. Im just an ordinary shopkeeper. Look, Ive got a degree, but there are no jobs for it. And even if there were, how much would I be earning? I wouldnt even be able to maintain myself on it, let alone help my parents out. At least Ive no financial problems like this, being a shopkeeper. Milorad went back to Switzerland. The man knows what he wants. Hes an engineer, and he works where people admire that. But as for me, I spent all day from crack of dawn buying provisions for the shop. I might as well not be an engineer. Five years study! Milorad again invited me to go there so we could work together. Well, this time I wouldnt hesitate for a second. Id go with him, but how can I, when Im sick? As though youre envious of your friend? I said, to induce him to face up to himself. Yes, I envy him. But that doesnt mean I dont love him, he said, head down, in a low voice. Ivan B. accepted his own weakness.

Of course you love him. But tell me, is there anyone else you love and hate at the same time? Yes, there are plenty of people I love and hate. My feelings for them vary depending on whats going on between us at any given time. I dont think thats anything unusual. Surely you must have similar feelings, he said, looking at me in expectation that I would agree with him. After a brief pause he continued in an angry tone of voice.

Dr. Sandi, Sarajevo www.drsandic.com.ba/en My father! My father! And why wouldnt I? When hes sober hes a completely different man, and I get taken in. I think then that this time hell keep his word and stop drinking. But the very next day hes back to his old ways, drinking and drinking.

And what about your mother? And yourself? Perhaps well talk about that at our next session? I said, preparing him for our working together to cure him with analytically-oriented psychotherapy. At the end of the session, with this message formulated as a question, I cautiously drew his attention to the crux of his mental illness, which had arisen from the unresolved relationships with his parents and himself, and which manifested itself in all those physical symptoms, and in the fear that he could pass out or go mad at any moment.

During the next three sessions, Ivan B., lamenting the way he was living, and actuated by the subquestions I put to him, told me his life story (the term is in quote marks to draw the readers attention to the fact that all of us experience our present and our past subjectively. As a result, we form our own subjective judgment of everything that happens to us and of our interpersonal relations. Quite often this openly clashes with real events. But it is this very subjectivity that must be respected in the psychotherapeutic process. It discloses the patients experience of reality, of the conditions in which he has been living. At the same time, it is only thus that the psychotherapist is able to know the patient as an actor creating his own life, although he personally experiences himself as its passive victim, as though he is the victim of circumstances imposed on him by others.)

Ivan B. grew up as the second child of the family, with a sister twelve years older than himself. He remembers her as a stubborn child, and later girl, persistent and able to turn her ideas into reality. Ivan B. recalls how, although she was allowed to stay out in the evenings until ten oclock and no later, she would stay in town with friends or boys as late as midnight. Then, said Ivan with mingled sympathy and envy, shed sneak back into the house, although she knew mother was waiting for her. Mother would scold her every time. Sometimes shed even threaten to tell father about these outings of hers. Sometimes, too, shed punish her by not giving her any dinner. But it was all like water off a ducks back. My sister always did just what she wanted. Jovanka is still living exactly the way that suits her. Ive stayed with her in Germany. She bosses her husband and children around and, believe me, they all obey her, Ivan B. said, lamenting his own nature, jealous of his sisters independence. When speaking to me about himself, his usual tone and timbre of voice was as if he was thinking out loud.

With me, its another story. I was afraid of my father, and I was an obedient child. I always felt anxious when I saw him drunk. I hated him when he beat up my mother. I wondered then, and I still do now, why she put up with it all. Why did she go on living with him? Mother still cries because of him. Shed cry when he was beating her too, when I was little. I felt sorry for her. But I always obeyed her, for that reason. I helped her as much as I could. I guess she deserved to have someone ease the burden for her a bit. And she really did have a huge

Dr. Sandi, Sarajevo www.drsandic.com.ba/en burden to shoulder. She always looked after the house alone. She worked all day. She still does. She took care of my father, my sister, and me. Everything was always clean, even though shed have a migraine for a couple of days every month. Lunch was always on the table at the right time, and all three of us would be clean, with freshly ironed clothes. There was a tacit understanding that she had to do all this. Instead of being grateful to her, father would beat her up, go for her. As for my sister, she lived in that house as though everything was perfectly in order. Even now Jovanka wont share with me in looking after our parents. True, she does send a bit of money now and then. Ive tried to persuade her to set aside a specific sum of money and send it to them every month. I could behave differently with them too, then. Wouldnt that be fair of her? But Jovanka wont have anything to do with commitments. She made it perfectly plain to me that shed send them the amount she wanted when she wanted. She made it clear to me, the way she knows how, that I wasnt to meddle in her life and her relationship with our parents, he said, falling sheepishly silent. I looked at him. His eyes, his body language, revealed feelings of impotence and disillusion, but also a hint of suppressed, controlled feelings of anger.

After a long pause he continued:

I remember children calling me to come and play. Mother was sitting in the kitchen and crying. How could I go out? I wanted to play with the other children. But how could I leave her alone, crying? I was often in two minds whether to go out and play with the other children or to stay at home with mother. And quite often Id stay with her. Id try to amuse her, to comfort her. I often thought up some event that hadnt happened. I liked to see her smiling. Even now, at thirty, Ivan B. lives in a close relationship with his parents. For all that, he decided not to be part of their daily discords any more, and rented a flat. But as he himself says: The flat is close by, so as soon as I wake up I go over to their place for coffee. We have breakfast together. Then I go to work and work until late in the evening. After work I drop in on my mother. We have dinner, we relax a bit, and then I go home. When I find my father drunk, which isnt that unusual, I get in a state. I say all sorts of things to him. I threaten not to give him any more money. The two of them cant live off his pension, and he knows it perfectly well. I threaten him, although I know I couldnt do it. But Id really like to punish him like that. Sometimes he makes me so angry that I wouldnt even give him a single mark for bread, let alone drink. But what would happen to mother then? She shouldnt have to go hungry because of fathers drinking.

Do you have a girlfriend? I asked him, trying to ascertain the level of maturity of his detachment from his parents.

No, I dont. You know what girls are like today! he replied, trying to go along with his own views. They want to be driven around in a good car, spend time in cafs. And they dont even offer love or understanding in return. Feelings like that dont seem to exist any more, he said, accompanying his assertion with a tone of voice and a look on his face that expressed his resolve not to permit himself any over-intimate contacts. I have a good car and money for going to the caf. I wont pay for love. I dont have any trouble finding a piece of skirt to take

Dr. Sandi, Sarajevo www.drsandic.com.ba/en to bed. I cope. I go out with someone for a week, a month at most, and then I find some excuse to break it off. I feel most comfortable with one night stands. My mother cooks, washes, irons and keeps my flat clean. Why should I make extra problems for her with a permanent relationship?

_________________________ After gaining an insight not only into the symptoms shown by Ivan B. in certain circumstances (sometimes they are prompted by external events, and sometimes by his thoughts, but its not unusual for them to come out of the blue, as he puts it. However, the psychotherapist knows that this phenomenon of symptoms appearing out of the blue is prompted by a sudden irruption of unprocessed contents activated by the patients fantasies originating in his unconscious. They find expression by taking hold of his conscious mind and his body, leaving him dysfunctional in his everyday life), but also into the dynamic of his major relationships, I began to reflect on the following parameters:

The symptoms first appeared when he was with a friend whom Ivan B. had experienced as a person of average abilities, similar to himself. This was the first time he had seen his friend for a long time, and now he sees him as a very successful person. Comparing himself to his friend, his inferiority complex was set in motion. The two of them had grown up together, studied, daydreamed and made plans for the future. Back them, Ivan B. seemed markedly more successful than his friend, not only in evaluating reality, but in facing the future. It was he who kept his friend with him, by deciding what they would read together at university, electrical engineering. This enabled both of them to go out into the world with a sense of security, to do the jobs they were qualified to do, and not to work as gastarbeiters. The patient graduated without difficulty. He even felt proud and happy to be the first in his entire family to have a university degree. He and his best friend, Milorad, procured the documents they needed to go to Switzerland. But when the time came to leave and begin their new lives, he pulled out. His explanation was that he wanted to help his parents, especially his mother. He thought that once he had made sure they were provided for, he too would go and live in Switzerland. But many years had elapsed, and he had achieved none of his former plans. In giving up going to Switzerland, he chose to live in surroundings where everything was familiar and certain. Ivan B. was afraid of encountering an unfamiliar way of life. At the same time, he had not yet reached the maturity of an adult, able to live independently. He did not have enough strength or courage to start from the beginning. He had himself said this during our conversations. So the fear of the unknown, given that he was aware of it, was not the result of his illness. Rather, to a great extent he revealed his attitude to life, and his inability, despite having sufficient intellectual capacity, to make his wishes come true.

________________________ Why is Ivan B. sick?

Ivan B. has not attained the level of maturity of the average person of his age. As a result, his relationship with his parents and friends, as well as his attitude to himself, is immature,

Dr. Sandi, Sarajevo www.drsandic.com.ba/en morbid, and more often contradictory than is characteristic of a healthy population. His perpetual inner vacillations in his attitude to his surroundings and to himself arose from his fear that if he were to stand up to someone and achieve his aims, aims that do not fit in with that person, he will lose his or her love or affection, have prevented him from forming appropriate relationships with his surroundings and from achieving spiritual equilibrium. He too, like all of us, lives and communicates with others with both the healthy and the unhealthy facets of his personality.

Meeting Milorad, his childhood friend, though he did not know it Ivan B. was encountering himself, partly at a conscious level but largely at the unconscious level. In that contact with Milorad, he was evaluating his own personality at some profound level of his own soul. The inner drama (the conflict between the healthy and the unhealthy facets of the personality) resolved itself in an unhealthy way. Ivan B. would remain passive, like all neurotics, every time he was unhappy or dissatisfied. Verbally, in conversation with others and angry with them, he would expect them (his parents, his friends) to change their attitude to him. He would demand that they behaved properly towards him, and often demand that they protect him, without rectifying his own behaviour at all. But his unconscious, and part of the healthy facet of his personality, were angry with that passive facet. They demanded that Ivan B. change himself. This inner discord, which troubled him through the symptoms he experienced, drove him to find other solutions in his relationships with others. His personality had not attained a healthy spiritual equilibrium. He could only attain it by changing, by creating his own life in a new, more mature way. Ivan B. conceived of the world much as a pre-school child does.

What is the evidence for these assertions?

Even as an adult in years, Ivan B. is stuck in his relationship with his parents. This is clearly visible in his relationship with his father as well as with his mother. Unable to mature, and seeing both his father and his mother as personalities existing for themselves as they were out of their own needs, he continues as an adult to reproach them with many things as a child would. Ivan B., like all neurotics, expects them to change once and for all. He thought that if they did so, he too would find a better way of life for himself. (I have selected the word stuck to express the quality of Ivans relationship with each parent individually, a relationship full of feelings simultaneously of love and hatred.) He relates to his friends, and to himself, in the same way as he communicates emotionally with his parents. o Ivan B. consciously has feelings of intolerance, contempt and anger towards his father. He equates him with the person his mother presents him as, and experiences him as a aggressive beast. But he also remembers another facet of his fathers personality, which he recalls from his early childhood. At that time his father used to take him to the park to play with the other children. He would proudly show him off, as a small child, to his friends. Later his father used to boast about his successes at school. Ivan also came to know that his father was proud of his university successes. Ivan B. spoke of this father in tones of warmth. He loved that facet of his father. In appreciating this facet of his good father, Ivan B. unconsciously learned to appreciate himself. (I use the term learned to draw the readers attention to the fact that children unconsciously adopt their parents attitudes to good and evil, to their own worth or

Dr. Sandi, Sarajevo www.drsandic.com.ba/en deficiencies. As they develop, in their contacts with their parents children unconsciously accept their views, which later become part of the way they evaluate themselves as well as others.) In Ivans early childhood, then, as well as later when he was concerned with his son from time to time, his father would put himself between the child and his mother. Sometimes he would make it easier for him to go out, to detach himself and to mature. At other times, it was his fathers behaviour that caused Ivan B. to stay at home, and he was more closely tied to his mothers apron strings than he should have been for his age. At those times, as now, the father would be a supplementary figure of the absent and inattentive husband. Out of this good relationship with his father, Ivan B. found the strength to stand up for and achieve part of his own ambitions. But as a result of the bad relationship with him, he was inclined to submit to the will of others and renounce the satisfaction of his own needs. o Ivan B. had a complex relationship with his mother. He experienced her as a victim, as a martyr. Feeling sorry for her, Ivan B. was weighed down by her unhappiness and by her monotonous, difficult life. His mother would cry over him every day, thus displaying her helplessness. In a profound, unconscious facet of his personality, Ivan B. despised his mother for her weakness, and did not respect her. Because she constantly exploited him (from his earliest childhood she has burdened him with her relationship with his father, as she still does to this day), he lived with a suppressed feeling of anger towards her.

His relationship with his mother is also filled with feelings of love. She welcomes him with pleasure, and sees him off when he leaves for work. She takes care of him and his flat. Ivan B. likes to visit her and spend time with her. His mother humours him by cooking him dishes he particularly likes. Ivan B. spoke with a smile of the hot doughnuts and the clotted cream his mother would buy specially for him. He liked to speak about the house, that smelled of food, a smell he connected with his mother. His mother respected his nature. He is taciturn and grumpy in the mornings, so she gives him his breakfast, and then coffee, in silence. It is only over coffee that they would begin talking. His mother is the only person who takes care of him. In the morning she asks him if he has slept well, and whether his sheets were warm and clean. She is interested in what he has done during the day. She listens attentively to his accounts of his business deals, his meetings with his friends, his clashes with rival colleagues. Thus every day begins with this morning chat with his mother. After that he would go to work. But when he came back home in the evenings, no sooner did he come through the door than he would see that she was not in a good mood. He remembers her in this way from his earliest childhood. He sees her cleaning, washing, cooking and tidying the house. Tired of being ill-treated by his father, she took no pleasure in his excellent marks at school or his success at university. In the deeper layers of his own personality, Ivan B. still reproaches her for this.

It is as a result of this relationship with his mother that Ivan B. is, like her, passive, inert, inclined to lead a monotonous life. So as to maintain a non-conflictual relationship with the people around him, he almost invariably adapts to others. Knowing his background, it is not hard to see that these features of his personality have been formed by equating himself with his mother.

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o With himself, Ivan B. has succeeded in standing up for his own desires to the extent that his father stood up for him. He graduated from university and has achieved a decent level of financial independence. Like his father, he is properly and adequately functional in the workplace. But unlike his father, he feels a sense of repugnance for alcohol. Ivan B. has very complex relationships with his friends. Feeling he lacks the strength to tell them what he is thinking or feeling about one or other of them at any given time, he often feels threatened. He is afraid to put his own views, and in many situations he feels inferior. From time to time he becomes angry both with his friends and with himself. Sometimes he tells them so out loud, but he is in no condition to change anything in his attitude either towards himself or towards them. Like his mother, he spends his leisure time at home. In that private space, Ivan B. relaxes after a hard day. He feels secure, protected there. Since he has always protected his mother, in the unconscious facet of his own personality Ivan fosters the hope that she will one day find the strength to protect him.

Because Ivan B. is stuck in his relationship with his parents, he is incapable of detaching himself from them and living independently, as would be appropriate for his age. Dissatisfied with himself, he lives out of inertia, not recognizing that for the most part the outcome of his lifestyle is to satisfy his parents wishes. He spends the mornings and evenings with them, and is the ever-present third member filling the vacuum in their communication. By being present in this way, he is both a mediator and, at times, an active participant in their quarrels, to some extent alleviating the endless current of conflict between his parents.

Ivan B. freely satisfies his sexual instincts. This is a desire that he in fact satisfies solely at the instinctual level. His relationships with girls have always lasted a night, a week, a month at most. It is no accident that he chooses partners who lack the very qualities he values. As a result, he forms no emotional bond with them. So far not a single girl has attracted him enough to want to get to know her. This defective attitude towards girls is prompted by his excessive spiritual bond with his mother. At the unconscious level, Ivan B. has such a defensive attitude to any serious relationship with a girl that he belittles every girl he goes out with. He is afraid of becoming more intimate with any woman, of establishing emotional contact with her.

Why?

Ivan B. hopes that some woman will be able to understand and love him, but the price that would have to be paid for this is too high. He is afraid that a woman with the kind of attributes his mother has could trap him. Ivan B. expresses his fear of marriage. He is afraid that his marriage might resemble that of his parents.

Unable to understand what motivates either his fathers or his mothers behaviour towards him, and then to adopt an appropriate stance, the patient has only one choice: to get away

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Dr. Sandi, Sarajevo www.drsandic.com.ba/en from the family, as his sister did, or to adjust to it, at the expense of losing much of his own independence. For the most part, Ivan B. submits to his parents demands. Ever since his childhood he has hoped that by his helping them, his father would stop drinking and that his mother would finally be happy. In the family relationship, he has taken the role of his fathers complementary figure. Deep in his unconscious Ivan B. hates his mother, hates her daily manipulations, the tentacles with which she clasps him tight in a net, the unhealthily confined relationship with her.

His fear of passing out or going mad is his fear of losing self-control. If he were to lose control, Ivan B. is unconsciously afraid he might vent the years of accumulated aggression in a socially unacceptable way. This aggressive impulse, repressed to the unconscious level of his soul, and primarily linked only to the parent figure, is now evoked by every situation that has threatened him. Sometimes he has really been threatened in the outside world, and at times that sense of threat, out of the blue as he puts it, has erupted from his own inner self in a way that he does not recognize.

The psychotherapeutic process aims to assist Ivan B. gradually to confront his own suppressed defensive aggression. During treatment, he needs help to find new ways to release his so-called benign (defensive) aggression. This means that in recognizing their presence in his symptoms, Ivan B. will liberate himself of part of his suppressed instinctive power. He will then be able to react appropriately to situations and relationships that threaten him. Gradually, from within himself, Ivan B. will find a way of changing his behaviour towards others while at the same time compelling them to change their attitudes to him. As his selfconfidence and self-respect grow, so too will his feeling of independence and autonomy. I drew Ivan B.s attention to the fact that he must be an active partner in the healing process. My expectations of the therapy were as follows:

o that Ivan B. would free himself of his immature dependence on his parents

o that he would develop a more healthy relationship with his friends, meaning that he would be able to form sound judgments on what to give to whom and when, and what to withhold from whom and when

o that he would achieve reciprocity in his relationships with others, as his healthy personality demands o that he would build more coherent relationships with girls

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Dr. Sandi, Sarajevo www.drsandic.com.ba/en The psychotherapeutic process took place by conducting analytically-oriented psychotherapy. The sessions took place once a week and lasted from 45 to 50 minutes each. At each session, as he talked with me as his psychotherapist, Ivan B. faced up to his childish, immature behaviour. We talked about what had happened to him between sessions in his relationships with his friends, colleagues, parents, girlfriend. Gradually, Ivan B. came face to face with himself, and quite often came to acknowledge his own weakness in that goodness of his. He used to give in to others, afraid that if he embarked on an open clash of views he might lose a friend. It had been impossible from his earliest childhood for Ivan B. to get his own way consciously, and even more often unconsciously, by standing up for himself. This disorder in his character make-up was shaped in his relationship with his parents. He was thus afraid that if he were to contradict them or do what he wanted he might lose the affection of the people he was emotionally dependent on. As we worked together, he realized that his friends, and even his parents, did not acknowledge him as what he really was. Instead, currying favour with them in various ways, he offered them the kind of image of himself that they wanted. This gave rise to his feelings of impotence, isolation, dissatisfaction and illness, as the expression of his alienation from the healthy facet of his own personality. During the psychotherapeutic process, Ivan B. drew ever closer to himself, to the Ivan he wanted to be. He also came to reward or hold back from his father and mother, as well as his friends, largely according to his own judgment. He noticed that they too had altered their attitude towards him. They respected him more and were more sincere in their liking or love for him. The symptoms that had been the reason for his coming to psychotherapy began to diminish and slowly disappeared.

During the first third of our time working together, on his own initiative Ivan B. bought himself a little dog. He played with it, took it for walks, fed it. Towards the end of the psychotherapeutic process he dreamed the following dream:

Im in the bathroom with the dog. Ive given him a bath and am drying him with the hairdryer. I then take the scissors to cut his claws. All at once I wake up, drenched in sweat. My heart was pounding really hard. I was afraid I would choke. The whole day I felt rotten, although Id been fine for the last two weeks.

How is your dog? I asked him.

My dog? he asked, surprised, with a smile. Oh, hes my pet. He sits on my lap like a cat. He barks when someone came. He makes a noise, but he doesnt bite. Hes absolutely harmless. Perhaps it would be better for him not to bark at nothing? I asked him indifferently. Ivan B. smiled and went on:

He barks the way I bark. I bark and bark, merely threatened to keep my father short of money. I know I have to do so. The man does nothing but drink! But how am I to do so? My

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Dr. Sandi, Sarajevo www.drsandic.com.ba/en mother wouldnt have any money even for the basics, he said, falling into a reverie. Was it while you were cutting your dogs claws that you felt that sense of constriction? What? Should I have pulled his teeth out? he said, his mind boggling at his own words. Well, yes. If he was a real dog itd be a tooth. My poodle is as gentle as a cat, and if Id cut his claws hed have no means of defence. Sometimes it seems to me my dog and I are very like each other. I wanted to cut his claws, but I was flooded with fear. Claws are what animals use to defend themselves.

To defend themselves, or to attack? I asked, testing out the degree of aggression that had taken hold of him.

To defend themselves, said Ivan B. Im perpetually trying to find ways to defend myself against my father, to find my own standard in my relationship with him. How can I defend myself when I probably cut my own claws a long time ago, just as I was doing with my poodle in my dream?

After a long silence Ivan B. suddenly struck his forehead, recalling something. But its simple! Ill sort him out, sort out his drinking! I know what Ill do. I wont give my parents money any more. Ill buy them food, and Ill buy a few other little things for my mother as well. That way, once Ive stopped giving them money almost every day, hell only have a few marks over for the odd beer. Therell be no more getting drunk! he said, clapping his hands together with delight.

During the next three sessions we dealt with his fears of soon being parted from me as his psychotherapist. Ivan B. had already taken several independent steps in life. He even had a girlfriend, whom he loved. He had been going out with her for five months, and they were now living together. He visited his parents from time to time, and took care of them as his mature personality demanded.

The following text is a translated excerpt of a case study of psychoanalytic psychotherapy performed with a panic disorder with Ivan B. It is originally published as a chapter in a book How To Help Yourself And Your Child by M. Sandi i A. Sandi. Thus copyright belongs to the authors. If data concerning the original publication are needed, such in a case of intended citation or any other, you may send an inquiry e-mail to ordinacijasandic@gmail.com or visit the official web page of Dr. Sandi provided in the header of this document.

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