Anxiety Clinic Frees Physician from Decades of Anxiety in Eight Sessions — A Therapy Report

This should come as no surprise, for the physician who reports here on his ten-year ordeal within the healthcare system freely acknowledges:

"My medical socialization, too, had driven me into dependency rather than equipping me for life, as I came to realize."

For this reason, one can hardly expect physicians and psychotherapists who are themselves prisoners of medical socialization and of a dysfunctional healthcare system to show patients a way out of the prison of anxiety or depression.

The study of medicine molds physicians, psychiatrists, and medical psychotherapists less into independent thinkers than into academic slaves of the medical-industrial complex and the pharmaceutical industry, whose products they have been trained to sell.

Thus, physicians themselves frequently become victims of a sick system, unaware that anxiety disorders, panic attacks, generalized anxiety disorder, social phobias, and specific phobias can be permanently overcome through cognitive psychotherapy in as few as 8 to 14 sessions in total³ — without psychopharmaceuticals.

In an interview with the Süddeutsche Zeitung, Peter Gøtzsche, Professor of Research Design and Research Analysis at the University of Copenhagen and a specialist in internal medicine, stated:

"I estimate that we could eliminate 95 percent of spending on pharmaceuticals without patients suffering any harm. In fact, more people would be able to lead longer and happier lives."

Peter C. Gøtzsche "The Pharmaceutical Industry Is Worse Than the Mafia" Süddeutsche Zeitung. Feb. 6, 2015.⁴

In the therapy report that follows, a German physician describes with unusual candor and honesty how the dysfunctional healthcare system victimized him for over a decade, until he found his way to the Stuttgart Anxiety Clinic with his anxiety disorder in February 2002 — the clinic I was running as a psychotherapist at the time.

The cognitive psychotherapy this physician received from me enabled him, "after eight therapy sessions," to resolve his problems swiftly and with lasting success on his own — and to arrive at what he calls "an absolutely life worth living."

Cognitive psychotherapy gave this physician the knowledge and the tools to extricate himself from the psychodynamic and psychoanalytic morass of the therapy market and to heal himself.

The text was written by the physician nearly one year after his psychotherapy, with the explicit aim of "giving as many people suffering psychologically as possible the courage to seek the right psychotherapy." To protect the identity of the physician, who today runs a successful specialist practice of his own, the pseudonym Norbert Nordes was assigned to him when the text was first published in the journal Psychotherapie on March 11, 2003.

Chronicle of a Misdiagnosis — A Physician's Experience with Psychotherapists and Psychotherapy

A physician's therapy report on himself

By Norbert Nordes
March 11, 2003

"Patient Physician," "the sick profession," "perverted doctors – a diseased medical profession" – if the titles of books and journal articles are to be believed, we physicians are a rather sickly lot, or at the very least, we are by no means an especially healthy population. And this applies as much to our physical health as to our psychological well-being. According to numerous reports in the literature, physicians commit suicide more frequently, are more often dependent on alcohol or prescription drugs than other people, and they suffer from the very same psychological disorders and problems whose treatment they studied in medical school. Moreover, they are particularly adept at denying their own need for help.

But what happens when a physician becomes acutely aware of this and, as a patient, turns to psychotherapists seeking psychotherapy? The likelihood is considerable that reality-detached psychotherapists and therapeutic schools that cannot withstand scientific scrutiny will turn him into a victim in his own right. I would like to recount my ten-year odyssey from psychodynamic therapy through Gestalt therapy to the liberating moment when I finally experienced cognitive behavioral therapy.

My first step toward recovery began with a visit to the website of the ABARIS Anxiety Clinic.¹ After reading its content, I was still saddened and angered by the valley of tears I had been forced to walk through before finding a competent form of psychotherapy. However, once I had also read the book by psychotherapy researcher Klaus Grawe and his colleagues, "Psychotherapy in Transition — From Confession to Profession," which Dietmar Luchmann had reviewed in 1994 in the journal Verhaltenstherapie & psychosoziale Praxis, I was no longer in the least surprised that it had taken me so long to find help at the ABARIS Institute¹ for Psychotherapy: I had simply experienced the perfectly ordinary incompetence of the German healthcare system.

In the fourth semester of medical school, in 1992, just before my first major examination — the Physikum, comparable to a preliminary degree and marking the completion of the preclinical phase — I was suffering from extreme exhaustion and depressive moods. What troubled me most was my tendency to become upset over every minor adversity in my life, whether it was a traffic jam, a late bus, a line at the checkout, or a dropped plate. In short, I was reacting to trivial everyday annoyances so disproportionately that I told myself, "This can't be normal!" In this feeling of "I'm not normal" and "this isn't how one behaves," I felt trapped and could see no way out. What does a person do who is still half medical layman, yet already partly educated? He thinks about seeing a psychiatrist! With the ulterior hope that "he'll hopefully confirm that I'm normal — or at least not too ill — and that I can be helped." And naturally with the anxiety lurking in the background: "I hope I'll pass the Physikum!"

No sooner said than done. I went to a psychiatrist and described my situation. Quite reasonably — from my present vantage point — he recommended behavioral therapy and referred me under the so-called "delegation procedure" to a psychologist who practiced hypnosis and behavioral therapy. This psychologist began with five sessions of hypnosis, which in themselves did me some good, but then declared — very much the classical behaviorist — that no treatable problem existed in my case. If I became upset about a line at the checkout, these were "everyday difficulties" that could not be treated. Modern cognitive behavioral therapy, however, appeared to be unknown to him; otherwise, my saga of suffering would probably have ended before it had properly begun.

On my general practitioner's recommendation, I then sought psychotherapeutic help from a female physician who shared his practice and whose sole qualification was the supplementary title "Psychotherapy." She described her approach as psychodynamic and initially saw no clear indication for treatment. Her standard phrase was: "We need to see!" After several "probationary sessions," she finally recommended a combination of talk therapy and Guided Affective Imagery. Nothing changed about my symptoms. When I raised this after the eighth session, her only response was: "Things aren't moving fast enough for you!" When I asked what I could do to feel better, she replied: "The point is not for me to tell you what to do, but for you to learn to sense: What is going on inside me?"

Her paramount concern at all times was to "see how you feel about it" — her most important and most frequently uttered sentence.

If I ventured to say, "I think we can wrap up this topic. Or do you still have a concern?", she would reply, with clockwork predictability: "This isn't about my concerns!" If I began a sentence with "Do you want to…?", I invariably heard: "The question is what you want!" In my desperation, I threatened to terminate the psychotherapy (she said that would be "fine with her") unless she finally disclosed at least her diagnosis. At this point she said something about a condition she called "primary narcissism" and declared that I had a narcissistic personality disorder.

It took me 18 months to end this not merely ineffective but positively harmful psychotherapy — to summon the strength to extricate myself from this pernicious relationship. The fact that in my medical school course on "Psychotherapy and Psychosomatic Medicine" I had been taught that narcissists are "profoundly disturbed individuals" incapable of normal "object relations" discouraged me ever more deeply. I considered my case hopeless; I could not imagine that my situation would ever improve. After all, I had been "damaged early on," which meant that the technique of psychoanalysis could not properly take hold because I was supposedly incapable of developing a genuine "transference relationship" with my psychotherapist! They could hardly have told me more eloquently, in so many words: "There is really no helping you!"

During the following three years, until 1996 — the year in which I nonetheless completed my studies successfully — I managed reasonably well without psychotherapeutic help, though depressive moods and the omnipresent anger continued to weigh on me heavily. I held on until my third and final state examination, then fell into a veritable abyss. I felt burned out and empty, unable to envision how I could ever meet the demands of my profession. I had no position yet either, and so I resolved to undertake another course of psychotherapy alongside finishing my doctoral dissertation. Given the severity of my symptoms, I believed at the time that this would be best accomplished in an inpatient setting — which would also be feasible during this enforced hiatus between completing my studies and starting work.

My choice ultimately fell on a private clinic in the Black Forest, primarily because of the absence of waiting lists and the short duration of treatment. After protracted wrangling with my statutory health insurance over coverage, I was finally able to begin inpatient treatment in the summer. My extraordinary stroke of luck was that a very personable, highly qualified clinical psychologist had started working at the clinic that very day and was assigned me as his first patient. I had sought admission because of excessive anger and agitation in everyday situations, and I found in him an ideal interlocutor. Within a matter of days, through his unconditional empathic acceptance and active listening, he brought me first to an emotional breakdown in tears, and then very rapidly to a sense of liberation and relief. I quickly came to understand the underlying patterns: how I had learned the agitation, how I had experienced my environment as omnipotent and myself as powerless, and how I had perpetually evaded my own feelings through suppression and repression. For the first time in years, I felt something other than fury and rage; I even began to experience myself as truly alive and as part of the world again.

Contrary to the predictions of the psychoanalysts in my medical training, who had forecast the gravest difficulties in group therapy for all "narcissists," I got along very well in the therapy group. Above all, it helped enormously to discover that other patients had quite similar difficulties dealing with criticism and emotional injury — even if these issues were not as prominent for all of them.

Under the influence of art therapy, movement therapy, body awareness work, and running, my rigid demands on myself gradually began to loosen. I started to recognize that vitality and the capacity for experience, along with the ability to empathize, mattered far more than the ability to be the best at everything or to do everything as perfectly as possible.

For the first time, I learned: A different way of experiencing and behaving is possible — not just for others, but for me as well. I have avenues of influence that I would never have thought possible. I can feel at ease and enjoy life — indeed, truly "experience" it in all its richness — without being perfect. Perfection as a goal steadily lost its appeal for me. I had also noticed that I could substantially influence my own experience and behavior through my thinking; all I still lacked were the targeted techniques I would later discover in cognitive behavioral therapy.

I was, in fact, sufficiently restored to endure the subsequent 18 months as a physician in practical training (the German "Arzt im Praktikum," or AiP) without needing psychotherapeutic help during that period. I had found a position at a university hospital in southern Germany and initially worked primarily in the laboratory.

The laboratory work was genuinely enjoyable; my only persistent sensation was the feeling that I had never done enough, even when I left the lab at 9:00 p.m. After six months, with nothing beyond an abstract to show for it and still no publication in sight, my supervisor took the occasion for a stern conversation: "the honeymoon is over," he said, and I would now need to start producing results. I did manage to secure two conference appearances in the United States for 1997, but a publication remained stubbornly elusive. As any chemist, physicist, or biologist can attest, it is simply in the nature of things that a new laboratory method does not work immediately, and that a period of one year is extremely short for establishing a new technique. Clinical duties in a specialized outpatient clinic alongside my research consumed additional time and gradually led to exhaustion — from which I was unable to truly recover even during my only real vacation: a single week following the conferences in the United States.

In the fall of 1997, I transitioned fully into clinical work and was assigned to the oncology ward. The crushing workload — 7:30 a.m. to 8:00 or 9:00 p.m. on many days — on-call duties, and the so-called "seniority principle," under which the most junior residents have the fewest rights, drove me to such extreme exhaustion that I found myself in alarming proximity to the dreaded burnout. It was then that a thought took root in me that would long become the leitmotif of my thinking whenever difficulties arose: "I can't go on!"

It horrified many who heard it; my parents had already interpreted it as a suicidal threat. At every turn, the words escaped me almost involuntarily: "I can't go on!"

First, I left my position at the university and returned home to my parents, both of whom were ill at the time and could well use my help. To do something for myself alongside, I once again sought out a psychotherapist — this time, once more a physician, a psychiatrist. When I raised the matter of my workload during my practical training year, he responded, quite reasonably: "That is less of a psychological problem than a very real, practical one!" We had conversations; with my consent, he also prescribed antidepressants, and I felt, as with every previous therapy, somewhat better at first. When I say "at first," I mean a temporary improvement during the course of treatment that did not endure. Here, too, what was missing was a clear direction: the correction of the cognitive errors that sustained the ongoing problem, and the imparting of new, better patterns of thought. Medication cannot accomplish this in any case, but even the conversations we held largely exhausted themselves in the supportive assurance that my problems were really not all that serious and that I could essentially be regarded as psychologically healthy. Very often, we drifted into collegial small talk about working conditions in hospitals and private practice, health insurance funds and medical associations, and the various idiosyncrasies of colleagues — conversation that bore only an indirect relation to my actual difficulties and did nothing to lift me permanently out of my depressive state.

A professional setback — a brief six-month position at a hospital with a particularly toxic workplace culture and severe bullying — plunged me into crisis and panic. Would I ever be equal to the demands of my profession? What if I could never find another position?

Deep despair and the first thoughts of suicide gradually arose in me. I considered checking into a clinic again, but managed to keep my head above water through outpatient psychotherapy — which amounted to little more than supportive conversation — with my psychiatrist. A hospital outpatient department also assisted me for a short time, and horseback riding and art therapy contributed additional stabilization. Then, as if by a miracle, just as things were beginning to look slightly brighter, I found the ideal clinical position in a small town very close to my home.

At last, things were looking up! Professionally, at least, I was now as successful as I had always wished to be. But did this also make me personally content? Far from it! In connection with a mild gastrointestinal infection in the late summer of 2001, I developed a mysterious set of symptoms that bore a distant resemblance to restless legs syndrome, accompanied by nausea and diarrhea. This recurred on multiple occasions without my having any explanation for the cause. Gradually, anxiety crept in, which then amplified the symptoms further. Although I knew the classic manifestations of anxiety disorders reasonably well from medical school, it would never have occurred to me that pathological anxiety might play a role in my own case. Increasingly, however, I had to face this fact.

While I never developed the classic avoidance behavior, the anxiety attacks took a heavy toll and impaired my life in many areas. Professionally, I was above all afraid of falling ill too frequently and thereby being unable to practice medicine in the long run. If I missed work at my current position, my two physician supervisors would have to manage the clinic and consultations on their own — inconvenient, but manageable for a short time. But what would happen if this occurred later, when I had my own practice? What if I had to perform a surgical procedure, for example, and was suddenly stricken with bouts of nausea and diarrhea? Was I even equal to the ordinary demands of medical practice? Did I perhaps have to reckon with premature disability and social decline?

My ruminations spiraled ever wider. Was I equal to the self-responsible life of an adult at all? Was I "normal"? Or was I, in fact, severely personality-disordered? Mentally ill? Might an even graver condition be looming — a psychosis, perhaps? Or possibly cancer — leukemia, lymphoma, or the like? What if my parents were suddenly gone? My father was constantly talking about dying! A harrowing thought, to lose him — and with my mother, I could not even allow the thought to reach its conclusion without being seized by anxiety. What if I myself had to die? And then, as a recurring leitmotif, the same thoughts: I can't go on! I don't want to go on! I can't bear any of this anymore!

When the first severe anxiety attacks struck, I came across the information from the ABARIS Institute¹ for Psychotherapy in Stuttgart on the internet. I was fascinated. Everything sounded so utterly different from what I had heard in medical school that I felt compelled to explore it further. I had certainly heard the term "cognitive behavioral therapy" before, but had never considered it as an option for myself. Never before had I encountered so coherent and internally logical a model of psychological disorders as the one presented by ABARIS. Its openness and transparency convinced me, and I knew at once: here, I could genuinely expect help within a reasonably short time.

Equally transparent and coherent were the terms of engagement at the ABARIS Institute¹ for Psychotherapy: if you want ABARIS quality, you can obtain it only under ABARIS's established conditions. This rigor extended to the financial arrangements: at this private institute, no psychotherapeutic service is rendered without a credit card or advance payment. It was only here that I grasped how preposterous it is to expect effective help from psychotherapists who have spent years publicly lamenting their fees while proving themselves unable even to provide for themselves. My medical socialization, too, had driven me into dependency rather than equipping me for life, as I came to realize. And so I now assumed full responsibility for myself: whereas all previous therapeutic attempts, however costly and inefficient, had been billed to my health insurance, I regarded the 1,564.69 euros in fees I had to pay at ABARIS as a highly profitable investment in my future. I completed the online registration, called Mr. Luchmann directly at the number provided with my enrollment confirmation, and arranged an initial consultation.

In February 2002, we met for the first time in Stuttgart and discussed my professional and personal situation. Mr. Luchmann identified the core of my psychological problems within a short time. I felt profoundly understood in my history of suffering. My ten-year odyssey of misguided treatment did not surprise him. He said it was, regrettably, rather typical of the failures within the German healthcare system, where psychotherapists are permitted to certify their patients' need for continued treatment for as long as their appetite holds. But Luchmann also made clear that there are, nonetheless, efficient pathways that could swiftly lead me out of my deplorable situation. Clients, he said, were in his view autonomous partners to whom he made available his knowledge and techniques so that they might achieve their therapeutic and life goals. He would point me toward a new, healthy way of thinking, he explained, while I would have to undertake the demanding work of implementing these changes in my daily life. I accepted this offer.

At last, I was experiencing psychotherapy as a professional service, free of mysticism, arrogance, and secrecy: I wanted answers, and the psychotherapist gave them; I defined my therapeutic goal, and the psychotherapist set up the signposts that guided me toward it.

To begin with, I was assigned the task of preparing in detail for my requested therapy block. Over the following weeks, as I followed his instructions and devoted myself intensively to this assignment alongside my professional duties, I noticed that some of my problematic patterns of thought and behavior were already beginning to loosen as a result. Ironically, this specific therapeutic preparation, following a single one-hour conversation with Mr. Luchmann, yielded more new insights than all of my previous psychodynamic and supposedly "uncovering" therapeutic attempts combined.

An intensive weekend in March, comprising two therapy blocks of four hours each (Saturday and Sunday), marked a turning point in my life unlike anything I had previously experienced. The very review of my life history made clear to me that the diagnosis of "narcissistic personality disorder" had been a grotesque misjudgment on the part of the psychoanalysts. Far from being personality-disordered, I had to recognize that my principal difficulties were typical of highly gifted individuals — never before had any psychotherapist connected my membership in this group with my symptoms. "The handicap of giftedness" and "social phobia" were the terms Mr. Luchmann used with deliberate caution to describe my condition.

An enormous weight was lifted from me. At last, I could shed the paralyzing label of "personality-disordered" and free myself from the misguided psychodynamic influences that had burdened me grievously for more than a decade by making me believe my problems were insoluble. Liberated and happy, I spent the Saturday afternoon, only to have Mr. Luchmann explain to me the following morning the causes of and therapeutic approaches to anxiety and panic attacks — and a good deal more. For the first time, it was made clear to me in plain, straightforward language what elementary cognitive errors had been steering me into anxiety and panic. I was almost inclined to ask myself: Why didn't I figure this out on my own? Put differently: there are, presumably, people who cope with their principal life problems largely on their own and never feel the need for psychotherapy. Might they perhaps be applying the principles of cognitive behavioral therapy intuitively and correctly? Especially when I compare this to the unsatisfying results of my ten-year history of psychotherapy, I now understand that it requires great psychotherapeutic skill to illuminate for clients the intricate fallacies of the psyche through a logical explanatory model and to provide them with a clear set of instructions showing the way out of the labyrinth.

In all previous therapies, I had experienced only temporary improvement before gradually sliding back into my former behavioral patterns. Small wonder: no previous psychotherapy had ever addressed my faulty and one-sided patterns of thinking. Instead of regressing, I was now making further progress entirely on my own! With the help of cognitive literature, I deepened what I had learned from Mr. Luchmann and worked ever more deliberately toward the goal — one he himself had explicitly articulated — of becoming my own therapist.

Not that I experienced no relapses into old thinking and behavior — far from it! But I now stopped condemning myself for a relapse and ceased making my self-worth contingent on my behavior. Speaking of self-worth: the central problem of the supposed "narcissists" dissolved in an elegantly simple way through a key insight that cognitive behavioral therapy imparted to me. The very term "self-worth" implies that my value is determined by me, for me — otherwise it would not be self-worth but other-worth! It follows that no one else can diminish my self-worth or offend me — only I can do that, by generating self-demeaning thoughts in response to an alleged "offense"! Had someone explained this to me ten years earlier, instead of leaving me standing with the erroneous diagnosis of "narcissistic personality disorder," what suffering I would have been spared!

By the summer of 2002, I was sufficiently free of pathologically exaggerated anxiety (not of normal, healthy anxiety!) to fly alone to the Maldives and resume my hobby, scuba diving — after a total of just six therapy sessions! In September, I called Mr. Luchmann once more for two concluding sessions: to give him feedback and to obtain a bit of "cognitive refreshment" for myself. After eight therapy sessions over the course of half a year, my supposedly severe "personality disorder" and my suicidal thoughts had given way to a life that was largely normal and absolutely worth living.

As a conclusion to my psychotherapy, I promised Mr. Luchmann that I would write up my experiences and publish them under a pseudonym on his website. My aim in doing so is to encourage other sufferers to discover cognitive behavioral therapy for themselves. The possibilities of modern psychotherapy have advanced to such a degree that the majority of patients who suffer from psychological disorders need not endure suffering so prolonged and so severe — because they could, in fact, be helped effectively. And this in remarkably little time and at comparatively modest financial cost.

It is particularly tragic that physicians, of all people, still possess almost no knowledge of these possibilities and find it difficult to acquire any. For my specialist certification, for example, a course in "Basic Psychosomatic Care" is required. Nearly all the courses I was able to find for this purpose teach nothing but outdated psychodynamic and psychoanalytic concepts! During my medical studies, I heard the term "cognitive behavioral therapy" mentioned, but received no further explanation of any kind. In my view, the current state of care will not change until highly effective cognitive psychotherapy, or cognitive behavioral therapy, has become the standard and is made accessible to all those seeking help. Since my own psychotherapy, I have already recommended cognitive behavioral therapy to several of my patients and integrated its approaches into my own clinical conversations — with outstanding results.

The information provided by the ABARIS Institute¹ and other resources on the internet make an important contribution in today's information age to the dissemination of effective, modern psychotherapy. My personal odyssey in search of qualified psychotherapy deformed and damaged me over many years of my life — and led to suicidal thoughts. When physicians today struggle with the most severe psychological problems of their own, when they destroy themselves with pills, alcohol, and burnout, I now understand: they were never taught any better. If this article succeeds in contributing even modestly to changing this untenable state of affairs, and above all in giving as many people suffering psychologically as possible the courage to seek the right psychotherapy, then it will have served its purpose.

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