It was also necessary to differentiate PFPP from open-ended, non-panicfocused psychoanalytic psychotherapy. Thus, one of the features captured by the PFPP adherence scale is that when the patient pursues topics other than anxiety and panic, the therapist brings the patient back to panic disorder and its associated dynamics. Based on our clinical experience, we consider this focus on panic symptoms to be a crucial component of what makes PFPP effective, though this has not been systematically assessed. The scale item reads as follows: “Relating intervening, seemingly unrelated concerns to the dynamisms connected to panic and anxiety. When the patient pursues topics other than anxiety and panic, the therapist eventually relates the information back to the dynamisms (conflictual issues, such as difficulties with separation or becoming angry) that have been identified as being central to the patient’s panic disorder or episodic experiences of anxiety.” Lower ratings are given to therapists who pursue patients’ free associations and fail to bring the patient back to discussing panic dynamics. Another item is designed to assess whether the dynamics central to panic disorder are addressed by the therapist.
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