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Michael Robbins, in his discussion of “Unmentalized Aspects of Panic and Anxiety Disorders” (Vol. 42, No. 2, 2014), notes the “…extensive review of the literature on absence of mental representation is especially valuable for readers not familiar with contemporary developments in this area” (p. 197). However, he closes his commentary urging “caution, or even skepticism” (p. 201) in considering the specific ideas put forth in the article. Certain clarifications are warranted so that the reader is not left with a confused view of PFPP (panic-focused psychodynamic psychotherapy) or the purpose of the article.
PFPP is not a “therapeutic proposal,” but an evidence-based psychodynamic treatment for panic disorder. Unlike many psychodynamic treatment approaches, this therapy has been manualized and systematically studied in comparison to other treatments (Busch et al., 2012; Milrod et al., 2007). The treatment differs from more traditional psychodynamic psychotherapies in its focused approach on panic and anxiety disorders. The manual also includes a suggested formulation of intrapsychic conflicts, dynamics, and defenses that contribute to panic and anxiety disorders, which are addressed in the course of treatment. Despite Robbins's claim of “an absence of a relational perspective, such as transference and countertransference” (p. 200), work in the transference has been well described as a central feature of PFPP, particularly in the termination phase.
Robbins conflates our focus on “unmentalized” aspects of mental functioning with a mentalization-based treatment as well as one that is “remedial” and psychoeducational. In addition, Robbins inaccurately identifies Fonagy and Target's work as the “perhaps major source” (p. 197) for our article. Although we would argue that his critiques of mentalization-based treatment are problematic, PFPP is not a mentalization-based treatment. Perhaps identifying poorly symbolized content as “unmentalized” created the false impression that