Psychoanalysis.  2018 Oct;29(4):72-82. 10.18529/psychoanal.2018.29.4.72.

Communication with Psychosomatic Patient: With a Clinical Vignette “When Words Are Unspeakable: A Bridge Beyond the Silence”

• Jahng EJ

• KMID: 2435493
• DOI: http://doi.org/10.18529/psychoanal.2018.29.4.72

Abstract

What should a therapist do if the patient has lost the ability to speak in sessions? How should the therapist understand and approach this "˜deadly silence'? Psychosomatic patients have poor ability to mentalize their experience, so they create a "˜shunt' from emotional experience to body bypassing symbolic sphere. This makes psychosomatic patients vulnerable to expressing their emotions in words. With the case vignette "˜When words are unspeakable: a bridge beyond the silence' written by Wirth in a book "From soma to symbol" we observe how psychosomatic pathology arises, from inappropriate mirroring and poor containment; and how this escalates into a vicious cycle of sin and punishment in the patient's conscience. This conscience scenario imprisons a talented and creative mind in a dark, silent place, wherein symbols and words are forbidden. This seemingly impossible task of providing silent patients with a "˜talking cure' finds breakthrough with containment, and transformative thinking using therapists' reveries.

Keyword

Psychosomatic; Containing; Dream thinking; Transformative thinking; Reverie

MeSH Terms

Aptitude
Carisoprodol
Conscience
Containment of Biohazards
Humans
Pathology
Punishment
Thinking
Carisoprodol