Challenges in treating patients with psychosomatic disorders: some patterns of resistance

Abstract

The treatment of people suffering from psychosomatic disorders poses important clinical challenges to psychoanalytic practice, including early abandonment, difficulties in engagement and superficial involvement in the treatment. The lack of systematic research on the subject suggests that a better understanding of the resistances and dynamics involved in such episodes is needed. Using supervision group to study treatments and inspired by action-research paradigm, this paper presents the results of an 18-month mixed-method qualitative clinical research on treating 22 cases. Thematic analysis revealed a frequent pattern of resistance to experience emotions that presented in two states: failure of repression (thin-skin) and massive repression (thick-skin). Narcissistic dynamics in the therapeutic relationship taking the form of ‘resistance to transference’ and a tendency to action were evident in both presentations. Symmetric and complementary counter-transference reactions, which compromised treatment, were also identified. Some technical implications are highlighted, such as the need to focus in the recovery of the patient's actual emotional experience and to understand such experience in the context of the ‘here and now’ of the therapeutic encounter. These findings suggest the need for a flexible approach to therapeutic work that moves between an ‘intrapsychic’ and a ‘relational’ focus.