Psychodynamic thinking about psychosomatic symptoms working as a counsellor in a GP surgery

Abstract

In general practice a group of patients referred to the counsellor for psychological help also suffer with physical pains considered to be hypochondriacal or psychosomatic. This article describes attempts to engage such patients, who show varying degrees of resistance, in a counselling relationship. Detailed descriptions are given of two clients with whom it was possible to penetrate massive somatic defences and to make contact with their mental pain and conflict. Both are female and although they share a similar physical pain, a bloated, sore, colicky stomach, this has a different meaning in each case. Bion's theory of the ‘container-contained’ structure between infant and mother, which facilitates the development of a capacity to think about mental pain, has application for the counselling relationship. Also, because of the primitive unconscious defences of splitting and projection which are operating, it is important for the counsellor and the GP to develop a good working relationship in order to contain these clients.