Updating the Model for Psychotherapy of Psychosomatic Problems

Abstract

There is a pressing need to broaden the base of the therapeutic efforts used to treat psychosomatic and stress induced disorders. Before this can be accomplished, it is necessary to accept the heterogeneity of the disorders which carry the same label. Psychosomatic phenomena must be clearly defined so that specific treatment goals can be formulated for the various treatment modalities which are available, e.g., modifying patterns of communication and of human relationships; altering expressive and instrumental behavior patterns; broadening of an individual’s perception of the external world and internal experiences; changing the internal state through feedback, drugs, relaxation; modifying mal-adaptive behavioral or psychopshysiological response patterns with conditioning techniques. The range of symptoms which can be defined as psychosomatic include: (1) Symptoms referable to the body which are the expression of ideas, thoughts, or feelings and are not related to altered physiology (conversion, depressive, hypochondriac or body delusional symptoms). (2) Specific physiological changes which accompany psychological states (anxiety, anger, vigilance). (3) Symptoms of organic disease which lead to secondary psychological reactions (somato psychic). (4) Symptoms of diseases whose onset is related to the loss of significant objects and the feeling of hopelessness and helplessness. In order to integrate relevant developmental, psychodynamic, social stress and biological data in relation to illness, a new biopsychosocial model is needed. <i>Engel</i> (11), <i>Weiner</i> (40), <i>Nemiah</i> and <i>Sifenos</i> (29), <i>Sandler</i> (34), <i>Mason</i> (25), <i>Bahnson</i> (6), <i>Luria</i> (22) and <i>Miller</i> (26) have all suggested comprehensive psychobiological etiologic models. These models should be useful in establishing the methods and goals of a more scientific psychobiologically based therapy for psychosomatic disorders.