AbstractThe relationship between somatic symptoms and psychological functioning were investigated in two intensive case studies of the processes and outcomes of psychodynamic psychotherapy involving clients with chronic abdominal pain. A main objective of the study was to see how change might be experienced at psychological and somatic levels, and how findings might best fit into a model of biopsychosocial functioning that could assist both therapist and client. The analyses of client process in each case involved (1) a psychotherapeutic formulation of client functioning in terms of conflicts perceived and self-regulation strategies used to cope with them, and movement during therapy from both therapist and client points of view (2) an assimilation analysis of client movement during the therapy process, (3) a pain analogue analysis in which symptom changes were correlated with shifts in conflict status, and (4) baseline and outcome psychometric measures of symptom intensity and frequency, quality of life, presence of psychological distress and defensiveness. Findings were related to existing approaches to psyche-soma relationships explored in a cross-disciplinary review of theory, research, and clinical accounts.
Analyses of the findings showed that for these clients, gastrointestinal pain represented more than one meaning. At a psychological level, it offered an expression of psychic pain existing at primitive levels of the psyche, which had been warded off, or disconnected from other ongoing perceptions of bodily function or self- experience. Pain and other symptoms appeared to result from the activation of defensive processes, themselves responses to emerging aspects of the patient's personality, which had been historically restricted from awareness. Intrapersonal conflicts revealed by these two patients shared some similarities even though their surface presentation was different. Conflicts emerging in therapy in both cases evolved from developmental deficits in ongoing self-object development.
It is argued that combining process analyses with measures of outcome can be useful in observing and integrating multiple domains of client self-awareness. The implications of this methodological strategy for future research and the structuring of therapeutic tasks for psychosomatic work is discussed, and the value of the assimilation model in formulating conflicts, and mapping change is explored.
|Date of Award||4 Jun 2003|
|Supervisor||John McLeod (Supervisor)|