Posted by Dr. Vollmer on November 30, 2016
The patient comes in with a stomach-ache, many things could explain it, but the psychoanalyst wonders about the psychology, the historical roots, and the meaning of the stomach-ache, while the patient wants her stomach to feel better. This cross-purposes describes the “analytic stance” where the therapist is thinking on multiple levels, even if the patient is not. The stomach ache could be present as a way to communicate that she needs nurturing, but rather than asking for nurturing, or saying she needs nurturing, she presents with a stomach-ache because as a child she learned that the only way she could get attention was by being physically sick. So now, as an adult, she experiences psychological distress through her body. In other words, her psychological stress transforms into a bodily complaint, because talking about how her body is betraying her is a comfortable way for her to communicate with a doctor, even if that doctor is a psychiatrist. To say, that she is lonely or scared, or at loose ends, are feelings that she is not at ease to discuss. By contrast, complaining about her stomach is familiar and, in the past, has rewarded her with attention which helps her feel cared for. To understand her stomach ache in context, as code language for asking for emotional support, is the beginning of a psychoanalytic process which might grow into a deep treatment, that is, a deep understanding of her distress. The patient may walk out with the same stomach-ache she walked in with, but at the same time, she is stimulated to consider her distress in different ways, and in so doing, the stomach-ache could gradually recede, and with further work to understand her issues, her stomach-ache may not come back. She will discover more direct ways of communicating her feelings and in so doing, her relationships with others, and with herself will feel fulfilling. The psychoanalytic process will pay off, but not in the immediate way of relieving her chief complaint.