The Result Of Psychotherapy In "psychosomatics". 10 Reasons Why It Won't Work

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The popularization of "psychosomatics" through pivot tables and functional metaphorical projections (legs - movement, stomach - digestion, etc.) made it possible to take a big step towards the global public awareness that mental balance and our physical health have a direct connection. However, in real practice, we are faced with the fact that the concept of "psychosomatics" is so multifaceted and diverse that the principle of "awareness-forgiveness-acceptance" can cause frustration, depression and new neurotic symptoms not only in the client himself, but also in the psychologist-psychotherapist. if this method is key in his arsenal.

Over the past 10-15 years, there have been many changes both in the world of practical psychology and in the psychotherapeutic approach to working with psychosomatic clients. On the one hand, we have more opportunities for information exchange and basic preparation of the client to understand the essence of the psychotherapy process. Most people already clearly understand the difference between psychologists and psychiatrists, many have learned about the functions of psychological defenses, resistances, transferences and, in fact, about the organizational aspects of the issue of psychotherapy. This partly facilitated the establishment of contact between the psychologist-psychotherapist and the client. On the other hand, the uncontrolled and unregulated process of introducing unscientific knowledge into the masses has complicated the work to achieve the result. The modern client has become more well-read and informed, and more mature psychological defenses in the form of intellectualization and rationalization have replaced the old repression and denial. In this note, I want to share with you the main modern barriers that arise between the client and the psychotherapist on the way to achieving results in psychotherapy of psychosomatic disorders and diseases.

1. Expectation of a quick result

You can often hear the following phrase from specialists: "You have been earning your disease for years, but you want to get rid of it in 1 month?" Not many people voice it, but there is also a client's answer to it: "Why not, if there are people who get rid of it in a week? Maybe you are just a bad specialist?" In fact, the result of each case is individual, and competent psychosomatic diagnostics helps to predict the outcome. A quick solution is really possible in a number of situations, for example, when the disease is actually not psychosomatic and the result is achieved more due to drug treatment or clarification of the essence of the symptoms (the client thinks that he is sick, but in fact it turns out that his symptoms are normal). It also often happens that a psychosomatic symptom is associated with current situational difficulties (emergency at work, conflict at home, etc.), and as soon as the client's problem in real life is resolved, the psychosomatic disorder immediately recedes. However, clients with these kinds of problems rarely see a therapist.

More often than not, we have to deal with people whose problem "has not been treated for a long time." Why isn't it treated? In scientific psychosomatics, it is customary to use the formulation "picture of the patient's personality". This implies that the nature of the disease is closely related to the structure of the client's personality, and sometimes getting rid of the problem is tantamount to becoming a completely different person. That is why the same psychological cause can cause completely different diseases in different people (it depends on our constitution), and vice versa, the same disease can have a completely different cause and prognosis. The second, most common among other reasons for the duration of the psychotherapy process, is that the shift of a psychological problem to a somatic one in itself is not natural and normal, and arises from truly difficult traumatic experiences. So, it is impossible to solve a somatic problem without first understanding the psychological disorder that caused it. According to the totality of symptoms and the results of psychosomatic diagnostics, the prognosis for the duration of psychotherapeutic work ranges from one year to several years.

At the same time, clients often think that if they go to a psychoanalyst, it will be for years, if they work in the technique of behavioral therapy, then it will be 3 months. In fact, in psychotherapy, it is not so much the method that works as the client himself, and the result depends not only on his personal history of the disease or disorder, but also directly on his nature and the actual cause of the psychosomatic symptom. Whatever technique is applied to the client, he will still remain himself, and if the reasons for holding the disorder are stronger than the prospect of getting rid of it, all the more we cannot talk about an immediate result.

2. Lack of trust

Some clients find that telling the most intimate and intimate details of their life, they show trust. In practice, it is very often found that clients deliberately keep silent about some traumatic events, hoping that by discussing the problem "nearby", they will be able to sort out their question themselves, without introducing a stranger into such personal experiences. In fact, self-diagnosis and introspection in psychosomatics often turn out to be ineffective precisely due to the fact that if the client could cope with his trauma on his own, the psyche would have no reason to hide it, suppress and sublimate it through the body … So, the client is constantly faced with his projections and defenses, and only the decision to let the psychotherapist into his world brings him closer to solving the issue. At the same time, it is impossible to open up to a real person who does not inspire confidence and this again takes time.

3. Working with several specialists at the same time

"This is definitely not about me" - thought many. However, by this point I do not mean the process of selecting a specialist. On the contrary, if work with psychosomatics is impossible without a trusting relationship, then before entering into long-term therapy, it is advisable to visit several different psychotherapists in order to feel which one is closer to you. At the stage of selection, it is important not only to make sure of his qualifications, the acceptability of the organization of therapeutic work, rules, etc. It is important to feel how comfortable you are in interacting with him as a person. And when the choice is made, and you have decided for yourself that you can be frank with this person, I recommend that you still trust him and not scatter your attention on additional psychotherapeutic "offers" in the form of trainings, popular articles on the Internet and books / programs on popular psychology.

The fact is that the psychologist studied for at least 6 years (usually 8-10), not just some generally understood truths. Unlike any other specialist in the helping profession, he has a specialized basis and basis on which one can apply certain theories. Popular articles on the Internet, the purpose of which is more often to "interest" or explain, but not give an effective recommendation (because you cannot give a recommendation without knowing your personal case), can consider the same basic element in dozens of different articles, with different accents and different words … While it seems to you that these 10 articles are about different things, for a specialist they are all about the same thing, but this "one and the same" is not really a solution, but only 1/100 of a real understanding of the essence of the issue. Moreover, good specialists always interact with colleagues and can get supervisory help if they have any difficulties and doubts, but this help will be really "point-like", and not hypothetical, as in the example from the article. Unfortunately, sometimes, instead of working with a client, the process of sessions turns into answers to the questions: "What do you think about this specialist?" and let's do this technique "," and this psychologist says so and so, I think I just need it "," read this article "or" watch this video, there is just a psychologist talking about me ", etc. …

Actually, no matter what school the psychologist-psychotherapist belongs to, he always has a "plan", there is an understanding of what the problem is (in terms of its direction) and how to come to a solution … Arbitrary jumping of the client from one method to another, from the opinions of different specialists from different articles and books, does not provide an opportunity for real work. In general psychotherapeutic practice, this may not be so critical, because in any case, while interacting with a psychotherapist, the client will receive something in return. In psychosomatics, this becomes an obstacle, since the client wants to receive not "something", but the result - a healthy state.

4. Passion for popular psychosomatics

Very often, in children's development kits, books about numbers with a count of up to 5 are sold. Bright and colorful, but not 0-9, but 1-5. Can you imagine such a situation that a mathematician would operate with numbers from 1 to 5? The tables on psychosomatics for specialists also look approximately. Just as it is important for a mathematician to know that the range of numbers is different, and to be able to operate with these numbers not at the level of addition / subtraction and division / multiplication, but at the level of higher mathematics, so it is important for a psychosomatics specialist not only to know that there is a probable direction in which to look the reason, but also to understand the basics of physiology and pathophysiology, neurophysiology, neuropsychology, pathopsychology, etc. The presence of this knowledge distinguishes a psychologist-psychotherapist from a client who diagnoses himself from popular books and articles on psychosomatics. If you pay attention, the reasons often described in popular literature can be applied to completely different situations and, in principle, to any person. Therefore, if you have any suspicions that your disorder or illness is psychosomatic, trust a specialist who will personally take care of your case and analyze your history personally. When something new, really important happens in the scientific world, it is impossible not to find out about it to the practicing psychologist himself … If a specialist does not diagnose you from tables and popular books, most likely this is not because he does not know about their existence;) Most psychotherapeutic cases begin with phrases in the context: "I have identified myself, I have recognized the reason, I work hard, but nothing happens. ". Because, as already noted, "it turns out" most often where psychocorrection did not really matter.

5. A hoax, or the belief that "all diseases are from the brain," etc

As noted above, not every disease has a leading psychological cause. In the light of psychosomatics, both physiological and psychological processes constantly affect each other, but this does not make them the cause of pathology. Any psychosomatic pathology has a complex mechanism, and somewhere the leading is a radiation, epidemiological, situational, genetic or other factor, and somewhere a really psychological problem. This can distinguish the same disease in two different people, respectively, one of them will be cured quickly and without the help of a psychologist-psychotherapist, the other can be treated for years by different specialists. It is the idea that "doctors are powerless because all diseases are from the brain" often becomes an obstacle in working with psychosomatic clients. Since in this case, the psychotherapist is expected to give a specific indication of the reason and recommendations on what to think or do to get rid of the problem 100%. While there are disorders that are basically impossible to get rid of, and all that can be done is to learn to live with them, to make sure that the impact on the client's life is minimal and to minimize the frequency of manifestation of certain symptoms or chronic diseases.

6. Lack of knowledge of physiology and pathophysiology

This applies equally to both the client and the beginning psychologist. In my practice, there was an amazing case when a psychologically literate client, all in regalia and certificates, could not cope with the symptoms of IBS, which bothered him almost from childhood, but he realized this only recently (he made a diagnosis himself). I consulted with colleagues and was ready to admit that he was "incurable" until I accidentally slipped a phrase from which it became obvious that he was in fact completely healthy, but his ignorance of basic physiological principles almost turned into a neurotic disorder). This is one of the reasons why the diagnosis with which a client turns to a specialist should be made by a doctor, and not by the client himself. Often, "seriously ill" clients are surprised when they find out that what happens to them fits into the physiological norm and has its own explanations. Such situations just refer to "quick" psychotherapy) It is important to understand that knowledge of physiology and pathophysiology is the basis of any person who plans to somehow influence the work of the body.

7. The client's specialization in his disease

A fairly common case in psychosomatic practice when a client knows everything about his illness better than any doctor and psychotherapist. He sits on support forums, looks for new information in articles, reference books, operates with special terms, and has tried almost all methods of treatment on himself, but psychotherapy is the last chance. Most often, it is psychological defenses that manifest themselves in this way, where under the curtain of an "expert" there is a very powerful resistance and fear of actually searching for causes and eliminating them. As noted above, the reason for this is often a complex psychological disorder, where the trauma is so severe that the client will do anything to distance the specialist from it. Only in the case when the client decides to start deep psychotherapeutic work, it can be assumed that the result is possible. Most of the time will be spent not on solving a psychosomatic problem, but on establishing trusting relationships (and these clients tend not to trust anyone), unblocking psychological defenses and transforming traumatic experience.

8. Codependency

In working with a psychosomatic case, it often turns out that the solution of the problem is impeded not so much by the client's resistance itself as by the system in which he is used to living with his illness. As an example, you can cite loved ones who unconsciously support his state of helplessness and dependence. I wrote in more detail about the problems of codependency here. Definition of codependency in "psychosomatics"

9. Distortion of the expected result

Due to the fact that clients often learn about psychosomatics not from doctors, but from articles on the Internet or from friends, their expectations from the result of psychotherapy are far from reality. So, for example, when people hear that some oncological diseases are classified as psychosomatic, they assure sick relatives that "it is possible to cure cancer with the help of a psychotherapist."Or when obese girls read about the cause of the problem - "stress seizing", they expect that working with a therapist they will turn into skinny. In fact, psychotherapy does not give either a miraculous cure or a change in the constitution (and more often it is people who are constitutionally inclined to be overweight who suffer from obesity). In any psychosomatic disorder or disease, the initial diagnosis will show whether the disease is actually psychosomatic, and if so, depending on whether the cause is situational, psycho-traumatic, existential or related to the personality structure, it will be possible to determine the likely result of working with a psychotherapist. And in some cases, general psychological work with self-perception, personal growth, etc. will help, and in some cases it will be important to accept the disease as incurable and learn to live with it, while maintaining the quality of life at a sufficiently high level.

10. Denial of other factors affecting health

Often choosing to work with a psychotherapist, clients refuse medication, surgery, etc. This is especially common in psychosomatic disorders, when a medical examination does not reveal changes in the organ, and the client is afraid to take antidepressants and so on. In the case of psychosomatic illnesses, this approach is regarded as "self-destructive" because when changes in the body have already occurred, whatever the root cause, it is necessary to correct organ changes by influencing physiology first of all. A pathology that is not treated or becomes chronic, or adds other pathologies, until the client comes to hospital with a "bouquet" of physical problems. And the point is not really that psychological work takes time, but that psychological work does not affect the altered organ (for example, it does not tighten stretched veins in case of varicose veins, does not remove kidney stones, does not kill bacteria etc.). In the case of neurotic disorders (PA or cardioneurosis, IBS or intestinal neurosis, etc.), refusal from drug treatment only complicates and prolongs psychotherapeutic work, and what can be done in a year or two, the client can correct for 8 and 10 years.

In developed countries, several specialists deal with psychosomatic clients at the same time, since we are talking about a related pathology. Even in psychotherapy itself, psychosomatic clients belong to one of the most difficult categories. Just think about how the consciousness actually evaluates the situation as difficult and hopeless, that the brain has to resort to repressing it into the body, as the last resort? And of course, that disorientation and helplessness cannot be leveled with the help of popular psychosomatic tables, articles and classifiers that not only lead away from the real causes of pathology, but also increase the feeling of guilt and destructive auto-aggression. Since, without knowing the individual history, they cannot give a real tool, but in general they create the impression that everything is simple and clear. It turns out that since everything is so clear and you do everything point by point, but there is no result, then you are generally hopeless and incapable of anything? Of course not! As noted, everything is easy and simple when it comes to the so-called. situational, epidemiological, or even symptoms without pathology, when the disease goes away without any special psychocorrection. If we are talking about true psychosomatic disorders and diseases, then you need to be prepared for a long journey and a "new" self, since it is precisely the old that was in the client's life that led him to psychosomatic pathology.