Tuesday, May 18, 2021

Electives: Students Present: Somatization in Group Therapy Part I

In Somatization in Group Therapy, we start with a brief introduction of the model which provides the theoretical base for the accomplishment of the therapeutic goals in our work with the group. These are the Interpersonal model by Irvin Yalom and Relational Psychoanalytic Psychotherapy. We present the most important points of a Davies' article, searching for answers to the question: why some therapies fall apart from the burden of repetitive self-destructive behaviors of both the patients and the therapists. How the emergence of envious, embarrassing selves at the beginning of treatment blocks the mutual acceptance of toxic introjections but finally allows the analytic work to proceed.

In Part II, we will present the case studies of the personal stories of the two therapists
which coincide with the stories of the group members. In such moments, the enigmatic feelings of the therapists and the group members became valuable analytical data. In Part III, we will explore how the space for new experiences is created.

The group is the place for the repetition of internal conflicts and unbearable feelings of therapists and patients alike. The participants cannot avoid the impact they have on each other every minute. We are interested not only in what is said but also in what is not said. Our bodies, sometimes restrained, other times weak and tired, inform us that something is coming. Based on Davies' article, we will try to show how aspects of our subjectivity - regarding the therapy of the heart problem of one of the therapist's children and the pregnancy of the other therapist, carrying her first child, that is, somatization in our relational stories - helped the group and the therapists realized the difficulties of mother-child relationships. Then comes the realization, how certain interactions with our patients helped us, the therapists, to understand how we can be vulnerable together and how we can stay connected and collaborate in a joined effort to understand what is happening. 

Theorists have moved from one-person analysis to more interpersonal models. The interpersonal theory developed by Irvin Yalom was strongly influenced by Sullivan’s view of the development of the human personality. Even before Sullivan, Winnicott [there is no such thing as a baby] talked about the importance of the relationship: the infant is nothing [would not come into being, or, would not survive] outside the mother-infant relationship. Sullivan also believed that the way we perceive ourselves is the consequence of others' views which have become internalized. We see ourselves through the eyes of significant others, especially the ones in our early lives, and then we interact accordingly. He suggested that the modifications of the beliefs and habitual patterns of interpersonal behavior should be a primary focus of treatment. The group can function as a mirror, so we expect that these internal representations and beliefs will emerge in the group, and that the members can understand their patterns and how they co-create their relationships. This is a model that focuses not only on interpretation and soothing but also on providing new relational patterns.

The main techniques of the model are that we work in the here and now of the group and we concentrate on the process and not on the theory or content. At the heart of the model is the emphasis on the feedback, (how the person connects with others and their impact on others). and the interpersonal learning. Lastly, in this model the group leader(s) is not only an observer but also a participant and so needs to be aware not only of transference but of her/his counter transference as well. The development of therapy cannot happen outside of the relationship, it is a co-creation. The interpretations are at three different levels, the individual, the intersubjective, and the group as a whole, the latter being the main level of interpretation.

Reading Davie's article, we will see that in modern psychotherapy the psyche is composed of the interaction of the self in relation to others. All these that we are going to see today are also going to discuss on the second week of our presentation.

Though in the beginning the communication is nonverbal, from the first lines of the Davies article the impact of the therapist on her patient and vis versa is evident. Davies is aware through somatic stimulus that something difficult is coming based on the expressions on Karen's face and via the tension in her own body. Here we observe the first aspect of unconscious communication between the analyst and the analysand which continue through the interaction. Karen seems to discern sides of the therapist before the therapist's realization. Davies allow herself to surrender to the experience of the here and now, and to an internal dialogue about what is happening during their interaction. She is receptive in the influence of the unconscious of the patient on her (and the other way around).


We see the focus on the here and now where priority falls on the instant events of the session and on the procedure of transference-countertransference. Davies has in mind the concept of negative transference and its use as a bad object, but she is not concerned with the understanding or the solving of this projective identification which evacuates the badness to the other, and, instead Davies examines her subjective countertransference at the moment of her interaction with Karen. She moves from the psychology of the one (which is the patient pathology) to the psychology of the two, emphasizing the mutual impact and shared responsibility of their relationship. She does this by examining the procedure [process]. Davies wonders what her statement reveals and the numerous factors which emerged due to their interaction. She sustains the capacity to reflect on the experience by being both in the moment and out of it at the same time. In the intersubjective moment they are both constructors of toxic self-states and vulnerable simultaneously, while managing to survive and feel sane and feel loved by the other. These elements are also found in group therapy ensuring cohesion and change for the group as a whole. 'My milk will heal you', Karen says. We can see how the experiential content is as important as the verbal one in an interpersonal meeting thus the patient feels able to heal the therapist. This experience can be the most healing experience of all.


-Alkinoi Lala and Fotini Doumoura 


Davies, J.M. (2004). Whose Bad Objects Are We Anyway? Repetition and Our Elusive Love Affair with Evil. Psychoanal. Dial., 14(6):711-732.

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