Thirty years of abdominal pain

In this paper, the author describes a brief psychotherapy with a man who has struggled with abdominal symptoms for most of his adult life. After an unhappy childhood, the patient (Mr A) married and then was witness to the birth of his stillborn child, in a foreign country. Soon after his abdominal symptoms started, and plagued him for the following 30 years. In the therapy, Mr A began to explore areas of guilt, hostility, and shame, together with previously unknown-about unconscious phantasies. By the end of the therapy, he reported a substantial diminution in his symptoms, as well as changes to his relationships, and mode of thinking and feeling. Some aspects of working psychoanalytically with patients with somatic symptoms, especially those pertaining to the gastrointestinal tract, are discussed.     

Psychoanalytic thinking in primary care: The Tavistock Psychotherapy Consultation model

This paper describes the conceptual underpinnings, structure and operations of a novel service, the City and Hackney Primary Care Psychotherapy Consultation Service – a service set up partly with the aim of addressing the needs of patients who present with ‘medically unexplained symptoms’. As part of the Tavistock and Portman NHS Trust, this service moves its clinical base, staff members and daily work, as well as the foundations of psychoanalytic thinking that define the Trust's work, into the heart of a community, and provides psychoanalytically informed clinical practice and consultation to patients and general practitioners in the City and Hackney, one of London's (and the UK's) most deprived and ethnically diverse boroughs. The authors describe the psychoanalytical underpinnings of the model, the design and structure of the service, patient demographics and preliminary outcome data, as well as an example of consultation work with general practitioners. The authors propose that psychoanalytic applications have a place in primary care and that psychoanalytic thinking can help general practitioners and patients alike, even when the clinical interventions offered are not solely based on psychoanalytic technique or therapeutic approaches. The paper concludes with thoughts about the model, its origins and its future.     

PREDICTORS AND EFFECTS OF SELF-OBJECTIFICATION IN LESBIANS

The majority of research on self-objectification has focused on heterosexual women's experiences. This study sought to examine experiences of self-objectification in lesbian women. A path model was developed to examine the relationships between participants' feminist self-identification, levels of internalized heterosexism, objectified body consciousness, and the clinically relevant variables of negative eating attitudes and depression. As has been found with heterosexual women, body surveillance led to shame, which led to negative clinical outcomes. A direct path was also found between levels of surveillance and negative eating attitudes, consistent with previous research on self-objectification among lesbians. Feminist self-identification was not significantly related to the other variables, in contrast to previous research with heterosexual women. Internalized heterosexism was related to negative clinical outcomes, both indirectly through objectification variables and directly to depressive symptomatology. These results provide evidence that self-objectification and internalized heterosexism have negative impacts on the mental health of lesbian women.