The Dream Sense,Emergent Clinical Process,and the Question of Symmetry: Reply to Brown and Colombo

In recent years I have become interested in Bion and neo-Bionian field theory, but the origin of my interest in dreaming does not lie in scholarly or clinical sources. The source of the idea of the dream sense is my own experience. After addressing that point, I reject what appears to be Colombo’s impression (this issue) that detailed inquiry is necessarily the basis of interpersonal and relational clinical practice, and then take issue with Brown’s understanding of expressive participation in relational thinking (this issue). Responding to Brown’s wish that I offer more detail about my own clinical process, I present an overview of my understanding of the way I work. I conclude by addressing the understandings offered by the discussants of symmetry in the analytic relationship, and offering more details of my own.     

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.