A grounded theory exploration of therapists’ experiences of somatic phenomena in the countertransference

Somatic phenomena in the countertransference have historically received minimal attention despite evidence of their occurrence in the therapeutic encounter. In the field of Counselling Psychology, there seems to be an apparent gap in the academic coverage and clinical utilisation of therapists’ somatic states. The purpose of this study was to explore therapists’ somatic experiences in the countertransference using a grounded theory methodology, based on a sample of 12 participants that was composed of psychotherapists, counselling and clinical psychologists. The results indicated that therapists made sense of their somatic experiences through a developmental process of ‘relating to the body’ that combined stages of defensive operations, intellectual reflections, attributions of somatic ownership and recognitions of various working patterns in the management of somatic experiences. This study addresses the factors that constituted therapists’ processing of the experience, and the findings suggest that therapeutic work may be affected when psychosomatic phenomena as such become undermined and ignored.     

Cutting the silence: initial,impulsive self-cutting in adolescence

The paper explores initial, impulsive self-cutting in adolescence and conceives of early cutting as having the most potential for a communicative function, as the adolescents themselves and those around them may be most shocked at their self-harm. The author also conceives of the symptom of early, initial cutting as an effort to ‘cut through’ an emotional and familial circumstance that has been silent, suggesting that cutting generally implies a failure in containment and symbolisation. Using Green’s (1975) discussion of the original word symbol as ‘an object cut in two, constituting a sign of recognition when those who carry it can assemble the two pieces’ (Dictionnaires Le Robert), the author demonstrates that cutting has the potential to elicit intense feelings in the analyst who can have (in Green’s terms) a homologous experience to that of the patient. This elaboration within the analyst’s feelings returns a part to the patient. The meeting of the two communications (the patient’s cutting and the elaboration in the analyst’s mind) can create a potential space between them. The paper uses clinical vignettes and extended clinical material from a 16-year-old girl to elucidate the relationship between cutting – an emotionally inarticulate state – and the development of communication, containment and symbolisation through homologous experiences in the analyst.     

Negotiating time: the significance of timing in ending inpatient work

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person may be ready to leave and cope with the transition back to life outside the unit. Indications of medical stability, in patients where this has been an issue, is a factor of prime importance. Other important factors include family functioning; the availability of adequate ongoing local CAMHS support for the child and family; suitable school provision; and the identity of the child within a peer group. The reality of NHS resources and the demand for inpatient beds is another pressing consideration. The young person's own motivation emerges as crucial at this stage – towards the end of treatment – not only in terms of what is said, and therefore evident verbally, but also through signs of internal shifts in the child that indicate a capacity to re-engage with life outside in a lasting way. Decisions about when to stop are taken with all this in mind and when the decision does not seem straightforward, it can provoke considerable anxiety in the multi-disciplinary team. Clinical material from psychotherapy with a young adolescent boy with anorexia nervosa is used to illustrate some of the dilemmas.     

Characteristics of perceived electromagnetic hypersensitivity in the general population

Health problems evoked in the presence of electrical equipment is a concern, calling for better understanding for characteristics of electromagnetic hypersensitivity (EHS ) in the general population. The present study investigated demographics, lifestyle factors, frequency and duration, coping strategies, proportion meeting clinical criteria for intolerance attributed to electromagnetic fields (EMF ) and comorbidity. Using data from a large‐scale population‐based questionnaire study, we investigated persons with self‐reported (n = 91) EHS in comparison to referents (n = 3,250). Middle age, female sex and poor perceived health was found to be associated with EHS . More than 50% in the EHS group reported having EMF ‐related symptoms more often than once a week, and the mean number of years experiencing EHS was 10.5. More than half of the EHS group reported that their symptoms started after a high‐dose or long‐term EMF exposure, that they actively tried to avoid EMF sources and that they mostly could affect the EMF environment. A minority of the EHS group had sought medical attention, been diagnosed by a physician or received treatment. Exhaustion syndrome, anxiety disorder, back/joint/muscle disorder, depression, functional somatic syndrome and migraine were comorbid with EHS . The results provide ground for future study of these characteristic features being risk factors for development of EHS and or consequences of EHS .     

The Potentiality of the Embryo and the Somatic Cell

Recent arguments on the ethics of stem cell research have taken a novel approach to the question of the moral status of the embryo. One influential argument focuses on a property that the embryo is said to possess—namely, the property of being an entity with a rational nature or, less controversially, an entity that has the potential to acquire a rational nature—and claims that this property is also possessed by a somatic cell. Since nobody seriously thinks that we have a duty to preserve the countless such cells we wash off our body every day in the shower, the argument is intended as a reductio ad absurdum of the claim that the embryo should be afforded the same moral status as a fully developed human being. This article argues that this argument is not successful and that it consequently plays into the hands of those who oppose embryonic stem cell research. It is therefore better to abandon this argument and focus instead on the different argument that potentiality, as such, is not a sufficient ground for the creation of moral obligations towards the embryo.     

The day‐to‐day concurrence of bodily complaints and affect in patients with severe somatoform disorder

Based on the concept of somatization, psychological distress can be experienced as symptoms of physical illness. This suggests a close‐fitting intra‐individual association between bodily complaints and mood in patients with somatoform disorder (SFD). The contemporaneous day‐to‐day complaints‐mood association was investigated in patients with severe chronic SFD using an ecological momentary assessment (EMA) design. Eleven patients, who had recently received specialized tertiary care treatment for severe chronic SFD, kept an online electronic diary for four consecutive weeks. They were prompted at intervals throughout the day to complete questions on their momentary primary symptoms (pain and fatigue), and mood state (negative and positive). For each measure, day‐mean aggregated values were computed and analyzed using linear multilevel (mixed model) regression analysis. Fixed factor results showed that symptoms were associated with both negative mood state (β = 0.47) and positive mood state (β = –0.59). Random results, however, indicated large inter‐individual differences, with correlations varying between 0.17 and 0.99 for negative affect, and between –0.88 and 0.14 for positive affect. A substantial day‐to‐day contemporaneous association between symptoms and affect across subjects, as well as large inter‐individual differences in this association, were demonstrated in patients with severe chronic SFD. EMA‐data showing the relationship between both negative and (inverse) positive mood and complaints has potential clinical relevance: providing SFD patients with feedback consisting of their personal day‐to‐day concurrency graph may promote their understanding of their own complaints in a broader context than the somatic area.     

Face-name memory training in subjective memory decline: how does office-based training translate to everyday situations?

This study aimed to examine whether people with subjective memory decline (SMD) benefit from face-name memory training (single session) as much as older adult controls in an office-based setting. Approximately 2 months later, groups were reassessed for translation to a naturalistic setting. In the office setting, there was a significant interaction between stimulus type (cued name; uncued name) and training condition (spaced retrieval, semantic association, no training), but no group differences nor interactions. Semantic association was only beneficial for cued names, whereas spaced retrieval was beneficial in cued and uncued conditions. In the naturalistic setting, however, there were no training effects. Naturalistic performance was predicted by demographics, cognition, and motivation. All groups reported improved memory control beliefs and contentment. Our study demonstrates the benefit of simple memory strategies for older adults, including those with SMD, in office-based settings. Translation to everyday settings is complex and may require prior intervention to increase motivation.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7–18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Perseverative thoughts and subjective health complaints in adolescence: Mediating effects of perceived stress and negative affects

Stable tendency to perseverative thoughts such as trait rumination and worry can influence somatic health. The purpose of the study was to investigate the relationship between perseverative thoughts and somatic complaints, and the possible mediating effects of perceived stress, negative and positive affectivity in adolescence. Having an acute or a chronic condition was also assessed to be controlled for and to reveal their effects on symptom reporting. Three hundred and six adolescents from 7th to 12th grade with mean age of 16.33 (SD = 1.29) participated in the study. Mediation analysis suggested that impact of trait-like perseverative thoughts on complaints were mediated by perceived stress and negative affectivity. Having an acute condition had also an effect on symptom reporting through increased negative affectivity. Our results highlight that ruminations or worry as stable intrapersonal characteristics are relevant processes in health and can be potential targets in prevention programmes in adolescence.     

Subjective health complaints and health related quality of life in a population of health care workers

The aim of this study was to assess whether Subjective Health Complaints (SHC), demands and coping are associated with health-related quality of life in a population of health care workers. One hundred and nineteen employees in two nursing homes for the elderly filled in a questionnaire on health, exercise, psychological factors, and work conditions. Main outcome measures were SHC and quality of life measured by SF-36. High level of SHC was associated to low health-related quality of life. Low coping and high demands were related to low scores (low quality of life), and high coping and low demands to high scores on mental health. Pseudoneurological complaints (e.g. tiredness, sadness), high demands and low coping were associated with low mental health. The expected negative association between SHC and health-related quality of life was found. There was a positive association between coping and quality of life.