My childhood and life experience were instigative in my entering this area of work. It took many years to recognise this for the gift it was and as I matured with increasing self-awareness I paid more attention to the connectedness of messages twixt body (soma) and mind (psyche). I developed a model which I initially referred to as mind and body counselling and now psychosomatic counselling.
Psychosomatic counselling is a way of working which involves looking at how our core beliefs are held in the tissues and postures of the body and how the body attempts to help us identify underlying emotional stresses or imbalance through physical pain or discomfort (1). Outcomes include a deeper understanding of how our thoughts and life experiences have created the habits that inform our body and mind. These emotions affect our attitude throughout life and are expressed through the physical body. Many counsellors, would agree that we set great store in gut-reaction and intuitive sense, in addition to our training and interventional skills. These senses are evidenced in other non-clinical professionals such as police officers, social workers and teachers. A wise tutor, held the view that ‘a gut-reaction is a professional opinion, internalised’.
In order to further my knowledge and credibility I attended lectures and courses on applied psychology, primal therapy, human biology and consciousness. Avidly read many books on relevant topics including trauma, pain and resilience (2) Maximised opportunities to pick-the-brains of other professionals in the field. There are now copious areas of thought and training on the topic, the preponderance being through distance learning (3). Some weave psychosomatic with the esoteric. Herman Muller’s phrase, ‘our issues are in our tissues’, provides a concise illustration of the psychosomatic approach (4). There is now scientific evidence to support the fact that our emotions and feelings influence our state of general health and even affects our DNA. There is a fascinating study conducted by the Institute of Heart Math with regard to the effect of emotions on DNA (5)
Quotes and sayings have hidden truths within them; and to bring home this message the soma may develop the appropriate symptom; for example, giving someone the ‘cold-shoulder’ or referring to another as ‘a pain in the neck or 'thorn in the flesh'. How often we exclaim, ‘it’s written all over your face’, before a friend or partner has spoken a word. The forehead for example indicates our frame of mind and how we approach the ‘world’. Eyes reveal an incredible amount of information instinctively picked up on often at the first meeting. Very few physiognomies are symmetric; one ear or eye maybe slightly lower than the other, the mouth may have a curve up or down; our ‘slant’ on the world. We speak of kind eyes, cold eyes, piercing eyes and famously, the eyes as the 'light of the body' (6).
I was having a quick drink and catch-up with a friend and colleague who was about to return to a job he loathed after his annual leave. Holding his head in his hands, he wailed, ‘I just can’t face it’. His wife telephoned me the following morning saying that he woke with a partially paralysed face; diagnosed later by his GP as Bell’s Palsy.
Abreaction; releasing of unconscious, psychological tension by talking about or reliving events that preceded or caused it has long been acknowledged as therapeutic. Psychosomatic counselling aims to translate physical symptoms which are manifested in place of a suppressed memory or trauma, not immediately available for conscious recall. Searching for the veracity of the emotion as expressed in the pain. Dreamwork is also valuable and should a client agree I suggest they note down their dream-life and bring it to a session. Along with Jung my experience encourages my theory in that our unconscious mind holds resolutions of our conscious dilemmas and manifests these through our dreams, in ways which are unique to each of us (7).
Psychosomatic counselling tends to be utilised often when the client has ‘tried everything’, is exhausted or dipping into depression. It appears that people of-a-certain-age are attracted to the technique, particularly women and of those many who are in their perimenopausal or menopausal years.
In the 19th century the menopause was thought to cause insanity, it was only in the 1980’s that the diagnosis of ‘involutional melancholia’, associated with the menopause, was removed from the Diagnostic and Statistical Manual of Mental Disorders (8). In the 1990’s with the development of hormone replacement therapy, treatment of menopausal women shifted from the domains of psychiatry and psychoanalysis to gynecology and endocrinology (9).
The menopause years can be a traumatic time for some women. There are physical and clinical reasons; the loss of estrogens and other hormones may result in a decline in energy levels, joint pain, depression, panic attacks, anxiety, confusion and even psychosis (10). The way we deal with stress, pain and challenge is linked to our sense of self, our values and family codes. Some of my clients speak of being haunted by symptoms and emotions associated with and symptomatic of the onset of puberty and the menarche, which they had assumed were in the past; such as resurfacing of ‘period pain’. Conditions such as anorexia nervosa and bulimia primarily associated with the young are appearing more frequently in menopausal women (11). In some women intrauterine and urinary problems appears to have their roots in maternal relationships.
‘I can’t see that counselling will do any good’. Were Linda’s first words over the telephone, she continued. ‘Though my GP thought it might help, he thinks my persistent urinary infections are to do with ‘the change’. I have all my mother’s allergies and now her water-works!’
Linda was 56 years old about 5’5” with dark blonde, highlighted bobbed hair framing her round ‘smiley-face’, looking softer than the voice on the telephone. Hands wresting in her lap, she spoke, it seemed without emotion and the smiley face remained fixed as she told her story.
This was our first meeting as she had cancelled several times saying she was suffering from acute stomach pains – I had tried to encourage her to attend this time even if for part of the session.
Linda was animated as she related the happy relationship she had experienced with her father until her parents divorced when she was aged ten. Linda had remained wither mother until going to University and contact with her father lessened when he met and married again. ‘Young enough to be his daughter,’ Linda often stated with a snort. Linda’s mother had since died.
Linda described herself as an unplanned and unwanted child, she felt she knew her mother ‘hated her from the start.’ ‘The day I was born I looked into my mother’s eyes and met an icy gaze from lifeless holes.’
The content of much of our sessions was Linda’s exorcism of the rage she felt towards her mother. Syllables erupting from her tongue with the power and devastation of a volcano as she projected it onto me!
A breakthrough came in Linda’s recalling of her mother’s words during a conversation on family history. ‘We have a very difficult time in the menopause.’ Linda states that she just let the comment go and until now had not thought of it. As Linda was able to acknowledge her mother’s ‘humanity’ she found the rage dissipating along with her infections and pain. ‘Mum’s gone now so I can’t even talk to her about things’. I suggested she write her feelings down, maybe in the form of a letter to her mother. We worked on it together at Linda’s request and she ‘posted’ it on the floor at the foot of her bed!
My remit is specific; I am not a clinician and refer clients on to their GP’s for psychiatric assessment or to the Community Mental Health teams and other professionals. Some clients choose an holistic approach and as such I may remain involved. ‘Thought I’d give it a try’
‘Thought you’d give it a try?’ This hackneyed counselling reflection was more of an echo response due to my bewilderment and frustration. Well, I was weary; Harriett had been attending for over a year and still the same repetitious expounding of her extensive medical history of physical ailments which had surfaced during her perimenopausal years.
Harriett was an adopted child. Confident her childhood was happy, she praised her adoptive parents; they had been, ‘truly wonderful,’ loving, encouraging and supportive; answering Harriett’s queries on her background and roots as best they could. Our psychodynamic ears can prick up on the word ‘adopted’ and we can too readily start drawing our own conclusions. It is she, not myself, who holds the solution – to help her find it, is my task.
‘I believe it may be a ‘blood condition’ so I am seeing a psychic healer as my GP has run out of ideas’. Each session revolved around Harriett’s ‘story’, her most recent trip to the consultant or homeopath or change in medication. I wondered whether I was just another person with whom to ‘hold court’, Münchausen’s even? But she appeared genuinely to be seeking answers and maybe as equally frustrated as myself?
‘Of course I knew it wouldn’t last. My relationships never do, well, no more than a couple of years anyway.’ Harriett was telling of the ending of yet another romance. ‘Just go off them I suppose’.
I pondered with my Supervisor; relationships and illnesses with a similar pattern?
Harriett’s ailments seemed to be diminishing when she began referring to herself as Annie though not one of her given names. I queried that. ‘Oh Orphan Annie, I played her in a school production; no one wanted her, snatched away because she was a naughty little girl’.
I felt this could be a line worth pursuing at our next session to which Harriett agreed.
The person at my door was almost indistinguishable from the Harriett I had seen just a couple of weeks previously. ‘I‘m so frightened, I don’t understand, I thought I was getting better!’ she wailed.
I felt suspicious, a different tack now? I suggested she visit her Gp as she certainly appeared very depressed – even if it was an ‘act’ it was an act of expression. Depression in adulthood may have its roots in unresolved issues of childhood?(12) I considered again the implications of Harriett’s adoption.
During this time Harriett’s mother became ill and was admitted to hospital and as Harriett had no siblings she was responsible for handling her mother’s private affairs including finances, applying for nursing care etc. We put the sessions on hold.
Three weeks later Harriett telephoned, through sobs she relayed that she had found a document of which at first she could make no sense – papers referring to an adoptive child aged two years. She describes her feelings of bewilderment, ‘Mum had another child? Maybe she had died? Why wouldn’t she tell me?’ Further reading left Harriett feeling sick, numbed, ‘Like I’d been hit over the head with a shovel’, as it gradually dawned that this child was in fact herself. Previously named Ann, adopted at birth, yes, but then returned to the children’s home to be adopted aged two years by the people she now knew as her parents.
‘I’m so angry, so bloody angry!’ Then in silence Harriett paced the floor – struggling for words but seemingly unable to express the depth of despair and loss she felt; until sobbing and exhausted, she crumpled into a chair. I cried inside. Neither of us spoke for several minutes– silence in the room, cacophony in the head – making the connections; ‘Orphan Annie’, ‘blood condition’, two year relationships; Harriet had the answers all the time.
Harriett’s depression deepened with suicidal ideation. I contacted her GP who referred her for psychiatric assessment. We began to bring closure on our sessions and at our ‘ending’ Harriett asked if she could contact occasionally to which I agreed.
Several very worrying notes from Harriett had me very concerned about her mental state; until her most recent. A simple one-liner in a Christmas card, which I recognised from the musical ‘Annie’.
‘The sun will come out tomorrow’.
2) Herman J (1992) Trauma and Recovery. Basic Books
4) Australasian Board of Psychosomatic Therapy
5) Institute of HeartMath
6) The New Jerusalem Bible (1990) Matt 6v22 Dartan, Longman, Todd. London
7) Jung C. G. (1995) Memories, Dreams, Reflections. Flamingo
8) American Psychiatric Association. Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association, 1987.
9) British Medical Journal 1996
(10) A Guide for People with Psychosis and their Families First Episode Psychosis:
Centre for Addiction and Mental Health. Toronto
11) Schupska Stephanie University of Georgia
12) Miller Alice (1987)The Drama of Being a Child, Virago London