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Communication with Psychosomatic Patient: With a Clinical Vignette “When Words Are Unspeakable: A Bridge Beyond the Silence”
Psychoanalysis 2018;29:72-82
Published online October 31, 2018;
© 2018 Korean Association of Psychoanalysis.

Eun Jin Jahng

Dr. Jahng’s Psychiatric Clinic, Seoul, Korea
Eun Jin Jahng, MD
Dr. Jahng’s Psychiatric Clinic, 313 Teheran-ro, Gangnam-gu, Seoul 06151, Korea
Tel: +82-2-501-7751, Fax: +82-2-501-7736, E-mail:
Received September 14, 2018; Revised October 4, 2018; Accepted October 4, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
What should a therapist do if the patient has lost the ability to speak in sessions? How should the therapist understand and approach this ‘deadly silence’? Psychosomatic patients have poor ability to mentalize their experience, so they create a ‘shunt’ from emotional experience to body bypassing symbolic sphere. This makes psychosomatic patients vulnerable to expressing their emotions in words. With the case vignette ‘When words are unspeakable: a bridge beyond the silence’ written by Wirth in a book “From soma to symbol” we observe how psychosomatic pathology arises, from inappropriate mirroring and poor containment; and how this escalates into a vicious cycle of sin and punishment in the patient’s conscience. This conscience scenario imprisons a talented and creative mind in a dark, silent place, wherein symbols and words are forbidden. This seemingly impossible task of providing silent patients with a ‘talking cure’ finds breakthrough with containment, and transformative thinking using therapists’ reveries.
Keywords : Psychosomatic · Containing · Dream thinking · Transformative thinking · Reverie.

October 2018, 29 (4)
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