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The phenomenon of acting-out behaviour alternating with psychosomatic symptoms in the same patient is well known to those who treat psychosomatic patients psychoanalytically. This is a transitory and to some degree regular occurrence during certain phases of the analysis and can be managed psychoanalytically (Sperling 1952), (1955), (1967).
Psychoanalysts encounter more often the reverse phenomenon, namely, the occurrence of psychosomatic symptoms in the analysis of acting-out patients. Some patients who enter analysis because of acting-out behaviour may develop psychosomatic symptoms during the analysis, either for the first time or as a recurrence of such symptoms from the past. It may occur early in the analysis or at any time, even during the terminal phases of the analysis. If this occurs early in the analysis and the symptoms are of a severe nature, the patient is usually dropped from analysis as unsuitable. This happens in private practice and not infrequently in supervisory analysis. This is an undesirable experience, especially for the analyst in training, as it equals a prohibition to treat such patients psychoanalytically. It is unfortunate for the patient who is deprived of analysis when he needs it most, and is left to resort to inadequate therapies such as supportive psychotherapy and tranquillizers, steroids, etc.
If this phenomenon occurs in the terminal stages of analysis, it may be regarded as unrelated to the analysis, and the analysis may be terminated as successful. Here the case of an adolescent boy with acting-out behaviour, presented by a colleague at a meeting, comes to mind. Among other earlier diseases his case report mentioned asthma, but no connection between the earlier asthma and the later actingout behaviour was made by the presenting analyst. Nor was the recurrence of the asthma during the analysis considered as related to the concomitant changes in the patient's overt behaviour. Instead the analysis was terminated as succes