Physiological Responses and Clinical Phenomena During the Psychotherapeutic Process

As psychoanalysts, we attempt to understand conscious and unconscious processes by relying on verbal and nonverbal communication. Both verbal and nonverbal behavior, however, are simultaneously accompanied by complex physiological responses involving the voluntary and autonomic nervous systems. For example, talking alone can raise mean arterial blood pressure in normotensive individuals, while silence does not. Certain affects, such as anxiety and anger, are associated with increased autonomic nervous system activity. Patients frequently exhibit frank somatic symptoms during therapy sessions; these include headaches, gastric discomfort, pain, nausea, and various motor or sensory disturbances. Those who suffer from psychosomatic disorders sometimes experience exacerbations of their illness, often in the course of a single session (e.g., migraine episodes, blood pressure elevations, asthmatic attacks).

Normal as well as pathological physiological responses can provide us with a great deal of information about a patient in the course of therapy. They may serve as reliable, objective indicators of significant affects, conflicts, fantasies, and resistances. Historically, psychoanalysts have not placed particular emphasis on the meaning of physical events during treatment. Ironically, Freud (1893) paid a great deal of attention to the pathogenesis of somatic symptoms and eventually described the mechanism of