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Practicing within a theoretical framework and treatment methodology that have vastly expanded the efficacy of talk therapy first imagined by Freud, modern analysts have historically embraced working with difficult patients.
In “When the Body Does the Talking,” Rory Rothman describes the challenges encountered and insights gained in working with somatizing patients over a long-term course of treatment. Case studies are presented, each unique in regard to symptoms, but all revealing unmentalized instinctual conflicts enacted through the body and provoking negative countertransference experiences such as numbness, anxiety, and the feeling of being invaded.
Using Hyman Spotnitz's and Phyllis Meadow's contributions as a clinical and philosophical basis from which to conduct treatment, Rothman has built a theoretical framework to further understand her cases by investigating the writings of (among others) Eugenio Gaddini, Joyce MacDougall, and Andre Green, all of whom emphasize the drives and early mental states, as well as the work of Pierre Marty and the Paris School of Psychosomatics.
Rothman characterizes somatic symptoms as revealing unspoken inner conflicts. Maturationally, these patients exist (or are trapped)