Introduction: When the Body Speaks

The body always speaks. The task of the analyst is to listen to what it expresses or conceals in its relative noisiness or quietness. In some cases the patient’s body is ‘loud’ and is the presenting complaint: it is a hated body or a body felt to be in physical pain. In others the body is ‘quiet’, neglected or denied in the patient’s experience, and yet powerfully present in the analytic relationship echoing in the analyst’s somatic countertransference where its as yet unarticulated story is received and gradually put into words.

How we listen to the body and its narrative is filtered through the analyst’s own subjectivity (which comprises bodily and psychic components) and her guiding theoretical and technical principles or assumptions. As analysts we all implicitly and/or explicitly orientate ourselves in our encounters with patients according to theories and assumptions that ideally function as flexible ‘guides’ in our work allowing us to meet the needs of the patient at any given point.

In this book the reader will notice at least four such assumptions, which I will briefly outline and which function as a constant background to my attempts to understand the patients I describe here. I hope that these assumptions have not acquired in my thinking the status of ‘overvalued ideas’ (Britton and Steiner, 1994) – the danger that they can function as such, and can be thus used defensively by the analyst, is always present and needs to be closely monitored.

The book draws on my applied psychoanalytic work with adolescents and adults in forensic and psychiatric settings within the public health service as well as my work as an analyst seeing patients on the couch 3–5 times weekly. In my view psychoanalytic work is defined as such first and foremost by the analyst’s internal setting (Parsons, 2007) and not by the external setting in which one practises or the frequency of sessions offered to the patient. The distinctiveness of psychoanalytic work lies in the analyst’s systema