The Body and the Ego Boundaries: A Case Study on Psychoanalytic Therapy With Psychosomatic Patients

Advances in clinical and scientific experience concerning the psychodynamic diagnosis and psychotherapy of psychosomatic patients have taught us to be modest and cautious; we who work within the field of psychoanalytic psychosomatics no longer want to perpetuate long-standing erroneous assumptions, for example, on specific traits and generalizable character pathology in psychosomatic patients—assumptions that have been shown to be too simple and too broad. To use Winnicott's words (1953) in a different context: “There is no such person as the psychosomatic patient”; that is, the range of psychopathology, psychodynamics, and communicative abilities is too wide to encompass a unitary model of psychosomatic disorder. For a long time, the search for specific psychosomatic disturbances (specific conflicts, a specific personality structure, specific affect, regulatory inabilities) was the main research focus of psychosomatic medicine; while this aim could not be attained, the research and clinical work was not in vain, however. Even though all psychosomatic psychopathology cannot be explained within the framework of one concept, a variety of concepts does remain useful. Concepts are theories that are stimulated by hitherto unsolved clinical problems or unusual empirical results and that provide a structural context for