Transference Neurosis in Patients with Psychosomatic Disorder
Sperling, M. (1967) Psychoanal. Q. 36:342
In this paper Sperling's fundamental formulation is restated, emphasized and elaborated. The psychosomatic patient has not resolved the pregenital relationship to the mother. Consequently the symptom represents a dyadic communication which conveys the idea that being sick allows the child to retain the love of mother; to be healthy and independent would lead to a loss. It is important to note that this is a message which the mother consciously and unconsciously establishes and reinforces. Sperling argues against "anaclitic" therapy as described by Margolin (1954). She maintains that the purposeful introduction of regressive permissiveness, including reassurance and physical touching which Margolin advocates voids the possibility of analysis because the capacity to establish a working transfercnce neurosis has been contaminated.
In essence Sperling finds that what works best is an analysis with little or no parameters. This approach seeks to have the patient express all thc forbidden aggressive impulses and hidden fantasies in thoughts and words which are in turn interpreted in the transference This is illustrated with 3 brief vignettes, a 39 year old paranoid man with chronic diarrhea, a 9 year old boy with ulcerative colitis and a 16 year old girl with anorexia nervosa. All work successfully in analysis. To be sure there are pitfalls. Counter transference is most important. In one of the vignettes, Sperling lost her analytic stance becoming a reassuring mother with the result that the patient's symptoms retumed. A second caveat - everyone must agree that the analyst is in charge. Sperling emphasizes the importance that the analyst is a physician and that he be responsible for medical decisions as well.
Today we would ask about how this stance impacts on the transference. Is she not assuming the role of the omnipotent mother? Might this not be an issue that makcs for difficulty in resolving the transference and thus in the definition of analysis? The author concludes with a word of caution. She feels that physicians with psychosomatic symptoms should not treat these patients. In her view they cannot tolerate the impact of the aggression. In addition other analysts, according to Sperling, tend to ignore psychosomatic symptoms which perpetuates the myth of the mind-body separation. It is her contention that resistance to treating these patients analytically is based on thc analyst's unwillingness to tolerate the impact of pregenitally fixated patients rather than the inappropriateness of the patient.
Kenneth D. Cohen, M.D.
Margolin, 5. (1954) Psychotherapeutic Principles in Psychosomatic Practice. in Recent Developments in Psychosomatic Medicine, ed. E.D, Wittkower, London:, pp.134-153
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