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Psychotherapy with Alexithymic Patients

  • Henry Krystal

Abstract

Alexithymia presents a number of problems in regard to “uncovering”, dynamic, psychoanalytic or “anxiety producing” psychotherapy. In patients with active psychosomatic disease, the patients may, instead of experiencing strong emotion, develop a serious or even life-endangering exacerbation of their illness. Under these circumstances, we must be mindful of Sifneos’ admonition that psychotherapy should be contraindicated (1). In the addictive patients, the increase in intensity of their difuse distress may drive them to drink, or whatever their usual form of drug abuse involves (2). Most of all, the conclusion has been reached by many who have tried it, that these patients simply do not respond to insights derived from psychotherapy (3, 4, 5, 6, 7) or any “form of treatment which emphasized verbal expression and requires a capacity for emotional interaction” (5, p. 261). The hazards of psychotherapy with psychosomatic patients and their peculiar rigidity led Sifneos to caution that any but supportive psychotherapy was contraindicated (8). This peculiar rigidity and unresponsiveness to therapeutic intervention made Sifneos conclude that the defect was organic (8). Studies supplied the statistical evidence of an inherited trait involved in alexithymia (9). But the problem was not laid to rest here.

Keywords

Object Representation Psychodynamic Psychotherapy Psychosomatic Disorder Emotional Interaction Supportive Psychotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1).
    Sifneos, P. E.: 1974. A reconsideration of psychodynamic mechanisms in psychosomatic symptom formation in view of recent clinical observations. Psychother. Psychosom. 24: 151–155.Google Scholar
  2. 2).
    Krystal, H.: 1979. Alexithymia and psychotherapy. Am. J. Psychother. 33: 17–31.PubMedGoogle Scholar
  3. 3).
    Nemiah, J. C., Sifneos, P. E.: 1970. Affect and fantasy in patients with psychosomatic disorders. Modern Trends in Psychosomatic Medicine-2. p. 26–34. Edited by Hill, OW. London, Butterworth.Google Scholar
  4. 4).
    Nemiah, J.C.: Oct. 1978. Alexithymia and psychosomatic illness. J.C. E. Psychiatry, pp. 25–37.Google Scholar
  5. 5).
    Sifneos, P.E.: 1973. The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychother. Psychosom. 22: 257–262.Google Scholar
  6. 6).
    Nemiah, J.C.: 1972. The psychosomatic nature of anorhexia nervosa. Adv. Psychosom. Med. 7: 316–321.Google Scholar
  7. 7).
    Sifneos, P.E.: 1975. Problems of psychotherapy of patients with alexithymic characteristics and physical disease. Psychother. Psychosom. 26: 65–70.Google Scholar
  8. 8).
    Sifneos, P.E.: 1974. A reconsideration of psychodynamic mechanisms in psychosomatic symptom formation in view of recent clinical observations. Psychother. Psychosom. 24: 151–155.Google Scholar
  9. 9).
    Heiberg, A. and Heiberg, A.: 1977. Alexithymia: an inherited trait? A study of twins. Psychother. Psychosom. 28: 221–225.Google Scholar
  10. 10).
    Overbeck, G.: 1977. How to operationalize alexithymic phenomena: some findings from speech analysis and the Geisen test (GT). Psychother. Psychosom. 28: 106–117.Google Scholar
  11. 11).
    Freyberger, H.: 1977. Supportive psychotherapeutic techniques in primary and secondary alexithymia. Psychother. Psychosom. 28: 337–342.Google Scholar
  12. 12).
    Krystal, H.: 1968. Studies of concentration camp survivors. Massive Psychic Trauma. p. 23–30. Edited by Krystal, H. Int. Univ. Press, New York.Google Scholar
  13. 13).
    Krystal, H.: and Niederland, W. G.: 1968. Clinical observations of the survivor syndrome. pp. 327–348. Edited by Krystal, H. Massive Psychic Trauma, Int. Univ. Press, New York.Google Scholar
  14. 14).
    McDougall, J.: 1974. The psychosoma and the psychoanalytic process. Int. Rev. Psycho-Anal. 1: 347–359.Google Scholar
  15. 15).
    Hoppe, K. D. and Bogen, J. E.: 1977. Alexithymia in twelve commisurotomized patients. Psychother. Psychosom. 28: 148–155.Google Scholar
  16. 16).
    Schur, M.: 1955. Comments on the metapsychology of somatiza tion. Psychoan. Study Child. 10: 119–164.Google Scholar
  17. 17).
    Schmale, Jr., A. H.: 1964. A genetic view of Affects: with special reference to the genesis of helplessness and hopelessness. Psychoan. Study Child. 27: 411–436.Google Scholar
  18. 18).
    Krystal, H.: 1975. The genetic development of affects and affect regression. Annual of Psychoanalysis. 2: 98–126.Google Scholar
  19. 19).
    Krystal, H.: 1977. Aspects of affect theory. Bull. Menninger Clin. 41: 1026.Google Scholar
  20. 20).
    Krystal, H.: 1978. Trauma and affect. Psychoan. Study Child. 36: 81–116.Google Scholar
  21. 21).
    Krystal, H.K.: 1978. Catastrophic psychic trauma and psychogenic death., pp. 79–97. (eds) Bales, GU, Wurmser, L. & McDaniels, E. Psychiatric Problems in Medical Practice. Butterworth, Boston.Google Scholar
  22. 22).
    Krystal, H.: Trauma: consideration of its intensity and chronicity. Psychic Traumatization. Edited by Krystal, H., Niederland, W. G. Psychia. Clin. Vol. 8. Little, Brown & Co., Int., Boston.Google Scholar
  23. 23).
    Krystal, H. & Raskin, H.: 1970. Drug Dependence. Wayne State Univ. Press, Detroit.Google Scholar
  24. 24).
    Krystal, H.: 1975. Affect tolerance. Annual of Psychoanalysis, 3: 179–219.Google Scholar
  25. 25).
    Krystal, H.: 1978. Self-representation and the capacity for self-care. Annual of Psychoanalysis. 6: 206–246.Google Scholar
  26. 26).
    Wolff, H. H.: 1977. The contribution of the interview situation to the restriction in fantasy and emotional experience in psychosomatic patients. Psychother. Psychosom. 28: 58–67.Google Scholar
  27. 27).
    Bastiaans, J.: 1977. The implications of the specificity concept for the treatment of psychosomatic patients. Psychother. Psychosom. 28: 285–293.Google Scholar
  28. 28).
    Apfel-Savitz, R., Silverman, D., & Bennett, M. J.: 1977. Group psychotherapy of patients with somatic illnesses and alexithymîa. Psychother. Psychosom. 28: 323–329.Google Scholar
  29. 29).
    Schellschopp-Rueppell, A.: 1977. Behavioral characteristics in inpatient grou psychotherapy with psychosomatic patients. Psychother. Psychosom. 28: 316–322.Google Scholar
  30. 30).
    Braeutigam, W.: 1977. Panel-and Plenum-Discussion: Psychotherapeutic problems with psychosomatic patients. In: Toward a theory of psychosomatic discorders. pp 361–375. Edited by: Braeutigam, W. and Von Rad, M. Basel/ New York: S. Karger.Google Scholar
  31. 31).
    Becker, H.: 1977. A non-verbal therapeutic approach to psychosomatic disorders. Psychother. Psychosom: 28: 330–336.Google Scholar
  32. 32).
    Krystal, H.: The hedonic aspects of affects. Annual of Psychoanalysis IX.Google Scholar
  33. 33).
    Heath, R. G.: 1973. Marijuana effect on deep and surface EGG on rhesus monkey. Neuropharmacology 12: 1–14.PubMedCrossRefGoogle Scholar
  34. 34).
    Marty, P., de M`Uzan, M.: 1963. Le “Pensee Operatoire”. Rev. Franc. Psychoan. 27 suppl. 345–356.Google Scholar

Copyright information

© Plenum Press, New York 1983

Authors and Affiliations

  • Henry Krystal
    • 1
  1. 1.Department of PsychiatryMichigan State UniversityEast LansingUSA

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