“Am I crazy or is there a reason that I’m suffering?" Sally looks up with pleading eyes. “I know it’s probably stress related but I’m good at sucking things up and moving on. But for some reason it isn’t working. My stomach cramps up, I am constantly bloated and just feel so uncomfortable in my skin. Can you do your therapy magic and help me feel better? Clearly the medical tests don’t find anything, so this is my next stop”.
Sally looks up. Tears slowly fill her soft chocolate brown eyes. I can see the confusion, worry and despair. I’m glad she’s here as, based on my assessment, her symptoms seem psychosomatic. Thought therapy is far from "magic", body based symptoms are highly treatable using somatic informed, mind-body-focused psychotherapy. We begin the session with a mindfulness exercise and a body scan where she points out areas of discomfort as well as areas of less tension.
This exchange is a common one, where a clients inquires on a consult call or in our first session, seeking relief from chronic pain, discomfort, digestive issues, focusing difficulties and other body-related pains.
If you do, you may experience inexplicable symptoms that seem to come out of nowhere. Common symptoms:
Constipation/ Bloated Belly/ Abdominal Pain
High blood pressure
Some other psychosomatic symptoms include numbness, dizziness, chest pains, weight loss, ongoing cough, jaw tightness, shortness of breath and insomnia. Muscle Paralysis and Non-epileptic Seizures (also known as Pseudo- Seizures) are on the more severe end of psychosomatic pains, and have best results with early-intervention.
The voice of Sally echoes the worry of many who have overturned every rock but have found no cause to their pain. It hurts to hurt, but the pain digs deeper when there is a worry that there is no method of treatment for relief. In these instances, however, there often are. When there is no medical cause, we don’t give up, rather, we are compelled to dig deeper. In my years as a therapist I have treated many individuals who suffered with debilitating pain and finally experienced relief when they finally had the space and support to identify, understand and address the underlying psychological causes.
There are beautiful moments that unfold when working alongside another in their healing. One of the moments is watching how one’s heart expands, and experiences relief when they unleash tension that has been trapped in their body, often, for many years.
As Sally continued her treatment, she began experiencing shifts, insights and reduction in the intensity of her previously confusing symptoms. One early morning Sally came into session with a wise look on her face, excited to share a creative metaphor to her treatment process.
It's like I had a clogged dam. Obviously I don’t have a real dam inside of me, but I had a clogged "emotional dam" that was holding fears and frustration. But bam, I’m slowly clearing it out. And, those tears, I didn’t know I can cry that much. It’s interesting though, because I’m starting to feel lighter when I let go and express those pent up feelings".
There’s a twinkle shining from the corner of Sally’s moist eyes. She gently wipes her salty tears and takes a deep breath. The glow on her face represents that her body is getting enough oxygen. I’ve seen her calm down and take deeper breaths this session than sessions previous. I mirror her body language, and my face breaks into a gentle grin.
Just as I join clients in holding the pain and sadness, I’m equally involved in (sometimes fleeting) moments of relief and subtle shifts. To me, therapy is about helping my clients find their way home; finding home in their own minds and bodies. A way back to themselves. A safe embodiment of self. And right here, we’re on a good track.
The studying of psychosomatic pain has been explored extensively. In 2007, Dr. John. E. Clarke shared that in more than 50% of medical patients, the causes of the symptoms were psychosomatic. Clarke shares that many physicians are not knowledgable about psychosomatic pain and often leave the patient with the message of “it’s all in your head”. Hearing this in response to pain, confusion and debilitating symptoms can be experienced as invalidating and trigger feelings of helplessness.
Dr. John Sarno, a M.D. at the Rusk Institute for Rehabilitation Medicine in New York, is a famous doctor who is known for his famous film called “All the Rage”. Sarno expresses that it is often unconscious rage and inhibited anger that is often a contributing factor to the psychosomatic pains.
What usually happens is that these individuals are often “too nice”. They may be people pleasers, had the responsibility of keeping things“even keeled”, and frequently, taking care of others before their own needs.
Now not everyone who has somatic/body pains have unexpressed anger or rage. Rather, sometimes those symptoms are related to clogged emotions, unexpressed fears, worries, memories, experiences or trauma events that are stuck in the body.
Often, there may not be any “apparent reason” for the distress you’re experiencing, and that is normal too. Whatever the reason, if your body is sending you messages, lean in and listen to its expression.
There is an exchange between the conscious mind (rational, ethical mind) and the unconscious mind (carries repressed hurt, sadness, emotional pain and anger). When the conscious and unconscious are disconnected (or have a “disagreement) that’s when you’ll see psychosomatic symptoms.
For example: if your conscious self wanted to speak up to your dad when he would raise his voice and say “stop yelling” but the unconscious was afraid he would condemn you for being disrespectful and rude. So, you swallow the emotions and put on a show, pretending everything is ok. Here is the disconnect.
Now, one time incidents don’t necessarily leave an impact. However, if you had to shut down your core need for expression on an ongoing basis (due to trauma, messages from your environment), your body accumulates the tension.
Somatic symptoms are a form of asking for relief or change from a situation, self-belief, relationship or memory. The physical discomfort of pain forces you to stop, focus and listen to what’s really wrong.
As Sally leaves the session, her stance looks softer and her muscle tone solid yet flexed and her face looks brimmed with a light glow. When I check in on how she’s doing before we wrap up the session she’s shares:
It’s a new sensation. I’m learning what it’s like to actually live in my body, and not just think of my body as something that comes along with me for the ride. Of course now it makes sense that my belly was bloated most of the time. In my family I had to hold my breath and sift every single thought I wanted to share. There was never a moment where I could sigh a deep breath of relief. What's fascinating is that my thoughts were tiring not just my mind, but also my body. My bloated-ness has gone down, and I now notice when it gets worse. I’m starting to learn how my body talks to me and it’s pretty interesting.
Sally has learned some body focused breathing skills and, as her body settled in, it uncovered something that was bottled up for a while. At first glance, it didn’t seem related to the stress until we listened in. In our work we continued decluttering the layers that have been weighing on her, one session at a time.
Clients like Sally are on a good path of healing, as they work through the pain + learn new ways of being in their skin that help in daily interactions. As a therapist, I want clients to be able to integrate the knowledge and skills way beyond their time on the couch.
If you’ve been holding a lot inside and you’ve been experiencing some psychosomatic symptoms, I want you to take time to get curious and better understand your body and its signals. A small shift can go a long way in experiencing relief.
If you want more tips on finding ways to offer yourself relief, read click here for “ 6 Tips for Relief from Anxiety + Stress related (psychosomatic) pain”.
If you're looking to do deeper work with a therapist to help you heal psychosomatic pains, I encourage you to look for a Mind-Body informed therapist.
Therapy methods such as Somatic Psychotherapies (somatic experience/ sensorimotor psychotherapy), EMDR, Mindfulness Based Stress Reduction, amongst others, have been effective in helping clients heal.
*writings are based off of common themes, however, are in no way specific to client stories to protect confidentiality.
*originally posted on integrativepsych.co
Esther Goldstein LCSW Is An Anxiety and Trauma Specialist With A Private Practice In Cedarhurst, NY. Esther Specializes In Treating Professionals With Anxiety, Survivors of Trauma And Individuals Who Want To Have More Meaningful Relationships. Specialty Areas Include: Family-of-Origin Work, Inner-Child/Ego State work, Trauma Treatment, Attachment Traumas, Complex Ptsd And Dissociative Disorder Treatment. As Well, Esther Provides Trauma Informed Consultation To Therapists Committed To Improving Their Trauma-Informed Practice And Attachment Focused EMDR Consultation To Therapist Attaining Hours Towards EMDRIA Certification. Esther's Website Is Integrativepsych.Co