The unconscious in work with psychosomatic patients 1

Speaking about the manifestations of the dynamic unconscious in psychosomatic patients calls for a few preliminary remarks. Since the 1950s, different schools of psychosomatics, defending various theoretical models, have argued about the question of the unconscious meaning of somatic symptoms. The hypothesis of the separation of the systems unconscious and preconscious implies that an idea or presentation may exist simultaneously in both places—the thing-presentations in the unconscious, thing-and word-presentations in the preconscious—and advance from one position to the other, Sigmund Freud writes (1915e, p. 175). Preconscious affects of the psychoanalyst can be perceived by the patient and meet in him or her an unconscious potential beginning which seeks to break through. In the analyses of psychoneurosis, the guiding thread that allows us to gain access to unconscious material is free association. In analytic work with non-neurotic patients, actual neuroses, borderline, and somatic cases, one is frequently faced with non-associativity.