Working at the boundaries of intersubjectivity: Toward a clinical conceptualization of somatosensory transmissions in psychotherapy.

摘要

This investigation examines a relatively narrow category of clinical psychological phenomena known as somatosensory transmissions---that is, clinicians' experiences of spontaneous, idiosyncratic physical sensations or bodily symptoms occurring in meaningful relation to the psychotherapy process. I contend that somatosensory-level transactions between patients and therapists constitute a coherent category of clinical phenomena worthy of greater recognition, and more rigorous scrutiny, by psychotherapists. I evaluate existing scholarship relevant to psychotherapy-related somatosensory transmissions and propose a conceptual framework that better organizes the limited-but-growing number of references to these phenomena. I highlight and attempt to address certain insufficiencies within the existing psychotherapy literature relevant to somatosensory transmissions in an effort to formulate more compelling clinical and conceptual understandings of these phenomena and consider their broader implications for evolving psychotherapeutic models.;To bolster my proposals, I identify additional evidence for somatosensory transmissions within empirical research-based disciplines including interpersonal neurobiology, social neuroscience, and developmental science. I focus especially on the work of social neuroscientists who have proposed models of human empathy built upon empirically-validated neurophysiological processes known as perception-action mechanisms. Essentially, these mechanisms are believed to underlie human tendencies to mimic---at neurophysiological levels---certain behaviors, expressions, and sensations observed in others. I review extensive empirical research that supports the existence of perception-action mechanisms---as well as their central role in human empathic functioning and interpersonal relations---and propose conceptual links between these findings and psychotherapists' experiences of somatosensory transmissions.;On this basis, I propose and elaborate an empirically-grounded conceptual model for psychotherapy-related somatosensory transmissions that: 1) better explains how somatosensory transactions between patients and therapists occur, 2) better anticipates with which patients, or under what specific clinical circumstances, these transactions are prone to occur, and 3) offers technical guidance to clinicians for making optimal therapeutic use of these clinical episodes. An illustration of psychotherapy-related somatosensory transmission is also presented to: 1) emphasize the range of clinical circumstances most often associated with somatosensory transmission between patients and therapists, and 2) further elaborate the practical and theoretical implications (and complications) of conceptualizing the psychotherapy process from a more "thoroughgoing two-person" intersubjective clinical framework (Wachtel, 2008).