[Aspects of the preliminary psychotherapeutic phase before analytic treatment of psychosomatically ill patients].

Practical aspects of the treatment of badly affected psychosomatic patients with deficient ego functions are to be presented and discussed here: The presence of the therapist with the patient must be measured in terms of time, space and emotion (not more than 30 minutes; the distance of eye-contact of 1-1,5 m must be kept; kind, dependable devotion). The growth of self-representation and a separate object-representation should be encouraged. This happens a) by enticing the patient to turn his attention from his inner body to the surface of his body and finally to the therapist; b) through the willingness of the therapist to let himself be scrutinized in peace; c) through dialogue between the patient and the therapist. It is of value to attain libidinal cathexis of the body ego of the patient with the help of the therapist and by the patient himself; thereby the old significance can retreat into the background. Overcoming the primary disassociation should be encouraged, namely a) by accepting the limited possibilities of the therapist. b) by showing opposite feelings in the therapist. The present social as well as the previous social situations with the various accompanying inter-personal feelings should make up the content of the discussions between the therapist and the patient in the latter part of the preliminary phase of the treatment. Only after the depicted phase in psychotherapy with badly affected psychosomatic patients attention can be focused on analytical treatment.