The psychosomatic paradigm: integrative pathways in psychological counselling, clinical psychology and psychotherapy

Abstract

This article considers the psychosomatic paradigm an integration framework in psychological counselling and psychotherapy. Based on psychoanalytic legacies, the model developed into a multidimensional theory that respects the convergence of biological, psychological, social, and ecological systems. This is a transformation of the reductionist towards systemic and meaning-driven practices in the clinic. Central concepts by Franz Alexander, George Engel, and the Chicago School are revisited, demonstrating the progression of developments in the transition from the initial psychodynamic formulations to Engel’s biopsychosocial model. Concepts of alexithymia and allostatic load further refine the specifications of the effects of emotional processing and chronic stress on somatic health. The Pesseschkian’ psychosomatic curve, developed by Arno Remmers, accounts for the progression of symptoms from the disruption of affect to the development of symptoms at the vegetative and organic levels. This diagnostic and therapy-providing model invites clinicians to examine symptom stories in metaphor and embodiment. Recent research underscores the role of epistemic trust and mentalisation in treatment outcomes. Efficiently developed, these capacities promote emotional control, insight into the patient, and treatment adherence. Therapeutic response at the beginning of therapy, dictated by the patient’s beliefs, also foretokens the improvement in the longer term. Strategies applied include Well-Being Therapy, somatically oriented techniques, and clinometric measures like the Diagnostic Criteria of Psychosomatic Research. They facilitate differential, holisticallyoriented treatment and the contextualisation of symptoms. Its significance in the public health and lifestyle medical sectors is in recognising disease and therapy’s structural and social determinants. Ultimately, the paradigm is a humane, collaborative, and person-oriented approach to care.