Efficacy of Writing a Dialogue between Good Me and Bad Me in Relieving Negative Affect Projected onto the Therapist : Report of a Case

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  • Ogawa Ryuichi
    Department of General Internal Medicine, Sasebo Kyosai Hospital Department of Internal Medicine, Fukuoka Teishin Hospital

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Other Title
  • 二人の自分の対話という形式でのレポート記載が治療者に投影された陰性感情の緩和に有効であった心因性嚥下障害の1例
  • 症例研究 二人の自分の対話という形式でのレポート記載が治療者に投影された陰性感情の緩和に有効であった心因性嚥下障害の1例
  • ショウレイ ケンキュウ フタリ ノ ジブン ノ タイワ ト イウ ケイシキ デ ノ レポート キサイ ガ チリョウシャ ニ トウエイ サレタ インセイ カンジョウ ノ カンワ ニ ユウコウ デ アッタ シンインセイエンカ ショウガイ ノ 1レイ

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<p>It is critical how a therapist deals with patient’s negative affect projected onto him in the treatment of psychosomatic diseases. I report a case of psychogenic dysphagia in whom writing papers in the form of a dialogue between good me and bad me was effective in relieving negative affect projected onto the therapist. A male in 40’s had been suffering from locked up feeling of throat and difficulty in swallowing since he was a junior high school student. While he had already been treated with a variety of pharmacotherapies and psychotherapies, his symptoms were not relieved and the amount of food intake and body weight were reduced. He was admitted to our hospital with alexithymia and depressive state and was treated following behavior restriction therapy. He wrote reports describing his feelings and thoughts every day. His social activities were reduced and the concept of good me and bad me was introduced to him. It was difficult for him to understand the concept in the beginning. A series of medical interviews were conducted by the therapist referring to the reports written by the patient. Step by step he learned to understand the concept and share it with the therapist. Nevertheless, he exploded with rage against the therapist because of poor relief of his symptoms. His negative affect projected onto the therapist expanded and the treatment fell into a tense critical situation. He was proposed to write reports in the form of a dialogue between good me and bad me by the therapist. He followed the proposal reluctantly. His negative affect projected onto the therapist was gradually relieved and the patient-therapist relationship improved subsequently. He learned to reflect his own feelings and thoughts. His symptoms were eventually relived. In conclusion, writing reports in the form of a dialogue between good me and bad me was considered to be effective in relieving patient’s negative affect projected onto the therapist, developing a good therapeutic relationship and facilitating patient’s introspection in the treatment of psychosomatic diseases.</p>

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