Working with dual realities: psychological and physical
This chapter describes the approach and techniques used in counselling clients who present with the emotional impact of a physical illness and/or a disability. The intrapsychic conflicts that counselling will aim at bringing to light so that they can be explored will be similar in physical or psychosomatic manifestations. The difference lies in the aim of the counselling, which is to support clients in adjusting to the loss that inevitably accompanies illness and disability and in finding the meaning of the illness for the client. The aim of the counselling is to confront the phantasy and to present reality in a way that allows the client to keep healthy defences and use them in a bid to recognize and overcome manic and destructive defences such as splitting and projection. The phantasy that is likely to accompany some physical illness is that he or she has a psychological aetiology and therefore can be "cured" by the psychological interventions of the counsellor.