French psychosomatic school

Domain I · Psychodynamic & depth psychology · Pierre Marty, de M'Uzan, David · 1963 · Paris

What it is

This is a psychoanalytic theory of how psyche and soma are organised, with a matching style of assessment and psychotherapy for people with somatic illness, lesional or functional. It is not a manualised therapy. There is no session-by-session protocol. The founders described the concepts, the…

Format

• Phase 1: Psychosomatic investigation (1–3 interviews). These are face-to-face, unstructured psychoanalytic interviews modelled on L'investigation psychosomatique (1963), which documented seven cases. Goal: assess mental functioning from an economic point of view, looking at all of the person's…
• Face-to-face psychotherapy, 1–3 sessions a week, for serious illness, narcissistic insufficiency, operatory functioning or poor or uncertain mentalisation. This is the usual IPSO indication. Historically, Marty's consultation at rue Falguière saw patients twice a week.

Who practises it, and how they are trained or regulated

• Phase 0: Referral and medical frame. Patients typically come through physicians who sense "something psychic" beyond the complaint. Historically, the School set out to answer questions from non-analyst hospital colleagues. Goal: a shared frame with the treating physician, in which the psychosomatic work runs alongside medical care and never replaces it. Recommended practice: get consent to exchange information, name…
• Who treats: IPSO's position is that these psychotherapies should be done by psychoanalysts with additional psychosomatic training.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• A flare after each reduction in frequency means you should slow the taper.
• Giving too much reassurance can shut down affect. It is working when the patient arrives calmer and can stay with one theme.
• Mockery, or a playfulness the patient cannot share. Respect the patient's level. It is working when the patient laughs, adds lines, or brings a fantasy.
• Mentalisation varies with circumstances, so reassess after life events. A poor rating is a reason for face-to-face maternal work, not for refusing treatment.
• Your boredom or sleepiness is information (see 4.14). It is working when a story slows down and the patient starts adding a feeling, a memory or a comparison.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.