Relational psychosomatics

1. Introduction

Version followed: Sami-Ali's relational theory as he applied it clinically in Corps et âme : pratique de la théorie relationnelle (2003) and Le rêve et l'affect (1997), built on Corps réel, corps imaginaire (1977), Le banal (1980) and Penser le somatique (1987); supplemented by the Centre International de Psychosomatique (CIPS, now CIPSR Sami-Ali, Paris) volumes of the EDK series Recherche en psychosomatique (Boquel 2008, 2009; Bensoussan 2013). The primary books were read through excerpts and quotations, not in full [uncertain]. Note on spelling: the terms are French; English renderings are mine.

Relational psychosomatics is first a theory (with a method of thinking, not a manual). Its authors say so: a new therapy of body and soul is "not a matter of applying a method" (Sami-Ali, intro to Affect et pathologie, 2013). What follows gives the clinical procedures its authors actually describe; where I turn them into steps, the step order is [synthesis].

Core idea: the psychic and the somatic are both relational ("le psychique est relationnel au même titre que le somatique", Convergences 2014). Relation precedes the terms it links. It has dimensions of space, time, dream and affect (later also mother tongue). Illness of the real body tends to arise when the person is in an impasse (a situation with no way out) and when the imaginary as a function (the dream and its waking equivalents) has been repressed into a conformist, adapted, "banal" way of living (the pathology of adaptation). Change happens when therapy, in a live face-to-face relation, gives dreams and affect back their place, links them to present and past, and so transforms the terms of the impasse until it dissolves, "à défaut d'être résolue" (failing being resolved) (Sami-Ali 2003, p. 24-25). [source: Sami-Ali 2003 and 1987 as quoted in UCLouvain thesis ch. VII; Convergences extract; Boquel 2008 extract]

2. Framework

No staged protocol, session count or manual exists in the sources; Sami-Ali explicitly rejects a fixed method [source: Sami-Ali 2013 intro]. What is documented:

• Format: individual therapy, face to face, "à raison d'une séance par semaine" (once a week) (Sami-Ali 2003, p. 28), deliberately unlike the couch with a neutral analyst out of sight. Duration is open-ended; no typical total number of sessions is given [uncertain]. With physically ill patients (e.g. cancer) there is "no pre-established frame but a space to build" (Bensoussan 2013), because psychotherapy is rarely what the patient first asked for. Children: drawing and play alongside talk (Nanzan journal case report) [secondary].
• Training/recognition: CIPS (Paris, founded 1986 by Sami-Ali) trains doctors, psychologists, psychotherapists, psychomotor and relaxation therapists; it describes itself as recognised by the FF2P [source: CIPS Palermo 2013 presentation]. Current CIPSR training runs as weekend seminars with case-based "analyse de la pratique"; a DU in relational psychosomatics exists at Université Côte d'Azur (Nice) [source: CIPSR 2024-25 programme; UCA DU page].

The sequence below is my ordering of the moves Sami-Ali describes in Corps et âme; the moves are his, the phase labels and transition criteria are [synthesis].

3. Guiding principles

[source: as tagged per line]

• The relation comes first. Subject and object are made by the relation, not the reverse (Boquel 2008, citing Sami-Ali). Practice: read every symptom, dream and session event as a relational fact, including the relation with you.
• Psychic and somatic are both relational; causality is circular. No "mysterious leap" from mind to body (Convergences 2014). Practice: never tell a patient their mind caused their illness; look for the relational situation in which both changed.
• Unity, not division. The approach rejects splitting psyche and soma; Bensoussan's "reciprocal inclusion of subjective and objective" (Santé Mentale 2017 abstract). Practice: take the organic illness as seriously as the distress, and work alongside medicine.
• The imaginary is a function that can be repressed, not a deficit. "Pas une carence mais un refoulement caractériel parfaitement modifiable" (1997, p. 186). Practice: do not label the patient "unable to symbolise" (Sami-Ali rejects the "lack of mentalisation" model, Convergences); assume the capacity is there and blocked.
• The dream is the central axis. "Prendre l'activité onirique comme l'axe central" (2003, p. 24-25); dream repression precedes affect repression (Bensoussan 2013). Practice: ask about dreams in every phase.
• Do not take dream absence literally. Treat "I never dream" as a negative manifestation of something, not a fact (Bensoussan 2013; Seabra). Practice: hold the dream's place open even when empty.
• Do not interpret by reduction. Interpretation "reduces, brings back to something else" (Convergences); dreams are not wish-fulfilments to decode. Practice: link and receive; don't translate symbols.
• Meaning of a somatic symptom is created, not discovered (Seabra, citing CIPS authors). Practice: no symbolic reading of a lesion; accompany the patient's new interest in their own functioning.
• Dissolve, do not resolve, the impasse. Practice: aim at changing how the terms are held (impasse → conflict), not at finding "the solution".
• Think impasse in order to see it. "Il faut penser à l'impasse pour pouvoir la percevoir" (Boquel 2008). Practice: keep the impasse hypothesis actively in mind; it is easy to miss under adapted, factual talk.
• Do not recreate the impasse in therapy. Dream-telling and a mishandled (sometimes medical) relationship can rebuild it (2003, p. 27). Practice: monitor whether the therapy itself has become a no-exit situation.
• No technical neutrality. Neutrality as technique and role-play "parfois s'avère délétère" (2003, p. 28). Practice: be visibly present, face to face, with your own affect available.
• Receptivity. "Recevoir sans déformer" (receive without distorting) by a projected reading grid (Boquel 2008, 2009). Practice: put your theory down while listening; prefer receptivity over knowledge (Boquel 2009, p. 43).
• Spontaneity. An active stance that affects the other beyond objectification (Boquel 2008). Practice: let yourself respond as a person, not only as an instrument.
• Therapist's own dream and affect life. Free access to it, "la sienne autant que celle de l'autre" (Bensoussan 2013). Therapy unfolds according to the therapist, not an intellectual process (Sami-Ali, via Bensoussan). Practice: track your own dreams, boredom and feelings about the patient as clinical data.
• Non-savoir (not-knowing). A deliberate "non-knowing" and "non-practice" frees the patient from fixed objectifications (Boquel 2009, p. 14). Practice: tolerate not knowing where the session goes.
• The imaginary is not automatically curative. "L'imaginaire n'a pas la vertu curative qu'on serait tenté de lui attribuer" (2003, p. 27); the protective negative correlation between imaginary and somatisation operates only once out of the impasse. Practice: return of dreams is not proof of safety; stay alert to somatic events.
• Symptom variability. Health and illness move along a single process; symptoms can shift between registers (Imaginaire et pathologie, ISPA; Bensoussan 2017). Practice: expect symptom displacement (e.g. from body to mood) and read it relationally.
• Mother tongue matters. It must be considered especially when setting up the therapeutic situation (Convergences). Practice: when possible, let the patient speak, dream-tell and swear in their first language.
• Banality is the adaptive eclipse of the imaginary. "Une subjectivité sans sujet" (Sami-Ali 1998, via UCLouvain). Practice: hear clichés and factual over-adapted talk as the symptom of the functioning, not as uncooperativeness.

4. Intervention inventory

The sources describe clinical moves and stances, not scripted exercises. Each entry below is a move the CIPS literature documents; step sequences and all example wording are mine unless quoted [synthesis]. No standardised CIPS assessment instrument was found [uncertain]; Rorschach findings appear in research (e.g. high banal content in colitis) but not as a prescribed clinical step [source: Seabra/ALSF].

4.1 Locating the enclosure in the first meeting

• Purpose / when: from the first contact, identify "le type d'enfermement" the person is caught in and gauge available potential in space, time, dream and affect (Sami-Ali 2003, p. 24) [source: UCLouvain ch. VII].
• Steps: (1) Let the person tell their story, symptom and medical course in their own order. (2) Note life events around onset and flare-ups, especially losses. (3) Listen for a situation with no exit: two options that both fail ("lose oneself in the other or be lost without the other", Nanzan paper's formula). (4) Ask about dreams (4.3). (5) Note time (rhythm, sleep, chronology), space (home, body, closeness/distance), affect (named or absent). (6) Form a provisional hypothesis: failed repression (imaginary body, functional, reversible symptoms), successful repression (banal adaptation, real-body lesions), or a shift from one to the other, often after a loss (Imaginaire et pathologie, p. 326-328).
• Example language (illustrative): "What was going on in your life, around you, in the months before this started?" "When you think about that situation, was there any way out that would have worked?"
• Watch for: the patient's discourse being purely factual (a clue to adaptation pathology, not a non-finding). Working sign: you can describe, privately, the two horns of the impasse.

4.2 Setting and building the frame

• Purpose / when: from the start; establishes a face-to-face, once-weekly relationship in which you are present rather than neutral (2003, p. 28). With medically ill patients, build the frame "de toute pièce" because they rarely came for psychotherapy (Bensoussan 2013).
• Steps: (1) Sit face to face. (2) Agree weekly sessions, open duration. (3) Name the initial "malentendu" (Bensoussan 2013): they come for distress, you are also interested in the illness. (4) Say plainly that you will be interested in their dreams. (5) Agree contact with treating physicians (4.17).
• Example language (illustrative): "I'll be interested in your illness and your treatment as well as in how you feel, because here we don't separate the two."
• Watch for: the frame becoming one more adaptation task the patient complies with. Working sign: patient uses the space for something unplanned.

4.3 Introducing the dream into the relationship

• Purpose / when: early and repeatedly; core act of the therapy. The therapist must "rappeler que les rêves existent, qu'ils ont leur place dans la relation thérapeutique" (1997, p. 231). Simply saying their importance can bring "un changement véritable" (2003, p. 25). Interest in dreams was explained "dès la première séance" in the Nanzan cases.
• Steps: (1) In the first or second session, state that dreams matter here. (2) Ask whether they dream, remember, used to dream as a child. (3) Invite them to bring any dream, fragment or image, however small. (4) Return to the question periodically without pressure.
• Example language (illustrative): "Here, dreams have a place. If anything comes back from the night, even a scrap, bring it."
• Watch for: dream fragments ("par bribes", Boquel 2009, p. 29) as a first result. Return of dream memories is often the first therapeutic effect (Boquel 2008).

4.4 Handling "I don't dream"

• Purpose / when: when the patient reports no dreams or a "néant" dream life (Sami-Ali's Mme G, 2013 intro). In successful repression, dreams exist objectively but not subjectively (Imaginaire et pathologie, p. 326).
• Steps: (1) Do not accept the absence as fact; Sami-Ali calls for recognising "the negative manifestation as a manifestation of the negative" (via Bensoussan 2013). (2) Do not insist or demand either. (3) Explore the absence itself: since when, after what. (4) Keep the dream's place open in each session. (5) Note waking equivalents of the imaginary (daydreams, images, play, humour).
• Example language (illustrative): "So the night is blank at the moment. Since when has it been like that? Was it ever different?"
• Watch for: your own rigid belief in the absence: such a priori belief would "only confirm the repression" (Seabra). Working sign: an initial dream eventually arrives (4.6).

4.5 Receiving a dream without reducing it

• Purpose / when: whenever a dream is told. Dreams are not objects in themselves (Boquel 2009, p. 20, 26) and not decoded wish-fulfilments (Convergences).
• Steps: (1) Receive the dream with interest; let it be told fully. (2) Ask what the patient makes of it ("À ma demande sur ce qu'elle comprend de son rêve", Boquel 2009, p. 22). (3) Reflect a concrete detail back (the Nanzan therapist's "avec des lunettes ?"). (4) Ask about the affect in the dream. (5) Avoid symbolic translation; Boquel criticises even the patient's own stock symbolism (pelvis = maternal womb) when it closes rather than opens. (6) Go to linking (4.7).
• Example language (illustrative): "What do you make of it?" "What did you feel there, in the dream?"
• Watch for: dream-telling becoming another dutiful report that recreates the impasse (2003, p. 27). Working sign: dreams change in content or in the dreamer's position across sessions.

4.6 Recognising the initial dream

• Purpose / when: "La première constante est le rêve initial" (2003, p. 28-29): it arrives after a variable time, is transferential, and sketches the whole future course. Sami-Ali names further constants that are not covered here [uncertain].
• Steps: (1) Note the first substantive dream carefully, verbatim if possible. (2) Read it as a statement about the relationship that has begun, and about the impasse. (3) Keep it in mind as a reference for later dreams; do not hand the patient a forecast.
• Example language (illustrative): "This is the first dream you've brought here. Let's keep it with us."
• Watch for: later dreams that rework the same scene; the Nanzan author describes a "rêve-feuilleton" (serial dream) where a fixed scene becomes dynamic and the dreamer moves from passive to active (that author's concept, not Sami-Ali's).

4.7 Linking dream, present and past

• Purpose / when: once dreams return; restores continuity and historicity. Establish "des liens entre le présent et le passé, allant jusqu'à l'enfance" (2003, p. 25), "liens simples mais vrais" (via Bensoussan 2013), as "un travail de mise en rapport qui s'effectue en commun" (2003, p. 25).
• Steps: (1) Ask what happened the day before or in the week of the dream. (2) Ask what the dream recalls from earlier life. (3) Offer one simple, concrete link at most, tentatively. (4) Let the patient correct or add. (5) Show by example that dream and waking can include each other ("initiation" to dream life, 2003).
• Example language (illustrative): "You dreamed this the night after the hospital appointment. Does that fit?" "Does this house remind you of anywhere?"
• Watch for: links that are clever but not "true" to the patient. Working sign: the patient starts linking spontaneously.

4.8 Working with the impasse

• Purpose / when: the core of the work once a hypothesis exists. Goal: "transformer les termes même de l'impasse en libérant tout l'imaginaire entravé" (2003, p. 24-25); the impasse becomes a conflict and dissolves. The impasse is a closed relational conflict where every apparent exit is illusory, unlike the hysterical case where a solution exists but is refused (Bensoussan 2013). It is "above all an impasse of thought" (Nanzan paper).
• Steps: (1) Keep the impasse in mind actively (Boquel 2008). (2) Help the patient represent the situation in words or images, not to fix it. (3) Look for the "except" in the formula that thought had closed off (Nanzan paper). (4) Use dreams that show the impasse undisguised (Mme A.'s "rêve d'impasse", Boquel 2009, p. 25-26). (5) Expect affect to be released as the impasse is represented (p. 26). (6) Resist offering practical solutions as the goal; the aim is a progressive awareness (Seabra).
• Example language (illustrative): "It sounds as if staying costs you yourself, and leaving costs you her. Is that what it's like?"
• Watch for: the impasse being re-enacted with you (4.15). Working sign: the patient can speak about the situation as a conflict with sides, rather than as a fact of life.

4.9 Freeing affect and mourning

• Purpose / when: when losses or griefs appear. Repression of affect, especially in mourning, always goes through repression of dream activity (2003, p. 26); a shift from failed to successful repression is often linked to grief (Imaginaire et pathologie, p. 328). Once dreams return, very early affects emerge, often guilt-tinged, revealing early impasses (2003, p. 26).
• Steps: (1) Date the losses against symptom onset and dream loss. (2) Let affect be present in the room; Boquel suggests affect may be "la voie principale" for dreams to transform (2009, p. 36). (3) Expect guilt and childhood material; receive it without hurrying.
• Example language (illustrative): "You stopped dreaming around the time your father died. What happened to the grief?"
• Watch for: a changed relation to the loss (Mlle R.: "Je suis maintenant en paix avec l'accident", Boquel 2009, p. 35).

4.10 Attending to time and rhythm

• Purpose / when: throughout; time is a dimension of the relation (biological rhythms, sleep-wake, history). Under banality events lose history and collapse into a redundant present (Bensoussan 2013); Seabra lists circular, linear, repetitive and discordant temporalities of the impasse.
• Steps: (1) Note how the patient tells time (tangled chronology, everything the same, no future). (2) Notice your own feeling of being lost in it (Mme H., Bensoussan 2013). (3) Help reconstruct sequence and dating gently. (4) Aim at sharing the same temporal coordinates and rhythm in the room (Seabra).
• Example language (illustrative): "I'm losing track of the order. Can we put the events in sequence together?"
• Watch for: depression invisible because it is "blended into life" with absent hope and therefore absent demand (Philippe, Bensoussan 2013).

4.11 Attending to space and the body

• Purpose / when: when posture, bodily habits, closeness/distance or spatial disorientation appear. Having a body is equated with having a space (Karroum, citing Sami-Ali); Corps réel, corps imaginaire frames this theoretically.
• Steps: (1) Observe the body as it presents in the session or in reported activity. (2) Ask the patient how they understand it, rather than telling them ("Je lui demande comment elle peut comprendre cette cambrure lombaire", Boquel 2009, p. 30). (3) Relate it to relational positions only if the patient can take it up.
• Example language (illustrative): "You describe arching your back right at that moment. How do you understand that?"
• Watch for: sliding into symbolic interpretation of lesions (see 4.13). Body work in these sources is observation and questioning, not touch.

4.12 Hearing and loosening banality

• Purpose / when: in adaptation pathology: clichés ("c'est la vie", Bensoussan 2013), objective, reality-bound talk, a depersonalised social role that masks transference (Seabra).
• Steps: (1) Register cliché and factual talk as the form of the functioning. (2) Do not answer in kind (no reassurance by cliché, no technical neutrality). (3) Bring in your own spontaneous, specific response (4.14). (4) Use paradox or unexpected framing to unsettle purely rational thought; Boquel names "paradoxe" and "koân" (2008) without spelling out procedure [uncertain on how]. (5) Return to dreams and affect as the counterweight.
• Example language (illustrative): "You say 'that's life.' I find myself wanting to ask: whose life?"
• Watch for: your own boredom; Bensoussan treats boredom as a thread running from present to past. Working sign: one personal, non-generic detail enters the talk.

4.13 Accompanying, not interpreting, the somatic symptom

• Purpose / when: whenever patients ask "why did I get this?" In real-body (literal, neutral) somatisation the symptom has no symbolic meaning in its genesis; meaning is created afterward (Seabra). Interpreting the symptom is ineffective (Moreau, via Seabra).
• Steps: (1) Do not offer a psychological cause of the disease. (2) Actively counter direct causality and self-blame (Paul, who blamed his cancer on lifelong guilt, Bensoussan 2013). (3) Welcome the patient's new curiosity about their functioning and let them make their own sense. (4) Treat any meaning as a bridge from literal to figurative, not as an explanation.
• Example language (illustrative): "I don't think your feelings gave you this illness. What I'm interested in is what you have been living through, with it."
• Watch for: guilt increasing after sessions: a sign you or the patient have slipped into linear causality.

4.14 Therapist stance: receptivity, spontaneity, own dreams

• Purpose / when: constant. Receptivity: "recevoir sans déformer" (Boquel 2008, 2009); spontaneity: affecting the other (Boquel 2008); "résonance syntone" in an authentic, reliable presence and free access to one's own dream and affect life (Bensoussan 2013); the therapist as a possible "new object" (Seabra).
• Steps: (1) Before sessions, set aside your diagnostic grid. (2) Notice your own affects and any dreams you have about the patient [sources mention the therapist's dream life; a procedure for using therapist dreams was not found, uncertain]. (3) Let a genuine response show where it can help. (4) Prefer receptivity when knowledge and receptivity compete (Boquel 2009, p. 43).
• Example language (illustrative): "I notice I felt sad just then, more than you seemed to."
• Watch for: spontaneity becoming self-disclosure that centres you; neutrality creeping back as safety.

4.15 Preventing the therapy from becoming the impasse

• Purpose / when: whenever sessions feel circular. Dream-telling can "recréer de nouveau l'impasse à l'intérieur d'une relation thérapeutique" (2003, p. 27); with Mme H. the relationship must not repeat a distant parental bond (Bensoussan 2013); analytic thinking can mirror repetition (Boquel 2009, p. 23).
• Steps: (1) Ask yourself which relational position you are being placed in (the absent one, the demanding one). (2) Check whether the therapy has two options that both fail for the patient (e.g. bring dreams = obey; don't = fail). (3) Shift your position: drop the demand, change pace, or say what you notice. (4) Revisit the frame if needed.
• Example language (illustrative): "I wonder if bringing dreams here has become one more thing you must do right for someone."
• Watch for: compliance without change. Working sign: the patient brings something unbidden.

4.16 Taking the mother tongue into account

• Purpose / when: with bilingual or migrant patients and when setting up the therapy (Convergences: mother tongue "finally determines what we are").
• Steps [synthesis beyond the principle]: (1) Ask which language they dream and swear in. (2) Invite key words, dream lines or childhood phrases in that language. (3) Ask for their felt meaning rather than translating them.
• Example language (illustrative): "In which language was the dream? Say it to me in that language first."
• Watch for: a shift of affect when switching languages.

4.17 Coordinating with medical care

• Purpose / when: always, with somatically ill patients. Faced with the real body and vital risk, the psychotherapist becomes a co-therapist and must attend to exchanges among caregivers; Bensoussan recommends collaborative exchanges between GP, psychiatrist, psychologist and organ specialists, with the patient included, and "décloisonnement des pratiques" (2013). CIPS practice is embedded in dermatology, oncology, gastroenterology and psychiatry settings (Karroum; 2024 colloquium list). Sami-Ali warns that dichotomous thinking leads the doctor to act on the psyche and lose the unity of the phenomenon (Convergences).
• Steps [ordering synthesis]: (1) With consent, identify the treating physicians at intake. (2) Never suggest stopping or delaying medical treatment; psychotherapy is complementary. (3) Share, with consent, relational observations useful to care (e.g. timing of flares with losses), not psychological explanations of the disease. (4) Invite the patient's voice in exchanges. (5) Ask for medical review promptly when new or changing symptoms appear (symptom variability, and the warning that the imaginary is not automatically protective, 2003, p. 27). (6) Be ready to support the patient's position in medical decisions without deciding for them (Paul asked the psychiatrist's view on surgery, Bensoussan 2013).
• Example language (illustrative): "I'd like to be in touch with Dr X so we're working on the same person, not two halves. What would you want me to share?"
• Watch for: being drawn into causal blame ("it's psychological") by either patient or team; the therapy being used to avoid medicine.

4.18 Ending

• Purpose / when: not specified as a technique in sources [uncertain]. Case endings show a changed relation to the conflict or loss (Mlle R., Boquel 2009, p. 35) and, in the Nanzan child case, finishing an unfinished drawing at the last session.
• Steps [synthesis]: (1) Look for: regular dream life linked to waking, affect available, the impasse thinkable as a conflict, symptom course discussed with physicians. (2) Name ending ahead of time; review the dream series with the patient, including the initial dream. (3) Leave the door open.
• Example language (illustrative): "Looking back at the first dream you brought, what has changed?"
• Watch for: ending that repeats an abrupt loss.

4.19 Children: drawing and play

• Purpose / when: with young children (secondary source: Nanzan paper, bereaved 4-year-old seen again at 8). CIPSR training includes child relational psychotherapy and "art and drawings" [source: CIPSR 2024-25 programme; content not described].
• Steps [mostly synthesis]: (1) Offer drawing and play materials with some verbal exchange. (2) Treat drawings and play like dreams: receive, ask, link simply. (3) Keep continuity across gaps; offer to finish unfinished work at the end.
• Example language (illustrative): "Do you want to finish your drawing from last time?"
• Watch for: parents' relational situation; work with parents is not described in sources [uncertain].

5. Handling problems

Sources address few of these directly; tags mark which is which.

• "I don't dream" / no material. See 4.4. Expect it in adaptation pathology; it is not failure. Stating the dream's place is itself an intervention (2003, p. 25). Do not press; persistence of interest over months is normal [source: Sami-Ali via UCLouvain; Bensoussan 2013].
• Flat, factual, banal discourse; no apparent transference. The depersonalised social role hides the transference (Seabra). Respond with specific presence, not neutrality; use your boredom as a clue (4.12) [source: Seabra; Bensoussan 2013].
• Stuck: sessions circle. Ask whether the therapy reproduces the impasse (4.15); revisit time and space (4.10-4.11); return to the initial dream [source: 2003, p. 27; synthesis for the sequence].
• Patient wants the symptom explained or cured, not therapy. Name the "malentendu" openly (Bensoussan 2013); keep medical care primary for the disease; offer the therapy as a place for what they are living with it [source + synthesis].
• Self-blame ("I gave myself cancer"). Actively counter linear causality (4.13) [source: Bensoussan 2013].
• Symptoms shift or a new somatic event arrives as dreams or affect return. Expected under symptom variability; the imaginary is not automatically protective while the impasse holds (2003, p. 27). Ensure prompt medical review; then explore the relational situation around the change [source + synthesis].
• Overwhelm when affect and early guilt return. Slow the linking; stay with present-day containment; space out dream work for a time; consider increasing session frequency if needed [synthesis; sources only note that early, guilt-tinged affect emerges, 2003, p. 26].
• Depression or suicidality. CIPS reads depression as relational enclosure (Bensoussan 2013), but this does not replace standard suicide risk assessment and, where indicated, psychiatric referral; do the formal assessment and coordinate (4.17) [synthesis].
• Non-adherence (missed sessions, no dreams brought, refusal of advice). Treat as relational information about the impasse, not defiance; avoid making attendance or dreams a demand (4.15). Mlle R. refused the therapist's advice to delay a diving level; the authors simply noted her need to prove herself (Boquel 2009, p. 29-30) [source + synthesis].
• Ruptures. Ask what position you have taken (absent, intrusive, neutral); acknowledge your part spontaneously and simply; repair through the relation, which is the therapy's medium [synthesis consistent with non-neutrality, 2003, p. 28].
• Patient uses symbol-dictionary readings of dreams. Gently open rather than confirm closed readings (Mme A., Boquel 2009, p. 22-24) [source].
• Face-to-face is too exposing for some patients. A UCLouvain critic notes this possibility. Adjust seating angle or pace while keeping presence [source: UCLouvain ch. VII comment; response is synthesis].
• Therapist pulled into knowing. Return to receptivity and non-savoir (Boquel 2009, p. 14, 43); seek CIPS-style case discussion/supervision ("analyse de la pratique") [source].
• Medical team splits psyche and soma or refers "because it's psychological". Re-frame with the team: the work is complementary, not causal; propose shared meetings including the patient (Bensoussan 2013) [source + synthesis].

Sources

Sources:

• UCLouvain thesis, ch. VII "Sami-Ali : le refoulement de l'imaginaire et l'impasse relationnelle" (quotes Sami-Ali 1987, 1990, 1997, 2003)
• Boquel et al., Recherche en psychosomatique. Impasse, handicap et traumatisme (EDK 2009), open-access PDF
• Boquel, Boukhobza, Chahbazian (dir.), Affect refoulé, affect libéré (EDK 2008), extract
• Sami-Ali, Convergences. Essais de psychosomatique relationnelle (EDK 2014), extract
• Cady (dir.), Affect et pathologie (EDK 2013), extract with Sami-Ali introduction
• Cancer et psychosomatique relationnelle (EDK 2013), extract: Sami-Ali intro, Bensoussan chapter
• Seabra, "El síntoma somático dentro de una teoría psicosomática relacional" (ALSF Chile)
• Seabra, same article, CeIR e-journal V1N1
• Sami-Ali, Imaginaire et pathologie (ISPA repository)
• CIPS presentation, Palermo colloquium 2013 (psychomedia.it)
• CIPSR Sami-Ali, Formations 2024-2025 programme
• Université Côte d'Azur, DU Psychosomatique relationnelle
• 33rd International Colloquium of Relational Psychosomatics, programme 2024 (egora)
• Karroum, relational psychosomatics in hospital practice, Syndicate of Hospitals magazine (Lebanon)
• Bensoussan, "Psychosomatique en psychiatrie", Santé Mentale 214, 2017 (abstract only)
• Nanzan journal article on relational therapy and dream (clinical cases; referred to above as "Nanzan paper")

Further reading (not drawn on in full; quoted via the pages above):

• Sami-Ali (1977). Corps réel, corps imaginaire. Paris: Dunod.
• Sami-Ali (1980). Le banal. Paris: Gallimard.
• Sami-Ali (1987). Penser le somatique : imaginaire et pathologie. Paris: Dunod.
• Sami-Ali (1990). Le corps, l'espace et le temps. Paris: Dunod.
• Sami-Ali (1997). Le rêve et l'affect : une théorie du somatique. Paris: Dunod.
• Sami-Ali (2003). Corps et âme : pratique de la théorie relationnelle. Paris: Dunod.
• Sami-Ali (2014). Convergences. Essais de psychosomatique relationnelle. Paris: EDK.
• Boquel, P., et al. (2008, 2009); Cady, S. (dir.) (2013); Bensoussan, M. (2013), in the EDK Recherche en psychosomatique series.

Not covered here [uncertain]: the remaining "constants" of therapy in Corps et âme; the chapter "Travailler avec l'impasse" in Convergences; any CIPS assessment grid; formal ending criteria; procedure for using therapist dreams; parent work with children; an FF2P listing page (recognition stated only by CIPS itself).