抄録
1. In view of clinical application of transactional analysis and Gestalt therapy, it is convenient to classify psychosomatic disorders into 2 major types : a. Actual PSD in which psychological problems are more related to the actual stress situations of life.b. Character PSD in which patients develop symptoms on the basis of their personality disturbances.2. Egograms are used to diagnose psychosomatic disorders. In general, when the egogram shows high scores in the Adapted Child and low scores in the Free Child, psychological influences are indicated in somatization. However, the egogram is not a proper tool to detect deeprooted personality disturbances such as alexithymic traits and basic faults.3. With actual PSD patients, treatment contracts can be made to cause a shift in energy balance in ego states. Behavior analysis and behavior modification techniques are applied to bolster up weak personality parts. Treatment results are evaluated by therapist and patient together weekly to further improve the patient's daily programs. A treatment contract is expected to be fulfilled successfully within 3 months.4. With character PSD patients, resistances to change need to be considered. The idea of impasse, postulated by Gouldings, is useful to discriminate the difficulties of treatment. Gestalt techniques, which is combined with transactional analysis, are used when the patient is able to be aware of his inner conflicts. The techniques include confrontation by use of chair techniques, use of projections, awareness exercise, dream work, body exercise, saying good-bye, etc.5. Patients with severe ego disturbances cannot tolerate the inner dialogues or attacks in Gestalt therapy. When the patient cannot handle the challenging and confronting manner of the therapist, psychological games may be played in the therapeutic situation. The therapist needs to take caution as he is tempted to play the role of an omnipotent figure. A good working relationship is a prerequisite before any integrative work is launched.
