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Milch, W.E. (1998). Psychotherapy in Severely Disturbed Psychosomatic Patients with Hypertension. Psychoanal. Inq., 18(3):445-468.

(1998). Psychoanalytic Inquiry, 18(3):445-468

Psychotherapy in Severely Disturbed Psychosomatic Patients with Hypertension

W. E. Milch, M.D.

Patients with hypertension are generally treated by the family physician who is well acquainted with psychic factors that can disturb blood pressure regulation. The patients themselves are frequently unaware of the psychic implications of their suffering and are usually not motivated to undergo psychotherapy. Even motivated patients approach therapists cautiously; after the initial interview, months frequently go by before the patient attends a second time or enters treatment.

In patients who suffer from essential hypertension (WHO, 1993) the illness has no demonstrable physical cause, although the etiology embraces multiple causes. In this article the psychodynamic implications will be considered. In specific situations, these patients frequently react with inner stress, which leads to elevated blood pressure (Herrmann et al., 1996; Lechin et al., 1996; Shimomitsu and Töres, 1996). In psychoanalytic terms this disturbance can be described as a severe deficit in the psychic regulation of physical requirements (first motivational system, Lichtenberg, 1989) and is frequently associated with a disturbance in another motivational system, that is, exploration and self-assertion. The motivational systems and their corresponding affect-states are regulated by the self. The sense of self develops as a center for initiating, organizing, and integrating motivation and experience (Lichtenberg, Lachmann, and Fosshage, 1992).

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