Metaphoric, metonymic and psychotic somatoform dissociation

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The present paper seeks to propose, using a combination of psychoanalytic and linguistic thinking, a distinction between three degrees of symbolicity across the somatoform dissociative continuum: the metaphorical, in which there is a symbolic connection between the somatoform phenomenon and the traumatic content, the metonymic, which constitutes a revival of the traumatic experience without the ability to reflect on it, and the psychotic, in which the somatoform phenomenon is experienced as ego-syntonic, thus neither causes distress nor evokes thinking. Three clinical vignettes demonstrate how the higher the degree of symbolization, the more effective the therapeutic process. Finally, a fourth vignette demonstrates how acoustic association in the therapist's countertransference can constitute an antidote to the patient's acoustic dissociation, allowing the reclaiming of the capacity for linking.

Original languageEnglish
Pages (from-to)429-442
Number of pages14
JournalPsychoanalytic Psychotherapy
Issue number4
StatePublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • Trauma
  • dissociation
  • metaphore
  • metonimy
  • somatoform

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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