Disclaimer
This material is provided for informational and educational purposes only. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
Psychological dimensions of arthritis
Arthritis is a chronic inflammatory joint disorder that can profoundly affect quality of life. Alongside physical symptoms such as pain, stiffness, and fatigue, arthritis frequently coexists with considerable psychological challenges.
Psychological responses to arthritis
A diagnosis of arthritis can elicit a diverse array of emotional responses:
— Denial: Initially, an individual may dismiss symptoms and overlook the necessity for treatment.
— Anger and frustration: Restricted mobility and persistent pain frequently lead to irritation.
— Depression: Prolonged illness and pervasive feelings of helplessness can result in depressive states.
— Anxiety: The fear of worsening one’s condition and the potential loss of the ability to maintain an active lifestyle contributes to anxiety disorders.
— Social isolation: As a result of restricted mobility and fatigue, numerous patients start to withdraw from social interactions.
Psychological issues related to arthritis
— Chronic pain: Persistent discomfort results in irritability, sleep disruptions, and diminished motivation.
— Limited functionality: Challenges in executing daily tasks result in feelings of helplessness and diminished self-esteem.
— Fatigue: Persistent fatigue adversely affects mood and the capacity to manage responsibilities.
— Lifestyle modifications: Patients frequently must forgo their preferred activities, leading to diminished life satisfaction.
Psychological support for arthritis
Cognitive Behavioral Therapy (CBT)
— Assists in transforming negative attitudes and perceptions regarding the disease.
— Alleviates symptoms of anxiety and depression.
Enhances the capacity to manage chronic pain by employing self-regulation strategies.
Relaxation and meditation methods
Mindfulness practices diminish pain response and enhance emotional resilience.
Relaxation exercises facilitate muscle relaxation and alleviate anxiety.
Group therapy
— Enables patients to exchange experiences and obtain support from others facing similar challenges.
— Aids in alleviating feelings of isolation and loneliness.
Existential and humanistic psychotherapy
— Assists patients in discovering meaning and value in life, even when confronted with chronic illness.
Family therapy
Collaborating with the patient’s family aids in minimizing interpersonal conflicts and fostering a supportive interaction strategy.
Psychoeducation
Educating patients about the characteristics of arthritis, its treatment options, and self-care strategies alleviates fear and anxiety.
Practical recommendations for individuals with arthritis
— Master pain management: Employ relaxation techniques, breathing exercises, and distraction methods.
— Establish attainable objectives: Gradually resume physical activity and domestic responsibilities.
— Social support: Engage in open communication with loved ones and friends.
— Regular physical activity: Adhere to the activity levels advised by your physician to ensure the mobility of your joints.
— Cultivate positive thinking: Emphasize accomplishments rather than constraints.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is an effective psychotherapeutic approach for individuals with chronic illnesses, including arthritis. It aids in alleviating stress, enhancing emotional well-being, and developing more effective coping strategies for chronic pain.
Objectives of Cognitive Behavioral Therapy for Arthritis:
— Transforming negative thoughts: Assisting patients in identifying and rectifying beliefs associated with helplessness and fear of pain.
— Pain management: Acquiring self-regulation techniques to diminish pain perception.
— Enhanced engagement: Gradually resume daily activities and an active lifestyle.
— Emotional stability: Diminished symptoms of anxiety and depression.
Fundamental CBT techniques for arthritis:
Cognitive reframing
Patients acquire the skills to recognize and modify negative attitudes, including:
«I will never be able to move with normalcy.»
«The pain necessitates a complete cessation of activity.»
The therapist assists in substituting these thoughts with more realistic and adaptive alternatives, such as:
«I can progressively enhance my physical activity despite the discomfort.»
«My discomfort does not necessarily indicate that my condition is deteriorating.»
2. Training in pain management skills
— Application of breathing techniques and relaxation methods.
— Visualization of enjoyable imagery to divert attention from discomfort.
— Organizing active intervals and periods of rest.
3. Exposure to motion
Patients progressively surmount their apprehension of movements they perceive as perilous due to pain. This facilitates the restoration of their confidence in their physical capabilities.
4. Objective formulation and proactive strategizing
— Patients establish modest, attainable objectives, such as a daily 5-minute walk.
— Maintain a record of activities and advancements.
5. Managing emotional responses
— Acknowledging and addressing anxiety related to the expectation of pain.
— Activities for self-sustenance and emotional resilience.
Approximate content of a cognitive behavioral therapy session:
— Examination of the patient’s present condition, encompassing his emotional and physical well-being.
— Examination of common scenarios that induce pain or apprehension regarding activity.
— Engaging in a cognitive restructuring exercise: recognizing and substituting negative thoughts.
— Engage in relaxation techniques or breathing exercises.
— Assigning a task for the upcoming week, such as incorporating a new minor activity.
Effectiveness of Cognitive Behavioral Therapy for Arthritis:
Research indicates that cognitive behavioral therapy (CBT):
— Diminishes the intensity of perceived pain.
— Enhances the psychological well-being of patients.
Encourages heightened physical activity.
Alleviates symptoms of anxiety and depression.
Examples of cognitive behavioral therapy exercises for arthritis
These exercises are designed to alleviate pain, enhance emotional well-being, and boost physical activity. They may be undertaken independently or with the assistance of a therapist.
Cognitive restructuring («Identify a negative thought»)
Objective: recognizing and substituting maladaptive thoughts with constructive alternatives.
Instructions:
— Throughout the day, observe the thoughts that emerge when you experience pain or restricted movement.
— Document negative beliefs, such as: «The pain will never subside,» «I am powerless,» «I must entirely avoid movement.»
— Pose inquiries to yourself:
«Is this thought a fact or merely an assumption?»
«Are there instances when I successfully managed pain?»
— Develop a different perspective:
— Instead of «I can’t do anything anymore,» — «I can pursue my interests, even if it takes more time.»
2. Respiratory techniques for analgesia
Objective: to diminish pain perception and alleviate muscle tension.
Instructions:
— Assume a comfortable seated or reclining position.
Inhale deeply for a count of 4, retain your breath for a count of 2, and then exhale for a count of 6.
— Envision how, with each exhalation, the tension dissipates from the body.
— Continue for 5—10 minutes.
3. Maintaining an activity and pain journal
Objective: to monitor the correlation between activity and sensations, and to pinpoint pain triggers.
Instructions:
— Document daily:
— Duration and nature of physical activity.
— Pain intensity (on a scale from 0 to 10).
— Affective condition.
— Analyze the records: which interventions alleviated pain, and which exacerbated the condition?
4. Activity «Small Steps»
Objective: Incrementally elevate the level of activity.
Instructions:
— Select the least demanding activity you can perform, such as a 5-minute walk or three basic joint exercises.
— Incrementally enhance the duration or intensity of the activity each day (by 10%).
5. Visualization exercise («Oasis free of pain»)
Objective: alleviation of pain and mitigation of stress levels.
Instructions:
— Assume a comfortable seated or reclining position.
Close your eyes and envision a location where you experience tranquility and security (the beach, the forest, your preferred nook in the home).
— Envision the environment with precision: hues, aromas, and auditory elements.
— Concentrate on this location for 5—10 minutes.
6. Exercise «Conquering Catastrophizing»
Objective: to cultivate awareness and replace irrational thoughts regarding the future.
Instructions:
— Consider a thought associated with arthritis, such as, «If I engage in movement today, the pain will be intolerable tomorrow.»
— Pose inquiries to yourself:
«Is there any evidence to suggest that this will occur?»
«What steps can I take if the pain intensifies?»
«By progressing slowly, my condition is likely to enhance.»
7. The Distraction Strategy Approach
Objective: to temporarily redirect focus from discomfort.
Instructions:
— When the pain intensifies, participate in activities that captivate you (such as reading, drawing, or listening to music).
— Attempt to count backwards (for instance, from 100 to 0 in decrements of 3).
An illustration of a cognitive behavioral therapy session for arthritis.
Duration: 50 minutes
Objective: To assist the patient in transforming maladaptive thoughts regarding pain and limitations while fostering the development of more constructive behavioral strategies.
Patient: A 45-year-old woman diagnosed with rheumatoid arthritis reported persistent pain and apprehension regarding physical activity due to the potential exacerbation of her symptoms.
1. Initiating communication and providing a status update (10 minutes)
Therapist:
How are you feeling today? Is there anything that is particularly concerning you?
Patient:
«The discomfort was manageable in the morning; however, by lunchtime, it had intensified once more. I refrain from even light exercise due to my concern that it may exacerbate the situation.»
The therapist poses clarifying questions to acquire further insights into the patient’s experiences and to discern current automatic thoughts.
2. Psychoeducation regarding pain and movement (10 minutes)
The therapist elucidates:
— The necessity of moderate activity even in the presence of pain.
— The consequences of avoiding movement may include the deterioration of joint conditions and heightened sensitivity to pain.
The brain occasionally interprets movement as a threat, thereby amplifying the sensation of pain.
The patient articulates uncertainties:
However, I genuinely experience pain following exercise!
Therapist:
This is a natural bodily response; however, it is crucial to differentiate between the pain associated with injury and the transient sensations that accompany long-term benefits.
3. Recognizing automatic thoughts and addressing catastrophizing (15 minutes)
The therapist requests the patient to document negative thoughts associated with pain and physical activity.
«If I begin to move, the pain will become intolerable.»
«My joints will give way if I exert them.»
The therapist poses inquiries:
«Are there instances where movement has exacerbated joint conditions over an extended period?»
«Can you recall a moment when moderate activity enhanced your condition?»
The patient acknowledges:
Yes, there were days when I engaged in light exercises and subsequently felt improved.
4. Cognitive reframing (10 minutes)
The therapist and patient collaborate on alternative perspectives:
— Instead of «Movement destroys joints» — «Moderate activity fortifies joints and alleviates pain.»
— Instead of «The pain will become unbearable,» — «I can manage my activity level and cease if I experience discomfort.»
The patient articulates the new instructions aloud.
5. Assignments and conclusion of the session (5 minutes)
Homework:
— Maintain an activity and pain journal: document the type of exercise, duration, and pain level both prior to and following the activity.
— Engage in breathing exercises to alleviate tension.
— Acknowledge and substitute negative thoughts regarding pain with constructive beliefs.
The therapist assures the patient that gradual movement will enhance her well-being and yield positive outcomes when practiced in moderation.
Outcomes of cognitive behavioral therapy for arthritis
Research and clinical practice indicate that cognitive behavioral therapy (CBT) positively influences patients with arthritis, enhancing their quality of life and alleviating the adverse effects of chronic pain.
Key outcomes of CBT:
— Alleviation of pain intensity:
CBT does not completely eliminate pain; however, it aids in altering the perception of pain and diminishing its subjective intensity.
Patients learn to concentrate on an active lifestyle despite discomfort.
Mastering relaxation techniques alleviates muscle tension and related discomfort.
— Alleviating pain catastrophizing:
Many patients cease to view pain as a catastrophe or an unavoidable indication of deteriorating health.
— Instances of substituted installations:
— Instead of «The pain is destroying my joints,» — «I can manage the pain through movement and emotional regulation.»
— Enhancing physical activity:
— Patients increasingly participate in moderate physical exercise with greater confidence.
Mastering techniques for progressively enhancing activity results in improved joint functionality.
— Alleviation of anxiety and depression:
CBT facilitates the alteration of negative cognitive patterns linked to illness and pain, thereby diminishing levels of depression and anxiety.
— Enhancing emotional regulation:
Patients cultivate self-regulation skills through breathing techniques, mindfulness, and self-observation.
— Enhanced sense of self-regulation and self-efficacy:
Awareness of one’s capacity to manage pain and emotional responses enhances the overall psycho-emotional condition.
Long-term effects:
— Enhancing the quality of life for patients.
— Decreased reliance on analgesics.
— Enhanced social engagement and strengthened interpersonal relationships.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) seeks to cultivate mental flexibility and promote the acceptance of pain without resistance. In the realm of arthritis treatment, ACT assists patients in embracing life fully, despite the challenges posed by chronic pain and physical limitations.
Fundamental principles of ACT for arthritis:
— Embracing discomfort:
Patients learn to cease avoiding or suppressing physical pain, instead embracing it as an integral aspect of their present experience.
— Example of technique: «Gentle observation» of discomfort without attempting to alter it.
— Dissemination of ideas:
— Attention is redirected from automatic negative thoughts regarding pain and the future (such as, «I will never be able to walk normally again») to a mindful awareness of the present moment.
Diffusion techniques entail perceiving thoughts as clouds drifting through the sky.
— Mindfulness:
The practices assist patients in concentrating on the present moment rather than perpetually scrutinizing pain and anxious thoughts.
— Exercises: breath meditation, mindful body scanning.
— Definition of values:
— Identifying what is truly significant to the patient (such as communication with family, creativity, and an active lifestyle).
— Concentrating on actions that align with these values, even amidst adversity.
— Engaged activities:
— Gradually resume essential activities and physical exercise, notwithstanding any discomfort.
— Illustrations of activities: morning workouts, strolls with friends, pastimes.
— Cognitive adaptability:
— Instructing the patient to approach pain and discomfort with openness and curiosity rather than resistance.
Benefits of Acceptance and Commitment Therapy for Arthritis:
— Alleviating emotional stress and depression.
— Enhanced tolerance to pain and functional activity.
Enhancing the capacity to focus on significant facets of life.
— Alleviating feelings of helplessness and reliance on medications.
Examples of Acceptance and Commitment Therapy (ACT) exercises for arthritis management.
1. Exercise «Embracing Discomfort» (Pain Clouds)
Goal: to diminish resistance to pain and cultivate the ability to perceive it without emotional attachment.
Instructions:
Assume a comfortable position, either seated or lying down. Close your eyes and focus on the area where you experience discomfort.
— Rather than resisting this pain, envision it as a cloud drifting across the sky.
— Allow that cloud to remain without attempting to push it away or alter it.
— Monitor the variations in pain — whether it intensifies or diminishes.
Reflection: Engage in a discussion with your therapist regarding the evolution of your perception of pain.
2. Exercise «Thoughts resemble leaves drifting on a river»
Goal: to cultivate diffusion skills (diminishing the impact of negative thoughts regarding pain).
Instructions:
Imagine yourself seated beside a tranquil river, with leaves gently drifting along its surface.
— Whenever a thought of pain or anxiety arises, «place» it on a piece of paper and observe it drift away with the current.
If your thoughts wander, gently redirect them to the sheets of paper and resume your observation.
Reflection: Examine how this exercise influenced your understanding of thoughts.
3. Exercise «Me and Pain» (Metaphor of Bus Passengers)
Goal: to instruct patients to take action despite experiencing pain and discomfort.
Instructions:
Envision yourself as a bus driver, with the passengers representing your pains, fears, and uncomfortable emotions.
These passengers are yelling, attempting to intimidate you and insisting that you cease.
— Rather than succumbing to these appeals, persist in steering the bus toward your values (e.g., family outings, creativity).
Reflection: Contemplate the values that hold significance for you and consider how you can persist in pursuing them, even in the face of adversity.
4. Exercise «Values and Incremental Progress»
Goal: To recognize values and devise proactive strategies despite arthritis.
Instructions:
— Compile a list of what holds genuine significance for you (for instance, familial support, creativity, physical fitness).
— Identify a manageable step you can take today, despite the discomfort (for instance, reach out to a friend, take a walk, or engage in some crafting).
— Execute this action while being mindful of your feelings and emotions.
Reflection: What challenges emerged during the execution of the exercise? What facilitated your progression to the next step?
5. Exercise «Engagement with the Present» (Mindful Breathing)
Objective: Alleviate stress levels and enhance focus on the present moment.
Instructions:
— Assume a comfortable position and gently close your eyes.
— Inhale and exhale slowly several times, concentrating on the flow of air.
— If thoughts of discomfort emerge, simply acknowledge them and gently redirect your focus to your breathing.
— Perform this exercise for 5—10 minutes.
Reflection: In what ways did your condition evolve following the completion of the exercise?
An illustration of an Acceptance and Commitment Therapy (ACT) session for arthritis.
Duration: 50 minutes
Session objective: To assist the patient in accepting the physical pain and distressing emotions linked to arthritis, while also identifying values and actionable steps toward a more fulfilling life.
Greeting and initiating communication (5 minutes)
— Therapist: «How are you feeling today? Did you encounter any challenges related to pain or other experiences?»
The patient expresses his emotions and psychological condition.
2. Examination of pain and perspectives regarding it (10 minutes)
— Therapist: «When the pain intensifies, what thoughts arise? How do you typically respond?»
The patient may articulate sensations of helplessness, frustration, or apprehension regarding the exacerbation of symptoms.
Primary emphasis:
— Identification of pain mitigation strategies (e.g., refraining from walks, limiting communication).
— Examination of the emotional ramifications of illness.
3. Exercise «Thoughts resemble leaves drifting on a river» (15 minutes)
Goal: cultivate the ability to detach from negative thoughts regarding pain.
— Guidelines for the therapist:
«Let us engage in a brief exercise. Envision yourself seated beside a river. Leaves drift upon the water’s surface. Each time a painful thought emerges, place it upon a leaf and observe it as it floats downstream. Strive not to linger on these thoughts; instead, redirect your focus to the river’s flow.»
The patient engages in the exercise under the supervision of a therapist.
Post-exercise reflections are deliberated:
— Patient: «It was challenging to avoid being preoccupied by thoughts of pain; however, when I envisioned leaves, it became easier for me to release these thoughts.»
— Therapist: «That is entirely normal. The more frequently you engage in this exercise, the easier it will be to regard thoughts as merely transient occurrences.»
4. Engaging with Values (15 minutes)
Objective: to identify personal values and outline steps to attain them.
— Therapist: «What holds genuine significance for you in life, despite the suffering?»
— Patient: «Quality time with family, creative pursuits, and strolls in the fresh air.»
— Therapist: «What incremental actions might you consider to align more closely with these values, despite your arthritis?»
— Patient: «Perhaps consider a brief stroll in the park with your family, even if it lasts only five minutes.»
5. Session conclusion and reflection (5 minutes)
— The therapist concludes:
«Today, we explored the concept of observing painful thoughts without resistance and contemplated strategies for living a life aligned with our values. In the upcoming session, we will examine how we have put these strategies into practice.»
The patient consents to undertake a brief walk and engage in the leaf exercise by the river.
Homework:
— Engage in the «Leaves on the River» exercise daily for a duration of 5 minutes.
— Enjoy a brief stroll with your family and reflect on your emotions.
Comment:
The session assists the patient in transitioning from grappling with pain to embracing active acceptance and aligning with personal values, despite physical constraints.
Outcomes of acceptance and commitment therapy (ACT) for arthritis
Research and clinical practice indicate that Acceptance and Commitment Therapy (ACT) is an effective psychotherapeutic approach for patients with arthritis, assisting them in managing pain and emotional challenges while enhancing their overall quality of life.
Primary positive developments:
— Alleviating the fear of pain and emotional distress:
Patients start to view pain as an inherent aspect of life, rather than a calamity that necessitates perpetual evasion.
— Ruminative thinking (obsessive thoughts regarding pain) is diminished.
— Enhancing physical activity:
Patients are more inclined to resume basic physical activities, such as walking, light exercise, or recreational pursuits, even in the presence of discomfort.
— Enhancing psychological flexibility:
— Cultivating the ability to embrace negative emotions and thoughts enables you to concentrate on essential values, rather than on managing discomfort.
— Patients are less inclined to abandon social and professional engagements.
— Emotional resilience:
— Enhances the capacity to manage depression, anxiety, and irritability, which frequently accompany chronic illnesses.
— Emphasize values and life objectives:
— Rather than passively evading discomfort, patients start to engage in alignment with their values (such as spending time with family, fostering creativity, and participating in social activities).
Clinical illustrations of outcomes:
A patient with rheumatoid arthritis observed after eight ACT sessions that she no longer concerned herself with temporary pain flare-ups and began walking with her children each evening, despite experiencing physical discomfort.
A middle-aged man resumed his passion for playing the guitar, a pursuit he had forsaken due to persistent concerns regarding the discomfort in his finger joints.
Psychoanalytic psychotherapy
Psychoanalytic therapy perceives arthritis not merely as a physical ailment but also as a manifestation of internal conflict, repressed emotions, and tensions that may intensify symptoms. This methodology focuses on engaging with the patient’s unconscious experiences and emotional responses.
Objectives of psychoanalytic therapy for arthritis:
— Recognition and management of internal conflicts related to chronic pain.
— Investigation of unconscious attitudes and potential psychosomatic origins of the illness.
— Identification of repressed emotions (anger, fear, resentment) that may exacerbate pain symptoms.
— Gradually cultivating a more positive perspective on the body and health conditions.
Fundamental techniques:
— Dream analysis: Assists in uncovering concealed emotional conflicts linked to feelings of helplessness and anxiety about the future.
— Free association: The patient articulates thoughts and emotions, enabling the therapist to uncover unconscious experiences linked to pain.
— Interpretation of defense mechanisms: Recognizing and acknowledging methods of evading emotional distress via physical manifestations.
— Engaging with relationships involving parents and significant figures: Can facilitate an understanding of the dynamics that shape the perception of pain and illness.
Examples of therapeutic dimensions:
— The theme of repressed anger:
The patient may discover that repressed anger directed at a loved one manifests in the body, exacerbating physical discomfort.
— Processing anger results in diminished tension and a lowered subjective experience of pain.
— The issue of dependency and vulnerability:
Unconscious fears regarding the loss of control and autonomy can intensify pain symptoms.
Psychotherapy aids in comprehending these fears and cultivating more sophisticated methods of engaging with the world.
— Navigating Guilt:
Some patients may subconsciously view the disease as a form of «punishment» for past actions.
Awareness and the processing of these experiences alleviate emotional stress.
Forecast and outcomes:
— Alleviating stress and anxiety levels, which can positively influence the frequency and severity of disease exacerbations.
— Enhancing emotional awareness and the capacity to articulate feelings instead of somatizing them.
— Enhanced body image and diminished feelings of helplessness.
Examples of exercises in psychoanalytic therapy for arthritis.
Psychoanalytic therapy primarily emphasizes the exploration of unconscious conflicts and emotions; however, certain targeted exercises may also be employed to assist arthritis patients in recognizing and processing their emotional and physical conditions.
1. Unrestricted associations
— Objective: to identify unconscious experiences and thoughts that may be linked to the disease.
— Exercise: Throughout the session, the patient is encouraged to express their thoughts openly, without self-censorship. This may encompass memories, experiences, or any emotions associated with pain, illness, or relationships with loved ones. The objective is to uncover concealed emotions that may affect the perception of pain.
What significance does pain hold for you? Which events or relationships in your life may be connected to your current feelings?
2. Dream Interpretation
— Purpose: to address unconscious emotions that may be linked to physical pain.
— Exercise: The patient is encouraged to recall their dreams and discuss them with the therapist. Dreams can serve as a means to uncover profound emotions, such as fear, anger, or feelings of helplessness, that may be linked to the illness.
In a dream, you may experience sensations of being attacked or a loss of bodily strength — how do you interpret these visions? How could this relate to your illness?
3. Examination of corporeal sensations
— Goal: To enhance the patient’s awareness of the interconnection between emotions and physical pain.
— Exercise: Throughout the session, the patient is encouraged to concentrate on physical sensations within the body, particularly in regions where pain or tension is experienced. The therapist assists the patient in interpreting these sensations in relation to their emotional state.
How do you perceive pain in your body? What occurs in your body when you encounter anxiety or stress?
4. Retrospective examination of relationships with loved ones
— Objective: to investigate the ways in which children’s relationships with parents and caregivers can shape their perception and experience of pain.
— Exercise: The patient is encouraged to reflect on their relationships with their parents and other significant individuals in their life, particularly those that may have elicited feelings of helplessness or anger. These relationships may influence the individual’s perception of their illness.
How did you perceive support, or the absence of it, during your childhood? In what ways might this influence your current experience of illness?
5. Creation of conflict scenarios
— Goal: to assist the patient in navigating feelings of anxiety or helplessness that may be intensifying the disease.
— Exercise: The patient is encouraged to reflect on conflicts encountered in relationships with loved ones or in the workplace. These conflicts may pertain to issues of control, dependency, or their perspective on their physical condition.
How do your conflicts with colleagues or loved ones impact your well-being? Do you experience feelings of helplessness or a lack of control in these circumstances?
6. Metaphorical exercise: the body as a «casualty»
— Goal: to assist the patient in articulating their emotions related to the perception of the illness as a «punishment» or a «victim.»
— Exercise: The patient is encouraged to metaphorically characterize their body, envisioning it as a distinct persona. This approach can assist the individual in understanding their perception of their body — whether they view it as an «adversary,» a «victim,» or as something in need of safeguarding.
«Envision your body as a character. Who does it represent? What feelings and emotions does this character elicit within you? What message do you wish to convey to them?»
An illustration of a psychoanalytic therapy session for arthritis.
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