The power of unsaid suffering: a reflexive thematic analysis on countertransference in psychological work with fibromyalgia and related symptoms

Background Fibromyalgia presents a clinical challenge - characterised by persistent, debilitating pain that does not easily fit within standard medical explanations. Patients are frequently left feeling unheard or misunderstood, while therapists and healthcare professionals can find themselves unsure how to respond. While existing research show connections with developmental trauma, attachment insecurity, and alexithymia; the relational dimension of this condition remains largely unexplored. This study uses psychoanalytic theory, especially relational ideas about countertransference and mind-body connections. It looks beyond symptoms to view fibromyalgia as involving both a “speechless mind and speaking body”. From this perspective, pain is not just something symptomatic; it can become a form of communication, a way for the body to express what the mind cannot yet put into words. Aims This study seeks to explore the distinct relational dynamics that unfold in psychotherapy with individuals experiencing fibromyalgia. It aims to deepen understanding of how countertransference can serve as a meaningful tool for attuning to patients’ embodied expressions of distress. Methods Qualitative data was collected via semi-structured interviews with 6 UK-based psychological therapists with experience of working with fibromyalgia patients. The data was analysed using a reflective thematic analysis approach. Findings The overarching theme, as captured in the title, is that unsaid suffering holds powerful relational force. Within that, four key themes emerged: (1) “Thinking about body-mind, mind-body all the time”; (2) Unspoken pain takes op space within therapists; (3) Therapists’ Loss of psychological ground; and (4) Therapy relationship is negotiated through suffering – pain as a relational gesture. Therapists described feeling pulled into a primitive, affective space. Pain and patients’ physical suffering seemed to carry emotional messages. Therapists often experienced feelings of deprivation, helplessness, anger, and confusion that seemed to come before words; importantly, these feelings in turn give therapists access to the patients’ unsymbolic experiences of bodymind. Conclusions These findings offer important insights for psychological work with individuals suffering from fibromyalgia and related somatic conditions. Recognising countertransference not as a hindrance, but as a vital mode of attunement to patients’ speechless distress, invites a more embodied and relationally nuanced therapeutic stance. Counselling psychology is uniquely positioned to deepen the understanding of fibromyalgia as it respects the emotional aspects of physical experience and challenging the persistent separation between mind and body that remains prevalent in healthcare. The findings also have broader implications for healthcare policy and practice, especially in developing care approaches that are more relationally sensitive and psychologically informed when treating patients with complex physical symptoms.

Name dc:type.qualificationname

DCPsych

Level dc:type.qualificationlevel

DCPsych thesis

Grantor dc:publisher.institution

Middlesex University / Metanoia Institute

Year dc:date.issued

2025

Author dc:creator

• Li, C.

Identifier

oai:repository.mdx.ac.uk:367y0y

OAI identifier oai:identifier

oai:repository.mdx.ac.uk:367y0y