The Voiceless and Unheard: Understanding Primitive Bodily Communications in Psychotherapy

Saturday 6 July 2019 - London

With speakers Gabrielle Brown, Raffaella Hilty, Professor Brett Kahr, Dr Valerie Sinason and David O'Driscoll

Every psychotherapist practitioner will know only too well what it means to experience the rage and hatred of one’s most vulnerable clients and the challenges that this raises in countertransference work. Most often these clients will express their hateful feelings verbally. But, what about those clients who cannot talk? Or those clients who are capable of talking but carry a complex range of unprocessed embodied feelings that cannot be verbally expressed?




Registration and coffee

Gabrielle Brown
Beyond the pale: Thinking about the “unwashed” patient
Individuals who neglect personal hygiene have evoked avoidance and hostility since the formation of bourgeois society. Such primitive rejection seeks to displace the homeless and “other” from our midst and block them from our understanding. If, however, we extend the offer of psychotherapy to those living precarious lives, we need to make sense of broken links between body and mind expressed through failures of “self-care”. How can psychoanalytic thought attend to the somatic terrors left by early trauma and attune to suffocating distress and melancholic protest in patients who smell? In this session, we will explore historical and anthropological notions of dirt and contagion and think through psychotherapy work with ex-prisoners, the homeless and the mentally ill.

Raffaella Hilty
The smelly patient
In this presentation Raffaella will explore the topic of primitive unconscious bodily communications and countertransference enactments. In order to explore this topic she will discuss a two-year treatment with a severely traumatised patient who presented with a mix of narcissistic and borderline diagnostic features. She will describe meaningful aspects of the difficulties faced in countertransference work when receiving and making sense of the patient’s use of primitive defences and will highlight their expression through a very uncomfortable symptom: the patient’s bodily odour. Her thesis is that the smell was used to communicate preverbal unsymbolised experiences of early physical and emotional neglect, as well as to evacuate the toxicity of those experiences


David O’Driscoll
When words fail – psychotherapy with people with a learning disability
In many ways, David’s psychotherapy training did not prepare him for some of the challenges working with adults with an intellectual disability can bring. These could include varied ways in which this group uses the body to communicate thoughts, feelings and internal distress. While their rates of self-harm are similar to the general population, the frequency and intensity in this group is much higher. Perhaps this is one of the reasons why they have been historically excluded from psychotherapy. In this presentation, David will reflect on this via his work as a specialist disability psychotherapy with a number of case studies.


Dr Valerie Sinason
Blood, shit and tears: Working with unbearable trauma and no verbal language
Talking treatment works even when it is the body alone that can communicate. Child psychotherapy training, with its focus on baby and toddler observations, privileges the body countertransference and understanding of pre-verbal states. It is not surprising that a significant number of child psychotherapists have also completed an adult training in order to work with those of all ages with profound multiple intellectual disabilities. In this presentation there is a focus on patients with no verbal speech, whose only communication could come through bodily behaviours such as head banging, defecating and bleeding.


Professor Brett Kahr
A mouthful of saliva: Psychotherapy with a profoundly handicapped spitter
Psychotherapists will be only too familiar with patients who raise their voices during the course of a session, in order to express rage. But what happens when a patient communicates angry feelings by spitting saliva? Although most of our patients will already have developed a well-internalised ability to keep their fluids contained inside their bodies (with the possible exception of tears), severely and profoundly learning disabled patients will often drool, vomit, urinate, defecate, ejaculate, and spit in the midst of a psychotherapy session. In view of this little-discussed, yet not infrequent, clinical phenomenon, how can a psychotherapist function when under attack from the patient and his or her actual bodily fluids? In his presentation, Professor Brett Kahr will discuss an eight-year treatment with a psychotic, brain-damaged psychogeriatric patient who spat compulsively, often as much as one thousand times per day. He will describe the four phases of the psychotherapeutic process which unfolded across this long period of time and will explore how he and the patient worked together to transform “spittingese” into more ordinary forms of communication.

Panel session with all speakers



Handouts and lunch included
Early bird:
£100 (Available until 4 May)


Self-funded x 2:


Psychotherapy trainee:
£80 (Limited to 10 places)

This event + the online module Forensic Psychotherapy:


Certificates of attendance for 6 hours will be provided at the event


The Tavistock Centre
120 Belsize Lane


09.30 Registration and coffee
10:00 Start
11:40 Coffee
13:00 Lunch
14:50 Tea
17:00 End


Regrettably, refunds cannot be given in any circumstances except as follows:

  • You cancel in writing to 60 days before the first date of the event you have booked, in which case you will be entitled to a 100% refund.
  • You cancel in writing to 30 days before the first date of the event you have booked, in which case you will be entitled to a 50% refund.

This does not apply to parts of an event such as a seminar within a series but only to a whole event or complete series. You may give your place to another person if you let us know that person's name at least 24 hours before the event begins.

We reserve the right to change a speaker at one of our conferences without offering a refund. However, if a solo presenter cancels we will offer a full refund OR transfer of your fee to another Confer event. If the entire event is cancelled we will offer you a full refund.

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