When Psychological Distress Presents as Physical Symptoms
There's a moment in many first sessions when a practitioner can either win the client's trust or lose it.
The client has described months of headaches, stomach trouble or exhaustion. The tests are normal. And then the practitioner says something like, "It sounds like this might be stress."
To the practitioner, that's a hypothesis. To the client, it can sound like, 'You're imagining it.'
When psychological distress shows up as physical symptoms, the way it's explained matters as much as the explanation itself. Research suggests patients reject explanations that feel dismissive or blaming and welcome ones that are concrete, take the symptoms seriously and give them something to do. Practitioners can learn to explain the mind-body link in ways that open the work up rather than shut it down.
Why Explanations Go Wrong
In a well-known study in the BMJ, Peter Salmon and colleagues looked at how patients with unexplained physical symptoms responded to their doctors' explanations. Explanations that seemed to dismiss the symptoms or imply the patient was to blame were rejected. Explanations that were tangible (a clear, physical account of what was happening), removed blame and involved the patient in what to do next were experienced as empowering.
The lesson applies just as much in the therapy room.
What to Say and What to Avoid
Instead of... | Try... |
"It's probably just stress." | "Your symptoms are real. Stress is one of the things that can make the body produce them, and that's something we can work on." |
"It's all in your head." | "The brain and body are constantly talking to each other. When the brain is on high alert for a long time, the body feels it." |
"There's nothing physically wrong." | "Your tests have ruled out the serious causes we'd worry about. That's good news, and it means we can look at what else is keeping the symptoms going." |
"You need to relax more." | "Let's find out what your body does under pressure and practise some ways to help it settle." |
A Concrete Explanation Clients Can Hold On To
Many clients find a simple, physical explanation helpful. For example:
It's accurate, it isn't blaming, and it points straight to what therapy can do.
Working Alongside the GP
Clients who feel caught between their GP and their therapist often disengage from both. Where possible:
• Acknowledge the medical investigations that have been done.
• Encourage the client to keep the GP informed;
• Refer back promptly if new or changing symptoms appear.
A consistent message from both professionals is one of the strongest things a client can hear.
From Explanation to Treatment
Once the client feels believed, the work can begin. An integrative practitioner, using more than one approach chosen to fit the person, might draw on clinical hypnosis to help the body settle, cognitive work on fears about what the symptoms mean, and trauma-focused work where symptoms are tied to a frightening experience.
But none of that lands if the first conversation goes wrong.
The First Gift Is Belief
Many clients with physical symptoms have spent months feeling disbelieved. Being taken seriously is often the first thing that helps.
If you'd like to build these skills further, the Advanced Practitioner Diploma in Integrative Psychotherapy (APDIP), including its module on Addictive Behaviours & Psychological Pain, develops exactly this kind of practice.
FAQ
Can psychological distress cause physical symptoms? Yes. Long-term stress and emotional distress can produce real physical symptoms, including headaches, digestive problems, fatigue and muscle pain.
How should a therapist explain psychosomatic symptoms to a client? With an explanation that's concrete, doesn't blame the client and involves them in what to do next, while making clear the symptoms are real.
Should therapists work with a client's GP? Where possible, yes. Consistent messages from the GP and therapist help clients engage, and new or changing symptoms should always be referred back for medical review.
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