In the therapeutic space, we sometimes encounter individuals who describe intense physical or spiritual experiences that can be challenging to interpret. These experiences may reside at the boundary between a meaningful spiritual journey and potential psychosis, presenting complex questions about safeguarding and clinical responsibility. In one recent case, I found myself carefully balancing respect for a client’s subjective experience with the need to ensure their safety and mental health.
This particular client began describing an experience that they interpreted as a form of “energy release.” They felt that certain pressures applied to their body could channel trapped energy that, when released, surged through their body in waves. This intense sensation often seemed to centre in their chest, producing a feeling that their heart had “stopped,” which frightened them to the point of calling an ambulance. Despite advice to seek further evaluation at a hospital, the client declined.
Over time, the client grew increasingly distressed, explaining that this energy seemed to “require release” through increasingly extreme means and that they feared it could even push through their skull. Such beliefs, especially when accompanied by somatic sensations that were overwhelming and distressing, prompted me to consider whether there might be an underlying psychotic element to these experiences.
In psychodynamic terms, these sensations and beliefs could be understood as bodily expressions of deep-seated psychological conflict. From a psychoanalytic perspective, unprocessed trauma or repressed emotional distress can sometimes surface in highly physical forms. When a client’s internal conflict cannot be articulated, it might instead find expression in the body—a phenomenon often referred to as somatisation. For some individuals, particularly those with unresolved trauma, the mind’s attempt to grapple with these unintegrated elements can produce intense sensations that are interpreted as a release of “energy” or, in some cases, as spiritual phenomena.
In line with UK safeguarding practices, it was crucial to recommend that the client consult their GP for a medical evaluation, as well as a psychiatric assessment. Symptoms such as perceived heart stopping or sensations of pressure in the skull can also be indicative of neurological issues, and an MRI scan would be an important step to rule out any organic factors, such as tumours, which might contribute to hallucinations or delusions.
Despite these recommendations, the client expressed reluctance to engage with traditional psychiatric or medical evaluations, feeling that these would not align with the spiritual or energetic framework they had constructed. They expressed frustration that the psychoanalytic language I offered no longer felt supportive, ultimately deciding to end therapy. This response highlighted the delicate nature of working with clients who experience strong subjective realities that they may find personally meaningful but which also border on delusional or psychotic realms.
For therapists, cases such as these highlight the importance of maintaining a balanced approach that respects the client’s subjective reality while also considering the potential risks involved. British Psychoanalytic Theory provides valuable tools for understanding how unprocessed experiences can be projected onto the body, becoming sensations or even hallucinations when the mind struggles to contain psychic pain. However, safeguarding always remains paramount. When experiences suggest a potential break from reality, a multidisciplinary approach is essential, incorporating psychiatric and medical perspectives to ensure comprehensive care.
This case also underscores the importance of flexibility in therapeutic practice, especially in instances where clients may feel alienated by traditional psychodynamic language or techniques. Although psychoanalytic approaches aim to explore and understand inner experiences deeply, some clients may find greater resonance in alternative therapeutic modalities, such as body-focused therapies, which directly address the physical manifestations of psychological pain.
In situations like these, therapeutic boundaries are tested, and the need for client-centred and adaptive approaches becomes clear. While not all cases will stay within the psychoanalytic frame, my priority is always to ensure that each client receives the care and support that best meets their unique needs.
Ultimately, my aim is to walk alongside clients on their journey with empathy, curiosity, and respect, even as we navigate the complexities at the border between spiritual experience and potential psychosis. In the field of psychotherapy, this is one of our greatest challenges, yet also one of our most meaningful responsibilities.
By Ari Sotiriou M.A. psychodynamic psychotherapist asotiriou@online-therapy-clinic.com