In this session, we will look at the symbolic meanings that illness can hold for a patient and their therapist, and the importance of recognising the difference between fantasies about illness or disability and real-world certainties. Illness or disability may be associated with loss of control or abandonment; it may be blamed on the self or others; therapy may be sought out of a hope that a healthy mind will cure an unhealthy body. While we need to hold in mind that psyche has an impact on soma, we also need to recognise that soma impacts upon psyche too. Some of the fantasies connected to illness, even when they appear to be hopeful ones, in fact form a defence against very frightening, but (importantly) very unrealistic fantasies. Understanding the role played by these fantasies can enable therapists to stay with their client's fears long enough to examine them, rather than being too ready to accept them as realistic and unbearable.

Not all illness or disability creates massive anxieties, and many people can take things in their stride. However, where an illness is life-threatening, relationships can suffer. Understanding and working with the psychic processes which come into play when bodily functions are under threat may help people to regain a sense of a common cause, which can make life with illness or disability more bearable. In this session we will consider the development over time of the patient's and the therapist's relationship with the illness, and look at the role of grieving in changing the way the illness impacts on daily life.

In this third session, we will examine thoughts and fantasies about dependence and independence and about caring and being cared for. Issues surrounding accepting help from someone else apply to anyone who seeks therapy, but a client's illness or disability changes the context; it may disable a therapist in some way and make it harder to hold a psychotherapeutic position.