I think this is a terrific and important question, hellokitty. Thanks for bringing it up.
I've heard many cases like what you've described and many example of the converse: people like myself and SteveO who haven't done any journaling and have still recovered. I think it's about how you live your life on a day to day basis. Are you preoccupied with your body? Are you constantly in fear? Are you able to find regular moments of relaxed happiness?
I think that this is why Dr. Sarno considered
information to be the penicillin of the disorder. For example, in
The Divided Mind, he wrote,
It soon became evident that knowledge was the key to treating TMS. Whatever else might be necessary to effect total resolution of the patient’s problem—psychotherapy, for example—people needed to know about the anatomy, physiology, and psychology of TMS and how these were related. This was made particularly clear to me when I encountered patients who were practicing psychoanalysts, men and women who were thoroughly familiar with their own personalities, unconscious dynamics, and life issues—all the things we have cited as important in the genesis of TMS—but who nevertheless had the disorder because they knew nothing about TMS. (emphasis mine, p. 130)
The psychoanalysts in the above clearly had done a great deal of depth psychotherapy, but still had symptoms. Likewise, in the following quote, from Mindbody Prescription, (pp. 164-165) he explains how one can have TMS even after extensive psychotherapy:
Q: “I was in psychotherapy for over a year. Why was I still having pain if it was psychologically induced? In fact, my therapist thinks the pain is somehow psychological but she’s never heard of TMS.”
A: You were still having pain because the brain would not relinquish its strategy. The pain will continue if you have not established the connection between the physical and psychologic events. Your psychotherapist, regardless of professional discipline, is not trained to make physical diagnoses and, therefore, cannot help you make that crucial link-up. You may be in psychotherapy but if you continue to take anti-inflammatory medications, undergo physical treatment for structural abnormalities and fail to acknowledge that your pain is caused by a harmless circulatory alteration induced by the brain, the pain will continue. In short, the brain will not give up the distraction unless it is forced to.
Journaling and depth-oriented (psychodynamic) psychotherapy can be wonderful tools, but, I think it's a mistake to consider them the core of TMS treatment. On the contrary, I emphasize what I call "the present based approach." It asks the question, "where is my tension coming from
right now." Depth-oriented psychotherapy and journaling can be very helpful at figuring out the roots of the current tension, but the real "action" still happens in the present, which is why I call this a present-based approach.
By the way, I'm reading your book right now and enjoying it a lot. I loved your story about picking up the case of beer - it was so funny! I know it probably wasn't funny back then, but the way you told it was hysterical - made me laugh. 