Psihološka perspektiva
Psychodynamic therapies primarily focus on interpersonal relationships and aspects of emotional processing, which they link to unprocessed conflicts and (traumatic) childhood experiences. There are relatively few studies that have examined the efficacy of a psychodynamic approach to the treatment of FND (e.g. see Gutkin et al., 2021), but its efficacy is assumed to be in a sub-population of FND patients whose perpetuating factors relate primarily to difficulties with emotional processing and interpersonal relationships (Finkelstein et al., 2022).
Within the psychodynamic approach there are a variety of interventions, but the following points are common to all of them:
linking FND symptoms to the expression of emotions (identifying, exploring and accepting emotions and linking them to physical symptoms) and to problems in interpersonal relationships (patterns of attachment and recurrent relationship problems)
increasing the ability to communicate about and tolerate difficult experiences and cope more effectively with stressors (Gutkin et al., 2021).
The success of the therapy will depend on the patient's acceptance of the psychological role in triggering and maintaining the symptoms of FND. The duration of the therapy depends on the type of approach (e.g. psychoanalysis), but can in principle last for several years.
Brief Interpersonal Psychodynamic Therapy
Brief Interpersonal Psychodynamic Therapy focuses on the assumption that the patient's problems are rooted in dysfunctional interpersonal relationships resulting from coping strategies developed in early childhood. It is a collaborative approach where the therapist and the patient discover, develop and try to understand hypotheses that try to explain the patient's feelings both inside and outside therapy. Explanatory hypotheses seek to clarify the causes and triggers of the patient's behaviour, especially repetitive patterns.
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Address negative beliefs about psychology, psychological therapy
Explain the diagnosis and offer initial psychoeducation on FND and the mind-body connection
Agree on a limited number of sessions and define the goals of the psychotherapy
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Development of an individualised model of the three types of FND factors
Take psychiatric and medical history into account
Take note of important life events and gain insight into the patient's life chronology
Consider interpersonal relationships (primary family and current partner/child relationship)
Take into account current life stressors and coping strategies
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Explain the link between the psychological and physical factors that maintain FND
Encourage the patient to keep a diary of symptoms and feelings
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Mindfulness techniques
EMDR
Relaxation techniques
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Setting goals
Promoting independence and self-care
Coping strategies for anxiety and separation
Reducing dependence on family members
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Assertiveness techniques
Techniques for self-care
Learning to set boundaries
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Emotion diary
Exploring emotional distress
Exploring emotions in the course of therapy
Encouraging emotional expression in interpersonal relationships
Linking symptoms to emotions
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Exposure
EMDR
Symptom control techniques
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Gutkin, M., McLean, L., Brown, R., and Kanaan, R. A. (2021). Systematic review of psychotherapy for adults with functional neurological disorder. Journal of Neurology, Neurosurgery & Psychiatry, 92(1), 36-44
Finkelstein, S. A., Adams, C., Tuttle, M., Saxena, A., and Perez, D. L. (2022). Neuropsychiatric treatment approaches for functional neurological disorder: a how to guide. In Seminars in Neurology (Vol. 42, No. 02, pp. 204-224). Thieme Medical Publishers, Inc..
Howlett, S., and Reuber, M. (2009). An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy: Theory, Research, Practice, Training, 46(1), 125-138. doi:10.1037/a0015138