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Essay on The use of Cognitive-Behavioral Therapy in the Treatment of Somatoform Disorders
Somatoform Disorders is complex and multidetermined, defying a simple schema of etiology and pathogenesis. Thus, for somatoform disorders alone, one might consider the etiologic role of psychodynamically based psychosexual conflicts, gratification of dependency needs, reaction to environmental stress, the phenomenon of dissociation, neurophysiologic predisposition, and the role of depression (Williams & Hirsch, 1988). Considerations with factitious disorders and malingering are similarly complex, generally requiring a thorough psychological and/or psychiatric assessment as a prelude to accurate diagnosis and treatment.
Many different treatment approaches have been used with patients having psychogenic seizures. As with most psychotherapeutic interventions, controlled studies are extremely difficult to implement (Goldstein, 1990; Karasu, Conte, & Plutchik, 1984). Those therapeutic approaches that eclectic clinical experience has found useful are considered here. Each of these treatment approaches has some potential value for some patients. Often, different treatment approaches can be effectively combined in the management of a given patient.
onsequently, it is advantageous for the clinician to be well informed about as many of these approaches as possible in order to structure a treatment plan that most effectively meets the unique needs of each patient. Implicit in this discussion is the observation that no direct correlation exists between the specific type of psychogenic seizure and the specific type of treatment intervention clinically indicated. Whereas a variety of modalities are outlined, some common underlying features may be delineated:
1. Psychotherapeutic intervention provides a framework, by psychologically oriented review of the history, whereby the patient (and family) can discern and articulate postulated psychogenic contributants to the uncontrolled seizures.
2. Once postulated psychogenic contributants are identified, a strategy for their attenuation or control can be delineated. This engenders a sense of hope in the patient and family that a new level of understanding and a new treatment intervention can be brought to bear. An intrinsic calming effect on the patient is inherent in this process, if successfully applied....................
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