The Body Comes to Family Therapy: Utilising Research to Formulate Treatment Interventions with Somatising Children and their Families

Abstract

Children and adolescents with functional somatic symptoms are challenging to understand and to treat. The challenges begin at the very outset of the intervention – with the neurological and psychiatric assessments. Patients presenting with functional somatic symptoms, as well as their families, frequently deny any emotional or family problem, and parents are often genuinely baffled as to why a child has suddenly become so ill and why no medical explanation is forthcoming. Families can be unwilling to engage in family assessment and therapy, and therapists may find that standard approaches to family therapy simply can end up alienating these families – the door to therapy is slammed shut. This article is the story of my struggle to understand somatising children and their families and to find a common language to enable us to co‐construct formulations, to agree to a treatment plan, and to work together towards a pathway to health. It is also about the role of research and how knowledge from different system levels – and most specifically about the body – may need to be integrated into the therapy to help bring about change.

Love in Times of Cholera: Systemic Reflections on Supporting Families Through the Journey(s) of Illness

“…It takes courage and insight for all of us as treating practitioners to know when we don't know. Kasia Kozlowska (), when recently reflected on working with somatising children, commented on how, as a therapist, ‘does one maintain one's own equilibrium in the face of “not knowing” and “not understanding”; (p. 7).…”

Barn og unge med uforklarlige kroppslige symptomer

“…Dette er ofte lite fruktbart når det gjelder fortvilte pasienter som presenterer et tilsynelatende uforklarlig fysisk symptom (2,4). Derfor er det viktigere å arbeide frem en helhetlig biopsykososial forståelse av pasientens symptomer (4 -6).…”

“…Den sosiale relasjonen som utvikles gjennom dette, bidrar til gjensidig tillit og respekt, aksept for plagene barnet eller ungdommen har og en bredere utforskning og forståelse av symptomene (4,5,7). En helhetlig felles forståelse omfatter delt kunnskap om pasientens symptomer, mulige sammenhenger, disponerende, utløsende og modifiserende biopsykososiale faktorer samt innsikt i pasientens erfaringer, behov, verdier og preferanser.…”

“…Først når en helhetlig forståelse av den individuelle pasient er arbeidet frem, kan behandler i samarbeid med pasient, pårørende og andre aktuelle instanser (f.eks. skole og fysioterapeut) skreddersy målrettede og meningsfulle tiltak som er avgjørende for behandlingseffekten (1,4). En fragmentert og mangelfull forståelse av barnets tilstand øker faren for at man iverksetter unødig utredning og uvirksomme tiltak, slik at helsevesenet bidrar til å forsterke de onde sirkler som opprettholder pasientens plager.…”

The Utility (or Not) of Self‐Report Instruments in Family Assessment for Child and Adolescent Conversion Disorders?

“…More recently, a series of cohort studies highlighted significant comorbidity with depression and anxiety (Kozlowska et al, 2007;Kozlowska, Scher, & Williams, 2011;Pehlivanturk & Unal, 2002;Wyllie et al, 1999). Studies using physiological markers such as heart rate, heart rate variability, and motor reaction time suggest a state of hypervigilance, motor readiness, and increased arousal (Kozlowska, 2016;Kozlowska, Brown, Palmer, & Williams, 2013a;Kozlowska et al, 2015a). Theoretically self-report measures that screen for mental health problems should be helpful in identifying or quantifying comorbid anxiety, depression, and emotional distress (Gledhill & Garralda, 2006) as well as states of physiological dysregulation.…”