Rehabilitation Model

A rehabilitative approach may also be useful in the treatment of patients with somatoform disorders. This perspective shifts the focus away from finding a cure for symptoms and instead emphasizes a return to normal functioning (Campo and Fritz 2001). The patient becomes an active participant in his or her recovery, which means that the sick role must be relinquished. Parents must be encouraged to view their child as capable, strong, and competent rather than passive, helpless, and fragile. Suc-

Table 8-6. Suggested guidelines for informing conference with patient and family regarding pseudoseizures presentation

1. Present objective evidence of absence of seizure activity associated with episodes.

2. Explain the common reasons for seizure episodes (e.g., epilepsy, cardiac, and/or emotional).

3. Give the good news that the patient does not have epilepsy.

4. Cite common examples of physical phenomena such as fainting or hand sweating which may be related to emotional arousal.

5. Acknowledge the patient's suffering.

6. Acknowledge the family's concern.

7. Emphasize that the events are not under voluntary control.

8. Explain that remote and recent events may contribute to the episodes, even if the patient is not feeling stressed.

9. Emphasize the physically disabling nature of the events and the importance of prompt, intensive, and appropriate treatment.

Source. Chabolla et al. 1996.

cess is measured by the child's ability to return to school and to resume normal social and recreational activities rather than a primary focus on symptom reduction.

Rehabilitative treatment approaches include the use of intensive physical and occupational therapies that emphasize the recovery of function and also offer face-saving remedies for the patient. Physical therapy may be particularly helpful in restoring function in cases of conversion disorder (Abbey 2005). This approach can be combined with a behavioral modification program, with incentives for improvements in functioning while removing secondary gain for illness behavior. For patients with severe disabilities, the preferable action may be to recommend admission to an inpatient treatment or day treatment program that specializes in the treatment of somatoform disorders. Three case study reports have shown that intensive inpatient programs with behavioral modification as well as physical therapy directed by verbal cues can eliminate conversion symptoms in an average of 8 days (Ness 2007).

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