Relational therapy in medical settings: working with somatizing patients and their families

Psychotherapy for patients who present in a medical setting involves certain unique challenges, including the need to bridge the mind-body split. Somatizing patients, in particular, live at the interface of mind and body. Their physical symptoms may be biological markers as well as psychological metaphors and interpersonal communications. As such, it is important to assess and treat both patient and family, in collaboration with the healthcare team. We review three foundational principles for working with such families: biopsychosocial integration, development of a collaborative stance, and moving from "Either-Or" to "Both-And" thinking. An extended report of a patient with psychogenic seizures illustrates the use of nine treatment strategies: (1) Validate the reality of the problem, (2) involve the family, (3) work closely with the healthcare team, (4) enhance curiosity, (5) actively attend to somatic symptoms, (6) link the somatic and the psychological. (7) use physical interventions, (8) tolerate uncertainty and practice patience, and (9) terminate gently.