Connecting body and mind: The first interview with somatising patients and their families

Abstract

In this article we outline the framework our consultation-liaison team has developed for interviewing families whose children present with medically unexplained symptoms. The framework was developed over many years in the context of our work with a large number of families, who collectively taught us to be more sensitive with regard to the experience of such families in the medical system, and who reacted strongly when we moved prematurely to the use of psychological language or to questions about family relationships or emotional functioning. Throughout the interview we maintain a focus on the body: the family history of illness and, in particular, the story of the child's symptoms. We take a detailed, temporally ordered history of the symptom and ask for collateral information - family illness, family life events, events at school, family emotional responses - all in relation to the story of the symptoms. In the assessment interview and in our work in general, we focus on the body. We move very carefully and very slowly from the physical to the psychological, from talking about the body to talking about relationships and about the mind.

Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature

“…HCPs are advised to acknowledge the existence of reported symptoms and recognise the adverse impact of symptoms on families' lives (Leary ), listen to parents' prior experience of the medical system (Kozlowska et al . ) and encourage families to engage in decision‐making (Kozlowska et al . ) to develop a medical consensus that is acceptable to all parties (Calvert & Jureidini ).…”

“…), identify contextual factors that have influenced the onset of symptoms (Dell & Campo ) and encourage families to participate in psychological therapies (Kozlowska et al . ). Furthermore, a multidisciplinary approach is advocated to manage the complex needs of young people (Campo & Fritz ), although Robins et al .…”

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

“…At the time of the initial family assessment interview, children presenting with conversion symptoms – and a parent – completed the youth and parent versions of the SDQ and the parent version of the CBCL (Kozlowska et al., 2013b). Subsequently, all children who had consented to the study participated in assessments of attachment (Kozlowska et al., ) and completed a battery of tests – including the DASS, SPHERE, BRISC, and NEO‐FFI – at the laboratory site (Kozlowska & Williams, ).…”

“…The challenges begin at the very outset of the intervention, with the neurological and family assessments. Children and adolescents presenting with conversion symptoms, as well as their families, frequently deny any emotional or family problems (Kozlowska, English, & Savage, 2013b; Leslie, ; Seltzer, 1985a), and parents are often genuinely baffled as to why a child has suddenly become so ill. Families find it difficult to accept that no medical explanation for the child's somatic symptoms – non‐epileptic seizures, inability to move a limb, deafness, blindness, or distressing movements – is forthcoming from the paediatric team.…”

Fabricated Illness: Working within the Family System to Find a Pathway to Health

“…The family assessment was conducted by the therapeutic team: a child psychiatrist, a senior social worker, a clinical psychologist, and a child psychiatry fellow (Kozlowska, English, & Savage, in press). Completion of a genogram (see Figure ) with the family revealed a complex history—domestic violence, mental illness, substance abuse, and a history of loss (miscarriages and deaths)—on both sides of the family.…”