Interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes: A metasynthesis of case studies.

Abstract

Patients with Functional Somatic Syndromes (FSS) often display troubled relationships with health care providers, psychotherapists, and significant others. Research shows that patients' history of trauma, attachment disturbances, and mentalization deficits may result in the emergence of maladaptive interpersonal patterns, which may later contribute to the onset and maintenance of FSS, "doctor-hopping," and dropout in psychotherapy. As the nature and therapeutic consequences of such maladaptive interpersonal patterns in FSS cannot be understood sufficiently by quantitative methods alone, there is a need for in-depth qualitative research. To address this issue, we conducted a metasynthesis of 23 published case studies of patients with FSS from various psychotherapeutic orientations. Results show that patients with FSS from our sample perceived others as unreliable, i.e., unavailable, overcontrolling, and overprotective. To adapt to such unreliable others, patients attempted to please and to control them. Patients also suppressed their emotional awareness and expression. Although alexithymia could also play a role, the primary reason for emotional avoidance seemed to be interpersonal in nature, i.e., patients were avoiding negative emotions in order to please and control the unreliable others. The onset and worsening of FSS were associated with both interpersonal and physical triggers. Showing signs of physical or emotional distress lead to more rejection, overcontrol, and overprotection from unreliable others, which could create a "vicious circle." Our results suggest that offering a more interpersonal perspective on emotion regulation difficulties would be beneficial for patients with FSS, counselors, psychotherapists, and other health care professionals.

Emotional self-states and coping responses in patients with chronic tinnitus: a schema mode model approach

“…The mode’s mediating role further suggests that a relational focus on patients’ emotion regulation strategies may further benefit psychological treatment outcome. This is in keeping with previous research that suggests an interplay of emotional detachment and seemingly pleasing (yet controlling) interpersonal coping styles in patients with functional somatic syndromes ( 55 ) - and a therapeutic need to adopt both intrapersonal and interpersonal perspectives regarding patients’ emotions and biographically influenced, dynamically applied regulation strategies.…”

Commentary: The framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSY-PSS)

“…Alexithymic characteristics in this patient group describe the difficulty of identifying and describing feelings that go along with the misinterpretation of bodily sensations that accompany emotional arousal ( 13 ). In addition to individual deficits, emotional avoidance often fulfills an interpersonal function in patients with PSS ( 14 ). However, modern approaches describe phenomena of alexithymia regarding affective processing as deficits in embodied mentalization ( 15 ), deficits in affective theory of mind ( 16 ), or as specific deficits of basic abilities such as affect differentiation or affect tolerance ( 3 ), all of which share an explicit or implicit dimensional model of personality functioning.…”

Different Dimensions of Affective Processing in Patients With Irritable Bowel Syndrome: A Multi-Center Cross-Sectional Study

“…Therefore, they are supposed to suppress and avoid emotions because of negative beliefs regarding emotions or learned reinforcements. A recent metasynthesis also emphasized interpersonal reasons for emotional avoidance like pleasing and controlling unreliable others (Krivzov et al, 2020). However, there are also indications that patients with IBS do express emotions, but more specific impairments appear.…”