Therapeutic activities and psychological interventions by cognitive behavioural and psychodynamic therapists working with medically unexplained symptoms: A qualitative study

Abstract

Aim: To explore therapeutic activities and psychological interventions used by experienced cognitive behavioural and psychodynamic therapists to treat clients with medically unexplained symptoms (MUS). Method: Twelve in‐depth, semi‐structured, qualitative interviews with psychotherapists, recruited from two British National Health Service (NHS) Departments were conducted. Interview transcripts were analysed using grounded theory. Findings: Therapists from two modalities share the following therapeutic activities and psychological interventions in their work with MUS clients: working together with clients, sensitive, empathic responding and building trust, being flexible with techniques, keeping an open mind and multi‐disciplinary cooperation. They also use modality specific interventions discussed in this paper. Even though participants experienced difficulties in forming alliances with MUS clients early on in their work, they expressed the importance of nurturing hope, empowering and engaging clients in jointly constructing understandings, which helps symptom management.

Engaging patients with “medically unexplained symptoms” in psychological therapy: An integrative and transdiagnostic approach

“…Although engagement via GPs has been explored, very few qualitative studies have explored therapists’ experiences working with patients with MUS. Luca () explored the interventions that therapists employ when working with these patients. The study emphasized the ‘concrete’ and ‘difficult and complaining’ nature of these patients and their resistance to linking physical symptoms with psychological experiences.…”

What works in the treatment of medically unexplained physical symptoms? The psychotherapist perspective

“…Changing the clients' passive, guarded, symptom-oriented, and hopeless attitudes to the treatment in the first phase were viewed as the most important for the treatment success. This aim was based on the therapists' response to challenging client characteristics reported previously by diverse professionals across specializations (Balabanovic & Hayton, 2019;Czachowski et al, 2012;Heijmans et al, 2011;Luca, 2012). Engaging clients in treatment by bridging the gap between clients' and therapists' understanding of clients' issues and their expectations from the treatment has been shown as essential for the success of treatment (Balabanovic & Hayton, 2019).…”

“…However, empirical research on psychotherapists' clinical strategies is rare. In two available Luca (2011Luca ( , 2012 explored the conceptualizations, interventions, and therapeutic activities of 12 CBT and psychodynamic therapists. The psychotherapists shared the view that clients with MUPS were "concrete" (i.e.…”

Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms

“…The need for a flexible use of techniques that aims to find a helpful focus of treatment for clients has been mentioned in other recent studies of professionals who focus on the treatment of people with MUPS (Balabanovic & Hayton, 2019;Cevelicek et al, 2020). These clients are considered difficult to treat (Heijmans et al, 2011;Luca, 2012), a position supported by observably mediocre therapeutic results (Kleinstäuber et al, 2011;van Dessel et al, 2014), leaving a high desire to explore different approaches to engage them in treatment. A flexible usage of personal therapeutic styles, similar to the one demonstrated in the present study, might improve psychotherapy outcomes and client engagement, specifically when client characteristics such as psychotherapy preferences, stage of change, reactance level, coping style, and attachment style are accounted for (Norcross & Wampold, 2018).…”