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

Psychotherapy for patients who present in a medical setting involves certai n unique challenges, including the need to bridge the mind-body split. Soma tizing patients, in particular, live at the interface of mind and body. The ir physical symptoms may be biological markers as well as psychological met aphors and interpersonal communications. As such, it is important to assess and treat both patient and family, in collaboration with the healthcare te am. We review three foundational principles for working with such families. biopsychosocial integration, development of a collaborative stance, and mo ving from "Either-Or" to "Both-And" thinking. An extended report of a patie nt with psychogenic seizures illustrates the use of nine treatment strategi es: (1) Validate the reality of the problem, (2) involve the family (3) wor k closely with the healthcare team. (4) enhance curiosity, (5) actively att end to somatic symptoms. (6) link the somatic and the psychological. (7) us e physical interventions, (8) tolerate uncertainty and practice patience, a nd (9) terminate gently. (C) 2000 John Wiley & Sons. Inc.