Client and therapist understandings of non epileptic seizures and the process of their treatment: towards a psychological understanding of non epileptic seizures

Submission note: A thesis by published work submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora.

Thesis with publications.

Psychogenic non epileptic seizures are seizure-like events of psychological origin. Little is known about effective treatment of this serious somatoform symptom. This thesis explored therapist-client perspectives on successful therapy for psychogenic non epileptic seizures. Using a theory building case study approach, a literature review was undertaken to develop a conceptualization of psychogenic non epileptic seizures (Study 1: Conceptualization of PNES), then three qualitative in-depth interview studies involving eight therapists and their clients were undertaken to develop a therapy model to inform clinical practice. Study 2 used grounded theory to explore therapists’ understandings. Study 3 explored illness and therapy experiences of two male client participants using Interpretative Phenomenological Analysis and process analysis. Study 4 used a case study theory building framework to synthesize the conceptualization that emerged from review of research and practice guidelines, with analyses of client-therapist dyads using Interpretative Phenomenological Analysis and process analysis. The Conceptual Study identified three patterns of co-morbidity and trauma history. In Study 2, therapists conceived of psychogenic non epileptic seizures as nonverbal communication that evolved in traumatic early attachment relationships in which verbal expression of affect was proscribed. In Study 3, the psychogenic non epileptic seizures of two civilian male participants resolved in attuned therapeutic relationships that sanctioned verbal expression of emotion and supported development of a robust masculine identity. In Study 4 client participants’ formative relationships were characterized by chronic Mal-attunement. Therapy involved establishment of safety, internal self-resourcing, development of adaptive emotional expression, then processing of traumatic material, in an attuned therapeutic relationship.