The client is an 11 year old female. She presents with swollen legs and soreness. She is utilizing crutches due to difficulty walking. A surgeon from the orthopedic department referred this client to the psychology department. According to the orthopedic surgeon, a physiological impairment did not explain the client’s symptoms. The onset of symptoms was approximately one year ago, the same time her parents separated. She began physical therapy a few weeks ago; however, there were no explanations for her problem. This was a last resort. The attending psychologist on this case was an intern in favor of family therapy. Due to the complexity of this case he conferred with a colleague. Based on the client’s symptoms, the therapist determined this client has a Conversion Disorder. Additionally, the entire family was included in the treatment of the client using strategic family therapy. The following paper will discuss this diagnosis as well as suggest another possible diagnosis. Finally, this paper will review the therapy technique used and a possible alternative therapy.
The client is one of five children. Prior to the onset of the client’s symptoms, the client was healthy. She was a member of her school’s cheerleading squad and had a normal social life for an adolescent girl. The client, accompanied with her mother and siblings, recently moved in with the grandmother. The grandfather is recently deceased. The client’s parents separated approximately one year age, her father lives on the west coast. The main factor reported for the separation was infidelity. Both of the client’s parent drake alcohol; however, the severity is unknown. The client’s father reported bouts of depression. At time of admission, the father was in town visiting. According to the parent’s report, the client’s symptoms worsened the closer it came for the father to leave. It was clear that the client was internalizing the separation. Additionally, this client seemed to take on her mother’s burdens.
The case study suggests a diagnosis of Conversion Disorder. Conversion Disorder is common in younger clients and related to a particular stressor (Morrison, 1995). Also, to meet criteria, there must be at least one pseudoneurological symptom, not explained by a general medical condition (DSM-IV-TR). Symptoms are not limited to pain or sexual dysfunction (DSM-IV-TR). Additionally, substance use dose not explain these symptoms, nor are they a manipulation for material gain. They severity of symptoms will typically worsen in the face of stressors. Symptoms are such that they warrant a physical exam, cause clinically significant stress, or impair an individual’s ability to work or go to school (DSM-IV-TR).
This appears to be a typical case of Conversion Disorder. In particular, this client has undergone numerous testing, medical procedures, and physical therapy in an attempt to determine the cause of her condition. Additionally, her symptoms began a year before the referral to the psychology department. Also, as noted, they worsened when the father was getting ready to leave from visiting. Two of the criteria for Conversion Disorder were evident at the time of admission. Additionally, when asked about the father, the client became notably upset. Matching the criteria for Conversion Disorder, the client’s symptoms caused significant impairment in her ability to walk. The client’s symptoms had also had negative effects on her social life as she quit cheerleading and stopped seeing friends.
While this diagnosis seems to be the best fit for this case, there is one symptom that is not consistent with Conversion Disorder, pain. The client reported soreness in addition to the swelling. This would suggest a Pain Disorder. The criteria for a Pain Disorder are similar to those for a Conversion Disorder. To meet the criteria for a Pain Disorder, there is pain in one or more areas of the body. Like Conversion Disorder, Pain Disorder affects daily living including work, school, and socialization. High stress situations typically act as a trigger for the symptoms. Finally, the symptoms no other disorder can explain the symptoms nor are the intended for material gain. As reported this client was experiencing soreness in her leg which affected her daily life and worsened under stress. This may be a better diagnosis for this client’s disorder as the symptoms had reached a chronic stage whish is typically of Pain Disorder. She had been experiencing symptoms for about one year. Illness is typically, determined chronic after six months.
The intern on this case conferred with a colleague on this case who suggested strategic family therapy. With this technique the therapist uses behavioral metaphors and a social hypothesis to: view the client’s problem in a social aspect as it relates to and affects the client’s current situation and determine the best course of action of the client in particular. In the case of this client, the therapist used the behavioral metaphor that the client was unable to walk because something was stopping her from moving forward. Examining this situation the therapist learned that there were family issues of separation and there was a promise between the mother and the grandfather regarding the care of the grandmother. This essentially left no hope of reunification of the client’s parents. Additionally, a therapeutic goal was to get the family to focus on the client’s healing. This included the client focusing on her own healing. As the client had internalized the problems of her mother and father, the therapist focused strategies on their issues and their relationship. While the parent’s were dealing with their issues, the client was included to allow the client to feel support from both parents. One useful technique that the therapist used was to place the client in the middle of the two parents. This gave the client the feeling of togetherness and allowed her to feel a relief from stress and focus on healing. Additionally, the therapist determined the reasons for the separation, the move across the country, and possible solutions to this family’s problems. Through information gathering, the therapist learned that the mother of the client felt bound to stay with the grandmother because the grandfather was gone and the mother has made a promise to care for the grandmother. The therapist was able to assist the client’s parents in problems solving. They came up with a solution for care for the grandmother and reunification of the parent’s. This included asking the client’s aunt to care for the grandmother since she lived in the same town. The family could them move back in together and the client’s mother would not have to feel the guilt of breaking a promise. The therapist also recommended and provided a referral for marriage counseling.
The outcome in this case was positive. The client’s symptoms dissipated within days and did not reoccur. However, this technique is dependent on the client’s willingness or ability to follow all directives. In this case the family seemed very committed to the client. Additionally, the client’s parents continued separation seemed contingent on the care of the grandmother rather then the original problems of infidelity. However, not all families will be as supportive or willing to listen to a therapist. In these cases this form of therapy will be less beneficial. Another downfall to this therapy was the fact that the client did not learn any new insights to herself or any new skills. The therapist wanted everyone in the family to give the client their full attention. In the meantime, he worked with the parents to solve issues that were at the root of their daughter’s disorder. The family did not follow up on family or marriage therapy once they returned to the west coast as a family, despite the strong recommendations from the therapist. While the case reported that the client was doing well with no reoccurrence one year later, there is no report that upon another highly stressful situation, similar symptoms did not appear.
In addition to family therapy, the client is in need for some individual therapy to learn to cope with the recent family events. An alternative therapy technique which could be beneficial would have been psychoanalytic therapy. This technique typically takes longer to see results; however, the therapist would be able to get to the root of the problem and possibly show the client insights to her own coping and problem solving abilities. This knowledge may go further in terms of future stressful events. Every individual is unique and will respond to different techniques. It was wise for this intern to obtain the assistance of a senior colleague. Not only did he recognize the need of an alternative therapy that the family could respond to but he also added to his own repertoire of therapeutic techniques.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSN-IV-TR. Washington, DC: Author.
Morrison J. (1995). DSM-IV made easy. The Guilford Press: New York.
