A relational approach to working with medically unexplained symptoms (or not yet explained symptoms)

Abstract

Abstract People suffering medically unexplained symptoms (MUS) or yet to be explained symptoms can be a challenging client group to engage in therapy for a number of reasons. Firstly, MUS is a term used to describe a wide range of presentations from short term, stress-related symptoms to functional neurological disorder (FND) and chronic fatigue syndrome (CFS). Of emerging importance are persisting physiological symptoms post Covid-19 infection. The aetiology of MUS has wide heterogeneity and there is often poor understanding amongst healthcare professionals about MUS and available support. Clients can feel overwhelmed by a lack of clear diagnosis and care pathway, and are often left feeling dismissed when they are referred for therapy. This chapter provides an overview of how psychological models have contributed to our understanding of MUS and the use of therapies in practice. Considering the challenges for clients attending therapy, we describe how the nature of cognitive analytic therapy (CAT)—to be open, curious, and work collaboratively—can provide a helpful approach with this client group. Using case examples, we describe how CAT enables the therapist to explore many aspects of the individual’s experience, including their early life and their relationships with others, themselves, their symptoms, their body, and their experience of the medical professionals. The process of co-constructed reformulation and self-reflection, creates a dynamic person-centred approach that has the openness, curiosity, and flexibility to explore and learn.