Creating a Space to Feel: An Integrative Therapy Approach with an Adolescent Diagnosed with Dissociative Motor Disorder

Abstract

The dissociative motor disorder is one of the most commonly diagnosed forms of dissociative disorder in the Indian population, especially among adolescents. However, there is a dearth of literature on effective psychotherapy practices in the Indian setting. This article details the unique process of employing an integrative psychotherapy approach with a 16-year-old adolescent girl diagnosed with dissociative motor disorder who presented with complaints of headache, deviation of mouth, multiple somatic complaints, inability to move her legs, episodes of loss of consciousness with jerking of upper limbs and a non-pervasive low mood. A detailed evaluation highlighted significant disruptions in attachment with caregivers, complicated grief, significant anger towards her family which did not find a space for expression, unhealthy coping mechanisms in the background of a slow-to-warm-up temperament and sociocultural stressors. The case formulation drew elements from the psychodynamic perspective, family systems approach, biosocial theory and the cognitive behavioural perspective. The intervention from the first session until termination is delineated in different phases which outline the significant themes that emerged along with the techniques used, challenges faced and therapist reflections. The role of the therapeutic alliance, working through transference, systemic work, primary and secondary gains and the importance of defences along with the aftermath of losing them becomes especially salient as the psychotherapy progresses in this case. The implications of the therapy process that can hold relevance to the management of dissociation disorder in the clinical setting are also discussed.

Keywords: Child and adolescent; case report; dissociative disorders; integrative psychotherapy; psychotherapy.

Figure 1.. Representation of the Integrative Case Formulation.