How can you foster patient alliance in somatic symptom disorders?
- Listen first and empathically and nonjudgmentally reflect the patient’s understanding and concerns and validate the patient’s experience of symptoms.
- Avoid use of unnecessary stigmatizing labels or colloquial jargon (e.g., “it’s all in your head”) and empathize with the real experience of symptoms (e.g., psychogenic nonepileptic seizures are still seizures, they’re just not caused by epilepsy).
- Find common goals (your goal should be the patient’s improvement), and focus on these rather than convincing him or her of your diagnosis.
- Anchor proposed interventions in known or presumed pathophysiologic mechanisms as appropriate (i.e., use psychoeducation).
- Encourage use of a symptom diary, and focus on reduction rather than elimination of symptoms.
- Encourage frequent follow-up with a single provider (you if appropriate).
- Maintain vigilance for changing psychological, social, and biological factors (including routine health maintenance and screening for development of medical disorders).
Post RM: Neural substrates of psychiatric syndromes. In Mesulam MM (ed): Principles of behavioral and cognitive neurology, 2nd ed. New York: Oxford University Press, 2010, pp 406-438. Georgiopoulos AM, Donovan AL: The DSM-5: a system for psychiatric diagnosis. In Stern TA, Fava M, Wilens TE, Rosenbaum JF (eds): Massachusetts General Hospital comprehensive clinical psychiatry. London: Elsevier, 2016, pp 165-170.