Ellen Godena, LICSW (SSW’11) Leads Case Study for Functional Neurological Disorder
BUSSW alum Ellen Godena, LICSW (SSW’11) recently published a case study that illustrates the complexity of Functional Nervous Disorder (FND), the second most common outpatient neurological referral, and how to engage clients in nuanced treatment. The disease has been misunderstood and misdiagnosed by medical and psychotherapy fields for decades. As Godena notes, “FND has been called ‘psychiatry’s blind spot.’ There is a striking dearth of psychotherapists and mental health providers that feel well-versed in the clinical assessment and management of patients with FND.”
The study, “Psychotherapy for Functional Neurological Disorder: A Case Bridging Mind, Brain, and Body,” is part of the series “Cross Talk,” which presents multiple perspectives on a medical case to facilitate treatment that is more than a sum of its parts. “Our goal with this case presentation and related discussion is to increase the proficiency of psychotherapists in providing treatment to patients with FND,” says Godena.
Addressing FND’s Troubling History
FND is difficult for both patients and clinicians because it has historically been assumed that symptoms were linked to “secondary gain.” In short: people with FND only displayed symptoms because they wanted to display them. “Traditionally, when patients visited neurologists like me, we treated FND as a diagnosis of exclusion,” says co-author Alice Flaherty. “After putting patients through exhaustive and frightening medical tests with ominously negative results, we tried to reassure patients that their problem was ‘just’ anxiety and discharged them with a psychotherapy prescription.”
This assumption is especially troubling considering FND symptoms can include intermittent slowed speech, seizures, and sudden knee-buckling, among others. Due to their intermittent nature and connection to mental or emotional stress and trauma, many patients and their families still struggle to understand and cope with FND symptoms.
Newer approaches like Godena’s case study acknowledge the fact that FND symptoms are not a choice, but rather connected to biological, psychological, and social anxiety, stress, and trauma. “Psychotherapy for FND, particularly cognitive behavioral therapy, is centered around exploring relationships between physical symptoms, thoughts, behaviors, emotions, and life factors,” says Godena. “Encouraging patients to explore factors that relate to their own personal equation for developing functional neurologic symptoms (across physical and mental health considerations) can be another useful framing of the psychotherapeutic approach to FND.”
Abandoning a One-Size Fits All Approach
One reason why case studies like Godena’s help clinicians is that it shows “how treating patients with humane and holistic understanding requires thinking both deeply and pragmatically, putting aside theoretical allegiances,” says co-author Jonah N. Cohen. Godena presented a case history and treatment course for a woman diagnosed with FND, and four therapeutic schools of thought evaluated the case:
- Psychodynamic
- Family Therapy
- Neurology/Pharmacotherapy
- Dialectical Behavior Therapy
By presenting these different theoretical allegiances side by side, the authors hope to show how incorporating a combination of approaches encourages better client understanding of and responses to their FND symptoms.