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Engaging Families Who Hold Strong Medical Beliefs in a Psychosomatic Approach

Dorset Healthcare NHS Trust, peter.hardwick{at}dorsethc-tr.swest.nhs.uk

Families holding strong medical beliefs about the nature and treatment of their problems despite contrary evidence often challenge our skills to engage them in the psychological part of a holistic psychosomatic approach. Although joining and engaging feature generally in the therapy literature, there appears little specific information on engaging medicalizing families. This article attempts to remedy the deficiency. It draws on the author's experience in paediatric liaison and systemic therapy and refers to what literature could be found. In attempting to understand over-medicalization, the somatization process is considered with reference to chronic fatigue syndrome and 'good' children. Iatrogenic aspects are discussed including our culture of medicalization, behaviour and beliefs of clinicians, and difficulties living with uncertainty. However, the bulk of the article is devoted to practical approaches that facilitate engagement. These include experimentation and curiosity, tackling beliefs, 'as though', developing an emotional language, practical philosophy, rehabilitation and recovery, and overcoming network paralysis. Measures to prevent excessive medicalization are proposed including better psychosomatic education and alternative systems of classification.

Key Words: engagement • families • medicalization • psychosomatic • somatization

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