Page 100 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Functional neurological movement disorders

while walking. Thus, a FMD was suspected, and she was patients’ first successive meetings with the neurologist, the
referred to a special unit for psychosomatic diseases. The physiotherapist, the psychologist/psychotherapist, and the
psychiatric investigation found her moderately depressed, nurses. It is important that in all four meetings, the patient’s
and she was treated with sertraline. She did not improve feelings are being heard, understood, respected, and given
neurologically and was finally referred to our department hope 24 h a day. The second part of the treatment involves
(NFTSUH) late March in 2016. training in a warm water swimming pool. Such training
At arrival, the patient was alert. The function of the often surprises patients in a positive way that they have a
cranial nerves was normal. The upper extremities were bigger control of their bodies than expected, encouraging
intact. The strength of the lower extremities was intact, them to continue receiving treatment and moving through
and she had normal tendon and plantar reflexes . We only the more difficult part of the training. The third part of the
treatment is building trust and a working alliance between
found mildly reduced sensibility in her left foot. Her gait the psychotherapist and the patients, which form the
was highly abnormal due to severe shaking and shivering foundation to facilitate an open-minded presentation of
of the legs. Her somatosensory evoked potentials and the subjective experiences and life stories of the patients,
motor evoked potentials were both normal. We started including the emotionally disturbing experiences of
graded physiotherapy for her in a warm water swimming conscious and unconscious traumatizing moments and the
pool combined with psychotherapy twice a week with a childhood-to-adulthood periods.
psychologist.
In the case of patient 1, important traumatizing
After 1 week of treatment, she was able to walk with
a walker up to 200 m. At this point, she realized that she elements in her life history were the early death of her
was angry with her father for his plan to marry his new mother and the subsequent failed mourning reactions of
girlfriend, and she was able to walk independently after the father leading to inappropriate behavior toward both
another week of treatment. Yet she still experienced muscle the patient and her best girlfriend. The emotions related
to these events were brought to the surface in the 4 and
th
cramps in the legs, but this issue normalized, and 5 days 7 sessions, and after implementing the intervention, we
th
later she was able to ride a bicycle and was then discharged observed changes in her physical training. A week later, she
from the hospital at the end of April 2016, following functioned normally and was discharged home.
4 weeks of rehabilitation.
In the case of patient 2, the psychotherapy sessions
Five months later, she encountered a new, sports-related
accident. She experienced pain in the back and disturbance revealed a traumatizing, violent assault, and attempt to rape
in her youth which had been neglected by the authorities,
of gait, and she was acutely referred to a local hospital. MRI and almost totally repressed by the patient. After a few
of the spine was normal, and she was transferred to our weeks, these memories, being triggered by the therapist’s
department. After having brief contact with a psychologist intervention, surfaced to her surprise in the 4 session,
th
and a neurologist in the NFTSUH, she attained a quick and she reacted in exasperation toward the therapist. A few
improvement and was discharged after 2 days with a days later, progress in the training was observed, and after
normal gait. In the following 3 months, she still suffered a few weeks, she had improved to a point that she was able
from intermittent symptoms when she felt stressed until to walk normally and was therefore discharged so that she
she had a confrontation with her father and stepmother could achieve further stabilization at home.
in the 26 psychotherapy session. Three years after that
th
session, she showed normal mental and physical abilities The third patient had been through several unsuccessful
in the follow-up interviews. She has moved into her own treatment courses before being referred to our department.
flat and obtained her high school diploma. Warm water swimming pool training helped her in addition
to the successive psychotherapeutic empathic exploration of
4. Discussion her sorrow after losing her mother. Further improvement
We have successfully treated a series of 42 patients with ensued after she expressed anger toward her father during
this combined method, achieving good results, and the therapy, who had let her down psychologically. The
31
later included patients who have not changed the results. improvements did not stabilize totally until she was guided to
The three cases presented herein are typical examples, confront her father with her feelings of being neglected and
chosen to illustrate how we understand the dialectic let down during psychotherapy, which has since helped her
interactions between mind, body, and brain processes. gain a feeling of more freedom and more control over herself
The combined treatment contains therapeutic elements and her life. Since then, similar symptoms did not recur.
that work across the whole patient sample. The first part is All these three patients suffered serious mental burdens
the creation of a treatment alliance, taking place from the that could result in an overload of the limbic system, which

Volume 3 Issue 1 (2025) 94 doi: 10.36922/jcbp.4369