Patients with Persistent Somatic Symptoms or Functional Somatic Symptoms: An Integrative Psychodynamic Treatment Approach

Patients presenting with persisting somatic symptoms or functional somatic symptoms constitute a very large subset of patients seen in routine healthcare. For instance, around 40% of patients with depression and anxiety also report high levels of functional somatic symptoms and long-term health conditions. Recent theoretical and empirical advances open up important new avenues for the treatment of these patients. In this talk, Dr. Luyten summarizes findings concerning the role of three related biobehavioral systems that play a central role in the development of these symptoms from a psychodynamic perspective (i.e., the attachment system, the mentalizing system, and impairments in epistemic trust), with a focus on the importance of fostering embodied mentalizing. He also reviews empirical evidence supporting the efficacy of psychodynamic psychotherapy with these patients. Finally, he outlines the treatment principles of dynamic interpersonal therapy, an integrative psychodynamic treatment that has been adapted for patients with functional somatic symptoms with varying levels of severity, based on a description of the treatment of a patient with chronic widespread pain. Dr. Luyten argues that labeling these patients as 'hard-to-reach' of ‘difficult-to-treat’ reflects a fundamental misunderstanding of their embodied mind.