Case Study of Conversion Disorder with Paralysis: Therapeutic Relationship and Assessment Strategies

Introduction
This manuscript discusses a case study of conversion disorder. The subject was Ms. S.r
(initials instead of real name) from my clinical practice suffering from functional
paralysis. Conversion disorder shows prominence of somatic symptoms associated with
significant distress and impairment. The psychologists jobs is to treat the somatic
symptoms plus the underlying cause of the problem in case of Conversion
disorder(Lowe, 2019). Taking into account the case study of Conversion disorder with
paralysis with persistent stressor, the current document deals with development of an
effective therapeutic relationship placing people at centre of their own decision making.
It also examines various assessment tools and strategies along with risk assessment
and management. Legal and ethical issues relevant to the case have also been taken
into consideration. In addition, evidence base supporting the notion of care and support
for people with mental health issues has also been discussed.
Summary of service user
The current report is about Ms. S.R. from my clinical practice. A 25 year's old lady
belonging from London. Her family was middle class with father as the dominating figure
in the family. Her relationship with her mother and siblings was very good. When she
was 15, her father married a widow. From then on, both wives kept a rivalry amongst
themselves, each competing to his attention. Relationship of S.R was never good with
her step mother and step siblings. About a year ago, her mother died. Since then, her
father had been more for her step mother. Her step mother had been strict towards her,
both verbally and physically abusing her. Her left arm is paralyzed about three months
after her mother’s death. There had been no medical evidence for the paralysis so she
was referred to psychologist by the physician. Her siblings were cooperative towards
her; father had shown interest in her treatment while a step mother labeled her as
malingerer. Her first cousin had been manic and her mother was an attention seeking
lady. The psychologist had to treat her functional paralysis in left arm and its root cause.

Therapeutic Relationship
The most important aspect in any relationship is the desire to be listen, understood and
unconditionally accepted (Czosnek et al., 2018). An empathetic therapeutic relationship
based on trust helps the client to be more open and receptive to the therapy (Kazantzis
et al., 2018).
In addition to physical, social and emotional support for their well-being, people also
need independence in their decision making, whether it is for their general life or
medical decision making (Thomas et al., 2018). People are usually made dependent on
others to decide for them that may lead to their self-doubting behavior (Marker et al.,
2019). In a therapeutic setting, patients are at the centre of the system’s framework.
This lays importance of a system inculcating patient centred health care (Saeidi and et.
al., 2018) and guidance of patient in all decision making of their healthcare. The most
important part of this process is promoting a better communication between the patient
and his health care team (Reiter-Palmon et al., 2018). Health care systems is include
shared decision making, leading and guiding the people towards making their own
decisions wherever and whenever possible. Shared decision making can lead to
recovery focused personalized care with person specific goals that have been
organized to harvest maximum achievements and encourage social integration (Wu et
al., 2018). The monograph of NCI has elaborated the functions of people-centred
communication as promoting the healing relationships, interchanging information,
acknowledging emotions, management of insecurity and doubt, making decisions, and
enabling people to self-manage (Hong and Oh, 2019) These functions dynamically
interact and affect the patient-therapist relationship quality and health outcomes. Self-
management facilitate people in managing their health issues as well as adopting to the
changing roles in their lives. It has been generally accepted that levels of safety and
security have close links to a better therapeutic and recovery focused experience for
both the patients and staff (Jeon and Kim, 2018).
Therapeutic intervention with Client
I followed psychotherapy and psycho-therapeutic relationship for the client. When first
brought to the clinic, S.r was defensive. She was briefed about psychotherapy and

hence report was built. Through verbal and subtle behavioral cues with non-judgmental
environment and she was asked open ended questions along with utilizing the
techniques of reflective listening and empathy. Emotional intelligence and sensitivity to
the client’s comfort zone along with a consideration of client’s needs and values was
also part of practice. Utilizing the expertise and unique insights, informal yet
professional communication led to cut through flood of information by S.r Goals, merits,
and risk of the applied treatment and therapeutic techniques relative to other available
options were discussed while considering each other’s values and preferences.
Emotional support in this process of shared decision making and person-centered care
for relieving fear or anxiety and also guidance on mental health issues was provided.
She was explicitly told that success of the therapy depended on her cooperation and
will. Her family was also interviewed and involved in the therapy.
Boundaries of the therapeutic relationship were set and maintained, as overly
involvement on behalf of clinician can hold the client’s opportunity to identify and
develop on their own resources (Matsuno, 2019).
Health Assessment strategies and tools
Differential diagnosis of a medical illness from a functional illness remains to be a
challenge (Jeon and Kim, 2018). A systematic and detailed psychiatric history and
examination is essential to elucidate symptoms, stressors, and comorbidity (Matsuno,
2019). Mental health assessment and screening tools are vital for getting information
about the patient’s illness, the extent and duration of illness, leading to correct diagnosis
and the treatment (Swann and et. al., 2018).
Assessment of client
The client was assessed both formally and informally. Information from both formal and
informal assessments was integrated to get an integrated picture of the case and later,
these assessment tools.
Interview and observation

A semi structured interview was conducted with the patient utilizing both open ended
question and cross questioning. The patient memory and orientation towards time,
place and person were intact. She had fair insight of her problem with motivation to get
better. She was carefully observed during the whole therapeutic treatment by both direct
and indirect observational methods. For observation outside the clinic, services of her
brother were taken who was provided with a rating scale for the observation of the
client’s behaviour after fixed interval of time.
Mental State Examination (MSE) and physical health
A client was presenting a dominant somatic symptom, left arm paralysis, she was first
examined for physically and neurological impairment. Her neurological tests were
normal, and she had no physical illness or abnormality. She was not suffering from any
type of thyroid problem, chronic heart disease and diabetes. She also had no history of
any substance or medication abuse. For mental status examination.
Family
Her family members were also interviewed. Specifically, her father, step-mother and
brother. These interviews revealed that her relations with her step mother and step
siblings had been very conflicting, yet she tried to maintain a good relationship with her
father and taking his attention. She had good rapport with her brother and sister from
her mother, and they had been very cooperative with her. After her functional paralysis,
she had very irritating and depressed behaviour. Since then she was receiving much
help in her work by her family member. Yet her step mother still considered her
manipulating the household through a fake paralysis (Goloshumova and et. al., 2019).
History- timeline, records
Analysis of her medical reports, educational record and personal and family history
taken from various sources revealed that she had a normal birth with no prenatal or
postnatal complications. She achieved her developmental milestone duration. She had
usual diseases of childhood that left no serious complications. She started school at the
age of five and was an average student. She took interest in extracurricular activities
and adorning herself. She had a vast social circle and was very friendly to everybody