Treatment For Munchausen Syndrome

As a clinical psychologist in practice for twenty-five years I had never worked with a patient with Munchausen syndrome until I met Andrea. For the first three years of her therapy, I was unaware that she was engaging in factitious disorder behavior and that all of her physical illnesses were self-induced. What I did know was that she had been the victim of horrific childhood abuse and, as a result, it was difficult for her to trust anyone. I realized I needed to gain her trust over time and turn to less conventional methods to do so. It became apparent early on that the therapy relationship itself was the most crucial component of my work with Andrea. As I wrote in our book, “I find nothing more meaningful than the bond that connects human beings and the communication that creates that bond. It is something that cannot be predicted or charted, but rather unfolds spontaneously, like all things that are special in life.” Andrea’s therapy unfolded in ways I could never have imagined and ultimately reinforced the power of the relationship.

The relationship with Andrea compelled me to reconsider the traditional boundaries of psychotherapy. My typical approach of talking with patients once a week, with no other contact in between sessions, wasn’t enough to help her. She had worked with several other therapists in the past without much benefit. Over time, I made conscious decisions to expand my availability to her. We increased to twice a week meetings, spoke frequently on the phone in between sessions and eventually began emailing one another. The increased contact not only enabled her to gradually work through her past trauma and ongoing emotional struggles, but it also allowed her to feel consistently heard and cared about by someone whose only agenda was to bear witness to her pain.

I recognize most clinicians would be understandably reluctant to make the therapeutic choices I chose to make with Andrea. My hope, however, is that in hearing our story, other therapists will consider alternative, less restrictive, approaches to working with trauma survivors, particularly those with Munchausen syndrome.

-Dr. Hall

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