Medically Unexplained Symptoms

The therapeutic relationship is crucially important when working with people experiencing medically unexplained symptoms. Having a good therapeutic alliance and working in collaboration with the patient is not only important in the early stages of therapy when the therapist is engaging and socialising the patient to the cognitive behavioural approach but it is necessary to ensure a good therapeutic alliance is present throughout therapy. This enables the patient to remain engaged and undertake the challenging cognitive and behavioural work which is essential for treatment to be effective. In this chapter we aim to provide the reader with the essential foundational ingredients to foster a good therapeutic relationship at each stage of therapy. We consider therapy to consist of three distinct stages, (1) engagement and assessment, (2) formulation and intervention, and (3) preparing for discharge. While these stages are distinct there is invariably some interweaving, for example, one will often need to reassess when formulating, and one should be preparing the patient for the end of therapy and discussing relapse management right from the start of any clinical work. We will discuss how to maintain a working alliance at each stage of therapy and how to repair ruptures to the relationship should they occur.