Abstract
Summary
The pertinent literature on the psychopathology and psychotherapy of individuals with ulcerative colitis is briefly summarized. A particular problem encountered in clinical practice is then described and an approach to its solution is detailed.
A 14-year-old, middle-class girl had experienced exacerbations of ulcerative colitis over two years. Without her agreement, she was referred for psychiatric assessment by a gastroenterologist when he found that she was not cooperating with medical treatment, and when she appeared depressed.
On assessment, the patient was found to be a silent adolescent whose main symptoms were indicative of immaturity, shyness and anger. This was understood in terms of the overprotective, domineering mother, a protective father and even a protective brother. The therapeutic problem was outlined on referral by her reluctance to take medication, to see doctors or to “let her friends know” of her illness. The patient and the family interactions are described.
Confronted by a girl whose denial was of such proportions it became clear that individual psychotherapy could not begin. There was no motivation and no contract to work towards this goal, and there was excessive resistance. With the girl's refusal to become involved in family therapy, it was decided that both parents should review their respective parenting roles in conjoint therapy. This had as its goal the provision of a more stimulating opportunity for the growth and development of the patient.
The author describes in detail the assessment and treatment, which was conceptualized as occurring in two stages. Stage one was an attempt at individual therapy and at developing a therapeutic alliance, both of which were unsuccessful. The second stage, conjoint therapy of the parents took place, and provided a more fruitful outcome.