Harnessing the patient's powers of recovery: the role of the psychotherapies in the irritable bowel syndrome.

The aim of this chapter is to provide a clear and balanced account of the role of the various forms of psychotherapy in the irritable bowel syndrome (IBS). It commences with an account of the philosophical basis for psychotherapy, attempting to integrate the concepts of autonomic arousal, repression, conversion and a developmental disorder of thinking and emotional expression. These concepts are used to explain why separation and loss can lead to the development of IBS and how the gut is such an important vehicle for emotional expression. Against this background the role and philosophy of relaxation therapy, hypnotherapy, biofeedback, cognitive behavioural therapy and analytical psychotherapy are discussed. These therapies describe a philosophical approach that is quite different from biomedical treatments in that it attempts to harness the patient's own powers for recovery. For that reason the efficacy of psychotherapies cannot be evaluated by randomized controlled trials. Psychotherapies rely on the relationship between therapist and patient and vary according to whether the locus of responsibility lies mainly with the therapist or mainly with the patient. Different patients may well require different therapies.