Overcoming therapeutic pessimism in hypochondriasis.

The treatment of hypochondriasis continues to be challenging because of the nature of hypochondriasis and reactions that it often elicits in therapists. In this paper, it is argued that due to complex interactions between hypochondriacal patients and their therapists, there should be a radically different approach to treating hypochondriacal patients. Within such a framework, it is crucial to determine whether therapists are "eligible" to treat hypochondriacal patients, rather than whether hypochondriacal patients fulfill criteria for particular types of treatment. Regardless of the specific treatment modality used, it is suggested that treatment of hypochondriasis should always entail empathy, acceptance, understanding, and explanation and education. In addition, good therapeutic results can be achieved and therapeutic pessimism about hypochondriasis overcome if therapists are accessible, reliable, and flexible, if their behavior is consistent and predictable, and if they express themselves clearly and in unequivocal terms.