Permission to speak: therapists' understandings of psychogenic nonepileptic seizures and their treatment.

Psychogenic nonepileptic seizures (PNES), somatoform symptoms that diminish quality of life, can be difficult to treat. A previously proposed conceptualization of PNES is further developed using grounded theory methodology to explore the understandings of therapists who successfully treated clients with PNES. Participants conceptualized PNES as nonverbal communication behaviors that usually evolved in traumatic, interpersonal systems in which verbal expression of affect was proscribed and nonverbal communication of affect was prescribed. Clients without significant trauma and psychiatric comorbidity were successfully treated by means of sensitive delivery of the diagnosis and brief cognitive interventions. Traumatized clients with compromised orientation to the present required a process of cultural transformation in a safe therapeutic relationship. Implications for clinical practice, research methodology, professional training, and service funding are discussed.