These are difficult patients. The handful of patients with symptoms resulting from conversion reaction I've worked with have all had diagnoses of major depression and experienced early childhood or adolescent trauma. I presume your patient is getting psychiatric and psychological help; if not, please make a referral. In working with such a patient on redeveloping occupational skills, accept the symptoms at face value. The symptoms are likely to significantly impair the patient's ability to function in the world and in doing so they are "sending a message." Until the symptoms resolve, the patient needs the symptoms (and the message) to be respected. I suspect the patient is likely to feel helpless and at the mercy of these symptoms; encouraging or challenging the patient to do things beyond his or her capabilities will be frustrating to them. Expect to go slowly. Let the patient identify areas where he or she is capable of functioning, and gradually expand on them. Without pressuring, note that sometimes symptoms can change rapidly for the better, but even if they don't, you'll help the patient as much as you can. But be prepared to be in for the long haul; change is likely to occur slowly in the areas you are concerned with until the underlying issues are addressed. Good luck!
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