MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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“The way that you present the rationale for treatment will be particularly important otherwise they may feel that you
are trying to ʺpsychologise” the illness”: this is could be interpreted as instructing the therapists to be
dishonest, because the CBT model is self‐evidently a psycho‐behavioural model.
“ It is particularly helpful if they are sceptical about this approach, to draw a model of illness together, to look at all the
factors that may have triggered it and be involved in maintaining it. Patients often feel reassured when they are
informed that CBT helps people with a wide range of health problems including cancer, chronic pain and diabetes. It
can be helpful for this group of patients to try to view aspects of CBT as an experiment”.
Therapists are provided with an illustrative dialogue, which seems structured to ensure that questions are
phrased so that the participant has to agree with the therapist and is gradually coerced into accepting the
rationale for continuing with CBT:
“The following dialogue may help to engage participants in therapy.
“Therapist: Up to now, you have been trying to manage your illness by doing things when you feel relatively ok, i.e.
when your symptoms are not too bad. However; from what you have said it seems that you can tend to push yourself
too much when you have a bit of energy, resulting in you feeling exhausted and resting until your symptoms have
reduced a bit. Does that sound right?
“Participant: Yes.
“Therapist: What I am proposing, is that I try to help you to do things in a slightly different way, i.e. that you
establish a routine of doing activities and taking breaks/resting at regular times. This will help your body clock to
become used to doing things at set times again. How do you think that would make you feel?
“Participant: Worried. What if I donʹt feel like doing things at certain times. What if I feel really awful when I am
supposed to be doing something, surely pushing myself will make me worse?
“Therapist: I understand that what I am proposing may seem a bit worrying to you. However how would you feel
about starting with very small goals? I would suggest in the first instance is that we look at all of the activity and rest
that you are having in an average week. I am going to ask you to fill in an activity diary and sleep diary for the next
week and to bring them with you to your next appointment. So for the next week you will not be doing anything
different, except filling in your diaries, would that be ok?
“Participant: Yes, that’s reasonable”.
Pages 67‐69 discuss how to manage participants who request further medical tests believing a physical cause
for their illness has been missed. Despite the minimal investigations the participants received, the authors
assume that this offers definitive proof that there is no underlying pathology and that nothing has been
missed; consequently, therapists are provided with highly specific instructions on how they are to dissuade
participants who believe that they are physically ill from seeking medical care.
“Feeling that a physical cause has been missed and wanting further investigations:
“Some participants may not hold a specific belief about what is wrong with them, but feel that despite many
investigations, something has been missed”.
“Participant: I am feeling so exhausted, I really cannot believe that all my tests are clear. I feel sure that something has
been missed. I think I might go to my GP just one more time to ask him if there are any other tests that I could have.