Injured brain, injured self: psychodynamic treatment of a patient with epilepsy

Abstract

There are few clinical case reports about patients who seek psychodynamic psychotherapy to cope with the emotional sequelae of epilepsy. After a brief review of the history of epilepsy and various treatment modalities, this paper describes the 18-month, psychodynamic psychotherapy of Salina, a woman who had endured an early history of abject poverty, verbal, physical, and sexual abuse, as well as the onset of generalized tonic–clonic seizures at age 12. By the time she began a second psychotherapy 10 years after a right partial temporal lobectomy and continued low-dose maintenance of antiepileptic medications, her seizures were substantially diminished, except for occasional auras. However, her injured brain from the lesion, the seizures and the lobectomy had resulted in a severely injured sense of self. Once we had established a strong working alliance, we explored in detail six psychological meanings of the seizures, which helped the patient understand how the epilepsy had compromised her sense of self and made her feel defective and alone. As a result of treatment, which focused primarily on the effect the epilepsy had on her sense of self, Salina was able to move forward in her life in a more confident, self-accepting, and productive way. The objective in presenting this case is to create awareness about the interesting and challenging clinical issues in working psychodynamically with selected patients with epilepsy, a typically highly stigmatized and underserved population.

Keywords:

• brain injury
• temporal lobe epilepsy
• trauma
• psychodynamic psychotherapy
• self-identity
• working alliance
• social stigma

Acknowledgments

The author wishes to express deep appreciation and gratitude to Mark Solms, PhD, for his supervision and guidance on this case, and to Estelle P. Bender, MD, Katherine Jong and David Yoon for their editorial skills, technological expertise and collegiality.