Chickens or eggs? A follow-up case study exploring links between physical and psychological impact of Tourette's syndrome and sexual abuse

Abstract

This follow-up case study highlights the complex relationship when working at the interface between physical and psychological symptoms. The paper draws upon conversations between an ex-client and myself, held seven years after the end of our six year therapeutic relationship. Conversational interviews, based upon social constructionist beliefs, led to an unexpected exploration of the client's subsequent diagnosis of Tourette's syndrome (given several years after the end of therapy) and evolved into a struggle to reach a shared understanding of how she now makes connection between her problem with eating in public, her neck and facial tics, and childhood sexual abuse. Our research relationship provided both of us with a rare opportunity to reflect upon how she had made meaning of her counselling and its outcomes. The paper draws attention to the impact of counselling and therapy discourses concerning sexual abuse on the work we did at the time and asks how that work might be different today. It also helps us understand the layers of complexity and ambiguity contained within the client's stories. This multi-layered case study represents the overlap and ‘messiness’ that mirrors the ‘lived experience’ of the persons involved, and provides an example of how co-constructed research conversations can evoke stories that create meaning as they are told.

Keywords:

• Case study
• Tourette's syndrome
• sexual abuse
• psychological effects of disability
• somatisation

My thanks to Connie for allowing me to use our conversations for this research.