Figure 9.1 summarizes techniques you can use to help the child begin to problem-solve adaptively rather than maladaptively by avoidance. Similar to your work on the child’s other long-term goals, gradually work on problem-solving strategies with the child. Be sensitive to nonverbal and verbal cues of resistance. If you meet with resistance, proceed cautiously. Also, see Chap. 15 for CBT approaches to problem-solving for anxiety disorders and depression associated with PNES and Appendix L for exercises the child can do to practice problem-solving techniques.

This eleven-year-old boy with epilepsy was referred to rule out the role of psychological factors for his “breakthrough seizures” that began shortly after the beginning of the school year. The father accompanied the boy, but knew little about his medical, neurological, and emotional history. He claimed that other than seizures and some mild learning problems, maybe ADHD, the child had no emotional or behavioral problems. A vEEG and psychiatric evaluation confirmed a diagnosis of PNES. The frequency of the boy’s episodes decreased markedly during the first few weeks of therapy in parallel with the parents’ acknowledgment of his testing results that confirmed a wide range of learning problems and with additional accommodations put in place at his special education school. The dialogue below occurred during the third month of therapy. As for previous dialogues, the blue bubbles present comments on the therapist’s approach and the yellow bubbles on the child’s responses.