SHIP® With a client experiencing Meige’s Syndrome : a Hermeneutic Single-Case Efficacy Study

Abstract

SUMMARY Meige’s syndrome is classified as a rare form of focal dystonia characterized by the following clinical features: • Facial, lingual, masticatory, pharyngeal, laryngeal and cervical dystonia. • Involuntary lower facial and jaw movements, including lip pursing, grimacing, jaw opening and closing and chewing. These movements may be tremor-like. • The symptoms typically begin focally and then spread to contiguous muscles. • The average onset occurs after 50 years of age. The aetiology of Meige’s syndrome remains unclear. It is currently considered to be multifactorial and to include genetic, psychogenic, neurological and environmental factors. Most of the current treatments for Meige’s syndrome require medical intervention. This is inherently invasive and has several possible side effects. At the time of writing the researcher was not aware of any studies investigating the efficacy of psychotherapy as a treatment for Meige’s syndrome. Furthermore, no publications have appeared on SHIP® as a treatment for Meige’s syndrome. Meige’s syndrome is often accompanied by depression and a marked reduction in quality of life. Psychotherapeutic interventions are generally focused on addressing the debilitating effect of Meige’s syndrome on a person’s life and not on treating the symptoms of Meige’s syndrome which are the result of unresolved psychological trauma. Given the probability that the symptoms may have a psychogenic origin, it was decided to investigate psychotherapy as a treatment option for alleviating Meige’s syndrome symptoms. SHIP® is described as a modality that contains both theoretical and practical components. SHIP® works according to a trauma-spectrum model which views all types of trauma, including PTSD and complex PTSD, as situated on a spectrum. The scope of trauma is seen to be broader than is presently recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Traditional psychological and physiological symptoms are classified as trauma-spectrum manifestations (TSM) in SHIP® theory. Examples of TSM range from loss of spontaneity, fragmentation of memory, compromise in personality structure, depression and anxiety to physiological symptoms like headaches or neurological dysfunctions. From a SHIP® perspective, the physical manifestations of Meige’s syndrome are conceptualized and treated as TSM. In order to investigate the efficacy of SHIP® as a treatment modality for Meige’s syndrome, the hermeneutic single-case efficacy design (HSCED) was chosen. The HSCED is a naturalistic design that makes use of multiple quantitative and qualitative data sources to draw inferences about the efficacy of psychotherapy. The HSCED design, which is flexible and compatible with different psychotherapeutic modalities, was judged to be a good fit for investigating the efficacy of SHIP® as a treatment modality for Meige’s syndrome. In accordance with the HSCED framework, the research addressed these questions: 1) What data collection methods within the HSCED framework can be utilised to compile a rich case record? 2) Does the data analysis show a change in Meige’s syndrome symptoms over the course of SHIP®? 3) Does the data show evidence for the causal role of SHIP® in the change of symptoms? 4) What factors (including moderator variables) could be accountable for the change? 5) What conclusions and recommendations can be made based on the results of the study?

The following data collection methods were used: idiographic case information, Rorschach inkblot method (RIM) pre- and post-SHIP®, a customized questionnaire pre- and post-SHIP®, a change interview post-SHIP®, weekly outcomes measures and records of psychotherapy sessions. After the collection and analysis of data, evidence of the change brought about by psychotherapy was considered. The researcher then considered eight possible non-psychotherapy explanations for the change in symptoms, as recommended by Elliott (2002). After considering evidence, both an affirmative and a sceptic’s case are presented. The affirmative case argues that post-psychotherapy changes are the result of SHIP® and the sceptic’s case argues alternative explanations for change. After both cases have been presented, the conclusions are drawn, the limitations of the research are considered and recommendations are made for future research.