Patients with psychogenic voice disorder (PVD), a disorder of voice in the absence of identifiable pathology, present a particular challenge to clinicians. Although the voice can usually be restored by the use of speech therapy, recurrences can only be prevented by psychotherapeutic intervention. Psychological factors have been long recognized as playing a role in these disorders, but the nature of this contribution has been unclear. Various conceptual frameworks have been used to understand this disorder. While for much of the last century, “conversion” has been seen as the primary process that underpins this disorder, little attention has been paid to the role of dissociation in this regard. This paper explores the utility of viewing PVD through a lens of Self. In so doing, PVD can be considered as a symptomatic expression of a compromised sense of Self which has its genesis in relational trauma and maladaptative defensive maneuvers. These are underpinned by complex dissociative processes which operate largely outside of conscious awareness. A clinical vignette demonstrates the utility of treating this disorder with both speech therapy techniques and a specific mode of psychotherapy, the Conversational Model, which is focused on the fostering of a sense of Self. It will be shown that this perspective not only provides a clear view of the genesis of thisdisorder, but also describes a pathway for effective treatment.
Nonverbal communication in the context of dissociative processes.
