A Reconceptualization of Pseudohallucinations in the Case of "Kate"

Abstract

In the case study of "Kate" (Shapiro, Bussing, & Nguyen, 2014), we discussed a case of a 16-year-old adolescent who initially presented with auditory hallucinations and secondary delusional thinking. A more thorough examination of the underlying dynamics of the patient and family pointed away from a diagnosis of a psychotic disorder, and the consideration of "pseudohallucinations"—conversion disorder symptoms in the form of psychiatric symptoms—was felt key by the treating child psychiatrist in tailoring treatment for Kate and her family. We  discussed potential definitions of "pseudohallucinations" and used a psychodynamic formulation as a conceptual framework to provide treatment in the form of cognitive-behavioral therapy, psychodynamic therapy, and family therapy. Kate improved during the course of treatment, and thankfully avoided long-term treatment with antipsychotic medications. In response to three thoughtful and stimulating commentaries on the original case study by Pienkos (2014), Westerman (2014), and Mertin (2014), we discuss other ways in which Kate's case can be conceptualized, and we further explore the phenomenon of non-psychotic hallucinations. We focus on the main thematic elements in these commentaries, namely, Kate’s struggle for autonomy and independence as a main driver in symptom formation; the theoretical approach to the case; and the continued focus on the hallucinatory experiences.