Sigmund Freud started his career as a neurologist. He first used his therapy couch (above) to treat the unexplained neurologic symptoms of conversion disorder.
12 sessions of psychodynamic therapy worked, but the study has flaws
STUDY: Dal Pasquale BG et al, Clin Neurol Neurosurg 2026
STUDY TYPE: Randomized controlled trial (pilot)
FUNDING: Brazilian federal research agency (CAPES)
Background
Psychotherapy is first line for conversion disorder, including seizures and neurological symptoms without a known origin. However, the largest CBT trial (CODES) failed to reduce seizures. Psychodynamic therapy, which explores conflicts and trauma behind symptoms, has mostly been tested in uncontrolled studies.
The Study
- 91 adults at a Brazilian public clinic with conversion disorder (two-thirds with seizures, one-third with motor symptoms). Most had trauma histories, and few believed their symptoms were psychological in origin.
- Randomized to 12 weekly sessions of short-term psychodynamic therapy plus standard care, or standard care alone; 74 completed 6-month follow-up.
Results
The primary outcome, days of symptoms, fell from 18 to 9 per month with therapy versus 17 to 15 with standard care (effect size 0.77). Two-thirds of the therapy group improved by at least 50%, versus 17% of controls (NNT 2). However, full remission was rare (16% vs 6%, not significant).
Therapy also improved depression (HAM-D, effect size 1.45), anxiety (HAM-A, 1.06), and disability (WHODAS 2.0, 0.74).
The improvements held steady at 6 months and were similar across subtypes.
Side Effects
None.
Limitations
A single-site pilot with two therapists, unblinded. Therapists rated each other’s patients, controls got no comparable attention, and registration was retrospective.
Practice Implications
- Psychodynamic therapy is feasible, and works better than treatment as usual. We’ll await comparisons with active treatments.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
