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ISSN: 2161-0487
Journal of Psychology & Psychotherapy

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Case Study of Functional Neurological Disorder (Aphonic)

Muhammad Zafar Iqbal* and Muhammad Ejaz

Hypnotherapist and Psychotherapist, Islamabad, Pakistan

Corresponding Author:
Muhammad Zafar Iqbal
Hypnotherapist and Psychotherapist
Islamabad, Pakistan
Tel: +923349585399
E-mail: [email protected]

Received date: January 01, 2016 Accepted date: February 20, 2016 Published date: February 27, 2016

Citation: Iqbal MZ, Ejaz M (2016) Case Study of Functional Neurological Disorder (Aphonic). J Psychol Psychother 6:243. doi:10.4172/2161-0487.1000243

Copyright: © 2016 Iqbal MZ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Mr. S (initial instead of real name), the clients, age was 23 years. He visited to the clinic along with his cousin. His cousin informed that client is suffering from speech disorder while his medical reports are clear. His cousin also mentioned about his aggressive behaviour, disturbed sleep, and use of drugs. The client was not able to answer vocally so his answers were in written form. After that, further informations were collected from his parents and family. Pre morbid history was taken in six days from him (in written form) and from his parents. Unstructured method was used for data collecting. After data collecting, client was diagnosed by “Functional Neurological Disorder (Aphonic).” He was fully recovered after ninety sessions.


Psychological disorder; Functional nurological disorder (Aphonic); Aphonic; Fear stimuli identification therapy (FSIT); Treatment


Major purpose of this particular case study was to reaffirm and prove the efficacy of Fear Stimuli Identification Therapy (FSIT) on empirical grounds. It was also intended to use FSIT in order to eliminate the symptoms of Functional Neurological disorder (Aphonic) Mr. S was suffering from. As the therapy was already successfully used FSIT to remove the symptoms of various disorders in different cases.


“It is expected that the FSIT method would effectively cure the Functional Neurological disorder (Aphonic) from which the above referred person Mr. S is suffering.”

Fear Stimuli Identification Therapy (FSIT)

Fear Stimuli Identification Therapy (FSIT) is Base on Missing References [1]. When some fear stuck due to stimulus and became negative association in the unconscious at childhood or ten age. Unconscious state of mind at that time is unable to caught full references of the incident it taken only negative reference. At that time of early childhood capacity of mind to capture some incident with full reference is not possible so, there is the chance due to these missing reference can create a problem that may result in different disorder and FSIT is a technique that can be used to complete these specific missing reference.



Mr. S (client)


No any specific material used in this case study.


In the first two sessions semi-structured interviews were conducted with Mr. S and his family. Assessment was made in the light of these interviews and reasons/causes for disorder were dig out. DSM-IV was consulted to decide the nature or type of disorder.

In the subsequent ninety sessions Mr. S was asked to write on specific topics. Cross-questioning was carried out over the ideas mentioned in the writings.

Case History

The client’s profile-family history, medical history was prepared through detailed interviews and incisive questioning pertaining to sensitive issues of his life.

Educational history

Mr. S was not good in studies from his childhood but he is intelligent. Due to lack of concentration from childhood so, he never develop interest in lecture in class. However his father always encourage him for study and gave him special assistance and care. After Matric he started more time on his studies and wishes to go to Business Administration Side, his father allow him and gave him every facility for this. He worked hard and improved in his studies. When he came to me, he was the student of BBA. He wished to do MBA but due to his problems especially Aphonic he was disappointed.

Social history

Before the start of Aphonic, Mr. S was a social person. During his studies in different level of Education he makes lot of friends. He was keenly interested to go in social parties like marriages, birthday parties etc. But after Aphonic his social life become much disturbs and he started to avoid social functions. This makes him more depressive. However his friends always encourage him to go with them outside. Due to Aphonic he also left the university. From his childhood he was too much attached with his same of his cousins, who lived in other city and he always ready to go to meet his family members. Before the Aphonic his social life was much rich.

Pre-morbid personality

Mr. S was too much insecure since his childhood. He became aggressive with passage of time. He started losing concentration from his childhood especially in his study. His level of trust towards females was shacked from his childhood. He was very dependent on his father in all emotional and social matters.


Mr. S was himself the main source of information about all of the problems; however his father also gave valuable information about past life of Mr. S. Mother of client was also interviewed three time on some specific matters specially relation between her and client in past. Semistructured method of interview was used. All these interviews able to me to find reasons of the all problems of client specially Aphonia


After taking history through the interview from client and his parents, Aphonia diagnoses. 1st day of treatment was very difficult for me and for client Mr. S is due to Aphonia. So we started question and answer session. In this process I asked questions and he wrote the answers not tell me by words. His first reply was not in many details but with the passage of time he started to reply in detail. We used this method for 15 days. After 15 days his speaking power improved a little bit. But during the writing process I observed that he felt burden on his shoulders and on his head on my specific questions. In these 15 days this writing made catharsis for him that’s why his speaking ability improved little bit. So he was able to talk but in a very irregular way. Then I started to talk about the exact reasons or causes of Aphonia and lit then during the therapy sessions. He was beaten by his mother with iron rod in his earlier childhood near about at the age of 2 to 2½. After this physical torture he became insecure at his unconscious level of mind which hit his fear instinct. He started avoiding his mother and it became a reason of his hatred from women. He lost his trust in the case of women. His mother behaviour was very strict and insulting with him. Even she physically and verbally tortured him before the guests. He became very conscious and felt stress during his stay at home. Whenever he awoke in the morning he felt that on this new day, new bad happenings would happened with him. So that’s why he got sleep disorder. He didn’t ask about his necessaries and wishes to his mother. At the same time, his father was lenient to him. He was soft than his mother. He lay down with his father even at night. He felt relax a little when his father was at home. With the passage of time when his sisters was born he had no passion for them. Even he felt hatred to them. He had no trust on anybody so for his own relation and in the react of his mother’s attitude he often made misbehave with his sisters. Now he tried to relax himself by torturing his mother by many ways like, making noise, beating his sister and breaking things and when his mother became angry he felt relax and happiness. He got many problems during this time period. He had no interest in studies, and felt the problem of lacking confidence, concentration and loss of memory. But he still continued his studies only due to his father’s wish. The important thing which is prominent at that time is that when he was in the school he felt relax but when he was in the way of his home he felt burden on his shoulders and head because he thought his mother was at home and his father was not there for his relaxation.

His parents had the religious attitude. Her mother forced him to obey religious duties and respect the religious rules. So in the irritation with his mother, he started many wrong doings which are not allowed in religion. He thought that God is just like his mother and as he hates his mother so he also had no attraction to God. So he took drugs and sometimes took Wine in college life because these things are forbidden in religion. He had no trust on God. He thought God and his mother were the same personalities because they both gave orders to fulfil and to obey and they also had the right of giving punishment. As he saw his mother’s attitude with him in his childhood.

So his relation with his mother and God is based on fear (fear instinct). Fear always shake the personality of any body and destroys the abilities of any person. He felt that his father was a kind and nice person who fulfilled his all desires, not gave him orders to fulfil and to obey. So he felt relax during his stay at home and felt comfortable in his presence. So unconsciously, he made him father a shelter for his own self.

One day when he was outside and taking drugs, his father saw him there. When he reached home, he was scolded by his father bitterly. It was the first time when he saw his father in this mode just like his mother. At that time he wanted to answer and gave reasons to his father. His way of talking was quite harsh. He himself felt his attitude and at the same time when he was doing this he lost his voice. Now the problem of Aphonia started. Now in the absence of his father his voice was little bit better and be tried to whisper in front of his mother in order to torture her. But when in the evening his father was at home. His voice became lost completely. It was another fear which was fear of misbehaving with father which completely lost his voice. After thirty sessions his voice is much improved. In next thirty sessions again I asked him to start writing specific topics like mother, sisters and father. On his written material on specific topic same like before I started cross questioning, now he was able to answer with his words. However, stammering in his voice was still there. I observed that during the cross questioning on the father this stammering increased. In these thirty sessions it was cleared that the behaviour of his mother in his childhood was basic reason basic of the aggressive behaviour another problem and father became shelter for him unconsciously against the fear of mother. And when father treat him strictly by first time and he try to answered strictly too, so then his voice completely lost.

In next thirty sessions I asked him to write again on the same topic but with possible positive associations with his mother and sisters and write some negative association with his father in his childhood. Resistance was there in all of these topics during the writing period but during the cross questioning his unconscious started to accept the positive associations with mother and sisters. Some negative associations in his childhood with his father were also accepted by unconscious of mind.

Results and Discussions


After diagnosis of Functional Neurological disorder (Aphonic), treatment was started in the light of FSIT method. Ninety sessions were conducted Five per week. In the course of treatment, his father and cousin reported about Positive behavioral change in different spheres of Mr. S’s life. Clinical observations during treatment also indicated a gradual positive change in his personality. The difference between preassessment and post- assessment confirmed precision of hypotheses and efficacy of FSIT. Feedback was obtained on weekly basis for a period of three months from Mr. S’s family about any possible reappearance of symptoms of Functional Neurological disorder (Aphonic) and this was confirmed that there was no reoccurrence of disorder’s symptoms anymore.


Before visiting my clinic Mr. S have had already consulted different psychiatrists and was mostly treated by means of anti-depressants. This had no significant effects upon client’s disorder. Anyhow these medications helped him in sleep as before he was not able to sleep.


• Mr. S was a patient of Aphonia.

• Basic reason was behaviour of mother which developed insecurity (fear).

• Mother became stimulus / reference for fear instinct.

• Unconscious level of mind made his father as a shelter against stimulus and reference.

• Treatment could not be possible without deep analysis of his unconscious level of mind that what were the stimulus and references for fear instinct.

• It was necessary to explore all positive associations with his mother.

• When all positive associations were realized by his unconscious level of mind and negative association with stimulus and reference removed so there was no need of any shelter and the role of shelter was also wiped out.

• Minimum 5 sessions per week required for treatment because if there was gap between each session and next session may not be conducted on consecutive day, the fear which was explored in one session may again suppressed and resistance level of the client may also again suppressed. So continuity in sessions without having gap is very important in treatment for proper cure.


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