Psychotherapy Process and Challenges in Dissociative Mutism: Attachment Theory as Framework

Dissociative phenomena are encountered across a broad spectrum of psychopathology, yet psychotherapeutic literature—particularly with regard to somatic presentations prevalent in non-Western contexts—remains sparse. This article presents the treatment of a young woman with dissociative mutism, motor symptoms, and non-epileptic seizures, and explores the developmental and relational underpinnings of her condition through an attachment-informed lens. Drawing on skills-based approaches and mentalization-based techniques, and evolving goals and techniques through the different phases, the therapy focuses on facilitating an integrated sense of self, using the here-and-now of therapeutic relationship. This article particularly emphasises the process of psychotherapy and challenges encountered, such as the patient's reluctance to engage, boundary testing, symptom escalations, and discharge planning. The article describes how attachment theory provided a containing frame for the patient and the treating team, and helped sustain therapy focus on integrating dissociated aspects of the patient's internal experience.