Background: Clinical practice and the medical literature abound with reports of mutual dissatisfaction between individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and health care practitioners.


In this paper we:

1) formulate and describe the common therapeutic challenges in the care of patients with ME/CFS and

2) present a patient-centered, collaborative practice model that may mitigate these challenges.


We have combined clinical experience with hundreds of patients, a thorough review of the medical and psychotherapy literature and comments from patients and colleagues to arrive at our proposed practice model.

Findings and Discussion:

We have identified six common therapeutic challenges listed below. From our experience and the psychotherapy literature we have identified a relatively simple patient-centered intervention for each therapeutic challenge. These interventions are recommended for health care practitioners who find themselves in difficulty while working with patients with ME/CFS.

  1. Disagreement about the validity and severity of ME/CFS – Validate the patient’s experience and openly discuss differences of opinion.
  2. Disagreement about the etiology and best management of ME/CFS – Find and validate the truth in the patient’s position.
  3. Frustration due to lack of improvement – Collaboratively search for hope.
  4. Altered power balance between practitioner and patient – Clarify and increase practitioner expertise.
  5. Working with patients who feel unheard – Listen to the whole story.
  6. Gap between needed and available services – Build a coalition to access needed services.


Therapeutic relationships with patients with ME/CFS can be rewarding and enjoyable. The interventions highlighted in this paper may assist practitioners who feel otherwise.

Improving the therapeutic relationships between patients with ME/CFS and health care practitioners  Eleanor Stein MD, FRCP(C), Eva Stormorken RN, CRNA, MNSc, Bengt Karlsson RN


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