Therapy, Toolkit

Working with Chronic Pain

Chronic pain is an issue facing many of our potential clients. It is important to understand the effect of ongoing, intractable pain on emotional health and wellbeing, and to be willing to address it as part of a comprehensive therapeutic plan if the client acknowledges this need. Chronic pain is often misdiagnosed, undertreated, and it can impact every part of a person’s life. Relationships, work, self-esteem – all can be affected by the experience of coping with physical pain.

I am a psychotherapist (Registered IMF) working  in a private practice, and I am also a pain management patient. I am fortunate enough to have a physician who is also a chronic pain patient. She “gets it.” We work as a team with mutual trust and open communication. My years of struggle in finding such support, however, provided the impetus for me to offer specialized psychotherapy for my own clients.

Pain can arise from a specific injury, or from a variety of medical conditions or disabilities. The physiological causes for chronic pain are many, and it is outside our scope as therapists to diagnose or treat medical conditions. We can, however, offer a number of interventions that have been shown to alleviate pain and increase the ability to manage its presence (Farrugia & Fetter, 1999). The most widely known to date is the use of Cognitive-Behavioral Therapy (CBT). CBT can help the client restructure his or her thoughts and increase the ability to cope with activities of daily living and interacting with others.

Cognitive distortions experienced by clients in pain include Jumping to Conclusions (“This twinge in my arm is bound to be another relapse.”), All or Nothing Thinking (“If I am going to be this way forever, I can never enjoy life again.”), Fortune Telling (“No one will ever want me now that I have to deal with this.”), or Catastrophizing (“I can’t go on like this. I can’t bear it.”). Given the pervasive nature of many chronic pain conditions, clients may feel overwhelmed or at a loss for ways to manage the emotional effects of pain.

Therapists play an important role in identifying maladaptive thought processes and beliefs that have become part of the client’s dominant story and working together to challenge those thoughts and create more useful strategies. Some effective interventions include teaching relaxation techniques, deep breathing, journaling, and restructuring daily activities to accommodate the need for breaks or adaptive tools.

Individuals with chronic pain may also experience symptoms of depression, anxiety, and other symptoms of comorbid mental illness. Given the overwhelming nature of living day-to-day with intractable pain, this is not surprising. By working with clients to increase their sense of hope, self-efficacy, and ability to cope, we often see a reduction in symptoms of depression or anxiety.

Medical management of chronic pain matters to us, as therapists, for a number of reasons. Your client’s medical doctor may be trained in comprehensive pain management and a proactive part of the client’s wellness team. Other doctors may not be as aware of the issues involved in pain management. Medical interventions can have an enormous impact on the client’s sense of hope and wellbeing.  A woman once shared her pain story with me, having developed chronic, severe back pain after a car accident. She was a Registered Nurse, and still works full-time. As an educated consumer, she looked to her physician to work with her on not only managing her pain adequately, but in resuming as active a life as she could. She stated, “That all ended the day I looked at my chart. It said ‘Drug seeking’ in red letters, and not much else. I knew then that this doctor did not understand.”

Unfortunately her story is not unusual. It can be challenging for people with chronic pain conditions to obtain an accurate diagnosis and then adequate pain management from their medical team. As therapists, we can be there to listen, offer resources, and provide interventions within our scope of practice to support clients living with chronic pain.

Works Cited:

Farrugia, D., & Fetter, H. (1999). Chronic pain: biological understanding and treatment suggestions for mental health counselors. Journal of Mental Health Counseling .

©Copyright 2010 by Tammy Fletcher MA, IMF, CFT. All Rights Reserved. Permission to publish granted to This article was solely written and edited by the authors named above. The views and opinions expressed are not necessarily shared by Questions or concerns about this article can be directed to the authors or posted as a comment to this blog entry. Click here to contact Tammy and/or see her Profile


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