Psychotherapy

Abstract

In talking about this topic I wish to place considerable emphasis on the context in which psychotherapy is more likely to be effective. This is particularly important in the management of chronic pain, because we are asking most of our patients for a conceptual shift which is very difficult for them to make, for two reasons. First, it is a complicated task to go from a somatic to a nonsomatic language. Second, it is perceived as a major and threatening demand when you imply to patients that they are required to give up their accustomed way of coping before you can help them to improve their condition. In other words, to tell them to stop being hypochondriacal or to stop complaining about chronic pain before you actually treat them for it would be like asking patients to stop showing abdominal guarding and rigidity before you treat their peritonitis. Now obviously, guarding and rigidity are inevitable responses when you have peritonitis, and they help to lessen the pain. Similarly, speaking and thinking about chronic pain the way our patients do is a way of guarding against the emotional pain that would emerge if they didn’t do so.