Working with Chronic Pain: Tips for Therapists

Chronic painView through window of woman sitting, lost in thought is an issue facing many of our potential clients. It is important to understand the effect of ongoing, intractable pain on emotional health and well-being, and to be willing to address it as part of a comprehensive therapeutic plan when a person acknowledges this need. Chronic pain is often misdiagnosed, undertreated, and it can impact every part of a person’s life. Relationships, work, self-esteem can all 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 the people I treat.

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 people 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.”), jumping to conclusions (“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, people 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 a person’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 individuals 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 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 well-being.

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 people living with chronic pain.


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, M.A., therapist in San Diego, California. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Nicole


    December 1st, 2010 at 2:43 AM

    Chronic pain can be a real cause of concern and can even impact the way a person takes to life.I have seen this happen with an old friend.Her reaction to various things has changed over the years due to her chronic pain and her very outlook has changed.

  • ferdinand k

    ferdinand k

    December 1st, 2010 at 12:39 PM

    My brother lost his right arm when he was very young and even to this day he has a very negative attitude to life. He never sees the bright side and is always negative about anything and everything. I have tried speaking to him about this but he just ends up getting wild and walking out. Please suggest a way to make him realize that having a positive outlook is better for him and those around him.

  • rose caroline

    rose caroline

    December 2nd, 2010 at 5:52 AM

    This is an area which has been ignored for far too long and I am so excited to read work from someone who is incorporating two very important issues into the one practice. There are many people who go through life perfectly ok until they begin to experience chronic pain for some reason or maybe they have an on the job accident. This can be a life changing experience and rarely in a good way. The medical doctors are trying to treat the physical issues but never any integration of treatment to help with the emotional health issues that the patient is undoubtedly facing now too. When one thing gets treated but another aspect is left untouched then there is never goignto be the steps toward recovery that there could be if the issues were all addressed together. Your practice and your approach makes wonderful sense to me and I really do hope that more doctors and therapists will jump on board soon!

  • Tammy Fletcher

    Tammy Fletcher

    March 14th, 2011 at 9:20 PM

    Ferdinand, I am sorry to hear of your struggles with your brother. It is hard to know why he seems to have a negative outlook about life. It sounds like it is something you really wish you could help him change. I wonder what happens when you show him love and acceptance just the way he is, negative attitude and all? Sometimes we forget how much family members need support too. I am glad you wrote – please keep reading and writing. I have an article upcoming on support for families and friends.

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