| Facilitating Self-Management
of Chronic Pain
Helpful Attitudes
- A commitment and choice to work with people
experiencing chronic pain.
- Curiosity about ways of facilitating self-management.
- A commitment to your own self-management program
and self-care.
(Check the prescription for self-management.)
- A belief in the reversibility of chronic pain
conditions.
- A willingness to do your own work using your
reactions to people in chronic pain
as the material for self-exploration.
- A willingness to expand your skill base and
learn more about other disciplines.
- A willingness to meet the client where they
are and not where you want them to be.
- A willingness to meet the clients’ needs
and not just do what you usually do,
or like to do.
- A willingness to let go of trying to fix your
client. Top of page
Simple Steps to
Facilitating Self-Management of Chronic Pain
- Limit the searching
for causes and cures.
- Refer to appropriate
therapists (those supporting self-management as well as providing
symptomatic relief).
- Enquire about
the patient's progress with self-management.
- Reward progress
(even small advances).
- Diffuse panic
with setbacks and flare-ups.
- Challenge self-defeating
thought patterns.
- Create positive
expectancies.
- Reinforce explanations
about chronic pain.
- Evaluate and
modify the program regularly.
- LISTEN without
advising (as much as possible): empathy and compassion heal.
- ENCOURAGE all
attempts to take responsibility and self-manage.
- SUPPORT through
all phases of the process.
Who comes to see you?
It is useful to identify who has come seeking your assistance. Is
the person a victim, a visitor, a client, or a self-manager? You
will need to meet the person where they are and work with them to
move towards becoming a self-manager. Top of Page
| VICTIM |
Blames |
| VISITOR |
No ownership |
| CLIENT |
Some responsibility |
| SELF-MANAGER |
Full responsibility |
Connecting with
the person in pain
Contact is the basic tool of every therapist and it demonstrates
that the therapist understands, accepts, is present and participating.
When contact is good, it builds rapport, trust and safety. It can
be verbal and non-verbal and the table below shows ways of making
verbal contact. Therapists can be inclined to say too much and this
approach to making contact encourages the therapist to say as little
as possible. There are some hints below to help you create a good
connection with the person in pain.
How to make contact |
Good Contact |
- Offer simple acknowledging statements
- Comment on the obvious
- Contact present experience
- Demonstrate understanding
- Notice the client’s response
to contact
- Say as little as possible (see below)
|
- Supports the flow/does not interrupt
- Demonstrates accurate following
- Moves the process towards inner experience
- Avoids questions and answers
- Builds safety, trust and rapport
|
| EXPERIENCE/SITUATION |
CONTACT STATEMENT |
| For Thoughts |
A lot going on
Many thoughts
Can’t stop thinking about it
Thinking about that
You believe that they’ve missed something |
| For Feelings |
That makes you angry
Feeling sad
Makes you nervous
Worries you
Worried about the future
Confusing
Given up
Seems hopeless
Feel helpless
Feeling really down
You’re concerned about that
That scares you |
| For Sensations |
Tensing up
Can’t keep still
Hard to handle
Painful
Really hurts |
| For Actions |
Avoiding that
Need some relief
Hoping the doctor will take it away
Have to get relief
Searching for answers
Hoping to find a cure |
| Related to the Workplace |
They don’t believe you
Giving you a hard time
They don’t understand
Seems like you’re not wanted
Missing your old job
Not ready to go back to work yet |
| Related to doctors/investigations |
He’s not listening
Suggesting it’s all in your head
Ignoring you
Lots of different advice
Nothing more they can do
Wished the scan had shown something |
| Around responsibility |
They’re to blame
It’s their fault
Not your problem
Can’t see your part in this |
| Around entitlement |
Not fair
They owe you
Need to prove your point
Have to convince them
Seems unjust |
| General |
Something just happened
Curious about that
Feels good to talk about that
Checking things out
Settling in
A lot going on
No energy
Fed up with it all
Can’t find the words
Hard to talk right now
Feeling lost
Not sure about that
Uncertain about what you should do |
Top of page
Questions
promoting self-management
One way to invite participation is by asking questions. It can avoid
the resistance that develops when clients are told what to do.
Pain relief
- What would it be like if the pain didn't bother you so much/at
all?
- I wonder how that could happen?
- What have you learnt about reacting
and responding to pain?
- I wonder how you could respond to pain
instead of reacting to it?
- Could you tell me what your life
would be like without pain?
- How could you begin to make that
happen?
Rewarding progress
- I wonder what progress would look like? (keep probing)
- What
progress have you noticed?
- How could you reward your progress?
Education
- What do you need to know?
- How do you learn best?
- What makes it difficult for you to change?
- What is making it
difficult for you to learn this?
Finding comfort
- Where are you feeling comfortable right now?
- Tell me about the
feeling?
- I wonder whether you could notice your comfort this
week?
Rediscovering fun and pleasure
- Could you imagine having fun/experiencing pleasure?... just
imagine
- How might that happen?
- How could you organise to have
some fun or pleasure
this week?
- What would it be like if
you started relaxing,
going out,
and having fun?
Solving problems
- I am puzzled about that. Could we solve this one together?
- I
wonder how you could get around that problem?
- What is stopping
you from ... (relaxing, going out, doing that ...)?
- Tell me
how the pain stops you.
Handling feelings
- I am feeling frustrated: are you?
- What could we do to relieve
the frustration?
- Can you remember a time when you lifted your
depression? How did you
do that?
- What helps
reduce
your anxiety?
How
could you do
that?
Self-management
- Which part of the self-management program is working for you?
- What
makes it difficult for you to do the exercises/relaxation?
- How
could you develop a routine?
- What would help with your motivation? Top
of page
How to Approach the Work
- Expect your
clients to work and get results from their work.
- Measure their progress.
- Set goals with
them.
- Teach them how to set goals
(specific and realistic)
- Design programs
with them.
- Teach them how to design their own programs.
- Discuss the obstacles
to meeting their goals. Keep exploring the obstacles.
- Let them turn the obstacles into challenges.
- Let them initiate action
by:
- Asking the right questions
- Inviting not telling
- Engaging their curiosity and sense of
adventure
- Thorough preparation before commencing
the program
- Ask about comfort/fun/pleasure
not pain.
- Ask about relaxation
not tension.
- Acknowledge
where they are.
- Give them permission
to be where they are.
- Only explore alternatives
when they have heard your acknowledgment and your permission.
- Ask yourself, “What
is missing?”
- Observe your reactions
(thoughts, feelings, actions)
- What is your agenda?
Ask yourself.
- What is their agenda?
Explore this together.
- Support their defences
rather than challenging them.
- Only challenge their
beliefs when they are ready.
- Acknowledge the way their beliefs have served
them in the past but invite them to look at whether they are serving
them well in this situation.
Random Thoughts
- Your level of commitment will usually be
reflected in your client’s.
- Working on yourself is as important as the
client working on him / herself.
- As you become whole your client can become
whole.
- Sharing the problem invites responsibility.
- Shared responsibility increases the chances
of a good outcome.
- The more you expect the more your client will
discover he/she can do.
- Your limits will become their limits.
- Your pessimism is catching.
- Blaming your client releases you from responsibility
but does little to facilitate self-management.
- Battering down resistance increases the resistance.
- Supporting defences allows the defences to
dissolve.
- Challenging your client’s belief system
can cause strong defence of their belief system.
A good coach knows when to be tough
and when to be gentle
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