It has been a long time since I wrote about psychiatry, psychotherapy, and chronic pain. I started my clinical psychology doctoral studies by learning how to lead CBT groups for chronic pain in rural Alabama. Every week, we would drive six hours total to go to Pine Apple, AL to run these groups at a FQHC. The groups were a part of my mentor, Dr. Beverly Thorn's R21 NIMH grant. At that time, Pine Apple was home to approximately 150 individuals.
It was an experience like no other, both Pine Apple and psychology graduate school. Despite the severe lack of resources, almost zero access to psychological care, and financial hardship, people of Pine Apple were one of the most generous group of patients I have worked with. Additionally, at that time, I was young, fresh out of medical school, new to US, and studying psychology - a long-cherished dream. Stepping away from medicine for some time to take this fascinating 4-year breather to study something I had a deep interest in, saved my life and my professional longevity more than anything else could have.
Since that time, I have expanded my skill-set to include many other treatment modalities, both therapy and medication management for pain. Regardless of the psychotherapeutic modality, the principles of working with chronic pain remain the same:
@ the stress-pain connection
@ gate control theory is still as relevant and effective
@ psychological distress does not cause chronic physical pain but can exacerbate it
@ the importance of pacing and continuing some form of movement in the face of fear of movement
@ catastrophizing is normal/natural; once we are able to identify and work it, it can make a significant positive difference
@ you are a complete unbroken individual who happens to have chronic pain, you are not your chronic pain
@ individuals with chronic pain need validation and your trust, not fixing
@ your chronic pain is real, even if it has persisted beyond what we would consider average time to recover
@ it absolutely gets better, just keep swimming, just keep moving forward
@ emotional pain is real and the intersectionality of trauma, physical pain, and emotional pain is also real.
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