Why see a psychologist to help with pain?
Research overwhelmingly shows that treating pain by addressing as many of the contributing factors as possible is much more effective than just treating one aspect of it. We call this ‘whole-person care’, and it is based on the biopsychosocial model of health. This means that we need to look at: 1) what is happening in your muscles, joints, neuroimmune system and other aspects of your biology; 2) what is happening with your thoughts, emotions, and memory; and 3) what is happening in your environment and social context.
A psychologist can help you particularly with the second two. We know that being in pain can take you away from the things you love and put you ‘on edge’. So, this often benefits from focused psychological help to ease some of the mood disturbance and anxiety that is a common and understandable part of chronic pain. But importantly, it also helps to soothe a hypersensitive pain system. Learning psychological skills can be an important part of the journey to recovery. While there is lots of evidence that seeing a psychologist can help pain by itself, you get even more benefit when this is integrated into a whole-person treatment plan where your psychologist collaborates with your physiotherapist, doctors and other health professionals. This is the approach we use.
Does seeing a psychologist for pain mean it’s all in my head?
No! All pain is real, you’re not imagining it. We will believe what you tell us about your experience. Pain is ‘multifactorial’, which means it is influenced by lots of different contributing causes. So, seeing a psychologist means you are taking a sensible, comprehensive approach to managing your very real pain.
What will it involve?
The approach we take aims to empower you to feel more confident in managing your pain and health. This involves developing and refining skills that are relevant to you. The process starts with getting to know your story in order to develop a ‘formulation’. This is like a map of all the factors contributing to your pain. Then we agree on some goals and strategies that might help to change those contributing factors for the better. These strategies will complement the strategies you are working on with your physiotherapist. Common elements of a pain psychology program might include:
- Making sense of your pain through dialogue so that it is less confusing, upsetting, and scary.
- Practising new ways of regulating your emotions so they place less stress on your nervous system.
- Learning how to harness your thinking more effectively so you are less bogged down by worry and rumination, and more able to use your brain for problem solving and savouring positive experiences.
- Developing a regular technique for calming your body and mind, for example through breathing exercises and meditation.
- Clarifying what is important to you in living a good life, and setting goals that align with these values and your personality.
- Tackling things step by step that you might normally avoid because they are uncomfortable or scary.
- Working on your relationships and ways of interacting with people so that you have a supportive social environment.
- Learning how to structure and pace your activities so that your pain system can handle them without constantly flaring up.
- Addressing old psychological problems that might have gotten ‘stuck’ and are contributing to a sensitive pain system.
- Developing sleep, exercise and eating habits that help to calm and nourish your nervous system.
The broad umbrella for these strategies is called Cognitive Behaviour Therapy (CBT). There are variants on this, such as Acceptance and Commitment Therapy and Mindfulness-Based Therapy. These approaches all have more similarities than differences and research shows they have similar outcomes. We will tailor aspects of these three approaches to you based on your individual situation and your other treatments.
What does success look like?
Our best bet is to aim for improving your functioning first, rather than just trying to get rid of your pain. This means focusing on how to live a more meaningful and fulfilling life alongside pain. This might mean doing the activities you love, connecting more fully with the people that matter, and cultivating more positive emotions. An easy trap to fall into is waiting for the pain to go away before you focus on these functional goals. However, often the best way to ease the burden of pain is to improve your life and allow pain reduction to follow along behind. So, success means being able to function better at work, home, and with others, while feeling less distressed and more connected. We will work together to personalise those goals so that you are clear about what success looks like for you.
How do we do that?
Most psychological interventions are ‘talk therapies’. We discuss the issues you are struggling with, break down individual problems to understand them better, explore how to break pattens that aren’t helping, and then try to test out these new strategies to see if they work and how we might make them better. While we do a lot of talking, just talking isn’t enough to really help you most of the time. With pretty mild everyday problems, just talking (we call this ‘supportive psychotherapy’) can help. It’s a bit like talking with a kind friend who is a good listener.
However, for more complex problems like chronic pain, we need an active approach that involves behaviour change. So, sessions with a psychologist are a bit more like coaching. They will help you get some direction, but the real benefit comes from practising new ways of doing things in between sessions. We will suggest activities to do as ‘homework’, just like your physiotherapist gives you exercises to do at home. Sometimes we will do more active tasks in session, like a guided meditation, or a behavioural experiment either in the room or outside.
How can I get the most out of it?
A good start is to set aside time after your session to make some notes. Ask yourself: What did we cover today? What are some important insights I want to remember? What changes do I want to implement and practice before the next session? It’s also a good idea to keep track of what you discover as you practice things at home, so you’re keeping a bit of a running journal through the process. It’s useful to review this before your next appointment and think about what you would like to address next. We will often ask you at the beginning of the session, “What would you like to get out of our session today?” so it’s useful to think about this beforehand. Sometimes you might come up with a blank, and that’s OK too; we can formulate a plan together.
What gives me the best chance of a good outcome?
Research shows that one of the best predictors of treatment success is a good ‘therapeutic alliance’. This means you feel heard and hopeful as you go through the process with me. If things aren’t feeling right, it’s important that we ‘name it’ and discuss how to get things back on track. The good thing about therapeutic relationships is they can handle more scrutiny and awkward conversations than your average friendship, so we encourage you to take risks in reflecting on what is going well and not so well in our work together. The other things that tend to help you get a good outcome are: 1) motivation or readiness to change (being willing to translate talk into action); and 2) psychological flexibility (being open to new ways of thinking, feeling, and acting).
How long does it take?
It depends on lots of things, like how long you’ve had the problem, how many different factors are contributing to your pain and what ‘protective factors’ or strengths you have. At times, it might not take much help from us at all – a couple of sessions might help steer you towards new ways of using your existing skills to great effect. Generally, 6-10 sessions is enough to see a positive shift in your functioning, although this doesn’t have be the end of your journey. Some psychologists here don’t offer long term therapy beyond 10 sessions, so check with reception or the individual psychologist if you are looking for that.
How often do I come?
Usually, we schedule the first few sessions at weekly intervals and then space them out to fortnightly or longer as needed. This lets us build some initial momentum and then gives you time to practice things at home as we get into the skill building phase.
What about confidentiality?
All psychologists are legally bound by a code of ethics enforced by the Australian Health Practitioner Regulation Agency. This requires them to keep all your information, including what is discussed in session confidential except in extreme circumstances (e.g., you or someone else is at immediate serious risk or a court subpoenas me). If you claim a Medicare rebate for your session or sign an information release as part of an insurance claim (e.g. workers compensation, motor vehicle injury compensation, income protection), then they am required to write reports periodically which include some information about our treatment.
You can discuss these aspects of the limits to confidentiality more in session so that you are comfortable. One aim of our strict confidentiality guidelines is to ensure you trust the process, so you get the most out of it. Another type of information sharing might come through me discussing your case with other health practitioners, especially your physiotherapist at Body Logic. This requires your consent, so you can let your clinicians know if you prefer for that not to happen. The reason we recommend it is because research shows that pain treatments are much more effective when they involve several health professionals working together in a coordinated way (i.e., integrated care). We have set up this model of care at Body Logic so please let me know if you prefer not to receive integrated care involving information exchange. We can further discuss the limits on what information is shared with who so that you are comfortable with it.
What about referrals, rebates and fees?
You don’t need a referral to see a psychologist. However, a GP (or Psychiatrist) can refer you on a ‘Mental Health Care Plan’ so that you can receive a Medicare rebate under the Better Access to Mental Health Care scheme. You can find out more about Medicare and Psychology here: https://psychology.org.au/for-the-public/medicare-rebates-psychological-services. Check with reception to find the fees to see each clinician. You can pay the fee and claim the rebate at reception. If you are referred under a worker’s compensation or motor vehicle injury claim and want the insurer to pay your bill, you will need to provide reception with written confirmation that they will fund psychology. Even if you have an accepted claim and are receiving physiotherapy, you will need to get special permission for psychology from your claims manager. The other option is to pay the bill yourself and claim it back from the insurer. If you are using private health insurance, you can claim via HICAPS at reception and pay the gap. Check with your health fund what they will cover for psychology.
Appointments and other support
Pain psychology sessions are not set up to offer crisis support outside of appointments. For urgent mental health support, please see your GP or access the following services:
- Lifeline (24/7) 13 11 14
- WA Dept Health Mental Health Emergency Response Line 24/7 (MHERL) Metro 1300 555 788 Peel 1800 676 822
- Crisis Care 1800 199 008 (operates 24/7: when you are concerned about the well-being of a child, you are escaping from domestic violence and need help, or you are homeless).