Making the first contact

How do we begin working with someone who is asking for help with their persistent pain? In this post I’ll describe some of the considerations I have when I begin, because as Benedetti points out, the “meet the therapist moment” is one of the most potent times in the therapeutic ritual (Benedetti, 2011). It’s the time when the person’s expectations and the clinician’s empathy and competence meet, and the “meaning response” blooms. My two clinical questions are: Why is this person presenting in this way at this time, and what’s maintaining their predicament? And what is this person’s main concern? But before I ask these questions, I want to take a moment to think about the person and what might be going on in his or her mind. Benedetti points out that expectancies are an important part of a response to treatment – whether that treatment has any active action, or not. Expectancies are about what a person brings to a therapeutic encounter: there are two, one is stimulus expectancies (anticipations of external events – eg that the next painful experience will be less), and the other is response expectancies (predictions of your own nonvolitional response – eg that after doing this thing, I expect to experience less pain) (Kirsch, 1985). People who come to see a clinician, especially a clinician from a little-known profession (occupational therapy!) will hold expectancies about what that p...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: ACT - Acceptance & Commitment Therapy Assessment Chronic pain Clinical reasoning Science in practice biopsychosocial initial assessment Occupational therapy pain management subjective Therapeutic approaches Source Type: blogs