Clinical Psychology within the Department of Pain Management
What is clinical psychology?
Psychology is the study of people: how they think, feel, and behave. A Clinical Psychologist is trained in using this knowledge to help people who are facing difficulties in their lives. Clinical Psychologists often work with people who have physical health problems, as there is a strong link between the mind and the body. Physical health problems can often lead to mood difficulties, which in turn can make it harder to cope with the given physical health problem.
Being recommended to see a Psychologist does not mean that your pain is “in your head” or that your pain is part of a mental illness. Chronic/Persistent pain affects the person physically, socially and emotionally so it is important that your treatment takes into account your experience as a whole person.
How does a clinical psychologist help?
Clinical psychologists work alongside you and other members of the pain management team (such as Medical Consultants, Clinical Specialist Physiotherapy, Clinical Nurse Specialists and Clinical Specialist Occupational Therapy) to help you manage your pain.
A Clinical Psychologist cannot cure your persistent pain. However, they will work with you to build on some of your existing ‘self-management skills’ and help you develop new ones to enable you better manage your pain. Usually, Clinical Psychologists aim to help people engage in useful pain management strategies by:
- Helping them make useful changes in the way they feel, think or do things.
- Helping them understand and manage their difficulties more effectively.
More specifically they can help you with:
- Coming to terms with having persistent pain.
- Improving your use of skills for self-management of persistent pain.
- Reducing the distress related to pain and ill health (commonly anxiety, low mood, anger, low self-esteem and stress related problems).
- Improving your communication in relation to your persistent pain.
- Decision making about treatment to support your discussions with health professionals.
- Lifestyle changes towards improving quality of life and preventing deterioration of physical functioning.
What happens at the initial appointment?
The Clinical Psychologist will ask you what you have read or found out about the bio-psycho-social approach to pain and will go through the questionnaire which you may have filled in, before your appointment.
Using this paperwork and by talking to you about the impact of pain on areas of your life, including work, leisure, socialising and relationships with family and friends, they will work with you to form a shared understanding (called a formulation) of the issues you are struggling with. This may highlight areas which you may want to work on or improve.
At the end of this session you will agree a plan with the psychologist. This may involve:
- Providing you with recommended self-help information and discharging you if this is all you require.
- Recommending that you attend further input offered by the department.
- Returning for a further session to decide on the best course of action (if it doesn’t seem clear at the initial appointment).
- Returning for further sessions to work on your goals (these sessions are time-limited and goal-orientated, i.e. the Psychologist will regularly review how the sessions are going in order that progress is being made).
- Being referred to a local service (perhaps via your GP) for further support that is closer to your home or more appropriate.
Please be aware that there is usually a waiting list to see a Psychologist. The department is doing its best to make the wait as short as possible.
Clinical Psychology use a variety of psychological approaches to help people. Some include Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) to name a few.
However whatever approach the psychologist and you agree on there is an expectation that you take an active role and do agreed activities in-between sessions to enable learning (research suggests that those who do “home practice” have much better outcomes than people who don’t).
What about confidentiality?
Sessions are held in a quiet, private room. The psychologist works as part of a multi-disciplinary team and will make a note in your medical file which includes a summary of our discussion. When the psychologist writes to you they will copy in your GP and other relevant clinicians where appropriate.
If you tell the psychologist information which you would rather is not passed on then please discuss this with the psychologist. Usually there are only a few reasons why such ‘sensitive’ information would be shared:
- Sharing knowledge will enable you to receive better medical, nursing and/or social care.
- It is necessary to refer you to another specialist.
- The circumstances are special, for example, if there is a concern for your safety or the safety of others.
The psychologist will do their best to discuss the reasons with you, before sharing such sensitive information. If you have any concerns about confidentiality then please raise them in the discussion with the psychologist.
As part of your assessment the psychologist may wish to contact your GP for any relevant information which may be helpful e.g. whether you have seen a counsellor in the past or any previous or current mental health issues. If you would rather this did not happen then please raise it with the psychologist at the first appointment.
What if you can’t get to an appointment?
Please call the department on 01733 678332, as soon as possible. Unfortunately, if you are unable to make it to more than two sessions or if you miss one session and you don’t get in touch, it is hospital policy that you will be discharged from the service.
What if English is not my first language?
It is possible to organise interpretation services for you if necessary. Please request this by calling the department at least a week in advance of your appointment.
Under what circumstances do the sessions come to an end?
There is a limit to the number of sessions the Psychologists offer and it is important that the sessions are proving useful in helping the person move towards their goals. But sessions will at some point come to an end for a variety of reasons:
- The person has achieved their goals of therapy.
- The person has made some progress and has learned strategies by which they can continue to work towards reaching their goals.
- The person has made enough progress in order to move on to another therapeutic approach e.g. physiotherapy, occupational therapy.
- The person has been unable to engage enough in the therapy to justify further sessions i.e. the person has been unable to regularly attend appointments, doesn’t or isn’t able to do the agreed ‘in-between’ session tasks etc.
- The person has made progress towards their goals but isn’t able to progress much further.
The psychologist will review the sessions with you regularly and agree on the best action to take.
What other support is there? Not everyone who is referred to the Psychologist needs, or is ready to commit to a number of sessions at regular intervals. In these cases postponing sessions until you are ready may be the most sensible option. Perhaps spending some time reading/looking at the resources contained on this website e.g. books/videos about understanding persistent pain, connecting with other people who live with pain via the pain toolkit website may be a good start.