I’ve been chatting with a lady at the pool whose friend struggles with chronic pain. She updates me each time I see her, letting me know what’s going on with her friend, and how I can pray for her. Recently, she told me that her friend has been referred to a pain psychiatrist. I had never heard of such a doctor, so I looked it up.
A pain psychiatrist’s primary function is to assess the psychological and social effects of chronic pain on a person’s thinking; and also to assess the effect of her thinking on her pain. In other words, this practitioner’s job is to evaluate how the pain is affecting the person’s life, and how her response to the pain is increasing or decreasing her perception of pain. Once the pain psychiatrist has made an evaluation, the next step is to look at the medications the person is on, perhaps consult with the primary care or another doctor who put her on those meds, and make sure there are no negative interactions. (Many people who suffer chronic pain are on several medications, prescribed by several different doctors.) He will then make adjustments as needed.
Next, the pain psychiatrist will enroll the patient in group or individual therapy—usually Cognitive Behavioral Therapy, or CBT—to help her change “maladaptive” thinking patterns that may be causing her perception of pain to be greater than what the injury or illness would clinically warrant. He believes that her thinking could cause her increased pain, and I agree. But I believe that there is another step that must be taken—we must get to her heart, which is responsible for how she is thinking. While the psychiatrist would stop at changing her thinking and behavior, the Bible says that the Holy Spirit must change her heart.
Over my next few posts, I’d like to present a case study about a chronic pain sufferer, and how the biblical counselor can help.
A Case Study
Jane is a 53-year-old homemaker who was in a car accident several years ago. She suffered a spinal injury, and now has chronic nerve pain that originates in her neck, but causes pain, weakness, and numbness in her arms and hands. She used to love to do needlework and other crafts, but now she is unable to do these things. She misses her hobbies, and the commonalities she had with the friends who shared them. She doesn’t go to her knitting and crafting groups anymore, and she often feels lonely and isolated. As she remembers her Tuesday morning group, she feels sad and left out. Jane was prescribed an antidepressant last year, and she is taking it but it doesn’t seem to help much. She is a professing Christian, but does not understand how God could have allowed this to happen. She is angry, and doesn’t attend church much anymore.
If Jane goes to a pain psychiatrist, he will use CBT to help her correct her maladaptive thinking. He might train her not to project negatively into the future (what-if) or dwell on the past (if-only). He will probably encourage her to seek new hobbies and social outlets related to those. Perhaps the church choir would be a good fit. He might also change her medications, or send her to a different type of doctor, perhaps a neurologist, to run more tests to see if anything more can be done medically to relieve her pain. (This may give Jane hope for a cure, but then increase her sadness when the results show that there is nothing that can be done.)
Jane definitely needs to change her thinking, but the psychiatrist is aiming at the wrong area of her thinking. He is trying to change her thinking about her pain. What really needs to change is her thinking about God. This is at the core of heart change. Even if she has not realized or admitted it, Jane is angry at God for allowing this to happen to her. She has begun to believe that He doesn’t care about her, or is out to get her somehow, and that is why she is suffering. She does not sense His presence anymore, and she believes that He has abandoned her in her pain. Who is at the center of Jane’s thoughts? Jane is.
Jane is thinking only of herself, her pain, and her loss. She has given in to self-pity, and has forgotten that the reason she was created is to glorify God, not to be happy and comfortable in this life. As a biblical counselor and fellow chronic pain sufferer, my approach will be quite different from the Pain Psychiatrist’s.
Biblical Compassion, Biblical Counsel
The first time Jane comes to see me, I will ask questions and listen. I want to know what happened to Jane, what her life was like before the accident, and how it is different now. During this session, I will ask her questions that encourage her to share with me the facts about her physical pain, and the emotions related to the pain. I want to know how her pain affects her life. I also want to know what her thoughts are about God in her pain. Where does He fit in the problem of pain, and how does her relationship with Him affect her pain levels? I want to hear her, and express the empathy I will surely feel as she reflects on the life she knew before, that will never be again. I will gain involvement by sharing a little bit about my own pain struggles, and how God has worked in my heart through them.
Also in this first session, it is very important that I offer Jane some encouragement, both for her practical needs and for her heart. I know that one of the keys to dealing with chronic pain is to keep moving. Exercise keeps blood flowing and organs functioning well. It also produces endorphins and other hormones that help with depressed mood. So I will ask Jane if she is exercising and if she isn’t, we will make a plan for something she can do to get moving. In this case, we agreed that Jane would sign up for water aerobics at the Community Center in her neighborhood. This will not only get her moving, but will also be an opportunity for social interaction.
To encourage her heart, we will look at some specific Scriptures to help her understand that her body is temporary, but her soul is eternal and that every moment of pain she suffers here will be redeemed as she spends eternity in a new, pain-free body. These might include 1 Peter 1:24-25; 1 Peter 1:6-7; 1 Peter 5:10. I want her to start thinking more about what the Lord has done for her soul than she does about what has happened to her body.
I want her to begin today to think about the ways that God might use her pain and impairment for His glory. I will share with her some of what He’s done in my life because of the pain and problems I have, so that she can see that He does indeed make good things come out of seemingly awful circumstances. My goal as we study these passages is for her to begin to get a glimpse of where her hope really is—not in wellness, pain relief or a return to “normal,” but in the precious blood of Jesus Christ; His work in her heart; and the glory that He says will outweigh all her pain.
For homework this week, I’ll ask Jane to meditate on the passages we’ve discussed, and I’ll also give her the small booklet, The Process of Biblical Change. In our next session, we’ll talk about her answers to the questions in the booklet, and this will give us a good start at renewing Jane’s mind when it comes to her view of God, herself, and her pain.
So helpful, thank you Suzanne! You should really write a book on this if you ever get a chance as so many are suffering silently in sadness & even shame!
Thank you for that encouragement, Kathleen! I know that there are many suffering in this way, and I hope to help those who come alongside them to be more effective in their counsel.
I agree with Kathleen! 🙂
It was very helpful to ‘sit in’ on your counseling session and see how you would help someone who is struggling with the wrong focus while suffering with chronic pain.
Thank you, Georgene!