Thursday, September 06, 2012


Welcome Allison! It was nice to meet you this week. What a pleasure it is for Rachel and me to have a Ph.D. student doing a group work practicum in our chronic pain group. Here we are, preparing to integrate another group leader. The great thing about having students is that we learn from them while they learn from us. Students, through their questions and their knowledge, teach us to be a little more clear about what we are doing, and why we are doing it. It’s hard to know what a student might expect a hope group for people with chronic pain to be. Group work done in a counselling setting is usually referred to as group therapy. Our work is therapy, though not direct therapy for the pain. It is therapy for the emotions and behaviours that attach themselves to the pain and make life difficult. Being psychologists rather than pain doctors, we will be using psychology to shape emotions and behaviours. . Our first stated objective is to bring people with chronic pain together in an environment that is fun and positive. The approach is rooted in the theory that bringing them together is good, that how you bring them together will matter, and that they’ll have more power against the pain in a fun and positive place than they would in other places. We’re expecting 8 participants. They will come to us for 2 hours on 6 consecutive Tuesday afternoons. Some may stand up or lie down because sitting is so uncomfortable for them, while others will sit peacefully and wait to be reminded that it is time for a break. Some may be very angry while others will say that they are grateful. Some may want to talk all the time while others might have to be addressed directly if they are to say anything at all. But all of them will have considerable experience with pain. Their pain is physical. Most of the people registered in this group were referred by pain specialists—experts in the art of medical remedies. The key word here, when you think of remedies, is chronic. Conditions are labelled as chronic when there is no cure. Chronic pain is persistent, resistant, insistent. It is as confounding to physicians as it is to sufferers. It refuses to go away when you bombard it with drugs. It sneers at you when you try to exercise it away. It turns you into a recluse, a grouch, a whiner. It drives your friends away and frustrates your relatives. Chronic pain scoops up your hope and bashes it against walls. When you search for a cure, it tells you to accept your condition. When you resign yourself to letting it win, it accuses you of being lazy. It blames you for being the cause of your own decline. When you get right down to it, chronic pain is not some little thing. It’s a big, big thing. That’s why professionals from many disciplines are experimenting with a variety of options. One option is a hope and strengths group. The group you will be helping to facilitate, Allison, is our 12th hope and strengths group for people with chronic pain. You’d think we might be getting tired of it, but we aren’t. Rachel and I have learned quite a lot along the way, as anybody would, repeating a process so many times. One thing we’ve noticed is this: you have to work on the hope and strengths before you work on the pain. When you bring together people who have chronic pain, chronic pain expects to be the elephant in the room—not the normal unmentioned elephant, mind you, but the big elephant that takes up all the attention. Everybody turns to look at the elephant, to talk about the elephant, to recount battles with the elephant, to curse the elephant. Left unchecked, the elephant tramples everything in its path. Suffice it to say, it’s not much fun paying attention to chronic pain. It’s not very hopeful either. So we are going against the tide when we promise to create an environment that is fun and positive. Having learned this the hard way, we carefully budget our attention—more paid to fun and positive at the beginning, more paid to pain later on. We’ve noticed that chronic pain withers a bit in the face of fun. Anything you can do to wither it before you address it has got to be good. Ignoring it doesn’t make it go away, but after you’ve made some space for the fun to grow, it’s hard for even the most intrepid elephant to trample it completely. Fun, though, is only part of the picture. If we wanted only fun, we might simply take the group to a comedy club and measure the impact. An environment that is fun and positive has more than just fun. It has the feeling that things can happen, that all hope is not lost, that more is possible. This is where our hope and strengths strategies and tools come to work. These are the tools and strategies you will be observing and using as we make our way through the six sessions. Using pictures and stories and modified language, people will identify themselves first as having hope, as possessing strength, as the bearers of possibility. These are the selves they will bring to our later discussions about ways of responding to the pain and all the complications it causes. We dare to hope that you will enjoy the group time as much as we do. We like to watch the people blossom, to laugh with them, to hear their stories, to see the pictures they choose for their collages. We like to learn when they teach us everything they know about dealing with chronic pain. Collectively they have a lot of wisdom about maintaining the personal relationships they cherish, and finding ways to re-imagine their lives. We like to see how much they enjoy working with our hope and strengths tools We like the idea of having a student. We have worked hard to establish a program that could gain the respect of physicians and teaching institutions. Being able to offer a place to a student is an indication that this work has been worthwhile beyond its benefit to the group participants. We are looking forward to working with you Allison.

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