Psychodynamic Therapy for Clients Experiencing Chronic Pain
To start, it’s important to clarify what we mean by chronic pain. This term is used when pain lasts for more than three months or goes beyond the usual time it takes to heal. Chronic pain can sometimes be linked to psychosomatic issues that arise from unresolved emotional struggles or past traumas. Even though there is a wealth of information about chronic pain, its complex nature can make people feel confused, overwhelmed, and reluctant or embarrassed to seek help. It’s vital to understand that chronic pain can take many forms, come from various sources, and impact each person differently.
If you have been experiencing ongoing pain and have ruled out any physical reasons, psychodynamic therapy might be a helpful option for you, providing a nurturing space to express your emotions.


What is Chronic Pain?
Chronic pain significantly diminishes the quality of life and often my clients present with depression and anxiety. While pain medication can give temporary relief, it might be helpful to look under the surface of how we experience pain and what it does on a psycho-social level, affecting our relationships and our inner self. Research has extensively demonstrated the efficacy of psychotherapy in managing pain to enhance emotional well-being.
Therapeutic strategies focus on three psychological factors related to pain-induced distress: pain catastrophising, fear of pain, and pain acceptance.
Techniques such as working with somatic exercises or using guided visualisations during sessions help facilitate self-regulation, allowing us to delve into internalised emotions that require expression and enhance our ability to relax and self-soothe. It aids in identifying ways to improve the conditions we create for managing the impact of chronic pain on our daily lives.
“I feel immobilised like a tree as if someone has put concrete all around me. It appears I am carrying a big weight with me, and I have no desire to connect with others, as no one truly comprehends the suffering I endure.”
Employing metaphors and exploring dreams serves as another method to engage both the mind and body, facilitating a reconnection that provides valuable insights into the unconscious processes influencing our experiences and management of pain. It helps the client and therapist comprehend the relationship between oneself and the external world, particularly in addressing internal resistances and external avoidance stemming from our circumstances.
Experiencing chronic pain can lead to significant losses, including diminished self-efficacy and self-confidence, which restrict our ability to engage in activities we once enjoyed. Consequently, we may construct emotional barriers and struggle to cultivate self-compassion. Our intense focus on pain can hinder our ability to practice such self-compassion, making it difficult to attend to our needs and connect with our inner selves.
Living with Chronic Pain
While clients struggle with their current functioning, they use coping mechanisms that often stem from past experiences. This is where psychodynamic psychotherapy can serve as an effective method for clients to re-assess their coping strategies through the therapeutic relationship, which gives them a sense of being recognised, understood, and acknowledged. The intensity of negative emotions a person encounters is closely tied to how deeply these feelings are internalised and rooted in our past. Clients’ developmental history plays a crucial role in how pain influences their lives.
Emotional distress, akin to physical discomfort, frequently leads individuals to retreat from social engagements and activities that could improve their overall health and happiness. Relying solely on pain medication may not be the most effective way to improve a person’s overall health. Exploring a multidisciplinary approach could be the key to progress.


Manages Chronic Pain
“I feel so much lighter. As I described the tree stuck in the ground I began to understand that I carry a weight that comes from my self-isolating behaviour. I had stopped doing the things I like. I felt emotionally stuck and my body needed my help to reconnect to a mind that was shutting down, avoiding anything that could replace negative, conditioned behaviour with self-caring strategies. I had prevented myself from moving forward because I fell back into old patterns of neglect experienced as a child. But this time I was neglecting myself and I did not think that I could have the strength to grow out of it. I simply didn’t see that pathway because I had no one supporting me to build self-trust. Therapy helps me to recognise myself and to develop self-worth. The more I was alone, the more I felt the pain creeping up on me like this strong presence that made me totally identify with it. It prevented me from finding solutions to improve. It became my only friend. I needed someone to give me permission to cry, feel deeply, to mourn my losses and to reclaim my strength and resilience. Through psychodynamic therapy, I found a safe space to explore the connections between my past and present at my own pace.”
Psychodynamic Therapy assists my clients in revisiting their understanding of pain. This approach promotes exploration of their emotions, and the deeper feelings associated with cultivating a healthier body experience, thereby supporting the formation of a lifestyle that significantly improves their overall quality of life.
Elisabeth, our Psychodynamic Psychotherapist and Creative Arts Therapist, has extensive experience in assisting clients who are dealing with chronic pain alongside various other health issues and presentations.
Article by Elisabeth Eitelberger
References
Dourouka, V., Vlastos, D. D., & Theofilou, P. (2024). Psychotherapy and chronic pain management: a quantitative study evaluating the contribution of psychotherapy to quality of life and treatment compliance in chronic disease patients. Health Psychology Report, 12(3), 209–218. https://doi.org/10.5114/hpr/171847
Jimenez, X. (2019). Parallel Pains and Dynamic Dilemmas: Psychodynamic Considerations in Approaching and Managing Chronic Physical Pain. Psychodynamic Psychiatry, 47(2), 167–182. https://doi.org/10.1521/pdps.2019.47.2.167
Sturgeon, J. A. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7(default), 115–124. https://doi.org/10.2147/PRBM.S44762
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