Collaborating with our patients

Have you noticed how some of the literature on pain management seems to distance the therapist from the patient as if the therapist is the ‘expert’?
I’m not sure where this started – perhaps with the behavioural approach where reinforcing well behaviour is carried out alongside ignoring or not responding to sickness or pain behaviour. Or maybe it was the ‘stinking thinking’ or ‘maladaptive thoughts’ of cognitive therapy that brought about the idea that patients are ‘doing it wrong’ and therapists know all…
Or maybe it’s an impression that patients get sometimes, that therapists ‘should’ know everything, so that if they do as they are ‘told’, and it doesn’t work out, the therapist carries the responsibility.

Whatever, I think the most helpful therapy is carried out when the therapist and the patient collaborate as equals: the therapist has professional knowledge and experience that can shed light on the functions of certain beliefs and behaviours, while the patient knows about his or her own values and the effect of making changes. Together they can work out what is going on and perhaps why, and what the options might be for doing things differently.
In the end, the patient has the responsibility for actually deciding to take action – no-one else can do it!

The therapist’s role? To make the options clear, to be up-front about known outcomes or consequences of a course of action, to find out what is important to the patient – and how the patient’s actions are moving them closer or further away from what they value.

It’s a dance rather than a teacher-student process. A flow of interaction between the two, with the therapist needing to take extra care to ensure the patient’s vulnerability to differences in ‘power’ and amount of knowledge about each other is not exploited.

I feel so privileged to work with people who have chosen to share something of themselves with me. It’s a gift to treasure. And an absolute joy to see someone learning and taking steps to live the life they have chosen.


  1. there needs to be more than a language shift, rather a conceptual framework shift, where the clinicians are providers of information and options and the patients truly drive their own care. If patients were held accountable for their choices and not the clinicians, then clinicians could be technicians
    (for procedures) and facilitators in pain management. . . .nice post

  2. I agree with you about the need for a conceptual shift – in the end it is the person who makes the choices. I’m not so sure I agree with the you that clinicians could be ‘technicians’ because I think the work is much more about being able to apply skills therapeutically according to a theoretical framework (the knowledge-base) than simply following a series of steps. Facilitators – yes! That’s the work we do, in facilitating people to resolve their ambivalence. Thanks for taking the time to comment!

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