Physical pain can touch the very core of a sufferer’s life; it reduces emotional resilience, interferes with relationships, impacts on the ability to have and give pleasure and can have myriad psychological manifestations including anxiety disorders, bipolar disorder, depression and stress. Emotional pain or stress meanwhile can manifest as headaches, joint pains, stomach aches, nausea, vomiting, fatigue, dizziness, memory problems, weakness and / or numbness.  It is this co-dependent nature of physical and emotional pain that creates clinical conundrums for us as psychotherapists and psychologists.

At this intellectually stimulating and therapeutically oriented seminar, Dr Jan McGregor Hepburn & Dr Tessa Hepburn will first discuss theoretical concepts which illuminate these issues and will then draw on the lived experiences of both sufferers of and clinicians working with chronic pain to help us delve deep into the complications of working with the mind and body in these seemingly intractable situations. Using case vignettes, the webinar will discuss pertinent clinical issues including:

• When is pain a communication, a warning, a displacement, even a welcome experience?
• What perpetuates the split between the mind and body in adults? This split can mean that the body ‘speaks’ that which the mind and voice cannot. We will look at instances when this can reflect as chronic pain
• Understanding how, based on the facilitating environment, different clients respond differently to chronic pain (Winnicott). What happens when some of our clients come into adulthood without the capacity to recognise what their bodily experiences mean?
• Delving into psychosomatic territory and understanding the client’s resistance to the idea that their pain has a psychological component, much less a psychological root
• Comprehending situations when our clients are using self-harm and / or masochism to gain illusion of transforming pain and the illusion of agency

With this theoretical understanding as a base, Jan will use case examples and vignettes to help us gain a deeper understanding of the underlying issues of chronic pain, with a view to guiding our therapeutic endeavours. Specifically, we will discuss:

• Working with situations when our client’s mind / body split is a functional defence against very early and basic anxieties – how do we address the denial that our clients have bodies and that all chronic pain experiences are embodied?
• Without help from the facilitating environment, our clients may continue to have a persecutory experience of their pain – how do we therapeutically assist them in such cases, particularly considering body-memories and trans-generational trauma?
• How do we work with medically unexplained symptoms, considering that the location of the pain, what it prevents and what it enables all need investigation if the sufferer is to be relieved
• How we can work with resistance and our client’s fear that there is something they need to do that they feel they cannot, and the loss of the longed-for ideal early experience where someone else will take care and take the pain away?
• Working with chronic pain situations where self-harm and / or masochism are present as manifestations

Jan & Tessa will also schedule to discuss case examples that delegates may bring and share ideas with practitioners on how they can work effectively with these clinical challenges.

Learning Objectives:

• Explain when is pain a communication, a warning, a displacement, even a welcome experience.
• Explain how to work with medically unexplained symptoms, considering that the location of the pain, what it prevents and what it enables all need investigation if the sufferer is to be relieved
• Discuss working with chronic pain situations where self-harm and / or masochism are present as manifestations

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