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Facilitating Self-Management of Chronic Pain
Helpful Attitudes
  • A commitment and choice to work with people experiencing chronic pain.
  • Curiosity about ways of facilitating self-management.
  • A commitment to your own self-management program and self-care.
    (Check the prescription for self-management.)
  • A belief in the reversibility of chronic pain conditions.
  • A willingness to do your own work using your reactions to people in chronic pain
    as the material for self-exploration.
  • A willingness to expand your skill base and learn more about other disciplines.
  • A willingness to meet the client where they are and not where you want them to be.
  • A willingness to meet the clients’ needs and not just do what you usually do,
    or like to do.
  • A willingness to let go of trying to fix your client. Top of page

Simple Steps to Facilitating Self-Management of Chronic Pain

  • Limit the searching for causes and cures.
  • Refer to appropriate therapists (those supporting self-management as well as providing symptomatic relief).
  • Enquire about the patient's progress with self-management.
  • Reward progress (even small advances).
  • Diffuse panic with setbacks and flare-ups.
  • Challenge self-defeating thought patterns.
  • Create positive expectancies.
  • Reinforce explanations about chronic pain.
  • Evaluate and modify the program regularly.
  • LISTEN without advising (as much as possible): empathy and compassion heal.
  • ENCOURAGE all attempts to take responsibility and self-manage.
  • SUPPORT through all phases of the process.
Who comes to see you?
It is useful to identify who has come seeking your assistance. Is the person a victim, a visitor, a client, or a self-manager? You will need to meet the person where they are and work with them to move towards becoming a self-manager. Top of Page

VISITOR No ownership
CLIENT Some responsibility
SELF-MANAGER Full responsibility

Connecting with the person in pain

Contact is the basic tool of every therapist and it demonstrates that the therapist understands, accepts, is present and participating. When contact is good, it builds rapport, trust and safety. It can be verbal and non-verbal and the table below shows ways of making verbal contact. Therapists can be inclined to say too much and this approach to making contact encourages the therapist to say as little as possible. There are some hints below to help you create a good connection with the person in pain.

How to make contact
Good Contact
  • Offer simple acknowledging statements
  • Comment on the obvious
  • Contact present experience
  • Demonstrate understanding
  • Notice the client’s response to contact
  • Say as little as possible (see below)
  • Supports the flow/does not interrupt
  • Demonstrates accurate following
  • Moves the process towards inner experience
  • Avoids questions and answers
  • Builds safety, trust and rapport

For Thoughts A lot going on
Many thoughts
Can’t stop thinking about it
Thinking about that
You believe that they’ve missed something
For Feelings That makes you angry
Feeling sad
Makes you nervous
Worries you
Worried about the future
Given up
Seems hopeless
Feel helpless
Feeling really down
You’re concerned about that
That scares you
For Sensations Tensing up
Can’t keep still
Hard to handle
Really hurts
For Actions Avoiding that
Need some relief
Hoping the doctor will take it away
Have to get relief
Searching for answers
Hoping to find a cure
Related to the Workplace They don’t believe you
Giving you a hard time
They don’t understand
Seems like you’re not wanted
Missing your old job
Not ready to go back to work yet
Related to doctors/investigations He’s not listening
Suggesting it’s all in your head
Ignoring you
Lots of different advice
Nothing more they can do
Wished the scan had shown something
Around responsibility They’re to blame
It’s their fault
Not your problem
Can’t see your part in this
Around entitlement Not fair
They owe you
Need to prove your point
Have to convince them
Seems unjust
General Something just happened
Curious about that
Feels good to talk about that
Checking things out
Settling in
A lot going on
No energy
Fed up with it all
Can’t find the words
Hard to talk right now
Feeling lost
Not sure about that
Uncertain about what you should do

Top of page

Questions promoting self-management

One way to invite participation is by asking questions. It can avoid the resistance that develops when clients are told what to do.

Pain relief

  • What would it be like if the pain didn't bother you so much/at all?
  • I wonder how that could happen?
  • What have you learnt about reacting and responding to pain?
  • I wonder how you could respond to pain instead of reacting to it?
  • Could you tell me what your life would be like without pain?
  • How could you begin to make that happen?

Rewarding progress

  • I wonder what progress would look like? (keep probing)
  • What progress have you noticed?
  • How could you reward your progress?


  • What do you need to know?
  • How do you learn best?
  • What makes it difficult for you to change?
  • What is making it difficult for you to learn this?

Finding comfort

  • Where are you feeling comfortable right now?
  • Tell me about the feeling?
  • I wonder whether you could notice your comfort this week?

Rediscovering fun and pleasure

  • Could you imagine having fun/experiencing pleasure?... just imagine
  • How might that happen?
  • How could you organise to have some fun or pleasure this week?
  • What would it be like if you started relaxing, going out, and having fun?

Solving problems

  • I am puzzled about that. Could we solve this one together?
  • I wonder how you could get around that problem?
  • What is stopping you from ... (relaxing, going out, doing that ...)?
  • Tell me how the pain stops you.

Handling feelings

  • I am feeling frustrated: are you?
  • What could we do to relieve the frustration?
  • Can you remember a time when you lifted your depression? How did you do that?
  • What helps reduce your anxiety? How could you do that?


  • Which part of the self-management program is working for you?
  • What makes it difficult for you to do the exercises/relaxation?
  • How could you develop a routine?
  • What would help with your motivation? Top of page

How to Approach the Work

  • Expect your clients to work and get results from their work.
  • Measure their progress.
  • Set goals with them.
  • Teach them how to set goals (specific and realistic)
  • Design programs with them.
  • Teach them how to design their own programs.
  • Discuss the obstacles to meeting their goals. Keep exploring the obstacles.
  • Let them turn the obstacles into challenges.
  • Let them initiate action by:
    • Asking the right questions
    • Inviting not telling
    • Engaging their curiosity and sense of adventure
    • Thorough preparation before commencing the program
  • Ask about comfort/fun/pleasure not pain.
  • Ask about relaxation not tension.
  • Acknowledge where they are.
  • Give them permission to be where they are.
  • Only explore alternatives when they have heard your acknowledgment and your permission.
  • Ask yourself, “What is missing?”
  • Observe your reactions (thoughts, feelings, actions)
  • What is your agenda? Ask yourself.
  • What is their agenda? Explore this together.
  • Support their defences rather than challenging them.
  • Only challenge their beliefs when they are ready.
  • Acknowledge the way their beliefs have served them in the past but invite them to look at whether they are serving them well in this situation.
Random Thoughts
  • Your level of commitment will usually be reflected in your client’s.
  • Working on yourself is as important as the client working on him / herself.
  • As you become whole your client can become whole.
  • Sharing the problem invites responsibility.
  • Shared responsibility increases the chances of a good outcome.
  • The more you expect the more your client will discover he/she can do.
  • Your limits will become their limits.
  • Your pessimism is catching.
  • Blaming your client releases you from responsibility but does little to facilitate self-management.
  • Battering down resistance increases the resistance.
  • Supporting defences allows the defences to dissolve.
  • Challenging your client’s belief system can cause strong defence of their belief system.

A good coach knows when to be tough and when to be gentle


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