Psychotherapy and Chronic Pain: An Interview with Alison Bowles

Here’s an online interview with my wife (and PoT blogger) Alison Bowles, conducted by Raymond Barrett of the Telehealth Certification Institute in Canandaigua, New York. Alison is a psychotherapist in private practice with an on-ground presence in Manhattan, and a developing online practice.

The interview focuses on an under-discussed issue in therapy–therapy with people suffering from chronic pain. We hear so much about the “opioid crisis” that we forget that it’s overshadowedby a long shot–by a chronic pain crisis. There’s also a dangerous trend in mental health of pretending that chronic pain conditions can be managed and resolved by the magic of mindfulness and meditation. Though many studies suggest that such claims are nonsense, that hasn’t stopped the mindfulness gurus from making them:

Kabat-Zinn’s et al. (1986) described the process of pain reduction in his paper on mindfulness and meditation. The process of pain reduction occurred by “an attitude of detached observation toward a sensation when it becomes prominent in the field of awareness and to observe with similar detachment the accompanying but independent cognitive processes which lead to evaluation and labeling of the sensation as painful, as hurt.” Thus, by “uncoupling” the physical sensation, from the emotional and cognitive experience of pain, the patient is able to reduce the pain.[]

Stoicism with a vengeance: as far as mindfulness-based therapy is concerned, the key to dealing with pain is to stop feeling it. The way to stop feeling it is to pretend that it’s not there. And denial, I suppose, is the key to mental health as such.

Believe it or not, such claims are now standard in textbooks on mindfulness-based approaches to therapy. “The basic premise of ACT [Acceptance and Commitment Therapy] as applied to chronic pain is that while pain hurts, it is the struggle with pain that causes suffering” (Dahl & Lundgren, “Acceptance and Commitment Therapy in the Treatment of Chronic Pain,”p. 286). It sounds a lot like blaming the victim, but hey, the struggle is real.

I’m pleased to say that our cat Hugo makes a cameo appearance around 2:20, making a wordless pitch for animal-assisted therapy.

4 thoughts on “Psychotherapy and Chronic Pain: An Interview with Alison Bowles

  1. Note: actually a lot of this video is about offering tele-mental health services but my hopes to help those who suffer from chronic pain is addressed. My practice is at least 60-70% online at this point; and perhaps by summer, it will be completely online (and then maybe I’ll go traipsing back to Budapest for a while.

    Anyway, on this idea that meditation will set you free: no it won’t! I have a post on meditation that I’ve been working on called “Meditation, Schmeditation” as I’m sick and tired of hearing about it. It’s as if meditation is some kind of magic bullet for just about every problem. I guess the Buddhists weren’t as entrepreneurial as psychotherapists are since they didn’t find a way to justify charging people $200-$350 an hour to teach meditation (as if that’s the ONLY possible intervention or activity a person can engage in to reduce their anxiety). In fact, there are thousands of ways to reduce anxiety with meditation being only one of them, and only good for some people.

    That said, it does fucking nothing for real chronic pain! It might for someone who is a hypochondriac, but the bulk of intractable and severe chronic pain sufferers are like me: they’ve got all kinds of metal in their spine, scaffolding holding the darned thing up. Or they have serious nerve conditions, conditions that have NO cure. Or they have horrible autoimmune diseases like rheumatoid arthritis. Now people go on and on about opioids as if they do nothing for chronic pain when in fact “milk of the poppy” was used for pain for centuries before we had more modern pharmaceuticals. It was used because it fucking worked!

    Meditation is NOT a cure for pain, and it’s utter nonsense to say so. Honestly, it’s tiring listening to my own kind most of the time. The sad thing is that their attachment to meditation is nothing more than marketing, and it shows that psychotherapists don’t have much to offer patients with chronic pain, much less chronic illness, if they can’t even take the patient’s medical condition seriously.

    I’m planning to present at conferences and hopefully train my kind to be a little bit more sensible and to treat chronic pain patients with a bit more respect for their minds, and their abilities to cope. After all, if you have severe and intractable chronic pain, and you’re still alive, you’re probably more together than most of the therapists you’ve seen, particularly these idiots who market meditation as a psychotherapeutic intervention that is somehow new and improved. Jesus. The dumbing down of the culture — did it start with academia or is it affecting academia??

    Liked by 2 people

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