Question
How should therapists choose appropriate therapies for chronic pain or illness while staying within their professional scope?
Answer
Therapists should select therapeutic approaches for chronic pain and illness based on both their own expertise and what resonates with the client’s needs and experiences. Cognitive Behavioral Therapy (CBT) is most appropriate when clients exhibit clear cognitive distortions about their illness, such as feelings of worthlessness or hopelessness, rather than simply when medical tests are inconclusive. Acceptance and Commitment Therapy (ACT) is beneficial when clients are disconnected from their values, experiencing existential distress, or engaging in high experiential avoidance.
Somatic approaches are indicated when there is body dissociation or nervous system dysregulation; however, specialized training is required to avoid exacerbating dissociation. Internal Family Systems (IFS) can be helpful when clients experience internal conflict or identity confusion, while Pain Reprocessing Therapy (PRT) is considered when pain persists without clear ongoing tissue damage, typically after extensive medical evaluation. Clinical hypnosis, particularly for gastrointestinal issues like IBS, is supported by growing evidence and requires client engagement in self-hypnosis practice.
Therapists must remain within their professional scope, focusing on psychological support, coping strategies, emotion regulation, and facilitating adjustment to illness. They should not diagnose medical conditions, interpret medical tests, recommend or alter medications, suggest specific medical procedures, or advise on diet, supplements, or exercise. Instead, therapists should empower clients to seek appropriate medical advice and support them in navigating the emotional and psychological impacts of chronic illness.
This Ask the Expert is an edited excerpt from the course, 'Ethical and Practice Considerations for Working with Chronically Ill Clients,' presented by Destiny Davis, LPC, CRC.
