Pain is a complex and subjective experience that requires a person-centered approach in its management. In the realm of healthcare, person-centered communication is often underestimated in the management of pain. It extends beyond the mere collection of information: it serves as a gateway to understanding and a crucial alliance between the healthcare provider and the patient. The ability to truly hear and understand the unique narrative of the patient's pain experience is foundational to effective pain management. The core conditions of Carl Rogers offer valuable insights into fostering meaningful connections.
The role of the therapeutic alliance
The therapeutic alliance, a collaborative partnership grounded in trust, mutual respect, and open communication, plays a pivotal role in healthcare. An environment that instills feelings of respect, understanding, and support empowers collaborative efforts essential for therapeutic progress. Research consistently underscores the influential impact of the therapeutic relationship on treatment outcomes (1-4). Carl Rogers, a pioneering figure in psychotherapy, introduced the concept of the Core Conditions for person-centered Therapy (5); three fundamental elements of a therapeutic relationship.
Rogers' Core Conditions
The three core conditions that Carl Rogers identified in his person-centered therapy are unconditional positive regard, empathy, and congruence.
Unconditional Positive Regard
Providing an atmosphere of acceptance is paramount in pain management. Patients with chronic pain often carry a burden of skepticism, fear, and frustration. By offering unconditional positive regard, healthcare providers create a safe space for patients to express their thoughts and emotions without judgment. This acceptance fosters trust and openness, crucial elements in the therapeutic relationship.
Empathy
Empathy involves the ability to understand and share the feelings of another. In pain management, acknowledging the emotional toll of chronic pain is as important as addressing the physical symptoms.Healthcare providers validate the patient's experience, reinforcing the notion that their pain is not only recognized but also understood on a deep emotional level.
Congruence
Congruence refers to the therapist's authenticity and openness, expressing genuine feelings and thoughts within the therapeutic relationship. It involves the therapist being transparent and honest, contributing to a trusting and authentic connection with the client.
Person-centered communication
The core conditions proposed by Rogers serve as foundational attitudes ("being") that pave the way for the development of person-centered communication skills. These skills may encompass various aspects such as open questioning, reflective listening, the recognition of non-verbal cues, among others. The article of Lin et al. (2020) provides a useful summary of examples of person-centered communication for the various recommendations for optimal musculoskeletal pain care.To conclude with a statement from the article of Lin et al. (2020): “To achieve high-quality musculoskeletal pain care, we should focus not only on what we do, but also on how we do it”.
Lore Dams
Lore Dams is postdoctoral researcher at the University of Antwerp and physiotherapist in oncological rehabilitation at the University Hospital Leuven.
2024Pain in Motion
Further reading:
Lin I, Wiles L, Waller R, Caneiro JP, Nagree Y, Straker L, Maher CG, O'Sullivan PPB. Patient-centred care: the cornerstone for high-value musculoskeletal pain management. Br J Sports Med. 2020 Nov;54(21):1240-1242. doi: 10.1136/bjsports-2019-101918. Epub 2020 Jun 25. PMID: 32586944.
https://pubmed.ncbi.nlm.nih.gov/32586944/
Diener I, Kargela M, Louw A. Listening is therapy: Patient interviewing from a pain science perspective. Physiother Theory Pract. 2016;32(5):356-67.
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