The Problem of Psychic Pain

There have probably been times when we, as professional helpers, have been with someone who describes suffering a deep unshifting emotional hurt, a type of agony that seems immovable.

Physical Pain vs. Psychic Pain

With many types of pain, even the most extreme pain that is physically generated, there can be solutions, albeit temporary ones. Many severe forms of physical pain can respond, at least temporarily, to the strongest of painkillers. However, strong psychic pain does not respond to these or other types of measures.

This type of psychic pain can feel unbearable and unsolvable, causing the person to feel trapped, powerless and defenceless. It can arise for a variety of reasons, including trauma, grief and as the consequence of various forms of mental illness. Examples are given in three case studies detailed in this excellent article about psychic pain.

Supporting Someone in Psychic Pain

We can often find it confronting being with someone who is experiencing psychic pain. This can be the case whether we have a personal or a professional relationship with that person. It can be difficult listening to and witnessing this type of pain for which there is no immediate answer.

Psychic pain has been described as gut-wrenching and teeth-gnashing, anguish. Not surprisingly, it is an identified risk factor for suicide. Working with people who experience psychic pain can be challenging for several reasons.

Empathy and the Professional Helper’s Struggle

For the helper, there is the phenomenological experience itself. The experience can be a difficult one for a professional helper who sits with the person and who attempts to be as empathetic as possible, listening to or absorbing (to the extent that they can) sometimes extreme descriptions of hurt, anguish and despair. If psychic pain is sufficient for some people to be driven to suicide, it can be also difficult to listen to and sit with those descriptions, especially in a clinical environment.

The intractable nature of the person’s experience can also be challenging. We want the person to overcome their pain, don’t we? That is why we are there as professional helpers, to help them. How can we help someone who reports an agonising inner pain that they feel helpless to prevent or to overcome?

We, as helpers, can struggle.

Rethinking Approaches to Psychic Pain in Therapy

It is sometimes said that goal-based therapies, such as cognitive behavioural therapy, can help someone with psychic pain. CBT has its place. However, it also has its limitations. With its emphasis on goal-based strategies, CBT can sometimes inadvertently reinforce feelings of failure, loss, and helplessness. Sometimes the person can believe, “You are applying strategies with me that usually work for other people, but they are not working for me. There must be something really wrong with me. I am a hopeless case.”

In her book, “Psychic Suffering”, Gemma Fiumara writes that many of us may need to re-imagine our mindset and attitude towards psychic pain, and overcome the widespread aversion to it. What is needed is an increased capacity to use pain in a creative way.

Finding Meaning in Psychic Suffering

If we view suffering as a worthless experience and one that must be neutralised, we are setting up an expectation for ourselves (as well as our clients) that will not always be realised. Fiumara suggests that we need to abandon the idea that inner suffering is bad, damaging and useless, and which must be avoided at all costs. Instead, we should adopt the view that it can be an experience which, if understood and managed correctly, can lead to positive outcomes.

Empathic Witnessing: A Powerful Tool in Addressing Psychic Pain

Joel Yager, in his article “Addressing Patients’ Psychic Pain”, puts it well. As a clinician, the best that he could do was to sit silently with the person as they described their inner torment, trying to soothe their pain through empathic witnessing and acknowledgement. As professional helpers we can straightforwardly acknowledge the psychic pain experiences of others. When it is appropriate, we can also help them to discover meaning to their experiences.

We can let them know that there is someone with them and that they are not alone.