Abstract

This research explores the potentialities of psychotherapy for the
management of chronic pain. The model used is brief therapy of systemic
orientation and the chronic pain managed is primary headaches (namely, migraines
and tension-type headaches). In order to produce clinically relevant material, this
research is carried out within an alternative research paradigm. The raw data are the
audio-recordings of two cases: one with a man suffering from migraines; the other
with a woman suffering from chronic tension-type headaches (aggravated by
migraine episodes). These were selected from a pool of cases because they illustrate
the phenomena under study and both completed a follow-up which confirmed an
acceptable headache management outcome. The recordings were transcribed in
order to be studied using discourse analysis of social constructionist orientation (DA
hereafter). The research questions explored are: How were the headache problems,
the therapeutic aims and the resources for managing them constructed during
therapy? What did the participants do with these constructions? How was this
particular type of talk interaction helpful in changing the way these two people
managed their primary headaches?
DA reveals that: (1) the headache problems are entangled in many vicious
cycles, Catch-22 situations and even double-binds, and that these patterns have the
tendency to perpetuate the problems; (2) the meaning of the headaches vary from
one patient to the other, being greatly influenced by their personal experiences,
family histories and interaction with health professionals; (3) these meanings
influence the co-construction of the therapeutic aims, with management (rather
than a cure) emerging as a more achievable goal, with additional auxiliary aims also
becoming very important; (4) specific interventions for managing the headaches and
for achieving the auxiliary aims lead to concrete changes; (5) these changes are
sometimes generalized for other situations, and therapy is seen as a useful resource.
Thus, this study shows some of the potentialities of brief therapy of systemic
orientation to manage primary headaches, producing concrete suggestions that can
be applied in clinical work.