Allen, Ruth; (2000) A qualitative study of the process of change in patients participating in a residential pain management programme. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

The study aimed to identify non-specific aspects of a residential pain management programme that influenced the changes patients made whilst attending. Specific aspects of the programme consisted of input from psychologists, physiotherapists, occupational therapists, doctors and nurses, in identifying non specific aspects of the programme, literature concerning therapeutic alliance and group therapeutic factors were reviewed. The prospective study recruited 13 patients with chronic pain who were attending the residential pain management programme. Patients eligible for the programme completed a comprehensive assessment and had had pain for longer than 12 months. Patients were interviewed during week 2 and week 4 of the programme. The interviews were recorded and subsequently transcribed. Open ended interview questions were administered in 3 areas: (i) what was/was not changing for the patient during the residential programme, and their perceptions of what had influenced these changes; (ii) how patients perceived the staff; and (iii) the experience of being in a group of people with chronic pain. Interpretative Phenomenological Analysis (Smith 1997) was used to identify themes from the recorded interviews. Patients reported physical, behavioural and psychological changes whilst attending the programme. Emergent themes influencing change were; (i) the acceptance of patient's pain by staff and fellow patients (ii) group identity as patients with chronic pain, and as patients participating in the programme (iii) mutually supportive group environments, including altruism (iv) witnessing change in others and (v) staff perceived as giving time. Tentative conclusions suggested that patients felt sufficiently safe to attempt changes whilst attending the programme. Factors that contributed to this safe environment were staff attitudes, empathy and the therapeutic factors of universality and cohesion associated with being in a group of patients with chronic pain.

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