Therapist's Guide to Clinical Intervention - Sigmund Freud

158 2. Assessing Special Circumstances
CLINICAL INTERVIEW
Individuals with pain often present with additional coping difficulties. Chronic pain is
exhausting, physically limiting, and challenges an individual's identity and sense of control.
Be sensitive to not minimize or invalidate their experience of pain.
1. Identifying information
2. Relationship history
3. Work/academic history
4. Relevant background information and developmental history
5. History of pain (intensity, frequency, quality)
6. Medical history (injuries, hospitalization/surgery, medication, etc.)
7. Psychiatric history (therapy, biofeedback, hospitalization, medication)
8. Mental status
9. Coping mechanisms and problem-solving ability
10. Strength and weakness
11. Diagnosis
12. Tentative treatment plan listing planned collateral contacts for further
information and case management
Use of the MMPI. MMPI scales can be very helpful when used as predictors of pain-coping
strategies likely to be preferred by individuals with chronic pain.
ASSESSMENT AND MEASURING PAIN
1. Behavioral Observation. Observed outward manifestations of pain may be
offered by any significant person in the individual's life and by the therapist.
These observations may include distorted posture, distorted ambulation,
negative affect (irritable, fatigue, etc.), avoidance of activity, verbal complaints,
and distressful facial expressions.
2. Subjective Reports. The accuracy of subjective reports of pain are highly
variable. It can be helpful to offer a conceptual range of pain from no
experience of pain to pain that is intolerable (can't be any worse). This
information can be clarified by using:
A. A basic anatomical chart for identifying location/points of pain and type of pain.
B. Facilitate the initiation of a journal for a brief period of time if clarification is
necessary. ** Concern is creating increased focus on the pain. However, information
which can be gathered includes location, frequency, intensity, time of day which is
worse, pain management techniques (what is helpful), etc.
Using the pain chart on the next page show where you experience pain. There are different
symbols for making the location of pain on the diagram which are descriptors of the type of
pain that can be experienced.
Every area that you mark as a location where pain is experienced should also be numbered
between 0 and 10 to indicate the intensity of the pain experienced. For example if a
location had the symbols and numbers such as:
1111 4
1111