Single-session emotion-focused psychodynamic interview for chronic pain

Domain I · Psychodynamic & depth psychology · Lumley, Ziadni · 2016

What it is

What it is: one structured, intensive interview for people with chronic pain or other persistent somatic symptoms in which no structural disease explains the severity (often called centralized, primary or nociplastic pain). In it, the interviewer: (a) takes a life-course health history; (b) elicits…

Format

• Before the session (not described procedurally in the sources:). Confirm a medical evaluation has excluded red-flag and structural or inflammatory causes that need their own treatment. Screen for exclusions (see Phase 0). Agree with the referring clinician how findings will be communicated.
• Decision rule for the experiential phase. Start with the relationship that carries the most charge but that the patient can tolerate. The EAET manual advises beginning with lower-difficulty relationships and never forcing disclosure. In ISTDP terms, choose the graded (supportive) format when…

Who practises it, and how they are trained or regulated

• Format. One session of about 90 minutes, delivered in person (clinic exam room in primary care, or a specialty pain or urology clinic) or by secure videoconference (Krohner). In the trials, interviewers were clinical-psychology doctoral students. Sessions were audio- or video-recorded and supervised by a licensed psychologist. Outcomes were reassessed about 6 weeks later. The protocols describe no booster session.
• Version followed: the Lumley group's single-session (~90 min) life-stress, emotional awareness and expression interview. Its four-phase structure follows Carty et al. 2019 (also used in Ziadni et al. 2018). Its emotion-focused psychodynamic variant follows Krohner et al. 2024 (EAET + ISTDP, by video, adults with chronic musculoskeletal pain and 3 or more adverse childhood experiences, five components per trial…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• pressure to forgive. Don't push it; legitimate anger is acknowledged first.
• patients who sent the "unsent" letter. Clarify the instruction is not to send it.
• any plan to confront a dangerous person. Advise against it and use private expression instead (see 5.8).
• passive compliance ("whatever you think"). Abbass treats this as defeating the work, so get an active yes.
• sadness used to avoid anger (weepy helplessness with no protest). Collapse into despair means stepping into 4.15.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.