Sarah Benamer on Working with Chronic Pain

Sarah Benamer is a UKCP registered Relational Attachment Based Psychoanalytic Psychotherapist and supervisor who works with individuals and couples. She has a particular interest in the many roles of the body in our emotional and relational worlds. Sarah originally trained as a psychotherapist at The Bowlby Centre and has subsequently undertaken a COSRT psychosexual and couples therapy training.

Sarah will be delivering her CPD workshop with Wimbledon Guild Counselling Training : TOWARDS A SHARED LANGUAGE OF PAIN: Exploring the body, chronic pain and illness in the consulting room on Saturday 6th October 2018


What drew you into becoming interested in the topic of working with clients who experience chronic illness and pain?

Before training as a therapist, as a community worker supporting individuals who were physically disabled from birth I learnt that my understanding of my own body was not one that I could rely upon as universal. I began to think about how our experiences of our body in the world shape us. How we feel in our bodies (as subjects), and are made to feel about our body (as objects) is vital to the way we relate to others and to ourselves. My clients who had become disabled later in life, who comprehended themselves differently before and after helped me to think about bodies and minds trying to ‘go on being’ through loss and pain. I saw how this grieving process for their lost bodies, lost ways of lives and sense of themselves was impacted upon by factors including their attachment history, social context, and present relationships. As a therapist I am interested in how bodies are used in a myriad of ways in the expression of emotion. For example, we can split off our physicality, or perceive of our body as a dumping ground for our feelings. Neuroscience has demonstrated that we experience emotional pain and physical pain in similar areas of our brain and with this in mind I have learned to listen more holistically in the consulting room, and am fascinated by the relationship between the concrete and the symbolic. Rather than thinking of psyche and soma as separate I believe it can be useful to explore which parts of the self are being expressed in what ways; to think of our narrative as including both what we can express verbally and what is being spoken of by our body. If our body cannot be assumed as safe because of trauma or illness, or because all consuming chronic pain closes down upon the space to make meaning, you can feel alone in facing ‘the enemy’ within, and cut off from others. Feeling truly connected in an intimate therapeutic relationship can offer a potential space for relief - at the very least for two bodies and minds to encompass the pain.

In your experience what have you felt to be some of the challenges in working with clients who experience chronic illness & pain?

“What good is talking to you going to do?” is a question that frames some of the challenges of working with clients who have chronic illness or pain. Many come to us having tried a cornucopia of treatments. The dominant medical model offers the paradigm of pain management, killing, or cure. If the pain persists you can be left to process feelings of self-hatred or blame, fear, disappointment, anger and shame alongside trying to deal with the original pain, only now without the prevailing wind of hope. When working with clients who have been on this journey it can be hard for all concerned to bear with the therapeutic process as we would normally understand it. Staying present with pain is humbling and takes us to the heart of our own humanity. We can become lost in the concrete. In the urgency of distress located in the body, psychotherapy can feel ephemeral. We can feel impotent, that our compassion is not enough, and that we must immediately ‘do’ something beyond the usual to alleviate the suffering. Feeling this is profoundly uncomfortable but also an important part of understanding what our clients are going through. Working with chronic illness and pain it is impossible not to be touched in the place of our own vulnerability - in fact maintaining empathy relies upon this – but what we experience with our clients may one day be ours. The realities of limitation, illness, ageing and mortality are disquieting, and not something that the therapist themselves is protected from.

What would you hope delegates take away from your CPD day with us?

I would hope that delegates would have increased understanding of chronic illness and pain:

Theoretically - To have an understanding of some of the ideas that inform our understanding of pain as a phenomenon, and how psychotherapy may offer possibilities distinct from the medical model. To be better able integrate the personal as professional - as therapists we can find ourselves attempting to address the body of ‘the other’ without recognition of the fact that we too are embodied. Greater awareness of our individual understanding of, and relationship with pain can free us to be more curious and supportive of our clients pain without responding defensively. Clinically - To think about how pain and chronic illness is presenting in our consulting rooms, and how best to explore with individual clients what their pain means for them. To feel confident in what we might be able to offer clients who are in distress of this nature and to have conscious awareness of our ‘growing edge’ and limitation in this endeavour.