Psychodynamic Interpersonal Therapy for Chronic Pain

The aim of this thesis was to understand more about the potential applicability and utility of the Psychodynamic Interpersonal Therapy (PIT) model in chronic pain. The thesis is presented as three separate papers. In Paper One we present a narrative review setting out the theoretical and empirical case for PIT as a treatment in chronic pain. We describe the central tenets of the PIT model and present evidence demonstrating their applicability in chronic pain populations. The practical elements of the model are then described with reference to how they can be used to improve clinical outcomes in people with chronic pain. We conclude by comparing and contrasting PIT with other approaches to chronic pain and considering the clinical and empirical implications of the model. Paper Two is an empirical investigation examining the feasibility, acceptability, and safety of PIT as a treatment in chronic low back pain (CLBP) patients, and a preliminary evaluation regarding its efficacy as an approach. A case series of six sessions of PIT with eight participants with CLBP was conducted. An A-B replication design with multiple baseline and follow-up was used. Results suggest that PIT is feasible, acceptable and safe for use with CLBP; indicated by high attendance and adherence to treatment protocol, high satisfaction questionnaire ratings and no reported adverse events. Substantial improvements were observed for depression and to a lesser extent for interpersonal problems. Pain distress ratings were stable throughout. Clinical outcomes indicate that PIT may reduce depression and interpersonal difficulties in chronic pain. Finally, Paper Three is a critical reflection of the processes involved in conducting the project. This paper provides further detail on the methodology and decision making processes which took place within the research, alongside considering the strengths, limitations, and suggestions for future research. This paper concludes with personal reflections on the thesis project.