Thanks for visiting my professional home page. If this is your first time here, you may be looking for my curriculum vitae.

At this point in my clinical training, I have spent nearly a year on what is called the psychodiagnostic practicum. What that means is that my main job for the last year, as a psychodiagnostic extern at the Diamond Headache Clinic inpatient unit, has been to figure out what psychological factors are playing a role in our patients’ headache pain.

This is a tricky thing to do, for a number of reasons:

• It’s tricky to figure out what’s going on with anybody, psychologically. People are pretty complicated; when things go wrong, they rarely go wrong for just one reason. Typically any psychological problem will have some genetic components, some environmental components, some relational components, and some intrapsychic components. You don’t really get the luxury of pointing to one thing in someone’s past and saying you’ve found the answer.
• These people tend to be especially complicated. There’s some research to suggest that chronic pain patients are more likely to meet criteria for personality disorders than other types of patients. In my experiences, I’ve found that even those who don’t meet criteria for those diagnoses usually have pretty deep-seated ways of interacting with the world that unintentionally serve to maintain their pain status.
• Headache patients, in particular, are usually pretty resistant to psychological asssessment. This is mostly because they have gotten used to being told that the very real pain that they experience on a daily basis is “all in their head.” Usually they hear this from physicians who are simply frustrated that none of their tests come back positive and nothing they do seems to change anything. The same goes for any other type of chronic pain patient, and probably many people with IBS as well. » Read the rest of this entry «