Audience Q&A: My Patients Don't See a Need for a Psychologist

Asked at AAPM 2020: Regarding Whole-Patient Integrative Care: “How do I respond to patients who say, 'I’m not crazy, I don’t need to see a psychologist'?"

Pain management providers appreciate the benefits of whole-person, integrative pain care, including the role of a psychologist in treating a patient's chronic pain. But not all patients understand the biopsychosocial aspects of pain and long-term pain care.

As a result, the question above seems to be common among clinicians. It was asked during Dr. Aram Mardian’s talk at AAPM 2020 in National Harbor, MD. Dr. Mardian works at the Phoenix VA healthcare system in Arizona. While pointing out that he has unique opportunities at the VA, Dr. Mardian responded that his team uses “co-disciplinary visits in which a psychologist is in the room with the patient from the start.” All visits are then conducted as a team. “Language can also be key to destigmatize this issue,” he said. “Clinicians need to explain to patients that pain is complex, that emotional and social pain are processed at same time as sensory pain.” 

Not all clinicians can offer such a team approach, however, especially when it comes to billing. Added Dr. Beth Darnall of Stanford University, who shared an update on her EMPOWER trial, which is focusing on opioid-free ways to manage pain, as part of the same session: “This issue is not going to change until the system is changed.”

Culturally, psychological services are often reserved for a subset of the population, so patients automatically feel singled out, she noted. “If we shift the narrative on the front end and talk about our philosophy to patient care and how we screen and offer psychological services to every single person, then we can make them feel that it’s part of their pain care plan. But we need to do this at all levels in the system.”

See related articles from our Behavioral Medicine columnist, David Cosio, PhD:

When Pain Clinicians Have to Be the Villain: Communication Strategies to Bridge the Divide

Pain Assessment Tools for Malingering in Patients with Chronic Pain

Chronic Pain and the Psychological Stages of Grief