When Helping Isn’t Helping: The Practitioner’s Role in Chronic Pain Recovery
Heidi Clarke
As health professionals, we enter the therapeutic relationship with a desire to support, to heal, and to guide our clients toward better health and quality of life. But what happens when our well-intentioned efforts aren’t leading to meaningful change — especially for those navigating the complex terrain of chronic pain?
It’s an uncomfortable reality, but one worth confronting: sometimes, we are not helping in the way we think we are. And even more critically, we may not always recognise when that’s the case.
The Blind Spot in Chronic Care
Chronic pain doesn’t play by the rules of traditional biomedical models. It doesn’t always correlate neatly with tissue damage, it rarely resolves on a linear timeline, and it’s deeply interwoven with a person’s history, beliefs, nervous system sensitivity, trauma, and psychosocial environment.
Much of our training emphasises fixing through the identification of a pathology, applying the treatment, and expecting improvement, full recovery, or resolution. Unfortunately, chronic pain often doesn’t follow the expected ‘rules’. When the expected outcomes don’t come to fruition, it can be tempting to double down on what we know, or worse, subtly shift blame onto the client (“non-compliant,” “resistant,” “not ready to change”).
These responses, even when subconscious, can erode trust and stall progress.
Are We Really Helping?
If a client isn’t achieving their goals or showing meaningful progress, it is not enough to assume they need to “try harder” or “give it more time.”
Instead, we must look inward and ask:
- Am I truly meeting this client where they are, or am I pushing an agenda they’re not ready for?
- Have I created a space where this person feels heard, validated, and safe?
- Am I operating within my scope and expertise, or am I out of my depth with the complexity of this case?
- Have I created a safe space for the client to provide feedback about what is or isn’t working in our sessions?
Chronic pain recovery is not a solo endeavour, it is a collaborative process, and if that collaboration is not producing results, it’s time to examine what part we are playing in that dynamic.
The Courage to Step Aside
There is no shame in recognising that something is not working. It could simply be that we are not the right fit for the client. In fact, it’s a mark of clinical maturity and humility to acknowledge the failure to progress, and by addressing this, it is far more respectful and helpful to the client to say, “I don’t think I’m the best person to help you move forward right now. Let’s explore who might be.”
Referral is not failure. Recognising it is not working and referring out, is vital to ensure that the client has the best outcome possible and communicates to the client: Your recovery is more important than my ego or attachment to this therapeutic relationship.
In some cases, the best thing we can do is help a client find a pain psychologist, a trauma-informed therapist, or a practitioner with a different lens or set of tools.
Being Part of the Solution
The biopsychosocial realities of chronic pain are still relatively young, and we need to stay curious, reflective, and open to evolution. Regular peer discussion and honest self-reflection are essential for client outcomes. Importantly, creating a professional culture where stepping aside is not seen as weakness or lack of skills, but as putting our client first for best possible outcomes.
Clients living with chronic pain often carry a heavy load of disappointment from previous care. Let’s not add to that burden by pretending we have all the answers. Instead, let’s honour their journey by being honest about our limitations and committed enough to their progress to know when it’s time to pass the baton.