The application of the existential-phenomenological four-dimension model in working with chronic pain

Pain is important for survival, but chronic pain has lost this danger-signalling property. It is highly prevalent in our society and many sufferers struggle with their lives. The National Health Service treats chronic pain predominantly with the biomedical model despite recommendations for multidisciplinary team treatments, where clients often arrive only when conventional treatments have failed. Within these multidisciplinary services, evidence-based psychological treatment is offered, mainly using cognitive behavioural and recently acceptance and commitment therapy. However, the evidence suggests high dropout rates, and research trials have tended to exclude the more complex client group, often with multiple psychiatric comorbidities, who are, however, very prevalent in pain clinics. We suggest that when treating such complex clients, a phenomenological understanding of chronic pain could be useful. Counselling psychology's phenomenological model of practice can offer insight into the complexity of chronic pain and thus enhance clinical work. This article shows evidence of the usefulness of the existential-phenomenological four-dimension model by exploring the chronic pain treatment of Paul, a composite client. The paper aims to show that this phenomenological engagement empowered Paul to work with the facticity of and choices beyond chronic pain. Consequently, the authors will argue that the four- dimension model could be helpful for any multidisciplinary chronic pain team and discuss why this model can work well within acceptance and commitment based services despite their different epistemological roots.