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When I worked at Denver General Community Mental Health Center, in Denver, Colorado, as a clinical specialist, I carried both a case load of patients and consulted with the nursing staff throughout the hospital regarding behavior problems and psychiatric patients. I had been working with a young mother of two children for two and a half years, who was classified by all who knew her as a multi-problem, low-resource patient. With numerous actual and psychogenic medical problems, she was well known throughout the hospital and to the emergency room, which she frequented with 'hysterical' illness and injuries from accidents. Flamboyant and dramatic, she described herself as having been 'born in a trunk' to an acting family. Although frequently frustrated with her progress, I had grown to like her. Following a temporary successful period of work and personal adjustment, she was badly burned while cooking the evening meal. A once attractive woman was turned into a charred, badly swollen monster.
Although her care was physically and psychologically difficult, both she and the staff felt her primary problem was incessant pain. Medication worked for a short while, but the rest of the time, no matter what the staff did, she had no relief. Her dramatic complaining was unsettling to the staff and to her. I felt helpless but decided to utilize some approaches that I knew helped patients with pain. I had learned the Lamaze method and had taught clients in labor that approach; I also knew vivid imagery distracted patients from their pain. I decided to try these approaches with her. I first told her I knew some techniques to diminish pain and promote sleep; I explained these would not replace her pain medication, but would help between doses when the medication seemed less helpful. I asked her if she wanted to try. She was cooperative, enthusiastic, and willing.
She first learned to progressively relax all her muscles. She attained relief and fell asleep following the procedure. I then instructed her in guided imagery. She liked to imagine the beach, being in a field of flowers, or floating on a cloud. Again she was more comfortable and the staff described her as more cooperative and pleasant. The staff learned these techniques and used them with equal...