Headache therapy session 7: the world around me

Useful material

Meaning of messages worksheet My headache formulation worksheet Possibility dimensions worksheet Possibility goal hotspot worksheet Steps to my possibility goal worksheet Selection of buttons or pebbles


Explorations of

  • • the impact of headaches on social situations and interactions
  • • social possibility goals and social values
  • • communication styles
  • • the sense of belonging within social networks


“Today we want to explore how other people respond to your headache experience. I want you to imagine that you are now a health coach for your family, friends, colleagues and acquaintances. Imagine what it would be like for them to benefit from all the insights you have gained. How can people within your social group support your efforts to achieve your possibility goals, regardless of your headaches?”

Main therapy section

Social interactions

Use the my headache formulation worksheet “First, let’s have a look at your worksheet my headache formulation.

What has changed regarding your social interaction and contacts over recent weeks?

How have you noticed others responding to your condition?

What has helped you engage more socially and perhaps experience the benefit of social support and understanding by others?

What changes have you made to feel more involved, to feel more connected? What strategies and pacing methods have helped in your interactions with people?”

Social possibility goals and social values

Use the possibility dimensions, steps to my possibility goal and possibility goal hotspot worksheets

“The fact that you have already practised your possibility goal means that you can now apply this to your social goals.

How are social activities important for you?

What would you say are your social roles? Could you rate them on the worksheet?

What is the one goal you can potentially achieve in most areas of your social life?

How can you pace your routines in order to enjoy a healthy social life?

How can you communicate assertively and interact positively to gain and maintain pleasant relationships?

Use the possibility goal-related worksheets as guidance to reflect in more detail about your social needs and goals.”

How do other people respond to your headaches now?

“The people in your life may have also been affected by your accident and your persistent health problems. Immediately after the injury, they tried to help you recover as quickly as possible. Relatives and others often feel deeply affected if someone close to them has experienced a significant health event. They may attempt to do anything in their control to gain relief from their worries and to restore the situation to normality as soon as possible. One way of achieving this is to be as actively involved in your care and headache relief as possible. Surely, you have noticed sympathetic responses from others. They might have taken over tasks and responsibilities from you in the hope that easing the burden for you will speed up your recovery. However, after a while and when symptoms persist, such an approach can become counter-productive. Perhaps, you might have felt excluded from your usual activities and responsibilities, but have lost the confidence to take them back. Others may have become frustrated as they did not expect to carry out extra tasks and commitments for prolonged periods.

“In therapy, you have made gradual changes to your routines, graded and paced your tasks, used coping strategies and relaxation to improve your energy levels. The people around you may now benefit from acknowledging your progress so that you can take back some of your former roles and responsibilities.

How can you regain your former level of responsibility and independence without offending others?

You might have come across responses like these:

‘Oh, you don’t look very well. Would you like to lie down; have a cup of tea/glass of water/an aspirin; let me do this for you.’

Other responses may indicate some frustration about your headache condition:

‘Have you got a headache again? This means I have to do this... for you; 1 have to do the shopping on my own/you won’t come out with me tonight.’

What would it be like if you confidently inform your family or friends that even if you have a (mild) headache, you have now learnt to pace yourself, that you can carry out some of your jobs or that you only have to modify your approach and this will allow you to do a great deal more than in the past?

You can now ask others to encourage you and perhaps even join you in using strategies and adapted routines.”

Meaning of messages

Conversations can often lead to misunderstandings as a result of different interpretations by the speaker and the listener.

On the other hand, talking with others who share similar experiences can be very powerful in reducing the subjective experience of distress caused by acute and chronic pain.

People who are better integrated socially complain about less pain disability and pain-related anxiety. Also pain patients who live close to their family or have a bigger social circle show more potential for adequate pain management. Most people would agree that better social integration and mutual social support seems to have a long-term improving effect on the functional impairment that chronic pain can cause.

Consequently, it is favourable to communicate and interact with others in such a way that closer bonds can be established. Authentic connections with others can happen when the content of a conversation and its inherent meaning is aligned with the listener.

Use the meaning of messages worksheet

‘‘As you know, messages can convey direct or indirect - i.e., subtle - meanings.

At times, meanings are not understood on the same level as intended by the sender. This is how misunderstandings are created.

This diagram on the worksheet describes four options of sending and interpreting messages.

Which one is direct and which ones are more indirect?

How would you like to be understood?

How can you make sure your message contains the intended meaning?”


One way to communicate more clearly is to use “I-messages.” This means, the speaker’s intentions are stated from a first-person perspective and include the following three components.

  • • State the situation: “I have a headache.”
  • • State the intention: “I want to continue preparing the vegetables for ten minutes. Then I am going to practise my relaxation. I would like you to let me carry on with my task and make sure I am not disturbed during my relaxation practice later.”
  • • State the consequence of the intention: ‘‘Doing it this way helps me get something done while also coping better with the headaches.”

Direct communication provides an opportunity to clean up conversations and prevent unnecessary assumptions, obscure meanings and misunderstandings.

“Applying a direct and authentic communication style may take a while to get used to. Tell your significant other that you wish to talk about your headaches differently. Rather than commenting on headaches and well-being, you may wish to talk about your tasks, how you plan your day, how you are pacing yourself to move towards your possibility goals and how you can achieve a sense of purpose.”

Social networks

Notes for therapist: Interactions with people within social networks can illustrate the helpfulness or dilemmas of relationships. Systemic or family therapy methods can be very useful in this section of the programme. It is beyond the scope of this manual to go into detail with regards to systemic therapy techniques. Nevertheless, one simple and interactive method can be implemented to illustrate the different roles and dynamics in social groups.


The therapist can supply a selection of different buttons or pebbles.

For the purpose of this exercise, each button represents a person within the family or social network. Patients then lay out representations of their own networks. The features of each button (size, material, shape) symbolise the characteristics of the person it represents. The strength of relationship can be indicated by the distance between buttons. By using the buttons, patients can reflect on the communication and interactions they have with the people in their social network. They can explore how relationships have changed over the course of their headaches therapy and perhaps what would need to happen to optimise their network.

Sociogram. The big button represents the client who is surrounded by the family and friends

Figure 3.10 Sociogram. The big button represents the client who is surrounded by the family and friends.


“Think ahead about how you can implement examples of clear communication styles with people in your social network. Try to practise them once a day over the next week. Tell me what happened.”

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