Treating Shoulder Pain with Psychotherapy - a Case Study

I’ve written up this case study as an example of how the mind and body can be connected. While the client responded very well to talk therapy, I generally recommend that clients see a medical professional to rule out an organic basis for their physical symptoms before I use talk therapy treatments.

Annabel is a middle-aged, Caucasian, married executive living in Europe who started therapy with me to treat symptoms of post-traumatic stress arising from sexual abuse as a child. We have since worked on other issues in her life and are preparing to terminate therapy.

She started her recent session slightly agitated and anxious. She explained she had been somewhat distressed this week for two reasons. Her aged mother recently fell and was unable to get up. After waiting 2 ½ hours, the ambulance arrived but refused to take her to hospital. They explained that her overall frailty meant that being in the local, rural hospital could be counterproductive as she may catch Covid and die. 

The second reason for her distress was a significant shoulder pain on her right side that had no obvious cause. She demonstrated limited ability to turn her head to the right and limited range of motion of her right shoulder. She explained that she also had some peculiar sensations going down her right arm. We discussed the benefit of having her shoulder assessed by a medical professional. She decided she would see the local osteopath. 

Aware that my client has at times had physical reactions to psychological trauma, I wondered if her shoulder pain might have some psychological origin. During our session I combined both clinical hypnosis and somatic experiencing to gather insight about the condition and to help treat it. Hypnosis may help some clients see the underlying cause of a problem; Annabel, however, is particularly adept at using it.  

In trance, she told me the heaviness and pain in her shoulder where to block another, more terrible pain. She explained that deeper pain was related to her need to acknowledge that her mother would soon die and it would be before ever finding her, my client, good enough. Annabel experienced more childhood sexual trauma than perhaps any client in my career. Her mother was directly and indirectly responsible for emotional, physical, and sexual abuse of Annabel since the age of four and probably before. Despite that, she continues to crave her mother’s love and to try to make her happy. While in trance, she said, “My mother was not a happy person. I kept trying. I feel despair and desolate. My heart hurts.”

In order to help integrate the psychological pain that she experienced, I asked her to describe it in detail. She said there was a sense of sadness and defeat. She felt like she was 11 years old and desperately alone. After spending some time asking her to integrate that pain by feeling it, we switched focus to move away from the pain so that we didn't re-traumatize her. I asked her what the 11-year-old girl needed. She explained she would like someone to be there for her, a warm drink, and to be able to have clean sheets in her bed. I asked my client if it would be OK to imagine her adult self providing that care. She nodded and created a reverie of helping to tend to the 11-year-old girl. 

She felt exhausted after this exercise. She also described feeling more calm and demonstrated more ease and range of motion at moving her shoulder and her neck. (Exhaustion and flu-like symptoms aren’t uncommon after this sort of work. It tends to wear off after a good sleep.) 

After her trance, she had very limited recollection of the work we had done. I went over it with her only enough to make sure that the ending of the exercise didn’t leave the 11-year-old girl – a fragment of her personality – did not feel abandoned. I did not encourage any further memory retrieval. If her mind wanted to block out what we had done in those exercises, then it was probably best to leave those experiences from memory. 

In our sessions a week and two weeks later she described feeling much better. Her sleep had been unusually good, her anxiety was down, and her shoulder pain had gone. On a scale of 1 to ten, it had been at a 7 and was now at a 1. She explained it was at the level of tights of her “normally tight shoulders.” She had not seen an osteopath to help her with the pain. Her feelings about her mother’s approaching demise are still a mixture of fear, guilt, and relief. But the intensity is much less than it was when she had shoulder pain.

I’m not in a position to evaluate if there was an organic cause to her shoulder problem. And I don’t know if the apparent change was real or if she was trying to demonstrate improvement in order to please me. But my strong sense is that there was a psychological component to her shoulder pain and that it was connected to her having to confront that her mother may not live much longer. While I presume treatment of the tissue alone would have been somewhat helpful, a psychological treatment was important for a more complete resolution to her problem.  

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“Annabel” is a pseudonym. The real Annabel has given permission for the publication this article.