Evidence is the perfect comeback


Tell us about a time when you felt marginalized or stigmatized by someone because of your health condition. Maybe at the time you didn’t speak up, or maybe you did – what did you say or what would you have said to take back control and let them know they were out of line?


It was the fall of 2009. and just weeks from graduation.

It was a course in Cognitive Behavioral Therapy led by a professor I had admired as an undergraduate many years before. I looked forward to learning from him once again. Yet the years had changed us both. Mine was shaped by one war and his by another. Many of the things he taught seemed at odds with what I thought I remembered from many years before. Yet I learned my neuroscience lessons well. Memories are not recordings of exact events. They are forged in the fire of our emotions. I was remembering what I needed to remember.

His lessons challenge me in ways that made me uncomfortable, forcing me to face my own prejudices, faulty thinking, and irrational beliefs. It was a healthy process for a soon-to-be therapist. I was beginning to develop a new appreciation and understanding of this man.

Then he just had to bring up pain management.

Image courtesy of Stuart Miles at FreeDigitalImages.com
Image courtesy of Stuart Miles at FreeDigitalImages.com

Two years earlier I discovered the work of Teri Robert. My clinical understanding of Migraine Disease far surpassed that of my professor and I knew it.  His “therapeutic” answer was based on outdated theories, such as a “migraine personality”. His treatment solution was a tiny thermometer stapled to card. He offered one to each of us and encouraged us to place our thumbs on the thermometer for a few minutes to obtain a reading. Once registered, we were then instructed to focus our attention on changing that temperature. He called this “biofeedback.”

I suppose it was a rather crude form, though not nearly as scientific as my own first experience with biofeedback in 1995. Surely the treatment hadn’t taken such backward turn in 15 years! After several minutes he instructed us to teach this technique to future clients. If successful, their “headaches” would “be greatly reduced, if not eliminated.”

The woman I am today would have torn his theories to pieces.

I froze. I felt small and exposed. I could have walked out or challenged him. I knew there was solid evidence contradicting everything he was teaching. Unfortunately, it was not within my grasp at the moment. He was the professor and had made his point. I saw no reason to press the matter with him in the future…except that I felt humiliated in front of the 20 people who has been my closest companions for the past two years. These were the professionals with whom I would be trading referrals for years to come. It was essential that we respect one another.

They all knew about my lifelong, hard-fought battle with Migraine and Cluster Headache. They had been witness to it, firsthand. All of the professors knew it, too. He had known about it for 15 years. We’d had many conversations about it. That was what made his lecture feel like a personal betrayal. I felt as if I were being singled out as his object lesson.

I may have stayed silent that night, but I have not stayed silent since.

I’m an ardent supporter of using Cognitive Behavior Therapy as one of many tools in the treatment of chronic pain, particularly for headache disorders. Even biofeedback can be beneficial for some patients when administered by properly trained professionals — not newly graduated therapists who hadn’t even passed their licensing boards. As a practicing therapist, I employed CBT strategies with nearly every client, especially ones that disclosed chronic pain disorders. I also spoke from a place of empathy that can only happen because I have similar experiences.

I offered clients everything I needed from my professor that night:

  • Validation that the pain is real
  • Assurance that they did nothing to deserve it
  • Acknowledgment that chronic pain is complex
  • Explanation that there are no easy answers
  • A promise to be with them every step of the way.

One thought on “Evidence is the perfect comeback

  1. Well said, Tammy. I’ve often run into practitioners who have tended to blame the patient if the practitioner’s treatment didn’t help. I know many chronically ill people manage to work or got to school full time and probably the social interaction and distractions of work are therapeutic for them. But that approach didn’t work for my son. His chronic headache disorder made it extremely difficult for him to concentrate in school, particularly when the material was too easy for him or not interesting. His pain level is still gradually increasing, but he’s happier home-schooled than when he was fighting to get through a day at school when the pain wasn’t as bad as it is now. He’s tried all the usual recommended things for chronic headache, including biofeedback, and none of it helps. He’s learned to accept that he’s stuck with this for now and manages to find ways to distract himself from the pain and we continue to search for something that will reduce to pain and trouble concentrating.

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