Clinical
The client has seen the physiotherapist. Completed the exercises. Done the scans. Tried the medications, maybe two or three rounds. Then a course of CBT for pain, where they learned about catastrophizing and pain acceptance and behavioral activation. Perhaps EMDR. Perhaps somatic experiencing. Each practitioner competent. Each treatment well-executed. The pain didn’t move.
This is a specific clinical presentation, and it tells you something specific.
When a single treatment fails, the treatment may have been wrong for the problem. When multiple competent treatments fail across different modalities, every treatment addressed the same level of the problem. And the maintaining mechanism operates on a different level.
Physiotherapy addresses the body’s mechanics. Medication addresses neurochemistry. CBT addresses cognition. Somatic therapy addresses the body’s stored activation. Each framework is correct about the part of pain it targets. The client’s pain persists because none of them targeted what keeps it in place.
The clinical question shifts. Instead of “which technique haven’t we tried,” the question becomes: what function does this pain serve in this person’s life?
Function is a specific, technical concept in strategic therapy. A symptom’s function is the role it plays within the relational system surrounding the person. The function is not conscious and the client is not faking. The pain is real. And the pain does something.
It might keep a marriage organized around caretaking, giving both partners defined roles. It might prevent a return to work that the client dreads for reasons they haven’t named. It might maintain proximity to a parent who would otherwise have no reason to stay involved. It might protect the client from expectations they can’t meet, giving them a way to say no that everyone accepts.
None of these functions are pathological. They’re structural solutions to problems the client doesn’t have another way to solve.
Identifying the function requires a different kind of clinical attention. The practitioner asks when the pain started. What was happening in the client’s life at onset? What would change if the pain disappeared tomorrow? Who in the client’s life would be most affected? What does the client avoid because of the pain, and what would they face without it?
These questions often reveal a pattern. The pain tracks a relational or life-structural reality. It worsens when certain dynamics intensify. It eases when those dynamics are absent.
Once the function is visible, treatment becomes specific. A practitioner trained in PRT (Pain Resolution Therapy) designs interventions that address the function directly. If the pain keeps a marriage organized, the intervention reorganizes the marriage. If the pain protects the client from expectations, the intervention addresses the expectations. The work is directive, brief and targeted at the maintaining structure.
The pain resolves because its structural basis changes. The maintaining structure shifts, and the pain that depended on it loses its reason to persist.
For the practitioner with a treatment-resistant pain client: the resistance is in the assumption that more of the same type of intervention will eventually work. Four treatments that address the body, the brain chemistry, the cognition and the stored activation have all failed. The fifth option is to address the function. That is what PRT was designed to do.