Abundant Practice Podcast

Episode #739: Working with Chronic Pain

Featuring Sean Hershey

Host: Allison Puryear
Date: March 11, 2026

Episode Overview

In this episode, Alison Puryear is joined by therapist and former Abundance Practice Building student, Sean Hershey, to discuss working with chronic pain from an emotional and psychological perspective. Drawing from both personal experience and clinical practice, Sean introduces the “mind-body” model of pain, highlights how therapists can effectively support clients with chronic physical symptoms, and demystifies pain reprocessing therapy. Together, they explore why many clinicians feel unprepared to address physical complaints, the emotional underpinnings of chronic pain, and practical ways to begin helping clients (and themselves) reframe their experiences of pain.

Key Discussion Points & Insights

Sean’s Journey and Transition into Chronic Pain Work

• Origin story: Sean started his career working with LGBTQIA+ clients on relational issues but shifted to chronic pain due to his own battle with severe IBS and chronic hip pain.
• Personal healing: Emotional and psychological work led to significant improvements and even resolution of his symptoms.
• Clinical passion: Helping others heal similarly is now central to his practice, though it’s been a slower process to build professionally compared to his previous niche.
  • “It’s been very deeply gratifying from a personal and clinical standpoint because I relate so much to the work.” (05:44)

The Mind-Body Approach to Chronic Pain

• Challenging Conventional Assumptions:

  • Most therapists and medical professionals are not trained to address the mind-body connection in pain, creating a massive treatment gap.
    • “We feel very disempowered in working with clients with physical symptoms... it seems possibly unethical to even suggest that a therapist could work with somatic complaints. Not true.” (07:42)

• Key Influences:

  • Dr. John Sarno’s work (“Healing Back Pain”)
  • Pain Reprocessing Therapy (PRT), a newer, evidence-based approach

• Core Message:

  • Chronic pain is not always due to structural issues—many cases are linked to emotional and psychological factors.
  • Unlike CBT for pain (which focuses on managing persistent symptoms), mind-body approaches target reducing and even eliminating chronic symptoms.
    • “You do not have to have severe chronic pain. If you treat it psychologically and emotionally, the symptoms can come way down and even go away.” (12:26)

Recognizing Mind-Body Pain

• Classic conditions: Includes chronic back/neck/shoulder pain, disc-related pain, sciatica, neuropathy, migraines, IBS, pelvic pain, interstitial cystitis, fibromyalgia, chronic fatigue syndrome, and more.
• Paradigm shift: Many clients and clinicians focus on physical fixes (e.g., diet, exercises), yet the “emotional side” often gets neglected—even when physical remedies don’t fully work.
  • “Diving into the emotional side of life and really feeling it is so much harder and so much… I’m so much more willing to neglect that and not put it on my to-do list than some physical therapy exercise, or not having coffee.” - Allison (13:38)

The Three Pathways to Chronic Pain

Sean outlines the main contributors to mind-body chronic pain:

1. Emotional Pain

   • Repressing or being afraid to feel strong emotions creates inner “danger signals” that manifest as physical symptoms.
   • Many with chronic pain grew up where emotions were invalidated; over time, this becomes embodied as pain.
   • “There are some things you can’t fix for, and you meet—every therapist knows that. There’s a huge difference between fixing your emotions versus just feeling your emotions… most of us with chronic pain are the type who want to fix everything.” (19:30-20:22)

2. Psychological Pain (The Pain-Threat Cycle)

   • The fear and hypervigilance around physical symptoms drives further pain—similar to the “anxiety about anxiety” in panic disorder.
   • “When you feel pain and you’re threatened by the pain, and pain is a danger signal, so feeling threatened will make the pain worse… you just go down a downward spiral.” (22:40)
   • Breaking this cycle by reducing fear of the pain can gradually reduce symptoms.

3. Disconnection from the Authentic Self

   • Chronic pain often develops in people taught, consciously or unconsciously, that their true selves are not acceptable.
   • “If you are trained to dislike and try to repress whatever's inside you, that will be there all the time… but making friends with yourself and allowing yourself to be yourself will drastically help with chronic pain.” (24:40)
   • Cultivating self-acceptance, not just symptom relief, becomes essential.

Personality Traits Associated with Mind-Body Pain (per Dr. Sarno)

• Perfectionism, “goodism,” people-pleasing, high conscientiousness, stoicism, low self-esteem, self-criticism

• These traits are common in therapists and their clients.

• “If you or the clients who you have are experiencing chronic pain and have that kind of personality profile, there's a good chance that this is what they're either they or you are dealing with in their body or in your body.” (26:30)

Practical Guidance for Therapists

• Most clinicians feel out of their depth with somatic complaints; Sean encourages adopting an educational stance for both therapists and clients.
• Early steps:
  • Educate clients about the mind-body continuum.
  • Gently explore emotional patterns, self-criticism, and what their pain might “protect” them from feeling.
• Healing starts with curiosity—about sensations, emotions, and self-concept—rather than jumping straight to fixing or symptom management.

Notable Quotes & Memorable Moments

• On breaking the cycle of self-neglect in therapists:

  • “We’re very good caretakers and helping others, and oftentimes, we’re not on the list of people who deserve care... All of us deserve self-care and care by others.” — Sean (28:58)

• On denial being part of the syndrome:

  • “Denial of the syndrome is part of the syndrome, because if your emotions are repressed and if parts of yourself are repressed, you’re protecting yourself against that, you know, subconsciously.” — Sean quoting Dr. Sarno (28:16)

• Reframing hope for recovery:

  • “There really is hope for this. It can absolutely get better... I needed this information so long before I actually got it. It feels good to be able to share this with people.” — Sean (27:00)

• Humor and recognition:

  • Allison attempts not to massage her shoulder while talking about these topics, highlighting how relatable the pain discussion is for therapists themselves. (27:46)

Important Timestamps

• 03:16 — Sean reflects on switching his niche from LGBTQIA+ work to chronic pain after personal healing.
• 06:09 — Allison recalls a gastroenterologist linking her stomach issues to unacknowledged emotions.
• 07:42 — Discussion on gaps in therapist and medical training regarding somatic complaints.
• 12:26 — Key distinction between symptom management vs. true healing in the mind-body paradigm.
• 16:04 — Sean introduces the three main pathways to chronic pain.
• 18:20 — In-depth breakdown of emotional, psychological, and self-concept-related pain contributors.
• 24:40 — Self-acceptance as the gateway to reducing chronic pain.
• 26:30 — Personality traits tied to chronic pain and hope for therapists and clients.
• 28:16 — The paradox of avoidance and the invitation to deeper emotional exploration.
• 30:00 — Sean shares about his own mind-body chronic pain podcast and offers resources.

Resources & Further Learning

• Sean Hershey’s Podcast:
  Mind Body Medicine for Chronic Pain (available on Apple, Spotify, etc.)
• Recommended Book:
  • Dr. John Sarno, Healing Back Pain
• Therapist Community & Trainings:
  • Abundance Party for clinicians seeking more in-depth training with Sean

Summary Tone

The conversation is open, compassionate, and gently challenging—inviting both therapists and their clients to move beyond the surface of symptom management and explore the deeper emotional and psychological roots of chronic pain. Sean’s blend of personal story and clinical insight, paired with Allison’s candidness and humor, makes for a hopeful and relatable episode that offers actionable entry points for both personal and professional growth.

Quick Takeaways

• Chronic pain often has emotional and psychological roots, not just structural ones.
• Therapists can and should address somatic complaints—education and empathy are key starting points.
• Healing chronic pain involves befriending emotions, breaking the pain-threat fear cycle, and embracing one’s authentic self.
• Therapists themselves frequently embody the perfectionist, self-critical traits linked to chronic pain.
• There’s abundant hope; transformation is possible, and more resources are available for those ready to dive deeper.
• “There really is hope for this. It can absolutely get better.” — Sean Hershey (27:00)