An ethical issue in the psychotherapy of pain and other symptoms

Pain presents an ethical problem in psychotherapy which it shares with other symptoms. It presents this problem because initially it does not give rise to the same expectations as overt psychological complaints such as depression or anxiety. At first glance pain appears to represent an obvious example of the traditional doctor/patient relationship...I hope to demonstrate that what began as a transaction in the medicine of organic disease, may become, before the patient recognizes it, a process of personal change of which the consequences may often not be foreseen. Such a development poses a problem in bioethics. If the development can be foreseen, the problem may be forestalled. If not, the proceedings may reflect paternalism and we need to consider if that is acceptable. The problem is not unique to pain but tends to be masked by the initial context of somatic treatment.