How do you make your Dualshock controller more comfortable for XIV?

[DamianFatale]

Does your cramping have to do with the gymnastics of performing the class to its and your max? Or does it occur even if you do something more casual like killing mobs on the overworld while doing other stuff?
If it's the first, you could try to rearrange your hotbars or play a less action intensive class. Believe it or not some set ups are hellish to work with. Mine for example, people cringe at it, but I'm used to use "the claw" to perform actions with the D-pad while moving.
If it's the second, I'd go to the doctor and search for any accessories that could help you game safely. For real, your doctor is your best friend in this. You could be developing carpal tunnel syndrome and you would only hurt yourself further if you persist in gaming as hard as you are now.
My two cents.

It's the first. Though I did have hand therapy, I am nervous to rearrange my hotbar. Is it really more optimal to change it?

[Erys]

It's the first. Though I did have hand therapy, I am nervous to rearrange my hotbar. Is it really more optimal to change it?

Depends on how you rearrange it. My example, I have combo skills (actions you are going to be pressing a lot) on the dpad, which wouldn't allow to move and attack at the same time (dpad and movement being on the same hand) unless you assume weird hand positions.

Ideally in your case you'd want to deviate from putting any skills on dpad keys and just go full triangle/square/x/circle. That way your left hand will only have to focus on trigger and joystick, getting rid of the dpad. It's the only real concession you can make when rearranging stuff on a controller, getting rid of finger gymnastics as much as you can.

Another thing that helps is rearranging your combos in ways that don't force you to react. For example making a 3 steps combo R2+square triangle circle so it follows a semicircular pattern clockwise pattern so you don't "panic" searching for the next skill, deeply rooting it in your muscle memory, further reducing gymnastics and sudden movements that could strain your hands. And practicing, a few minutes of practice a day will help your muscles to build some resistance and memory, just don't overdo things.

Keyboard and mouse not an option? Much more relaxed and much easier to operate for this type of game.

This depends on the person, I have a hard time with keyboard and mouse since they lack a certain feedback that the controller gives me. And the position on hands and arms is really awkward, doesn't really hurt but yeah.
He could try but it's not for everybody.

[UnluckyXIII]

This depends on the person, I have a hard time with keyboard and mouse since they lack a certain feedback that the controller gives me. And the position on hands and arms is really awkward, doesn't really hurt but yeah.
He could try but it's not for everybody.

Very much so, and just because it works for some doesn't mean it works for others, personally I couldn't imagine playing something like an mmo with its huge amount of input options on a controller with its limitations but to some this is a non-issue. I can't agree on that the position is "really awkward" though, for me Keyboard and Mouse feel natural as input methods for a device and for a game with restricted chat options I see them as a must to get the most out of an mmo when playing via a console.

Screw that noise. I tried to play a new character with a mouse and keyboard, couldn't last more than 10 minutes before going back to Controller.

Its very much a personable opinion thing, I've gamed across both platforms for years (PC and Console) and both have their pro's and con's - If OP hasn't tried Keyboard/Mouse combo I would say its worth trying just to see if it works for them or not.

[Erys]

I can't agree on that the position is "really awkward" though, for me Keyboard and Mouse feel natural as input methods for a device and for a game with restricted chat options I see them as a must to get the most out of an mmo when playing via a console.

For controller your hands fall on your lap in the natural position you put your hands to rest palms up. For keyboard you have to at least raise your right hand to reach to the mouse and if you have your keyboard on your desk aswell, in a piano like position. Already the arms in a 45º-ish degree angle is awkward and unresting. Dunno.
You are right about chatting tho, it's a "nightmare" on controller, but I'm used to type lightning fast with it. Not like I chat too much anyways.

Also OP, how do you grab your controller? Like, do you grab it firmly? Do you arch your thumbs over the joysticks and buttons to press them with your fingertips? This could also be important to alleviate some stress and I just realized x'D