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Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia
Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia

Section 14
Track #14 - Overcoming Stubborn Independence with an Emotional Essay

CEU Question 14 | CEU Answer Booklet | Table of Contents
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On the last track, we discussed three techniques for helping clients lessen their chronic pain in day-to-day life.  These three techniques to help lessen daily, chronic pain include:  Brain Talk; Focus Anger; and Name Your Symptoms.

On this track, we will examine three long-term coping techniques.  These three long-term coping techniques include:  Self-Motivators; Emotional Essay; and Assert Yourself.

3 Long-Term Coping Techniques

Share on Facebook Technique #1 - Self-Motivators
The first long-term coping technique is Self-Motivators. These Self-Motivators act on a much deeper level than just replacing automatic thoughts.  Because many clients lose their sense of self within their pain, I have found that by reasserting themselves, they can begin to regain their sense of identity.  To start off, I give my clients a list of Self-Motivators and ask them to pick out, if any, those that they relate to. 

The list included but was not excluded to the following phrases:
I tell myself that there are others who are much worse off than me.
I tell myself to carry on despite the pain.
I try and imagine that for some reason it is important for me to endure the pain.
I concentrate on convincing myself that I will deal with the pain and that it will get better in the near future.

I then asked my clients to write out their Self-Motivators on an index card and place the index card somewhere the client will see it frequently. 

David, age 32, experienced acute pain resulting from his leukemia.  I asked him if he related to any of the Self-Motivators.  David stated, "I chose to tell myself to carry on despite the pain.  I really liked that one.  It seems like when the pain gets bad, my negative thoughts try to get me to give up and give in to it.  I tell myself that I can't keep going if I'm in pain.  With this, I can at least continue on with my life as is."  David placed his self-statement card over the kitchen sink so that he could see it every time he did the dishes. 

Think of your David. Would Self-Motivators help to reverse negative distortions about the self?

Share on Facebook Technique #2 - Emotional Essay
The second long-term coping technique is Emotional Essay.  Emotional Essay involves having clients write about their deepest thoughts and feelings regarding trauma, loss, or illness.  I find this exercise particularly useful with clients who have trouble being vulnerable in front of their loved ones.  Clients who are stubbornly independent often find themselves confused and alone.  By writing out his or her feelings and emotions, he or she can make better sense of these factors rather than denying their existence. 

Helen, age 38, was one of these independent clients.  She stated, "My husband says I have a wall around me, and I won't let him in.  There are times when I am in the bed with the pain and it's so bad off that I lock him out of the room."  I asked her why she did that, and she stated, "I'm sparing him the hassle of taking care of me."  I asked Helen to write out a long expressive essay and to share with herself all the feelings and thoughts that she could not share with her friends and loved ones. 

I explained to Helen that it is not necessary share the specifics of what she wrote.  I find the exercise becomes much more effective if the client knows that his or her privacy is completely protected. 

The next week, Helen returned, wanting to share a bit of what she wrote.  She had written, "I always say that I don't want Jim [her husband] to feel burdened by me, but now I'm starting to think that I push him away because I'm terrified he might be disgusted by me and leave me.  I have this memory of my mother getting sick and really needing my father to help her with even the basic things.  One day when she was crying for help in the bedroom, he literally pushed her away and walked out the door.  I don't want to be vulnerable in front of Jim, because I don't want to be rejected." 

Helen's core beliefs had limited her ability to be vulnerable, a characteristic that is difficult to fight against, even with a strong, independent personality. 

Think of your Helen. Is he or she keeping some emotions hidden because of an established need to be independent?

Share on Facebook Technique #3 - Assert Yourself
In addition to Self-Motivators and Emotional Essay, the third long-term coping technique is Assert Yourself.   Clients with chronic pain--especially those clients who engage in a great deal of catastrophic thinking--may have a high need for emotional support, but lack sufficient communication skills to express themselves in an assertive manner.  

Clients dealing with chronic pain need to be able to ask for what they want and need in a straightforward, nonapologetic, and honest manner.  However, many chronic pain clients are reluctant to do so, feeling that they are placing too much of their burden on others.  To increase my clients' assertiveness skills, I set up an "Assertive Conversation."  This exercise works well in a group therapy session, but in single therapy sessions, I have found it effective to fill in the role the group would have played. 

Jerry, age 45, suffered from fibromyalgia and found it difficult to ask her family for help around the house.  She stated, "I hate to make them do the work, I don't want to be a burden to anyone."  I asked Jerry to try an Assertive Conversation and picturing me as one of her family members.  I told her to state her needs and to also give explanations while at the same time not giving an apology

Jerry stated, "I've been having a lot of pain recently and much of it has to do with the housework I've had to do.  Do you think you could help out more around the house?"  I stopped and corrected Jerry, telling her that phrasing her request in the form of a question was another form of submissiveness.  She restated, "I need you guys to do more work around the house."  I also asked her to give out specific tasks to each family member, so there would be less bickering later on. 

Think of your Jerry.  Would a crash-test lesson in assertiveness help ease their pain?

On this track, we discussed three long-term coping techniques.  These three long-term coping techniques include:  Self-Motivators; Emotional Essay; and Assert Yourself.

Online Continuing Education QUESTION 14
What are three coping techniques? To select and enter your answer go to CEU Answer Booklet.

 
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Pain Management: Cognitive Therapy for Chronic Pain and Fibromyalgia

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