On the last track, we discussed three considerations regarding self-victimization. These consideration regarding self-victimization included: sense of betrayal; projections; and resentment.
On this track, we will examine three sources of guilt for clients with chronic pain. These three sources of guilt include: unmet obligations; burden guilt; and external influences.
3 Sources of Guilt
#1 Unmet Obligations
The first source of guilt we will discuss is unmet obligations. This source can include the inability to provide for family or to be self-supportive. Clients who experience guilt arising from unmet obligations have unrealistic expectations for their state of health. They have not completely come to grips with the limitations of their condition and as such they still believe they have to function as a healthy person would. When it becomes difficult or impossible for them to accomplish this, they begin to feel guilty for falling short of their expectations.
Maxine, age 40, had tried to continue her life as a single mom as usual. Even with her severe fibromyalgia, Maxine tried to maintain a full-time job and take an active part in her daughter’s life. She stated, "No one else is going to take care of my daughter for me. Whenever I can’t get an extra hour in at work, I know it’s going to hurt her more than me. What if I can’t buy her clothes or food? Social Services may take her away and give her to her dad, and he is so violent, I won’t see her raised in that kind of an environment."
Maxine had taken it upon herself to provide for her daughter financially and because she could not meet these financial expectations, she underwent feelings of maternal inadequacy. I stated to Maxine, "You can support your daughter in more ways than just financially. There are governmental programs designed to aid you in that respect. However, what you really need to concentrate on is supporting your daughter emotionally and mentally. Here, you need to shift your sense of responsibility from the economical to the more abstract and emotional."
Think of your Maxine. What unmet obligations are causing her guilt? How would you address these feelings of guilt?
#2 Burden Guilt
The second source of guilt is burden guilt. This type of guilt arises out of the client’s reluctance to share their needs and weaknesses with others. They do not want to become a drain on their family members and friends. In addition to this, clients experiencing burden guilt also suffer from an underlying fear that if they become a inconvenience to those they love, those loved ones may reject and pull away from the client.
Kylie, age 33, suffered from acute pain as a result of her spina bifida. Many times in her life, she has been rejected by men and friends because of her debilitating condition. Because of this, Kylie has found it near impossible to ask her new boyfriends for help. She stated, "I don’t want him to have to change his life for mine. That’s not fair to him and besides, every time I open up and ask for help, everyone runs away. They just can’t be bothered, and I can’t blame them."
Coupled with her passed experiences, Kylie had begun to develop the belief that her condition was such that her needs were far beyond the call of any normal person’s patience. I stated, "Your needs are not overburdensome, but rather reasonable and valid. Those that rejected you purely because they could not handle putting extra time into the relationship are not the type of people that could support you in the way you need."
Think of your Kylie. Does he or she suffer from burden guilt?
Technique: Needs List
For clients like Kylie who suffer from burden guilt, I suggest that they write up a "Needs List." I ask that they make three columns which are headed as: "casual acquaintances," "intimate acquaintances," and "self-served." In the column "casual acquaintances," I asked Kylie to list needs that she may be able to share with those she only knows casually. In this column, she listed, "asking for assistance carrying and transferring objects."
In the column, "intimate acquaintances, I asked Kylie to list needs she felt were appropriate to ask of friends and family members she was intimate with. In this column, she listed, "help getting up from sitting or reclining position," "support standing," and "help putting on back brace." In the column "self-served", I asked Kylie to list needs that she could fulfill for herself. These included, "going to the bathroom," "emptying catheter," and "minor household chores."
After reviewing the list, I asked Kylie if any of these seem unreasonable to her. She stated, "Not really. If someone really liked me, I don’t think this would be too much to ask for."
Think of your Kylie. Would a "Needs List" help to alleviate his or her sense of burden guilt?
#3 External Influences
In addition to unmet obligations and burden guilt, the third source of guilt is external influences. Clients who suffer from chronic pain are often met with confusion, misunderstanding, and misrepresentation of the client’s condition. I have found, especially in clients with fibromyalgia, that loved ones and friends do not always comprehend the severity of the client’s condition, most especially if no dermatological disorders persist. Because they cannot see the symptoms, some clients’ family members do not believe in the efficacy of the disease.
Bethany, age 26, developed fibromyalgia after a severe car accident triggered the condition. Because the fibromyalgia came as a result of the car accident, many of her family members believed that she was just having what they labeled "phantom pains." In short, they believed Bethany’s condition was purely mental and not physical. Because of this, her family consistently denied the validity of her complaints.
Without the support of her family coupled with the guilt she felt asking for help, Bethany’s condition worsened as she tried to handle the disease on her own. She stated, "I can’t ask them for anything. They make it seem as though I am doing this to get something from them. I can’t stop it just by turning off my brain!" I asked Bethany to have the doctor who diagnosed her to speak to her disbelieving family members. I also suggested that she give them informational packets and try to familiarize them with this confusing and often misunderstood syndrome.
Think of your Bethany. Are his or her family members confused or misrepresenting the client’s condition?
On this track, we discussed three sources of guilt for clients with chronic pain. These three sources of guilt included: unmet obligations; burden guilt; and external influences.
On the next track, we will examine three concepts related to depression and fibro fog. These three concepts related to depression and fibro fog include: depression: fact vs. fiction; fibro fog; and dispelling the fibro fog myth.
Peer-Reviewed Journal Article References:
Finlay, L. D. (2015). Evidence-based trauma treatment: Problems with a cognitive reappraisal of guilt. Journal of Theoretical and Philosophical Psychology, 35(4), 220–229.
Serbic, D., Pincus, T., Fife-Schaw, C., & Dawson, H. (2016). Diagnostic uncertainty, guilt, mood, and disability in back pain. Health Psychology, 35(1), 50–59.
Wiltermuth, S. S., & Cohen, T. R. (2014). “I’d only let you down”: Guilt proneness and the avoidance of harmful interdependence. Journal of Personality and Social Psychology, 107(5), 925–942.
Online Continuing Education QUESTION 10
What are three sources of guilt for clients with chronic pain?
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