In CBT and practically all schools of therapy, the guiding principle is to reduce suffering. And who can argue against trying to wipe out depression that is so excruciating in its level of pain that you think of anything you might do to stop it; OCD that takes up the better part of your days and sets you up to run in some circle of hell; panic symptomatology that stuns your psyche and your body, and constricts your attention so that you become a heavily armed sentry to every little sensation in your body.
But what about pain that is not so crippling? Sadness over a breakup. Anger when a spouse or friend glazes over at the moment you are trying to express something delicate. Shame when you remember the harsh tone you took with the waiter who made a mistake with your order.
Even though the level of pain in these situations may be less intense, isn’t the therapeutic mission the same? That is, note the painful feeling and then move quickly to identify the (presumably) distorted thinking that produces the misery, as well as the behavior patterns that reinforce the pain, and move to counteract these unfortunate thinking and behavior patterns. This was the implicit stance in the earliest iterations of CBT and no doubt continues to be with many practitioners and some self-help authors.
But the zeitgeist is changing. There are many states of pain. All of them deserve to be listened to and understood. And it turns out many of them need to be validated, explored, mined for their potential for growth, and followed because they are telling us something important, sometimes ennobling, and almost always adaptive.
It is important to make good decisions about pain that deserves to be eradicated vs. pain that deserves to be honored, and, quite often, followed. Important in therapy. Important in life.
But not easy. Or simple. How to decide when to go deeper into pain, elaborate on it, and find the adaptive information vs. when to counteract pain that is unhealthy, unproductive and, often, cruel?
A few guidelines that can help the therapist and/or client determine if a particular painful thought or feeling deserves to be challenged because it is maladaptive; or whether a particular painful thought or feeling deserves to be explored because it contains meaning that might enhance adaptation.
Individuals who meet diagnostic criteria for an Axis I disorder in DSM-5 deserve the best change efforts they can receive. This is the no-brainer category of pain referred to at the beginning of this blog post. The harsh and rigid self-criticism of someone suffering from clinical depression; the outburst of rage associated with PTSD; the wracking guilt and uncertainty that accompanies OCD: none of these afflictions holds the potential for growth or useful self-understanding.
Of course, mental health professionals are trained to diagnose these disorders and
pinpoint the symptoms that will be targeted in treatment. If you are not a mental
health professional you can — as a first step — take the self-assessment tests
available on this website or google the disorder you suspect you might have.
Understand the adaptive function of different painful feelings and ask if they might fit what you or your client is going through. For example, sadness that is healthy tells us something important about ourselves, most often a loss. Losing someone that you cared for or had hopes about underscores the value and meaning of that relationship. Also one can also feel legitimately sad about not succeeding in a task, not being understood, being alone or not meeting some ideal. This type of sadness is free of blame and focused on a particular person or issue.
Adaptive sadness slows us down, so we can fully absorb and understand the loss or
failure that triggered it. If we don’t avoid it, sadness can be a time of growth where
we learn what is truly important to develop resilience in the face of inevitable loss and
It can be difficult to be with a child, loved one or client who is sad. However, it is important not to rush them through it or simply counteract it. Sadness, when intense, is often expressed in tears. This conveys distress and the need for support and caring from others. Support that is most helpful involves being with the person as they live through the sadness, rather than encouraging avoidance of it.
Andrew Solomon, a student of adversity, in his beautiful book, Far From the Tree, notes the desirability, indeed the necessity of facing disappointment, even trauma in forging meaning and building identity. As we construct the narrative of our life, from the inside out, the story of who we deeply are rests not on the delights of our life, but the misfortunes. Sadness needs to be allowed, understood and struggled with. To become a hero, one needs to slay dragons.
The adaptive potential of the painful states of fear/anxiety, anger, and shame are listed below. Future posts will provide a more comprehensive discussion of the healthy vs. unhealthy expressions of each of these states.
Fear. Fear informs us of something threatening. It is instrumental to survival. It organizes us to flee or fight. Fear helps maintain connections and seek appropriate solutions. It helps avoid rash risk-taking. Fear is often a rapid response to a specific situation. It abates quickly once the anger has passed However, even when fear is about personal insecurity or vulnerability, it can have an adaptive purpose. Acknowledging insecurities and vulnerabilities, rather than disavowing them, enables people to be self-aware and work to build real strength rather than a facade of it.
Anger. Everyone understands anger can be destructive. But it is a built-in emotion that has adaptive value. It is often triggered by an offense against ourselves and loved ones. It helps provide energy and focus to protect boundaries and prevent
Shame. Shame is typically only thought of as a destructive emotion. It often does
involve a diminishment of self and a sense of hiding that compromises connection
with others. However, shame can be adaptive when it is felt in response to societal
standards that one feels are reasonable; or in response to violation of one’s own
implicit standards or values. Shame in response to triggers such as drinking too
much or being unkind to others provides valuable feedback that can guide one’s
behavior in the future.
Possible Markers to Help Determine if a Painful Feeling is Adaptive or Maladaptive
More Likely to be Adaptive
- The trigger is clearcut: seems logically related to the feeling evoked
- Feeling has fresh quality
- Feeling is fluid — shifts in relation to differing circumstances
- Sense of openness, vulnerability
- If try to verbalize emotion, voice quality is searching, gentle
- Usually involves current, thwarted need
More Likely to be Maladaptive
- Trigger is not clearcut. Painful feeling often related to past events or relationship with self
- Feeling has stale quality
- Feeling lingers, has a stuck quality
- Sense of knotted up, defensive
- If try to verbalize emotion, voice quality is monotone, critical or strident
- Usually involves past wound or trauma