I’ve mentioned before that one of the main problems with helping people to develop new ways of managing their pain is internal rules – things that we all learned as kids probably! Things like ‘if a job is worth doing, it’s worth doing well’, ‘never leave a job unfinished’..
These are great general rules, but for people who are learning, for example, to work to a quota, or to use activity ‘chunking’, or even to use a relaxation strategy at set times during the day, they can prove to be a cruel rod for their back.
How do you know when someone is applying a rigid rule?
Using the same method as for identifying automatic thoughts, ask the person ‘what when through your mind when you started to take a short break?’
If they respond with something like ‘I just couldn’t’ or ‘It didn’t feel right’, or ‘I could never leave a job undone’ – you have an opportunity to help them soften their rule, or make an exception.
I may ask them why they couldn’t, or why didn’t it feel right – and uncover a rule then. Remember that rules are mainly beliefs that have the word ‘should’, or ‘never’, or ‘always’, or ‘must’ or similar – and there is usually a further thought about what it might be like if that rule is violated, and this is usually an attitude ‘it would be awful’, ‘I would be so ashamed’, ‘it would be horrible’, ‘I wouldn’t cope’.
The simplest way to soften this rule is to ask them to substitute that ‘rule’ word for a more gentle one, one that offers them a choice. This can be something like ‘could’, or ‘might’.
You can also ask the person whether they can make an exception to that rule – and when they might think an exception applies. I may use something like ‘what would you do if you had pneumonia or the flu and were laid up in bed?’. I then might ask them whether there are any other situations they might relax that rule. Some people then say that they know they can relax the rule, but ‘it doesn’t feel right’ – and this provides an opportunity to talk about emotional reasoning.
It’s worth also asking yourself – are there some rules you live by too? For example ‘I must make sure all patients feel good about what I do’, ‘I must never upset a patient’. Be aware that sometimes a crisis or a challenge exposes the contradiction the person faces between applying a rigid rule and still being able to carry out important things in their life. For example: having a wonderfully tidy home which interferes with being able to spend time with the children; being a very hard worker which interferes with being able to live a balanced life that promotes wellbeing.