After musing about the previous two posts on coping and motivation (this is the second one), today I want to complete the set and think about how we as treatment providers might view the range of coping skills a person uses.
Van Damme, Crombez & Eccleston (2008) point out that ‘behaviour will emerge to be adaptive or maladaptive depending upon the match between a person’s appraisal of their abilities and their real abilities, the accuracy of their appraisal of the threat, and their ability to switch to a different coping approach if their chosen strategy fails.’ They use the Brandtstadter and Rothermund model of goal-directed coping – assimilative in which people try to work out how to achieve the goal despite barriers, and accommodative in which people adjust their expectations about their goals in order to reduce the internal tension they experience from striving for the unattainable.
What this means for us as therapists is that we will find people using a range of different coping strategies depending on whether the person is trying to achieve old goals in a different way, or new goals because the old goals are thought to be unachievable. It’s our job to help the person appraise whether the old goals are still valid (eg that returning to work is possible, but in a different way) or whether new goals need to be developed (eg returning to work but perhaps not working at 110% all the time).
The fact is that neither assimilative nor accommodative coping strategies are wrong – different coping approaches work for different goals and at different times in the process of coping with chronic pain. It’s much more about whether the approaches (and sometimes the goals) fit with the person’s values and beliefs and whether they are accurate in their appraisal of how close they are to achieving the goal.
Let me unpack that for a moment: if a person’s value is ‘to live without pain’, and their approach to achieving this is assimilative, we could expect the person to pursue treatments that they hope will reduce or remove their pain. This is probably not achievable with our current knowledge of chronic pain – some people will continue to have pain.
At some point it’s important to let the person know that their goal is unattainable, and at that point it’s likely they will need to move from assimilative coping to accommodative coping. This might mean helping the person identify what they want to be able to do in life and then helping them disengage, mourn the loss and start to renegotiate what else is important apart from being pain-free.
Others may prematurely disengage from trying to achieve goals because of inaccurate appraisal that there is ‘only one way to do it’ (110%!) and because of the mismatch between their current abilities and their expectations from themselves. It’s these people I think that have a lot of trouble returning to work because of their belief that ’employers only want people who work 110%’ and their own belief that because they no longer work that way, they are unemployable. Therapeutic work is then to help the person realistically appraise their abilities and the demands from employers in order to identify whether it’s possible to use assimilative coping strategies (ie doing things differently) or whether they need to consider new goals (accommodative coping).
It seems to me that part of our work as therapists is to help people develop flexibility. Flexibility to recognise that it’s OK to do things differently, that unpleasant emotions and thoughts and experiences do occur (but they also fade), and most importantly, that at different times in different contexts, people can and do use a range of different coping strategies – there is no one way to get somewhere in life!
I don’t think we have spent much time studying people who cope in healthy ways with adversity, particularly chronic health problems. And given that there are so many more people who do have chronic pain than those who actually ask for help, it seems timely to find out how on earth these healthy people live fulfilling lives.
We know so much about such a skewed sample, and perhaps we’ve tried in vain to classify coping strategies into ‘good’ and ‘not so good’ without really considering the context those strategies are being used in. After all, we are hardly going to shout ‘Just hold it there, I need to do my pacing break now’ during a fire!! What is most important in life is the ability to live a rich and fulfilling life despite life’s ups and downs. Spending some time finding out what is valued in someone’s life, and how they can achieve it despite troubles and woes needs to be our goal. Does that sound awfully like occupational therapy to you?
I hope you’ve enjoyed these posts on coping and context. I’ve enjoyed writing them! If you’d like to read more, you can click on the RSS feed above and you can get the headlines right there on your browser. Or you can bookmark this page and come on back! Or, for occupational therapists, there is a new OT Blog aggregator OTBlogs that provides the headlines from a whole bunch of occupational therapy-related sites. Enjoy!
S DAMME, G CROMBEZ, C ECCLESTON (2008). Coping with pain: A motivational perspective Pain DOI: 10.1016/j.pain.2008.07.022