How often do we spend most of our assessment time looking at people’s problems, deficits, functional difficulties? I know that much of my time in assessment involves looking across a range of domains and experiences – and whooops! by the time we come to an end I’ve hardly looked at what this person has continued doing despite their pain and distress. After reading this 2005 paper by Tedeshi and Kilmer I’m ready to re-orient myself and review the structure of my assessment interview to see how I can integrate the resources and strengths that a person brings into the situation.
There are three main areas that Tedeshci and Kilmer identify as useful to explore when looking at the positives of an individual:
Strengths – ‘the measurement of thos eemotional and behavioural skills, competencies and characteristics that create a sense of personal accomplishment; contribute to satisfying relationships with family members … enhance ones ability to deal with adversity and stress; and promote one’s personal, social and academic development’ (Epstien and Sharma (1998).
Resilience – ‘attributes or characteristics that might include positive temperament, self efficacy, positive self worth; problem solving skills; internal locus of control’ along with ‘a warm family environment, sound relationships’ and ‘good supports within the community, connections to school and work’ (Tedeschi and Kilmer, 2005). In other words, things that help people ‘bounce back’ under adversity.
Growth – this area refers to ‘positive changes in individuals that occur as the result of attempts to cope in the aftermath of traumatic life events…become transformed by their struggles with adversity’ (Tedeschi and Kilmer, 2005).
Something I have emphasised in my work with people living wih chronic pain is that everything they have ever done to cope with or manage their situation has both positive and not so positive aspects to it. We need to remember that people don’t deliberately set out to fail or have negative consequences. Typically the short-term consequences, if not helpful or positive, at least avoid the immediate negative emotional impact of a situation. It’s the longer-term consequences that often cause the problems! Something I can readily appreciate is how a person can choose a course of action believing that it is the ‘right’ path, such as resting or over-using medication or avoiding certain movements – it does stop pain! But of course, we know what happens over time…
So in looking at strengths, perhaps some of what we might view as a negative – for example, the ‘boom and bust’ pattern of activity – could in fact be a strength. The person who does this may well be very good at task persistence, sticking to a quite difficult activity until it’s done, perhaps even have very high standards and values, but simply be misapplying this to the activity, and failing to manage the long term consequences.
I’m sure we can all appreciate how recognising and affirming strengths might help develop rapport, increase the person’s sense of personal competence, and improve ‘motivation’. It may help move us from trying to ‘fix’ a problem to building a solution or enhancing a characteristic that already exists.
A couple of questions that might help us assess strengths (and I’ve modified these from Tedeschi and Kilmer):
- Let’s talk for a while about what you’ve managed to keep doing despite your pain.
- Tell me what you’re good at and what makes you proud
- How do you keep doing important things when your pain is bad?
Resilience can act as a protective factor when people are exposed to stress, it’s often described in terms of flexibility, and can reflect the interaction between the individual, the family and the community. Tedeschi and Kilmer suggest that ‘rather than viewing a goal of evaluation as assessing resilience per se, it may be more appropraitely framed as seeking to assess factors associated with positive adjustment, competence in core domains, and healthy outcomes under adversity.’ (Tedeschi and Kilmer, 2005).
In pain management, we’re most often looking at self efficacy for managing pain – something like Mike Nicholas’ Pain Self Efficacy Questionnaire can be helpful to establish ‘what can you still do despite your pain’. Some other questions based on those suggested in this paper are:
- How do you go about doing things when times are challenging?
- What do you do to figure out something by yourself?
- What do you do when you’re faced with a problem or stressful situation? How do you handle it?
- What is getting you through this tough situation?
These questions might highlight areas to draw upon when extending the person’s coping framework – do they have certain people or agencies that help? Do they have a core set of problem solving strategies that could be extended to deal with chronic pain? Do they already have skills they use in a helpful way?
Growth – it’s not often that we hear about how chronic pain can help a person grow and develop. I know I’ve heard about the positives from having depression, and I know I’ve experienced this myself, but I can’t say I’ve heard many people talk about the good things they have experienced or the way they have been transformed by their pain. However, if we take a good hard look at what can happen as a result of facing tough times, I think it’s clear there are some good things – like knowing you do have strength, like valuing time out and family, like recognising vulnerability and appreciating the ‘little things’ in life. Some people have told me that by stopping work they’ve lost their sense of self identity as a worker – but gained a sense of being a person within a community or family.
Tedeschi and Kilmer note that people who report positive growth after adversity ‘may not be able to leave all of their distress behind.’ They go on to say ‘many indicate that they are still suffering from the aftermath of trauma.’ There are, however, five domains of possible growth after trauma that can be assessed – improved relationships, new possibilities for one’s life, a greater appreciation for life, a greater sense of personal strength, and spiritual development. And yes, some of these are areas that people I’ve worked with have said they now appreciate more deeply – and don’t take for granted any more.
I hope this brief tour through areas of positive psychology might tantalise – perhaps we’ll stroll through the sunny side of the street this week. Let’s accentuate the positive today!
Tedeschi, R., & Kilmer, R. (2005). Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions. Professional Psychology: Research and Practice, 36 (3), 230-237 DOI: 10.1037/0735-7028.36.3.230