In the first session with a client, I emphasize that there’s no right or wrong way to feel.  Your feelings are what they are, and nobody can tell you that you shouldn’t feel that way.

But that’s sometimes easier said than done, especially when working with families influenced by Chronic Pain.  Much of the work with those families involves helping them resolve confusion about whether the Pain is actually real.  (The people suffering Chronic Pain aren’t normally confused about it; they’re feeling real Pain, even if others in the family doubt it.)

Friends and family try to be supportive, but often they get frustrated and say things like, “Suck it up already!” (By the way, that’s not normally helpful.)  But don’t judge these frustrated friends and families too harshly. More often than not, doubters simply can’t process what Pain actually means for their loved ones.  Is there an illness that’s being missed?  Is the person “faking it” to get out of doing something?  Is Pain psychosomatic?  (For the record, psychosomatic Pain is still real Pain.)

Denying the existence of Pain is, in an odd way, a coping skill.  The doubter doesn’t know how to help their loved one reduce Pain’s influence, so it’s just easier to deny Pain altogether than to admit that you can’t help someone that you love.

Here’s an example. Let’s say a teenage girl (let’s call her Jane) comes to see me because she’s trying to cope with Sadness related to Chronic Pain.  Sadness combines with Pain to make Jane miss a lot of school.  As a clinical social worker, I believe family sessions are important because everything that happens to one person also affects the rest of the family, so the family is involved in sessions, too.  Eventually, the dad (let’s call him Dad) says in session, “This is silly.  There’s nothing wrong with her.  Jane just needs to suck it up and go to school.”

Again, that sounds pretty harsh, but this attitude is common in families influenced by Chronic Pain.  Someone in the family – not always Dad, but often – feels overwhelmed about how to help Jane.  This happens a lot with dads because Chronic Pain thumbs its nose at Dad’s traditional job, which is to protect his family.  If there’s a problem, Dad think it’s his job to fix it; if he can’t, he thinks that makes him a “poor protector” and “a poor excuse for a man.”  But there’s no way for Dad to protect Jane from Pain.  He can’t control it, can’t threaten it, or even take it outside for a “chat.”  Dad can’t see Pain, can’t tell where it’s coming from, can’t smell it, and can’t even appreciate the experience of it.  Only Jane knows how it feels.

If Dad accepts that he can’t make things better for Jane, he also has to accept that he doesn’t meet his definition of what a father is supposed to be.  So he goes the other way, denying that Pain exists at all.  If Pain doesn’t exist, then Jane doesn’t need protecting, and Dad can focus on making Jane get off her “lazy butt” and go to school like the other kids.

That makes perfect sense.  Dad’s not a bad guy; he’s just overwhelmed.  His denial is actually his coping skill – not a healthy one, but a coping skill nonetheless.

This escalates problems in the family, of course.  Someone else (often Mom, but not always) defends Jane and the existence of Pain.  Jane’s brothers and sisters often get involved, taking sides with either Mom or Dad, and Jane is left in the middle of it all, feeling more and more rotten with each conflict.

Chronic Pain, meanwhile, is a bullying dictator.  It likes being in charge of the entire family.  Jane wants to ignore Pain just as much (or more) as her family wants her to ignore it, but Pain insists on being noticed.  It hammers Jane repeatedly until she’s ready to give in.

Chronic Pain craves family turmoil because the chaos helps it become even more entrenched in the family system.  The constant conflicts increase Stress on everyone, especially Jane, and Pain feeds off that Stress.  Picture Chronic Pain as the man-eating flower in Little Shop of Horrors, and Stress as the human flesh that it needs to eat.

Thankfully, family therapy can help Jane and her family.  It won’t make Pain go away (although we can work on relaxation techniques that might take the edge off Pain while reducing Stress on Jane and her family).  But the role of family therapy is to help families make positive, lasting changes that reduce Pain’s influence on their thoughts and behaviors, and I’ve seen many families take control back from Chronic Pain.

Pain hates that, by the way.  Too bad for it.

(Carl Grody, LISW-S, works with families at Grody Family Counseling in Worthington, Ohio.  He’s a trained group leader in the Incredible Years parenting program, and he’s worked extensively with clients suffering from Chronic Pain.  He’s also the Family Therapy columnist for Columbus Parent magazine.  For an appointment with Carl, call 614-477-5565.)

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