It hurts to hurt, but if we wait for the pain to go away, we’ll miss everything else.
My client starts our session by telling me, “I’m coming to therapy today feeling angry. I want to feel better and this isn’t making me feel better.”
It’s not any therapist’s favorite part of the job to receive this criticism, that therapy isn’t making the pain go away, but it’s not uncommon. We think therapy will heal our emotional wounds and take away the pain of psychological suffering.
Somehow, it doesn’t always happen the way we hope it will.
My client continues, “I come in here shoveling shit and I leave feeling like I’ve got a lot more shoveling to do.”
I’ve responded to these kinds of complaints in different ways over the years, but today, in this session, I’m distracted from my client’s emotional pain by my own physical pain.
Maybe I didn’t stretch this morning. Maybe I didn’t take any NSAIDs. Maybe it’s just a bad day.
I’ve got some shoveling to do myself.
In 2017, I developed an intense and mysterious pain in my sternum. I was active every day, biking to and from my graduate school classes, climbing at a rock gym several times a week, and swimming on the weekends.
Suddenly, with no warning and no clear cause, it hurt to lean into my handlebars and a vigorous breaststroke made me feel like my chest would split in half.
I went to a doctor. And then another. And then another.
Eventually, I was referred to a rheumatologist who diagnosed me with “seronegative arthritis,” meaning that I had all the symptoms of autoimmune arthritis but lacked the associated antibodies in my blood, considered markers of autoimmune inflammation.
Later, as the pain shifted from my sternum to my lower back, I was told I had psoriatic arthritis, which frequently involves inflammation of the sacroiliac joints and, occasionally, the sternomanubrial joint in the chest.
Since then, I seem to see a new cluster of healthcare providers for every new cluster of symptoms. Occasionally, a new doctor will offer a new diagnosis.
The bottom line is usually the same: I have a lot of pain and an uncertain prognosis.
The pain is bad enough, but, at first, I couldn’t live with the uncertainty. I would find myself sitting on the couch at the end of the day Googling each strange new sensation that showed up in my body. Then I would lie awake in bed and imagine the worst possible outcomes of every associated condition.
The doctors didn’t seem able to put my mind at ease. If the known-world of medicine were represented on one of those medieval nautical charts, rheumatology would be located in the part where the continent trails off into a dark and troubled sea, populated by monsters.
It turns out that we still don’t have a very good understanding of why the body attacks itself.
Yet to this day, I walk into every doctor’s office hoping for an answer that will make the pain go away.
Failing to find one, I’ve sought my own in all the usual and unusual places: yoga, meditation, elimination diets, arnica salve… I could exhaust my allotted word count for this piece by enumerating them.
In this way, I’m not so different from my client. I’m always seeking answers and I’m often disappointed. But I think we might both be asking the wrong questions.
It’s a cornerstone of my practice as a therapist that emotional suffering is not a pathology, but rather a normal part of life.
None of us can expect to live free from sadness, anxiety, or the experiences of loss and uncertainty that trigger them. The quantity and quality of these difficult emotions are unique to each of us, but having them is universal.
Physical pain is similar. We all get sick. We all age and weaken. We all have limitations.
None of us will escape this truth, but people living with chronic pain have had to confront it differently, more intensely, and sometimes sooner, than our more able-bodied peers.
Given that this is a reality, let’s try changing the question.
For those of us living with chronic pain, and for all of us who live with emotional pain, instead of asking, “How can I make this go away?” what if we try asking, “How can I learn to live — and even to thrive — with this reality?”
First, it’s important to acknowledge that some things do help. What those things are will be different for each of us. I like a hot bath and some morning yoga when I can fit it in.
Finding the things you can do to take care of yourself and lessen the impact of your symptoms can substantially lessen your suffering and return a small sense of control to your life.
However, while some things help, for many diagnoses, nothing fixes. This is where changing your mindset may help more than changing your treatment.
Here are some tips that have worked for me:
Think about what you can do, not what you can’t
Depression is often linked to sadness about the loss of something real or hoped for.
In the same way, chronic pain hurts all the more because we tend to linger on the ways it limits us.
It’s important to find joy in the things you can do to temper the understandable sadness about the things you struggle with.
Focus on now, not on the future
Your life is happening right now, not in some vague and uncertain future where your symptoms might worsen.
Find ways to enjoy and be present with what’s happening in this moment. This could be as simple as the meal you’re eating, the conversation you’re having, or the scene outside your window.
Mindfulness, yoga, meditation, and other contemplative practices can help you learn to focus your awareness on the present moment and discover what it has to offer.
Look for good sensations in your body, savor them, and expand them
Here is a simple somatic exercise for how to do this:
- Take a comfortable seat with your feet on the floor and your arms in your lap.
- Draw your attention to your body and begin to notice all the places where your body makes contact with another surface.
- Start by noticing your feet against the floor and move your awareness up your body. Notice your calves, your thighs, and your seat against the chair. Feel your back against the backrest.
- As you become aware of all these places, look for a sensation of support and comfort.
- Explore that sensation. Is it heavy or light? Warm, or cool? Is it constant or does it fluctuate?
- As your awareness of this feeling increases, balance it against whatever pain you’re feeling in your body.
- See if you can become aware of both feelings, the comfort and the discomfort, knowing that our bodies always contain both.
Regrettably, no therapy can completely eradicate your physical or emotional pain, but it can help you to manage it.
Mindfulness based therapy can help you to live more fully in the present moment.
Somatic experiencing, sensorimotor psychotherapy, Hakomi, and other forms of somatic therapies can help you change your relationship to the sensations in your body.
Psychodynamic talk therapy can help you see through the fears and fantasies you have about your pain and the stories you tell yourself about why it happens and what it means, so that you can develop a new and better narrative.
In another session, my client is beginning to steer his focus away from his own suffering. He wants to do more for other people, to help make the world a better place.
He tells me, “I think I’d be so much better at helping others if I could stop obsessing about my own problems.”
The wisdom in this struck me; it’s about how we manage our attention.
Our own pain, emotional and physical, is often the loudest and most demanding part of what we experience. However, other things are happening too, both in our bodies and in the world around us.
If we can accept it as a part of our lives, then it can be just that, only a part.
To be sure, it hurts to hurt. But if we wait for the pain to go away, we’ll miss everything else.
Michael Waldon, LMSW is a psychotherapist, writer, and clinical social worker based in New York and California. He is trained in relational, psychodynamic, and somatic psychotherapies. Michael provides individual therapy to clients based in New York and coaching services to clients all over the United States. You can learn more through his website or at Tapestry Psychotherapy, where he maintains a practice specializing in anti-oppressive and integrative approaches to the treatment of trauma.