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Section 2
Self-Presentation Effects of Chronic Pain

Question 2 | Test | Table of Contents

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In the last section, we discussed three characteristics of stress related to pain.  These three characteristics of stress related to pain included:  spontaneous stress and chronic stress; stress as an automatic thought trigger; and physical manifestations of stress.

In this section, we will examine three concepts related to redefining self-worth in chronic pain clients.  These three concepts related to redefining self-worth include:  poor self-image; grieving; and building the new identity.

3 Concepts Related to Re-Defining Self-Worth

♦ #1 Poor Self-Image
The first concept related to redefining self-worth is poor self-image.  Clients who suffer from chronic pain are often prevented from being free and independent.  According to the extent of the debilitating effects of their respective conditions, clients' activities become more and more restricted to the generosity of others.  Reliant on the help and skills of others, many clients, I have found, lose their sense of accomplishment.  They can no longer achieve the same status at work, play, or in their hobbies that they once enjoyed.  Without this source of self-esteem, clients fall prey to depression and poor self-image. 

Julia, age 52, suffered from fibromyalgia.  She had been an active participator in her children's school activities, she was well respected in her career as a lawyer, and she also prided herself on her weekend gardening talents.  However, after the onset of her condition, Julia could no longer take part in bake-sales, long court trials, and even her garden fell apart. 

Julia stated, "All those activities I once cherished and took pride in are gone!  I'm so idle and worthless.  I'm less confident and energetic.  All I want to do is sleep and not wake up!"  Julia had begun to succumb to depression.  The absence of her main sources of self-esteem caused her to project a low view of herself and consequently, this resulted in lethargy and even activity. 

Think of your Julia.  What were the sources of his or her self-esteem prior to the onset of their chronic pain?  How has the loss of this good self-image affected his or her mental health?  Physical health?

♦ #2 Grieving & Technique:  Goodbye Letter
The second concept related to redefining self-worth is grieving.  In the event that a client loses their sense of identity, they must go through the long and arduous process of learning to live without that particular sense of self.  The grieving process for the self comes in the same form as the grieving process for a dead or dying loved one. 

Clients will experience all five stages, but I have found that some clients can get stuck in the depression stage, unwilling to let the past go.  They become wrapped up in who they once were and are not yet willing to move on to a new identity.  For this reason, I feel that the grieving process is one of the most important steps in redefining self-worth.  It wipes the client's slate clean, paving the way for a new sense of worth.  I have found that many clients are familiar with the grieving process, but they never attributed it to such an abstract concept. 

Do you ever run into this problem? 

Julia stated, "I know about going through all the stages of grief: denial, anger, bargaining, depression, and acceptance.  But somebody didn't die.  I'm still here and my heart's still ticking."  I stated, "But in a sense, Julia, something has died:  your sense of identity.  You defined yourself through your activities and success.  But your definitions have been eradicated by your condition.  The person you were is no longer there, but there is still potential for another person just as worthy to arise, you just have to let go of the past." 

I asked Julia to write a "Goodbye Letter" to her former self.  I asked that she include in her letter the attributes she once prided herself with and also the reasons she must leave that self behind. I also asked that she make the letter as hopeful as possible.  Remember, Julia was stuck in the depression stage, and I wanted her to continue on to acceptance. 

Think of your Julia.  What stage of grief is he or she experiencing?  Are they stuck in one stage?

♦ #3 Building the New Identity
In addition to poor self-image and grieving, the third concept related to redefining self-worth is building the new identity.  After the client has successfully completed the stages of grief, I ask that they begin to redefine their own identity.  This step involves the client delving into different perceptions of worth and significance.  Instead of focusing on success, I ask many chronic pain clients to think of their character.  In their struggle with chronic pain, many clients do not realize the skills and coping talents they have developed. 

Julia, previously an active and engaged person, stated, "I don't know how to be anything other than Super Mom.  It's so hard to be anything else.  I still feel like the same person, but less of the same person."  I stated, "Prior to your onset of fibromyalgia, you defined yourself as an active, successful person.  Can you define yourself as that now?"  Julia stated, "No.  I know I'm a completely different person now, but I thought you said I shouldn't let my pain define me." 

I responded, "You're right, you shouldn't identify with the pain, but redefining yourself because of the pain is something different.  Right now, you're reacting to a pressure to rebuild your identity outside of your preconceived notions of self.  To successfully accomplish this, it's important you shift your value system."  Julia, although acceptant of the loss of self, cannot yet understand the concept of redefinition.  Think of your chronic pain client.  How would you explain this concept?

♦ Technique: Character List
To help clients like Julia redefine their identity, I ask them to write a Character List.  In this list, clients include characteristics that define, for them, the best in their nature.  I ask that these clients focus on positive attributes that are not measured monetarily or with accolades. 

Julia's list contained the following characteristics:
--Generosity
--Loving mother to my children
--Good sense of humor
--Sensitivity
--Selflessness

I asked Julia to review this list every morning, night, and incident when she began to feel worthless. 

Think of your Julia.  What other ways could he or she redefine his or her characteristics?

In this section, we discussed three concepts related to redefining self-worth in chronic pain clients.  These three concepts related to redefining self-worth included:  poor self-image; grieving; and building the new identity.

In the next section, we will examine three manifestations of anger commonly found in chronic pain clients.  These three manifestations of anger commonly found in chronic pain clients include:   anger arising from limitations; outbursts; and inbursts. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Chen, S., & Jackson, T. (2018). Pain beliefs mediate relations between general resilience and dysfunction from chronic back pain. Rehabilitation Psychology, 63(4), 604–611.

De Vita, M. J., Maisto, S. A., Ansell, E. B., Zale, E. L., & Ditre, J. W. (2019). Pack-years of tobacco cigarette smoking as a predictor of spontaneous pain reporting and experimental pain reactivity. Experimental and Clinical Psychopharmacology, 27(6), 552–560.

France, C. R., Ysidron, D. W., Slepian, P. M., French, D. J., & Evans, R. T. (2020). Pain resilience and catastrophizing combine to predict functional restoration program outcomes. Health Psychology, 39(7), 573–579.

Gilliam, W. P., Burns, J. W., Gagnon, C., Stanos, S., Matsuura, J., & Beckman, N. (2013). Strategic self-presentation may enhance effects of interdisciplinary chronic pain treatment. Health Psychology, 32(2), 156–163.

Kirkham, J. A., Smith, J. A., & Havsteen-Franklin, D. (2015). Painting pain: An interpretative phenomenological analysis of representations of living with chronic pain. Health Psychology, 34(4), 398–406.

Vase, L., Skyt, I., Laue Petersen, G., & Price, D. D. (2014). Placebo and nocebo effects in chronic pain patients: How expectations and emotional feelings contribute to the experience of pain. Zeitschrift für Psychologie, 222(3), 135–139.

QUESTION 2
What are three concepts related to redefining self-worth in chronic pain clients? To select and enter your answer go to Test.