Living a Healthy Life with Chronic Pain (27 page)

Getting and giving help are a part of life, but offering and requesting assistance can cause many problems. Even though most of us need help sometimes, few of us like to ask for it. We may not want to admit that we are unable to do things for ourselves. We may not want to be a burden on others. We may hedge or make a very vague request: “I’m sorry to have to ask this …,” “I know this is asking a lot …,” “I hate to ask this, but …” Hedging tends to put the other person on the defensive: “Gosh, what’s he going to ask that’s such a big deal, anyway?”

To avoid this sort of response, be specific when you ask for help. A general request can lead to misunderstanding. The person being asked to help may react negatively if the request is not clear. This leads to a further breakdown in communication and no help. A specific request is more likely to have a positive result.

People with chronic pain sometimes are given offers of help that are not needed or desired. In most cases, these offers come from important people in your life, such as friends, family, and coworkers. They can be overly sympathetic and try to do things for you that you can do yourself; it just might take a bit longer. These people care for you and genuinely want to help, but when other people take over activities that you can do yourself you may feel dependent and disabled. This may lower your self-esteem A well-worded “I” message allows you to decline the help without embarrassing the other person. You could say, “Thank you for being so thoughtful, but today I think I can handle it myself. I hope I can take you up on your offer another time.”

You may often hear, “How can I help?” Your answer may often be, “I don’t know” or “Thank you, but I don’t need any help.” Meanwhile you are thinking, “They should know …” Be prepared to accept help by having a specific answer. For example, when general offers of help are made, respond with specifics such as, “It would be great if we could go for a walk together once a week,” or “Could you please take out the garbage? I can’t lift it.”

Remember that people cannot read your mind, so you need to tell them what you want. Think about how each person can help. If possible, give people a task that they can easily accomplish. You are giving them a gift. People
like being helpful and feel rejected when they cannot assist someone they care about. It is also beneficial to be grateful for the help you receive. When people help you, thank them for it! (See “Practice Gratitude,”
page 94
, in
Chapter 5
.)

Let’s consider the flip side of the same coin: imagine that you are the one being asked to help out with some activity or task. Using communication skills that get at the specifics will avoid problems. It is important to understand any request fully before responding. It is probably best not to answer right away. Asking for more information or restating the request will often bring more clarity. “Before I answer …” will not only clarify the request but also prevent the person from assuming that you are going to say yes. If a request for help from someone leaves you feeling negative or unsure, trust your feelings. A good rule of thumb is don’t answer until you know enough about the request to feel comfortable saying yes.

The moving example we just discussed is a good one. “Help me move” can mean anything from moving furniture up stairs to picking up pizza for the hungry troops. Or, if you are asked to help with a community fund-raising event, does it mean standing while serving coffee and sandwiches or sitting at a counter collecting donations?

If you are feeling overwhelmed and the request is unrealistic for you at this time, saying no is an important self-management tool. However, if you decide to say no, it is important to acknowledge the importance of the request. In this way, the person will see that you are rejecting the request rather than the person. Your turndown should not be a putdown. Instead, include a positive note in your refusal, such as, “That sounds like a worthwhile project you’re doing, but it’s beyond what I can do this week.” Again, specifics are the key. Be clear about the conditions of your refusal: Will you always turn down this request, or is it just that today or this week or right now is a problem? You may wish to make a counteroffer, such as, “I won’t be able to drive today, but I may be able to do it next week.” But remember, you always have the legitimate right to decline a request, even if it is a reasonable one.

Good listening is probably the most important communication skill. Most of us are much better at talking than we are at listening. When others talk to us, we are often preparing a response instead of just listening. There are several steps to being a good listener:

1. Listen to the words and tone of voice, and observe body language
   (see
   page 177
   ). There may be times when the words don’t tell the whole story. Is the speaker’s voice wavering? Is he or she struggling to find the right words? Do you notice body tension? Does he or she seem distracted? Do you hear sarcasm? What is the facial expression? If you pick up on some of these signs, the speaker probably has more on his or her mind.
   
2. Let the person know you heard what he or she said
   . This may be a simple “uh huh.”
   Sometimes when we are troubled, it is helpful just to talk to a sympathetic listener. Many times the only thing the speaker wants is acknowledgment or just someone who is willing to take the time to listen.
   
3. Let the person know you heard both the content and the emotion behind what he or she said
   . You can do this by restating the content. For example, “Sounds like you are planning a nice trip.” Or you can respond by acknowledging the emotions: “That must be difficult” or “How sad you must feel.” Responding to either the content or the emotion can help communication. It discourages the other person from simply repeating what has already been said. When you respond on an emotional level, the results are often startling. These responses tend to open the gates for more expression of feelings and thoughts. Don’t try to talk people out of their feelings. They are real to them. Just listen and reflect.
   
4. Respond by seeking more information
   (see the
   Table 10.1
   on
   page 172
   ). This is especially important if you are not completely clear about what was said or what is wanted.
   

Getting more information is a bit of an art. It can involve both simple and more complicated techniques.

The simplest way to get more information is to ask. “Tell me more” will probably get you more, as will “I don’t understand; please explain,” “I would like to know more about …” “Would you say that another way?” “How do you mean?” “I’m not sure I got that,” and “Could you expand on that?”

Another way to get more information is to paraphrase, or repeat what you heard in your own words. This is a good tool if you want to make sure you understand what the other person really meant. Paraphrasing can either help or hinder effective communication. It depends on the way the paraphrase is worded. It is important to paraphrase in the form of a question, not a statement. For example, someone says:

This response might provoke an angry response such as, “No, I didn’t say that! If you’re going to be that way, I’ll stay home for sure.” Or the response might be no response—a total shutdown because of anger or despair (“he just doesn’t understand”). People don’t like to be told what they meant.

Here’s a better paraphrase, expressed as a question:

As you can see, the second paraphrase helps communication. The real reason for expressing doubt about the party has been discovered. As this example illustrates, you get more information when you paraphrase with questions.

Be specific. If you want specific information, you must ask specific questions. We often speak in generalities. For example:

Health care providers are trained to get specific information from patients, although they sometimes ask general questions. Most of us are not trained, but we can learn to ask specific questions. Asking for specifics is a good way to start
:
“Can you be more specific about …?” “Are you thinking of something special?”

Avoid simply asking “Why?” This is far too general a question. “Why?” also forces a person to justify something and can put him or her on the defensive. A person may respond at an entirely different level than you had in mind. Rather than using
why
, begin your responses with
who, which, when
, or
where
. These words promote a specific response.

Sometimes you may not get the information you’re seeking because you do not know what question to ask. For example, you may be seeking legal services from a senior center. You call and ask if there is a lawyer on staff and hang up when the answer is no. If instead you had asked where you might get low-cost legal advice, you might have gotten some referrals.

Part of listening to what others are saying includes observing
how
they say it. Even when people say nothing, our bodies are talking. Sometimes they are even shouting. Research shows that more than half of what we communicate is done through our body language.

If you want to communicate really well, be aware of body language, facial expressions, and tone of voice. These should match what you say in words. If you do not do this, you are sending mixed messages and creating misunderstandings. For example, if you want to make a firm statement, look at the other person. Stand tall and confident, relax your legs and arms, and breathe. You may even lean forward to show your interest. Keep your expression friendly. Try not to sneer or bite your lip; this might indicate discomfort or doubt. Don’t move away or slouch, as these communicate disinterest and uncertainty.

When you notice someone’s body language does not match his or her words, gently point
this out. Ask for clarification. For example, you might say, “Dear, I hear you saying that you would like to go with me to the family picnic, but you look tired and you’re yawning as you speak. Would you rather stay home and rest while I go alone?”

In addition to reading people’s body language, it is helpful to recognize and appreciate that we all express ourselves differently. Many things influence how we communicate—our culture, country of origin, education, occupation, and especially our gender.

For example, women tend to ask more personal questions than men do. These show interest and help form relationships. Men are more likely to offer opinions or suggestions and to state facts. They tend to discuss problems in an effort to find solutions, whereas women want to share their feelings and experiences. No one style is better or worse; they’re just different. By acknowledging and accepting these differences, we can reduce some of the misunderstanding, frustration, and resentment we sometimes feel when we communicate with others.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Beck, Aaron T.
Love Is Never Enough: How Couples Can Overcome Misunderstandings, Resolve Conflicts, and Solve Relationship Problems Through Cognitive Therapy
. New York: HarperCollins, 1989.

Caudill, Margaret A.
Managing Pain Before It Manages You
. New York: Guilford Press, 2009 (especially
Chapter 8
).

Davis, Martha, Kim Paleg, and Patrick Fanning.
The Messages Workbook: Powerful Strategies for Effective Communication at Work and Home
. Oakland, Calif.: New Harbinger, 2004.

Gottman, John M., and Joan DeClaire.
The Relationship Cure: A 5-Step Guide to Strengthening Your Marriage, Family, and Friendships
. New York: Three Rivers, 2001.

Gottman, John M., and Nan Silver.
The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert
. New York: Three Rivers, 1999.

Hendrix, Harville.
Getting the Love You Want: A Guide for Couples
n. New York: Henry Holt, 2007.

McKay, Matthew, Martha Davis, and Patrick Fanning.
Messages: The Communication Skills Book
. Oakland, Calif.: New Harbinger, 2009.

Tannen, Deborah.
You Just Don’t Understand: Women and Men in Conversation
. New York: HarperCollins, 2001.

Turk, Dennis and Frits Winter.
The Pain Survival Guide: How to Reclaim Your Life
. Washington, D.C.: American Psychological Association, 2007 (
Chapter 5
).