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Character Strategies And Chronic Pain

We all have characteristic ways of being in the world. These patterns of thinking, feeling, behaving and relating have their origins in early childhood where they developed to help us survive in our world. These character strategies, or styles, are imprinted in our neurophysiology and our psyche and, consequently, are not changed easily. It requires depth psychotherapy to explore and transform what can be limiting, as well as, protective character strategies. These strategies become particularly apparent in stressful circumstances as we revert to old and familiar ways of dealing with the stress. It is not surprising, then, that people with chronic pain resort to their character strategies to help them survive but find that these same strategies can severely limit their recovery. Many people with chronic pain need to work with their character strategies to find their path out of pain. It is not enough to learn some relaxation and attend a functional restoration program. As you read more about the strategies you will see how they interfere with learning the self-management skills necessary to recover. They can also be limiting in negotiating a return to work and to resuming a more normal and functional lifestyle.

Self-Reliant And Dependent-Endearing (Oral)

These two character strategies are focused on “needs”. A person with the Dependent-Endearing style desperately seeks to get his/her needs met. Commonly they would be called “needy” people. They can be very successful in finding people who will help them but sometimes people experience them as draining or demanding and consequently tend to avoid them. Unfortunately, people with this character style have difficulty actually taking in the nourishment that they so desperately seek. This is why people can be drained by their demands. It is as though “enough is never enough”.

In contrast to the Dependent-Endearing style is the Self-Reliant style. People with this style discovered early in life that their needs were not going to be met and decided to have few, or no needs, and to meet these few needs themselves. Others see these people as self-sufficient and don’t offer to help, or stop offering to help, because their offers have been rejected. Self-Reliant people can feel disappointed that they are not cared for by others, and can’t understand why it is this way.

People with the Oral strategy, particularly the Self-Reliant style, help every one else and tend to run themselves into the ground in the process. They are so busy helping others that they don’t take care of themselves and become ill. This seems to be the only way that they can rest and take time out for themselves. Chronic pain and chronic fatigue syndromes can be a result of this way of living.

Sometimes people oscillate between the two styles, but generally use one more than the other. It is common for people with the Self-Reliant style to become dependent on health professionals when they have chronic pain. It is as though they have found a legitimate, or acceptable way, of getting help from others. Once they experience the care that is being offered by the health professionals, they find it difficult to let it go and take up self-management practices. It is very familiar to people with the Dependent-Endearing style to seek help whenever they face difficulties. They experience no difficulty in seeking help from health professionals to get pain relief.

Dependent-Endearing

You believe that others are much more capable than you and that you can’t do it yourself. It seems like you can never get your needs met. You feel needy all the time

Characteristics Of People With This Strategy

  • Seek nourishment but can’t take it in
  • Tendency toward dependency
  • Give up easily
  • Cry a lot
  • Often tired
  • Have very low expectations
  • Minimize needs and wants
  • Tendency toward depression
  • Want a lot of attention
  • Inner feelings of emptiness

Themes
Missing Experience
Core Beliefs
Poverty
Loneliness
Abandonment
Loss
Abundance
Being cared for
Bonded
Nourished
Freedom from want
There’s nobody there for me.
Everybody’s going to leave me.
I’m alone. I can’t get support.
I’ll never get enough.
They feel that they were judged and found wanting.

Self-Reliant or Compensated Oral

It is better to do it yourself because others can’t be relied on to do it for you. Or, you can do it better yourself so why bother asking for help. After years of doing it yourself, it is very hard to ask for help. Even when you might need help you don’t know how to ask for it or you don’t dare take the risk of asking.

Characteristics Of People With This Strategy

  • Afraid to let others take care of them
  • Do things for themselves without expecting help from anyone (even in therapy)
  • Feels isolation under stress
  • Like to work alone
  • Take on challenges
  • Expect no help from others
Themes
Missing Experience
Core Beliefs
Challenge
Going it alone
Support from others
Freedom from challenge
I don’t need anybody
I can do it myself
I don’t need support

Burdened- Enduring

A Burdened strategy develops when the child is overly pressured to conform to the will of others against his or her own needs, impulses or desires. The strategy is about “freedom” and “choice”. Practitioners working with people who have chronic pain will recognize this strategy when they feel resistance to their suggestions, advice or to return to work programs. It may appear that the person is complying but they will find ways of doing it their own way regardless of what others are suggesting or even requiring in a return to work program. Because they have a general sense of inadequacy, they can find it very hard to get motivated to do what is required to recover. They also fear failure. They have difficulty “getting going” and this becomes more exaggerated when they have chronic pain. They would prefer to wait than to take action.

You believe that it is better to wait and see what happens rather than take action. You have a great capacity to “wait it out”

You believe that there is nothing you can do to help yourself. It feels like you are carrying a huge weight on your shoulders and there is no way of unloading it. You have to keep putting up with whatever comes your way. Your future seems grim. You feel hopeless.

You believe that you aren’t responsible for what has happened – you are innocent. You blame others and feel hurt and resentful about your suffering. You feel like a victim, unable to do anything about your situation and your pain. If anyone tries to push you into doing something you don’t want to do, you resist in every way you can. Life is miserable and it is not your fault.

Characteristics Of People With This Strategy
  • Feel stuck, impotent, incompetent, not as attractive or effective as others
  • Under stress get stubborn, slow down, prepare for the worst and delay the inevitable
  • Difficulty expressing emotions and asserting self
  • Difficulty getting energy going
  • Indirect means of getting out anger (passive aggression) – silent treatment
  • Can’t see that they could drop their burden and have fun
  • Try to win approval by trying hard
  • Eternal negatives / complain constantly
  • Take role of innocent victim
Themes
Missing Experience
Core Beliefs
Control
Guilt
Inadequacy
Inferiority
Avoiding mistakes Martyr
Absence of pressure, responsibility, and guilt
Freedom to do for self
Freedom to express
I’m a rotten person.
I do everything wrong.
It’s hopeless.
Look how miserable I am – please love me.
I must obey others to be loved.
It’s not ok to have fun.

Industrious-Overfocussed


This strategy is organized around performance for love. Parents have unrealistically high standards and this is conditional on the child’s performance. The parents may be critical, competitive, withdrawn, and obsessive. The child is given premature responsibility, not being allowed to be a child.

Our culture supports and rewards this strategy. Schools expect children to do a lot of homework and they may be shamed for wrong answers. There are high rewards for achievement at school and in life. Competitiveness is often emphasized at the expense of collaboration and teamwork. Workers are being increasingly required to increase their efficiency and output. Mothers often hold full-time jobs and do the greater share of home duties. It is, therefore, not surprising that this strategy is common in our culture.

It is common for people with this strategy to develop chronic pain because they have spent their lives in activity, never stopping to rest. They work extremely long hours in their jobs, doing overtime or staying late to finish everything. As soon as they get home they begin on all the chores awaiting them there. Chronic pain is a catastrophe for them as they have to stop and face the emptiness of inactivity. Their self-worth is measured by what they do and they feel useless and worthless when they can’t work or even manage the basic household chores. They lose their identity overnight.


You live with a feeling of urgency. As you think about all the things that need doing you say to yourself, “there isn’t enough time”. When you go to bed, you think about what you didn’t manage to do that day and when you get up in the morning, your head fills with the tasks that await you in the coming day. You can’t afford to sit down and rest because there is too much to do. If you do stop, you feel guilty.

You are pulled in many directions; you feel torn between your responsibilities to family, the house, your work, your study, and your friends. There is always something to be done. You live on the run, rushing from one thing to another. Most of the time you don’t question your activity but occasionally you wonder what would happen if you stopped. You decide it is better to keep going because it would be too painful to stop.
People with this strategy may get industrious about finding a solution to their pain, rushing from one doctor to another searching for a diagnosis and cure. They will keep trying new treatments as they are desperate to recover and return to their old level of activity. They may become overly industrious with a self-management program, trying too hard and aggravating their condition.

Characteristics Of People With This Strategy
  • They take refuge in action
  • Workaholic and serious
  • Love action and doing
  • Difficulty completing jobs and relationships
  • Quick to feel frustration and anger
  • May seem cold or businesslike to others
  • Under stress they generate more effort and work harder
You are always trying to get it right or perfect and yet you never seem to get there.
There is always more to strive for and you can’t afford to stop. Whatever you do, it is never good enough.

Themes
Missing Experience
Core Beliefs
Perfection
Competition
Failure
Effort and Striving
Not being loved for oneself
To be loved for who they are not what they do.
Freedom to relax and play
I have to work to be OK.
There’s always something else to do.
I have to be on guard or I’ll get hurt/used.
I can’t relax or let down.
I have to perform.

Tough-Generous

During the phase that the child develops the abilities to be more independent and autonomous a natural sense of omnipotence and grandiosity emerges. For a healthy self-esteem to develop, parents need to support, admire and love the child but, at the same time introduce realistic limitations and boundaries. Some children are used by their parents for their narcissistic needs, shamed or betrayed, seduced, over controlled, ignored, or ridiculed. They learn that being vulnerable, real, weak is unwelcome, or brings hurt and shame. Their true self becomes despised and ways of staying in control and presenting a false image are developed.

This strategy is apparent in people with chronic pain who tough it out even when their pain is severe. They can’t show their feelings or hurt and keep putting on a brave face.
.
Characteristics Of People With This Strategy
  • Desire to be in position of power/authority
  • Great difficulty in being real and honest
  • Great difficulty in being vulnerable
  • Great difficulty showing hurt or weakness
  • Hide their weakness, insecurity and fear
  • Look tough and act important
  • Adventurous and creative
  • Impulsive
You believe that you have to cope with whatever happens in life. You keep going long after others would have stopped or asked for help. You keep shouldering the load even though your body is cracking up. Others see you as a coper and keep asking you to do things for them. You have convinced everyone, including yourself, that you can cope with everything

Themes
Missing Experience
Core Beliefs
Superman/woman
Power and control
Using/manipulating others
Being used by them
Being real
Showing weakness, needs..
Freedom from being used or manipulated
I’ll never show my hurt to anyone.
You can’t hurt me.
It’s not safe for people to come too close.
It’s not safe to show my feelings.
I don’t need anybody.
“ Look up to me”.
“ I am special”.
“ I’ll show them”.
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