1. Beyond Illness: Developing Competence
Beyond Pain and Distress ….
On being human
Let’s look at the BASIC impact of ill health …………….
Dr Anne Waters
Consultant Clinical Psychologist
Pain Management Team, HHFT

2. Severe illness and treatment is a considerable physical and psychological burden to the patient
A more in-depth personal look at the impact
I don’t want to be sick
Mary Andrus

3. Being ill/unwell is not just Being Unwell It effects ………
Your overall energy levels
How you feel physically & What you can physically do – ( + coping with the treatments / drug side effects etc…)
How you feel emotionally – being ill can be a distressing experience – physical illness is emotionally distressing)
The ‘normal’ roles that you have in life (work / family / friends)
How you feel about yourself – useful/worthwhile
Fear of loss of future direction and loss of sense of self (particularly following passively received and intrusive treatments)
And then there’s the immediate impact of pain – day by day, moment by moment …….What is Pain?

4. What is Pain?
An effective alarm system – bringing your attention to tissue damage or the potential for tissue damage ………….. How? [the science bit – pain matrix and limbic system]
Pain interrupts attention, motivation, behaviour, concentration, memory - Pain is very disruptive!
Fear of loss of future direction and loss of sense of self (particularly following passively received and intrusive treatments)

5. Future Direction (loss of…)
The greater the discrepancy ……..slide
Our personal history shapes how we view ourselves and interact with the world around us
a complex myriad of self-definitions developed and shaped through childhood and beyond. …….A physical health crisis => loss of assumed ‘future self’ and a desperate striving to do what you’ve always done – to hang on to our identity…

6. When pain persists and we become less able [increasingly disabled]…..
It impacts on our identity – our sense of self ……..
Increasing the discrepancy between how we are now and our hoped for self (ideal self)
Increasing the likelihood of depression
Morley, Davies & Barton, Pain 2005

7. In summary – people with pain frequently present with ‘clattering heads’ [pain interruption] and ….
Poor understanding of physiology/maintenance factors
Behaviour – poor Self-Management (over/under-activity cycling)
Psychological distress
In short ……………..

8. “You’ve got to have a dream……..”
The huge burden that is pain can leave us flattened
How do we help our patients to stand up again, see a future – despite their pain?
“You’ve got to have a dream……..”

9. What do we want …….
To be valued (listened to, noticed/noted… responded to)
To feel confident (in our ability to …….)
To feel competent
We want to be the best we can ……….

10. Where to…. (rather than where from)
Prerequisites: Good self-management strategies - (pacing, planning, gentle exercise)
Three ‘simple’ questions:
1. What are your best hopes (preferred future)
2. What would you notice about yourself if you were a little more …x,y,z (what difference would that make? / what would you (others) notice about yourself?)
3. What are you already doing … and what have you done in the past that might help these hopes become reality? (How far have you come already?)
KH patient: Debbie K – accountant;
To be in control, rather than the pain controlling me … To feel more confident
engage more (with colleagues at work), smile more, be happier around my mum
Using biofreeze, doing one thing each evening (pilates, orchestra), voice recognition at work, taking more breaks – previously? Motivation to learn new role (CV), strive
Think of a time when you have felt good about yourself – you’ve had that ‘YES!!!’ feeling - what were you doing?, what did it say about you?, how did you respond to yourself? How did others respond to you?

11. Scaling Best Hopes 0 100 35% 70% Worst it has been Best hopes
Tiny signs of progress in the preferred direction
(How will you know you’ve moved up one point?)
35%
70%
Worst it has been
Best hopes
Current position:
What have you done to reach this point ?
How did you do that?
What does it say about you ? Who would agree?
What else have you done?
and what else?
etc etc
Realistic aim:
what would you notice that would tell you you’re coping better? / a bit more motivated?
What would others notice (partner, friend, work colleague)
Example in audience?

12. Thank you!