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“Ten Commandments” for Counseling the Chronically Afflicted, Part One

September 7, 2011

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Mark Kelly

“Ten Commandments” for Counseling the Chronically Afflicted Part 1

A weeping family member sits across from your desk describing the devastating impact that Chronic Pain (CP) has brought into their family. Their loved one suffers miserably and yet all attempts to encourage seemingly either fall on deaf ears or are given the cold shoulder. As a biblical counselor or pastor what biblical wisdom for communicating with someone suffering with CP can you give this grieving counselee?

The following “Ten Commandments” were written from a CP patient’s viewpoint and specifically designed to assist in the area of communication. Used in conjunction with other biblical principles dealing with communication, these commandments provide a resource that allows grace to flow freely in the conversations between sufferer and care-giver.

The goal of these commandments is to improve communication between someone suffering with CP and their loved ones. No one who suffers with CP suffers alone. Every relationship they have bears their load in some manner. The difficulty comes when the pain cannot be communicated adequately or the desire to minister becomes frustrated because a loved one does not know what to do. Communication often grinds to a halt as CP whittles away at relationships as well as physical well-being.

A biblical counselor will no doubt encounter this frustration on one of two levels: either with the patient themselves or with their loved ones. The patient might be frustrated because they cannot describe the pain or their desires and the loved one may be frustrated because they have tried to help and seemingly cannot make progress. Knowing how to counsel to improve communication will go a long way in the healing process, not only relationally, but even perhaps physically.

Thou Shalt Listen Well

Often the CP sufferer finds their greatest relief when someone just listens to what they have to say. The counselor, the care-giver, or friend will just hear them out, even when it sounds as if they are complaining. They often want to let people know they hurt and struggle with the complexities of communicating that. The listener should understand that along with “hearing” the conversation, they need to be “reading” the conversation. In other words, look for the frustrations and the clues which indicate the severity of the pain the sufferer might be in. Ask yourself, “Can I listen to how someone says something as well as hearing what they are saying?”

Listening means that you will give complete attention to the CP sufferer. Plan on spending time with them. Please don’t become distracted by the clock or your next appointment. This conversation will not be had in 30 seconds or less. Sometimes the CP sufferer struggles with putting thoughts together. This can be a result of the pain itself or the medication they may be on to alleviate the pain. They will often be most frustrated when they cannot complete a thought and will feel the real pressure of wasting the listener’s time.

Perhaps you also suffer with CP. You should realize that CP varies from individual to individual. Ensure that you do not attempt to assign your assumption of pain and suffering to the one to whom you are listening. Rather, be eager to hear what the sufferer is saying so as to learn about their condition. Do not attempt to fix it—just listen.

Thou Shalt Be Genuine

If you made it past the first commandment, you are pretty dedicated to helping your friend. It is very difficult to listen to someone bare their soul about how much pain they are in. It pains us to see how CP is negatively affecting them. (Can you imagine what they must be going through?)

Do not ask someone suffering with CP how they are doing, if you are not prepared to listen completely to them. And if you begin to listen, do not pretend to have all the answers… or any of them really.

A CP sufferer sees clearly if the listener genuinely cares about them. They have not lost their capability to discern genuine interest. They do not desire to burden people down with more than they are capable of handling, so many times the CP sufferer will not say anything. Especially if you have faked interest in the past, glance impatiently at your watch or appear uninterested in any way.

Thou Shalt Understand: That CP Sufferers May Be Afraid to Reveal Their True Feelings

Because CP sufferers interact with a variety of people throughout the day, they may be hesitant to reveal exactly what they are feeling. Sometimes they have been told to just “suck it up” or “cowboy up” and endure the pain. Often they are unable to describe the pain they are feeling in such a way that it makes sense to the listener. Have you ever tried to describe the feeling you experience with a tiny paper cut? Explain it in detail so that someone not seeing the cut would completely understand. It is a difficult task. Multiply the complexity of chronic pain in an individual and the task becomes almost impossible. Please do not laugh at the feeble attempts or descriptions of pain that a CP sufferer uses as they paint the picture of pain.

Often a CP sufferer will hesitate to share what they are truly feeling because they feel they will be judged by other people for what they are thinking. The CP sufferer experiences temptations at a heightened level when the pain is the greatest. They may reveal to you that they have considered obtaining illegal drugs as a way to escape their pain, or considered suicide in a hopeless moment. Relief from pain becomes a temptation in and of itself. Compassionate understanding is needed at this point in the conversation.

Often the CP sufferer will simply say they are “fine” or refuse to admit how much they truly are hurting. Often that is simply a way to deal with what is really happening in their body. You may be able to see that they are hurting worse than they are letting on, do not call them out on it, just reassure them that you are available to talk. If they need to talk to you, they will.

Thou Shalt Look for the Non-Verbal

Many times you can tell if a sufferer of CP is hurting more than they are letting on. We find that we are terrible liars. Here are some physical cues to look for that indicate someone having increased pain levels:

  • Sweating
  • Irritability
  • Lack of sleep / tiredness
  • Restlessness
  • Lack of focus / can’t concentrate
  • Lack of activity / desire to stay immobile
  • Suicidal tendencies

Often the CP sufferer is used to dealing with these symptoms so they may not even notice they are exhibiting them. Do not point them out to the CP sufferer, just take note of them. They often do not need to be reminded that they are sweating profusely. They know they are and often are prepared with a handkerchief or something similar.

Thou Shalt Believe the Sufferer

When a CP sufferer reveals the intensity of pain to you, they really are hurting. The difficult thing to realize is that the CP sufferer may not look any different to you than before. They may not demonstrate they are suffering apart from what they have said. If they verbalize their pain, they are hurting.

Often there is an assumption that CP sufferers will exaggerate pain levels to gain attention of their care-givers. Their desire is to be rid of pain. They do not fabricate pain descriptions to garner sympathy or as an escape from responsibility. Most CP sufferers would love to complete the responsibilities they have and do them well. When they say they are hurting, they are hurting.

The Rest of the Story

Be sure to return for Part Two where you can read and apply “Commandments Six through Ten.”

Join the Conversation

Do you find that sometimes as a biblical counselor or family member of a person suffering with chronic pain, that you give platitudes instead of true hope? What aspect of helping those who suffer with chronic pain needs development in the Church today?


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