Theory Thoughts: Is Pain Good or Bad? A systemic exploration of neutrality and what it means to ‘help’

“When they’re in enough pain, they’ll do something about it”

A psychiatrist said that to me once, and it really got me thinking. Years later, I began studying Bowen Theory, and then it really got me thinking! My mind generated many questions around this, but what they mostly come down to is this: What kind of help is helpful? I’ll address this by breaking it down into sub-questions.

Sub-question 1: What is enough pain?

This will be different for every individual, of course, and it will vary across one’s lifespan as well. I have a friend, for example, who got to a point in her addiction that she became homeless. Three months into living on the streets, she was bitten by a spider (this wasn’t in Canada) and almost died. After that, she got (and stayed) sober. In contrast, I have a friend who got so sick from drinking too much on New Year’s Eve in her early 20s that she never drank again. These examples bring up a medley of other questions, but that’s a whole other article!

What if ‘enough’ pain brings someone to the point of being nonfunctional? Is that helpful for them? For the system? Is it better to stay out of ‘enough’ pain or to fall into it to prompt change?

These questions propelled me into the next train of thought.

Sub-question 2: Does being ‘helpful’ keep them from reaching ‘enough’ pain? Should it?

We’re all familiar with the idea of coping strategies. Some are calm and thoughtful (e.g., exercise, spending time in nature), while others are driven by emotional reactivity (e.g., overeating, having an affair). In Bowen Theory, these reactive ways of managing anxiety are sometimes described as dysfunctional, in that they lower anxiety in the short term but increase it over time by maintaining emotional reactivity. Dysfunctional ways of managing discomfort (anxiety, tension, stress, pain, etc.) are effective at protecting us from feeling the depth of the discomfort, which is why we developed them and why we maintain them.

There are also more subtle ways that this can happen. When someone validates a choice I made, reframes a situation for me, or reassures me that my kids aren’t ruined for life because I once tore up a Pokémon card in front of them in a fit of rage because they were fighting over it, they’re helping me get out of the discomfort that those situations brought on. Can this be truly helpful? Yes! Can this be truly unhelpful? Yes! The very unsatisfying truth of it is…it depends. Which leads to the next sub-question.

Sub-question 3: When is it useful to stay out of the deeper pain?

Certainly, sometimes we need to keep it together and move past the discomfort. These can range from in-the-moment relief, like making a joke during an awkward conversation, to developing chronic patterns (that create problems of their own) in order to function in various aspects of your life. For example, a person might drink a bottle of wine every night to manage their chronic stress, but without that nightly relief, they may become unable to function at work and lose their job. People can live their whole lives in these patterns, and who am I to say that they need to change? Introducing: Sub-question 4.

Sub-question 4: How do I decide what’s helpful?

As clinicians, we are constantly deciding during sessions with our clients. What do I think about what they just said? What does the theory tell me? Am I being neutral about this? Should I tell them what I think? Am I responsible for deciding whether they should or shouldn’t be doing x, y, or z? Using the above example, if I convinced the person who drinks a bottle of wine every night to stop doing that, there could be disastrous consequences. Assuming my decision wasn’t made out of reactivity, it would be made from a good place of wanting to help my client get themselves out of addiction and into a ‘healthier’ lifestyle. Would that really be helpful? What are they going to do about their anxiety? Will they become so overwhelmed that they can’t function at work anymore? Is that anxiety going to be directed at their spouse or their children? Or maybe those situations, in time, would bring about desirable outcomes. The point is that we don’t know. This sub-question of How do I decide? Is one that I actually have an answer for: I don’t. It’s not up to me to decide what someone should or shouldn’t do.

Sub-question 5: Can I stay neutral?

None of the scenarios presented here are ‘good’ or ‘bad’. This is the critical importance of neutrality. One thing to note about neutrality is that being neutral does not mean that I don’t have an opinion. For example, I might be uncomfortable with my client continuing to drink a bottle of wine every night because I know it will negatively affect their physical health. Neutrality is understanding that this pattern developed in this client for valid reasons. It’s a systemic issue, so focusing on only one person and only one aspect of their wellbeing (e.g., physical health) could exacerbate problems and/or create new ones.

When someone is in enough pain, they’ll do something about it.

This isn’t good or bad. Arriving at the point of being in so much pain that you make a significant change, will have an assortment of impacts on you and your system(s). Only you can decide what you want to change, and when you want to make the change. One caveat though, is that we don’t always have a choice. At some point, your body (or an external entity) might decide for you that it’s time to fall deeper into the pain, and you experience an involuntary shutting down (a.k.a., breakdown, menty-B, meltdown). Here, you can decide how you think about the situation and how you want to move forward.

Extremely important ethical note: If a client tells me they are contemplating or planning to die by suicide, I will do what I reasonably can to prevent this (e.g., call their emergency contact, call local authorities). While this isn’t part of clinicians’ legally mandated reporting guidelines, I am not neutral about suicide.

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Can parents be “too helpful? Watch this “Family Matters” discussion – When parents are focused on fixing their child

Rebecca Van Der Hijde is a Family Systems + Behaviour Analyst with Living Systems. In her private practice, Resonance Autism + Family Therapy, she works with a variety of families, including those who are raising neurodivergent children. She has been working in the field of autism and developmental disability for over 20 years and is very excited about integrating Bowen Theory with Behaviour Analysis in her practice.