Lisa's doctor referred her to me to help her in dealing with chronic pain

Lisa suffers from tinnitus and has resultant chronic pain in her ears. The neurologist was familiar with the efficacy of cognitive-behavioral therapy and its application in treating pain-related syndromes and referred the patient to me as a part of a multidisciplinary approach in chronic pain treatment.

What is tinnitus?

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. Nearly 36 million people suffer from this disorder. Many factors, such as certain medications, ear wax, fluid, infection, or disease of the middle ear bones or eardrum can cause tinnitus. As with any pain syndrome or disturbance, emotional factors can exacerbate the disorder.

Lisa complained of a loud, swishing sound emanating from both ears. The disturbance was significant enough that it began affecting her ability to function in a meaningful manner. At home, while preparing dinner, she found herself shifting her head in an unusual position toward her right shoulder in a ritualistic attempt to minimize the annoying vestibular volume.

Her bodily compensation reminded me of a clutched position that battle-scarred soldiers assume in combat that represents a way of warding off impending doom. In reality, such posture actually symbolizes the heightened hypervigilance experienced by those who have been exposed to physical and emotional trauma.

Pain is often a metaphor for life

My experience shows that a pain syndrome often serves as a mysterious metaphor for the way we relate to the world. M. Scott Peck, author of the Road Less Traveled, used to talk about the nemesis of his neck pain. Although he sought surgery to rectify his condition, he viewed his problem as a more complex pattern. The origin of his neck stiffness transcended bones and tissue. Peck often said “he was afraid to stick his neck out." His malady was a metaphor for holding things in and avoiding conflict at all costs. Learning to assert himself paid dividends, and further minimized the significance of this problem.

We explored Lisa's childhood

As Lisa and I explored her problem, I began to see a thread that linked her nonsensical noise into a self-defeating cycle. "The volume was chronically turned up in Lisa’s life and it made her head spin.” She often affirmed this impression through the narrative of her life’s experiences.

Lisa had always done what others required of her. Her earliest recollections of this behavior occurred when walking home from school on a rainy day with several friends. As a mean-spirited lark, her friends asked her to stick her feet into a large puddle of water soaking her shoes and socks. She obliged her friends so as not to disappoint them. She felt humiliated as her schoolmates looked on and mocked her. From that moment forward, the power of pleasing others emerged as a benchmark for how she would conduct her life.

Alfred Adler used to say that our earliest childhood recollections embody a constellation of beliefs, thoughts, and feelings that have the power to profoundly impact one’s future behavior.  Lisa’s experience in a mud puddle would fuel her later behavior within adulthood.

We explored Lisa's current life

Lisa worked as a full-time tutor. Her students loved her. One day, she taught ten students in a row, driving to and from each student's house. She then went home, did her chores and prepared her evening meal for her husband. It was typical for her to push to accomplish tasks for others without ever setting appropriate boundaries for herself. She never requested or required anything from others—finally she gave in to exhaustion.

As Lisa began to disclose more freely in therapy, her story of unyielding sacrifice for others at her own expense became more evident. All the money she earned went to subsidize her granddaughter, who refused to work. Lisa disclosed that her granddaughter had a $200 a month smoking habit. Although she was conflicted about supporting her granddaughter’s addiction, she paid her the money to cover the cost. Lisa’s showed regret rather than appropriate resentment for enabling her granddaughter’s behavior.

In order to decrease the background noise in Lisa’s life, we worked on the following issues:

• Balancing the need to please with a sense of personal protection
• Learning assertiveness skills
• Requesting and allowing others to care-take for her
• Letting go of the need for frenzied activity
• Listening to her body and honoring it by slowing down
• Learning to get un-trapped from the fear of abandonment
• Learning to never do for others what they can do for themselves
• Relaxing the sympathetic nervous system through exercise and meditation

In order to address the above issues and decrease the volume of her tinnitus, I work with Lisa on her thoughts, distorted cognitions, and underlying assumptions about life. I taught her to rationally respond to self-defeating thoughts and behaviors.

Some of the types of thoughts we reframed were:

• "Where is it written that people can't get along without me?"
• "If I say no, and people don't like it, it's their problem."
• "It's okay to have abandonment feelings, just don't act on them by trying too hard.”
• "I need to focus in the moment, rather than stressing about things I can't control. If certain things don't get completed, it's not the end of the world."
• “I need to treat myself as if I were a dear friend.”
• "If I give in to others, I'll only resent it later."
• "What's the hurry, anyway?"

As a result of the modifications in her thought-processes, Lisa began to make progress with her tinnitus and she learned that self-defeating thoughts were a metaphor for self-defeating assumptions which aggravated her ears. These factors complicated her condition by creating unnecessary stress.

Note: This case is a composite drawn from my practice as a psychotherapist. The narrative has been altered to protect individual rights to confidentiality and privacy.