Clean pain and dirty pain

A client came in the other day full of complaints and worries. She had seen a line in a journal that advised her to “think only thoughts that serve you.”

“What does that even mean??” she asked irritably.

I told her that I understood her difficulty with such a vague admonition.

“But let’s try an experiment” I suggested.

She told me she felt so lousy she was willing to try anything.

I asked her to share one of her regular unhappy thoughts with me.

“The medicine I’m on makes me fat,” she answered. “I think that all the time.”

“OK,” I said. “Let me tell you a little bit about clean pain and dirty pain.” She nodded.

This was a chance to talk about some of the ideas that come from a very useful therapy called ACT – Acceptance and Commitment Therapy.

“Clean pain is pain that comes from a real hurt or grief. We all have lots of clean pain. But often we don’t let ourselves feel that pain. We jump right to our thoughts about what’s happening and all the stories we tell ourselves about what’s going on – and that’s the dirty pain. It tangles us up inside and causes us much more hurt than the original pain.”

My client looked puzzled. “I don’t know what the ‘clean pain’ even is.”

“What are some of the thoughts before the one about the medicine and feeling fat?”

“I am angry that I’m sick and even have to take this stupid medicine. I avoid taking it whenever I can.”

Now we were getting somewhere.

“It sounds like the clean pain has to do with having this disease.’

“Oh yes. I hate it. It scares me and makes me sad.” She started to tear up and I could feel all the pain of that grief.

“So you are letting yourself feel that clean pain, and it seems like it might go on forever, but it won’t. Feelings don’t really last all that long – good or bad!”

Now let’s examine the dirty pain. That comes from this thought that is part of a story you are telling yourself about the medicine.”

“But it’s true !” she protested.” I am getting fatter and I know it’s from the medication!”

Here is where ACT really kicks in. The goal of ACT is to promote psychological flexibility – that it, the ability to detach from our thoughts and see them as thoughts. It is similar to the goals of mindfulness and other meditation practices. The benefit is that you don’t get stuck in a repetitive loop. You are in charge of your thoughts – they aren’t in charge of you.

In order to get this kind of flexibility, you challenge your thoughts in some silly ways.

“What if the opposite is true?” I asked.

“Like what?”

“What if the medication is making you thinner?”

“That’s crazy.”

“Really? How could it be true?”

She frowned. “Well,” she said slowly.” I guess there are all the times I don’t feel like eating when I’m taking it.”

“Hmm. So, it could be that you could also say to yourself, ‘This medication makes me thinner.’

She smiled. 

We were done for the day – and now I can suggest the same thing to you – pick a thought you think very frequently that gives you a dismal feeling. If you’re feeling adventurous, pick two or three. thoughts

Write them down.

Now write the opposite. This can be quite challenging – because your rational mind will want to complain that this thought is “true”! But the aim is not to prove your thought wrong – just to open up options and possibilities so you have a little more mental and emotional room. It’s a game, an experiment, and an opportunity to feel better. Look at your opposite thoughts every day – just to let them sink in.

This is how you can begin to re-work some of that “dirty pain” that you cause yourself.

Letting go of some of the “dirty pain” makes room for some relief, some pleasure, and even the occasional joy. 

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