I would like to share with you an article and talk that I provided for Wounds UK. The focus of the talk at the conference was aimed at the nurses who were there, but this topic is relevant and adaptable to all. It explores Anxiety, Relationship with Self, Psychological Tension and Conditions of Worth.
The article below was published after the talk, as a reflection of my personal process and a restating of the main areas of the talk. I hope you value it and it gives you some insight and understanding.
The Person in Nursing – Reclaim yourself from ‘Shoulds‘
In this article, I hope not only to explore the areas that I focused on in my talk for the Wounds Annual conference 2024, but also share a little of my own process, which helps to illustrate the theory in action! In addition, I would like to offer some invitations to explore these areas for yourself, including some reflective questions throughout the article.
The article will focus on the Person-centred Approach, based on Carl Rogers’ theory, including Psychological Tension, Conditions of Worth, Unconditional Positive Self-regard, Authenticity and much more (don’t worry, they will all be explained below!). As always, I am open to any questions or contact about this and you can also watch the talk in full here.
Psychological Tension
It’s a bold claim, but Carl Rogers, the founder of The Person-centred Approach, believed that psychological tension was at the root of many of the difficulties that we face. In short, psychological tension refers to times when we don’t accept our experiences into our view of ourselves. He linked this to incongruence, or, to be put another way, a lack of genuineness or authenticity. To try and break this down into a simpler and more relatable way, in the hope that you not only understand what Rogers was describing but also see where you may spot psychological tension in yourself.
In the build-up to delivering my presentation on this topic at the Wounds Annual Conference 2024, I didn’t have to look very far to be able to spot this psychological process in full force! My tight chest, shortness of breath, nerves, anxiety – why was this happening, when this was a theory that I know so well and subscribe to wholeheartedly, when I was excited to give a talk I have given many times, on a topic I am so passionate about?
Well, it turned out that my own incongruence, or lack of authenticity, was not being able to admit that I was really nervous about delivering this and wanted to deliver it well. This was a new setting, with a different from the audience I am used to and in a fairly sizeable room! This will be fine, Chris. You do it all the time and have taught this for years. What’s the problem? Well, the experience that I was not accepting into my view of myself was of someone who was worried, anxious and scared of getting it wrong…
Reflective Question – What might be, the hardest part of yourself, or the hardest feeling you experience, to accept? (It may help to think of things you judge negatively or don’t like, both in yourself and others).
What Are Your ‘Shoulds’ and Where Do They Come From?
Rogers argued that a large part of our difficulty in being authentic, or accepting into awareness the ways that we are and feel, is due to many of the ‘shoulds’ that we carry, mainly from childhood, but as we will see later, there is also a significant amount in our adult lives too.
I think it is fair to say, that it is almost impossible to come out of childhood without some form of blueprint about how we should (and shouldn’t) behave. Rogers called these Conditions of Worth, which are ultimately messages that we get, from our primary caregivers, about what makes us more or less loveable.
To use the term “loveable” might seem a little extreme, but ultimately, this is often what we translate it to, given that we are organisms that are really just seeking love, acceptance and understanding (more on these later!) To give a simple example, we might get the message (often implicitly) that “boys don’t cry” and “girls don’t get angry.”
These are not often explicitly stated or told to us (although they certainly can be), but more so, what we might experience is a disapproving look, a reduction in attention or care or maybe even told to “pull ourselves together” and “stop acting so silly.” There can be many and varied ways that we get these messages in childhood, but we certainly get them. And in their droves!
During the talk, I asked the audience to consider what their family motto would be? The reason I asked this is because it can so often capture some of the main messages that we get when we are growing up – “work hard”, “be strong”, “look after number one”, “be kind” – the list is endless. But if you are able to think what your own family motto may be, you may be well on your way to uncovering what some of your strongest Conditions of Worth may be, and therefore, where you might be facing some Psychological Tension in your life.
Reflective Question – What would your family motto be?
The Person in Nursing
Not only do these ‘shoulds’ dictate so much of who and how we are, but we also often tend to get more as we continue to grow older and experience new areas of life. For example, what unspoken rules come with being an adult, a nurse, a parent, a student and so on?
And this is where the focus on ‘The Person in Nursing’ came from. So often, we may relate to our role, its demands, expectations and shoulds, and I thought it might be helpful to tune back into the person that is the Nurse. The authentic self, the self that has valid feelings and responses to the many demands and expectations that are part of the role.
And talking about this, is where one of the areas I wish I had delivered better as part of the talk! I think in hindsight, opening a conference by celebrating the right to not want to do this job anymore, was maybe not the most fitting battle cry and also something that I was meant to phrase quite differently! So, what was I trying to say here?
Quite simply, I wanted to give rise to the many parts of ourselves that we deny and distort. The parts of ourselves that we feel we couldn’t possibly give voice to or entertain – our incongruence. And whilst one of these may be a re-evaluation of our jobs, I also wanted to make space for the ‘shoulds’ that we have in our friendships, relationships, family ties, social interactions, life roles. Quite simply, in almost everything that we do.
Because this is often the source of our psychological tension. Our stress, our anxiety, our dis-ease and our battles. What would it mean to allow ourselves the true feelings and responses that we have to life’s many situations and not have to contort ourselves into the many narrow and ill-fitting ‘shoulds’ that have been communicated to us in all walks of life?
And what does this mean for being a Nurse? And a Nurse in your specific situation, with your specific environment and staff hierarchy? As I mentioned in the talk, beginning to accept and understand these parts of ourselves, does not mean that we have to instantly go out changing everything and explicitly communicating it to the people in question. But what would it be like to just be able to acknowledge it to yourself? The bits that are hard, the bits that you feel you “shouldn’t” be feeling or are not “right” or “proper”? This, I believe, is the first step in being able to ease the psychological tension, and ultimately, the many different stresses and strains we experience in our day-to-day life.
Reflective Question – Make a list of some of the roles you have in life and think about what rules might come with these (e.g. What ‘should’ you be like as a nurse?)
Unconditional Positive Self-Regard
The core conditions that we aim to offer clients as a Person-centred therapist are understanding, acceptance and authenticity. But one of the most challenging things that we can face, is also offering these things to ourselves.
Can we offer the same understanding that we offer to our patients, to ourselves? To really treat ourselves with the same respect that we so consistently do to those that we are there to help?
Unconditional Positive Regard is quite simply an acceptance and prizing of the clients that we are working with. To withhold judgement and accept that each person is doing the very best that they can, in their unique situation, no matter how that might look from the outside. However, the real test may be offering that same self-regard to ourselves.
Can we accept, in ourselves, whatever we might be feeling or experiencing in response to life’s many challenging situations, our job and our roles? Can we fight against the ‘shoulds’ and ‘ought to’s’ that we may place on ourselves in terms of our expectations of self, our conditions of worth and implicit rules that we have for ourselves and live by, whether we are aware of it or not?
I know that this was my own battle as I was preparing for, and delivering, this talk. Can I offer myself the same understanding and acceptance of what I was experiencing and feeling in wanting to do this justice and communicate what I was wanting to in an acceptable way? To accept, understand and tend to the parts of me that were nervous, anxious and worried and see that it was an understandable reaction to the task that had been set?
Reflective Question – Think about something you have been struggling with about yourself. How would you respond if a friend told you the same situation?
What can we do to help ourselves?
I wanted to share some thoughts about what may help us on this quest, to both know ourselves better, but also offer ourselves some of the conditions we so naturally do to others.
The first thing to be aware of, and can make this task harder, is that we do live in an incongruent world. That is, a world that promotes inauthenticity, the stiff upper lip and doing as we “should.” This creates an uphill, but liberating, battle to challenge the social constructs and structures that we live in.
As I have mentioned previously, this does not have to be an immediate expression of all our deeper truths and true feelings from the off, but just a commitment to honour these processes and feelings, internally, as a starting point. To make conscious space, where we are checking in with how we actual feel, and allow the answers to be anything that may be showing itself, whether comfortable or not.
Sometimes people find it easier to do this on their own, but equally, others may feel more able and comfortable to do this with another person that you trust and you can be honest with. This may be a good friend or family member, but if not, this is where something like Counselling or Supervision may come in handy.
Whilst I feel there is a huge absence of Supervision in many helping professions, it not only matters that this is present, but also that you trust the person you are sharing these things with. For myself, Supervision is a place where I share all the things I got wrong, the things I regret or am embarrassed about and so I need to have a good relationship with my Supervisor, to feel accepted and understood and also take the risks to share some of these more difficult areas of myself.
What I hope this highlights is the importance of intention and honesty in making space to check in with ourselves, and of finding the right place to do it, whether that be on our own, or with trusted company. Ultimately, if we have the intention to do this, and the right space in which to do it in, we really increase our chances and ability to tune in to our more authentic self.
This can often be a tentative and gradual process. This may start with acknowledging there is some form of discomfort in a situation – at work, in a friendship, in a certain setting, and then beginning to be curious about what this might be telling us, and giving it care and attention, to see if we can hear what this is trying to tell us, without censorship.
Reflective Question – Is there just one small change that you could make to help make space for yourself, tune into how you really feel or take some action to care for yourself?
Bringing it all together
What I have hoped to show, in this article, is something of what might be at the heart of many of the struggles we face, and also how we may relate to, and ultimately overcome, these in a healthier way.
That the struggles we face are not often about the things themselves, but more about how we relate to them, and ourselves. The rules, conditions and ‘shoulds’ that are in so many of the things that we do, and how being aware of, and understanding these, at a deeper level, may give us some reprieve in the difficulties and tensions that we face.
And that ultimately, the more authentic, accepting and understanding of ourselves we can be, the less psychological tension and anxiety we are likely to face.
I will end, in the same way that I did for the talk, to share a very apt quote, from Rogers, about what may actually be at the heart of change…
“The curious paradox is that when I accept myself just as I am, then I can change.”
Thank you for reading this article. If you are interested in the areas that I explored in this post, then you will likely value reading my new book. Whilst this is obviously a shameless plug, it was also written on the very same topic, but allowed me to go into much more depth.
I spoke about authenticity and psychological tension in this talk because it matters to me and I do believe it is central to so many of the struggles we face; as professionals and in our personal life.
So the book was a natural extension of this belief and allowed me to expand on many of the ideas you have read above in much more detail. You see more here.
