Understanding psycho-emotional adaptation

There is a need to understand the process of psychological adaptation and the range of responses relating to adaptation. The listener is required to consider psychological adaptation in a non-judgmental way. Past evidence (Soundy et al., 2010; 2010; 2013) has illustrated adaptation is described by health care professionals using specific words (like acceptance, denial, or anger). These words likely some understanding of adaptation in stages for instance they could represent consideration to the work of Kübler-Ross (1969) which considers denial, anger, bargaining, depression and acceptance. It was considered as a basis for other work to be considered within different context for e.g., (Perlman and Takacs, 1990) expanded it to 10 phases of change. This work is summarized more recently to represent traditional phase or stage models of adaptation (Smedema, Bakken-Gillen, & Dalton, 2009). These models are important for the consideration of adaptive processes that are involved in the experiences of illness. However, they do not fully represent the more recently developed understanding of the illness expressions which includes adaptation, emotion and hope (Soundy et al., 2016; Soundy, 2018).

The past understanding of expressions relating to adaptation identify the importance of hope as a part of the response to illness and as something which is particularly identified in the stage models as it relates to the experience of loss for instance through the identification of depression (Kübler-Ross, 1969) or the experience of chaos (Perlman and Takacs, 1990). However, these categories do not identify hope more generally or what is hoped for in the future. The other danger of the traditional models of adaptation is that categories of responses are established which may be considered as correct, ideal or right versus less correct, inappropriate or wrong. This is in contrast to recent understanding that stories of illness are not represented by one category of adaptation (Soundy, 2018). The early work by Kübler-Ross (1969) also identified the importance of energy in relatedness to the response and identified that as a construct which accompanied adaptation. This is important because it recognizes the impact of emotions. Other work (Wright 1983) recognizes alternative emotions such as shame or guilt experienced as part of the social experience of illness or fear and anxiety as a period of crisis. These emotional responses to illness are identified as factor which prevents acceptance of what has happened. Thus, broader understanding than the categories of emotional responses are needed within stage and phase of psychological adaptation. 

Reactions to the stories of that illustrate the experiences of illness can have common plots. We have evidence that suggests that when health care professionals consider, listen to and respond to common stories of illness, they do so by categorising the experience or narrative in limited ways. An example of this could be health care professionals identifying a narrative as realistic (judgement relating to the hope that is identified through an expression), or as being ‘in denial’ (judgement relating to the process of adaptation identified through an expression of illness). This type of categorisation represents a direct identification of what works or doesn’t work alongside the goals of rehabilitation. Health care professionals become very good at identifying what responses are ideal and realistic and what are not within a rehabilitation setting. The danger of such judgements is that the story, context and factors which are revealed by an individual with illness can be reduced and the patient categorised by their response. A key aim of this book is to recognise categories but not make a judgement upon them. The reasons for this are considered below.

Psychological adaptation needs

Specific adaptation needs are needed for a healthy psychological adaptation (Soundy and Elder, 2018). These include; (a) the need to identify those things which are personally meaningful in one’s life and acknowledge the impact of a TCC into one’s presentation situation and recognising a uncontrollable or unknown future that could being both positive or negative outcomes and have an acceptance that there may need to be a change in one’s goals, plans and actions as a result. (b) a sense of empowerment which enables an individual through their own sense of belief and a willingness to act in order to take ownership of the TCC. As this becomes a reality and action begins individuals becomes more independent and able to coping with the TCC. There is an ability to create and co-create understanding of how management is possible, however there is a need to preserve dignity through interaction if empowerment is not possible. Both needs are affected by the factors which influence hope (Soundy et al., 2014) as well as emotional expressions which bring meaning to experience (Soundy, 2018) and may require time to understand.