Learning the art of assertiveness is an important factor for all individuals, but for those living with chronic

illness it is absolutely essential. Many of us are uncomfortable with asserting ourselves and not sure how to go about it. Our society is not good at teaching us how to do this and not very comfortable with assertive people and thus we have a lot of misunderstanding and conflict among relationships as people tend to go from one extreme to the other by being either aggressive or a quiet little mouse. The key is to find a happy medium. When living with chronic illness there will be many experiences which call for assertiveness. For some, our survival depends on it when dealing with friends, family, health care providers, hospitals, social service agencies, pharmacists etc. in regard to needs surrounding illness. Expressing ourselves, asserting ourselves and getting our needs met is essential to our mental/physical/spiritual health. If we dont practice assertiveness, then we stuff our feeling, or ignore them or push them aside, which can lead to many problems. When we dont engage in assertive behavior, we are being disrespectful to ourselves. If we are disrespectful to ourselves, it will degrade our self-confidence, self-esteem and selfimage. We wont feel good about ourselves and it will affect our health. Non-assertive behavior can make us more achy, lethargic or nausea and it can even weaken our immune system and make it more difficult to heal. The mind and the body are an intricate, delicate web of intertwined connections, which have a profound impact on one another. If we feel good about ourselves, it improves our level of functioning, makes us more receptive to treatments, improves our mood and outlook on life and improves our over all level of well being. Being non-assertive is a learned behavior of holding back your feelings and denying their expression. We are taught by society rules beginning at a very young age not to express our feelings with messages such as: dont talk back dont question authority do as I say Being non-assertive can be exhibited by two extremes. On one end there is being passive by holding back your feelings and not expressing them and on the other end is aggression at the expense

of others. Some people can swing like a pendulum between passivity and aggression. Lack of assertiveness can make us feel powerless and cause feelings of depression, low self-esteem and helplessness, and so can living with a chronic illness. Therefore, by engaging in assertive behavior it can help us regain some of our power and boost self-esteem. Since non-assertive behavior is learned it can be unlearned and be replaced with assertive behavior. Initially the new behavior may feel unnatural or uncomfortable, but with practice eventually it will become a comfortable part of who you are. Assertiveness is a learned ability to express your needs, preferences, opinions, and feelings without stepping on others rights. Assertiveness is direct and informs. It is honest and respectful to all parties.

Steps for Developing Assertiveness

1. Watch your behavior and keep track of when youre not assertive and how this makes you feel. 2. Set realistic goals for yourself. Start out with baby steps and low risks and gradually move towards more difficulty situations. Example: If you are very intimated by your mother in law, she would not be a good place to start practicing your assertiveness. Start small with someone who feels safe for you. 3. When expressing yourself talk about what a person does and not who or what they are. (Focus on their actions, not their personality or character. Example: Say When you dont listen to me I feel like Im not important. Not you are such a jerk, you dont care about me at all 4. Talk about particular observations of behavior, dont make assumptions about a persons motivations or thoughts. Example: Say It sounds like you are very angry Not I know you are angry, 5. Try to be neutral and non-judgmental. Dont attack. Example: Say It would be very helpful if you could contribute more to keeping the house clean Not You are such a slob.

6. Try to express yourself when the situation occurs and not let yourself stew about it and dont let a long list of complaints build up before expressing. 7. Try not to overload the person with more than can be absorbed at one time. 8. Try to avoid generalizing statements such as you always or you never. 9. Focus on the specific behavior on hand Example: I need more intimacy in our relationship not you are never intimate with me 10. Timing is very important. Try to express yourself when the listener will be receptive. Use I statements instead of you statements 11. If the other person does not hear you, be persistent. Calmly repeat your expression over and over until you are heard. 12. Dont call names, accuse or put the other person down. 13. Be clear, specific and direct with assertiveness statements. 14. Confront diversion tactics when necessary. 15. Express your anger in a healthy way. Example: I get very mad when you do that I am very angry I am furious not you are a F----- A--- or You are such a jerk

Basic Assertiveness Pattern

1. Describe the persons behavior 2. Express how you feel about it 3. Identify changes you would like Example: I feel______________ when you ___________ and I would like _________ to happen.

Keep in mind that if this is a new behavior for you that people around you may not like it. They will be used to the old you and the old way you interact and may respond to your new found assertiveness with resistance, anger, or manipulation. They may try to manipulate you back to your old ways of interacting. Some people are very uncomfortable with someone who is honest, up front and expressive and again you may be met with resistance, rejection, anger, or manipulation. Dont let this inhibit you. Do what you need to do for yourself