Westover Heights Clinic - Making Adjustments

L. Ricks Warren, Ph.D., Psychologist
Portland, Oregon

    I am a psychologist in private practice who counsels people with a variety of problems. In recent years, I have become involved in counseling people who are attempting to cope more successfully with having genital herpes. My approach to counseling is based on the notion that our sustained emotional reactions result not only from what happens to us but largely from what we think about what happens. It goes something like this:

    Let's say two people go through a divorce. One person thinks, I am a total failure, and I am doomed to be alone forever. The resulting emotions would likely be depression and despair. The other person thinks I have suffered a great loss, but it is certainly possible to make a new life for myself. The resulting emotions for that person are likely to be sadness and grief, but hopefulness about the future.

    In the above example, two different people have the same thing happen to them (divorce), but they feel quite differently because of their different ways of thinking about their divorce. My approach to counseling, then, attempts to help people in distress identify the particular beliefs that are causing their continued emotional upset. After determining their unhelpful beliefs, we work together to develop more helpful and realistic ways of thinking. The result is emotions that actually help them obtain their goals in life. Since I have been practicing this kind of counseling for the past 20 years, I was not surprised that people with herpes varied greatly in their emotional reactions. Many people take the news in stride, make the necessary alterations in their sexuality, and proceed with their lives without much difficulty. However, some people have more trouble doing this. My goal with these people is to help them discover their specific beliefs about having herpes that are creating their emotional discomfort.

    Let me hasten to add that I am not minimizing the difficulties that herpes presents to some people. As with any change in health status, ones lifestyle may have to be changed in certain ways, and a variety of emotions (like anger, frustration, sadness) are normal, especially in the beginning. However, by changing certain ways of thinking depression, anxiety, shame, and hostility can be reduced so that people with herpes can adjust successfully to this change in their life. What are the main types of thinking that cause the most emotional distress? The specific categories of problem thinking are listed below, with examples of destructive thoughts, along with a more constructive alternative.

OVERGENERALIZING

 
Destructive thought: I am a less worthwhile person since I have genital herpes.
    This type of thinking causes problems because it involves identifying with ones herpes - I am my herpes. Constructive alternative: My worth as a person is not affected by having herpes. I am a person with hundreds of different characteristics, some positive and some negative. Herpes is only one characteristic, not all of me.

    At times, particularly during outbreaks, you may like yourself less, feel like you are less desirable, less attractive. The herpes seems to dominate your thoughts, and you find it hard to remember what your attributes are. But theyre there; just keep reminding yourself about them. No, you arent perfect, but you werent before you had herpes either. People are drawn to you or move away from you for a variety of reasons; herpes is only one of many. Having herpes will challenge you to build on your strengths, and encourage you to look honestly at your shortcomings. Destructive thought: I will never find anyone who will want to be sexual with me, because I have herpes.

    This belief (rather like fortune telling), generalizes from the present to the entire future, with no evidence to support the conclusion. Constructive alternative: Where is the proof that I will never have sexual, long-term relationships? Some people may not want to take the risk of getting herpes, but there are most likely people who will, especially if the relationship is a good one. When some people are first diagnosed as having herpes, they swear they will never have sex again, that the risk of being rejected by someone is simply too great to bear. This kind of thought implies that there is no way you could stand it if you were rejected. What about a life alone? Wouldn't that, in the long run, be very hard to stand (if you would have preferred to be with someone)? How would it feel to be 85, alone, and have to look back and say, Well, at least I didn't give anyone small blisters on their penis/labia? The reality is that once you begin having sex in your life, it is very hard to simply stop being sexual. The frustrations and emotional conflict that arise as a result of trying to become celibate due to herpes may be worse than having herpes. It is important to remember that the fears about transmitting herpes will ease with time, and a realistic plan to prevent transmission will replace the fears. Destructive thought: Lets say I am honest with a sexual partner, and they are willing to have sex with me, even with the herpes presenting a small risk. I would be a terrible person, totally responsible for ruining their life, if they got herpes from me. This belief is an example of over responsibility for another persons right to make choices. It also assumes that herpes would be devastating to them. Constructive alternative: A full life involves risk taking. While I would be deeply disappointed and sorry if an informed sexual partner contracted herpes from me, it would not be my entire fault. Other people have the right to make their own choices and take risks. It doesnt have to devastate their lives. Transmitting herpes is only one risk that you will take in a relationship. You also risk losing someone to an incompatibility in personalities, risk that you will grow apart over time, and risk that issues like money, children, and sex will present irresolvable problems. The list is long, and herpes is only one item on the list.

CATASTROPHIZING
 
Destructive thought: Having herpes is catastrophic!

    This belief usually implies that having herpes is simply too much to bear, and that one cannot possibly be happy in spite of having herpes. Constructive alternative: Having herpes is certainly inconvenient, and an unfortunate hassle. However, other people manage to find happiness (they do, you know), in spite of their herpes, and so can I. If you really think that having herpes is a catastrophe, get more information about the disease. The more you know, the better you can cope. Seeing a counsel or may al so be helpful (further detail in the treatment section.) Having a close friend to talk to will be very useful. Keeping all your thoughts inside can make you feel pretty lonely.

DEMANDING

 
Destructive thought: I should not have contracted herpes, and my infecting partner should not have given it to me

    These thoughts involve jumping from the realistic desire to have avoided getting herpes to the unrealistic demand that such an undesirable thing must not have happened. Constructive alternative: I wish so much that I had not contractedherpes, but at the time I got it, I was unaware that my partner was contagious. We did the best we could given the information we had at the time.
Destructive thought: I should not have to deal with the pain, discomfort, and practical problems associated with herpes. This thought also implies that ones preference for not having to endure misfortune must be granted.
    Constructive alternative: I certainly dont like dealing with the disadvantages of having herpes, but life often deals us unfair blows. It is truly part of the human process. It is not essential to use the specific constructive alternatives suggested above to replace the self-defeating ones, but it is important that you come up with your own believable, more helpful ways of thinking.

    In order to believe the helpful beliefs more than the unhelpful ones, three steps are recommended. First, try to see why the helpful thoughts are actually more reasonable than the unhelpful ones. Second, frequently, remind yourself that the unhelpful thoughts will lead to emotional distress while the helpful ones will lead to emotions that will help you achieve your goals. Third, act in accordance with the more helpful beliefs. This involves facing the discomfort of risking new relationships, if you are currently unattached. It involves not becoming reclusive and acting as if you do not deserve the benefits of sex and intimacy. In summary, herpes itself may involve physical discomfort and impose certain restrictions on ones spontaneity. Many people experience a variety of intense emotions when they first find out they have herpes. Anger, sadness, and confusion are normal. However, if you are significantly depressed or immobilized with fear of the future, there are effective ways of combating these difficult emotions and regaining your confidence. See if you can identify the beliefs that are hurting you and make a concerted effort to change them. For help with this process, I would suggest reading Feeling Good by David Burns and A New Guide to Rational Living by Albert Ellis and Robert Harper.