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Assertiveness: A Tool for Reducing Symptoms
Presented by Bruce Campbell


We talk a lot in the self-help program about factors that intensify symptoms, things like the push/crash lifestyle, poor sleep, and stress. But one factor that often gets overlooked is lack of assertiveness. If we’re not able to stand up for ourselves and our needs, we’re likely to find it difficult to say “no” to demands that take us beyond our limits.

Unfortunately, being ill can make it difficult to be assertive. We may feel dependent on others or fear that we will be abandoned. But to protect our health, we need to communicate our limits to others in a way so that the limits are understood and accepted. In other words, to be assertive.

Three Communication Styles

Let me explain how to do that by contrasting assertiveness with two other styles of communication: being passive and being aggressive. After that, you’ll find an assertiveness success story.

In the passive style, people are hesitant to speak up for themselves and have difficulty expressing their feelings and opinions. They may feel that it is selfish to ask for what they need.

As a result, they may feel anxious, helpless and resentful because their needs are not being met. Sometimes grievances build up, leading to explosive outbursts. The outburst may lead to shame and guilt, which in turn leads back to being passive.



People using the aggressive style act in a way that is disrespectful of others. People who are aggressive often try to dominate and control others, using criticism and blame. They use intimidation to get their way. They are unlikely to use a phrase like “let’s have a win/win solution.”



The assertive style, in contrast, is one in which a person states her feelings and positions clearly, and advocates for her rights and needs, while being respectful of others and their rights and needs. People who are assertive create an environment conducive to mutually-satisfying solutions. 

Assertiveness Success Story

A person in our program, who I’ll call Mary, recently had a situation in which these communication styles played out. During a discussion on assertiveness, Mary, who has severe CFS, described a pattern of passivity and said she wanted to use the occasion of our discussion to learn about assertiveness and apply it to one relationship in her life.


The trigger was a visit Mary had from a friend named John. He stayed for six hours, way more than Mary’s body could tolerate. Because John had driven an hour to get to her house and fixed lunch, Mary was reluctant to end the visit when her body starting crying out for rest.


An irony in the situation is that he has made equally-long visits weekly for more than a decade, so there was a long-term pattern of passivity. Mary reported that the visits had been using up all her energy for the day of the visit and also some of the energy required for the following two or three days, meaning that she began each week in an energy hole.


The price of this particular visit, in combination with the discussion in our group gave her the motivation to work on restructuring their time together.


She told the group that the visits had been very important to her and she views the friendship as very special. She wrote: “I have been largely housebound for a long time and a lot of people have drifted away, but [John] has remained a loyal and understanding friend.”


She said it was tempting to say “your visits are too costly and I wish you weren’t so terribly negative sometimes because it drags me down.” But she dismissed this aggressive statement, saying her goal was to find a new way to spend time with her friend that “maintains the friendship and respects his needs and feelings, but which doesn't knock me around.”

In sum, she had a long-term pattern of passivity, which had been costly to her and a temptation to be aggressive in response, but a goal of being assertive.

Finding a Solution

Although initially she was not clear about how to proceed, she knew that she wanted to find a way to explain to her friend that the visits were costing her too much. She also wanted to think about what alternative would work for her and believed it would probably involve an earlier start, a shorter visit, and her taking one or two rest breaks during their time together.


She asked for suggestions from the group and was particularly grateful for one of them, a model of assertive communication. It stated Mary’s views, was factual and respectful of John, did not blame him for the relapse and invited him to work with her to find a solution.


John, your visits have been incredibly important to me and your friendship is very special. I have been housebound for a long time and a lot of people have drifted away, but you have remained a loyal and understanding friend and I can't tell you how much that means to me.

But right now I am in a relapse and I hate it that physically I just can't handle a five hour solid visit, much as I would like to and as much as I appreciate your coming.


I have been reluctant to bring this up because I am scared of hurting you or losing your friendship. Can we brainstorm together and come up with some ideas where we could enjoy each other's company, but in a way that it doesn't make me feel worse?

The Outcome

Mary reported back to the group a week later, in an email titled “Assertiveness: I did it!” She said she had a discussion with John, and began by telling him how much his friendship and loyalty meant to her and how much she had enjoyed their times together.

Then she added that the visits had been using up all her energy for the day of the visit and beyond. She added that she wanted to discuss how to change the visits so she could stay within her limits.


Working together, they came up with a plan to break the visit into two parts with a 1 1/2 hour break in the middle, where John reads the Sunday paper and she retires for a rest. In addition, Mary would take two 15 minute breaks.


Mary told the group that the experience had been “life changing. I am now fully set up for living within my limits and therefore improving my health, and I have experienced how gentle, caring and cooperative assertiveness can be.”

Reporting back to the group a year later, she said that the visits had worked out as planned.