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How Do You Manage Other People's Expectations Around Your Illness:

Three new roles that can flip the script.

By, Teresa Jansen, LPC

I was sitting in a little café west of Portland with a beloved friend recently, who asked me:

"As a therapist, do you have any thoughts about how to manage other people's expectations around chronic illness?
Short answer? We can't.

Ultimately, none of us can "manage'' other peoples' needs or expectations. A wise therapist once told me: "we can't 'think, feel, or do' for others, only for ourselves." But that's not to say that we don't all try, at times. Managing life with chronic illness or mental health challenges means constantly attending to your "spoons" (a metaphor for the finite energy we each have for any given day, despite what others may expect or demand of you). We can do our best to respond to other people's thoughts, feelings, beliefs, needs, or behaviors, but we can't "own" them. Trying to "manage '' anything outside of our own "lane" means operating with a lot of limited assumptions. Especially while managing a finite number of spoons, trying to "manage other people's expectations'' may be a quick recipe for disaster.


To understand the danger of assumptions: imagine a herd of Zebras across a wide Savannah. Across the crowd, suddenly a distant zebra's ears jolt up straight. Clearly, the crowd assumes something is happening. But each guess is just that; a guess. One zebra assumes, "Danger! He must see a lion!" and sprints the opposite direction ... and right into a swamp of alligators. A second zebra assumes, "Huzzah! He's excited. He must see some good grass!" And sprints forward past the crowd ... and right into a hungry lion. A third, wise zebra walks up to the first and simply asks, "Can you tell me, why are your ears doing that?" To which the first zebra replies, "Oh, I was just twitching away a fly." So they stand together, happily swatting flies and watching the sun go down.

Humans are not that different from zebras. We are designed to live in a community, have many similarities, and based on our worldview, are quick to make assumptions to conserve energy or survive. But, like the wise zebra, if we want to thrive, we need to include ourselves among the "list of important people to pay attention to" when it comes to noticing our own lives: attuning our own experience, thoughts, feelings, needs, and then choosing what to do next.

Calling all people-pleasers: we need to to stop assuming, rescuing or fixing others.

If someone is asking directly for your help to process their problems or feelings (and it's within your role, current energy, and ability to do so): for the love, stop working harder than they do on their stuff. Period. It just doesn't end well for either person.

While these are "tricks of the trade" I've taken to heart as a therapist, more importantly, they are lessons "hard won" through my own battles of the mind and as a recovering people-pleaser. After a particularly brutal battle with postpartum depression, I needed to re-learn how to attune to my own thoughts, feelings, and needs, and change the script with how I interacted with others like my life depended on it, because at times, it nearly did.

Torbay and S. Devon Writers' said it well: "I had to learn, painfully, through a broken marriage and the trauma of a daughter addicted to heroin, that in attempting to ‘rescue’ my nearest and dearest – i.e. save them from themselves – I was merely trying to fulfill my own definition of love. Real love, as I later discovered, sometimes demands that we ‘let go’ and facilitate self-responsibility in those we love (From Shine a Light on Life, August 2020).

Sound easier said than done? Don't worry. We're going to break it down.


When it comes to managing other people expectations, particularly through chronic illness or mental health challenges, there are three common archetypes, or "roles" people play, popularized in the 60's by Stephen Karpman's "Drama Triangle:" the "Victim," the "Persecutor," and the "Rescuer." Understanding these archetypes have helped many people learn new ways to manage conflict in their relationships. These archetypes, though well-meaning or even adaptive (helpful) in their most natural state, can quickly unravel into dysfunctional behaviors under severe stress or trauma. Now, we all "switch" roles from time to time (and sometimes hour by hour) but there tends to be a "lane" we're most comfortable in. I wonder if you can recognize, in yourself or others, some of the roles listed?

VICTIM "Poor me." Fears failure, but feels powerless to change (may also fear success).

To be clear, we're not talking about - nor minimizing - "real" victim moments, such as someone in the throes of a violent relationship, famine, or war. Rather, the Victim is a mindset that, despite a person being technically safe, leaves them feeling trapped, helpless and hopeless. They see adversity as "personal" and feel caught in the current of life happening "to them." They drift along as a helpless observer, unwilling to take responsibility for any areas they'd like to change (as they don’t think they have the power to do so). Victims blame the Persecutors and seek Rescuers to solve things for them. When you're around a Victim, they may only see you as a Rescuer or a Persecutor.

Example: "I don't understand why you won't help me today, I thought you loved me!"

PERSECUTOR: "It's all your fault." Fears being vulnerable. Focuses on problems.

Persecutors are bullies who think they have all the answers, much like an overly critical parent or partner. They are harsh, good at finding fault, and control others with very rigid, often changing "rules." They may feel pressure to win, whatever it takes. Persecutors blame the Victims, and criticize Rescuers (without providing any genuine guidance, support, or solutions) and keep Victims oppressed. When you're around a Persecutor, they may only see you as a Victim or a Rescuer.

Example: "Why are you always in bed, if you just did X, you'd feel better by now."

RESCUER: "Let me help you." Fears not being needed. Seeks to relieve pain.

We'll spend a little more time here unpacking the Rescuer today. Why, you ask? Because people who ask (or read an article about) "How do I manage other people's expectations" are typically Rescuers at heart. While you may or may not align with the Rescuer, you certainly know one: a Rescuer is an ultimate "people-pleaser." This fairly "innocent" sounding presentation can become terribly toxic over time. People-pleasing means putting someone else's needs ahead of your own, but often to your own detriment, and without asking the other person if they even want or need your help. People-pleasers are often highly attuned and empathetic to others, seen as agreeable, helpful, or kind. However, empathy has its downsides, and can lead to enmeshed or poor boundaries over time. They often have trouble identifying or validating their own needs, and struggle to advocate for themselves, which can lead to a harmful pattern of self-sacrifice, self-neglect, fatigue, or bitterness ("But I did all of this for THEM!"). Furthermore, their relentless "savior" mindset resigns others into opposing, two-dimensional roles: that of either the Victim or Persecutor. That is to say, when you're around a Rescuer, under conflict, they may only see you as a Victim or Persecutor. That means that, while they'd never admit this as a goal, Rescuers also work to keep Victims oppressed, and to keep the Persecutors in place. (If there were no Persecutors or Victims, after all, who could the Rescuer rescue?) Their ultimate fear is not being needed.

Example: "Don't worry about the DMV tags or your late taxes, I've got it!"

Something I'll often share with clients who are on their own journey through the people-pleasing drama:

You don't have to suddenly drop everything and figure out how to "not care what others think or need." Just start by adding yourself to the "list of important people to notice," too.

I was recently working with a recovering people-pleaser in my practice: a sweet, older client who was exploring feelings about getting "back out there" in the dating field: "I just spent all week in mental agony trying to figure out whether or not this stunning-looking person I've been dating wanted to sleep with me. But by the end of the week, I finally asked myself, 'do I even like them?' and it turns out, much to my surprise, I don't!"


It might be helpful to pause here to acknowledge: the "Drama Triangle" exists for a reason. Since the beginning of time, our ancestors were excellent at conserving energy as a means to survive. The "Drama Triangle" reflects that skill: our tendency toward quick "fight, fight, freeze, or fawn" and "black and white thinking" that leads to quick (albeit all-too-often erroneous) answers. It's still a common symptom and response to trauma today. If the Drama Triangle "game" is kept in balance, then all parties involved can continue to "conserve energy" by acting out of those "black and white" roles. Short term, it helps us cope by feeling comfortable in our old roles derived from an old trauma, family system, or worldview. But long term, it can certainly lead to more harm or suffering. As we grow older, we can "unlearn" those roles, to adopt more natural and adaptive roles as we relate to others.

Some perceived benefits of "drama:"

  • The Victim may not appear to feel self-pity, they may actually feel like a winner at all times, enjoying the attention of the Rescuers, even enjoying appearing "strong" in the face of a Persecutor (despite continuing to funnel energy into proving to others how weak or helpless she is, while finding limited success nor real connection in life).

  • The Persecutor may continue to feel strong, finding a degree of happiness in control or personal successes. (But as a relentless bully, the Persecutor is resigned to live life alone, or among "false friends" and "yes people" too scared to challenge the Persecutor off of their self-righteous tower).

  • The Rescuer may continue to feel "helpful" and in-control, finding a degree of happiness in "helping" or watching others succeed. (But they often feel undeserving or powerless to help themselves find a fuller purpose, successes, or mutually satisfying, empowered relationships.

Our job, then? Learn to recognize the "game," and in time, refuse to play out those unhealthy archetypes. It may infuriate the Persecutors. It may terrify the Victims. It may confuse the Rescuers. Still, when you can, put down the "tug-a-war" and refuse to play. It's time we explored our better, more natural roles.


When we refuse to play the game:

CREATORS: Victims return to their natural role of being Creators. They observe what is needed, and focus on effort and outcomes, rather than problems. Creators get clear about their own thoughts, feelings, and needs, and take ownership for initiating behaviors to achieve those desired outcomes. Creators are innovators who don't waste time comparing themselves to others, rather, accept what is, engage with humility, and enjoy finding new ways to grow and contribute, again and again.

Example: "Assertive Repair"

"I feel __ when __ happens. I need __ in order to feel ___, heal and grow."

"I feel hurt when you compare your week with the flu to my illness. I believe that you care, but I need you to just reflect what you hear me saying a few times, so I can feel like you hear me, and can engage in this conversation again."

*In this example, a Creator owned their part in a relational rupture before it became something bigger, and invited the other person to work together on repair.

CHALLENGERS: Persecutors return to the natural role of Challengers. They notice and attend to their own stuff, and are good at noticing other people's (or organizations) strengths and limitations. They challenge assumptions and the status quo and focus on strengths, growth, and development. They lift others up instead of criticizing, blaming or shaming, and hold Creators accountable to connect, grow, and succeed in healthy ways.

Example: "Switching Roles to Grow"

"I feel like we're mis-firing a little bit here - I wonder what would happen if we switched roles for a minute? Will you try?"

(A tired person now acting as the friend)" It sounds like you're really tired today. I'm really glad you're here with me, and I'd love you to stay as long as your energy allows it."

(The friend now acting as the tired person) "I do feel sad today because I wanted to stay longer, but I'm just too tired, could we wrap up in 10 minutes or so?"

*In this example, a Challenger moved through the discomfort of feeling mis-heard and challenged the friend to try new way to see things from another point of view.

COACHES: Rescuers return to their natural role of being Coaches. Coaches have experienced enough hardship or life experience to carry sincere compassion for others, and they believe in Creators. They empower others by helping them build awareness, plans, and action. Coaches encourage individuals to identify and come up with their own solutions, instead of "fixing it" for others. Instead of swimming in empathy ("I feel what you're feeling, so much that I wonder if I AM you!") Coaches can engage with compassion ("I'm deeply moved to action by your experience, while maintaining a sense of being separate, beloved, and whole."

Example: "It sounds like you're really upset with your messy roommate. I know you really value keeping the peace with people, what have you tried so far? ... "Would you like any help practicing what you want to say with them?"

A Coach can encourage people to speak-up from a strengths-based point of view.

"The Floor"

There is a helpful exercise where two people work to resolve conflict by one person first having "the floor," speaking to their own experience briefly, then letting the other person reflect what they heard. Then they switch turns so the next person has "the floor."

A - "I feel unhappy when there's a lot of dishes in the sink at night, because it makes me feel unsafe - I had a lot of germs and ants growing up. I don't have the energy or interest in cleaning up after others right now, but it's really hard to feel relaxed at night."

B - "It sounds like you feel pretty unhappy and frustrated about the dishes, is that right?

A - Yup, you got it.


B - "I feel a lot of pressure about the dishes, because my brain fog doesn't always allow me to remember to clean up after myself right away, especially when I'm studying all night. Sometimes I prefer to do the dishes in the morning when I feel "fresher," and I wonder if that's an option here?"

A - "It sounds like you care, but really prefer to not do the dishes at night, is that right?"

B - "Yup."

From there, now that everybody feels heard, they might move to working out a collaborative solution.

*In this example, a Coach encouraged a friend to remember their strengths, and asked if they wanted to practice a healthy conflict resolution.

Trying to "managing other people's expectations" will likely lead to more fatigue, hurt, or anger. But with time and practice, we can all begin to identify "old roles," own the ways that they may have caused harm and discover our strengths as Creators, Challengers, and Coaches: new ways of relating to others that can leave everyone feeling stronger, kinder, and more connected.

Teresa Jansen, LPC

Licensed Professional Counselor

*All resources provided by this blog are for informational purposes only, not to replace the advice of a medical professional. MTL encourages you to always contact your medical provider with any specific questions or concerns regarding your illness. All intellectual property and content on this site is owned by This includes materials protected by copyright, trademark, or patent laws. Copyright, More Than Lupus 2022.

**The author has protection under these copyrights; however, the words belong to the author and can be used for other creative purposes or for personal archive's. May 2022

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