Coping With CFS: Five Capacities of Improvisation

By Patricia A. Fennell, MSW, LCSW-R
Albany Health Management Associates, Inc.

“The Four Phases of Chronic Illness” is an excerpt from the updated 2012 edition of The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life by Patricia A. Fennell, MSW, LCSW-R. Fennell has extensive experience with CFS.

Improvisation, the skill of top artists, can offer new ways to respond better to change (including the vast numbers and variety of life changes caused by CFS, fibromyalgia, or any other chronic illness). In improvisation, we use our existing knowledge and skills to create something new in an unplanned, innovative way. The arts, whether through music, humor, movement, writing, painting, or other methods, can help people with chronic illnesses use capacities of improvisation to develop acceptance and meaning in their experience.

There are five capacities of improvisation that are explored through the arts and which help people with chronic illnesses establish acceptance and meaning in their changed circumstances.

Fennell-21. Tolerate Ambiguity: This capacity recognizes that ambiguity is unavoidable and it’s possible to survive in spite of not knowing what lies ahead. Here, people take the time and allow themselves to feel uncomfortable in order to get where they need to be. They find the patience to wait for the right answer, rather than the quick answer, even if it is difficult. People learn how to do the “emotional heavy lifting” that leads to the wisdom of appreciating the value of the unknown and the understanding that something good can come of even the worst of circumstances.

2. Become Curious: This capacity understands that change is an opportunity and that curiosity leads to innovation and change. Unfortunately, our culture sometimes squelches children’s curiosity, wonder, and risk-taking, often pushing people into conformity. A culture’s toleration of questioning common knowledge, customs, and expectations is influenced by gender, race and social class. For example, someone from the upper, educated and/or wealthy class might be praised for ingenuity in asking why something is done a certain way, while someone from the lower, uneducated, poorer class might be accused of insubordination. Curiosity may have positive (“childlike wonder”), negative (nosy, “killed the cat”), and ambiguous (questioning authority) connotations; context and culture are determining factors on how curiosity is perceived.

3. Take risks: Risk taking can be very difficult for many people. The very act of “sticking your neck out,” intentionally engaging in activities without a certain outcome, is uncomfortable. But without risk, there is no reward. To be successful, risk taking should be conscious or planned, versus unconscious or impulsive. Calculated risk taking is informed by a person’s understanding of his or her physical, mental, financial, etc. limits and abilities. It also is engaged in a manner that minimizes shame, embarrassment, or fear of failure, and has a pre-planned “exit strategy” in case things don’t go as planned. An important consideration in the evaluation of what risk to take is a thorough evaluation of the traditional forms, interventions, or strategies that would be, or already have been, typically utilized. Can they be utilized or referenced in your current situation? Can options/possibilities be reengineered within the traditional frameworks and approaches? Or is it time to stretch these forms/constructs to the point of innovation?

4. Take action: To improvise – to respond in the moment to present circumstances – requires making a choice to take action. This statement or choice results in an action. This action then produces a reaction, to which you must then react, and the cycle continues. The painter chooses to pick up a paintbrush. Then he decides what color to use. Some people wait for that “light bulb,” the “a-ha moment” before making a choice to act; waiting for certainty may mean missed opportunities and stagnation.

5. Innovate: Once a person has been curious, taken risks, made choices, and taken action, innovation is the result. It’s important to recognize that the result – an idea, a paragraph, a picture, a song – whether small or large, is a victory. People should consider tapping into their community to get outside help, such as training, instruction, or assistance, to further or improve their creative expression. In all cases, the chronically ill need to accommodate their limits and abilities throughout the capacities.

Using The Five Capacities To Respond To Change

Using the five capacities to respond to uncertainty, crisis, or change requires first defining the present situation, problem, or crisis. Through artistic expression — music, visual art, writing, drama, etc. — you can apply the capacities to the crisis or trauma you are experiencing. Like the phases of illness, your improvisational capacities change and evolve over time.

An attitude of persistence and fortitude is a key element of the five capacities. This willingness to fail is crucial in developing the self-reliance and resilience in the face of change, trauma, and crisis that are integral with the chronic illness experience. The five capacities also recognize the importance of community, and the ability to borrow from the strength of others when you don’t feel you can persevere.

Patricia A. Fennell, MSW, LCSW-R, is an expert on chronic illness, focusing on how the experience of chronic syndromes and trauma influence the psychological, social and physical experience of the patient and the family. She developed, researched and validated the Fennell Four-Phase Model (FFPM) for understanding and treating chronic medical and mental health conditions, trauma, disability and the effects of crime. Learn more about Patricia and her practice, Albany Health Management Associates, Inc., at


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August 16, 2012