I began explaining, “I should have….,” when a friend interrupted. Don’t should on yourself! Let’s explore the risks and benefits for patients of this directive.
The semi-humorous phrasing was coined in the 1950s by American psychologist Albert Ellis, PhD, a pioneer of cognitive behavioral therapy (CBT). Here, “should” means “obligation, duty, or correctness.” Ellis’s intention was helping patients escape the burden of irrational “shoulds, oughts, and musts” that carry judgment and often lead people to unhealthy conclusions about themselves as failures, unworthy, bad, or worse.
It matters whether we’re talking about...
Actions: I should do XYZ
Thoughts/Feelings: I should feel XYZ
Milestones: I should have achieved XYZ by now
Let’s focus on actions in medical settings. If a “right” or “best” action exists, telling myself, “I should….,” empowers and motivates me to proper action because of the implied ending: “to increase my chance of achieving the desired outcome.”
Whenever clinicians say to me, “You should…(do this),” I’m grateful for the definitive direction. I want their judgment on what I must do to help achieve our shared goal of the best outcome.
If, for whatever reason, I didn’t take proper action, saying to myself, “I should have….,” acknowledges and takes ownership of the lost opportunity. Ideally, the judgmental weight of “should-ing on myself” prompts self-forgiveness and renewed commitment to taking proper action in the future.
As a patient in pursuit of Healthy Survivorship, telling myself, “I should….,” helps me get good quality care and live as fully as possible.
Next: If not happy with what you’re feeling, don’t should on yourself.
Albert Ellis, PhD
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