If I could go the rest of my life without hearing the words "coping skills," I think I would be a much happier therapist. In the counseling world, this little phrase is rampant. And don't get me wrong; I don't despise coping. But much like John Oliver's recent spotlight on the use of the "prosperity gospel" in the church, I find the same issue with "coping skills" in the therapy office. It simply doesn't preach across the board.
In my graduate school training, if I were to combine ideas from differing models, I had to ensure that they fit together and worked toward the same goal in a similar way. I find the same to be true with how to address different problems that come up in therapy. I like to believe that my model (or at least my framework for change) is the same for any particular issue that might arise in my therapy office, which is where coping skills become an issue for me. I never thought I'd use Taylor Swift as a reference for anything to do with counseling, but, in her recent hit, "Bad Blood," she has a line that speaks perfectly to this idea:
"Bandaids don't fix bullet holes."
Simple. Poignant. Perfect example of how some therapists use coping skills in therapy. In my course of therapy, I will ask questions about attachment, how my client has felt safe over the course of his/her life, and how someone provided that safety. I am yet to hear someone say, "Yeah, my deep breathing really helped me feel safe after my sexual abuse" or "You know, nothing really helped except that thought stopping. I just didn't think about it, and I felt so much better. It never came up again." You know what I do hear? "I felt so scared. I didn't know what to do, but when I went to my grandmother's house, she would make me pancakes and let me sit on her lap. She'd hold me and say she loved me, and I just felt like everything would be all right" or "I didn't have anybody there. I didn't know how to handle anything going on, but I would go ride my horse. He was the only thing I had that made me feel not so alone." Whether it's trauma or abuse, loss, depression, or marital strain, my clients have genuine pain. John Green says, "That's the thing about pain; it demands to be felt." I cannot and will not sit with someone in her/her pain and apply a bandaid to a gaping, untreated wound. There is already so much pain and shame surrounding events in my clients' lives; how could I even add to it the responsibility to cope with it on their own?
Connection is vital to coping.
Clinicians are spending ample time treating symptoms of a problem that can only be "fixed" by connection and secure attachment. We are not designed to handle pain alone. There are brilliant reasons for for recommending these skills, though: when someone is securely connected, his breathing naturally slows down just by thinking of a safe person. We become more resourceful, more creative to solve problems, and more able to access skills (Johnson, 2010). So here we are again attempting to assign what only comes naturally from secure connection. It doesn't go both ways. While it makes sense to tell someone to use a coping skill because that's what happens to healthy people when they are able to cope, it won't work over the long haul. That need for connection is still there and will inevitably come up, which will then signal the therapist to inquire about using coping skills, which then shames the client for not being able to handle her/his own emotions, which triggers more emotional instability because of the lack of secure connection, which carries this cycle on and on... until that client is labeled "crazy" or "borderline" or "too much." That's what Bandaids do to bullet holes; they may hold back the bleeding for a little while, but they won't ever address the pain.
We have to stop blaming our clients, even indirectly, for hurting. Isn't it why they come in in the first place? Our culture is obsessed with coping with problems but never actually dealing with them. Our job is to step into their pain with them, not to apply bandaids, but to feel it with them and say, "This hurts so badly. How are you able to deal with this every day? I want to fight for you in these places. You deserve to have someone there with you when it comes up like this." That is the fix: jumping into the pain with them, validating their experience, and making sure they know that someone is there for them in the middle of their struggle.
That's what will preach across the board.
And though pain demands to be felt, the fix is not to feel it alone.