Beyond "Coping Skills" - Why Your Coping Skills Aren't Working in Trauma Therapy

A key phrase that almost anyone who has ever been in therapy for five minutes knows: coping skills.

I've grown tired with the constant talk about coping skills or mechanisms and grounding techniques in therapy, and my clients have too. This isn't to say that there isn't a place for these powerful tools, of course there is. However, for many survivors of complex trauma and deep relational wounding, what is intended to be a therapist's genuine approach to stabilization can often feel invalidating, unhelpful, detached, misattuned. I have had a growing number of clients meet me and say, "my coping skills aren't working, what do I do now?" Of course, therapists, especially those of us that are trained in trauma-informed or trauma-responsive care know that stabilization is the first step in trauma treatment. We also know how body-based this process is and how vital these techniques are to being able to guide our clients to live full, joyous, and integrated lives.

A growing concept in trauma treatment, but one that is less frequently focused on yet vital to bringing healing to humans across the globe is nervous system regulation. Trauma specialists across the industry are beginning to see the value in shifting their language from "coping" to "regulating." The difference in these two concepts and likely the primary reason why clients are over the "coping skills" phrase is this: "coping" is what we consciously choose to do to navigate tough emotions and experiences, and "regulation" incorporates the ways that our bodies automatically respond to the overwhelming stress.

Early on in my work, I can distinctly remember working with one client in particular. Her upbringing was gruesome - moving from understaffed orphanage to abusive foster care home after the next, eventually struggling with addiction and prostituting at 19 to keep herself and her two children fed. She had little resources and no healthy support systems. She laid all this and more before me during session #1, through tears and long pauses to catch her own breath. As an eager-to-help new therapist that I was, I jumped in with everything that I knew about coping skills. Journaling, breathing techniques, meditation apps, all the things. She nodded quietly. Her eyes glazed over. Nothing was something that she hadn't heard before or tried at least 47 times over. Over time, as I got to know her and read her and see how her body responded to certain conversations - both pleasant and unpleasant - I realized that this was the real beginning. Those coping skills that had been drilled into my own brain, the logical and rational part of my brain, weren't anywhere close to touching the depth of this person's experience. These practices required her to have enough self-regulation to make the conscious choice to do something to try and shift it. To her, that felt like an impossible task that she had already failed at, time and time again.

Coping skills have been a staple of therapeutic conversations for years, offering tools to manage stress, anxiety, and other emotional difficulties. As named above, these strategies definitely have their place but they often fall short of addressing the root causes of emotional distress. They often ask the client to do something that their brains and bodies almost literally will not let them do. For many, it can feel like putting a band-aid on a shark bite.

Moreover, the emphasis on coping skills can unintentionally create a sense of detachment from one's emotions. Encouraging clients to "cope" might inadvertently communicate that their emotions are something to be managed rather than understood and integrated. Focusing on coping skills without education around the brain and body and guidance toward the felt sense of safety may hinder the full exploration of what's underneath the surface. This level of therapeutic work requires a client to feel a sense of control and safety within their bodies at an automatic level. Without this, it becomes that much more difficult in the heat of a moment to remember the 5,4,3,2,1 breathing strategy that your therapist practiced with you last week.

Nervous system regulation delves into the core of emotional healing. Our nervous system, comprised of the sympathetic (fight or flight) and parasympathetic (rest and digest) branches, plays a pivotal role in our emotional responses. Trauma, chronic stress, and unprocessed emotions can dysregulate the nervous system, leading to a cascade of emotional and physical symptoms.

Clients are becoming more and more interested in the why behind what therapists incorporate during session so that they can best integrate the work into their lives. When therapists incorporate nervous system regulation in their work with traumatized clients, they create an opportunity to better attune to their client, get their clients' brains and bodies back to working with one another rather than against, and lay the foundation for clients to truly be able to use the conscious choice parts of the brains and take control of their lives.

By introducing the concept of nervous system regulation, therapists empower clients to understand the profound connection between their mind, body, and emotions. When the nervous system is dysregulated, individuals might experience heightened anxiety, irritability, and difficulty focusing. One of the first steps in this work is to help clients identify these signs and develop strategies to recalibrate the nervous system - not to distract or push the emotion aside, but to find a new way to integrate this part of being human into their lives.

When we shift language and take an approach that gives the "why" behind some of these practices, we empower our clients to create a deeper understanding of their own experiences, therefore experiencing a greater felt sense of control and safety. We can shift the focus from merely managing emotions to truly understanding them and understanding the impacts on our bodies and nervous systems. This shift in perspective not only enhances the alliance between therapist and client, but also equips clients with the tools they need to navigate life's challenges with resilience and self-awareness.

References:

Aust J Psychol. Author manuscript; available in PMC 2014 Jun 1.

Published in final edited form as:

Aust J Psychol. 2014 Jun 1; 66(2): 71–81.

Published online 2013 Dec 24. doi: 10.1111/ajpy.12043

Psychol Rep. 2019 Aug; 122(4): 1192–1210.

Published online 2018 Jun 21. doi: 10.1177/0033294118781855

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