As a clinician, I have spent years trumpeting the value of self-care, coping skills, and mindfulness practice. Typically, there is a point where I see a client’s eyes glaze over as they dismiss what I’m saying.
What’s the deal? Is it that I haven’t perfected my elevator-pitch regarding the value of self-care? Is it because I’m talking at them rather than to them? While I’m confident there are ways I can refine my pitch, I have also come to recognize that there is a natural resistance to the use of coping skills and self-care behaviors. Let’s take a look at some of the reasons for this resistance, and what to do about it.
It Can’t Be That Easy
Often our clients resist the use of coping skills because they believe their challenges are so complex and difficult that there is no way simple coping skills can be effective. We see this complexity bias in business, medicine, relationships, and even our own mental health. But research actually indicates that often the best solutions are simple and straight-forward.
There are many reasons for this, but one chief among them is the fact that we are more likely to remember simple solutions. (For more information on integrating simplicity, check out this great book Simple Rules: How to Thrive in a Complex World).
While we have no wish to minimize clients’ experiences or to offer simpleton advice to challenging situations, it’s also important to acknowledge that clients are often overwhelmed by their challenges and are seeking help to deal with concerns that overwhelm them and their capacity to cope. One aim of our work as clinicians is to help clients decrease overwhelm, regain hope, and recognize the ways they can—and indeed must—tackle their challenges. When we accept clients’ refusal to use coping skills due to a complexity bias, we unwittingly join them in their overwhelm.
In these moments, I acknowledge the significance of clients’ concerns while also pointing out the research supporting the use of self-care activities. I challenge all-or-nothing thinking. Or the mistaken belief that coping skills are a magic bullet, but focus on these skills as helping to reduce suffering by even a small amount. Consistently using coping skills can reduce suffering, even while we are realistic that clients may continue to struggle despite the consistent use of skills.
Coping Skills Are Just a Bandage, Not a Real Solution
There is often a misconception about the true value of self-care activities or the mistaken belief that coping skills are just a short-term solution to a long-term problem. Not so. This is where a clinician’s understanding of the research is essential to helping clients understand the specific ways coping skills can be beneficial.
I often describe coping skills as a bridge to clearer thinking and less emotional reactivity. For example, slowing down one’s breathing can help an individual de-escalate from a 9 to a 6 on an anxiety scale so that he or she can then enlist additional skills such as cognitive redirection, finding contrary evidence to a fear, and seeking emotional support. Coping skills help clients ground themselves and orient to person, place, and time. As clients ground themselves they are better able to think clearly, identify options, and make decisions consistent with well-being.
Helping clients conceptualize coping skills less as a bandage and more as a bridge to clearer thinking and emotional management may help increase willingness to experiment with self-care.
Self-Care is for Others
Clients often resist the use of coping skills either because they believe they are undeserving of self-care or see self-care as something only weak people need. Underlying both beliefs is shame at having emotional, physical, and cognitive needs.
A belief that one is undeserving of self-care serves to keep individuals stuck as they marinade in shame, feel chronically needy, and invisible to others. Loved ones to these individuals tend to get enlisted in co-dependence as they strive to meet their loved one’s needs, with frustration eventually setting in at their loved one’s unwillingness to take care of themselves.
These individuals are particularly resistant to practicing self-care—the concept may be completely foreign—so you may need to get creative when engaging them in this work. With these individuals I speak less about the personal self-care benefits to them, as the idea that they can or should feel better may feel repulsive to them. Rather, I ask them to engage in coping skills as a way of helping someone else, say their loved ones. Of course, eventually it will be important for them to have some buy-in for themselves and recognize the value of self-care to their well-being, however aiming at this target too directly initially often leads to greater resistance.
Now to the belief that self-care is for those who are weak or lack self-discipline. Although it comes out as angry judgment, shame also underlies this belief as these individuals enlist a hard driving perfectionism as a cure for their “weaknesses.” These individuals fail to see themselves as human and hold unrelenting high standards for themselves. There is a perverse self-esteem gained from seeing oneself as an exception, and the last thing these individuals want to believe is that they are “normal” and require self-care.
Contending with this hostile arrogance can be challenging, but is essential for helping these individuals identify their shame and develop compassion for themselves (and others) as human. In Kristin Neff’s seminal work on self-compassion, one of the three tenets is the acknowledgement of our common humanity. In acknowledging our humanness, we can develop compassion not only for others but for ourselves as well (Her book is a fantastic resource on the importance of self-compassion).
A direct assault on these beliefs is not recommended, as it often leads to a battle of wills. Rather, with gentleness help clients see where there may be a flaw to this logic while never shaming or judging the belief. I often speak in terms of “I can see how you came to believe this” while also asserting how the belief may not be serving the individual. And, even if these individuals tend to be very hard on others, often it is possible to help them identify someone in their life who they believe is deserving of self-care. This identification can help them further challenge their perfectionistic beliefs as they connect with compassion for themselves and others.
I’ve Tried Coping Skills Before. They Didn’t Work
As clinicians, we’ve probably all heard this argument before. I find it helpful to dig into individuals’ beliefs about how coping skills should “work” to disabuse them of magical beliefs, such as the idea that meditation should eliminate all anxiety.
I also take this opportunity to discuss the importance of consistency when it comes to self-care, since often these efforts are done half-heartedly or at the very least inconsistently. I discuss how sometimes the use of these skills may initially increase anxiety (such as meditation), but that consistent practice can serve to decrease anxiety over time and empower individuals to feel more capable of taking on their challenges.
Related to consistency, it’s also important that as clinicians we are consistent with our clients. If we make a strong case for coping skills, give a specific self-care assignment, and then never follow-up about the practice, we undermine ourselves and the potential value self-care can have for our clients. In holding our clients accountable to self-care activities, we convey the importance of these practices and help build more motivation to experiment with them.
Following up with clients on self-care challenges not only provides important accountability, but it allows us to see the gaps in their understanding and practice. We can troubleshoot problem areas while helping them connect to needs and preferences. For instance, sometimes clients approach self-care activities in rigid, perfectionistic ways. Checking out their progress can highlight these concerns as we redirect clients toward more gentleness with themselves in integrating coping skills.
Specific questions can spur valuable discussion. Was the coping skill helpful? What was challenging about doing it? What questions do they have? Did they find something that was more effective than the suggested activity? Following up on therapy assignments is essential for increasing motivation and accountability, but especially relevant when it comes to using coping skills as often there is a gap between when a client begins utilizing these skills and when they start to experience benefit from the activities. Clinician’s encouragement, recommendations, and tweaks can help clients stick with these activities so they get to the point of realizing the value of self-care.
Value of Coping Skills is Two-Fold
When introducing coping skills to clients, I often talk about twin benefits. First, the specific coping skills in and of themselves can be helpful. For instance, strong research support exists for the role of breathing for reducing anxiety and physiological arousal.
Second, and this is the one I find most valuable, is the empowerment that can come with consistently using coping skills. Often when we are flooded with anxiety, dark thoughts, sadness, or hopelessness, we can feel helpless to change our situation. However, as we work to implement even one coping skill, we are signaling a belief that our situation can change, that we can change, and that we are not helpless to our current state of being. Cultivating this belief is critically important in mental health treatment, and one we want to be encouraging in our clients at every opportunity.
Helping Clients Get Started
Here is a great list to get clients started.
Taking the first step to use a coping skill is often the most challenging step, so anything we can do to spur our clients to action on these activities can help build investment in the practice of self-care.
I often utilize a stepwise approach when it comes to coping skills and self-care. I may start by talking about the benefits of a specific practice, such as meditation, or by sharing several self-care options. I will then encourage clients to do their own homework relative to self-care. Google “coping skills” and begin generating a list of options. Ask loved ones what they do to take good care of themselves. Review recommendations made in favorite self-help books.
Once they generate a list of coping skills, I ask clients to identify 1-5 skills they are willing to try out in the next week. I don’t ask them to use the skills daily, but to experiment with them, recognizing that what’s effective for one person may be less helpful for another. At this point consistency matters less than a willingness to experiment with self-care activities.
Once clients have engaged with a few skills, I then ask them to identify 1-3 skills they are willing to use proactively on a consistent basis, say 3-5 times per week. I talk about how different coping skills are effective at different points on the anxiety scale. For instance, thought redirection is much more effective when anxiety level is a 5 and essentially useless when anxiety level is at 8-9. When providing specific assignments on self-care activities, I always bracket frequency so clients have flexibility of thought and approach. Rigid thinkers, perfectionists, or those with OCD tend to focus so much on completing a self-care activity a specific number of times that the point of the activity often becomes lost.
This stepwise approach invites collaboration. Self-care is all about helping individuals attune themselves to their experience. As clinicians, we don’t want to assume we know what will be most helpful for clients. Rather, we want to engender clients’ self-awareness as they learn to identify needs, integrate feedback, and indeed take good care of themselves.
In these moments, clinicians act in a consultant or coach role: providing suggestions, offering supporting evidence and didactics, but ultimately helping clients develop awareness of their own unique experience, learn to interpret feedback, and develop a practice that is sustainable and growth-enhancing.
Physician, Heal Thyself
Finally, our ability to convey the value of coping skills to our clients hinges on our own engagement with these practices. Often clients may resist self-care recommendations if they suspect hypocrisy on the part of their providers. In all things we must be congruent and this is nowhere more true than when it comes to self-care.
Do we as clinicians practice self-care? Are we self-aware and respectful of our bodies, our need for rest, and our need for balance? Do we carry an unrelenting schedule with little time to breathe? There have certainly been times in my clinical career where I was only paying lip service to coping skills.
Don’t get me wrong: I have always seen the value of coping skills, but I haven’t always been great at practicing them in my own life. This incongruence comes through in our conversations with clients. I have found that as I truly make a commitment to my own self-care and well-being, my pitch has substantially improved. I get passionate when talking about meditation because I feel the benefits in my daily life. I can also speak to the challenges I’ve experienced with a mindfulness practice and what I have found to be helpful while always making the case for evidence-based practices.
For instance, I may mention my personal favorite meditation app, while also sharing other suggestions colleagues prefer, and encourage clients to experiment with options as they discover what may be a good fit for themselves. Thus, the conversation is geared toward collaboration, the many ways to approach self-care, and finding fit with self-care activities.
As clinicians, we need to make the case for self-care. As we help our clients carry the work home with them, they will find more motivation, hope, and compassion for themselves.
Resources
Self-Compassion: The Proven Power of Being Kind to Yourself by Kristin Neff
Simple Rules: How to Thrive in a Complex World by Donald Sull & Kathleen M. Eisenhardt.