Thursday, July 7, 2016

Coping Skills

Chapter Nine
Coping Skills
If stress is the body’s normal reaction to challenges and changes, then behavior, whether positive or negative, is the person’s way of coping with that energy.  Sometimes that coping is adaptive, healthy, and legal. Sometimes it is maladaptive, unhealthy, or illegal.  Sometimes it is self care.  Sometimes it is self harm.  We know what is good for us and what is not.  The goals are reducing harm and increasing functioning. Having faced those experiences head-on, it is time to return to calm and a sense of safety.   This is the pattern or rhythm I try to achieve within a session or from one session to the next.  I return to the client’s list of strengths and achievements to highlight what is already working.  Self-help books and the internet are full of coping strategies; from healthy eating to exercise; journaling to meditation; music to hot showers.
With families and children I introduce these ideas by drawing an “angry volcano”.  I describe anger as a secondary or superficial emotion that we see at the top outside the volcano but below inside, the hot lava holds the primary or deeper emotions.  “It looks like anger, but it’s really….”, and the client, with support, lists frustration, confusion, sadness, illness, embarrassment, and so forth.  This is part of developing emotional intelligence, figuring out what we really feel.  It also helps the parent or others develop a different response to the client.  Rather than reacting to the anger we think we see by misunderstanding, judging, and rejecting, we can respond to the underlying feeling by accepting, empathizing, and connecting.  On the sides of the volcano I draw “vents” and explain that while some volcanos “blow their top” destroying people and property including the volcano itself, other active older volcanos never blow their top because they have vents to “let off some steam”.  Then we list the things the client likes to do to let off steam. 
Healthy coping means expressing not suppressing emotions.  To that end, I demonstrate and guide children and parents through an exercise designed to discharge emotion.  I have used large wet sponges thrown against an outside wall of the building or soft foam balls thrown at the door inside the office.  I ask clients to verbalize what makes them angry while throwing the sponge or ball.  The physical release and the sound of the sponge hitting the wall are satisfying.  I encourage children to “let the anger go” even if the anger seems directed at parents over petty disputes.  However, parents need some limits.  This is not the time for them to express their anger at their children.  Instead, like the role plays parents validate their child’s anger, speaking for the child, using “I statements”.  I connect the trauma history to current emotions by expressing anger for the child about, “leaving my first Mom and Dad”, “getting hurt in foster care”, “not seeing my brothers and sisters”.  We return to the activity often, sometimes with children saying they need it, and suggesting it as a regular preventative routine before emotions become overwhelming.
If the goals are building connections and co-regulation then theraplay is an effective intervention.  Because parents and children communicate emotionally before they communicate intellectually, theraplay emphasizes the experiential nature of this connection.  Theraplay replicates the parent-child relationship across all developmental dimensions; social, emotional, physical, and cognitive.  I introduce the four styles of theraplay; structure, challenge, engagement, and nurture.  Each allows the parent to introduce an activity and interact with their child playfully in a way that may not be routine in an average family focused on homework, chores, and bedtime.  Structure addresses the parent’s ability to set safe limits the child can accept.  I have the parent measure the child’s body; height, arms, legs, ears, and smile.  We play a version of “Mother may I?” in which the child is encouraged to jump on one foot, pat their head and rub their stomach, or do jumping jacks until the parent says to stop.  Challenge allows the parent to set expectations that stimulate the child’s development.  Parent and child walk across the room holding a pillow between them.  The child balances a pillow on their head and walks carefully to dump it on the parent’s lap.  Engagement fosters social interaction.  The parent applies band-aids to the child’s bumps and bruises or the two create a special handshake.  Nurture meets the child’s needs for affection.  The parent feeds the child a bottle and applies lotion or decorates the child with tin foil.  While talking about problems may become overwhelming, theraplay returns the parent-child relationship to playfulness and soothing.
Play and relaxation provide great coping for all clients.  For children play is not an escape from problems but a way to make sense of them.  Whether they are drawing pictures or making crafts, children almost always reveal themselves.  If a parent can learn to interpret the play as the child’s language communication and connection happen.  Returning to the example of the parallel drawing I encourage parents to be both the leader with theraplay and the follower with creative play by noticing and describing the child’s activities as if they are a “play-by-play announcer” or “sports color commentator”.  Board games that include “thinking, feeling, acting” cards or the terrific Ungame provide both the safety of the structure of taking turns and the freedom to express concerns.  The magic of The Ungame is that when the session seems to stall the game takes a family back to the very concerns and issues they have come to address, even if it is just the way they communicate and work together.  Parenting requires both up regulating and down regulating.   For movement I turn on the music and encourage parents and children to dance or do yoga poses.  The small percussion instruments allow parents and children to express their emotions from loud to soft and “speak” to one another with rhythm and sound.  I lead parents and children in progressive relaxation.  “Stiffen each part of your body starting with your toes and going to your head, making each one like a piece of wood or stone, then go ‘soft and floppy’”  Parents check the child’s body and we repeat.  Both children and adults enjoy guided meditation and relaxation breathing either led by me in session or using applications and websites like and Franticworld, com.

The Power of Silence
People and parents often feel the need and responsibility to take charge, to lead, and to teach.  We most often do so by giving directions and explanations.  Talking yields diminishing returns.  We help children and partners self-regulate by lending them our self-control.  In their anxiety they often draw us in to an endless escalating discussion we feel we must win by repeating ourselves with increasing determination. When we lose our self-control, the anxiety level goes up.  When we “lose it” we lose our power.  In these situations silence seems weak, as if we are giving in or giving up.  It is difficult to realize that doing nothing is doing something; that saying nothing speaks volumes.  Conscious use of silence is a powerful intervention.