Wednesday, August 10, 2022

"Not a coping skills kinda therapist"

Recently, I've been hearing more than ever before the phrase, "coping skills" as it relates to therapy. And each time, I have the same basic response, which is, "I'm not a coping skills kinda therapist." And of course I explain what I mean by that, but I thought I'd comment on it here too.

Of course, to a certain extent, "coping skills" can just be a buzz word (phrase?) that takes off, which I assume has happened lately. And, of course, all therapy does include increasing coping skills in one way or another. But, when I say, "I'm not a coping skills kinda therapist," I mean that I'm not a therapist whose focus is teaching this or that coping skill. I guess my thought process is that, essentially, one can read a book and be taught coping skills, so why would I be charging people to do the same?

That probably means I should find some really good coping skills books, but, I promise, I tried for years to read self-help books so I could recommend them, and I just cannot. I mean, do you want to read about your work during your free time? No, me neither...

So, if I'm not a coping skills kinda therapist, what kinda therapist am I? Well, in graduate school, we had to "defend" our therapeutic approach prior to them letting us go out on internship. I had a firmly held belief that Interpersonal Therapy and Cognitive Behavioral Therapy worked together in eating disorder treatment. Now, I was warned to never try to defend this at the time. Butttttt, I'm stubborn, and it genuinely was my approach to therapy, so I did exactly that. And, against all odds, I passed. Shortly thereafter, it became more mainstream to see these two approaches, previously seen as somewhat opposite, as blending well. Whew!

It's been a long time since graduate school, and I work very hard to not speak in psychobabble, so here's a very short blurb of how I see IPT and CBT going hand in hand in ED treatment: Interpersonal therapy basically looks had how relationships have impacted a person (the very, very short version) and sees healing as existing in relationship. CBT challenges your thoughts and behaviors (pretty obvious how that applies to EDs). I believe that our experiences in our relationships impact our thoughts and behaviors. (Believe me, I had to say more than that perfectly clear sentence to defend it a the time!!) And, I believe relationships are what have the power to provide healing.

So, early in treatment, I am more CBT. The behaviors must change for reasons thoroughly discussed in other posts. But, the other focus is building a relationship where what I say matters, and a relationship in which healing can occur. And that is anything but "coping skills kinda therapy." I can teach a coping skill without any real relationship; again, a book can teach a coping skill. But, what I hope to be able to do is understand someone on a deep enough level that I can help them to make lasting change.

(On that note, if you ever want what I believe to be a massive challenge....try writing what you hope to accomplish as a therapist without sounding like a fluffy...well...ball of fluff. It's not easy to put into words.) 

I will tack on...I do also believe both IPT and CBT help someone work through PTSD also, though believe it is MUCH MORE about the IPT and also body-focused therapies advocated for by Bessel van der Kolk and Peter Levine. 

Social Media Often Seems Socially Acceptable Bullying

 My dressage coach yesterday told another rider and myself to be sure to watch a particular ride from an international dressage show. I had been following scores, but had not watched any specific rides, because....as awful as this is to say.....dressage is not the most fascinating thing to watch, and I have watched A LOT of Grand Prix dressage by now. 

So, I went and watched, and it was fantastic. But, as I explained to my coach today, these major events bring up two sides for me. One, watching the experts at riding can be phenomenal learning, whether it's what "to do" or what "not to do." But on the other hand, each major events brings the "armchair equestrians" out in droves, and, boy, are they brutal online.

I'm an amateur equestrian, which I think might well be synonymous with being an insecure equestrian. This sport is like none other; because you do not have full say over what is going on, and perhaps could argue that the 1000lb animal might truly have the most say, you literally never truly know "how to do" the sport; we are all truly always learning. And, it's a sport we can only practice so much each day; our partners can only tolerate 30-60 minutes per day, so there's no practicing for hours like there is in other sports. And, lastly, what an expensive sport! So, us amateurs work too; I am lucky to ride two horses per day. Many only ride one. Put all that together, and I would argue it's very hard to feel confident, and many days, competent. 

So, I read the things that people say about the riders at the top....topics include to what extent they are abusing the horse, how awful they are as riders, how awful their training methods are purported to be, how the judges are not looking out for the horse, which leads to arguments that dressage is abusive and should not occur. I just watched a video that proclaimed that this one lesson by this one trainer for this one rider was evidence of "the downfall of dressage." Sheesh!! For one who loves her horses, this leads to a major internal "aaaack," as I then wonder, "Wait, am I like that? Do I do that? Do I do that and not know I do that? Is the sport I love actually abuse???"

And, when people stand up to the bullies, they are told, "So, you don't care about the welfare of the horse?!" Oh boy. Okay. Well. Essentially, it never ends. And yet it's so easy to get sucked into reading the threads, in hopes that eventually it will all make sense.

That has led me to assume those that rise to the top of this sport must be very brave individuals, as they are literally signing themselves up to be judged in a public forum. And not just by the judges they pay to ride in front of, but everyone with various agendas on social media. And, to be fair, I think this applies to any one of us, at this point, in a public role, because the bottom line is, if you put a human behind a screen, particularly without their name attached to their words, that human might very well be brutal.

Before social media, word didn't spread like it does now. There were not venues for trashing other people, building up into a frenzy at times. Yes, as a rider, I do observe those at the top and have my own opinions on what I like to see and what I do not, what I want to emulate and what I do not. I had that same experience with my first experience in the eating disorder field too; I learned what I'd never do in addition to things I continue to put to practice to this day. But it's hard for me to imagine sharing my views other than to ask my coach if what I'm thinking has any validity at all! But, whew, some people really get into it online, for sure.

But, here, I am talking about adults. Now, imagine it's a teenager, or a pre-teen, trying to figure out how to navigate what is being said online. They all think they can handle it, and I assume most will never experience the worst that is out there. But, for those who do? Sheesh, if reading strangers' reactions to the top riders can actually make me ponder whether riding my horse is abuse...well...I guess I just have to assume that a teenager can easily end up questioning themselves too. 

My coach told me today, as I explained all of this, "You have to not read that stuff," and I guess I believe that might just well apply to the vast majority of social media. Humans are brutal when they are behind a screen, and I will continue to encourage everyone to go back to the "good ol' days" where interactions are face-to-face, not keyboard to keyboard.