Uncovering the Unmet Need Behind Coping Strategies
I am fortunate to connect with a wealth of clients, each with their own life stories, lenses, fears, dreams, hopes, histories, strengths, and challenges. These diverse experiences paint a distinct picture for each individual—a unique canvas marked by the brushstrokes of their life events, coloured by their emotions, and shaped by the ways they’ve survived and thrived. Despite these differences, a funny thing happens when inquiring into clients' intentions or goals for therapy: individual stories collapse and coalesce into a common theme—a request for coping skills coupled with a yearning to feel better.
Many clients express a desire for tools and coping strategies, a desire that, while valid, might obscure the deeper work that requires attention. In the world of psychotherapy, many clients seek coping strategies to help them cope with life’s inevitable challenges. The aim of coping is the reduction of the negative effects of stress (Hefer & Willoughby, 2017). Coping skills dictate how people respond to stressful situations and how they work through and process difficult experiences (Wang et al. 2020). While these tools can provide short-term relief, they may distract or deny our felt reality and keep us from seeing the bigger picture.
I understand why people seek out coping strategies—they promise relief from the heaviness of loneliness, guilt, shame, grief, and stress. When you're facing these challenges alone, feeling invisible, unsupported, or unsure of how to reach out, the burden can become overwhelming, and can even culminate in mental health challenges like anxiety and depression. I hear your request, and here's how I choose to respond:
When a client asks for a “tool,” “mechanism,” or “strategy,” it reveals to me their deep struggle to manage life’s hardships alone and a desire to lean, or depend on, external comforts. In these vulnerable moments, I see this request as a testament of their bravery and desire for change. It reflects a recognition that old patterns are no longer working and have left them feeling stuck. I view this as a call for support to build a better life and discover new ways to address their pain and challenges together within the safety of the therapeutic bond.
Coping skills—whether external like activities, relationships, or substances, or internal such as self-talk and mindfulness—can sometimes fall short or be difficult to access. A person disconnected from their body may struggle with mindfulness, someone overwhelmed by panic might find breathing techniques nearly impossible, and those who grew up with dismissive or invalidating caregivers may have a hard time acknowledging their struggles or reaching out for support. Even when they find success, these methods may address surface symptoms rather than root causes. Coping might offer temporary relief, but it can also perpetuate a cycle of denial, delaying the confrontation of deeper pain.
A Case Vignette: Sarah Lost in a Sea of Anxiety
To illustrate, consider Sarah, a 29-year-old client who struggles with persistent anxiety and relentless "what if" thoughts. Each morning, Sarah wakes up overwhelmed by panic, consumed by fears about her future, relationships, and even minor decisions; all of which leaves her feeling ‘stuck’. Simple tasks become daunting as her mind races with endless scenarios of potential failure.
In therapy, Sarah seeks relief from her anxiety and hopes to find strategies to regain control over her fears. She specifically requests coping skills and tools to manage and reduce her symptoms.
Putting it into Practice: The Integration of Coping Strategies Across the BETA Model
Effectively addressing Sarah’s anxiety involves using psychotherapy techniques within a therapeutic relationship to address issues related to thought, cognition, mood, emotional regulation, perception, or memory that might impair her judgment, insight, behavior, communication, or social functioning (College of Registered Psychotherapists of Ontario, 2024).
The path to change is a winding journey with many turns. The BETA model—an acronym representing different approaches to therapy—captures this complexity by organizing and collapsing therapeutic modalities into four main focal points to facilitate measurable and meaningful change: Background, Emotion, Thought, and Action.
Background: This approach investigates how Sarah’s past experiences contribute to her present anxiety.
Emotion: Here, we delve into how Sarah’s emotional responses shape her fears and behaviours, and how she interacts with these emotions.
Thought: By identifying and addressing her “what if” thoughts, we work to restructure these patterns, aiming to alleviate anxiety and foster meaningful decisions and actions.
Action: This approach emphasizes practical, time-limited strategies that provide immediate relief and solutions.
Certain modalities integrate coping skills more readily than others. To illustrate, we will compare and contrast two approaches: one emphasizing coping skills and another prioritizing Sarah’s context and using the therapeutic relationship.
Cognitive Behavioural Therapy (CBT)
CBT is a time-limited, present-focused approach designed to alter unhelpful thought patterns to improve emotions and behavior (American Psychological Association, 2024). A CBT therapist would help Sarah identify and challenge anxious thought patterns, such as catastrophizing or overgeneralizing. Techniques might include examining evidence, keeping thought records, and practicing new coping skills. The goal is to reframe thoughts, leading to reduced anxiety and improved well-being. This approach empowers clients to manage their mental health independently, focusing on immediate symptom relief and behavioural change.
Psychodynamic Therapy
Psychodynamic therapy explores the psychological roots of emotional suffering through self-reflection, self-examination, and the therapeutic relationship. It aims to alleviate symptoms while helping clients lead healthier lives (APA, 2024).
For Sarah, a psychodynamic therapist would investigate the origins of her anxiety and its effects on her relational patterns. Within the therapeutic relationship, therapists have the opportunity to observe these patterns in real time: How does Sarah interact with the therapist? How does she attempt to meet her needs, and what does this reveal about her familial dynamics? How does she handle ruptures in the therapeutic relationship, and what might this suggest about her experiences with conflict resolution outside of the therapeutic space? The therapist would also explore how Sarah’s parents responded to her emotional needs—whether they recognized and addressed her anxiety or encouraged her to manage it independently. By considering the impact of past relationships on her current fears and investigating unresolved unconscious conflicts or repressed emotions, the therapist seeks to uncover and address the root causes of Sarah’s anxiety. This approach aims for a deeper understanding, rather than simply alleviating symptoms, helping Sarah feel truly seen and supported as she confronts her fears within the therapeutic relationship.
What’s the Difference?
As noted, therapy can either delve into underlying issues or focus on managing and finding solutions within a client’s capacity. The approach you choose depends on what you’re seeking—temporary relief or long-term change. Neither is better; both reflect different ways of navigating life’s challenges. As a psychodynamic therapist, here’s my critical analysis of CBT, a modality that champions coping skills. I invite you to reflect on what resonates with you and take what feels right, leaving the rest.
Overlooking the Client’s Past: This approach seems to ignore how the client’s current thoughts originated, such as how they learned to speak to themselves harshly, who conditioned these responses, and how these thoughts, once adaptive, now keep them stuck.
Impact of Independent Homework: Emphasizing independent homework can unintentionally heighten a client's anxiety, especially if they find it challenging to complete. This approach may exacerbate the very issues they're trying to resolve, as it lacks the supportive environment of the therapeutic relationship, which is crucial for those needing a safe space to explore and process their emotions.
Time-Limited Nature of Therapy: The typical 10-12 session limit may compress the therapeutic process and create undue pressure. This approach may not allow sufficient time to explore and understand the client’s extensive personal history, including 29 years of experiences, which is crucial for understanding their relationship with anxiety.
Top-Down Approach: The method focuses on addressing thoughts first and then moving to physical experiences. This top-down approach may neglect the importance of bodily experiences, which can be vital in understanding and processing emotional and somatic information.
True change, as both research and clinical practice suggest, goes beyond coping. In fact, the literature informs that the therapeutic alliance is a crucial factor contributing to positive outcomes in therapy, so much so that across different therapeutic approaches, the quality of the therapeutic relationship consistently emerges as a strong predictor of successful treatment outcomes (Norcross, 2011; Wampold, 2015).
Coping vs. Containment: Seeking Relief or Finding Support?
The psychoanalyst W. R. Bion (1962) introduced the concept of containment, which refers to a caregiver’s ability to attune to, hold, and manage a child’s distress. This nurturing process helps the child learn to regulate their emotions independently as they grow older and become less reliant on the caregiver. Effective containment is essential for developing self-regulation skills. When caregivers fail to provide this support, often due to their own unresolved trauma, children may struggle with emotional regulation and seek external sources of comfort. This highlights the profound impact of early attachment experiences on emotional development and how coping strategies may reflect an unmet need.
Research by Fonagy et al. (2002) and Schore (2001) underscores the critical role of early attachment relationships in developing emotional regulation. Caregivers who act as emotional containers help children learn to manage intense emotions. When clients lack these early models—having grown up without a consistent source of emotional support—they may turn to coping strategies as a substitute. Therapy provides a relational space where clients can build trust, express vulnerability, and find the courage to confront their fears. With the support of a
compassionate therapist, clients can develop the skills to manage their emotions and approach challenges with greater resilience.
The therapeutic relationship can act as a form of containment, demonstrating to clients that they are not alone. In therapy, clients can momentarily release the roles they adopted for survival in their family systems—such as the exile, black sheep, protector, supporter, or peacekeeper—and instead experience a safe, supportive space, inviting them to show up authentically. This environment enables them to address emotional wounds and gain corrective emotional experiences, fostering healing and new ways of relating.
Wrapping It Up: What’s the Point and Why Should I Care?
When we consider each client's unique journey, marked by personal struggles and challenges, a shared theme emerges: the quest for effective coping strategies. This pursuit is like patching a leaky pipe with band-aids—temporary fixes that offer brief relief but don't resolve the underlying problem. Life's pressures can be overwhelming, and while quick remedies may soothe momentarily, they often fail to address the root causes of distress.
Just as a skilled plumber delves into the core of a pipe issue to fix it properly, therapy aims to build resilience and offer a supportive presence, guiding clients to explore and understand the deeper sources of their struggles. Clients seeking tools and strategies are often reaching out for help with profound fears and unmet needs, a plea that should not be overlooked. The therapeutic relationship can serve as a container, providing a safe space to confront and resolve these core issues.
So, when you're drawn to quick fixes, pause and ask yourself: Why? What does this reveal about where I am in my journey of change, and how can I support myself accordingly? What keeps me from addressing the underlying issues, and how will I know when I’m ready to face them? Consider what’s most important to you: managing and controlling, or seeking understanding, developing insight, and consciously breaking old patterns.
Reflect on how your focus or intention in dealing with your struggles mirrors how others have related to and responded to your despair, despondence, or dissonance, and how you wish it had been handled. Then, find the courage to enact that response as the adult you always needed when you were younger. Think about what might be standing in the way of uncovering the true sources of your distress, and how you can tune in to your inner experience to recognize when you feel safe and prepared for self-exploration. Consider what you'll need to feel supported as you navigate this path. Just as a well-maintained pipe ensures a steady flow, a well-understood psyche leads to a more balanced and fulfilling life.
References
American Psychological Association. (2024). Cognitive behavioral therapy. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.pdf
American Psychological Association. (2024). Psychodynamic therapy. Retrieved fromhttps://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy
Bion, W. R. (1962). Learning from experience. Maresfield Library. College of Registered Psychotherapists of Ontario. (2024). Retrieved from
Fonagy, P., Target, M., & Gergely, G. (2002). Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 14(3), 771-791.
Hefer, J., & Willoughby, M. (2017). Coping with stress: A practical guide. Springer. Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence-based
responsiveness (2nd ed.). Oxford University Press.Schore, A. N. (2001). The effects of early trauma on the development of the self-regulation
system. In Affect regulation and the repair of the self. Norton & Company.Wang, K., Chen, X., & Xu, Q. (2020). Coping strategies and their effectiveness in managing
stress. Journal of Stress and Health, 12(4), 543-556.
Wampold, B. E. (2015). The research evidence for the therapeutic relationship. In The heart and soul of change: Delivering what works in therapy. American Psychological Association.
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