Resourcing for Internal Equilibrium and Mediatory Controls for Externalized Environmental Activation

Or...You Have to Practice Coping Skills (de-fancied)

Therapy has developed a remarkable talent for making relatively straightforward things sound extraordinarily complicated. Maybe you are not learning how to notice that you are getting anxious and calm yourself down. You are developing state recognition and resourcing for autonomic regulation. Or you are not practicing tolerating an uncomfortable feeling without immediately escaping it. You are expanding your window of tolerance through graded nervous-system capacity building. Maybe you are not learning to recognize an unhelpful thought and reconsider whether you should believe everything your brain tells you. You are engaging in metacognitive restructuring of internalized cognitive narratives.

And heaven forbid we simply say, “You need to practice this when you get home.” That would apparently be far too easy. We may need something more sophisticated. Generalization of therapeutic resourcing into the externalized environment.

There. Much better. It also means exactly the same thing. And, before I throw stones-I'm to blame here too.

Therapy is (can be) sophisticated. Change is often remarkably basic.

None of this is meant to suggest that psychotherapy itself is simple. Good therapy requires considerable clinical skill. A competent therapist is assessing patterns, symptoms, history, behavior, relationships, cognition, emotion, avoidance, physiological responses, environmental factors, and often several competing explanations for why a person is struggling. The therapist then has to figure out what actually matters.

That is the sophisticated part. The resulting treatment, however, frequently involves doing some decidedly unglamorous things over and over again.

• Notice what happens in your body when anxiety begins.

• Practice regulating yourself before you are completely overwhelmed.

• Recognize the thought that reliably sends you spiraling.

• Stop avoiding the thing that keeps teaching your brain it is dangerous.

• Set the boundary.

• Tolerate the discomfort after setting the boundary.

• Get out of bed.

• Go for the walk.

• Have the conversation.

• Practice the breathing exercise when you are not panicking so you know how to use it when you are.

• Do the thing, again.

And then, irritatingly, do it again.

Your therapist cannot practice for you

One of the most important things I tell clients is that I have a very limited amount of power over what happens in their lives. I might see someone for one hour in a week containing 168 of them.

During that hour, I can help identify what is happening. I can explain why a particular pattern keeps repeating. I can teach a different response. We can practice it together. I can notice something the client cannot yet see. I can challenge an assumption, identify avoidance, help make sense of a physiological response, or point out that the strategy someone has been using to feel better temporarily may actually be keeping the problem alive.

That hour can matter enormously. But then the client leaves, and I don't get to go with them.

I am not there Tuesday morning when the anxious thought shows up. I am not sitting in the passenger seat when someone's heart begins racing. I am not hiding behind the ficus when a family member violates a boundary. I cannot emerge dramatically from the shrubbery and announce, “Remember your coping skills!”

At some point, the client has to do it.

Insight isn't the same thing as change

Insight is important. Understanding why you respond the way you do can be enormously helpful. It can also become a very sophisticated way of staying exactly where you are. You may understand your attachment patterns beautifully and continue participating in the same unhealthy relationships. You can identify every childhood experience contributing to your anxiety and continue avoiding everything that makes you anxious.

You can understand precisely why you become emotionally dysregulated and never practice regulating yourself. You can know your triggers, name your nervous-system state, identify your cognitive distortions, understand your family dynamics, and possess an impressive therapeutic vocabulary. And still not get better.

Knowing is not doing. Therapy should help you develop insight. Eventually, however, that insight has to change something about what you actually do.

Coping skills are not supposed to be impressive

The term coping skill has somehow become almost insulting in parts of the therapy world. It sounds basic; that's because it is basic. Basic does not mean ineffective.

Professional athletes practice fundamentals. Musicians practice scales. Surgeons rehearse procedures. Nobody concludes that fundamentals are beneath them because they aren't sufficiently sophisticated.

Psychological skills work similarly. If you want access to a skill when your distress is an eight out of ten, your first attempt probably shouldn't occur when your distress is an eight out of ten.

You practice when you're relatively calm. You learn to recognize the earlier signs. You use the skill at a level three, then perhaps at a four. You'll discover which strategies actually work for you and which ones don't. And, eventually, the response becomes more familiar.

Call that resourcing if you would like. Call it autonomic state regulation. Call it internal equilibrium enhancement through somatically mediated adaptive responding.

Whatever terminology we choose, eventually you still have to practice the skill.

Counseling isn't magic

A good therapist should be doing considerably more than listening sympathetically while you describe your week. There should be a reason for what you are doing together. You should increasingly understand the problem that brought you into treatment. You should develop tools for responding to it differently. You should have opportunities to practice those tools. Your therapist should notice when something isn't working and adjust treatment accordingly.

Over time, something outside the therapy room should begin to change:

• Perhaps you recover from anxiety more quickly.

• Perhaps you stop avoiding situations you once feared.

• Perhaps you recognize an emotional reaction before it controls your behavior.

• Perhaps you tolerate uncertainty better.

• Perhaps you stop needing reassurance.

• Perhaps you establish healthier relationships.

• Perhaps you simply discover that having an uncomfortable emotion does not mean you need to do anything about it.

Those changes may emerge from sophisticated psychological treatment. But they are built through remarkably ordinary repetition. Therapy provides a place to understand, learn, experiment, practice, and course-correct. Then you take those things into your actual life. Because the goal of good therapy isn't to become exceptionally good at therapy. The goal is to become increasingly capable of living your life without needing it.

Even if we could come up with a much fancier name for that.

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