James Barrett, PhD

I’ve grown tired of the term “coping skills” and have decided to ban it from my own practice and writing.  If I had a dollar for every time I hear or read “he needs to develop coping skills,” I could close up shop.  The reason I am fed up with the term is because it doesn’t tell us anything meaningful.  What exactly is a coping skill?  Imagine if you went to a physician and he or she said “you need to get healthier” or your financial advisor told you “you need to be better with money.” How useful would that be?  Now, I am all for  using specific techniques or strategies like relaxation breathing or self-talk to address specific problems.  My concern is that I see many boys referred for therapy due to acting out and the recommendation uses “coping skills” as a blanket term.  My issue with this, besides it being lazy, is that there is no thought put into what specifically is causing the distress and what will help the boy or teen.   For example, lets take a boy who has been getting into fights after school.  If the boy struggles with a reactive temperament or impulsivity, we would look to teach him how to self-regulate and self-soothe.  However, if the boy is able to remain calm but fights out of a sense of saving face and wanting to avoid being labeled a “punk,” our intervention may focus on teaching conflict resolution through assertive communication.  Same problem at first glance, but the “coping skills” we would teach are very different.  It is worthwhile for us to take the time to examine what lies underneath the problematic behavior and think critically about what we hope therapy or intervention will accomplish.  I hope to see the day when I never have to read “needs to develop coping skills” on a referral form or assessment again!

One of the most frustrating things about the mental health landscape as it currently stands is that insurance companies will only reimburse for the standard 50-minute therapy session.   Many families drag their sons to therapy for them to sit there for an hour shrugging their shoulders while they play Monopoly with their therapists.  The truth is that many boys are just not accustomed to sitting in a room across from an adult in a 1:1 setting and talking about emotions.  Unfortunately, many boys drop out of therapy and families end up “going it on their own.”

Now let me be clear, for many boys (such as those suffering from anxiety or depressive disorder) individual therapy has been proven to be effective and helpful.  However, many families seek mental health assistance for problems such a disruptive behavior in school, problems with following rules at home, risky behavior, or problems with friends – problems that may not be best addressed via individual therapy.   Indeed, It can be unrealistic to assume that what takes place in one session a week will be generalized to the problems going on in the “real world.”  What often has a greater impact is the psychologist acting as a consultant to the boy and family and coming up with a targeted plan to address the behavior that involves frequent follow-up by phone and e-mail as well as substantive advocacy with the school.  While the HMO’s may not agree, it has been my experience that many boys and young men can be helped by thinking outside the box of the 50-minute session.  Please check back in to the blog as I plan to write more about what these services can look like and how we can make them both effective and affordable for families.