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Critique of "Maladaptive" Coping, Emotional Regulation, and Other Related Concepts

 
Consider this article a work in progress. Been thinking through these concepts for a while and it's hard to phrase the critiques effectively and concisely. Please consider everything a proposed draft and not a fully confident conclusion.

Topic is a reply to the broader notion of "regulation", especially as applied to skills development.

Can follow my writings here. Hoping to develop learning presentations / training modules eventually.

Saw the following comment in social media group centered on trauma-informed care...

"It’s a life skill to regulate. Many kids have learnt maladaptive coping skills when they are disregulated- such as self harm - in all its forms - cutting, burning, binging, purging, using alcohol and drugs, violence etc. when I teach self regulation skills the first step is identifying the feeling and what it’s trying to communicate and validating this. When it’s done right it’s not about suppressing emotions but rather knowing what to do to when they come up that’s not going to make the situation worse."

Here are a number of thoughts that came up in reply to these notions.

1) I'm noting how everything in the comment is centered on the individual
Really hoping we continue to push past the individual-alone focus that so much of health and trauma work hyperfocuses on.

2) Maladaptive is a loaded phrase
Even self-harm, as vicious at it is, can be seen an understandable response to something being triggered. We need to separate the impact - the physical harm itself - form these value-based scientific sounding descriptions of "correct" and "incorrect" behavior.

The harm is real. It's also only one of a larger complex of potential harms being experienced (emotional, social, cognitive). Any or all three of self, others, and society can be focuses of our efforts

3) Let individuals self-determine which skills inflict less additional harm in their minds
We constantly take away the individual's power to declare what harm means to them. We can certainly suggest other strategies and we can honor individual choice to give them more self-ownership of choice and say in what harm means to them.

4) We overemphasize physical harm and underemphasize emotional and cognitive harm
Note how everything in the above list being called problematic is physical and material in origin? It's all use of substances and/or physical harm. I think we focus on these things because it's so objective. We can see these things. Society loves objective observations. That means proof. That means evidence.

But even objective evidence is subjective. We're not asking how the individual feels about these things.

We can't directly see, nor ever fully prove, what the inner experience of the mind is experiencing. That harm can't be proven, and tends to be looked for less and policed less. If you're not physically cutting but have gone completely dissociated from self to attempt to appear outwardly "normal", that will count as a success in mental health metrics.

Does that mean we should not care about the physical harm? No.

Does it mean we need to step back and think through what we can see versus what we can't? Yes.

Per #3, do we also need to remain vigilant in not over-prescribing value systems of which harm is "good" or "bad" on others? Yes.

5) A note on the term "coping"
I prefer a term like "addressing" versus "coping". To me, coping has too much connotation of success. It can almost imply deal with or solve.

Sometimes emotional reactions aren't "solved". We can distract. We can push through and remain outwardly functional to meet demands often placed on us by society (work, be productive, etc.)

But what are those activities really? I almost feel like suppression of emotion to maintain outward function and prevent other long-term harm needs it’s own term. It’s a horrific ask to make of an individual versus actual “from surviving to thriving”.

Maybe it prevents certain other harms (addiction and abuse of substances, violence to others, etc.). But at what other costs?

Look at, for example, the phrase “distress tolerance”. Isn’t that an awful thing to ask an individual to do? To “tolerate” distress? Versus to have routes for ending or resolving it?



6) Is it a "skill" to regulate or is that sometimes a socially-enforced harmful demand?
How much is regulation is truly within our actual control? Open question.

II worry that, like everything else in modern Western life, we place so much on the individual. An arguably impossible amount.

Can emotions sometimes be fully processed and resolved? Yes.

Can that at least sometimes be accomplished by self alone, especially for a person who already has a lot of other resources? Yes.

Beyond that, I worry about everything modern society teaches about emotions.

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There is so much to love about this post and the discussion that follows!  Thank you!  You touched on things I've been grappling with based on my experiences and my studies of trauma, self-regulation as opposed to self-control, the ubiquitous lack of shared definitions of words (with consequent divisive consequences), the reference to individualism (as if problems all exist within the individual and can be solved by the individual without looking at systemic issues).  I resonated with "help only helps if it actually helps."  Thank you for this post!

@Patti Bird posted:

I LOVE your dissection of the original comment! I have so much to say, but as a student I don't really feel qualified. Having commented that way, I couldn't agree more of the chronic "go-it-alone" (American ideal??) idea rather than considering community as a vital element of each aspect of regulation. How can a child or youth, for example, learn strategies to self regulate in the world as it currently is (especially) if others around aren't able to regulate themselves or maintain a regulated state? I look forward to more on this topic. Personally, maladaptive when used in context to me with my hcp's has an insinuation of something I've done wrong by choice. So, words matter, too.

No need to defer as a student. In this context we all are speaking as sentient and sensitive human beings. Your feelings, intuition and experience is as pertinent and valuable as anyone elses.  Empathy, support from others, caring and mentoring are the best RX to create resilience. This is not a context in which self reliance works.

I LOVE your dissection of the original comment! I have so much to say, but as a student I don't really feel qualified. Having commented that way, I couldn't agree more of the chronic "go-it-alone" (American ideal??) idea rather than considering community as a vital element of each aspect of regulation. How can a child or youth, for example, learn strategies to self regulate in the world as it currently is (especially) if others around aren't able to regulate themselves or maintain a regulated state? I look forward to more on this topic. Personally, maladaptive when used in context to me with my hcp's has an insinuation of something I've done wrong by choice. So, words matter, too.

@Jeoffry Gordon Seems my post touched a nerve and can acknowledge that you experienced it as off-putting. It is not my intent here to "bash" or "disparage" health service providers. The intent of these individuals is often well-meaning.

Within that, I retain my right to criticize impact. This issue is near and dear to my heart and has been a major struggle in attempts for my own self to access effective help. And is also something that seems to resonate with at least some others.

Is it "negative" to neutrally point out something that's, for at least some people, not working well? If we can't critique how help is provided how to do we know it's working or not?

I wonder if I caught you on a bad day?

I hope you'd agree that help only helps if it actually helps. Intent does matter but if intent doesn't match impact that needs talking about. I'd also mention, to your point about larger systemic considerations, that the language we use is, itself, a social system. One that can sometimes oppress.

The DSM called homosexuality an illness and launched decades of conversation therapy attempts, attempts that are still going on to this very day. The word choice, and the conceptualization behind them, very much matter.

Would recommend reading the wiki on epistemic injustice as a starting point on this topic.
https://en.wikipedia.org/wiki/Epistemic_injustice

@Mike Flaningam Thank you for the respectful and thoughtful reply. Would be delighted to continue discussing. As I mentioned in the article - "please consider everything a proposed draft and not a fully confident conclusion".

Going to provide a larger-picture response here to match the larger-picture notes in the first part of your reply. Time-permitting, would also love to get into exploring more details of the specific terms/concepts in the article above and enjoyed reading your observations and notes. 

Starting with your note about language and term clarity, I have observed that the trauma-informed / mental health community has what I'd call major, massive, problematic issues with non-clarity. They are far from trivial. We don't want to get "bogged down" and can't expect perfection from the messy, imperfect tool of language. Within that though, I can point to items like this.

Here are two definitions of the term sympathy from two of top web search definition sources online...

Merriam Webster

Sympathy is used to describe when one person shares the same feelings of another, such as when someone close is experiencing grief or loss

Psychology Today

Sympathy, unlike empathy, does not involve a shared perspective or shared emotions

...

Those two definitions directly oppose each other. Are the underlying phenomena fairly agreeable as concepts? Very likely. The ideas of correct understanding of another's psyche (thoughts and feelings), of shared emotion, of the effect another's experience has on self, etc. All seem useful to talk about. But our existing word choice is extremely clumsy and unwieldy.

If you told me you needed more "sympathy", how do I know if you're meaning Merriam Webster's definition of Psychology Today's?

The level of misunderstanding can have extremely negative consequences. A therapist can tell a client something that might sound extremely offensive under one interpretation, but agreeable and validating under another.

At other times, there may be very real issues of oppression and discrimination that go along with one word instead of another. The field has talked about "curing" homosexuality and autism for example, and that legacy of being at times improperly authoritative continues through to modern day.

I think the field needs to come together and really slow down and take a moment to self-assess and reflect on all of these related issues....

- Non-clarity of terms

- Who's defining what "healthy" is?

- Who's defining what "helpful" or "unhelpful" is?
- Working through questions of self-accountability versus external environment accountability and oppression

Will end by connecting Part 1 to Part 2 by saying - look how differently you and I are responding to both of the semantics used and understanding about the reality of the underlying phenomena attempting to be pointed to.

I for one don't understand how to make meaningful progress in this field until these issues are at least somewhat addressed and accounted for.

With a final caveat note that one starting point is establishing that humans, unlike physics concepts like carbon atoms, have fundamental uniqueness. There are very few fully "universal" skills and needs. And even within broadly agreeable "need" categories, each person's particular relationship to that need might be quite different (for example, "connection" may look very different from one person to the next). Makes this work so much harder, especially trying to live up to the standards of the natural science version of "evidence" that's been imposed on the field.

I really find this analysis to be off-putting. More than most people I have a "public health" perspective and think that larger systemic considerations (politics, wealth, racism, arrogance, bureaucracy, culture, etc) greatly influence individual feelings and behavior, both for good and bad. On the other hand, there are injured people, people in pain, people who cannot cope and who misfunction in society.  They need personal therapy and support. Providing help and support is a compassionate, empathetic response with or without attention to the bigger picture. Others may have the aptitude and energy to deal with the broader issues. This whole perspective and analysis, even delving down into textual analysis, seems out of sorts and off putting. Why criticize people who are trying to help? It would be appropriate if we were not talking about therapy, but about a cult, or a forced religion, or incarceration for a mental disorder.

This would be a better contribution if it focused on positive values, behaviors and remedial activities that improved what we can do instead of broadly negatively criticizing those already doing their best to provide help.

I very much appreciate this post, and the author's goal of working through these really complex and important issues (I hope it's OK for me to refer to the author by their name). In hopes of keeping the conversation going, I humbly offer my thoughts:

- Some of the questions/concerns arise over language and definition. This seems to come up often; for example, probably most of us have asked or been asked "What is the definition of trauma?" and heard a hundred different responses. My point here is that the English language doesn't have single words that encompass well a lot of the human experience. Trauma, maladaptive, and coping are simple words but all really complex ideas. Moving forward, on the one hand, we don't want to get bogged down delving into all these complexities every time we talk about PACEs, trauma, resiliency, etc, but on the other hand, it's important that at times we have conversations about them, as Max has started here; this ultimately improves clear communication of ideas.

- I largely agree with the quoted statement in the post, and also with Max's thoughts. I wonder if some of the concerns Max brings up are because the person giving the quote didn't go on to further explain these very complex issues. One critique I have with the statement is that it says "Many kids have learnt maladaptive coping". It feels to me more trauma-informed to assume we all have some coping skills that have some not-so-healthy effects. "Many kids..." limits in a judgmental-seeming way to just some groups.

- I agree that "maladaptive" is a loaded term that implies judgement. All ways of coping have a benefit, otherwise we wouldn't do them. Furthermore, even "healthy" ones can lead to problems, with one of countless examples being the well-intentioned person who tirelessly helps people to the point it causes burnout.

- Regarding "coping" vs "addressing", I had never heard of using "addressing" before, but it resonates with me, and I'll be using it in place of "coping" in the future. That said, I don't have a big problem with "coping".

- It seems to me that there might be a contradiction in some of the ideas Max brings up (absolutely no judgement by me; am just hoping to keep the interesting conversation going). On the one hand, it's criticized how society tends to hyperfocus on the individual, but then it's promoted that it should be the individual who takes ownership of what is harmful to or best for them. This yet again is a complex topic. The goal might be to strike a balance. Self-agency is critical to well-being and we should value the individual, but sometimes sensitive conversations are needed when addressing the individual. Ideally, such conversations are happening with the individual's permission, and are done non-judgmentally. Additionally, we are social creatures who need each other for our well-being; the key on the latter is surrounding oneself with safe people (or animals). Max, what could the statement have done differently to address your concern#1?

- Finally, on point #6, I'll give my 2 cents. I consider self-regulation a skill, and a fundamentally critical one for each of us to continually try to hone. This is where I find being Polyvagally-informed so helpful. Life happens - often beyond our control - and our limbic system is inevitably going to trigger the physiologic survival responses of fight-or-flight or shutdown, usually multiple times daily. Self-regulation comes in by (hopefully) having a keen enough self-awareness to realize early on that a physiologic shift has occurred. Once this observation has been made, the person then reaches into their toolbox to use the tool(s) that shifts the physiology back towards one of safety (homeostasis). From a Polyvagal perspective, resilience isn't the avoidance of going into fight-or-flight or shutdown, but rather the ability to quickly get back to homeostasis when we are in one of those states. Self-regulation is primarily something the individual addresses, both by having the interest (and sometimes courage) to becoming more self-aware and then building up their toolbox. If they so choose, they can seek the help of others to improve both of these, though whether a person seeks it or not, co-regulation with another person (or animal) might be the most effective of all tools. Regulation is a "skill" in the sense that it takes practice to improve.

Thanks again for the great post, and I look forward to keeping the conversation going.

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