Despite the mountains of snow outside, it is a beautiful morning in Boston! The sun is shinning through the window. My coffee is just right. I need something fun to do... crochet or write? Reading would cap off the morning! What a perfect start to my day!
I begin to read a journal article in Psychological Bulletin, “Searching for the structure of coping: A review and critique of category systems for classifying ways of coping” (Skinner, Edge, Altman, & Sherwood, 2003). After the first paragraph, I thought I bit off more than I can chew. From analyzing over 100 assessments of coping, the authors compile a list of 400 ways of coping and suggest a framework for categorizing them. I was put off by the length of the article and its dense terminology. But I persevered, and with patience I was able to take away meaning from the article; in addition to learning a new framework for understanding coping skills, I realized that perhaps this practice of patience, and taking my time, will help me build a better relationship with my provider.
This realization was important to me because I often struggle to understand how good people with good intentions (peers and providers) can go so wrong in trying to reach a shared understanding and build mutual respect. My colleague Wayne Centrone, a doctor by training, recently wrote that communication is key to improving patient outcomes. But I continuously struggle to communicate with my providers. Does the problem lie in the medical context or in the relationship? What drives this discord?
Maybe, part of the answer can be found in the habitual use of long-held and unquestioned coping strategies. Maybe through recognizing that many of us cope by relying on assumptions about others, we can start to unravel this mess.
Coping styles are shorthand actions taken by individuals to help achieve a goal. As Skinner and colleagues emphasize, this process has adaptive function for all of us. When stressed, rushed, or in unfamiliar relationship territory, individuals may act on stereotypes and assumptions instead of getting to know the other person. They may cope by avoiding. We developed these behaviors to help us survive. However, often our shorthand falls short of the truth, and this can hinder our goals rather than help achieve them. Coping strategies are supposed to help us get through our day! But are we unwittingly posing barriers to connection and relationships?
Some of this harm is extremely detrimental. For example, consider the term “Health Care Disparities.” The clinical terminology belies the reality. People are dying because they are dismissed or hurt due to race, diagnosis of addiction and mental illness, homelessness, and innumerable other characteristics that ignite stigmatizing attitudes. People are dying because they are not valued.
[pullquote]In medical encounters we do not have time to build relationships. Funding doesn’t allow for relationship building.[/pullquote]
Many structural issues need to be addressed to repair the de-valuing of people. Still, I believe that one of the concrete problems is time. In medical encounters we do not have time to build relationships. Funding doesn’t allow for relationship building. The 15-minute hour is no longer resigned to mental health medication sessions, but is implemented across care settings. In stressful, fast paced environments, we resort to using our shorthand coping styles to fill in the gaps. Building relationships in medical care must be funded and revived. It is hard to accomplish patient centered care, trauma informed care, and recovery oriented care without the time to implement these essential skills.
We all need to take the time to get to know each other. Funding has to support engagement and relationship building to achieve the goals of respectful and quality care. Attitudinal barriers are real. But the walls between people can be dismantled.
We all share an evolutionary history that relies on coping skills. And we all share the medical context together. We can become allies for recovery through establishing mutual respect and thinking about how we deal with stressful situations.
Can we endure the messiness of change?
We have to try. Hope springs eternal!
Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129(2), 216.
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