Michael, here is some stuff that talks a little about radical acceptance:
Head & Heart
Robin Boyd
DBT OPENS THE DOOR TO RECOVERY FOR MANY
Every once in a while somebody comes up with a fresh idea, an innovative way to tackle an old problem. And they do it simply by recycling old notions into a new and different configuration. In 1991, Seattle-based psychologist and student of Zen meditation, Dr. Marsha Linehan, did just that with a revolutionary new treatment for Borderline Personality Disorder (BPD) called Dialectical Behavioral Therapy (DBT).
It sounds awfully dry and clinical but, in reality, it is a creative and eclectic approach to a heretofore intractable problem - that of finding an effective way to ease the suffering of people with the particular set of symptoms that constitute the diagnosis of Borderline Personality Disorder. According to the DSM IV, the diagnostic text of the mental health profession, BPD is "marked by instability of interpersonal relationships, self-image and affects, and marked impulsivity."
One of the prominent features of BPD is severe emotional swings or dysregulation that can lead to suicide and other self-harming behaviors in a desperate attempt to stop emotional pain. As a result, the treatment of this disorder is fraught with crisis and tries the limited resources of therapists and the health care system.
Carla Kirsh, MEd, a therapist and director of the DBT program at Monadnock Family Services, knows firsthand the long and arduous journey of the person with BPD.
Kirsh says that many, but not all, people with BPD have a history of abuse as children. That, coupled with a suspected genetic sensitivity, and an environment that does not meet their needs, can produce the dynamics for developing the disorder. The diagnosis has been categorized as a personality disorder, as opposed to more physically-based conditions such as schizophrenia or major depression. Personality disorders are considered to be unchangeable, carved in psychic stone and unresponsive to medications, but in light of the success of Linehans model, this categorization is being challenged.
For many years, the medical and mental health communities had a pejorative attitude toward the dysregulated patient. "It was taxing work and strained the system in many ways.
Marsha Linehans work has changed that by creating a systemic approach to teaching and reinforcing the skills that regulate extreme emotion," says Kirsh.
Kirsh says that Linehan, in her search for effective interventions, tried any and all techniques known to the behavioral health field and added the ones that proved most useful to her bag of techniques.
The term, "dialectic" comes from the work of philosophers, Immanuel Kant, Friedrich Hegel and Karl Marx, which holds that all things contain polarities and that, within those polarities, there exist points of synthesis or balance. Sometimes that balance is achieved by accepting the validity of two opposites simultaneously. For example, as Linehan tells her patients, "You have to change and youre perfect as you are," or "You are not responsible for your problems, but you are responsible for solving them."
"This attitude of radical acceptance is at the heart of DBT," says Kirsh. "Instead of criticizing the choices the client makes, the therapist accepts them while looking for opportunities to build skills and point out alternatives where different responses might be chosen in order to build a life worth living."
Radical acceptance is also a skill taught to the patient. By accepting things as they are, the focus is taken off the past and placed on the present and future. "It also encourages a non-judgmental attitude so the client does not get trapped by apportioning or assuming blame or guilt," Kirsh adds.
"It might be true that the patient was abused as a child. However, the abuse is over and cannot be changed. What can be changed is the patients current responses, choices, attitudes and behaviors," Kirsh points out. "Radical acceptance does not mean approval; it is an acknowledgment of fact about which there can be emotion."
The therapy targets and addresses behaviors according to a hierarchy of needs. The first priority necessarily addresses self-harming or suicidal behaviors. If these are present, no other issues are addressed until a behavioral analysis is completed and strategies for future behaviors are identified, and a commitment to use these strategies is in place.
The next treatment priority focuses on therapy-interfering behavior such as missing appointments or acting in ways that reduce the therapists ability to provide effective treatment.
"There can be therapy-interfering behavior on the part of the therapist as well," says Kirsh. "If the therapist is unable to truly attend to the client due to fatigue or illness or other distractions, the therapist has an obligation to address this as well."
Because people with BPD are often in crisis, therapy sessions in older treatment models were, by necessity, largely devoted to putting out one fire or another. This prevented the therapist and client from getting to the all-important work of skill-building in order to change the dysfunctional patterns. To remedy this, Linehan incorporates into treatment, skill-building classes which are separate from individual therapy. Clients work within a structured workbook format which covers a wide variety of cognitive, interpersonal and behavioral skills useful for regulating emotions, increasing individual tolerance to distress and ambiguity, building interpersonal skills and defusing potential crises.
The therapist then becomes a coach to the client, encouraging the client to tolerate stressful situations and interactions, and to appropriately use their new skills.
"An entire session might be devoted to analyzing a particular crisis, such as a self-harming incident. By reducing the event to its component parts, the therapist and client can identify points at which the crisis might have been averted and suggest alternate behaviors," explains Kirsh.
Another prominent feature of BPD is impulsivity. To address this, Linehan has incorporated mindfulness into the skills training to help clients learn to slow down their response time. Participants learn to observe a situation, describe it without judgment, act intuitively from a perspective that utilizes the combined wisdom of emotion and thought, to stay in the moment and to focus on what works. Linehan describes the state in which emotion and thought overlap as the "wise mind." It is a state of optimal functioning which both clients and therapists in DBT work to achieve.
The skills taught in DBT are easily transferable and can be used in a variety of settings. "Many therapists trained in DBT have found that the use of these skills outside the treatment setting has enhanced their personal and work lives," says Kirsh.
Lastly, Linehan has changed the therapeutic view of the disorder by creating a new set of assumptions about the person with BPD. According to Kirsh, many of these assumptions can be applicable to us all.
1. People are doing the best that they can.
People want to improve.
People need to do better, try harder; and be more motivated to change.
People may not have caused all of their own problems, but they have to solve them anyway.
The lives of suicidal, borderline people are unbearable as they are currently being lived.
People must learn new behaviors in all relevant contexts.
People cannot fail in DBT
Therapists treating people with Borderline Personality Disorder borderline need support.
The results speak for themselves. The State of New Hampshire is just one of a number of states across the nation who have incorporated DBT into their community mental health treatment programs. Across the board, mental health centers are reporting reduced hospitalizations, and a drastic reduction in time, energy and resources expended upon the treatment of BPD. And, of course, the best news of all is that people are getting better and resuming normal, functional lives.
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Michael, I came across this little poem that kind of sums things up too:
Radical Acceptance
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Radical Acceptance
Suffering is pain, plus non-acceptance of the pain
It comes from inability, refusal to accept
From clinging to the urge to get what's wanted for yourself
Refusing to acknowledge many things which have been kept.
Reality at present time is pushed away and lost
Then pain gets unsurmountable, impossible to bear
Transforms itself to suffering, which escalates in force
If only that reality was found, amidst despair
So suffering is like a cloud, distorting, misting, view
Reduction of the hurting, being unreachable, remote
Yet radical acceptance is a means unto the end...
That suffering, transforming into pain, you stay afloat
Imagine hating purple, it's the colour of your room
You'll never change that colour by refusal to accept
that purple is the colour of those walls you truly hate
You stay there, not repainting, yet so many times you've wept
See, life's like hitting baseballs from a pitching ball machine
You're asked to do your best, and no one asks much more of you
You stand your ground so firmly, won't accept they're coming out
Yet still they come regardless, there is nothing you can do
You will it, cry, you whimper, stamp your feet to no avail
Those balls just keep on coming over, over, in your face
You have some choices what to do, just stand there and get hit;
Do nothing, let the ball go by and strike at such a pace
Or stand there, taking swings at it, you may not always win
At least you make an effort, you accept things as they are.
Or life is like a game of cards, a player who plays well
Is not concerned what cards she gets, her hand just cannot mar
Her object is to play the cards, as well as possible
And as each hand is finished, take the next cards that are dealt
She lets go of the last one, focusing on what she has
So skillfully she plays each hand, remorse is rarely felt
If only it were simple, like a game of cards to play
But life has more uncertainties, appearing every day
A neverending challenge, to accept the trials you face
Just do the best you can each day, observing your own pace.
Sharon K. 2001
Peace..Andrew