The following is a synopsis of a weekly Dialectical Behavior Therapy (DBT) group lesson, based on the work of Marsha Linehan out of the University of Washington.
Disclaimer: I LOVE doing this, I think it is desperately needed, and I WANT to do it. However, I have zero time to do it so, while I am committed to giving it my all, I may fall behind or skip a week or two. I apologize in advance for that, and for the fact that I will not be spell checking, fixing formatting, or doing a read through before I post. No offense, but I gotta draw the line somewhere!
Distress Tolerance Skills Module: Radical Acceptance
Welcome to the last blog in this module, Radical Acceptance. This is, by far, THE most important skill that exists in life. Why, you ask me? First, because we all have at least one very painful, unfair, difficult reality that we have to live with. Second, because it is very difficult to accept these realities, and takes a lifetime. Third, because it is very hard to know whether or not you are accepting of these painful realities. Practicing radical acceptance in our daily lives is crucial to our eel-being, ability to experience happiness, and our overall quality of life.
“Accept” is a word I hear all the time. People tell me things like “I accept it, it’s whatever.”, “I’ve accepted it”, “I just have to accept it”, or “I don’t care”. When I hear these things, I suspect that it means that people don’t accept it, and need help doing so. It’s very easy to dismiss very painful, traumatic, complex, or confusing situations, because we don’t want to think about them. It is very easy to accept things that we like, want, or choose, as these are things that are comfortable, pleasant, or that we have control over. In fact, things that are kinda painful, difficulty or confusing may be easy to accept too. This skill is most important for those things in life that are VERY VERY painful, traumatic, confusing, and/or out of our control.
Interestingly enough, the week that this skill was discussed in group was the same week that Donald Trump was elected the next President of the United States. This election left the country divided, with many strong feelings about the outcome. Trump supporters were very angry and disappointed in Hilary supporter’s attacks on their choice to vote for him. Hillary supporters were very angry and disappointed in Trump supporter’s decision to vote him into office. The REALITY is that both sides have the right to make their own choices, and tolerance and ACCEPTANCE of those choices is what is needed by both sides. The people that were unwilling to accept the reality of the situation were having difficulty managing their feelings about it, were unwilling to see the good and/or the bad of the situation, and were determined to do something to change or fix the current situation. Those that were accepting of the situation were able to let go of trying to control it, choosing to be at peace with the current situation, tolerant of those who feel differently from them, and able to put aside their wants and needs of a different reality. THIS is Radical Acceptance.
Most of us have heard of and have some understanding of acceptance, but in DBT we call this skill RADICAL ACCEPTANCE. The term radical is important to this skill, because the hardest and most important time to practice it is with things that we feel very strongly about. Even the most traumatic, unfair, devastating situations can be accepted, in fact, those are the situations that we usually have no immediate control over, and thereby we must accept them in order to be happy, joyous and free (as Alcoholics Anonymous would say). This is one of the biggest, most important things to remember about acceptance:
ACCEPTANCE DOESN’T MEAN WE LIKE, OR AGREE WITH SOMETHING. Acceptance of reality as it is means that we are wise enough to know that we must be WILLING (that word keeps coming up!) to acknowledge reality as it is (not as we wish it was, not what we think is fair, not what we think is more comfortable, etc.). We do not like every aspect of any situation. I am writing this on a Saturday, in a hotel room, that is freezing cold. THAT SUCKS! But if I don’t like it, I can still accept it. I need to do this blog today, now is the best time to do it, and I have no control over the thermostat. So I can be miserable over this, hate the moment, bitch and complain about it, wallow in self pity, and make it WORSE. Or, I can refuse to do the blog, because it’s not fair, or perfect, or how I wish it to be. All of that is very willful, and is not going to make the moment any better. In fact, it will add misery to the already unhappy moment.
ACCEPTANCE DOESN’T MEAN THAT WE HAVE TO LIVE THIS WAY FOREVER. Or maybe it does. In my example, I have many choices. I can accept that my fingers are frozen so I can’t do my blog right now, and I can do it at a time that is less than ideal. Although, then I’ll have to accept the bad things about THAT moment as well, so I’m back to needing to accept. Or, I can call the maintenance person and ask them to fix the thermostat. I can CHANGE an aspect of the not so great moment. But instead, I choose to tolerate the moment. I am WILLING to tolerate the moment, and not try to fix it, or take control over it. I surrender to it. I can do this blog because I love to, I need to, and I want to. AND I can tolerate the parts of the moment that are not how I want them. In fact, IF I accept the WHOLE moment for what it is, then I may actually be able to change it. If I sit and complain and whine, and obsess about how cold it is, how I’m in a hotel and shouldn’t be working, and how I wish I didn’t have to do this, I will be much less likely to change it. I will wallow in self pity, be overcome with emotions, etc. If I work on accepting the moment, I may decide that I can change part of it, and then I will be more motivated to change it. Or, I will be more at peace with NOT changing it. This can be confusing, but just trust me when I say that focusing on acceptance rather than change is WAY more helpful and motivating then focusing on what we want to change.
ACCEPTANCE IS A PROCESS. Not an event. If a client tells me that he accepts that his brother died yesterday. Uh….no you didn’t. If a 15 year old kid tells me that she accepted that her biological parents put her up for adoption. uh…NO you didn’t. If I tell myself that I accept that it’s freezing in here and I’m working when I shouldn’t…..NOPE. I DIDN’T!!! Acceptance is a process that takes TIME. As I type, I am mindful of a thought that pops up every now and them…”I’m fucking FREEZING!”…”I hate this stupid blog, why am I doing this?.”,,,”This hotel sucks”…these are normal, everyday thoughts that I have NO control of. We don’t have control of thoughts, they just pop up like a zit. You can’t control a zit. You can wash your face, use products that help acne, drink a lot of water, etc. Those are things you can control, But if a zit pops up, you can’t stop it. So i can work on being a more willing person, a more tolerant person, a more loving person, a person that doesn’t hate herself, and those things will change the kinds of thoughts that pop up. BUT I CANNOT CONTROL automatic thoughts that just pop into my head. I CAN CONTROL WHAT I DO WITH THEM. So, I notice the thought and I tun away from it, putting myself into this moment and focusing on EFFECTIVENESS. What needs to be done is type. If the cold is interfering with my getting this done THAT MUCH, then I will call someone to help. I cannot control if he comes, when he comes, if he fixes it, etc. So I am CONSTANTLY practicing acceptance, ALL THE TIME. I am accepting this moment again, and again….and again. AND again. OVER TIME.
ACCEPTANCE IS FROM DEEP WITHIN. Acceptance requires a COMMITMENT! I have to decide that I want to accept something, because I have to. I need to commit to accepting it over and over and over. I need to turn my mind toward acceptance, and away from rejecting reality. I have to acknowledge my cold fingers and legs, my angry willful thoughts, and my sadness and disgust. AND TURN AWAY FROM IT. Towards the computer, my patients, this moment. I have to KNOW that this is the most important thing I can do. I have to COMMITt to doing it, and I have to KEEP doing it. I then will feel with every fiber of my being, that I am more and more and more accepting of something..IF I really am accepting. There is a very fine line between accepting and avoiding. If I say I accept something and it’s done, then I am really avoiding it. If I can be mindful of the thoughts, feelings, and physical responses I have over time to this painful reality, talk about it more and more over time (even if it still hurts), and be WILLING to work that process, then I can be at peace with anything that I am faced with. I may become very willful about how cold I am and how I don’t want to work for a few seconds, but I have to get back to accepting that this is my reality. I am willing to do that. I can get willful, self pitying and angry for days about much bigger struggles in my life, but I try to stay mindful that I am there, remind myself that I can’t stay there, love myself anyway, and get back to being willing to accept the pain as soon as I can.
RADICAL ACCEPETANCE is the most important skill in DBT. Non-Judgemental stance is the second most important. We have to be nonjudgmental of ourselves and others to help us be more willing to accept painful, difficult things. Working on these skills helps all the other skills work better and be easier.