Re: DBT for Depression & Anxiety
Secrets of Psychotherapy (Part 4) : Change or Acceptance?
...Acceptance is acknowledgment of what is. Acceptance is non-judgmental, not a matter of deeming something good or okay. Freedom from suffering requires accepting rather than resisting reality. Choosing to tolerate pain or distress in the moment is acceptance. Accepting rather than avoiding painful emotions actually alleviates suffering.
Dr. Linehan's emphasis on the dialectical relationship between change and acceptance in treatment is an excellent example of what needs to happen in any truly effective psychotherapy. To begin with, there are certain things in life that cannot be changed, and some that can be--albeit often only with sustained effort. This recognition is reflected in the famous serenity prayer of Alcoholics Anonymous: "God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference." Also inherent in the AA approach is the requirement to accept one's utter powerlessness over alcohol (or other substances or addictive behaviors) as a prerequisite for change. The problem must be unequivocally accepted before it can be changed.
Basically what must change is our refusal to accept ourselves and others as we and they are right now. This is a true paradox. When people first come for psychotherapy, they frequently hope to change themselves and/or others in ways that are simply not possible. But, by definition, wanting to change something or someone implies there is something wrong-- some insufficiency, inadequacy, flaw, weakness, inferiority--an inherent imperfection that needs changing. Many patients hold beliefs of being unlovable and unworthy of love as they are. What is lacking is the ability to unconditionally accept themselves just as they are in this moment, despite their human imperfection. (See my previous post on the "inner child.") At the very same time, certain changes must clearly be made. Changes in self-defeating perceptions, attitudes, old myths of oneself, life-style, and other destructive behavior patterns. But the paradox is that sometimes it is only through acceptance of what Carl Jung called the shadow that such changes can happen.
The acceptance of life on its own terms--the inevitability of suffering, the vagaries of fate, the tragic quality of existence, the reality of evil, impermanence, loss, illness, aloneness, insecurity, finitude, aging and death--is as essential as any behavioral or psychodynamic technique, pharmacological intervention or cognitive restructuring designed to directly change or "fix" the troubled patient.(See my previous post on The Trauma of Evil.) Accepting our own neurotic tendencies, resistances, defense mechanisms (see previous post), complexes, biology, temperament, typology (see previous post), feelings, thoughts, impulses, shortcomings, idiosyncrasies--and our innate capacity for destructiveness along with our strengths, talents and creative potentialities (the daimonic)-- is in itself a major therapeutic change for the discouraged, guilt-ridden, self-loathing, hyper-moralistic, narcissistic, repressed, dissociated or perfectionistic patient. Indeed, acceptance--of oneself, one's emotions, thoughts, behavior, problems, and one‘s proportionate responsibility for them--is precisely the kind of philosophical or spiritual reorientation required in psychotherapy for any real and lasting change to occur. And much of that enduring change adds up to acceptance.
"What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson