Friday, March 16, 2012

Radical Acceptance, Willingness vs. Willfullness

Hello, Gentle Readers. As some of you may know, I'm currently participating in DBT therapy, both group and individual. Unless you are in DBT or close to someone who is, you probably have no idea what that is. Here's a sorta dry but accurate description of what DBT therapy is:

Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality (BPD). It is not unusual for individuals diagnosed with BPD to also struggle with other problems -- depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems. DBT is a modification of cognitive behavioral therapy (CBT). In developing DBT, Marsha Linehan, Ph.D.(1993a) first tried applying standard CBT to people who engaged in self-injury, made suicide attempts, and struggled with out-of-control emotions. When CBT did not work as well as she thought it would, Dr. Linehan and her research team added other types of techniques until they developed a treatment that worked better. We’ll go into more detail about these techniques below, but it’s important to note that DBT is an “empirically-supported treatment.” That means it has been researched in clinical trials, just as new medications should be researched to determine whether or not they work better than a placebo (sugar pill). While the research on DBT was conducted initially with women who were diagnosed with BPD, DBT is now being used for women who binge-eat, teenagers who are depressed and suicidal, and older clients who become depressed again and again.

While one of my group members likes to describe it as its own little cult, to me, this great combination of psychotherapy and Buddhism, which provides and reinforces coping skills for living with the mental illness issues that I am dealing with. Oh, and despite what it seems like at the end of the previous paragraph, it is not just helpful for women, teenagers, and old people. I honestly think that many of the life skills can be helpful for anyone and my particular group has (has had) quite a few men who have found DBT helpful for them.

When I started the therapy, honestly, I just wanted to be able to make it through the day, or even just an hour, without crying. It was several months after my uncle's death. Everyone else seemed to be moving on. Mom and I had done a grieving support group. But I was still crying all the time, as well as backsliding into other behaviors which I knew were just negative coping skills. But I didn't know what else to do. It lead me to this.

But now I'm past 'just getting by,' past just wanting to make it through a day without crying, past wanting to JUST not hurt myself. I want to move forward with my life. I want to flourish. I want to deal with my problems (so I can get all new ones.) I want to turn mistakes into opportunities, instead of making them crisis. And, in DBT, the skill for making that transition, the basic skill for accepting reality, since you can't change something you don't acknowledge, is...drum roll please... RADICAL ACCEPTANCE. But what does that mean?, you might ask. Well, let's start off with the bullet point description in my book (capitalizations are the book's):

  • ACCEPTANCE is the only way out of hell.
  • Pain creates suffering only when you refuse to ACCEPT the pain.
  • Deciding to tolerate the moment is ACCEPTANCE.
  • ACCEPTANCE is acknowledging what is.
  • To ACCEPT something is not the same as judging it good.

All of this reminds me a great deal of Oprah's views on forgiveness. Forgiving is something a person does for themselves, not the person ze feels has wronged them. It is done to stop fighting that something has happened, to stop wishing that it was different, but to acknowledge the truth of the situation as it is and move forward from there. It does not say that something is good, alright, ethical, or legal. But the concept of radical acceptance moves beyond just things that others have done to you to encompass something one can do in all situations.

It also revolves around this very Buddhist distinction between pain and suffering. Pain is not only unavoidable, but it is helpful and necessary. Pain tells you when to stop. Pain draws your attention to damage and hurt. But pain is not suffering. We suffer because we refuse to accept the painful reality we are faced with. But the greater the pain, the more difficult it is to accept, because we don't want it to be the reality, so we fight it, deny it, wish for it to change, which is where the suffering comes in.

It isn't easy though. For bigger, more difficult situations, a person usually has to keep radically accepting again and again, which DBT calls TURNING THE MIND. (It has it's own bullet points but I think it's fairly self-explanatory.) Just like in Buddhism, meditation in DBT works, in part, as an exercise in radical acceptance. You just let everything be what it is. In a video we watched a few weeks ago, the creator of DBT, Marsha Linehan, suggests that you start trying to radically accept little things before you try to tackle big things. For example, radically accept that, though you don't like it and it may make you late, traffic on the highway will go at it's own pace. Maybe, if you are travelling at the same time of day again, now accepting the traffic for what it is, you'll leave earlier or bring a better cd to listen to in the car. But don't learn the idea of radical acceptance and make the first thing you try to radically accept be that you've been very damaged because your biological father has abandoned you. It's a good one to work on, but, if that's the first and only one you have in your mind, it'll be much harder to do without the other experience and you have much more on the line if you feel like you have failed.

Radically accepting things also requires WILLINGNESS, not WILLFULNESS. This sometimes gets me into trouble, as I'll talk about in a later post really soon. It's about having the right attitude, not being stubborn or obstinate, blah, blah, blah. They each have their own bullet points so I'll let those help me:

Cultivate a WILLING response to each situation.
  • Willingness is DOING JUST WHAT IS NEEDED in each situation, in an unpretentious way. It is focusing on effectiveness.
  • Willingness is listening very carefully to your WISE MIND, acting from your inner self.
  • Willingness is ALLOWING into awareness your connection to the universe- to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to.

  • Willfulness is SITTING ON YOUR HANDS when action is needed, refusing to make changes that are needed.
  • Willfulness is GIVING UP.
  • Willfulness is the OPPOSITE OF "DOING WHAT WORKS," being effective.
  • Willfulness is trying to FIX every situation.
  • Willfulness is REFUSING TO TOLERATE the moment.

So, if you weren't already, I bet you're asking yourself just why the hell I'm telling you all this. I am not trying to bring you into the cult. But all this knowledge will come in handy in the next couple of posts. See, all of these ideas are well and good, but, like Buddhism has always done for me, putting them into use means asking myself what the reality is that I need to accept, what it is that I need to be willing to do to accept that and then to change it if needed. That judgment has to come from inside me or it won't really be very effective, but sometimes there are complicated situations with no simple answers. (In fact, DBT works to steer us away from black & white thinking, challenges us to realize that there are many times when seemingly opposing things can be true at the same time and that is fine.) My next post will look at this dilemma in terms of food, eating, and weight issues, but there are many big situations in my life where, though I want to do what it takes to move forward or make things better, I'm not always sure what those things are, what things I might be not accepting right now which are blocking my ability to find the answers to. So just take the ideas for what you will, but they are meant as groundwork for the next couple of posts.

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