Radical Acceptance: A Vital Skill for Therapists in Training

You can’t rush, or control, the process of change. Perhaps that is one of the biggest lessons I’ve learned this year.

Change is like a current. It unfolds on its own, at its own pace and with its own force, because it results from many factors, both seen and unseen. As a therapist, you can’t control it. Therapy is only one factor in client’s lives, taking up only 45 minutes of the 168 hours of their week. In other words, you and therapy are only 0.006% of a client’s life. So you can’t control change, and you can’t rush change.

Before accepting this simple fact about change, I first had to struggle, for months, with several aspects of the process of change. The hardest part has been watching some clients stay stagnant, week after week. Or watching them take one step forward one week, two steps back the next. This, at times, has felt like torture to me, because I never lost sight of these clients’ true potential. Why couldn’t they see what I saw, use it as fuel, hurry toward change, I wondered.

The second hardest part about the process of change was perhaps watching its slow pace in regards to my therapy skills, and to the context within which change is supposed to take place (i.e., process of therapy itself). Entering sessions with lofty expectations and a plan for how things would go, only to watch these hours go differently than I expected – with less control, more unpredictability, sometimes doubt – was also sometimes torture. Why couldn’t I control what went on in a session or make it somehow go perfectly, like a well-steered ship, moving full steam ahead, inching closer and closer to that safe, exciting harbor in sight?

After many of these moments and reflections, I felt ashamed. Over time, I began to feel helpless. I started blaming myself. I often concluded that if I was better at therapy, these clients would have made more progress, or faster progress, or more efficient progress. The blame fueled my sadness and shame. When my supervisors praised me for things done well, I began to discount their feedback, because it didn’t fit the story I was telling myself about not being able to control the process of therapy and change.  

Yet there was a stark contrast between my perception and the facts. The reality is what was reflected in my supervisors’ feedback. Clients kept coming back. Some learned valuable skills that they used in their lives, some began to see improvement in their symptoms, some began to graduate. I had moments in therapy of wonderful connection, or moments that asked for quick, creative thinking, and I delivered. I continued to get positive feedback from my supervisors. “You have great clinical instincts” was a common phrase I heard as I described to them what went on in sessions. And, fully non-accepting, I continued to wince at these compliments internally.

Eventually, I began to feel ashamed at the discord, and started feeling anxious around my supervisors. Having first-row tickets to my own performance in therapy week by week, I could tell there were many areas of improvement. I also began to feel guilty for the clients themselves, who I thought maybe would benefit so much more with someone other than me – maybe a clinician with more experience, maybe my co-extern who seemed so much more competent than me in role plays. Maybe, I though, I was tricking these clients into believing this was the best it gets in therapy. And very likely, it isn’t.

These feelings and ideas ate at me for months. I coped by distracting myself from those uncomfortable feelings and continuing to work hard at learning the skill of therapy. I did improve, in many aspects, as trainees do, given that this is the purpose of training. But I made no progress in changing the internal discord I felt for a while. What finally allowed me to move forward from it was delving deeper into a skill I was trying to learn in one of my personal work-hard-at-learning-the-therapy-skill sessions: radical acceptance.

Radical Acceptance: What and How, and Why It Works

Radical Acceptance is an important skill in DBT that we use to teach clients how to accept the things they can’t change in their lives, or to accept the things they can change but need to accept first in order to be able to change them.  

The first step to accepting is looking at exactly what you need to accept fully. Fully facing all of the uncomfortable feelings. This is often the hardest step. My previous response to the muck I felt inside about my inability to control the process of change was to turn away from it and distract from it, because it made me sad and ashamed to think about, and deep down, I thought there was no other way.

Facing those feelings fully occurred in waves. It took a gradual and repeated process of applying RAIN: Recognize. Allow. Investigate. Non-identify. You first recognize the feelings you’ve been avoiding. You connect with them. Second, you make a conscious choice to allow them to be in you. You allow them to be in you, and to settle in you. It’s like you tell them, “It’s OK, there is space for you here.” Third, after some time of allowing them to settle, you start investigating them. “Why am I feeling this way? Why are these here? What is my mind telling me about this situation? What do I think about these thoughts?” To answer this last question, the fourth step is crucial: non-identification. You recognize the feelings as feelings, the thoughts as thoughts, both impermanent and temporary, neither as a necessarily accurate reflection of reality. Just feelings passing through, just thoughts passing through you. The feelings and the thoughts are not you, they are in you. There can be space in you for them. They too will pass.

With RAIN, I started getting better at facing the feelings. I started allowing them to settle instead of fearing them, and then investigating them and the thoughts that were attached to them. The many “shoulds” (“I should be better at this by now” “I should not have made that rookie mistake”) and “what ifs” (“What if my supervisors think I’m better than I am?” “What if I’ve tricked them by accident?” “What if this client isn’t making progress because I’m actually just so terrible at this?”). Not identifying with them helped me step back and, ironically, feel a little more in control. Just long enough to not fear allowing and investigating them anymore.

Some therapies take a cognitive focus and lead you to rationally consider these thoughts and deconstruct them. If I were to do that here, I may have benefited, but I think it would have been really hard, for two reasons: One, I wouldn’t have been able to open myself up to these thoughts because I would have been fighting the feelings still, and two, jumping to deconstructing the thoughts may have given me temporary relief because it would get me off the hook of having to tolerate the terrible feelings I was avoiding. In a way, it would have provided more cognitive distraction. Later, when I would have forgotten my rational responses, and the terrible feelings came up again, I may have resorted right back to my more automatic habit of avoiding the feelings (and the thoughts) altogether.

The power of Radical Acceptance, in part, is that it asks you to open yourself up completely to your emotional experience. You meet yourself exactly where you are. And then you hold yourself exactly where you are. You hold your inner experience instead of criticizing yourself for having it or abandoning yourself in the time when you need yourself the most. It teaches you how to hold yourself, your inner experience, and keep holding on to all the feelings that come up. Ultimately, you send yourself the message to yourself that whatever feelings pass through you, they are OK, they are just feelings, and you are not alone. You’ve got you.

When you are finally at that place, then you are not only ready to accept the circumstances, but do so radically. Radically means two things: 

First, you accept the whole truth. Not just the less painful part. Not just the part that you feel you can face right now. But rather, all of it. The whole truth. You accept the facts, the experience itself, the experience of having this experience. Even the urge to not accept the experience or the facts. You also accept the content of your thoughts, and you accept that you’re having thoughts. You accept everything.

Second, you accept it with your whole being. You accept it all with your mind, with your heart, with your spirit. You accept it fully and passionately, like your life depends on it. You do the things you need to do to bring your body and heart along – from accepting with open palms, from breathing in and out, from imagining what it might look like if you had already accepted and pushing yourself to now embody that experience.

So, I accepted. I took walks and accepted. I sat in meditation and accepted. I caught myself not accepting throughout the day and accepted. It took some practice. Some willingness to sit with the awful feelings of shame and sadness. It got easier over time because I also noticed that after acceptance, there was calm, a centeredness. I had accepted, and I no longer needed to run from these feelings. I could be present with myself, for myself, in full acceptance of myself as a therapist and as someone who had no control over change.

Even the process of reaching acceptance wasn’t perfect. It took some reaching acceptance and then falling off again … then realizing I had fallen of … then practicing Radical Acceptance all over again … then reaching acceptance again.

The result is that I am now at a place now where I feel that acceptance has sunk in and settled more deeply and stably than before.

So here is what I’ve accepted:

First, regrading change in clients’ lives …

1. I cannot control change. I cannot control who gets better and when. I can only be present with them, give them the tools that I know, in ways that I hope will resonate with them. That’s all I can do. Change is not up to me. I help increase the odds of change, but I do not control the outcome.

2. I don’t need to have expectations about how fast or when change happens. I may notice that I am attached to expectations of certain outcomes, and I can practice letting go of that attachment. I can remind myself that life takes care of itself. I only need to be present and prepared, giving without expectations of what will happen after they walk out the door. I can meet them in this present moment as they are.

3. Clients will sometimes take a long time to change. They will sometimes not change at all. They might even drop out because it isn’t time for therapy right now, and not change for many years, and then 5 years down the road, try therapy again and change in one day. Change is its own process; I do not control it, and I can have patience for it and for them. I can continue giving at those times, and continue letting go of expectations.

... and then regarding change (and belief) in myself as a therapist …

4. When sessions aren’t as helpful, there are many factors that go into that, aside from my performance. Factors like clients’ mood and the concerns they walked in with, the natural fluctuations of any process in flux (like change), and the sometimes natural slow pace of change. Not JUST my performance. My performance may contribute, and I am learning. I am not perfect, and I don’t need to be for therapy to work. These clients are coming in of their own volition, and when they stop benefiting, I can rest assured they will stop coming.

5. Learning therapy means I will have moments of insecurity. As a trainee (especially a trainee in DBT), I will have many moments of doubt. Learning (and doing) DBT comes with doubt because client problems are more chronic, more difficult. The clients themselves are often harder to read, more unpredictable. So, it makes sense that there would be many more moments of insecurity than learning any other therapy. I can face these. I am willing to, because the clients themselves are loved and lovable, and worthy of achieving a life worth living. I can tolerate uncertainty and insecurity and doubt, if this is what it takes to learn to be effective in the practice of giving.

6. My supervisors like me, now and as I change. They think I am competent. They think I am doing well. They are happy with my progress. I can believe them. They think I am competent. I agree, and I can believe them.

7. I am competent. I don’t need to be perfect to be competent. I need to be present, prepared, and willing to learn, just as I have been. I need to be invested, just as I have been. I need to keep trying, just as I have been.

Some Final Thoughts on Giving & Patience & Change …

The reading at my meditation practice this week spoke right to my heart and instantly made me tear up. It happened to be about all of these things that have been swirling in my mind, and so it resonated. I leave you with this and hope it resonates with you too …

May I offer my care and presence without conditions, knowing I may be met with gratitude, anger, or indifference.

May I find the inner resources to truly be able to give.

May I offer love, knowing I can’t control the course of life, suffering, or death.

May I remain in peace and let go of expectations.

May I offer my efforts and help, knowing it may be of great benefit, some benefit, or maybe even no benefit.

- Rev. Howard Thurman