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Radical Acceptance

Katelyn Haines & Fedor Volochtchik

Counselling Model

DBT

Dialectic Behaviour Therapy (DBT) is a biosocial type of cognitive behavioural therapy (Linehan, 1987) that combines client-centered empathy, acceptance, and understanding with cognitive behavioural problem solving and techniques to promote emotional regulation (Kring et al., 2014).

  • Aims to alleviate distress by altering perspective
  • Being consumed by an emotional reaction limits ability to think rationally and understand a situation.

What is radical acceptance?

Linehan (2015)

Radical

Acceptance

  • Acceptance without judgement - not fighting it, not getting angry at it, or trying to change it. Accepting it for what it is
  • Frees self from suffering, self-criticism and judgement by acknowledging reality and "what is"
  • One of DBT's treatment targets is promoting distress tolerance.
  • Radical acceptance is an intervention used to increase distress tolerance
  • Doesn't deny emotions, pain or suffering but aims to release that from which one cannot change
  • While taking responsibility for our involvement and contribution to an event to accept accountability and be in control (and not deflect blame)

It's not victim-blaming

Radical acceptance isn't always appropriate or applicable for all situations. It's not about giving up or accepting that bad things just happen. But, in situations where we can share responsibility (and we often contribute some sort of role in creating a domino effect in a situation) we accept our involvement, decisions made, and can respond to how to respond

Client

suitability

(Mckay, Brantley, & Wood, 2007)

Casual Assumptions

Our mood (emotions) cause behavioural reactions (Neacsiu et al., 2012)

Assumptions

Validation and acceptance helps to reduce emotional distress and behavioural dysfunction (Linehan, 2015)

Environmental factors contribute to our emotional state which results with a behavioural response (Neacsiu et al., 2012)

Conflict occurs when there’s polarization of internal forces that are not being understood and synthesized (Linehan, 2015).

Therapist and

client co-create

and agree to

treatment goals together which prioritizes

a list of

problems

experienced by the client

Prescriptive

(Mckay, Brantley, & Wood, 2007)

Clients do homework and keep journals of their progress to monitor thoughts, feelings, and behaviours

Therapist will balance change and acceptance strategies

Therapist and client share power and are considered equals

(Rizvi et al., 2013)

Holistic components intersect and influence reality

Linehan (2015)

Thesis and antithesis evolves new sets of opposing forces

Reality is a continually changing process

Paradigmatic

3 underlying theories; biosocial theory which posits that biological and environmental factors can contribbute to emotional regulation/dysregulation;

behavioural theory which assumes behaviour can be conditioned (classical and operant);

dialectics theory which posits that reality can be understood by interrelated opposing forces (there are many interpretations of reality that coexist, especially extremes, to produce change) (Linehan, 1987; Neacsiu et al., 2012; Rizvi et al., 2013)

Reality is made up of opposing forces (thesis and antithesis)

Procedures

Application

Can be adapted to accommodated cultural backgrounds when following CRSJ framework

Consider possible barriers:

  • Cultural values and beliefs - may differ
  • Language preferences and limitations
  • Trust - nurture the alliance
  • Accessibility to counseling services
  • Abilities and disorders (capacity considerations to appropriately accommodate)

Cultural considerations

Still a lack of evidence regarding application of DBT in a variety of cultural settings. However, evidence shows that DBT can be successful when cultural considerations are accommodated

(Mercado & Hinojosa, 2017)

(Moonshine & Schaefer, 2019)

Identify the client’s situation and context

Perform a "chain analysis" together with the client and the events that resulted in the problem:

Ask: "How will the client benefit from mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness?"

Vulnerability Link (In what ways was I Vulnerable?)

-Skills should be taught in a timely manner (15-20 min intervals). Client contexts, abilities and attention span must be kept in mind as well

Procedures

Connecting Link – can be thoughts or feelings, actions, impulses, people or places etc (What connected my triggers and Vulnerability?)

-Skills can be taught in a variety or contexts: groups and single settings, drop-in or continuous treatment scenarios, professional and home environments.

-Instruction can further be adapted for age, ability.

Triggers Link (What are my triggers?)

Connecting Link (What connected my triggers with the problem behaviour?)

Discuss the meaning and use of each skill in each situation

Problem Behaviour Link (What was the problem behaviour or related behaviour?)

3 skills from the DBT framework are then chosen to accommodate each of the links in the chain. A primary Meta Skill, a Secondary Skill, and lastly an Ancillary Skill

Clients are made to practice their skills in order to reliably use them during times of distress. Repetition and change of context during practice scenarios is integral to the client’s skill acquisition.

Clients may need additional motivational encouragement (offer hypothetical scenarios of radical change, pros and cons lists, rolling with resistance, etc.,)

Radical Acceptance as a Distress tolerance skill can be taught in various forms appropriate to the client’s preferred learning style (visual, kinesthetic etc.,).

Formats of instruction may include:

Format

Kinesthetic Activities

Auditory Activities

Visual Activities

  • Handouts
  • Discussions
  • Art Projects
  • Flash Cards
  • Lectures
  • Games
  • Power-point
  • Role Play
  • Small Group Exercises
  • Art Projects
  • Small Groups
  • Games

Radical Acceptance

Worksheet & Flash Card

Handout Examples

References

References

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34, 10-13.

Kring, A., Johnson, S., Davison, G., & Neale, J. (2014). Abnormal psychology (12th ed.). John Wiley & Sons.

Linehan, M. M. (1987). Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality Disorders, 1(4), pp. 328 - 333.

Linehan, M. M. (2015). DBT skills training manual. (2nd ed.). The Guilford Press.

Mckay, M., Brantley, J., & Wood, J. C. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. New Harbinger Publications.

Moonshine, C., & Schaefer, S. (2019). Dialectical behavior therapy, vol 1, 2nd edition : The clinician's guidebook for acquiring competency in dbt. PESI.

Moonshine, C., & Schaefer, S. (2019). Dialectical behavior therapy, vol ii, 2nd edition : More then 275 worksheets, activities and games for acquiring competency in dbt. PESI.

Mercado, A., & Hinojosa, Y. (2017). Culturally adapted dialectical behavior therapy in an underserved community mental health setting: A Latina adult case study. Practice Innovations, 2(2), 80-93. http://dx.doi.org/10.1037/pri0000045

Nelsen, M. D. (2021, August 12). Therapist explains radical acceptance using character Frodo [Video]. YouTube. https://youtu.be/kQWDdCZ26n8

Rizvi, S. L., Steffel, L. M., & Carson-Wong, L. (2013). An overview of dialectical behavior therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80. https://doi.org/10.1037/a0029808

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