Has life gone to shit? More importantly, are therapists saying ‘be OK’ with your situation regardless? As Dr Phil would say: ‘How is that working for you?’
I am a little snarky when posing this question. Nevertheless, gesturing to a pretty major issue with the idea of practising radical acceptance during the context of providing mental health treatment.
To get right to the heart of the matter, therapists, peers, and mental health professionals need to ‘help’ their consumers self-soothe and be at greater peace with their situation. The only issue is what constitutes as ‘help’? Professionals in mental health can’t agree.
Misapplication of techniques and misdiagnosis complicates everything further. Without the right treatment fit, how is anyone supposed to accurately track recovery progress? Well, another grossly misapplied skill is called radical acceptance. Misuse of this skill can be just as disabling, if not more harmful than dwelling or being upset.
Of course, there is a fine line here before helpful becomes harmful. In the mental health realm, practitioners are too clumsy when it comes to paying attention to crossing this line. In doing so, harm can be done when it could have avoided with more practice.
Researchers are hoping to explore this line and make it visible to the mental health worker. The research is revealing that people practising this skill are too often clumsy in their approach. They are sometimes working with limited information on how to correctly implement this skill in practice when providing therapy or peer-centric relationships.
So, let us get right to it. Depending on how these terms have been conceptualised from theory and applied to practice interventions, a small problem can become an even big problem.
It certainly seems to be for the camps in the mental health reform movement(s). I have bracketed the ‘s’ because it is not one movement. Theoretically, all of us in mental health want the best for our fellow people suffering or in distress.
Indeed, the climate in the rooms at mental health seminars, retreats, and the next team meeting at a local agency is never on the same page. Even when it comes down to our very intentions of helping others folks in distress, how to do so has become a bit nebulous lately in the field. This blip in the agreement between practitioners on best practices makes the helping process even more beguiling. When the helping profession cannot agree on what help means!
Unfortunately, there is no consensus (not even close) through care systems in Eurocentric expressions mental health treatment or the reform movement because help is far too unique to the individual. We are working with people with different cross-sections of society.
The manifestation of any ‘disorder’ or symptom (for those that lean towards DSM-oriented frameworks for positing mental health issues as a constellation of illnesses requiring treatment) will be different. Even for folks on the other end of the spectrum (and it is just that, a range of stances), the real issue at hand continues to beguile people in mental health.
Understanding these issues at hand as a direct or indirect result of complex traumas or learned behaviours from environmental, discriminatory, or any number of non-organic and codifying approaches to framing what the person needing makes it profoundly difficult to define the idea of help.
So, let us evaluate the different sides and various in-between areas of this spectrum of definitions intersecting help, mental health, and radical acceptance.
We will begin with a small survey of symptoms in the medical model of mental health treatment. There are indisputably many diagnoses that have problematic ‘symptoms’. These symptoms complicate our social lives. Well, for starters, let us take a look at depressive symptoms. When someone is feeling sad, they may choose to isolate, among other possible behaviours.
If we were to step inside the therapy room and observe this therapist practise radical acceptance, how might it approach? As a practising therapist, this theoretical therapist could have several possible inroads to suggesting to his or her consumer that sometimes it is OK to be sad. A safe approach (for now at least until it takes a dangerous turn, look out!) Sometimes, we all get upset, isn’t this a given truth? This therapist might say that acceptance of our sadness, grief, or negative feelings and being all right with not being okay in the moment is also very encouraging. Sometimes this is true as well. To begin to understand this more, we first have to realise we have landed there.
Now, isolating is normal behaviour for many folks (maladaptive but normal) when we are sad. Well, a piece of accepting landing in a tough spot means possessing a level of self-awareness. Ask questions and check-in with the status of personal wellbeing. A step forward to enacting self-actualisation is self-awareness. Other insight-oriented cognitive processes which make us think more about our behaviour.
Now, here is the line. Just thinking about our actions does not mean we will choose to make healthy decisions and enact positive behaviours in the future. After all, at this point, sadness and knowing things are going well. Being more aware does not mean choosing to do the right thing for in every situation.
Holding on to the belief solving a problem is futile is an even bigger problem. Therapists cannot gauge where people are in terms of the intensity of the symptom and its persistence/chronicity when it comes to patient safety. The risk of potential harm is even more dangerous. Now, this is just one symptom in a giant galaxy of human behaviour. More expressions and twice, many outcomes exist depending on the contributing factors we discussed earlier.
Now, this writer thinks very highly of himself and his colleagues. Despite these lofty beliefs, this writer is also a realist and needs to be pragmatic at work as a therapist. Not even the most skilled and calculating clinician or peer can predict or calculate every outcome (reading the DSM backwards and forwards or as an expert in human behaviour). Unless the therapist is supernaturally clairvoyant and can read into the future with their clinical gaze. For this very reason, there are always incidents in this line of work. Despite what we know, an element of unpredictability enmeshed into the exact web of how we practice radical acceptance in therapy and during peer centric relationships.
Now, let us delve into more peer centric interventions with the same need addressed: sadness, loneliness, or something similar. One great tested way of helping someone sad is not therapy or medication.
Sometimes, it is just plain old fashioned fun. Whether it is connecting with friends or feeling more connected to the community, socialization is a great way to reduce feelings of sadness. A full ‘recovery’ or experiencing relief for people experiencing sadness can be establishing more meaningful friendships, time spent socialising, and having plain wholesome fun with peers.
Now, that line that we talked about earlier is about to make is reemergence into this conversation. Don’t emotions like sadness sometimes make it more difficult to relate with others?
When we feel sad, you do not necessarily want to get out there and take the world head-on? Maybe not. Peer relationships, friendships can suffer tremendous interpersonal failure in the wake of behaviours which are not prosocial.
As a friend or a peer, how many figurative slaps in the face with untoward behaviour will you take before dropping a disordered peer?
Radical acceptance of a sad person feeling comes with it a mutual responsibility of the peer to accept these persons where they are at with life, right?
I mean, how can we practice mutuality and not be realistic about a sad person’s potential behaviours when he or she does not feel well?
Some friends may claim to be supportive. Some reality testing here. Let us be real if this were in the context of a job situation. Even within family systems, some behaviours warrant immediate police intervention beyond the support of a friend.
Threatening an ally and put them at risk of harm; this friend must call the authorities. There are so many symptoms that truly make prosocial interaction far too complex to practice radical acceptance without sitting on a vast litany of other interventions.
Knowing the craft will determine the practitioner’s or peers’ ability to identify this line and select an appropriate intervention congruent with a client’s clinical picture’s shifting nature. Increasingly tricky as old symptoms can manifest unpredictably.
New ones may emerge during the recovery process as a direct or indirect result of those discussed earlier. Understanding this will go a long way in reducing possible resentment and anger from allies that may hold accountable for unexplainable behaviours or symptoms. Friends who understand these issues when practising radical acceptance will always struggle with where the line is each time.
When practising radical acceptance, making decisions about safety may not be mutual. Instead, how comfortable a friend is with active symptoms and how adequate friends obtain support. Sometimes, like all relationships, the decision will not always be mutual. Be prepared for that sobering possibility.
There is no question that friends of someone carrying a mental health diagnosis deserve our unconditional radical acceptance of their symptoms and recovery journeys. Unfortunately, be prepared for times when this may not always be possible due to the nature of so many things that can go wrong with our mental health.
Image credit: Freepik
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.