Radical Acceptance

Radical Acceptance is a different way to deal with pain. Radical Acceptance is a change in your attitude: acknowledging what is.  The person who does not accept pain by getting angry or upset or blames someone or something for causing pain creates suffering. Pain becomes suffering when you do not accept pain. The more you deny the reality of the pain the more you suffer. The remedy is Turning the Mind.

Pain happens; it is a necessary part of living.  Pain is useful information when you touch a hot stove and move your hand to avoid a burn.  If you were without the sensations of pain you would be in deep trouble.  But pain cannot always be avoided. The psychological pain of loss of a loved one (grief) is particularly intense.

It is hard to accept many things that happen – the way a loved one died, the way your parents acted, or the way that others have treated you.  Sadness, anger, and resentment are natural emotional reactions to painful and difficult life events. These emotions (sadness, anger, and resentment) amplify the pain and cause suffering, feeling overwhelmed, and distressed. Denial is a way to avoid painful thoughts and feelings. Denial increases pain of sadness, anger, and resentment and creates suffering.

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Suffering is even worse than pain.  Suffering is when pain is denied, avoided, or rejected.

Suffering = Pain  x  Non-acceptance of the Pain

For example, the alcoholic is in denial of how his behavior hurts other people (the pain of abuse and neglect) and hurts himself (damaged relationships, losing jobs, getting DUI’s, and physical problems).  To break the vicious cycle of addiction and denial, the alcoholic needs to take the first step in A.A.  “We are powerless over alcohol and our lives have become unmanageable.”  He must accept his disease and that his life is out of control.  Once he accepts this problem, he can start to take responsibility for what he is doing and how he is treating others.

Radical Acceptance emphasizes acceptance rather than change, in the tradition of Zen Buddhism which emphasizes acceptance and awareness of the present moment, enhancing intuition, and experiencing emotions without inhibition.  Radical acceptance is the dialectical (resolving polarities) process of embracing and connecting AND releasing or letting go = finding the middle way.  Accepting the things you cannot change, awareness of how these things feel, this acceptance is total, complete, and without exception – RADICAL.
 

Some myths about acceptance:

  • If you don’t accept something, it will magically change and you won’t have to deal with it.
  • If you accept your painful situation, you will give in to it or it will take over your life. 
  • If you accept your painful situation, you are accepting a life of pain without end. 

 Practicing the skill of Radical Acceptance can relieve suffering by changing your attitude towards difficult realities into ordinary pain.  Radical Acceptance is accepting what “is.”  Acknowledging the truth as it “is” not what you want it to be.  Sometimes it is recognizing what is without judgment or opinion.  Radical acceptance is enduring the inevitable.

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Radical acceptance strives to be total and complete including mind, heart, body, and soul.  Such acceptance embraces reality as it is at the moment.  Accepting pain as it is dissolves denial and relieve suffering.  Accepting pain transforms suffering into tolerable pain. 
Radical acceptance stops pain from turning into suffering.  Pain can be almost impossible to bear, but suffering is even more difficult.  When you refuse to accept pain, you will suffer. When you cling to getting what you want and refuse to accept what you have, you will suffer.  Fighting reality, opposing the inevitable or struggling against what is – causes suffering.  Life can be worth living, even when there is pain.
Acceptance is the first step toward making a change for the better.

Imagine that you hate the color purple. Then imagine that you move to a house where your room is purple. If you refuse to accept that the room is purple, you will never paint it a color that you want.” Fighting reality causes suffering (I hate this room). Sometimes people get so caught up in hate that they don’t change things. First, accept the purpleness of the room, then paint it!
The Color Purple:
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Turning The Mind

We naturally want to turn away from (avoid) painful situations and back turn toward comfort.  Avoiding pain is automatic like pulling away from the hot stove.  But psychological pain is not like physical pain.  Accepting painful psychological realities requires mental effort and commitment to.  Turning the mind is the decision to not give up and turn to comfort or give in and turn to denial.  Turning the mind is the effort to deal with painful psychological realities without avoidance.
Suffering can sneak up on you in many forms.  One form is excuses, “it really doesn’t matter” when it really does matter.  Also taking the victim role, asking “why me?”  And focusing on how badly you feel and not what needs to be done.  Righteous anger, “that’s not right” again focuses on how you feel not the reality.  Worry makes you passive, “what do I do, what do I do, what do I do” and changes the focus from here-and-now to there- and-then.
The remedy for suffering is commitment to acceptance again and again and again.  Commitment implies a whole-hearted dedication to a purpose.  Commitment binds you to a course of action.  An enormous amount of evidence indicates that the commitment to behave in a particular way – or, more generally, commitment to a task, job, or relationship – is strongly related to future behavior.  Committed people finish the task, do the job, and stay in the relationship. Committed people are more likely to do what they promise to do especially when the going gets tough.

Willingness versus willfulness
Willingness is Radical Acceptance in action. Willingness is skill of realizing that you are part of and connected to the rest of the universe.  Willingness is playing your part, as best you can, with what you’ve got, at this point in time.  Willingness is a commitment to actively participate in your part of the cosmic process and allow the world to be what it is no matter what happens.  Willingness is bringing the attitude of full participation to your life.
Willfulness is disconnecting from your Wise Mind and the opposite of willingness.  If willingness is realizing you are a part of and connected to life, willfulness is denying reality, refusing to be part of the cosmic process, or giving up hope.  Willfulness is saying no to life itself, saying no to reality, and saying no to what is.  If you experience willfulness, turn your mind back to Radical Acceptance.
Alacrity is a special kind of willingness that is characterized by cheerfulness, readiness, and eagerness.  This is willingness as joyous activity.

Metaphors for willingness and willfulness

Hitting baseballs from a pitching machine is a metaphor for willingness.  Like the pitching machine keeps throwing balls at you, life throws reality.  You need to keep your eye on the ball to hit it and swing.  As each ball comes, focus on giving it your best shot not just thinking about it.  Willfulness, crying, defiance or just standing there does not stop the ball.  If you stand in the way of the ball, BAM!, the ball hits you.  You will not hit any balls if you stand there doing nothing.  Ignoring the ball does not make it stop coming.  Willingness is taking your best swing at the ball.

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Life is like a game of cards

It makes no difference to a good card player what cards she is dealt.  Her objective is to play each hand as well as possible.  As soon as one hand is played, another hand is dealt.  She puts the last game behind her and focuses on the current game.  She is mindful to play the current hand the best she can.  She knows that if she plays her cards skillfully, she is doing the best she can.  She can only control what cards she plays, not the hand she is dealt or how the others play.  When she plays her cards, she lets go of what she can control.  Win or lose, she accepts how the cards fall.  When one game is over, she focuses on the next hand of cards.

​Adapted from Linehan, MM.  (1993) Skills Training Manual for Treating Borderline Personality Disorder.  New York: Guilford pgs 176-177

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Follow-up appointments are flexible

In the beginning of treatment, people usually need to be seen more frequently. Follow-up with patients who started on new medication within one to three weeks regarding response to medication, side-effects, or any changes are normally scheduled for either 15 or 30 min.

Standard medication management follow-up appointment is 15 min. Sometimes longer appointments are necessary to gather more information for further diagnostics or to communicate important psycho-educational information.

Some patients may benefit from a psychotherapy process which involves exploration and understanding the patient’s circumstances. Once a patient is stable, depending on the situation, they may follow up every one month, three months, or six months.

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