Monthly Archives: March 2010

Radical Acceptance: Accepting the Unacceptable – Coming to Terms With Our Destructive Behavior to Heal the Emotional Pain of Shame, Guilt, and Regret

I recently responded to a LinkedIn discussion regarding the negative consequences of an individual being found “Not Guilty by Reason of Insanity.”  It was spurred by a Wall Street Journal article entitled, “The Trouble With the Insanity Defense” written by D. J. Jaffe, a co-founder of the Treatment Advocacy Center.  It was printed in the 3-26-10 edition.

http://online.wsj.com/article/SB20001424052748704896104575139801575696436.html

The writer notes, “Not guilty by reason of insanity is an inadequate remedy to violence by individuals with mental illness.” He raised some valid points.

As I work for a state mental health institution which provides treatment for NGRI patients, I responded with the following comment.

Pros and cons. Time in a psychiatric hospital is generally “easier” time than in prison – so that is a definite benefit to the NGRI population. Further, many of our NGRI patients have stabilized to a degree that they are among the highest functioning patients in the hospital and have the highest level of privileges. Those are benefits.

In terms of cons, in general the NGRI population spends more time in a psychiatric facility than they would if they served Guilty sentences in prison. Also, like the article notes, they are often held in a psychiatric hospital long after stabilization and likely safe release to the community. In Texas, the superintendent (CEO) of the hospital has to approve the potential release before petitioning the court for placing the patient on an outpatient commitment. Both the judge and the hospital CEO are risking their careers and reputation if the released patient recommits a significantly violent crime.

The headline test – ‘Judge ordered release of criminally insane man who kills again

In addition, the community mental health officials also have to ‘sign off’ on the release and attest that they can ensure adequate monitoring and treatment to prevent reoffending. It’s a risky business. However, many of the NGRI individuals are truly honorable, caring, competent individuals who regret their actions and strive for a productive life. It is a great shame for patients and victims. Our facility works very hard on behalf of these patients, the courts, and the community to carefully evaluate individuals who appear ready for an outpatient commitment and to ensure a sound outpatient treatment program / support plan is in place for these individuals. It is a risky situation however as a state psychiatric facility, we are charged with providing this service and level of care.”

Marilyn Miller, MS., LPC., a psychotherapist in private practice in San Antonio, Texas, comments in this discussion that she works with individuals with bipolar disorder to help them “resolve enormous shame for their actions during manic phases (pre-medication and -treatment).”  She notes that even though their acts did not involve violence against others, their behavior was so “devastatingly self-destructive” and “so counter to their own ‘real’ values that the hurdle of getting over that shame is quite high.”  She states that she “can not imagine the further horror” for NGRI individuals “knowing that they have taken lives (or attempted to do so).http://www.marilynmillerpsychotherapy.com/

My follow-up response using the vernacular and understandings of the DBT-CBT “Out-of-Control” Workbook I wrote…includes,

As you say Marilyn, it is horribly sad to work with the NGRI’s (or other patients) who are non-psychopathic…and in a period of being out of touch with reality or otherwise ‘Big Time in Emotional Mind’…enacted state dependent destructive behavior…and when they ‘come to’ reality (Rational Mind) and recognize what they have done and the impact on others and their lives…they are in great emotional pain and are devastated by their behavior.  Just this week in group at the state hospital, this came up as we were discussing the consequences of ‘Emotion-Driven Behavior.’  A cloud of great remorse and sadness came over the group in that moment of insight and understanding relating to why things are the way they are in their lives…why their people are so upset with them….and why they have lost so many of the things that they value and cherish.

I teach them that it’s not WHAT happened (like a relationship break-up, conflict on the job, abuse, etc) that has led to such life losses…that it is HOW they responded to the life situation (drugs, alcohol, suicide attempts, physical violence, saying ugly things to people, etc) that has led to the deterioration of their life and the widespread losses of all the people, things, and activities they love and cherish.  This is a painful truth that leads to a major moment of reckoning.  From there, we talk about what we can do to prevent getting ‘Big-Time in Emotional Mind’…and learning ways to respond through Wise Mind when we do experience out-of-control emotional moments.

This past week, this moment in group was so heavy in sadness that I told them that this is exactly why I wrote the workbook and why I am so passionate about helping them in group…that it pains me greatly to be among such neat, wonderful individuals who truly care about their lives and their people…and how it is so sad to live, eat, breathe Emotional Mind…and to be stuck in a ‘Cycle of Suffering’…a cycle of being upset, enacting destructive Emotion-Driven Coping Mechanisms, suffering more losses, feeling worse, continuing destructive copings, consequences worsen, feeling even worse….and on and on and on.

The depth of their pain is what drives me to work so hard to help them to understand Emotional Mind dynamics and to find new ways to respond to life stressors, problems, situations, losses, etc., to STOP the cycle of suffering, and to live a recovery lifestyle so they can reap all the rewards of doing so…to end their pain and suffering and to live a life that provides meaning and satisfaction.

For many, this involves understanding why they have done the things they’ve done, self-acceptance and forgiveness, being committed to change the way they respond to life, developing a Game Plan for recovery, and FOLLOWING THROUGH with their recovery plan.  This process also involves understanding why others have acted in certain ways towards them, acceptance and forgiveness of others, etc.

Another major point I teach them is that their destructive behavior is not a product of WHO THEY ARE as a person…not their character, personality, or true self…but a product of HOW THEY ARE (or were) when they are ‘Big Time in Emotional Mind’…as a result of psychosis, mania, intoxication, great anger or upset, the result of an altered state of consciousness, the one in which they are Big Time in Emotional Mind without any significant levels of Rational Mind going on.  It is not WHO THEY ARE….because most of these individuals are good-hearted people who care about others…and truly care about living a productive life and being kind, loving, and helpful to others.”

For this blog, I’d like to add the following text from Chapter 12:  “ACCEPTANCE” from the DBT-CBT Workbook.  This is an example of applying “Radical Acceptance” to our lives.  Radical Acceptance is about “accepting the unacceptable”….and boy, when we’re in recovery…we’re going to have to do a lot of that!

ACCEPTANCE OF THE BAD, HORRIBLE, ROTTEN THINGS WE’VE DONE

We’re human.  We ALL make mistakes.  When we’ve LIVED IN Emotional Mind, we’ve made MANY mistakes.  We’ve acted impulsively and have made MANY regrettable decisions.  We’re NOT bad, horrible, rotten people.  We’ve just done some bad, horrible, rotten things.  These things happen when people are drinking, drugging, in a manic or psychotic state, or are desperately overwhelmed with painful emotion.  When we’re CLEAN N’ SOBER, on our MEDS, making HEALTHY LIFESTYLE CHOICES, and ACTING IN WAYS to Mindfully Protect Our Peace and Stability, we’re GOOD-HEARTED PEOPLE with good morals and values…and WE CARE ABOUT PEOPLE.

Think of the REALLY NEAT people we’ve met in rehabs, AA, support groups, and hospitals.  They’ve lived a past JUST LIKE US.  They’ve done hurtful things to the people they love WHEN they were in the middle of their addictions and Destructive Coping Behavior.  They’re NOT bad people.  They’re the WALKING WOUNDED and IN THEIR DAYS of PAIN and IMPULSIVITY, they did some painful and impulsive things.  TAKE AWAY the drugs, alcohol, mania, depression, pain, anger, and bitterness…and what’s left are some PRETTY NEAT PEOPLE!

We’re the walking wounded.
We’ve experienced a lot of pain.
Being desperate for relief,
we’ve done a lot of painful things
that have hurt ourselves and others.

Think of two people YOU KNOW that fit that description.  What sort of bad things did they do when they were in the middle of their addictions and destructive coping behavior?  Also describe their character when they’re living a Recovery Lifestyle.  _________________________________________________ _________________________________________________

Our Recovery Task is to ACCEPT whatever we’ve done.  Then, we must WISELY decide which things we CAN DO SOMETHING ABOUT and which ones we CAN’T.  We need to focus our efforts on the things we CAN do something about that are a PRIORITY in our life.  We need to DO WHATEVER WE NEED TO DO to improve these things.  The things we can change that AREN’T A PRIORITY…
we need to LET THOSE GO… FOR NOW.

The things we CAN’T CHANGE…
we MUST let them go.
Letting go is a CHOICE.
It’s a choice for FREEDOM from burden
and a choice for PEACE and SERENITY.
Remember, “God grant me the serenity
to ACCEPT the things I cannot change.”
ACCEPTANCE is what gives us serenity
EVEN WHEN our lives are in turmoil.
It’s how we CHOOSE to THINK about things
and RESPOND to things
that ultimately affects HOW WE FEEL about things.
We can CHOOSE to be AT PEACE with our situations
or we can CHOOSE to be in turmoil.
We CANNOT LIVE NEW LIFE if we live in the PAST.
CHOOSE to let some things go
so you can GO ON with life…
and LIVE NEW LIFE!

Extra margin text from this section of Chapter 12:

We weren’t born this way.
We became this way
because of an Out-of-Control lifestyle.

Our people want us ALIVE and WELL,
so we need to bury the guilt and pain that’s killing us.
We cannot be the person we were meant to be
or live the life we were meant to live
if we are carrying around what makes us wish we were dead.

The only way to start over
is to START OVER.
We do that by accepting

what needs to be acceptedand by moving on down the Recovery Path.

This text was adapted from the DBT-CBT Therapy Workbook – “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” by Melanie Gordon Sheets, Ph.D. – copyright 2009 – Recovery Works Publications –

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Question: Is Spirituality A Major Component Of Your Work – Response: The Role Of Spirituality In The Development Of The DBT-CBT Therapy Workbook

Spirituality IS a major component of my work because it is a major part of who I am as a person and a major driving force for how I live my life.  The DBT-CBT recovery workbook that I wrote was initially written as a Christian DBT-CBT workbook; however, due to the biblical focus, I was not able to use it in the therapy group I conduct at the state hospital.   At the hospital, I was using packets of information (handouts) that summarized the major DBT-CBT concepts without spiritual references.  The patients continually asked for more information to study outside of group, to work on at home when discharged, and to share with their families…while all my time and energy was being spent on developing the Christian workbook.   The pressure mounted and I felt I had to leave the Christian project and develop a secular workbook for use with my patients.  Believe it or not, I feel God blessed that endeavor and guided the writing of the secular workbook.

Here’s the brief story.  While working on the Christian workbook, I became pregnant at the ripe age of 43 and naturally lost the energy and focus on the workbook.  I ended up losing the baby and did not immediately resume work on the workbook after physically recovering.  Within months, the internal (and external) pressure to write a workbook for patient use was mounting and by the following January, I was absolutely tormented by it…I had no peace.  I was so burdened by my lack of focus on the workbook that I had to complete a Wise Mind Worksheet to deal with it!  Of course, the end result was to set a date to re-engage in the writing process, but to abandon the Christian workbook to focus on a secular one.  I finally said, “Okay God, I’ll do it…I’ll start on January…” and I specified the date.

Amazingly, at that moment of submission of my will, I lost that pressure…that tormenting burden…and I finally felt “at peace.”  Oddly enough, as I write this now, I realize the date set  was the time period when the baby was due…towards the end of January that year…pretty cool synchronicity!

When the agreed upon start date came, I got back into the workbook as I agreed to do.  I took out all the biblical references and began writing it for a secular audience.  I remained insanely focused on the project for the following 23 months…until I “got ‘er done!”  That was 23 months of near “24-7” focus on the workbook during non-hospital job waking hours!  Everywhere I went, the workbook went…kid sport practices, rodeos, traveling even 45 miles from home, “vacations,” and even to Six Flags!  I said it was an “insane” focus!

Once the book was in print, I’d flip through it…and would be stunned at the amount of work and time that went into it.  It is astounding.  I’ve often said of myself that “I was born to work” and I’ve recently decided that my degree of task energy and persistence is a God given quality…because it is soooo unnatural…and if I had it my way, I’d play and entertain myself instead!  I whole-heartedly believe that God is the driving force that has enabled me the capacity to pull off the projects I have pulled off in my life!  Without the hand of God in my life, I really don’t think I would have made it through all the life experiences I have been through…the good ones and the bad ones.

All in all, spirituality is a major driving force in my life…something that defines my life…and thus flows into all aspects of my work…and not just in the form of “works”…but also in how I choose to interact with the people that are a part of my life…including the patients I serve!

What about you?  How does your spirituality affect your work?

What Frees You To Be Yourself…And To Achieve To Your Potential: Acceptance Of Self And Others From A DBT-CBT Perspective

I came across a discussion item on LinkedIn a little while ago about “What frees you to achieve to your potential.”  The individual posting the question focused on “self-discipline”…well, that was not what I had in mind when I read the discussion headline in my email.  Here’s my response!

“I believe self-discipline is a must, but that hasn’t set me free…it burdens me because I am overly-driven. I believe that my tenacity, perseverance, and ability to stay at a task long after others would have left it is a God-given gift…yet sometimes, I think it is also a curse! I guess I haven’t incorporated the “balance” component yet!However, I also believe that I am able to step out of my comfort zone, put myself “out there” or extend myself, try things…and achieve some pretty awesome things now and then because I do not expect that I will be perfect and I recognize that foibles, errors, and imperfections are very human. I realize that not everyone will like me or my style…and that’s okay…because not everyone will! No matter how great someone is…there’s always critics in every corner!I believe acceptance of my humanity and acceptance of the varied temperments of others helps to free me to be myself…extend myself…and be who I was designed to be…and do what I was designed to do. That sure helps me to work through the neurotic self-doubt and shame that has haunted me over the years.”

As I considered that response, it reminded me of a section in the introduction of the DBT-CBT Workbook I wrote last year.   This section is entitled, “Saving Face: DBT-CBT in Action” and the text from this section is below.

You’ve heard the saying about “stepping in it.”  Well, I sometimes “step in it”…and the work of this book is no exception!  I spoke to a professor at Texas A&M, Dr. Brian Stagner, about reviewing this workbook.  He was my mentor during graduate school and he graciously agreed.  Although I’m proud of this work, at the same time, I’m a little embarrassed by it!  That’s a dialectical problem by the way!  I figured he’d be impressed by the content, but stunned by the language and grammar…so, I never sent it to him!

Part of DBT-CBT is Choosing Our Battles and Taking a Stand and Fighting for what’s MOST IMPORTANT to us…NOT EVERYTHING in life.  It’s also about being prepared for and accepting the consequences of our behavior and choices.  It’s also about being wise…and we’ll see if I made a wise choice!  I expect to take some hits on grammar, like dangling participles, commas instead of semicolons, overuse of contractions, pronoun and antecedent disagreement, Texas slang, and other informal language and grammar.  The truth, I wrote this for the average person and in a language many people speak…except for some southern slang!  It wasn’t written for a professional audience, though I hope many in that audience will read it.  I’m an informal, “down-home girl” and I wrote this for “down-home people.”  I CAN BE formal if I have to be, but I certainly PREFER NOT!

Another criticism I expect is repetition in the workbook.  I tried to write this as I would speak it and teach it in Group.  When I teach important principles and concepts, I often repeat myself by explaining the same thing in different words…one sentence right after another.  Sometimes, hearing something said in different ways helps us to understand and remember it better…and if our minds have wandered, maybe we’ll get it the second or third time around!  I’m very invested in the people I work with…and I’m passionate about doing my part to change lives.  I drill home some points because this is intended to be a learning AND recovery experience.  It’s NOT designed for casual reading or entertainment purposes!

You’ll notice some repetition across chapters. My belief, most people don’t have audiographic memories…like they hear something once and remember it. My goal is for people to understand and remember these life-changing principles, concepts, and skills…so they’ll be equipped to apply them in Real Life. Many of us are hard-headed and need this information drilled into our minds. We may not WANT to hear some things and we may not be ready to look at or process some things. We usually have to be emotionally MOVED before we DECIDE to make difficult life changes. Being MOVED often involves looking at the Big Picture of Reality until our eyes are opened and the truth sinks in. Further, to learn how to carry out these skills and to live these concepts…we need to live, eat, and breathe this information until we know it so well we can repeat it back to ourselves. We LEARN by repetition.

Also, everyone doesn’t read a book cover to cover in a few days.  When time goes by, a review of important principles and concepts helps us to get the most out of what we’re reading.  Further, when we’re stressed out by life, our brain is working full capacity to survive and meet here-and-now demands…and it isn’t always so able to fully process and learn new information.  On top of all this, some of us have used a lot of drugs and alcohol, are aging, on medications, or have had head injuries…and our attention, concentration, and memories aren’t like they used to be!  Also, some folks have had learning problems all their lives.  Others may have symptoms of mental illness which affect their ability to concentrate.  In my mind…REPETITION IS GOOD!

The last point of embarrassment is…there WILL BE errors and typos…and Lord, I hope not…lost lines…where they disappear when the document is printed.  I know I’m obsessive-compulsive…a perfectionist in many ways.  I could review this book for ANOTHER year…and continue to make changes.  However, if I don’t GET ‘ER DONE…it’ll be half of forever before it’s in print and can be helpful to people who are HURTING and SUFFERING.  Getting this in print is much more important than perfection and my ego.

Some folks don’t like how I’ve used CAPITAL LETTERS.  I took some out, but left many.  Again, I’m trying to drill home points.  The capital letters are intended to draw attention to important principles and concepts…things I really want folks TO GET and be aware of!  Sometimes, they’re for emphasis (like to say louder when we’re reading), but most often they’re there to highlight a point.  The capital letters may make reading a little difficult until you get used to the writing style.

So, I resolve my dialectical problem of being both proud of this work and embarrassed by it.  I realize I want to print the PERFECT book to please a professional audience…however, I also recognize this book is for the average person who desperately seeks recovery.  THAT IS its value and purpose.  I ACCEPT that no matter how obsessive-compulsive and perfectionistic I am, I’m not perfect and I’ll make errors despite my best efforts to avoid them.  I also understand that although I’m a highly educated professional, it’s not my spirit to interact with the world in a formal manner.  I’m different, I’m down-to-earth, I am ME…and I’m okay.  Some people will accept and embrace this work…others will criticize it.  I understand some people will find fault no matter what…but, I’ve “stepped in it” and have set myself up for criticism because I haven’t used proper grammar or writing rules.

I’ll take my hits, do Damage Control, fix things as I see appropriate, and I’ll move on down the Recovery Path…and on with life!  Perhaps our paths will cross as we journey through the Pathways of Recovery.  Hope to see you there.

And to that, I say, “AMEN!”

So, what frees you to be yourself…and to be who you were designed to be…and to do what you were designed to do?

This text was adapted from the DBT-CBT Therapy Workbook – “Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior”  by Melanie Gordon Sheets, Ph.D.  – copyright 2009 – Recovery Works Publications