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A Modified DBT-CBT Recovery Program for a Forensic Population: A Presentation at the 2011 Texas Forensic Mental Health Conference

Texas Forensic Mental Health Services:
Issues in Treatment, Evaluation, and in the Court

October 25 – 27, 2011

Presented by North Texas State Hospital – Vernon Campus – Vernon, Texas
Wilbarger County Auditorium

Featuring:

Dr. Robert Morgan “Treating the Mentally Disordered Offender: A Model and Guide for Practice” 

Robert D. Morgan completed his Ph.D. in counseling psychology at Oklahoma State University and a postdoctoral fellowship in forensic psychology in the Department of Psychiatry at the University of Missouri-Kansas City School of Medicine and the Missouri Department of Mental Health. He is currently the John G. Skelton, Jr. Regents Endowed Professor in Psychology at Texas Tech University and the Director of forensic services at Lubbock Regional Mental Health Mental Retardation Services.  His research has been continuously funded for the past 8 years including by the National Institute of Mental Health and the National Institute of Justice. He is co-author of The clinician’s guide to violence risk assessment (2011) and co-authoring Treating the Mentally Disordered Offender: A Model and Guide for Empirically Supported Practice to be published by Oxford University Press. He is also the Series Editor-in-Chief for Correctional Interventions that Work also to be published by Oxford University Press. His research and scholarly activities include treatment and assessment of mentally disordered offenders, forensic assessment, and professional development and training.

Also Featuring:

Dr. Melanie Gordon Sheets“A Modified DBT-CBT Recovery Program for a Forensic Population: Treating Individuals with Highly Destructive Coping Behaviors”

Melanie Gordon Sheets, Ph.D. is the Chief Psychologist at Big Spring State Hospital, the Co-Director of the Lone Star Psychology Residency Consortium, and a Clinical Assistant Professor with Texas Tech University School of Medicine, Department of Psychiatry.  She earned a Ph.D. in Clinical Psychology from Texas A&M University in College Station, Texas. She has worked with psychiatric inpatients for 25 years and in Texas state mental health facilities since 1992. Specialty areas have included individual and group psychotherapy, psychological assessment (personality, neuropsychological, malingering, and trial competency evaluations) with forensic, VA, and general psychiatric inpatients. She has authored a therapy workbook entitled, “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Gaining Control of Our Emotions and Emotion-Driven Behavior” – 2009. Recovery Works Publications. She has conducted the DBT-CBT group at Big Spring State Hospital since 2004.

Dr. Stacey Shipley“Competency to Stand Trial: Forensic Evaluation, Report Writing, & Expert Testimony”

Stacey L. Shipley, Psy.D., completed her doctorate in forensic psychology from California School of Professional Psychology in Fresno, California and obtained her Bachelor’s Degree in Psychology from St. Edward’s University in Austin, Texas with a Minor in Criminal Justice.  Her clinical and forensic training has focused on both adults and adolescents, particularly in forensic settings. Dr. Shipley is a licensed psychologist in Texas, Iowa, and North Carolina and is the Director of Psychology at North Texas State Hospital.  She specializes in forensic evaluations (e.g., CST, fitness to proceed, insanity, risk assessments, psychopathy classification) and treating maternal filicide offenders. Her professional presentations have included those areas of forensic practice, as well as the relationship between mental illness and violent crime.  She has published articles in the International Journal of Offender Therapy and Comparative Criminology, regarding psychopathy and its clinical implications.  She has also published chapters on maternal filicide, serial rape and murder typologies, forensic case formulation for adult sex offenders, and co-authored Introduction to Forensic Psychology: Issues and Controversies in Crime and Justice (2nd Ed.) and the upcoming (3rd Ed.) published by Academic Press.  She co-authored The Female Homicide Offender: Serial Murder and the Case of Aileen Wuornos (2004) published by Prentice Hall’s Women in Criminal Justice Series.      

Additional features and workshops include:

Andrew W. Carruthers, J.D.; Brent A. Carr, J.D.; and Brian D. Shannon, J.D.“Interface Between the Courts and Forensic Hospitals Judges Panel”

Presentations by a legal scholar, felony and misdemeanor court judges, followed by a panel discussion of the legal experts.

Michele Borynski, Ph.D. & Jennifer Russell, Ph.D.“Violence Risk Assessment: An Overview for Community & Inpatient Evaluations”

Thomas R. Mareth, M.D. – Chair DSHS Dangerousness Review Board“Dangerous Review Board Training”

About North Texas State Hospital (excerpted from http://www.dshs.state.tx.us/mhhospitals/northtexassh/ntsh_about.shtm)
History of Wichita Falls State Hospital
“In 1917, the State of Texas created the Northwest Texas Insane Asylum. It was located on 940 acres seven miles south of Wichita Falls…In 1925, the name was changed to Wichita Falls State Hospital (WFSH). It had a modern surgical operating room, radiology, laboratory, electrotherapy apparatus, and hydrotherapy equipment. By 1930, the census was over 1500 patients with a staff of 235, including seven doctors and 93 attendants. During the height of the Depression, the hospital was virtually a self-sustaining community. It had an agricultural enterprise that included farming, hogs, chickens, and cattle. Most of the staff lived on the campus.

By World War II, the hospital consisted of 35 brick buildings and 60 frame structures. Due to wartime shortage of available employees, 234 staff members served approximately 2400 patients. Staff worked six days per week, 12 hours per day. Six nurses rotated coverage at night; three staff members offered occupational therapy. The end of the war saw the total number of employees rise to 503 by the early 1950’s. In 1951, Vernon State Home was activated as a branch of WFSH at the old Victory Field Army Air Corps training field. Vernon served about 400 patients “who do not require an active medical or psychiatric program,” while WFSH continued with a census of 2400. Volunteer programs and charitable donations made life more pleasant for the patients during this period.

In 1955, psychiatric treatment was revolutionized with the introduction of psychotropic medications. Major changes in mental health care continued to occur in the 1960’s. The Texas Department of Mental Health and Mental Retardation was created. New community MHMR centers and outreach programs were established through the state hospital system to better serve the citizens of Texas. The first volunteer services coordinator was hired in 1960, and the first social worker was hired in 1966. Vernon State Hospital (VSH) was established as a state hospital separate from WFSH in 1969. Child and adolescent services were added in the early 1970’s. With more effective medications, increased community services, and placement in nursing homes, the hospital census dropped below 900 by the middle of the decade…

The 1980’s saw the genesis of psychosocial programming and programs such as the client worker program, Fairweather Lodge, and Career Village. These programs profoundly affected the ability of patients to return to their communities. Vernon State Hospital was redefined as the state’s forensic psychiatric facility in 1987; as a result, WFSH’s catchment area grew from 23 counties to 53. By late in the decade, the average census at WFSH had fallen below 500, while the number of admissions and discharges increased. The hospital was more effectively and efficiently treating more people. The end of the decade also saw the introduction of the first atypical antipsychotic drug, Clozaril. Although extremely expensive and wrought with many side effects, it could effect profound improvement in some persons with mental illness.

Another change in Wichita Falls State Hospital’s operation came in 1993 when the responsibility for the substance abuse recovery program was removed from the state hospitals and given to the Texas Commission on Alcohol and Drug Abuse…Concern for healthcare costs and methods lead TDMHMR to explore new and more efficient ways of doing business. As a result of that initiative, TDMHMR initiated the merger of the administrations of Wichita Falls State Hospital and Vernon State Hospital in January 1996.”

History of Vernon State Hospital

The first state psychiatric facility in Vernon, TX, was a geriatric extension of Wichita Falls State Hospital called the Annex. It was first opened in 1951 at Victory Field, the former World War II Army Air Corp pilot training facility south of the city. It served about 400 “senile-type” patients. In 1967, construction of a new psychiatric rehabilitative facility began on 69 acres at the northwest edge of Vernon. In 1969, Vernon State Center began operation as a state hospital serving general psychiatric patients from 30 counties of northern Texas, independent of Wichita Falls State Hospital. It offered inpatient psychiatric services to a predominantly rural population and also operated seven rural-based outreach centers…

In 1971, the Texas Legislature created a statewide treatment facility for drug dependent youth. Because of Vernon’s remote location from the metropolitan drug scene, it was selected to be the site for this new service…Over the years, the adolescent population evolved: From the first years as a drug treatment facility, the need became one to serve teens with a dual diagnosis of drug dependency and a mental illness. The program – serving an average census of 75 patients — was eventually renamed the Adolescent Forensic Program (AFP) because approximately 90% of the patients had, in addition to a dual diagnosis, an involvement with the law enforcement/judicial system.

In 1983, Vernon State Center’s name was changed to Vernon State Hospital (VSH) to maintain continuity throughout the Texas Department of Mental Health and Mental Retardation (TDMHMR) system.

  • Persons with felony charges who have been found incompetent to stand trial;
  • Persons admitted for pre-trial evaluations for competency and issues of insanity;
    • Persons found not guilty by reason of insanity;
    • Persons from other state hospitals who have been found to be manifestly dangerous;
    • Mentally retarded persons who have been found incompetent to stand trial on misdemeanor or felony charges;
    • Persons from the Texas Department of Criminal Justice (TDCJ) and other jails who need inpatient psychiatric hospitalization. [The hospital has never been asked to fulfill this mandate as TDCJ developed its own psychiatric services.]…

The year 1995 also marked the birth of an initiative between TDMHMR, the Texas Youth Commission (TYC), Vernon State Hospital, the City of Vernon, and the Vernon Business Development Corporation to open a TYC youth boot camp facility at VSH’s South Campus. As a result of the cooperative efforts of all parties, the VSH South Campus (Victory Field facility) was leased to the Texas Youth Commission the following year. The VSH Adolescent Forensic Program transferred to the VSH North Campus in September 1996, moving into four renovated buildings on the south side of the Maximum Security Program. The move necessitated an $8.5 million construction project, resulting in the building of the Mooney Building, which houses the adult Behavior Management and Treatment Program, and the Heatly Building, a new adolescent activity building. It also necessitated additions to the administrative complex, new fencing, and other renovations. By the late fall of 1997, the adult maximum security and adolescent forensic programs were fully operational at one campus location.

In January 1996, TDMHMR combined the administrations of Vernon State Hospital and Wichita Falls State Hospital under the leadership of James E. Smith, Superintendent. This initiative was in answer to the ever-pressing need to provide the citizens of Texas with more effective and more cost-efficient mental health care. Consolidation of the two hospitals became official on September 1, 1998, under the temporary name Vernon-Wichita Falls State Hospital. Nine months later, the 76th Legislature formally renamed the organization North Texas State Hospital, retaining the location names – Vernon campus and Wichita Falls campus – to designate the individual sites.

The Vernon campus of North Texas State Hospital has a history of offering exceptional mental health care to the various groups of patients entrusted to its care and plans to continue to offer the best care available to the specialized populations of patients who are now in its charge. Throughout the years, it has maintained Joint Commission on Accreditation of Healthcare Organizations accreditation as well as a reputation for “country care.” It has become nationally recognized as a benchmark in the forensic mental health care field.

History of North Texas State Hospital

After two and a half years of intensive planning and incremental consolidation, Vernon and Wichita Falls State Hospitals officially became a single mental health care organization on September 1, 1998…the state legislature formally renamed the “new” organization North Texas State Hospital (NTSH).

Today North Texas State Hospital operates two sites 55 miles apart in north Texas. The Vernon campus provides forensic services for the entire state of Texas and offers both a 284-bed Maximum Security Program for adults and a 78-bed Adolescent Forensic Program for dually diagnosed youth ages 13-17. The Wichita Falls campus provides general psychiatric inpatient services for child, adolescent, adult, and geriatric patients with a bed capacity of 330.

Together, the two campuses of the organization comprise the largest state hospital in Texas.

Last updated April 08, 2011″

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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 –

The DBT-CBT Recovery Workbook Focuses On Self-Destructive Behaviors

DBT-CBT is a life-changing recovery program that inspires people
to make the life changes that will change their lives.
This program has turned many defeated hearts into empowered spirits
that are psychologically prepared to take on the challenges of
GETTING ON  and STAYING ON the Recovery Path.

Come join us in our journey.

This is a workbook for recovery from a variety of Self-Destructive Coping Behaviors. The philosophy of DBT-CBT is that “Many of our “abnormal” behaviors are normal given our experiences. They once served as survival skills.  However, their period of usefulness is long over.  We’ve overused these coping behaviors…and now, they’re causing us great pain and they’re destroying our lives.”

This workbook explains why we do the things we do…and why we keep doing these things even though they cause us more pain and problems.  It’s about what we do in the heat-of-the-moment…the emotional moment.  It’s about what happens when EMOTIONAL MIND drives and RATIONAL MIND takes a backseat…and WISE MIND is left on the side of the road.

When we’re filled with upsetting emotions, we often do things for quick relief…like drugs and alcohol; suicide attempts; cutting and other forms of self-mutilation; aggression; temper tantrums; walking off and leaving the situation; withdrawal; overeating or not eating enough; overshopping; “sleeping around”; rebound relationships; gambling; and other risky and reckless behaviors. The Nature of the Problem is…the things we do to feel better end up multiplying and intensifying our problems. Our Destructive Coping Behaviors help us to cope in the Heat-of-the-Moment…but, they have many negative consequences. They make our current problems more severe…and they CREATE many new problems for us to struggle with.   Over time, our lives spiral OUT-OF-CONTROL and into a CYCLE OF SUFFERING.

This workbook provides useful tools, attitudes, and plans for changing how we respond to life.  Our goal is to GET CONTROL of our OUT-OF-CONTROL emotions, behaviors, and thinking. We do this by PARTICIPATING EFFECTIVELY in our lives and by using LIFE-ENHANCING COPING MECHANISMS to deal with our pain and problems.  Our goal is to MINDFULLY PROTECT OUR PEACE AND STABILITY and the BIG PICTURE OF OUR LIFE.  Our goal is to STOP the CYCLE OF SUFFERING.

Radical Acceptance – “Accepting the Unacceptable” – From a DBT-CBT Workbook Perspective

We have a choice to accept difficulties as they come our way…
To lean into them and to get a game plan for dealing with them
AND a choice to Follow Through until we can Get Through…
OR we can choose to avoid, ignore, and numb-out our pain and problems
And stagnate in our pain and suffering.

When we choose to confront things
With an attitude of acceptance
That gives us the serenity to change the things we can
And the wisdom to know our limits.

Acceptance of our life situation and what we need to do about it…is a way of turning suffering we cannot tolerate into pain we can tolerate. It’s a way of turning hopelessness into hope. Most of us have been suffering the pain of our lifestyle and choices for years…and somehow, we remain willing to experience ongoing pain and misery because of them. We’re somehow willing to suffer long-term pain, but we’re not willing to go through the temporary pain of change. We’re somehow willing to dwell in a painful past, to remain in painful situations, and to continue painful addictions and impulsive behavior. We do so because we’re unwilling to accept and undergo the changes that will bring peace and stability.

Radical Acceptance involves accepting what we’d normally consider unacceptable. When we LIVE BY Radical Acceptance, we CAN ACCEPT something whether or not we approve of it and whether or not it’s right or wrong, fair or unfair, or pleasant or unpleasant. Radical Acceptance is about CHOOSING TO ACCEPT whatever is in our best interests to accept.

We MUST ACCEPT whatever we HAVE TO accept because NON-ACCEPTANCE keeps us emotionally troubled and stuck in negativity. To have peace, we must accept many things whether or not they’re acceptable. We must accept things from the past and present. Anything in the past that’s unfixable, we need to LET IT GO. Anything in our current life that we CANNOT CHANGE, we need to accept that it MAY NOT change. Anything we CAN change, we must LEAN INTO…to MAKE THE CHANGES we CAN MAKE. Our Recovery Goal is to live a life that MAXIMIZES peace, stability, meaning, and productivity. To do that, we MUST ACCEPT what has happened HAS HAPPENED, what we’ve done, WE’VE DONE…then, we need to LET IT GO…so we can GO ON with life.

From pages 313 and 316 – Excerpt from “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. – 2009 – Recovery Works Publications