The Acceptance Paradox and Specificity in TEAM
A Simple Definition
Most people reading this who are familiar with TEAM know about the Acceptance Paradox [1] already. Its paraphrased definition is to find truth within the negative thought that we are working on [Burns, 2000]. Most of us conceptualize acceptance as a tool to be used in the M = Methods phase. It can be very helpful in a role play setting and helps people paradoxically see the cruel, harsh nature of some of their thoughts.
The Context for this Blog Article
During one of our training classes, I was teaching the use of the Acceptance Paradox to a group of therapists in a role play. The technique did not seem to be having the intended effect on their fake client, so I had suggested one of the trainees ask their fake client to clarify what specifically they wanted to accept in their lives. One of my colleagues reached out with curiosity asking to clarify why I asked them to do this. Why was I setting up parameters and specifics when utilizing the Acceptance Paradox?
Intro and Acknowledgements
This topic is a special discussion in response to my colleague’s question.
I should add that because this is an opinion piece, I’ve done no rigorous/scientific research into what I’m going to say. What you’re going to read is just my own beliefs that are directly taken from and mildly adapted from David Burn’s work and based off my own clinical experience. Thanks, David!
I’d also like to take the time to thank Richard Lam, LMFT, a Level 5 TEAM-certified therapist at the Feeling Good Institute. Richard’s teaching helped inspire what I’m going to write below, particularly with the set up and execution of the acceptance paradox. Thanks, Richard!
With that in mind, let’s dive into trying to understand acceptance some more.
Acceptance as an outcome
Again, the paraphrased definition that we know and love for the Acceptance Paradox is to find truth within the negative thought that we are working on.
I see acceptance differently. I see it as an outcome when recovering from Depression/Anxiety. I personally define acceptance as two actions:
Understanding from the client on why they have the symptoms of Depression/Anxiety right now
Embracement from the client so they can make changes that are appropriate to the above understanding
As with any action in life, understanding and embracement are things we can help people learn how to do. However, it’s necessary to know what specifically it is our client wants to understand and embrace ahead of time. Knowing the specifics ahead of time informs the direction you and the client will go.
Specificity in Acceptance
I’m going to give an example below to help formalize this more. The information is completely made up and is NOT based on any clients, colleagues, or other individuals I’ve worked with. Any similarities to real life people or events are strictly coincidental.
Let’s say we’re working with a therapist doing personal work. The therapist feels insecure after being criticized by their client. The therapist agrees to work with you on the following negative thought:
Negative Thought: I’m a failure as a therapist
Let’s then say that this patient has the goal of wanting to have better self-esteem in working with clients, and wants to use the Acceptance Paradox to address this negative thought. This then begs the question. What exactly is it that the therapist wants to accept in order to gain better self-esteem? Below are some potential options.
Acceptance Options for a Therapist who feels insecure after being criticized by their client and have a goal of wanting better self-esteem
The therapist wants to accept their feelings of insecurity
The therapist wants to accept their imperfections as a provider
The therapist wants to accept that they will never be 100% perfect and can never 100% prevent failures in the future
The therapist’s practice and approach encourage criticism from clients, and the therapist wants help with accepting this
The therapist wants to accept the loss of their dreams of becoming an all-start therapist who always helps people, never makes clients upset, and never fails
The client may have a legitimate reason to criticize the therapist that the therapist cannot see
The therapist wants to accept that their skill level really is lacking and that they need additional help
The therapist wants to accept that this is a recurring problem due to an internal issue and that they need to seek out their own therapy
The therapist wants to accept that their client is legitimately unlikable/unpleasant
Etc…
The Importance of Direction
Do you see the tremendous amount of variability that is listed out above? This is why establishing the specifics of what it is the patient wants ahead of time is super important. If you just jump into using the Acceptance Paradox without knowing the direction the client wants to go in, you’ll come up with an acceptance of something that the patient doesn’t even want. For example:
Negative Thought: I’m a failure as a therapist
You may attempt the Acceptance Paradox in an Externalization of Voices format such as:
Acceptance Paradox: You’re right, I really have failed this client. However, my biggest issue isn’t that I’m a failure. My biggest issue is listening to your BS.
The above assumes that the therapist wants to accept their own shortcomings on being an imperfect provider. Given the fact that this is just 1 out of 10+ potential acceptance options listed earlier, that means the above response has (at most) a 10% chance of helping to resolve the issue.
What if the therapist actually wants to accept something different like how their client’s constant criticisms are a sign of how legitimately unlikable their client is? If that’s the case, a more helpful Acceptance Paradox is:
Negative Thought: I’m a failure as a therapist
Acceptance Paradox: You’re right, I am failing my client. This client is genuinely unlikable, and likely has bad experiences like this with many others. I’m not special in that regards. I’ve been doing exactly what others have been doing - feeling shocked/upset but hiding it by acting fake with the client. I actually don’t like them and dread our sessions together. It’s time to stop this. I’ll need to be honest with myself so I can be honest with my client. That’s the only way I can turn this around.
Even after the above is done, it’s NOT enough to say that the issue is fixed. The therapist in personal work will still need to embrace this by changing the way that they handle their client’s criticisms. This could mean changing how they set up their practice and/or changing how they reinforce boundaries and limits with their client.
Concluding Words
I hope the above explanation is clear and makes sense out of the concept of specifying the type of acceptance someone is looking for. It’s not enough to simply “find truth” in someone’s negative thought(s). “Truth” can mean practically anything. Real truth is informed by context which is why Specificity is so important! Specificity will help you determine what type of acceptance and truth needs to be sought out to help the client.
There are some limitations to this though. First off, the therapist needs a strong foundation in two things: what they believe is the truth and what they believe will help. Failure to know these things in advance will also make the Acceptance Paradox fail. Those two issues are outside the scope of this blog post, and I’ll consider writing about them some other time.
For now, what’s important to remember is the power of Specificity and how it cannot be easily overlooked, especially if we wish to offer our clients any form of acceptance.
References
Burns, David D. 50 Ways to Untwist Your Thinking*, 2000.
