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Psychotherapy has been practiced now for a little more than a century.

Psychotherapy is helpful for most people.

Psychotherapy is as much about acceptance as change.

Philosopher Friedrich Nietzsche proposed in his famous Stoic aphorism of amor fati (“love of one’s fate") that we should not only seek to accept but willingly embrace all that happens to us in life as necessary—the good, the bad, and the ugly. The concept of acceptance is particularly prominent in Eastern philosophy and religion, as well as in Christianity and other great religious systems. For instance, acceptance is central to so-called spiritual enlightenment, as illustrated repeatedly in timeless texts like the Old Testament's Book of Job, the Hindu Bhagavad Gita, the noble teachings of Siddhartha Gautama (Buddha), and the Tao Te Ching. But even practicing Buddhists, Hindus, Taoists, and other spiritual seekers can sometimes lose sight of the primacy of acceptance. Consider, for instance, this frustrated cry of one Buddhist devotee of meditation: "I've been meditating for thirty years—and I'm still angry!" In this case, the meditator evidently erroneously sought to change, eradicate, or transcend rather than accept, experience, and constructively express, redirect, or channel his angry feelings. (For more on dealing constructively or creatively with anger in psychotherapy, see my book Anger, Madness, and the Daimonic [SUNY Press, 1996].)

Drawing directly from these ancient wisdom teachings of the East, clinical psychologist Marsha Linehan incorporates what she calls "radical acceptance" in her dialectical behavior therapy (DBT). The secret to such radical acceptance is the nonjudgmental, tolerant, courageous, compassionate embrace of, rather than resistance to, whatever we are experiencing right here and now, in the present moment, juxtaposed paradoxically with the acknowledgment and unequivocal acceptance of the essential necessity for changing one's self-defeating behavior and negative self-talk. Another popular form of cognitive-behavioral therapy, acceptance and commitment therapy, or ACT, places similar emphasis on accepting our negative cognitions and painful emotions rather than striving to change them, while simultaneously committing ourselves to acting in ways that will change our lives for the better.

This clinical emphasis on the dialectical relationship between change and acceptance is, at least in part, what needs to happen in any truly effective psychotherapy. To begin with, certain things in life cannot ever be changed, and some others can be, albeit often only through sustained and heroic effort. This same recognition of reality is reflected in the famous serenity prayer from Alcoholics Anonymous: "God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference." Also inherent in the, for many, helpful AA philosophy is the requirement to totally accept one's complete powerlessness over alcohol (or other addictive substances) as an absolutely indispensable prerequisite for change. As the Swiss psychiatrist C.G. Jung, one of the early supporters of the AA approach, stated: "We cannot change anything unless we accept it."

There are profound implications for successful psychotherapy in these powerful words. The problem, whatever it may be, must first be fully and consciously acknowledged and accepted by the person before it can be changed. Without such acceptance, there can be no true change. This may sound easy, but it is not, for it necessitates acceptance of feelings, impulses, fantasies, tendencies, desires, and behaviors in ourselves that we find deeply unacceptable and may remain unconscious or unknown to us because we do not want to admit them to ourselves. These unacceptable and rejected aspects of ourselves must therefore first be confronted and made fully conscious before we can exercise our existential freedom to choose to accept them or not. This sometimes painful and arduous process of acceptance starts with acknowledging not only the subjective and objective existence of the problem itself, but the necessity to consciously confront the problem head-on and make the total commitment to oneself to do this. The big secret here is that sometimes it is only through acceptance that such transformative changes can eventually take place. Change—whether of one's behavior, beliefs, cognitions, presuppositions, self-perception, worldview, or ways of being in the world—always starts with the willing acceptance of the unacceptable.

At the same time, for the psychotherapy patient, as for all of us to some extent, certain behavioral or attitudinal changes must be made, as in the case of correcting or modifying one’s central myth or core schema of oneself and the world. This is the reason most people enter psychotherapy. They sense or recognize the necessity for change but have been unwilling or unable to implement that change in themselves, their situation, attitude, relationship, or behavior on their own. Sometimes, they have sincerely tried to change, often for years or decades, but to no avail. Seeking psychotherapy is a courageous and momentous decision. And it can be a deeply humbling one. This is just human nature. None of us likes admitting having a problem, let alone not being able to satisfactorily solve or resolve it ourselves. The ego strongly resists such an admission of perceived weakness. It is tantamount to a profound feeling of personal failure, powerlessness, vulnerability, weakness, ineptitude, impotence, and helplessness. Men, in particular, often have serious trouble asking for psychological (or other kinds of) assistance and are statistically less likely to seek psychotherapy than women, who are generally more receptive to psychotherapy, though this trend has been slowly shifting in recent decades. But those brave women and men who do take the intimidating and sometimes ego-deflating step to seek psychotherapy, voluntarily submitting or surrendering to it (tantamount to admitting to being powerless over the problem), take a decisive and heroic first step toward self-acceptance—and lasting therapeutic change.

Fundamentally, what must change for most of us is our rigid refusal to accept ourselves, others, and reality as we and they are right now. This is a true paradox. And much easier said than done. When people initially seek psychotherapy, they sometimes do so hoping or expecting, consciously or unconsciously, to change themselves, others, or the world in ways that are simply not possible. For instance, some people harbor and suffer from distorted core beliefs, self-schemata as they are called in cognitive therapy, a long-held (commonly since early childhood) unconscious “guiding fiction” (Alfred Adler) or personal "myth" (Rollo May) of being basically broken, unlikable, unlovable, and unworthy of love or recognition as they are. What is sorely lacking in such deeply wounded individuals is the ability to unconditionally accept themselves, others, and the world exactly as they are right now, despite their obvious imperfection. This sort of acceptance should not be equated with denying the problematic nature of human existence, nor the neuroses or bad behavior of ourselves or others. Denial is a maladaptive and dangerous defense mechanism. Accepting actually means acknowledging, confronting, and addressing problems as directly and constructively as possible. Clearly, simply by choosing acceptance, such individuals have not suddenly and miraculously rid themselves or the world of their difficulties or problems. But they are no longer in denial of these difficulties, having taken the first crucial step toward constructively addressing them. As stated in the ancient Chinese text the Tao Te Ching, “A journey of a thousand miles begins with a single step.” Indeed, for the psychotherapy patient, acceptance of one's problems and taking responsibility for constructively confronting and addressing them as best we can is precisely the sort of psychological, philosophical, or spiritual reorientation required to achieve real and lasting change and to restore and sustain one’s soul, self, and sanity.

This post is adapted from a chapter in my forthcoming book, Secrets of Psychotherapy: Clinical Wisdom for a Crazy World.

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Diamond, S.A. (1996). Anger, madness, and the daimonic: The psychological genesis of violence, evil, and creativity. SUNY Press.

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