Acceptance and Change in Psychotherapy

Therapy is a delicate balance of acceptance and change. People come into therapy because something is not how they want it to be. What that something is can vary dramatically, but there is always the same desire: something's got to change. It may then feel like a paradox, when I inevitably, at some point, bring up this idea of acceptance in my therapy sessions.So, let’s explore a little further here about how these two seemingly polarized concepts are actually part of the most central dialectic in all forms of psychotherapy.

One of my favourite quotes about human nature comes from Carl Rogers, the pioneer of client-centred therapy. It goes, “The curious paradox is that when I accept myself just as I am, then I can change”. Every time I read that, I can feel a chill go through my body. There is something that feels so deeply true here. I really believe this is the central pillar of psychotherapy, what is at the core of therapeutic change. One of the reasons for this, is because of what brings people in to counselling in the first place: core shame. Core shame is the feeling that one is completely disconnected, shunned from others and has no worth. It is no coincidence that solitary confinement is among one of the worst punishments available to someone. So what does core shame do to us? Well, if you've ever felt shame, you may have felt the feeling of wanting to make yourself small, invisible even, it feels viscerally painful and you want to do anything you can to make it go away. It certainly doesn't make us want to venture out and take risks. We believe we are bad, less than, and so we may believe it’s best for us just to stay put. In other words, it prevents us from exploring out in the world, making change impossible. So, what is the antidote to core shame? You got it, acceptance. Or, more precisely, internalizing the belief and feeling that we are OK as we are, that we are loved, that we can be accepted as we are. Acceptance nullifies shame, nullifying shame allows us to venture forward activating our social engagement system.

So, therapy is about creating an environment where you feels safe, loved, accepted, enough that you can take risks, be OK with not being perfect, and experiment new ways of being. You can take that risk of starting that conversation with a new friend, or finally beginning that new task at work you’ve been dreading, or having that tough conversation with your parter, because you can accept yourself if it doesn’t go perfectly. You can try out these new ways of being in a safe way, learning about yourself and growing in the process. You can hold the truth that, “I am OK, and worthy of love, just like anyone else, AND I want to change this particular aspect of my life. I want to be a better friend, or worker, or lover”. When we self accept, we may also decide we want to stand up for ourself a little bit more, and voice some hurts that we have been holding on to for far too long. Change begins with accepting you as you are. One caveat. To be clear, self acceptance DOES NOT mean being right all the time and not being open to feedback from others. In fact, the more self acceptance we have, the less someone's criticisms will hurt us in a deep way. Rather than, "wow I'm a really bad person for doing this" you might say, "hm, I really hurt that person, I want to apologize and do better next time". Acceptance and change are not polar opposites but rather have a symbiotic relationship with one another that allows them to function best when they work together.

Netflix’s ‘Love Hard’, New Year Escapism, & Authenticity in Therapy by Sakthi Kalaichandran

As we enter into a new year, the pandemic continues to challenge many of our previous ideas regarding certainty. To cope, many of us are turning to light hearted sources of escapism, which can be a genuine source of comfort during these unusual times. Indeed, several therapeutic modalities - including dialectical behavioral therapy - count moderate distraction as an effective way to tolerate distress. One of my favourite go-to’s for a dose of certainty, a genre that’s reassuringly consistent well into the new year, are made-for-TV holiday movies.

In case you’re not familiar with the format, here are the ingredients for this comforting staple:

i) the protagonists meet each other, usually when they least expect it. Oh and by the way, they’re totally not right for each other (big wink).

ii) Adorkable, eccentric best friend pushes the protagonist to take a romantic risk.

iii) After some hesitation, the protagonist takes said risk, then proceeds to clumsily fall/have an allergic reaction/burn some holiday cookies/charmingly make a fool of themself

iv) Protagonist enters a short period of self-criticism and self-sabotage before eventually dusting himself/herself off and trying their hand at love again.

iv) light conflict ensues between the two leads until they eventually end up bonding over a winter beverage while wearing aspirational yet attainable winter wear.

v) after realizing their affection for each other (to the surprise of no one) they ride off into the sunset, with the backdrop of twinkly lights framing their happy ending.

There you have it! The suspense - if any - is minimal, and most viewers can rest assured that any predictions made in the first 5 minutes will come true (it’s not exactly Dickens here). Although the storylines are simplistic, in these uncertain times, it makes sense that this comforting movie genre extends beyond Christmas and well into the New Year.

Last week, as the new variant started to make headway in my neck of the woods, I perused my Netflix queue looking for some predictability. I came across a delightful-looking film called “Love Hard” that, on the surface, seemed to tick all the right boxes. Within the first 10 minutes I was confident that I had successfully predicted the outcome, and joyfully enjoyed the familiar hijinks of a formulaic holiday classic. Thankfully, I was wrong. *Spoilers ahead!*

‘Love Hard’ stars a young woman - Natalie - who is searching for love via online dating. After several ill-fated matches, she eventually connects with her seemingly perfect match: Josh. Everything about their pairing seems ideal - until they meet face-to-face. It turns out that the man on the other side of her chats was using a fake photo to present himself in a more “positive” light. Together, the two leads face the ups and downs of confronting each other’s flaws and qualities, all while getting to know the real person beyond their profile. Overall, it’s a fun, low-stakes story about two people getting to know each other authentically while rapidly dismantling their social masks with comedic flair.

So what can we learn about the therapeutic process from this lighthearted, made for-TV, holiday comedy? Although the therapeutic relationship is necessarily different from a personal relationship, two themes stood out as relevant to consider when approaching the counselling process:

1. It takes time to find the right fit

The therapeutic relationship is a strictly professional dynamic, but it’s one that involves one-sided disclosure of very personal and vulnerable information. Research shows that the quality of the therapeutic relationship is a key factor for the improvement of client outcomes. As such, many therapists encourage clients to consult with several counsellors via free consultations to ensure a good fit. While it can take time to discover the right ‘match’ when it comes to your mental health care provider, finding a clinician that you feel comfortable with is well worth the effort.

2. Therapy involves removing your ‘perfect’ mask

In social interactions, most of us want to make a good first impression (therapists included!). However, therapy often involves disclosing some uncomfortable information that threatens the social mask of ‘perfection’ many of us hold.

In ‘Love Hard’, the character of Josh literally uses the image of someone he deems perfect to hide behind. Over the course of the film, this mask eventually slips and Josh’s true self is revealed. However, this process is hard won. Josh (like many of us), experiences several instances of shame, loneliness, and embarrassment before he finally comes to accept and celebrate his authentic self. Indeed, it’s only after removing this mask of perfection, that Josh is able to experience genuine interactions with his family, and lean into his passions and interests. Josh’s character arc is a poignant reminder that revealing our true selves is an arduous, and often messy process. Yet, choosing to be vulnerable in a safe environment, can eventually lead to experiencing authentic relationships and experiences, allowing us to be free in our perfectly imperfect selves.

By the end of ‘Lovehard’, Josh and Natalie’s true personas are revealed, beyond their initial masks of perfection. While the ending may seem predictable, the journey to both character’s ‘happy ending’ is filled with the ups and downs we all go through in order to discover our authentic selves.

In the midst of these challenging times, I hope you’re able to spend time getting to know yourself, and when it feels safe, opening up to healthy personal and professional dynamics where you can be seen for who you are. And while you’re on this roller coaster journey of self discovery, don’t hesitate to turn to the comforts of a familiar formula. You might be pleasantly surprised by what you find.

Wishing you a healthy and safe start to the new year!

Alexander Supertramp, Shel Silverstein, and a culture of Independence

I've had a knack for the outdoors for as long as I can remember. I grew up going to a summer camp with all the traditional campy things: canoeing, kayaking, swimming, nature hikes and campfires. I remember going on canoe trips and gazing up at the starts, marvelling at the vastness of the universe (A sight which still inspires awe in me today). It felt amazing being out in nature. It's no wonder that as I grew in to my teenage years I was captivated for some time by Christopher McCandless (AKA Alexander Supertramp). For those who don't know, Chris was a man who had an idea to leave his life behind and go live entirely off the land, and his life was portrayed in both the novel and movie "In to the wild".

Like many teenagers, I was struggling to find my identity, feeling lonely and isolated, at times, and so what was there not to love about Chris' idea? Being out in nature all the time? Um, yup. Feeling a sense of satisfaction from living off the land, providing for yourself and not having to rely on others? Uh huh. Running away from any problems in your life and never facing them again? Heck ya! I fantasized about how cool this way of life could be.

The trope that Chris represents of the uber-independent individual who needs no one but him or herself can be found in countless places, and particularly arises in narratives in western culture. It was an alluring idea for me, and obviously an alluring idea for many based on the success of the movie and novel. Chris embodies this ideal in the scene where he is leaving his family:

"I will miss you too, but you are wrong if you think that the joy of life comes principally from the joy of human relationships. God's place is all around us, it is in everything and in anything we can experience. People just need to change the way they look at things."

Chris held strongly on to this idea that human relationships are not the source of happiness and connection. Independence, self-sustaining, nature, and new experiences were what did it for him (apparently). Needless to say, this idea is not something that I held on to (Disconnection Counselling just didn't have the same ring to it), but I can certainly see the allure of this way of thinking.

In Western Culture especially, we place a high value on independence, individual accomplishment, and self-love, while placing a lesser value (and sometimes even deride) dependency on others. Independence is held to high esteem, while dependence is frowned upon, sometimes associated with words like clingy and needy, which carry a negative connotation. This is not the same for all cultures. Many cultures are more collectivist in nature, placing a much higher value on community and relationships, and not stigmatizing the need to depend on others for emotional and physical needs. Not so in Western culture. Even turn to the DSM (what clinicians use to diagnosis mental illness) and you’ll see “dependent personality disorder” but no “independent personality disorder”. Although there are certainly problems that can and do arise from being overly dependent on others, there are also costs to being overly dependent on our selves.

Let's come back to Alexander Supertramp. So how does our hero's story end? Well, he travels the Country, does a bunch of cool stuff, meets interesting people, but ultimately (Spoiler alert*) he ends up dying of starvation, unable to live off the land as he intended. In the movie, he etches out some of his last words “Happiness is only found when shared” shortly before his death. Happiness is only found when shared. This man who sought out to become one of the most independent individuals alive, in the end, could not shake the truth that human connection is a necessity for survival.

Now let’s consider another story. Wisdom can be found in many places, and I have been amazed at the pithy insights I re-encounter as I read old children’s books together with my niece. One in particular: "The missing piece meets the big O” describes this "piece” (A triangular cut out of a circle) that feels lonely, isolated, and is looking for someone else to make him/her feel complete. This piece goes searching around, finding circles with chunks missing and keeps trying to fit in, to no avail. The piece spends some time on its own, but this also, does not bring happiness. In the end, the piece finds “the big O”. This "Big O" is a complete circle with no pieces missing, and the big O encourages the missing piece to roll on its own. With the big O’s support, nurturance and encouragement, the missing piece gains the strength and courage to lift itself up and gradually flip over and over. Over time, the missing piece’s rough edges begin to smooth, and the two begin to roll together, side by side, supporting each other. One could look at this as yet another story emphasizing the self-love, prizing independence above all else narrative, however I think it is deeper, and more real than this. I believe the Big O represents a healthy, encouraging, loving friend, without which the missing piece could not have realized its independence. Independence first requires a dependence on another.

To me, this story is the perfect metaphor for healthy, human connection and relationships. Whether you see yourself in the piece as it is striving to find an individual to latch on to and fuse with, losing yourself in another's identity, or you see yourself as the one wanting to roll out on your own with no one, it may be time to consider, instead, rolling alongside a supportive other. A relationship (friendship, romantic, family) is most healthy when we feel safe, comfortable, allowed to try and fail, allowed to be ourself, allowed to depend on each other, AND allowed to do our own thing. This is what psychologists call the concept of a secure base. It is the kind of healthy relationship that children need from their primary caregiver. It is also analogous to a healthy romantic relationship. And I would assert that this applies to friendships as well. Fostering these relationships around us allows us to have more love for our self. Interdependence fosters independence. They are the yin to each others yang.

A friend knows our difficulties and shadows and remains in sight, a companion to our vulnerabilities more than our triumphs, (Even) when we are under the strange illusion we do not need them

-David Whyte