I recently listened to a podcast interview with Dr. Martin Seligman in which he commented on how Positive Psychology can improve psychotherapy. I was initially shocked by his suggestion that we need to teach our clients to "just deal with it!"
At first blush, this sounds like the sort of advice your average, anti-therapy neighbor might offer. Something along the lines of "Suck it up, Bub!" After 100 years of psychotherapy, is this really the great new breakthrough? Just deal with it?
To be fair, let me put Seligman's remark in context. In the interview, he says, "The dirty little secret of both clinical psychology and biological psychiatry is that they have completely given up on the notion of cure." He goes on to explain that, in his view, current psychotherapies, whether talk therapies or pharmaceutical interventions, are essentially "cosmetic." That is to say, they are palliative rather than curative. We are able to relieve symptoms but not "cure." Seligman says that during the past 25 years, there have been five editions of his text on Abnormal Psychology and that over this whole course of time there has been what he terms "the 65% barrier," which is to say that 65% of clients report symptom relief compared to the 40% to 50% that might be expected to improve due to the placebo effect. He goes on to say, that he thinks the 65% barrier is real and that we have reached the limit of what palliative therapy can achieve. To get beyond this limit, he says, we are missing two things. The first he calls "deal with it" and the second he says is teaching clients how to flourish.
In terms of "deal with it," he gives the example of a therapist treating a depressed person. According to Seligman, the positively-oriented therapist would say something along the lines of, "Look, I can teach you some tricks for handling your symptoms but you need to realize that maybe 50% of your depression is genetic and that's not going to go away. You need to learn to accept that 2 or 3 days a week you are going to wake up feeling sad and that, in spite of this, you can still function beautifully." Seligman concludes, "We need to teach people how to deal with what they are stuck with."
I have some reflections of my own on "just deal with it." First of all, I'm not certain I agree about the reality of the so-called "65% barrier." Dr. Scott D. Miller has conducted extensive research on therapeutic outcomes and argues forcefully that you get a figure like that when you lump the ineffective psychotherapists in with the effective psychotherapists. Just as with plumbers, auto mechanics, and physicians, some are better than others. Some time back, I interviewed Dr. Miller for my own Shrink Rap Radio podcast, during which he said:
"There is great evidence that what clinicians do works. In fact the average treated client in most studies is better off than 80% of the untreated sample in those studies... I'm saying that there is something about these people [therapists] that makes them better at their work overall... These [therapists] are people who seem to get reliably better outcomes, and here's what they are: they are open to feedback, in other words they listen to what the consumer is saying, as opposed to relying on their ideology or treatment technology, or training."
On the one hand, "just deal with it" strikes a certain down-to-earth common sense note. On the other hand, it is hardly a radically new concept. To me, learning to "deal with it" suggests learning to accept some of the unpleasant givens in one's own physical condition, genetic predisposition, or existential situation. There is a whole mindfulness tradition emanating from Buddhist meditation practices having to do with acceptance. For example, Tara Brach, author of Radical Acceptance, says in an interview:
"Radical acceptance has two elements: It is an honest acknowledgment of what is going on inside you, and a courageous willingness to be with life in the present moment, just as it is. I sometimes simplify it to ‘recognizing' and ‘allowing.' You can accept an experience without liking it. In fact, let's say you are feeling stuck in anxiety and disliking the feeling. Radical Acceptance includes accepting both the feelings of anxiety and the aversion to it. In fact, acceptance is not real and not healing unless it honestly includes all aspects of your experience."
Similarly, a number of Western psychotherapeutic approaches have embraced the notion of acceptance as a key component in their approach. For example, Dr. Steven Hayes has been developing and researching for the past 30 years an approach he calls ACT (Acceptance Commitment Therapy). I recently interviewed Russ Harris MD who has written The Happiness Trap an ACT-based self-help book. In that interview, Harris describes Acceptance in the following terms, saying "... it creates this expansive space inside them where they can open up and make room for difficult feelings and difficult emotions and difficult thoughts and just kind of let those difficult thoughts and emotions flow through their body without getting pushed around by them, without getting held back by them and also without getting into a fight or struggle with them... it massively reduces their impact over them."
In addition, I've interviewed Dr. Marsha Linehan, creator of DBT (Dialectical Behavior Therapy) who also emphasizes the role of acceptance in that approach. In our interview, she told me "[DBT] balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative from the contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients. The acceptance end of the treatment is two-part. It's a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it's called ‘dialectical' is because it's a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time."
I've also heard from some psychoanalysts and Jungian analysts, as well, that the goal of analysis is not so much a cure as it is a coming to terms with oneself, developing an appreciation for one's unique life, warts and all.
So, I guess I'm in agreement with Seligman that there is an aspect of the psychotherapeutic process in which the client finally comes up against the necessity to "just deal with it," in the sense of acceptance. However, I don't agree that this is a new development or a unique contribution of Positive Psychology.