Radical Acceptance

Marsha Linehan PhD desenvolveu  um modelo terapêutico designado por  Dialectical Behavioral Therapy - DBT ou, em português, Terapia Comportamental Dialética.  O modelo construiu-se a partir do da CBT (Cognitive Behavioural Therapy - Terapia Cognitivo-comportamental) e dos seus "pontos fracos" na terapia de indivíduos com perturbação emocional intensa. Entre as estratégias e princípios propugnados encontra-se o de "radical acceptance". Esta estratégia é dupla: para o "paciente" implica a aceitação da situação e realidade tal como ela é se apresenta pela prática das Brahmavihāras budistas, em particular da  Equanimidade. Para o terapeuta implica uma postura de aceitação e validação tanto da experiência, sentimento e legitimidade do sofrimento como das competências  do paciente como capacitadores da mudança: 

"HOW IS DBT DIFFERENT FROM REGULAR COGNITIVE BEHAVIORAL THERAPY?

 

DBT is a modification of standard cognitive behavioural treatment. As briefly stated above, Marsha Linehan and her team of therapists used standard CBT techniques, such as skills training, homework assignments, symptom rating scales, and behavioral analysis in addressing clients’ problems. While these worked for some people, others were put off by the constant focus on change. Clients felt the degree of their suffering was being underestimated, and that their therapists were overestimating how helpful they were being to their clients. As a result, clients dropped out of treatment, became very frustrated, shut down or all three. Linehan’s research team, which videotaped all their sessions with clients, began to notice new strategies that helped clients tolerate their pain and worked to make a “life worth living.” As acceptance strategies were added to the change strategies, clients felt their therapists understood them much better. They stayed in treatment instead of dropping out, felt better about their relationships with their therapists, and improved faster.

The balance between acceptance and change strategies in therapy formed the fundamental “dialectic” that resulted in the treatment’s name. “Dialectic” means ‘weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions.’ In DBT, therapists and clients work hard to balance change with acceptance, two seemingly contradictory forces or strategies. Likewise, in life outside therapy, people struggle to have balanced actions, feelings, and thoughts. We work to integrate both passionate feelings and logical thoughts. We put effort into meeting our own needs and wants while meeting the needs and wants of others who are important to us. We struggle to have the right mix of work and play.

In DBT, there are treatment strategies that are specifically dialectical; these strategies help both the therapist and the client get “unstuck” from extreme positions or from emphasizing too much change or too much acceptance. These strategies keep the therapy in balance, moving back and forth between acceptance and change in a way that helps the client reach his or her ultimate goals as quickly as possible. 

In http://behavioraltech.org/downloads/dbtFaq_Cons.pdf

  

Os efeitos do trauma complexo (complex PTSD) na saúde, nas perturbações nervosas, e cognitivas (por ex. défice de atenção) e em particular no desregulamento do eixo hipotalámico-hipofisario-adrenal (HPA Axis) está sobejamente comprovado. Síndrome de fadiga crónica, fibromialgia, perturbações gastrintestinais, asma, alergias, disfunções hormonais, etc.  estão entre as sequelas mais comuns.   O desregulamento do EHHA tem consequências "inflamatórias" em todos os sistemas corporais incluindo no cérebro perpetuando o trauma original pela debilitação das funções vitais. Tendo esta questão já sido amplamente estudada esta questão é incontroversa.

Vamos então continuar a medicar os sintomas? 
A partir o ser "às fatias"? 
Praticar  "medicina forense"? 
Autopsiar os vivos? 

A resistência de prestadores de cuidados médicos é assumida por Gabor Maté aqui: 

Gábor Máté MD Attachment = Wholeness and Health or Disease, ADD, Addiction, Violence: https://www.youtube.com/watch?v=Earq-eR3MQI 

Maté, Gabor. 2003. When the body says no: understanding the stress-disease connection. Hoboken, N.J.: J. Wiley.

http://restorativemedicine.org/wp-content/uploads/2013/03/5.-Addiction-Childhood-Trauma-Stress.pdf 

Ader, Robert. 2007. Psychoneuroimmunology: Vol. 1-2. Amsterdam;Boston: Elsevier/Academic Press. 

Se há

paralização, bloqueio  

sentimento persistente de desamparo

falta de foco e/ou défice de atenção

autodestrutividade

há Trauma.

"What to Do When There is Trauma

When stress is layered upon previous trauma, the dissociated and unconscious trauma memories can block the speedy resolution of present day stress without our even knowing why.  Uncovering un-integrated memories of previous trauma often works best with the skillful collaboration of a therapist trained in healing trauma ."

Linda Graham in http://lindagraham-mft.net/resources/published-articles/skillful-ways-to-deal-with-stress-and-trauma/

Stress vs Empathy

Stress vs Empathy

"What is empathy? 

Empathy is an appreciation of  another person's situation and experience".

Gabor Maté

http://www.youtube.com/watch?v=_eiiJiezRGg

Para quem ainda tem dúvidas: 

" What Is Empathy?

The term “empathy” is used to describe a wide range of experiences. Emotion researchers generally define empathy as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

Contemporary researchers often differentiate between two types of empathy: 'Affective empathy” refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety. “Cognitive empathy,” sometimes called “perspective taking,” refers to our ability to identify and understand other peoples’ emotions. Studies suggest that people with autism spectrum disorders have a hard time empathizing.'"

in http://greatergood.berkeley.edu/topic/empathy/definition

Trauma Complexo

" Good therapist were those who really validated my experience and helped me to control my behavior rather than trying to control me."  testemunho de vítima in Herman, 

Judith L. 1997. Trauma and Recovery. New York: Basic Books, p. 133.  

Herman, que é psiquiatra e Professora de Psiquiatria Clinica na Harvard Medical School  e ainda membro da Victims of Violence Program, Cambridge Health Alliance, and Department of Psychiatry,é especialista em trauma e vitimologia. No seu trabalho ela elabora e fundamenta a distinção entre trauma simples (tipo I,  em inglês designado pela sigla PTSD) e trauma complexo (tipo II, em inglês CPTSD). O último não foi incluido no Diagnostic and Statistical Manual of Mental Disorders e, assim, para muitos é como se não existisse.

O trauma complexo radica frequentemente na infância e adolescência sendo, consequentemente, tangencial ao trauma de desenvolvimento  (developmental trauma disorder - DTD). 

Veja-se http://www.mentalhealthconnection.org/pdfs/ptsd-predictors.pdf

"Can Mindfulness Help Adults Who Were Abused as Children?" 

http://greatergood.berkeley.edu/article/item/can_mindfulness_help_adults_who_were_abused_as_children

É o título de um post do http://greatergood.berkeley.edu/ website em  que seguimos aqui. A resposta é, obviamente, SIM, sem ser prescrição ou remédio. 

Estas práticas de meditação e meditação ancorada no corpo a que agora se convencionou denominar genericamente “mindfulness” em boa medida por razões de marketing e dessacralização e acessibilidade do público em geral buscam conseguir uma pacificação ou complemento terapêutico dos sujeitos traumatizados.

E como encarar o sistema social e de saúde das sociedades ocidentais modernas e a sua abordagem do trauma complexo  (Complex PTSD) como é o de infância seja ele derivado do clássico abuso sexual ou do ainda mais prevalente abuso emocional e negligência?

O trabalho de Gabor Maté é aqui crucial. Para uma imersão no seu pensamento na 1ª pessoa:

http://vimeo.com/55416414