Kweku’s Korner
By Dr. Kweku Akyirefi Amoasi
Kweku Akyirefi Amoasi, formerly known as Ramel Smith
Psychology is not a pure science. The diagnoses that medical professionals created through the Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-5-TR) are flawed at best. With each revision, it brings major changes to the psychological landscape. I try to explain to potential patients, the diagnosis helps to provide direction, but is not as important as the intervention. There are a plethora of interventions that can be used in therapy, the key is to find the correct clinician and then match with the proper intervention.
A lot of our psychological theories were created in the 19th and 20th century, and though they serve as a valid base, we need to recognize the cultural praxis on which these theories were created; even further, we need to be sure the therapies are keeping pace with the changing times and demands of today’s society. In the 1980’s a professor at the University of Nevada named Steven C. Hayes created something entitled Acceptance and Commitment Therapy (ACT). In a nutshell, this is an intervention that compels individuals to live more fulfilling and healthier lives by accepting the difficult thoughts, images, emotions, urges, and memories that often paralyze them from having the quality of life they could be experiencing. For example, those who suffer from anxiety, depression, self-esteem, and substance abuse will often avoid obtrusive thoughts; and, though this gives a momentary relief of the emotional pain, the continual disassociation does not allow them to live and enjoy the present moment.
Though relatively new as a theory, the volume of meta-analyses studies shows efficacy of use exceeds a placebo level at a significant level and is on par with other more recognized theoretical orientations, such as cognitive-behavioral therapy. ACT is not the answer to all issues, but it can be another psychological weapon to employ for services. There are six steps a patient is guided through: 1) Acceptance; 2) Cognitive Diffusion; 3) Being Present; 4) Self as Context; 5) Values; and 6) Commitment.
ACT is straightforward and plays out in six parts. The first step is to accept the reality of life, and sadly, it is not always beautiful. The key is to slowly begin accepting the reality of life. Marcus Aurelus used the term Amor Fati. This means to love fate, to love what has happened to you. Not just like it, not just accept it, but love it. It’s almost biblical in its meaning that we know all things work together for the good of those who love the LORD. This may seem laughable or nonsensical at first. How do I love something that was bad for me or hurt me? The key is to be accepting of it and not avoiding it is to destroy the bully in the room. At this stage, we acknowledge the situation(s), allow all the emotions to flow, and not run from them. This is the first step in acceptance. The next step is to allow ourselves to be present in the moment while feeling those emotions we once attempted to avoid and escape. Then we accommodate our changing behavior by giving ourselves grace to progress at the proper tempo to work. The goal here is to move from crawling, to walking, to running until we can fly, where we were once paralyzed. The last step is to appreciate. This ties back into the Amor Fati concept. Here we appreciate the discomfort and pain of the present moment with the knowledge that the more we face this giant, the smaller it becomes. This is not a quick fix, but with a determined individual and skilled clinician, the process is not a solo adventure.