of another symptom if the present one is removed
without attending to the underlying pathology.
Attacking a patient’s anxieties directly will not nec-
essarily force the anxieties to return in another
guise. This demonstration not only lent credibility
to the behavioral movement; it also chipped away
at the credibility of those psychiatric and psychody-
namic orientations that had so stoutly defended the
symptom substitution notion. As a result, the ave-
nue was opened for the development of specific
techniques for dealing with specific patient com-
plaints. However, these remarks should be tem-
pered by recognition that direct onslaughts on the
patient’s stated problem may not always be the most
efficient route. As noted earlier in this chapter, it
may turn out that a specific anxiety is being
sustained by something not immediately obvious
(Lazarus, 1971a).Breadth of Application. A contribution of major
proportions has been the extension of the range of
applicability of therapy. Traditional psychotherapy
had been reserved for the middle and upper classes
who had the time and money to devote to their
psychological woes and for articulate, relatively
sophisticated college students with well-developed
repertoires of coping behaviors who were attending
colleges or universities that made counseling ser-
vices available to them at little if any cost. Behavior
therapy has changed all that.
Now, even financially strapped individuals
with mental retardation or a chronic mental illnesswork on that. And getting you to agree, mean-
ingfully of course, and actually following through
on staying alive and not harming yourself and not
attempting suicide no matter what your mood is.
Now the question is, whether you agree to that.
C:Yes, I agree to that.In this segment (Linehan & Kehrer, 1993, p. 433), the
therapist reinforces the client for using distress toler-
ance skills when her request for pain medication was
refused by her physician.
T:That’s good thinking. That’s when you’re thinking
about the advantages and disadvantages of doing
it. OK, so at that point the advantages of making
it worse were outweighed by the disadvantages.
OK. So you keep up the good fight here. Now
what else did you try?
C:I tried talking about it with other patients.
T:And what did they have to say?
C:They said I should get pain medication.
T:Right. But did they say you should cut yourself or
hurt yourself if you didn’t get it?
C:No. And I tried to get my mind off my pain by
playing music and using mindfulness. I tried to
read and do crossword puzzles.T:Um hmm. Did you ever try radical acceptance?
C:What’s that?
T:It’s where you sort of let go and accept the fact that
you’re not going to get the pain medication. And
you just give yourself up to that situation. You just
accept that it isn’t going to happen, that you’re
going to have to cope in some other way.
C:Which I did yesterday. I needed a little Aptiva (lor-
azepam) to get me there but I got there.
T:Yesterday?
C:Yeah. I took a nap. When I woke up I basically said,
“Hey, they’re not going to change, so you’ve just
got to deal with this the best that you can.”
T:And did that acceptance help some?
C:I’m still quite angry about what I believe is discrimi-
nation against borderline personalities. I’m still
very angry about that.
T:OK. That’s fine. Did it help though, to accept?
C:Um hmm.
T:That’s good. That’s great. That’s a great skill, a great
thing to practice. When push comes to
shove, when you’re really at the limit, when it’s
the worst it can be, radical acceptance is the skill
to practice.PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 423