Anna was overwhelmed by the administrative burden of her job. Self-compassion was the answer | Gill Straker and Jacqui Winship

A central tension in psychotherapy is the interplay between acceptance and change. People usually seek therapy because they wish to alter some aspect of their lives. Yet, at its core, therapeutic change often begins with reaching an acceptance that suffering, distress and imperfections are an inherent part of the human experience.

While this tension is at the heart of all therapies, there are two forms of therapy that explicitly target this interplay.

Dialectical behaviour therapy teaches patients to radically accept themselves and their circumstances while simultaneously striving for meaningful change.

In acceptance and commitment therapy (ACT), clients are encouraged to embrace their thoughts and emotions rather than trying to ignore, change or eliminate them. ACT, which has resonance with Stoic philosophy and Buddhism, focuses on the paradox that it is through accepting our inner experiences that we gain the freedom to commit to actions that are aligned with our values and goals.

Patients are sometimes alarmed by the notion of radical acceptance, fearing it means they are “giving up” or signalling approval of difficult situations and feelings. However, acknowledging reality does not imply passivity or resignation – we must actively move towards acceptance of our circumstances and ourselves, letting go of judgment and resistance.

Often our attempts at transformation have been hampered by an inability to recognise our reality and our inevitable limits, and it is only once we have truly accepted these that we are able to strive for feasible changes. Thus, acceptance and change are not opposites, but rather complementary forces.

Too often in life we throw our energy and focus at what we cannot change (eg the behaviour of others) and don’t commit fully enough to what is in our control (eg our own choices and responses). Sometimes it takes time, discussion and reflection to reach this point of wisdom. Therapists too must hold this wisdom in mind, finding a delicate balance between validating their patients’ distress, empathically helping them to move towards acceptance, and finally shifting to a focus on what change might be within their control.

In an age of self-help literature, productivity culture and self-optimisation, there is often a relentless pressure to improve. While striving for improvement can be valuable, the danger lies in being wracked with shame and self-criticism when we fail to achieve some unattainable standard that is misaligned with our reality.

Self-compassion is an important antidote to this.

Accepting reality as it is, including distressing situations and uncomfortable feelings, is an inevitable struggle. This suffering is exacerbated when we berate and judge ourselves for our struggles. This self-critical narrative is also counterproductive, making it less likely that that things will improve than if we respond to ourselves with kindness and understanding.

An example of this can be found in the case of Anna*, a 27-year-old primary school teacher who came to see me because she was battling with procrastination in the context of having attention deficit/hyperactivity disorder (ADHD). As I got to know Anna, it became clear she was a gifted teacher but that she became easily overwhelmed by the administrative burden of her job. She was behind on her marking and was constantly missing deadlines for report writing.

As the end of each term approached, and the administrative deadlines loomed more potently, Anna would find herself caught in a cycle of good intentions, well-made plans, paralysing procrastination, a failure to stick to her plan, and a lot of shame and self-recrimination for her “laziness” and “inefficiency”.

Anna’s anxiety would skyrocket, and her mood would drop as she increasingly perceived herself as an incompetent failure. When I encouraged Anna to take a more compassionate approach to her struggles, she would argue this would only encourage more “laziness” and she needed to be hard on herself to change her behaviour.

I was able to challenge Anna’s beliefs in this regard by pointing her in the direction of research indicating that self-compassion reduces procrastination rather than encouraging it. Stress is a primary cause of procrastination, which is essentially a problem of self-regulation, and self-critical narratives increase stress and induce further procrastination. By contrast, self-compassion has been found to decrease stress and boost motivation, optimism and self-worth, resulting in more positive outcomes.

Over time, Anna was able to more readily accept the impact of ADHD without labelling this as a character flaw and to treat herself with more self-compassion when she found herself in the grip of procrastination. This allowed her to soothe and regulate her emotions, which in turn enabled her to recommit to the tasks she was struggling to complete.

She also allowed herself to ask for help and support when she was feeling overwhelmed and this in turn made the tasks feel more manageable and approachable. Through her commitment to therapy Anna was increasingly able to find a synergy between acceptance and change that both reduced her personal suffering and increased her capacity to cope with her job.

*Anna is a fictitious amalgam to exemplify many similar cases we see. The therapist is a fictional amalgam of both authors.