DBT for Psychosis: Radical Acceptance and Therapy-Interfering Behaviors

United States Department of Homeland Security

Validation, radical genuineness, and irreverence are closely related DBT concepts. Validation has to do with reflecting and normalizing someone’s experience, especially their emotional experience, not reinforcing inappropriate behavior. DBT considers radical genuineness to be the highest form of validation, in which a therapist is openly candid with a client. One form of radical genuineness includes irreverence, in which the therapist uses humor to challenge a client in a way they weren’t expecting.
Radical acceptance doesn’t mean that you agree with something, but rather that you’re willing to acknowledge and even embrace it anyway. Even though radical acceptance is difficult, not radically accepting is even more difficult and leads to suffering. When clients with psychotic symptoms learn to accept—and even befriend—their symptoms, their symptoms tend to decrease.
Instead of seeing treatment-interfering behaviors as inherent resistance, it’s much more effective to conceptualize these behaviors as opportunities to meet clients where they are at and to collaboratively problem-solve with clients. This is an example of what DBT calls functional validation.