Anger, Madness, and Destructive Behavior

Dr. Stephen A. Diamond, Secrets of Psychotherapy (IV): Change or Acceptance?

What is the ultimate goal of psychotherapy?

Let's start with a simple word association experiment: When thinking about psychotherapy, what is the first word that comes to mind to describe what therapy is all about?

Take a few seconds. Got it? For many,my guess is that one, if not the very first, of those words was change. But what if I were to say that psychotherapy is really at least as much about acceptance?

When Sigmund Freud made the oft-cited and misunderstood statement that the purpose of psychoanalysis is to "transform neurotic misery into common unhappiness," he was speaking of change.

But how is even such seemingly modest change accomplished in therapy? So much of the changes that happen in psychotherapy parallel a gradual process of acceptance: acceptance of life as it truly is, as opposed to the way we wish it to be.

Acceptance of past childhood trauma and its pervasive unconscious influence in the present. Acceptance of ourselves for who we are, rather than who we are not.

Freud's off-the-cuff comment may seem cynical. But when seen in the light of his own personal suffering from oral cancer during the final 15 years of his life and how he stoically faced that terrible fate, it is a mature and sober commentary on the absolute necessity of acceptance.

Rather than reflecting his profound pessimism about the human condition, as many mistakenly conclude, Freud's remark recognizes deeply and personally the need for courageous acceptance of physical and emotional suffering and, moreover, the high price we pay for trying to avoid or deny life's tragic aspect. More

• Evil Deeds: A Forensic Psychologist on Anger, Madness, and Destructive Behavior