Compassion Focused Therapy
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Continuing Education credits can be earned for this course at: https://allceus.com/member/cart/index/product/id/578/c/
Objectives
~ Define CFT
~ Explore the underlying theory
~ Identify techniques used in CFT and their rationale
~ Theorize about how CFT might be helpful to your clients
Compassion
~ The healing properties of compassion have been written about for centuries.
~ The Dalai Lama stresses that if you want others to be happy, or to be happy yourself – focus on compassion
~ Compassion can be thought of as a skill that one can train in.
~ Focusing on and practicing compassion can influence neurophysiological and immune systems
~ Compassionate mind training refers to specific activities designed to develop compassionate attributes and skills, particularly those that influence affect regulation
Observations About Compassion
~ Compassion-focused therapy and compassionate mind training arose from a number of observations.
~ First, people with high levels of shame and self-criticism can have enormous difficulty in being kind to themselves, feeling self-warmth or being self-compassionate.
~ Psychological consequences?
~ Physical consequences
~ Social consequences?
Observations About Compassion
~ Second
~ Problems of shame and self-criticism are often rooted in histories of abuse, bullying, high expressed emotion in the family, neglect and/or lack of affection
~ Imagine growing up in this family
~ What do you, the child want? —But you don’t get it.
~ What does this teach you about the world
~ Individuals subjected to early experiences of this type can become highly sensitive to threats of rejection or criticism from the outside world and can quickly become self-attacking (egocentric child) or defensive and aggressive
Observations About Compassion
~ Third, it has been recognized that working with shame and self-criticism requires a therapeutic focus on memories of such early experiences (similar to trauma work)
~ Fourth, some clients become skilled at generating alternatives for their negative thoughts and beliefs, but still do poorly in therapy.
~ I identify the logical fallacy, but it doesn’t make me feel any better
Key Element
~ Individuals prone to high levels of shame and self-criticism can find it very difficult to generate feelings of contentment, safeness or warmth in their relationships with others and themselves.
~ Psychological consequences?
~ Physical consequences
~ Social consequences?
Brain Systems
~ Threat and protection
~ All living things have evolved with basic threat-detection/protection systems (survival)
~ The behavioral outputs include fight, flight and submission
~ Sensitized schemas and strategies for threat detection and protection can become major influences on the ways in which a person perceives and navigates their world.
~ The clinician will identify, historically plot and validate the functions and origins of safety strategies (partly to de-shame them)
~ In compassion-focused therapy the focus is on understanding the functions of a person’s symptoms and difficulties in terms of safety strategies
Brain Systems
~ Drive and excitement
~ Animals need emotion and motivational systems that direct them towards important rewards and resources.
~ The function of the drive and excitement system in humans is to give us positive feelings that energize and motivate us to seek out things (e.g. food, sex, friendships)
~ If people take cocaine or amphetamine this is the system they are likely to stimulate.
Brain System Conflict
~ The drive system and the threat protection system can be linked in complex ways
~ Avoid negative events, which shows up in thoughts of ‘shoulds’, ‘oughts’ and ‘musts’.
~ Working to avoid rejection
~ Doing things we shouldn’t
~ Status Seeking (Wealth, power, (status))
Brain Systems
~ The contentment system
~ When animals are not threatened and not seeking resources they can become content
~ Contentment is associated with a positive ‘calm’, positive affects and sense of well-being; contentment is not just the absence of threat
~ The evolution of attachment behaviour utilised the contentment system, and enabled signals of caring and kindness to have soothing qualities that activate positive affects linked to feelings of well-being, safeness and social-connectedness. This aspect of the system may be called ‘social safeness’
~ The contentment/social safeness system is internally wired to act as a regulator of the threat protection and drive systems
~ Compassion-focused therapy and compassionate mind training are directed at facilitating development of the soothing and social safeness system
Contentment cont…
~ The contentment system has been significantly developed with the evolution of attachment behaviour
~ The key point is to recognise the importance of caring behaviour in stimulating the soothing and safeness system, and thus soothing overarousal and threat (dis)stress in the individual receiving care. Caring-affiliation operates through an opiate and oxytocin system.
~ there is increasing evidence that it reduces sensitivity, especially to socially threatening stimuli, in fear circuits of the amygdala
Balancing the Systems
~ Heightened sensitivity and overactivity of the threat protection and/or drive systems is a common problem in people with high shame and self-criticism
~ The soothing system, which provides relief and calming, is insufficiently accessible to them, making it difficult to feel reassured or calmed/soothed when they generate (believable) alternative thoughts or engage in helpful behaviors.
~ This system is particularly sensitive to interpersonal cues of social safeness, acceptance and being cared for.
~ The role of the therapist is to help the client experience safety in their interactions with them, and to replace self-criticism with self-kindness
The attributes of compassion
~ In compassion-focused therapy compassion is understood in terms of specific attributes and skills
~ Care for well-being
~ Sensitivity
~ Sympathy
~ Distress tolerance
~ Empathy
~ Non-judgement
The skills of compassion
The skills of compassion involve creating feelings of warmth, kindness and support in a range of activities
Compassionate Attention
~ If we are in conflict with someone (or ourselves), we often overlook the things that we like about them: by refocusing our attention we can create a sense of warmth, support and kindness.
~ In CFT, the focuses is on:
~ Identifying the client’s strengths, positive attributes or skills
~ Pay attention and bring to mind their positive qualities, perhaps by revisiting positive memories, and working on those aspects of self.
~ Attention-directing exercises linked to the savoring of experiences, to develop appreciation and gratitude. For example, an individual may be encouraged to appreciate their food, environment…
~ When the threat protection system is focused on problems and potential difficulties, it is beneficial to practice refocusing attention and liberating it from this dominance.
Compassionate Reasoning
~ Compassionate reasoning involves how we think about the world, ourselves and others.
~ Logic is not enough. ‘Evidence’ is secondary to the experience of being helped and supported.
~ Particularly important is how people reason, ruminate and reflect on their current mood states, their future and their sense of self.
~ Shame and self-critical thinking are clearly targets in compassion-focused therapy, but it is important to understand the functions of self-critical thinking and why people may fear giving it up.
~ The therapist teaches the problems of certain types of rumination and how to substitute compassionate refocusing in one’s thinking.
Compassionate Behavior
~ Compassionate behavior is focused on alleviating distress and facilitating development and growth
~ for example, when the individual has to engage in difficult or frightening behavior they will try to create an encouraging, warm tone in their minds associated with the supportive thoughts
~ This is a repetition of what would normally happen within a parent–child relationship, where the parent is encouraging and supportive
Compassion-Focused Therapy
~ Seeks to stimulate positive affect processing
~ Behavioral tasks encouraging exposure to positive emotions can help the client to learn to enjoy experiencing them.
~ Why might a client not be able/willing to experience pleasure?
~ Helping people become more process-focused (efforts) rather than task-focused (results).
Compassionate Imagery
~ Clients explore their image of their ‘ideal’ of compassion. The therapist guides the client through imagery exercises, exploring feelings associated with various images.
~ These images are usually fleeting and never clear in the mind, and the therapist advises the client of this
~ Sometimes clients prefer non-human images such as an animal, a tree or a mountain. These too must be imagined as sentient, with specific qualities of wisdom, strength, warmth and non-judgement.
~ The client imagines themselves as a highly compassionate person and explores their sense of age, facial expressions, body postures, voice tones and styles of thinking
~ Clients can be encouraged to practice each day at becoming ‘the compassionate self’, with the appropriate facial expressions, voice tones and ways of thinking.
Compassionate Sensation
~ Clients explore feelings in their bodies when they focus on being compassionate, experiencing compassion from others and being self-compassionate
~ CFT suggests that internal thoughts and images can act just as external stimuli do, activating different parts of the brain.
~ For example, if we are hungry and we see a tasty meal (external signal) this can start our saliva and stomach acids flowing. Equally, just imagining the tasty meal (internal signal) can have the same physiological effect
Compassionate Sensation
~ The therapist asks the client to consider how they would feel if someone kept putting them down, undermining their confidence, becoming angry with them when things did not go well.
~ Usually, clients are able to identify feelings of anxiety and depression and can recognize that this is because critical signals stimulate their threat protection system
~ From there the therapist can help the client understand how self-criticism can be so constant in a person’s mind that it literally harasses them into depressed and anxious states.
Fear of compassion
~ Many clients cannot easily access the soothing and social safety system that underpins compassion.
~ Much of the work in CFT addresses people’s fears and resistances to becoming
~ self-compassionate
~ compassionate to others.
~ Signals of kindness and compassion from another person (especially a therapist) will reactivate the attachment system and memories and feelings within the attachment system triggering considerable sadness and grief
~ The compassion-focused therapist will help to normalize, validate, contain and work with those feelings
Fear of Compassion
~ Some people find compassion-focused imagery physiologically stressful due to prior trauma, abuse or abandonment history
~ Some clients have negative beliefs about compassion as being soft, self-indulgent or not deserved.
~ Exploration might reveal that the individual is afraid that if they give up self-criticism they will
~ become lazy, unpleasant or unlovable.
~ be punished for self-compassion by ‘paying for it later’ or having it taken away
~ The therapist is constantly exploring the interactions between the functions of self-criticism and the fear and avoidance of self-compassion.
Summary
~ Many clients struggle not only with low self esteem, but also a highly critical negative internal voice
~ In CFT the therapist
~ Explores the roots and function of the self-criticism, helping clients see it was a survival response
~ Helps clients explore what a compassionate other would look like
~ Helps clients describe (and rehearse) being self compassionate
~ Explores the interaction between self-criticism and avoidance/fear of self-compassion
~ Explores the sensations and fears associated with self-compassion
~ Helps clients understand why compassion in the present may cause so much distress due to unresolved attachment issues from childhood
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