I recently attended Chris Irons' one-day workshop on Compassion-Focussed Therapy (CFT). I was interested in learning about yet another third wave CBT therapy and also wanted to find out the answer to a number of questions, such as
- What is compassion?
- Can compassion-based therapy help with shame and self-criticism?
- How different is this approach from standard CBT?
- What sort of client can CFT most help?
1. Compassion Focused Therapy (CFT) is an evidence-based, integrative third-wave cognitive behavioural therapy particularly useful for people who experience high levels of shame, are highly self-critical and have previously lacked sufficient positive nurturing experiences.
2. Paul Gilbert, the founder of CFT, is influenced not just by CBT but also by attachment theory, neuroscience, Jung and social and developmental psychology. Whilst CBT is very helpful for many people, Gilbert found that some self-critical clients really struggled with CBT. They could relate to alternative perspectives t intellectually but struggled to really believe more positive ideas about themselves with their heart. This "head heart lag" occured most when clients had no experiences of nurturing to draw on. They couldn't feel positive about themselves, because they had no experience of feeling positive about themselves to draw on. This led Gilbert to move beyond CBT and develop CFT.
3. From neuroscience, CFT takes the ideas of the old brain and new brain and three major emotion regulation systems.
The "old brain" is the fast automatic systems that occur in other animals, the "new brain" is the slower neocortex which more developed in humans and gives us our power to imagine, reason and plan and use language.
The three emotion regulation systems are particularly important in CFT and arecolour-coded in CFT to help clients remember them.
Threat and Protection (RED)
Achievement and Pleasure (BLUE)
Contentment, Soothing and Connection (GREEN)
The RED system. THREAT and PROTECTION. NEGATIVE EMOTIONS
The world is a dangerous place, So it's good we have a part of our brain dedicated to protecting us.When threatened, a stress response will kick off the "old brain" and we will feel a strong urge to get away. The new brain is also part of the RED threat system - it worries and ruminates to try to help us deal with threats.
The Red Threat System is not a bad thing. You wouldn't want to be without it, But you can have too much of a good thing. The question to ask is - is your threat system sometimes in overdrive? Would it be helpful to develop your own switch which could turn the threat system down a notch or two sometimes? For those who are strongly self-critical and experience high levels of shame as well as those who experience other psychological problems, the answer may well be "YES".
The BLUE system. ACHIEVEMENT and PLEASURE. UNQUIET POSITIVE EMOTIONS
Our body requires food, our species needs us to have sex in order to continue, society need us to achieve certain things in order for it to flourish. It makes sense that our brain motivates us to seek pleasure and achievement and rewards us when we do so. When we get depressed a lot of people have too little achievement and pleasure in their life. CBT and Behavioural Activation can help depressed people redress the balance. With other people, though, the blue system can become a problem. An addict may be too focussed on pleasure, the perfectionist on achievement. Self-esteem that is contingent on achievement can be as problem. If "You only sing when you're winning" is a problem in a world when not everyone can be winners. So as with the RED system, the BLUE system is both necessary and potentially dangerous.
The GREEN system SAFENESS and SERENITY. CALM POSITIVE EMOTIONS
As well as "unquiet" positive emotions such as excitement and adventure we can also have positive emotions associated with safety, contentment, serenity and peace.
These calm positive emotions are linked to attachment and caring. Clients who have lacked secure attachment in childhood and have had insufficient emotional nourishment may have a deficit in this system. CFT aims to make the green system more powerful.
A CFT therapist will explain these three systems to clients and ask this key question
If we were to draw your three systems as circles, what would be their relative size?For many self-critical clients who experience large amounts of shame, the green system would be very small and the read system very large.
4. Shame is different from and more problematic than either guilt or embarrassment.
Guilt occurs when you think you done something wrong and feel you need to make amends,. Guilt is linked to caring mentality and can be a good thing
Embarrassment occurs when you feel other people will judge what you have done adversely,
but the incident doesn't sum you up - you may have walked home with your flies undone, but that doesn't say much about you as a person. It is something you i can tell other people about.
Shame on the other hand is when you think that others will judge you adversely, and their judgement does encapsulate you as a person. You find it very difficult to tell other people about shameful episodes.
Shame is therefore a more tricky emotion and is more closely linked with hopelessness, suicide and less successful therapy outcomes. So if CFT can help people with high levels of shame, it will make an important contribution.
Shame is often divided into external shame - shame in other's eyes - and
internal shame - feeling ashamed of ourselves,
It is not your fault
Evolution has left us with a flawed system. The old brain and new brain do not always interact well. The three emotional regulation systems aren't always in balance. You didn't choose your genes. You didn't choose which family you were born into. You didn't choose whether the green calming system developed during childhood. It's not your fault
6. CFT helps clients to develop both mindfulness and compassion.
CFT uses a range of therapeutic techniques familiar to the CBT therapist including psychoeducation, formulation, listening, behavioural experiments, exposure, agenda setting and home practice. Two skills that are particularly prominent in CFT are mindfulness meditation and compassion meditation.
Mindfulness and compassion are different skills using different parts of the brain.
The mindful brain is a new brain capacity . It increases one's capacity to shift attention and awareness. and purposefully focus. You can have mindfulness without compassion - think of a sniper.
Compassion on the other hand is an old brain capacity. You can have compassion without mindfulness -think of a parent running into a house on fire to save their child.
CFT targets both.
8 Often clients will not like compassion at first. You need to expect resistance - this is part of the work. These people are uncomfortable with compassion, they aren't used to it, it may stir up difficult memories- you have to work with this. It's like working with a phobic -you don't give up just because they don't want to be exposed to their fear.
Clients may have a lot of metacognitive beliefs you have to deal with
Self-criticism keeps me from being selfish and lazy
To discover your client's specific beliefs about the benefits of self-criticism ask them
"What concerns would you have about the possibility of not being self-critical at all?"You need to challenge beliefs about the benefits of self-criticism. Remind them that compassionate people like Nelson Mandela are strong. Ask them if they would like their self-critic to be the teacher of a child they loved who was struggling with maths. Tell them that their aim is not to lose self-control and do whatever they like, but to replace the harsh self-critic (the "poisoned parrot") with a gentle compassionate internal self-corrector - perhaps like Dumbledoore.
9. It's helpful to use metaphors and stories.
This Native American story about feeding the good wolf can help foster hope and the realisation that CFT takes practice in compassion - and also the idea that it compassion is a choice.
10. There is growing evidence for the effectiveness of CFT. Most of the evidence comes from group CFT and as yet there are no randomised control trials. So whilst CFT promises to help with some of the difficult cases that CBT finds most tricky, it would be premature to abandon CBT altogether.
You can learn more about Compassion Focussed Therapy and get lots of free downloads and other resources at Compassionatemind.co.uk. This link provides many useful and free Scales