Workbook

An Introduction to the Theory & Practice of Compassion Focused Therapy and Compassionate Mind Training for Shame Based Difficulties

Paul Gilbert

2010 This Copy belongs to: ___________________________________________________________

www.compassionatemind.co.uk

Workshop Outline Introduction to the basic model: The nature of shame and compassion • • • • • • • •

Basic philosophy of this approach and model The reasons for our focus on shame and self-attacking Considering three interacting emotion systems of: Drive, Safeness and Threat Linking shame to threat, and compassion to safeness and affect system balancing Distinguishing safeness from defensive safety-seeking Distinguishing external and internal threats Exploring different types of shame and how shame is linked to self-criticism Exploring how self-criticism is linked to threat and safety behaviours

Developing threat focused formulations and linking them to a compassion focus • • • • • • • • • •

Therapeutic relationship and microskills Formulating problems in terms of threat and safety strategies Linking self-criticism to safety seeking strategies Using formulation to identify the therapeutic focus Introduction to the basic model: the nature of compassion as an antidote to shame and selfattacking What is compassion and self-compassion? Characteristics of compassion, the therapist, and therapeutic relationship The compassion circle What is the aim of compassion focused therapy and compassionate mind training? Fear of compassion

Compassionate mind training • • • • •

Key tasks of compassion-focus therapy Training our minds for self-compassion with compassionate attention, thinking, behaviour and feeling Using imagery Compassionate reframing Compassionate letter writing

The Compassionate Mind Foundation  2010 Page 2

Overview Shame and self-criticism are associated with a range of psychological difficulties, including depression, social anxiety, eating disorders, various personality disorders, and post-traumatic stress disorder. This workshop offers a way of understanding the nature and functions of shame & self-criticism and why and how to use a compassion-focus for your therapy. We will consider shame as related to threat processing and distinguish two types of threat: External and internal. External threats are threats that are perceived to lie outside of the self (e.g., from the actions of others towards the self). Internal threats relate to the emergence of internal experiences (e.g., emotions, thoughts, fantasies and dreams) that negatively impact on self-evaluations, self-identity and selfpresentations. Shame based self-critical dialogues are responses both to threats and sources of threat. This workshop will therefore consider some of the complexities of threat processing and how to derive formulations based on threat processing and safety strategies. Understanding shame and self-criticism as ways to try to defend ourselves via safety strategies such as avoidance, compensation or concealment are key to compassionfocused formulations. Based on new research in areas such as attachment and the nature of different types of positive emotions, we will explore how and why developing various components of self-compassion can reduce shame and self-attacking. Orientating the self towards self-compassion uses a range of cognitive, behavioural, emotional and imagery-based interventions. Through a variety of experiential exercises we will explore how to help clients recognise the value of self-compassion over self-attacking and how to develop a compassionate approach to the self that will enable them to become self-soothing and self-nurturing.

PLEASE NOTE YOUR PERSONAL SAFENESS We shall be exploring some of our own thoughts and feelings. Please be aware that very occasionally this might tap something painful for you, so only focus on examples that you feel are suitable to work with in this public workshop. Everything is voluntary so only go where you feel comfortable. Your emotional reactions in this workshop are your own responsibility. The Compassionate Mind Foundation  2010 Page 3

A Compassion-Focused Workshop Dear Delegate, We are delighted to be able to share with you some new ideas about working with complex and challenging difficulties, especially those linked to high levels of shame and self-criticism. Coming along today suggests you have recognised that helping people who have high shame and self-attacking can be difficult. So we are going to explore ways to think about shame, why and how shame is linked to self-criticism and why these can be so difficult to work with. Importantly of course we will outline what Compassion-Focused Therapy and Compassionate Mind Training are and why and how they can be helpful for people with these difficulties. The principles behind this work are drawn from a wide range of fields including evolutionary psychology, neuroscience, models of emotions and cognitive and behaviour approaches. We hope you will enjoy this workshop and be able take away ideas to integrate into your current practice. We also hope it may be personally useful. Developing ways to understand compassion and how to apply it to self and others is an ongoing scientific endeavour. To help facilitate these endeavours we have established the Compassionate Mind Foundation (www.compassionatemind.co.uk).

Our mission statement is: Promoting well-being through the scientific understanding and application of compassion


What is Compassion-Focused Therapy (CFT)? Compassion Focused Therapy (CFT) is based on evolutionary and biopsychosocial approaches to psychological difficulties and derived from the social mentality theory (Gilbert 1989, 1995, 2005a,b). It offers ways of focusing your therapy. This approach guides therapeutic interventions especially for the development of self-soothing and self-compassion. The interventions themselves are derived from many other therapies and include the importance of: the therapeutic relationship, guided discovery, Socratic dialogues, inference chains, function analysis, chain analysis, maturation awareness, behavioural experiments, exposure and toleration, mindfulness, guided imagery, expressive writing, and independent practice. Compassionate Mind Training (CMT) refers to the specific training and use of guided exercises to develop compassionate attributes of compassionate motivation, sensitivity, sympathy, distress tolerance, empathy, non-judging and noncondemning. CMT utilises a range of exercises that focus on developing compassionate attention and imagery, reasoning and thinking, behaviour, and feeling. CMT refers to the specific ways/techniques we can use to help us experience compassion, and to develop the various aspects of compassion for self and others (Gilbert, 2007, 2009; Gilbert & Irons, 2005).

Why Compassion-Focused Therapy (CFT)? High shame and self-criticism are associated with a range of psychological difficulties and are recognised as difficult to help with traditional therapies. CFT was developed to target shame and self-criticism. Individuals with these problems often come from harsh backgrounds and find it difficult to feel reassured or safe. CFT focuses on developing people’s abilities to feel inner safeness and selfreassurance as an antidote to self-criticalness. This requires working with specific affect regulation systems. Over the years various therapies have developed interventions (such as exposure and other techniques involving meta-cognitive processes) aimed at toning down negative emotions such as anxiety, anger, fear and sadness. Recent developments in therapeutic practice suggest that we also need to consider how to tone up and foster certain types of positive emotions. One cannot assume that by reducing negative emotions the positive ones will come on line. Developing the capacities for positive affect, linked to well-being, requires consideration of the type of positive affect that will be the focus of development. The Compassionate Mind Foundation  2010 Page 5

Summary We are an emergent species in the ‘flow of life’ So our brains, with their motives, emotions and thinking abilities are products of evolution, and are designed to function in certain ways Our lives are short (25,000-30,000 days), destined to decay and end, and are subject to various malfunctions and diseases - in a genetic lottery. In addition the Buddha pointed out that everything changes, nothing lasts and this is a source of tragedy. The social circumstances of our lives, over which we have little control, have major implications for the kinds of minds we have, the kind of person we become, the values we endorse, and the lives we live. Genotype + Environment = Phenotype Mental Health is related to phenotypic variation - people doing the best they can We all just find ourselves here with a brain, emotions and sense of (socially made) self we did not choose but have to figure out. Life involves dealing with tragedies (abuse, threats, losses, diseases, decay, death) and people do the best they can. Much of what goes on in our minds is not of ‘our design’ and not our fault - all in the same boat First steps to compassion is to be open to suffering, ‘what we are caught up in’, with a desire to relieve suffering - drive for scientific knowledge

Our brains are difficult to regulate 1. Old Brain Emotions: Anger, anxiety, sadness, joy, lust Behaviours: Fight, flight, withdrawal, engagement Relationships: Sex, power, status, attachment, tribalism 2. New Brain We can imagine, fantasise, look back and forward, plan, ruminate We can integrate mental abilities We can create a sense of self-awareness, self-identity, and self-feeling 3. Social Brain Need for affection and care Socially responsive, self-experience and motives What happens when new brain is recruited to pursue old brain passions?

Link between Motives and Emotions • • •

Motives evolved because they help animals to survive and leave genes behind Emotions guide us to our goals and respond if we are succeeding or threatened There are three types of emotion regulation

1. Those that focus on threat and self-protection 2. Those that focus on doing and achieving 3. Those that focus on contentment and feeling safe The Compassionate Mind Foundation  2010 Page 6

The Three Circles Diagram Depicting the interaction between three affect systems Three Types of Affect Regulation System Content, safe, connected

Driven, excited, vitality

.

Incentive/resource focused

Non -wanting/ Affiliative -focused

-

Safeness -kindness

Wanting, pursuing, achieving, consuming Activating

Soothing Threat -focused Protection and safety -seeking Activating/inhibiting

Anger, anxiety, disgust

(See Depue & Morrone-Strupinsky 2005 and Gilbert 2009 for details). These are, of course, very simplified ways of thinking about complex systems. Moreover, these systems are in constant interaction, generating various patterns of activity in our minds. So think of these systems as ‘rules of thumb’. This threecircle model can be useful in thinking about and guiding your therapy. CFT uses a lot of psychoeducation, including sharing this model with clients and inviting their reflections. With clients go though each circle and ask: “How does this affect your body; How does this system affect you attention and thoughts; What does your body want to do when this ‘emotion’ is aroused’; How easy is to stop if being activated Use examples. The Compassionate Mind Foundation  2010 Page 7

Compassion as a Mentality

A social mentality is: • the organisation of abilities, competencies and modules • guided by motives • to achieve social outcomes and roles (status, friendship, care, sexual) Compassion evolved from the care-giving mentality Compassion can be defined in many ways and as combinations of attributes: “As a sensitivity to the suffering of self and others with a deep commitment to try to relieve it” Dalai Lama. Compare the organisation of our minds with different motives guiding them

C a r in gM e n ta lity

C o m p te tiv Me e nta lity tive A tte n tion

Im aage ge ry F an a n tasy ta sy

M ootiva tivatio tio n

Th in k in g R eason ea son in g

C o m p eetting ing

A ttttee n ti tioo n

B eh a viou vio u r

E m otio otionn s

Im ag er y F a n ta ssyy

M ootiv tiv a ti o n


T h i n k iinn g R easoning

C aarr in g

B eh a vio u r

E m o ti o n s

The key attributes of compassion (inner ring) and the skills to develop them (outer ring)

Caring -Compassionate Mind SKILLS -TRAINING

Warmth

Warmth

Imagery ATTRIBUTES

Attention

Sympathy

Sensitivity

Feeling

Distress tolerance

Compassion

Care for well -being

Non -Judgement

Reasoning

Empathy

Behaviour

Sensory

Warmth

Warmth

Competitive Mind SKILLS -TRAINING

Imagery ATTRIBUTES

Attention

Compete

Feeling

Reasoning

Envy

Sensitivity

Competition

Judgemental Social Comparison

Distress tolerance

Empathy

Sensory


Behaviour

Experiencing Helpfulness? Cognitive-behavioural focused therapies help people distinguish unhelpful thoughts and behaviours - that increase or accentuate negative feelings - and alternative helpful thoughts and behaviours that do the opposite. This approach works well when people experience these alternatives as helpful. However, suppose a client says, “I can see the logic and I know these alternative thoughts make sense and I should feel they are helpful but I cannot feel reassured by them” or “I know that I am not to blame but still feel to blame”. This is called a cognition-emotion mismatch. In fact many of our feelings (such as falling in love) do not emerge from logic. There are many forms of cognitionemotion mismatch when feelings and thoughts do not seem to fit together (Haidt, 2001; Lee, 2005). For example, research has shown that you can prime an emotion non-consciously and lead people into false beliefs about why they are feeling what they are feeling (Haidt, 2001). There can be many reasons for why people ‘know’ one thing but feel another. For example ‘changing one’s mind’ is seen as too threatening or there may be powerful, classically conditioned threat responses; or there may be unresolved traumatic memories. A related reason is that the opiate/oxytocin soothing system that codes for safeness is insufficiently stimulated and thus people do not feel reassured. Some people who have never really felt safe, can find those feelings odd, threatening or not to be trusted. The emotional systems that give rise to feelings of reassurance are not active enough - or the threats seem so great that the threat system overrides them. Clinical and research work suggests that some people, especially those who have experienced early histories characterised by abuse and neglect, can have great difficulty in being able to access the soothing system. Not only may people have many experiences of being under great threat from others, but have had few experiences of being or feeling protected, safe and/or soothed by others. In consequence they are unable to self-sooth (Gilbert & Irons, 2005, Gilbert & Procter, 2006.)


Compassion focused therapy was developed to help people develop emotionfocused experiences of self-soothing, i.e., to tone up these positive affects so that they can be readily accessed, and help regulate threat based emotions of anger, fear, and disgust. These negative self-protective emotions also provide the distressing, emotional basis of shame and self-criticism (Gilbert 1989, 2000, 2005, 2007).

Key message: We need to feel congruent affect in order for our thoughts to be meaningful to us. Thus emotions ‘tag’ meaning onto experiences. In order for us to be reassured by a thought (say) ‘I am lovable’ this thought needs to link with the emotional experience of ‘being lovable’. If the positive affect system for such linkage is not activated there may be little feeling to the thought. People who have few memories/experiences of being lovable or soothed and safe may thus struggle to feel reassured and safe by alternative thoughts.

Compassion focused therapy therefore targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat based emotions of anger, fear, and disgust and shame. Two Types of Processing Systems Implicit

Explicit

Fast - Affect Evolved mechanisms Hard to verbalise Emotional memory /conditioning Specific signals (e.g., facial expressions and NVC) Involuntary

Slow Reflective Easy to verbalise Emerges with cognitive competencies Learn (social) rules Voluntary

These systems interact and can conflict – Use different brain systems – Therapy should work with both systems


The Threat System The

common task for all living things is survival. Over many millions of years all species have evolved ways of detecting and responding to threats. Humans, as evolved from other mammals, are born with a basic mammalian suite of defences that enable us to identify threat (physical, social and psychological) in our environment and respond appropriately.

We have a number of responses that can be activated quickly and automatically which are designed to protect us from threat. These systems interact with each other and include emotional, behavioural, cognitive and physiological responses. Some examples of defensive reactions are: Emotions (anger, anxiety, disgust) Behaviours (fight, flight, freeze, submit) Cognitive systems (as ‘better safe than sorry’) Physiological systems (role of the amygdala, FC, HPA system) Collectively these responses can be regarded as a menu of safety strategies.

The Amygdala: The Brain’s Alarm System The amygdalae are located in the limbic system and considered to be part of a fast-track, automatic and non-conscious processing system that does not rely on higher cortical functions. There is a right and a left amygdala. The amygdala detects/registers emotional stimuli, which can be both positive and negative. The primary emotions linked to the amygdala are fear, anger, sadness, disgust and joy. Consequently it stores emotional memories of both positive and negative experiences. There seems to be more loading on negative threatening stimuli than positive. The amygdala is highly sensitive to threat stimuli and thus has earned its name as the brain’s alarm system. Research conducted on non-human brains shows that if you stimulate one part of the amygdala you induce a flight response, if you stimulate another part a fight response is induced and if you stimulate a third part, a warm floaty feeling and excessively friendly behaviour is induced. The manifest behaviours of fight, flight and appeasement are well documented threat defence behaviours, observed in animals and humans alike.


Cerebral Cortex

Amygdala

Hippocampus Cerebellum Potentially threatening stimuli are picked up and identified by the amygdala: the left

amygdala is more responsive to vocal expression (the rasp of an angry voice, the contempt in a critical voice, a calm soothing voice) whereas the right amygdala is more responsive to facial expression (a look of scorn, a smile). Areas of the frontal cortex (FC) will then help regulate the ‘alarm response’ of the amygdala. The maturation and effectiveness of the FC to perform this function is related to early developmental experiences (Gerhardt, 2004; Schore, 1994; Siegel, 2001).

Distinguishing (Self-)Protection and Safety-Seeking from Safeness The focus of protection and safety-seeking strategies is on coping with threats by (for example) escaping or hiding, or avoiding the threat, acting aggressively to deter or subdue it, or acting submissively to deflect it. Thus defensive strategies include fight, flight, avoidance, immobilisation, submission and fleeing to a ‘safe base’. These behaviours can be triggered by specific stimuli or events and are designed for protection and damage limitation in threatening contexts. They can be automatic and easily conditioned (Rosen & Schulkin, 1998). When safety-seeking is activated threat is central to attention, thinking, feelings and behaviour.

Understanding the Complexity of Threat Processing The Compassionate Mind Foundation  2010 Page 13

Because our approach has three emotion regulation systems it's important to understand how each systems works. In particular it's important to understand how the threat self-protection system works. We must base this on a scientific understanding. So if anything that is written here turns out not to be validated in research then we must change it. Here are some key points: 1 Different processing systems We have different memory systems for processing threatening events. The amygdala is related to body memory, whereas the hippocampus relates to event and time memory. (Recall the example of a beer or cheesecake that makes you very ill and how sensory cues some days later can reactivate the feeling of nausea). Conditioning models are very helpful in understanding how people can react physiologically very quickly to threat cues. Explain this to your patients. 2 Threat emotions can set up conflicts We are all familiar with the fightflight system. But note that you can’t fight and take flight at the same time! In humans and animals problems can arise when both these emotions are generated with competing action tendencies. It can be helpful to explain this carefully to patients. Sometimes we will have one stream of feelings and thoughts to a threat but often there are multiple streams. Here is an example you can use: Imagine a boss with whom you get on reasonably well - strongly criticises your work. Note how you might feel: Anger (how unfair), anxiety (oh no I have made a mistake) or tearful (I tried so hard). Now you will try to control these because expressing them could make the situation worse. But you may also have reactions to your own reactions. You might be angry with yourself if you are anxious and submissive, or anxious if you were angry, or feel shame if you collapsed in tears. Because threat emotions often come in multiples some people can be overwhelmed and shut down. They may say ‘I do not know what I feel’ because they are too confused – too many competing/conflicting defences. The following diagram illustrates this further:


Multiple Processing and States Of Mind Threats Rapid access of safety strategies Angry-attack revenge

Anxious - flee submit

Cry want to seek reassurance

Threat to self -identity and self as social agent

Fragmented and fragmenting, confused and secondary safety strategies at management of inner conflicts

3. Draw out multiple conflict and confusing emotions (parts of self) Complex Feelings and Interactions We often have many feelings going on at the same time and these feelings can conflict with each other - then we judge ourselves too Meaningless Burden Anger Frustration

Anxiety

FEEL SHIT

Hopeless

Shame and Guilt Should not feel like this

SelfSelf-critical/hating (I am Shit)

Alone (no one understands)

Feel different than others Isolation Drugs SelfSelf-harm

4. Recognise the power of approach (reward) and avoidance (aversive) conflicts It was recognised well over a hundred years ago - even by Pavlov of ‘salivating dog fame’- that when animals are presented with signals indicating a reward and signals indicating punishment they can learn how to respond to each (Gray, 1979). But if they are presented both types of signal at the same time or the signal is ambivalent they show high arousal, fear and disorganised behaviour. Their capacity for thinking and solving problems seriously deteriorates. There are all kinds of science fiction The Compassionate Mind Foundation  2010 Page 15

stories where the computer blows up because it's given two incompatible directives. Humans too can become very aroused, disorganized and even dissociated in the face of strong approach avoidance conflicts. For example, Tom earned good money and felt he was supporting his family well. However, when a bullying boss arrived he became very stressed. The conflict of wanting to leave and wanting to stay (because of the good salary) created high arousal, rumination on what to do, confusion and depression. It is important to share with patients an understanding of how conflicts create disturbances in the threat system. Researchers studying children have also noted that a parent can be a source of both safeness and threat. This can set up strong conflicts and dilemmas in the child that can lead to disorganisation in their ability to process interpersonal information. Think about how for some people this can be re-experienced in the therapy. What you see from these ways of thinking is that we can’t over rely on cognitive explanations. We also find that this understanding helps patients make sense of why for example the stress of a conflict in one's life can disrupt thinking and create fatigue and confusion. 5. One protection strategy creates another. Individuals can find themselves caught between two different threats. For example Sam often felt he wanted to express his feelings to others especially when they hurt him. However, to do this activated the fear of rejection or counter-attack. So he stayed quiet, but would then ruminate on feeling ‘stepped on’ which in turn would reactivate his desire to express his feelings, which would reactivate his fears of rejection and so on. It is very useful to draw these loops and feedback systems for people. 6. Emotional Conditioning. Some people struggle to feel, tolerate and express emotions because of various beliefs they have about those emotions. It's also possible that some individuals have conditioned responses to their emotions. In the 1970’s behaviourists suggested that if a child expresses anger and the parent constantly punishes that, the child will respond with anxiety, upset and alarm to the punishment. After a time the child's feelings of anger will automatically activate feelings of anxiety and fear of punishment. If this is repeated the child may become unable to express his anger, even finding it difficult to acknowledge it, and does not develop a mature ability to work with the feelings of anger. In my experience explaining conditioning models to patients is very useful and often makes sense to them.


Reducing Threat via Attachment and Mutual Support The Sources of Safeness Safeness is a state of mind where threat is (relatively) absent from the attentional field and from affect. The processing of information is open and more integrative. Certain cues innately signal the presence of safe protective others linked to the attachment system, and stimulate feelings of safeness (Bowlby 1969, 1980). When we feel safe we process situations and events in different ways than when we feel threatened. Experiences of safeness tone up the FC’s ‘regulation of threat systems’ abilities. This has evolved because care from others is a major way to improve survival chances, defend and protect self, (and prosper). So infants and children rely on others to regulate threat arousal and distress. Key signals that do this include holding, stroking, voice tones, attending and interpersonal style (Field, 2000; Trevarthen & Aitken, 2001). Threat and safeness then are affected by: Accessibility of the other Disposition of the other Interpersonal style of the other

Availability of the other Competencies of the other How one exists in the mind of the other

Soothing parents provide the experience of soothing when confronted with feared or hurtful stimuli and model coping. A parent who tries to sooth a child but is also alarmed him/herself and is highly distressed may inadvertently send mixed messages to the child. The child may experience feelings of anxiety in this context. Consider the special problems for children, whose soothing systems are innately waiting for care signals, but obtain few such signals or even abusive ones.

Mutual Support In addition to the attachment system human survival has depended on other people’s support, help and co-operation and sense of belonging. So we have evolved to be attentive to how others feel towards us. When we think we exist as a ‘positive being’ in the mind of others we have a sense of safeness. These are also key qualities in the therapeutic relationships.


Creating Positive Feelings in the Minds of Others About the Self: The Attracting Self Humans differ from animals in many ways. Although animals are sensitive to many types of threat they do not have the capacity for the kind of self-awareness that creates a sense of self-identity. A range of cognitive abilities (evolved in the human mind) are thought to contribute towards a sense of self-identity. Our self-identity and our status and acceptance in the eyes of others are important in contributing to our capacity to engage in group belonging and in the formation of adult attachments. These help us feel safe. There are two key social strategies that we engage in to create and maintain our status/position in our social groups and in the eyes of others (i.e. interpersonal relationships) - those of aggression and of demonstrating attractiveness. The table below outlines the differences in behaviour and desired outcomes. Main Strategies for Gaining and Maintaining Status in Interpersonal Relationships (Gilbert & McGuire 1998) Strategy

Aggression

Attractiveness

Tactics used

Coercive Threatening Authoritarian

Showing talent Show competence Affiliative

Outcome desired

To be obeyed To be reckoned with To be submitted to

To be valued To be chosen To be freely given to

Purpose of strategy

To inhibit others To stimulate fear

To inspire, attract others To stimulate positive affect

Social acceptance, belonging, mutual support and feeling that ‘in the mind of others we are seen positively’ help us to feel safe. These outcomes have been linked to our survival for millions of years and we know they affect our physiological states. A first clue to shame is therefore that in the mind of others we are not attractive but unattractive in some way - we are at risk of put-down, exclusion or rejection - these are coded by the brain as major threats.


Different Sources of Threat Recall from Exercise 1 that we noted two sources of threat: External threats: these relate to threats that are located outside of the self. Thus the focus of attention is on the outside world; e.g., what others are thinking about the self – and how they may act as a consequence. Internal threats: these are located inside the self and relate to various experiences that emerge within the self. Thus the focus of attention is on the internal world and the implications of self with these aspects. Humans are highly vulnerable to internal threat because we have a type of selfawareness that gives rise to a sense of self and self-identity. We also have metacognitive systems – we can think about and give meaning to our thoughts and feelings (Wells, 2000). We can thus be threatened by things that are triggered in ourselves, such as pain or powerful emotions. Fantasies or memories can also be sources of internal threats. What makes an internal experience into a threat is related to a range of different processes such as feeling: Overwhelmed by emotions, memories and/or flashbacks Conflicts of emotions Beliefs about emotions and fantasies Internal threats are often linked to key beliefs about emotions and self-identity - thus we can feel ashamed of an internal feeling, fantasy or behaviour (Leahy, 2002). Internal threats can be accentuated by self-criticism and attacking, which are threat responses. Hence external and internal threats can feed off one another Coping with external and internal threats have many similarities such as avoidance or anger. However, dissociation, repression and denial can also be used to cope with internal threats. The Compassionate Mind Foundation  2010 Page 19


Key Shame Concepts

-

Shame is a self-conscious emotion it is an emotion about the self. It depends on certain types of mental abilities that include a form of self-awareness and theory of mind of ‘how we exist in the minds of others’ – and our ability to imagine a self, and a self as thought about by others. Shame recruits various negative and threat based emotions into the experience of self (e.g., anger, anxiety and disgust). It is not a separate emotion but a cognitiveemotion blend. The experience of shame is more than just a feeling. Shame involves: 1.

A social or external evaluative component: This relates to what we think is in the mind of others about ourselves, what we think others think about us. In shame, we believe that others see us as inferior, bad, inadequate and/or flawed; and because they think that - they ‘look down’ on us with a condemning or contemptuous view and feeling. As a consequence they may wish to avoid, reject, or hurt us (Gilbert, 1998a).

2.

An internal self-evaluative component: This relates to judgements of the self and feelings that one is inferior, inadequate or flawed. These judgements are typically experienced as a stream of self-attacking thoughts (e.g. I am useless, no good, a bad person, a failure). They are in essence shaming thoughts and negative self-evaluations (Gilbert, 1998a; Tangney and Fischer, 1995).

3. An

emotional component: Various emotions and feelings accompany the experience of shame. These include anxiety, anger and disgust and (self)-contempt. These emotions are part of our evolved brain systems for responding to threat with a defensive behaviour. For example, at times we have all felt excluded from a social group. In this example the exclusion can be seen as a social threat and our consequent anxiety or anger is our defensive response to this threat.

4. A

behavioural component: The experience of shame is typically associated with a strong urge to hide, avoid exposure, run away or (when anger is the emotion) retaliate against the one who is ‘exposing’ the self as inferior, weak or bad (Lewis 1992, 2003; Tangney and Fischer, 1995) e.g., ‘How dare you make me feel like this’.

5. A

physiological component: Shame is now known to be one of the most powerful activators of stress responses (e.g., heart rate, cortisol) in social interactions (Dickerson and Kemeny, 2004).

Key message: Shame is not a single emotion like anxiety but involves the selfawareness system and self-identity. Thus it involves complex dynamic processes between externally focused fears of ‘what others will think, feel and may do’ and internally focused fears of what will be activated in our own minds – e.g., overwhelming emotions or our own self-evaluations.


Types of Shame and Other Defensive, Self-Conscious Emotions Embarrassment: Is related to situations in which we make a social faux pas that is often humorous but is specific to that event and does not result in a global evaluation of the self. Examples of this may include knocking over your drink in a restaurant. External shame: relates to how we think we exist in the mind of the others and the feelings others have for us, which may include disgust, anger, disinterest or contempt. These subsequently results in feelings within us. Internal Shame: Relates to our own feelings and thoughts we have about various aspects of ourselves. Humiliation: Relates to external shame but where the other is blamed and anger and revenge are activated. Humiliation is often associated with thoughts such as ‘how dare you?’ as you feel others have pulled you down. Guilt: This is a different emotion that comes for the perceived harm (by acts of omission or commission) that we may cause others. This is associated with a focus on behaviour and efforts to repair. Shame is associated with defending the self from harm and as such is linked to the social rank systems. Guilt however is related to avoiding doing harm and is linked to the relationship building and caring systems. Guilt relates to sorrow, regret and remorse while shame relates to anxiety and anger.


The Foci of Shame Shame-based threats can be focused on different domains of our functioning. We can feel ashamed of: 1.

2.

3.

4.

Our bodies: This is common in some eating disorders, but also more typically can be associated with thoughts of being too fat, the wrong shape, getting old and disfigurements (Gilbert & Miles, 2002). We can also feel shame of bodily functions or diseases. Our feelings or fantasises: e.g. anger or sexual desires. Our traits or abilities: e.g. not being competent, lacking confidence. Our behaviours: e.g. making mistakes, saying something inappropriate, losing control, being submissive or running away and avoiding things out of fear. Our past: e.g. abuse, feeling damaged, ruined or scared. In regard to the therapeutic relationship, because shame can be so prominent in social interactions it can significantly interfere with therapeutic relationships, especially when people try to cover up what they feel ashamed about, or have been unable to process or work through painful shaming experiences. Note therefore the importance of safeness!

What Makes Shame so Aversive? 1. Shame is a normal emotion and some degree of it is helpful for everyday functioning (imagine a ‘shameless’ person). 2. However we have archetypal and innate fears of rejection and social exclusion

- a major survival risk - so our brains are highly sensitive to them. 3. Early experiences of being shamed often linked with powerful, hostile,

rejecting others. The context of being shamed was one of threat – thus shame experiences can be coded like trauma memories. 4.

Damage may be long-term within social contexts (e.g., to a reputation). 5. We have different safety strategies for coping with shame (e.g., concealment, compensation, avoidance). Safety strategies can inhibit learning helpful coping and acceptance.


Emotional Conditioning and Shame Memories Associations of threat

.

‘meanings ’ in shame -traumas

FROMOTHER

ARISING RISING IN SELF

Emotion and intent flowing fromthe other e.g. Aggression/contempt

Alone – no help/rescue Others are frightened or joining in(bullying)

Verbal labels defining the self stupid/bad

THREAT

Acute sense of self as ‘under attack ’ and defined

Intense sense of fear rage -contempt

-

Entrapment Sense of having done something wrong/terrible



Involve ‘scenes’ in the mind of being shamed and/or feeling ashamed being replayed (Kaufman, 1989).



Can operate like a conditioned, emotional memory such that when activate generates high arousal and fear that interferes with processing.



Different types of memory, e.g. semantic, episodic, somatic and emotional can give rise to different internal experiences.



Fragmented memories of various forms of abuse and/or other experiences of trauma can be experienced as shame fuelled flashbacks and intrusive thoughts/feelings. These are highly distressing experiences.

How we understand shame memories by drawing on our knowledge of theory from PTSD and memory processes Flashbacks are fragmented sensory memories. 

They can be experienced with the full force of the emotion experienced at the time of trauma.



They are thought to be generated by the amygdala, which is an emotional memory bank, but also a primitive memory structure. Thus it may have no access to temporal context or contemporary meaning.



When someone experiences a shame fuelled flashback, they can experience the memory ‘as if it were happening now’ and with the full impact of sensory, emotional meaning assigned at the time of the experience. The Compassionate Mind Foundation  2010 Page 24

Clinical example: An adult, who experiences a conditioned, emotional memory of a hostile critical parent in the form of a flashback, will relive the memory and feel as if it were happening again as the memory is being generated by the amygdala. Given this, the adult will feel fearful and others as powerful, hostile and overwhelming. Also always look for and discuss the ‘feelings of aloneness” because when the memory was laid down the child was alone – there as no rescue. The childhood feelings, compared to those of adults who can now defend themselves, may not be updated. Hence the emotional feelings experienced at the time of shaming are not updated. So implicit emotions/feelings can be of fear and aloneness. Furthermore, once shame memories are activated, then other shame memories are more likely to be activated leading to a ‘bombardment’ of painful memories in the mind.

Key Message: People who experience high levels of shame live in a mind that is condemning/critical, and live in a world where people are viewed as hostile/rejecting.

Example of working with externally-focused fears and internally-focused ones: Sally had just moved to a new area and had organised a dinner party for work colleagues and local neighbours. However she forgets a key ingredient and burnt the food. How I think others feel and view me What I feel and think about myself These new people will see that I'm I'm so annoyed with myself for forgetting such as disorganised. basic ingredient. They'll not be very impressed with my cooking abilities or my organisation.

What's the matter with me? Why can't I get my head in gear?

They'll feel let down at having to eat a takeaway.

The meal I cooked would have been so nice and impressed them.

I've probably blown it with them.

I’ve really let myself down again by being careless and not paying attention.

They'll now always see me as a bit scatty and not take me seriously. My key fear is: I'll not be able to make close friendships with people who respect me.

My key fear is: I'll not be able to make close friendships with people who respect me. I'll be marginalized and lonely.


A Shame Model This model outlines the flow of shame and how shame is related to both evolved needs for social relating and socio-cultural experiences. The core of this model is external shame – this is because our survival and prosperity has depended on the good will of others via creating positive feelings in the mind of others about the self - and if we lose that – then defensive actions are called for.

Innate motives for attachment and group belonging; needs to stimulate positive affect in the minds of others; Unfolding cognitive competencies for -self evaluations

Social-cultural contexts relating to economic opportunities, group conflicts, political structure, cultural rules for honour/pride/ shame PERSONAL EXPERIENCES OF SHAME - STIGMA Fam ily: Social group:

Internalised Sham e self-devaluation internal attribution depressed/anxious

Criticism , high expressed em otion, negative labelling, abuse Bullying, discrim ination, prejudice, stigma

External Shame Sham e devalued by other excluded avoided criticised

reflected stigm a (to fam ily or others) rejection by the com munity


Hum iliation Humiliation other-devaluation external attribution unjust- revenge/anger

Why is Self-Attacking so Important? A major aspect of internal shame relates to negative thoughts and feelings about, and directed at, the self. These negative feelings often emerge as forms of inner dialogue. This is called self-criticism or self-attacking. In essence one part of the self experiences anger or contempt and another part of the self responds to being the recipient of that anger (Whelton and Greenberg, 2005). To put this a different way internally generated signals can stimulate specific types of feeling. We can show this with a video and also with the diagram below. What this diagram shows is that internal images of (say) a meal or something sexual can stimulate our physiological systems in the same way as if it were a real meal or sexual opportunity. Similarly our self-attacking can stimulate systems that were originally designed to cope with being attacked. The same story pertains to self-compassion.

Stimulus-Response Sexual

Bully

Meal Meal

Sex

Kind, warm and caring

Bully

Limbic system

Compassion Soothed - Safe

Stomach acid Saliva

Sexual

Fearful Depressed


The Functional Analysis of Self-Attacking Self-criticism (SC) in childhood predicts a range of later psychological difficulties. Self-critics can have problems in forming, developing and maintaining close relationships (e.g., openness). SC is a marker for depression and may be linked to malevolent voice hearing. SCs are perfectionistic to avoid criticism for others – and thus rarely feel safe. However, it is so prevalent because many people acquire it early, they believe that they deserve their self-criticisms and that it has important functions for them (Driscoll, 1988). Let’s explore this: Some typical functions include:  A form of inner panic (or frustration) response to errors or losses  To stop us from doing things that could result in harm (part of a submissive

    

defence) To push us on to achieve To be rid of unwanted things in ourselves Habit To protect someone else Criticise ourselves before others do – seek atonement

Various major forms of self criticism Frustration and impulsive related Self-correcting, driving and improving Self-hating, self-contempt, commonly linked to the affect of disgust and to selfharming Self-critical focused shame can also have various ruminative qualities Self -Critical Mindis also Threat Mind Fu nctions un

Forms

Triggers Emotional Memories

-

-focu focused

Self Critical

Origins of shame an d self and

-criticism


Effects

Building a Therapeutic Relationship with Microskills Formulations are guided by the understanding of causal and maintenance processes and client narratives. The therapy process is a co-creation from which emerge unique and mutually agreed formulations with an intervention plan. The therapeutic relationship is key to the whole process. The use of the basic listening sequence, in the micro-skills hierarchy is essential to facilitate a gentleness and feeling of safeness so that shame is not so strongly activated as to produce shut down or drop out. This basic listening sequence (BLS) is a starting point or low gear in the therapeutic process, before moving towards ‘higher gears’ which can be experienced as more directive, challenging and threatening and can rupture the therapeutic alliance. If people appear to be backing off or closing down, then you can shift back to the BLS or openly explore the ruptures with your client (Ivey & Ivey, 2003). However, because psycho-education can be very de-shaming it should not necessarily be seen as challenging or to be used later in sessions (Gilbert & Leahy, 2007). Always explore with the person how this would be helpful for them. Safeness can be created through voice tone, non-verbal communication, attentive listening, asking for permission (would it be okay if we explore....) and validation feeling and difficulties (meta-microskills). These may act to soothe the amygdala (see Greenberg, 2007; in Gilbert & Leahy, 2007). Key to process are: Bonds, Task and Goals

Low (Challenging/ Changing) (BLS)

Microskills

Integrating with CFT

Process

Encouraging/restating Paraphrasing Summarising Reflection of feelings

To create safeness that starts an explorative and de-shaming process

Validating a person’s narrated experience with clear statements of feeling ‘in you’ e.g., “that sounds horrible for you” Deepening the shared understanding (empathy) and validating process. Feelings are understandable and not shame-worthy

Focusing Self-disclosure Feedback Moderate Open and Socratic (Swing Skills) questions

High (Challenging/ Changing)

Information/education Logical consequences Directive – training Confrontation/ boundaries

Clarifying and focusing the narratives. Connecting patterns in lived experiences Basic information on threat systems and safety self protection – the CFT model


Working out, and on the key task and practices for the therapy (e.g., Compassionate letter writing, imagery)

Threat-Focused Formulations Clinical formulations are a key element of therapeutic practice and are used by therapists to convey a mutual understanding of the client’s problems. The nature and focus of the formulations are informed by the theoretical underpinnings of the therapy. In threat-focused formulations we help people see that problems arise from key fears that generate both automatic and planned safety behaviours, and we seek to de-shame them. This requires a good history that will give rise to key themes in a person’s life including trauma and threats. There are four main domains for discussion: 1) Early background experiences (e.g., attachment and peers). 2) Key emotional memories with fears, threats and concerns. 3) Safety strategies that have developed to cope with external and internal threats. 4) Unintended consequences. Hence, during the history taking and formulation there are some questions that can be embedded in the general style and narrative of the therapy. The questions you may ask to elicit this information may take the following form: What kinds of threats do you think have affected you while growing up? Consider how these have coded the experience of self and of others and the relationship of self to other. Some people will be able to articulate key emotional memories – others may not, especially if there are problems of dissociation (see Liotti, 2007 in Gilbert & Leahy’s volume). What key fears have these left you with? Now here you want to get a handle on both external threats ‘what the world or others can do’ and internal threats or more specifically things arising in the self as well as coping behaviours. How have you tried to protect yourself - what kinds of safety strategies do you have for preventing these fears from occurring today? Give validation to these as understandable and best efforts to stay safe. This is very important and is not phrased as dysfunctional. Although these safety strategies can be more than understandable they may have unforeseen and undesired consequences. What do you think these may be? How do you think and feel about yourself when you engage in your safety strategies – and if the unintended and undesired consequences occur?


Threat/Safety Strategy Formulation for Shame and Self-criticism Historical influences

Key Fears

Safety/defensive behaviour

Unintended Consequences

Critical mother Distant father School bully

External: Rejection/shame Sensitive to people’s voice tones, facial expressions, moods

External Non-assertive/appeasing Try to please others/standards Focus on ‘mind of the other’

External: needs ignored Put upon and angry Not achieve person goals

Many emotion shame memories…, (Self as….. Other as…..) Small Powerful Vulnerable Hurtful

Internal: Feeling alone desperate, vulnerable

Internal Suppress own feelings and needs

Internal Lose sense of self Threatened/fragile self angry resentful Self-attacking I am weak and unlovable so revert to safety behaviours

Pointers Try to keep it relatively simple to start with - Just the four of five headings Focus on sharing and understanding together and encourage client to do his or her own or add to it Avoid language of cognitive distortion or maladaptive schema as this can be shaming for high shame clients Focus on “your defence system has tried to keep you safe; better safe than sorry etc” natural, but with unintentional drawbacks – e.g., little new learning, few opportunities for exploration.

The Compassionate Mind Foundation  Page 31

Compassion Focused Therapy and Compassionate Mind Training Process and stages of CFT and CMT Build the compassion focused Therapeutic Relationship and share the ‘story’ using Socratic dialogues and reflections. Then a short explanation of model

Shared formulation Validation of fears, painful experiences, threat sensitivities Make sense of safety behaviours/strategies and core beliefs Identify critic or inner bully as safety strategy (i.e. functions) Explain the three circles model and how thoughts, memories and images affect the brain

It’s not your fault focus We are evolved beings with built-in self-protection and resource systems Working with anger, and submissiveness to shame Distinguish taking responsibility from condemning and blaming Recognise that safety behaviours may not be dismantled until alternatives are in place

Development of compassion for self Discuss compassion as a focus and ‘direction of travel’ Note the foci of compassion: Compassion for others to self; from self to others and from self-to-self. Through the therapeutic relationship Mindfulness with re-focusing of attention, behaviour, thoughts and feelings Use letter writing and imagery (of self and others) Orientating to compassionate self-identity

Visualise, practice, and rehearse compassionate focus on self, goals and future. Must find a practice for each day


Responsibility vs Blame It is important to clarify this distinction, especially the key differences between shame and guilt, but all can be present to same event.

Guilt Care mentality

Shame Rank mentality

Attention is on hurt caused the other

Attention is on damage to self and reputation

Feelings are ones of sorrow sadness and remorse

Feelings are of anxiety paralysis confusion emptiness -selfdirected anger

Thoughts focused on the other, sympathy and empathy. Focus on behaviour

Thoughts focused on negative judgments of the ‘whole self’

Behaviours focused on genuine apologies, reparation, making amends.

Behaviours focused on submissive appeasement, escape, apologetic denial, avoidant displacement, self harm.

Humiliation Rank mentality Attention is the threat or damage done by the other Feelings are all anger in justice vengeance Thoughts focused on unfairness, negative judgments of the other Behaviours focused on justification, vengeance

Distinguishing Self-Correction from Shame Based Self-Attacking Compassionate Self-Correction is Focused on: * * * *

The desire to improve Growth and enhancement Forward-looking Given with encouragement, support and kindness

* Building on positives (e.g. seeing what one did well and then considering learning points) * Focuses on attributes and specific qualities of self * Focus and hope for success * Increases the chances of engagement

Shame Based Self-Attacking is Focused on * The desire to condemn and punish * Punishing past errors and is often backward looking * Given with anger, frustration contempt, disappointment * Focuses on deficits and fear of exposure * Focuses on self as a global sense of self * Focus on high fear of failure * Increases chances of avoidance and withdrawal For transgression • Shame, avoidance, fear • Heart sink, lowered mood • Aggression

For transgression • Guilt, engage • Sorrow, remorse • Reparation Use the example of encouraging supportive teacher with child who is struggling.

Use example of critical teacher with a child who is struggling.


Compassion Circles Compassion can be defined in many ways: “As a sensitivity to the suffering of self and others with a deep commitment to try to relieve it” Dalai Lama Eight fold path - represents a multi-modal approach for training one’s mind Compassionate Mind Training: The key attributes of compassion (inner ring) and the skills to develop them (outer ring) M ulti-M odal C om passionate M ind Training SKILLS-TRAINING Imag ery

W arm th

ATTRIBUTES

A ttention

Sym pathy

Sens itiv ity Care for well-being

F eelin g

C om passion

Reason in g

D is tress tole rance

E m path y

Non-Judgem en t

Kindness

B ehaviour

Sen sory

Kindness

W arm th

Multi-Modal Compassionate Mind Training Enhancing SKILLS-TRAINING

Warmth

ATTRIBUTES

Attention Needs Open to care receiving

Feeling

Playfulness

Imagery

Appreciation

Compassion

Happiness tolerance

Empathy

Strengths

Reasoning

Behaviour

Sensory

Playfulness

Warmth The Compassionate Mind Foundation  2010 Page 34

Compassion Skills CMT will then try to recruit attention, memory, meta-cognitive reasoning, behaviour and emotion systems. CMT tries to integrate these different elements and focus them all on the development of compassion. Compassionate attention involves the way in which we focus our minds; what we choose to attend to. The exact focus of attention will be worked out with the client but it may involve a focus on a compassionate image, an object, a smell, a smiling face of someone who was caring, a compassionate memory. Compassionate attention focuses on the sensory modalities. We will often use a short mindfulness exercise to help people think about the nature and importance of forms of attention (see exercise). Compassionate thinking/reasoning is related to the process of reasoning. The kinds of thoughts that crop up in automatic reactions can be a target for it but most of the work done in therapy is post the immediate reaction. A lot of the reasoning is what is called metacognitive. Thus compassionate thinking will focus on many cognitive therapy elements such as bringing balance to thinking, de-personalising and de-shaming, developing multi-causal ideas of responsibility, seeing each event as unique rather than overgeneralising, and common humanity thinking (to tackle negative social comparisons). When compassionate thinking is fused with compassionate feeling we move towards the position of wisdom. Wisdom emerges as we develop deep insight into the nature of things. Compassionate behaviour focuses on what people feel would be the most helpful, nurturing, supportive or encouraging thing to do. As noted by behavioural and Buddhist approaches ‘actions’ are important. There needs to be clarity on the distinction between compassionate behaviour and submissiveness. Compassionate behaviour is also more than being ‘nice to oneself’ - it must focus on the quality for growth, development and flourishing. Compassionate behaviour can focus on immediate behaviours or on longer-term goals. Compassion behaviour is often about developing courage. Compassionate emotion and feeling focuses on trying to generate a certain emotional tone in the whole process of change and growth. The emotions that we are interested in are therefore warmth, kindness, gentleness and soothing. Hence when we create thoughts in our mind we try to deliberately make them warm, gentle and soft in tone. This of course does not in any way preclude more excitement emotions and feelings of joy when we succeed or our children succeed at certain things. Joy is a part of compassion too, although probably has more activation in it. The key of the compassionate emotions is that they are focused on well-being and flourishing. Cultivating The Compassionate Mind Foundation  2010 Page 35

these qualities of mind develops the emotion system which is important for self-soothing and contentment.


Compassion Attributes (Inner Circle) This approach suggests the importance of a number of psychological processes that underpin compassion: Care for Well-being: This involves a motivation to be caring of other’s distress and also to promote their well-being. It captures the Buddhist notion of motivated concern. Distress and Need Sensitivity: This involves a capacity to be sensitive to the nature and complexity of distress. To be able to read emotion cues and have an awareness of distress. It also involves the emotional ability to be sensitive to other people’s needs and requirements that will help them prosper. Sympathy: Sympathy is the ability to be emotionally moved by both the distress and the joys of other people. It is a key component of compassion. For example, some people with psychopathic difficulties can be empathic and even distress sensitive, but emotionally cold to these sensitivities. Distress Tolerance: It is possible for people to be emotionally sensitive and sympathetic but to be overwhelmed by distress and thus avoidant. For example, therapists may struggle to withhold rescuing behaviours, or act out their own counter-transferences. Empathy: Empathy involves different qualities such as emotional resonance (feeling the same as others or being in tune with others). It also involves more cognitive awareness about the reasons for others peoples’ behaviour, intentions and motivations. This is called theory of mind, and empathy is related to ‘understanding the reasons for…’ It is the opposite of projection. Non-Judgment: Non-judgment is the ability to engage with the complexities of people’s emotions and lives without judging/condemning them. Sometimes this is more difficult than it appears. Focusing on the processes of empathy can help non-judgment. Non-judgment does not mean nonpreference – i.e., the Dalai Lama would like to bring compassion to the world. Warmth: This is an emotional quality of gentleness and kindness that operates through all of the above.


Compassionate Mind We can see that compassion is not a schema but rather a way various components of our minds are organised. This is why we call it compassionate mind. If you are (say) relating to those who you see as harmful to you or as enemies these various components of our mind are likely to be turned off, and instead your mind has patterns, motives, feelings and ways of thinking that are about subduing others rather than helping them. To develop compassion and self-compassion is to try to activate various components of compassion such that these organise and pattern our minds in certain ways. Key points with Compassionate Mind Interventions Compassionate attributes and compassionate skills are used to counteract the feelings, styles of thinking and behavior that arise in depression

Compassionate Attributes

Compassionate Skills

1. Developing a motivation to be more

1. Learning to deliberately focus our

caring of self and others

attention on things that are helpful and bring

2. Developing sensitivity to our feelings

a balanced perspective. Developing mindful

and needs of self and others

attention and using our attention to bring to

3. Developing sympathy, being moved and mind helpful compassionate images and/or a emotionally in tune with our feelings,

sense of self.

distress and needs

2. Learning to think and reason, use our

4. Developing abilities to tolerate rather

rational mind, looking at the evidence and

than avoid difficult feelings, memories or

bring a balanced perspective. Writing down

situations

and reflecting on our styles of thinking and

5. Developing our understanding of how

reasoning

our mind works, why we feel what we

3. Learning to plan and engage in behavior

feel; how our thoughts are as they are

that acts to relieve distress, against the

6. Developing an accepting, non-

depression and moves us (and others)

condemning, and non-submissive

forward to our (or their) life goals – to

orientation to ourselves and others

flourish. Developing courage


Using Compassion to Change our Minds In helping people work with distressing thoughts, feelings and behaviours, Compassionate Focused Therapy (CFT) follows a fairly standard CBT format in some ways. For example one might help clients to identify triggering events and explore current thoughts, behaviours and feelings associated with them. However, compassionate mind work also varies in a number of ways. 1. CFT suggests that automatic thoughts are related to automatic reactions, especially in contexts of threat. For thoughts associated with negative moods CFT distinguishes between external and internal threats. External threats are what the world/or people in it will do to the self. Internal threats are related to thoughts and feelings that arise within the self. People can of course then worry that they will be criticised or shamed for those internal reactions. Sometimes it is useful to have a simple flash card with a few key ideas written on it. 2. Not only can people feel frightened by the emergence of powerful feelings, but they can experience their own self-evaluations in a frightening way. Thus in CFT we focus on the emotions that can be generated within a self-critical or self-attacking sequence. The consequences of feeling attacked by one’s own negative thoughts may be to feel beaten down. However, CFT spends time exploring the emotions of the self- attack, e.g., frustration, anger, or aggressive or submissive contempt. We explore the function of the selfattacking, possible origins, and why one might submit/agree with it. The client can be asked to imagine the self-attacking part as if it were a person, “What would it look like; does it remind you of any one?” “What emotions would it be directing at you?” “What is its key aim and why?” This can help people recognise the power of their self-critical side. 3. CFT helps people recognise self-attacking as a component of their threat systems. Commonly when people become threatened about making mistakes or shame, there is a kind of inner panic and frustration, which becomes woven into a self-attacking focus. Sometimes, however, the selfcriticism is a memory of being attacked and one can identify the critical ‘voice’ as the voice of a parent or authority figure. When the client plays this in their mind they may adopt the same submissive postures they did as a child. Either way, threat fuels the self-attacking system. One can work on that by revisiting the authority, credentials or legitimacy of the critic. This helps people to see that they often maintain this bullying out of fear of change rather than logic. 4. CFT uses a lot of psycho-education to share with people the nature of threat processing and the power of self-attacking. We also link compassion The Compassionate Mind Foundation  2010 Page 39

to the process of developing self-soothing. Thus we often draw out the three circles and demonstrate how they work. We then are able to build a therapeutic alliance and agree to goals to try to become more selfcompassionate. We note, acknowledge and work with the threats-fears of becoming self-compassionate. Self-compassion can become a source for a new self-identity.

The New Emotional Experience 1. Mindfulness approaches work by helping people become better observers, attentive to the flow of their thoughts rather than being rushed along with them. The mind (or the field of consciousness) is empty but thoughts and feelings emerge within in it. Mindfulness helps us attend to the emergence of thoughts and feelings but be more in the process of consciousness rather than the contents. The idea is to change the relationship with thoughts, rather than the thoughts themselves. CFT utilises this approach but suggests that some people will find it easier, at least in the early stages, if they can also deliberately re-focus their attention in a compassionate way to be with themselves. 2. Some cognitive based approaches are focused on trying to generate alternative evidence to counteract negative thoughts. CFT may do this but notes that evidence will not necessarily be sufficient to help people change. Rather we need to enable processing from a different emotional source and create a new emotional experience in thinking that counteracts the emotional experience of the frustration, anger or contempt of the shame and/or selfcriticism. Rational and evidence based re-evaluations are useful in so far as they help to do this. 3. Common to other therapies now, the first movement into change is developing empathy for one’s own distress. This is directing the client’s attention to why this distress is understandable (though obviously undesirable). It is also about validation. This does require understanding rather than just acceptance. Many people can have a sense of shame and feeling that they are not coping because of their distress. Empathy for one’s distress can take a lot of work therapeutically but is key for the person to begin to work with their distress rather than avoid it. Explore how the person thinks and feels when they do this. Empathic understanding can also be extended to self-criticism because we can see it as threat based.


Some General principles and Interventions * Constantly return to the three circle model and the point of the exercise as ‘physiotherapy for the mind’. Collaborate and encourage clients to engage with ‘behavioural experiments’ and to try improve on the exercises, in their own their unique and personal way. * Stress that the therapy is about balancing systems, toning down those that are over enthusiastic/developed and toning up those that have not had a chance to be worked and developed. Bypass, as best you can, moral discussions and keep it very much on the physiotherapy for the mind focus. Note as with all exercises training/practice is important. Explain that, if we wanted to learn to ride a bicycle or play the piano we wouldn't expect to do it that well straight away. We can then learn to notice the changes step-by-step; we will also notice that sometimes we find it easier to do these exercises than others and this is all typical. * All exercises should be done mindfully where the therapist has explained and practiced the issue of wandering mind and the ‘gentle return and focus’. Often it is helpful for people to smile when they notice their mind has wandered off task. It can be useful to teach soothing rhythm breathing as a preparation for imagery work, but note, some people will find that difficult and sensory focusing may be easier for them. * Developing the skills of compassionate attention, compassionate thinking, compassionate behaviour and compassionate imagery. May use standard CBT thought forms. Each intervention needs to be conducted in the spirit and motivation of kindness and warmth, encouragement and support. Client must feel this within the practice of the intervention. When helping people develop alternative thoughts, focus first on the empathy for the distress, refocus attention, use a common humanity reflection, teach accepting limitations, distinguish self-correction from self-criticism, encourage opening out and seeking help, recall past coping efforts, access helpful memories. * Specific compassion-focused imagery involves the concept of a sentient mind, usually that has experienced similar things to the client but has moved on and is now wiser or enlightened (e.g. the Buddha was once unenlightened). Key qualities of this mind are: wisdom, strength, warmth, and non-judgement. Focused imagery can be animal, human (compassionate self, a compassionate friend, perfect nurturer, compassionate community) and occasionally nonliving (e.g. the sky, the sea and mountains). Explore various sensory modalities that work. For some it will be vision, for others hearing, for others just a bodily experience of warmth or affection. * Feeling compassion in the body and becoming the compassionate person: This uses a ‘method acting’ approach where individuals are encouraged to imagine themselves becoming a compassionate person focusing on having all the ideals and skills of compassion. This is usually done by their standing up and encouraging people to walk in a compassionate way, to hold the body in a compassionate way, to focus on the facial muscles and expressions of compassion, to feel a slight smile, to focus on the tone of one’s voice when in kindness mode, to focus on the nature of wisdom, and so forth. Ideally people can practice this whilst walking in the morning, or engaging in activities such as shaving or doing the washing-up or standing at a bus stop. They can also do it as a meditation of course. In Buddhist practice you can sometimes add-on sending compassionate thoughts to people close to you, friends, acquaintances, strangers, and then people you are not so keen on. Again the focus is on directing attention to compassion The Compassionate Mind Foundation  2010 Page 41

themes as this has an impact on our own feelings. Keep in mind all the time that clients can easily slip into shoulds, or become self evaluative if they struggle and this is not helpful. * Contrast body states: To help people recognise the difference between compassionate body states and other body states one can use contrast states. Here one asks the person to remember and put themselves into the postures and feeling states of anger or anxiety. We then direct attention to the facial expressions, the tone of the voice if it were spoken, the body posture, the flow of thoughts and attention and the basic emotion. If people are enacting anger they can usually notice a tightening of the muscles, a harshness in the voice a hostile/blaming stream of thinking. One can then switch them back to the compassion stance, with the relaxed musculature facial expressions, a slight smile and so forth and reflect on the differences. * Appreciation exercises: Behavioural psychotherapy has long focused on the importance of increasing positive rewarding behaviours, especially for depressed people who have disengaged from various activities. There is also increasing interest within positive psychology to help people build on their strengths and also to engage in gratitude and appreciation exercises. The key here is again the motive and spirit of the exercise. If clients are likely to do this exercise with thoughts of “I should appreciate things more; I am quite lucky really and therefore have no right to be depressed or anxious” this is completely the wrong tone and motivation and is therefore not helpful. If, on the other hand, the person recognises that appreciation exercises are about attention training and stimulating positive emotions systems, (again a kind of physiotherapy for the mind) then this exercise can be very helpful. Here the client is asked to keep a note of things they have liked and enjoyed and appreciated during the day. This can be quite small things such as the first cup of tea, taking a shower, the smell of a spring day. We invite people to spend time when they notice something that they “quite like”. Sometimes you can have sensory focused days. On Mondays we will focus on the things we like to see. This may be types of sky, colours of trees, and even going to a supermarket and noticing the colours on labels and thinking about the colours one likes. It's all about attention to the details of one's life. Then we can have a hearing day where we focus on things we like to listen to this might be the birds or music and engage with these activities. Another form of appreciation exercises is to focus on the things one likes in a relationship or in oneself. Many patients will say that type of letter will be a short letter and so the therapist will be able to help them refocus their attention on things they can appreciate within themselves and the importance of doing this. We stress here that shame, depression and so on tend to skew our focus towards threat. Quite understandably therefore we have to train the mind to become more balanced so we get some nourishment into the positive affect systems that the threat system is starving. The dominance of the threat system is not letting information get through to the positive affect systems.


Understanding Soothing Soothing is a complex and multi-component process involving complex interactions between soothing systems and threat systems. Hence feeling safe, reassured and soothed can arise, not just via the absence of threat cues that suggest a threat is absent or moving away, but from more specific cues that activate the soothing system. The focus is thus on cues that help us feel safe and that threats are manageable. Intimate soothing cues relate to affection cues such as physical touch, cuddling and hand holding, with evidence that these can affect the opiate systems. More general soothing cues of safeness relate to non-verbal communication (facial expressions, voice tones and postures), reflective attentiveness and empathy. As children grow they increasing feel soothed by others via what they think in is the minds of others. Here are some key aspects: Social referencing. A child may be anxious about approaching a potential threatening or novel stimulus and looks to the parent to see how they are feeling about the stimulus. The parent displays interest and approaches the stimulus, or may interact with the stimulus in a positive, low fear way. They may encourage the child to explore the stimulus. Thus reassurance here arises from a form of social referencing and modelling. A more complex example is when a person is able to socially reference their own feelings and discovers that others either have the same types of feelings as they do and are not alarmed by them. Living in the mind of others. Our abilities to feel safe in the social world often come from experiences of how we feel or think others feel and think about us. When we interact with others, so that they show pleasure in our presentations and liking, then we can feel safe. In fact people spend much of their time thinking about other people’s feelings towards them, have special cognitive systems for thinking about what others are thinking (called theory of mind) and many of our goals are orientated to try to earn other people’s approval and respect, and be accepted in groups. If you think about how you would like your lovers, close friends, counselling peers, clients and bosses to see you – it will mainly be to value you and see you as desirable, helpful, talented and able. If you can create these feelings in the mind of others then three things happen. First, the world is safe and you can know others will not attack or reject you because they value you. Second, you will be able to co-create meaningful roles for mutual support, sexual relationships and sharing. Third, receiving signals of others as valuing and caring of you has direct effects on your physiology and soothing system. Many clients can be frightened of how they live in the mind of others and that others may view them as odd, weak, inadequate or bad. Working with these internal representations of ‘how one exists in your mind’ can be experienced as soothing. Being heard and understood. People can feel threatened and become defensive when they think that others do not understand them and/or have little interest in ‘hearing them’ or taking their point of view into serious account. We can feel soothed when we feel the opposite – that others sees our views as something to be articulated and are valid and important – not to be overridden or dismissed. This need can take precedence over more physical acts of soothing. For example a client became upset and tearful. To this her husband would often try to sooth her by putting his arm The Compassionate Mind Foundation  2010 Page 43

around her. He felt hurt when she tried to push him away. Her account was that she felt he was saying ‘there, there’ and trying to quieten her feelings rather than actively listening to her concerns and giving her a chance to express herself and be understood. For her, to have someone really listen, and be with her in her distress, and tolerate that distress was soothing. Being listened to can also aid our own understanding and working through (hence mircroskills). Empathic validation. This involves the experience that another mind/person understands our mind – our feelings, thoughts and points of view - and validates them. Thus a therapist might say “losing your husband like that must have been a horrible experience for you; your feelings make a lot of sense because………” Empathic validation means that a) we have understanding of the other person’s point of view and connect to it because we can connect to our own basic human psychology – the other is not an unfathomable alien and; b) validation means that we validate their lived experience as genuine, and makes sense as part of the human condition. Thus empathic validation is more than reflection (e.g., ‘you feel sad or angry about this’), but acknowledges this as an understandable and valid experience. Once again however empathic validation begins via our experience of how we exist in the mind of others. Invalidation can be “this is neurotic, you are exaggerating; you have no need to feel like this; you are being irrational etc.” Many conflicts can arise when people feel others are invalidating them through lack of interest efforts to understand or care, or are pathologising them. Many people have a complex of feelings that may be difficult to understand and of which they may be fearful (Leahy, 2002). They may cope with these via avoidance, denial, dissociation or replacing one feeling with another. Socially referencing, being listened to and empathic validation are important experiences of ‘what is going on in the mind of the other’ that helps a person come to terms with, and understand, their own feelings. Client and therapist work together on the ‘basic feeling issues’ and help the person be aware of and address emotional memories, unmet needs or key fears that might make feelings frightening (see Gilbert and Leahy, 2007). Reasoning. CBT puts a lot of emphasis on reasoning. When we feel threatened the attention narrows down onto the threat and we shift to ‘better safe than sorry’ thinking. We can feel soothed when we are able to stand back and examine our thoughts in detail and come to a different perspective. As children we can learn how to reason by observing others, (e.g. parents and teachers), adopting their explanations, values and styles of reasoning to be in line with their values, and via direct instructions on how to think about this or that. In many ways CBT therapists are helping people with these processes of thinking and reasoning in the face of strong emotions or fears. Thus the degree of change may be how far the therapist can persuade or encourage a person to look more deeply at their reasoning and experiment with alternative views and behaviours. Processes that help us de-escalate threats or cope in new ways can affect soothing and reassurance. So reasoning is obviously very helpful and important to how safe or threatened in the world we feel. Keep in mind though that people need to be able to feel reassured by their alternative thoughts and that there are various reasons why these feelings may be problematic. Desensitisation. Key to many behavioural approaches are those linked to forms of exposure and desensitisation. In some cases coming to feel safe requires that we are The Compassionate Mind Foundation  2010 Page 44

able to experience both internal and external fears in new ways. Thus in CFT the ability to ‘stay with’ and learn to tolerate frightening feelings or situations can be key to soothing. However, just as the child may use a parent to navigate these domains so may a client need to feel ‘held and contained’ by the therapist during the process. An inability to trust others may be a key reason why people become resistant to engaging in these processes – because they feel they have no safe base. In fact a key ingredient of successful behaviour therapy may be the way the therapist is able to encourage, hold and contain the anxieties of their clients as they engage in various exposures. Overview: There are many other processes that can help to settle the threat systems and engage soothing (e.g. mindfulness). Here however we note that therapeutic soothing arises from a range of different types of interaction related to the enacting of the compassion circle (e.g., the therapist expresses sensitivity, sympathy, distress tolerance, empathy and non-judgement). In addition the therapist acts as a social reference point, encourager, teacher and coach. The full and active presence of the therapist is key rather than a detached, technical or over controlled therapeutic persona. CFT is thus not to be confused with just being ‘nice’ to people or ‘love’. CFT builds on many other therapeutic approaches and traditions that include Rogerian, a variety of cognitive behavioural approaches and emotion focused approaches. However, the underlying theory of CFT is rooted in understanding our evolved social needs (e.g., attachment and social affiliation), our social competencies (e.g., theory of mind), and the neuroscience of information prepossessing (types of affect systems).

Facilitating Flourishing The main focus of CFT is a balancing of the three affect systems not just stimulating the soothing system. Sometimes it is important to work on the drive system as well. Compassionate behaviour can actually involve providing people with things that are important for their flourishing in life. For example, at Christmas time providing a child with a long-wanted bicycle so that he or she can be like his or her friends could be an act of compassion. If we have a self deprivation psychology then learning how to enjoy and provide for ourselves can be important. Learning to take joy from our and other people’s achievements is also important for balancing our emotions. Indeed, in Buddhism the nurturing of joyfulness is very important. However, as in other therapies, there is a distinction between taking joy in having and the more “feeling need and must have”. Therefore therapist and patient need to think through whether pursuing achievements or possessions can be experienced compassionately and joyfully. Again, we come back to the balancing of the different systems. See the work of Martin Seligman and others (www.authentichappiness.sas.upenn.edu)


A Clinical Example We offer a rather complex thought form that you would simplify for certain people. The one here emerged from many hours of work and as an overview. You will need to use your clinical sensitivity and judgement here. The idea is to give you a certain flavour of the whole process put together. You will note that we include images and functions of self-criticisms and the images and functions of self-compassion. The Story of Jack Jack was a high executive and then became very depressed and had to go off work. He’d become overloaded with too much work, started to miss things and one day forgot an important meeting. So, his key worry became ‘not getting work finished’. As this built up he had more and more self-critical thoughts and feelings. We did a lot of normalising of the way in which stress does effect concentration and abilities, and the need for recuperation and time out. However, that recuperation will be compromised if he ruminates in a self-critical way. Our competitive society may be producing more and more people who suffer like this. He came from a ‘high flyer’ family who were also relatively emotionally distant and he had been at boarding school from a young age. You will also notice under compassionate thinking entry that part of him is also quite angry at having been put under this level of strain, which at one level is very unfair. Recognising and acknowledging the power of anger and the fear of anger/rage is important in CFT. He is rather inhibited and invalidates this anger, however, because he feels others have coped better with the stresses at work (negative social comparison), although in reality they were less conscientious and less in need of proving themselves.ms


hts and generating compassionfocused alternative thoughts and ideas Triggering Events, Feelings or Images Key questions to help you identify your thoughts. What actually happened? What was the trigger Not getting work finished

Depressing, Upsetting Thoughts

Feelings

Compassion-Focused Alternatives to Self-Critical Thoughts

What went through your mind? What are you thinking about others, and their thoughts about you? What are you thinking about yourself, and your future?

What are your main feelings and emotions?

What would you say to a friend? What compassionate alternatives might there be? What is the evidence for new view? (How) are these examples of compassion, care and support? Can you think these through with warmth?

External shame (what I think others think about me) People will think I am losing it. Disappointed in me – see me as no longer up to it –sad but dead wood. Overstretched myself

World feels very unsafe

Key Feared Consequences Disconnect -- they will look for, prefer someone else, Wish I was not on the team

Anxious and hurried and angry

Internal shame (what I think about me) Lost the plot Took on too much – Typical always trying to impress people Big ambition, small brain Key feared Consequences Failure, end up alone Image and emotion: Male, father’s age gloating “too cocky for your own boots” Contempt, pleased to see me fail. Memories of boarding school

Stress with physical changes, ruminating and sleep problems

Fatigue Loss of motivation, concentrati on

Empathy for own distress: Understandable, because I felt safe if I could do things well and others valued me. However I felt isolated as a child at boarding school, envious attacks from class bully, teacher and to some degree, father if I did well or showed high ambition. My thoughts are echoes of these fears and early experiences. Breathing and just allowing them to be there. Compassionate to the fears I have as in part coming from my past. Compassionate Attention: Although understandable to focus on threat, can also attend to work I have done and people’s reactions. Specific memory is – I developed a new procedure and can remember boss’s face of pleasure. Wife and children have shown genuine concern for me. Some work colleagues have shown concern. Compassionate Thinking: Has been a lot of work recently and many of us have felt stressed. Not my fault as have been trying my best hence problems related to overload not ‘big ambition, small brain’. Probably true I haven’t been looking after myself in terms of time out and sharing problems with others, which I can work on. Anger is part of the stress and also others feel like this. Compassionate Behaviour: Consider who to share problems with, be honest about my limitations and abilities. Develop more pleasurable activities. Talk more. Practice compassionate imagery and using a compassionate focus. Image and emotion: Kind, elderly man, who has seen it all


Understanding and change in feelings Write down any change in your feelings

Feel calmer and able to refocus my feelings towards being warm with self. In my heart I know I can get through this if I can accept and work with my fatigue and anger.

Function: Stop me trying to getting ahead.

before. Laid back. Concerned for me and values me. Function: To help me cope with difficult situations and the return of my fears. Helps me feel supported, keep it in perspective.


Mindfulness and Compassion Imagery and Focusing Mindfulness is derived for Buddhist practice to train our minds - that are seen as chaotic, unruly and driven by passions and fears. At its heart is ‘paying attention in a non-judgmental way in the present moment’. Consider the exercise in mindful breathing in the appendix. Many of the compassion imagery exercises we will explore are conducted in a mindful way – this requires your clients to have understanding of mindfulness. Thus when we engage in compassionate imagery we will anticipate that our minds will wander and that it will be difficult to remain focused. That is normal. Here the guidance is to simply ‘notice and return’. If one notices oneself becoming distracted and frustrated, ‘notice that arising within the self and return the attention to the task.’ This helps to be task focused rather than results focused with people worrying about not doing it right or not getting clear images. There is no right and wrong, only attention focusing. When doing mindful exercises we note the ‘fleeting nature’ of some of them. For example, when we do compassionate imagery it is important to indicate that these images are not like clear pictures in the mind, even though we may focus on elements of the image. They are much more like daydreams, fragments; ‘senses of’ or fleeting glimpses. Thus people can have a ‘sense of’ their compassionate image without necessarily having any visual clarity to it. Also, different individuals will have a preference for different sensory modalities. Images can change; there can be more than one image that functions as a compassionate image. The key thing is the mindful attention to the process rather than the result. We can explain that this is a bit like sleeping where we try to create the conditions that will help sleep but if we focus too much on whether we are ‘asleep or going to sleep’ this makes sleep more difficult (see Singer, 2005 for interesting discussions on the processes and uses of imagery in therapy)


Types of Compassionate Imagery Imagery has been used for thousands for years to stimulate different states of mind (Leighton, 2003). It is a potent way to stimulate physiological systems (e.g. think about sexual imagery and fantasies). Note that such imagery is relational. Compassionate mind imagery seeks to generate a relational image that can stimulate the soothing system.

Guided Memory Recall feelings when someone was kind to you Recall feelings of you being kind to others

Guided Fantasy The ideal compassionate self The ideal compassionate other (unique v given, human v non-human) Loving kindness meditations often involve the person imaging themselves looking back on themselves with loving kindness. High shame individuals however struggle to do this, so we have developed another way of developing a compassion focus called Compassionate Letter Writing. This is like a focused task for stimulating one’s own inner abilities for compassion and directing them at the self.

Imagining self in a role Let us use something that actors have used for hundred of years – assuming a role and tying to put oneself in states of mind by doing so. If we want to feel sexy we imagine ourselves in sexy roles. If we want to feel angry we imagine ourselves in an angry role. Sports people may use various techniques to ‘gear themselves up’. Take a moment and a breath or two and image yourself in different roles. Try to feel into these roles from the inside. First imagine yourself in an anxious role. Take on the postures and thoughts of an anxious role. What do you notice happening in you body and emotions? Now shift position and take a breath or two. Now imagine yourself as a calm, wise and mature adult who can deal with these anxieties. Take on the postures and thoughts of a coping adult – ‘being here before’ role. Note how this changes your internal feelings and sense of yourself. You can see that spending a few moments allowing yourself to get into a role can be interesting and helpful. Now take a slow breath and shift your postures and imagine yourself in a kind compassionate and wise role, maybe you are an old wise sage. Focus on your compassion and inner sense of gentleness. Try to feel that part of you that can be kind and understanding of others; how you would be if caring for someone you like. Consider your general manner, how you are dressed, your facial expressions, voice tone and feelings that come with your caring self. Think about that part of you as the type of self you would like to be. Think about the qualities you would like your compassionate self to have. It does not matter if you feel you are like this – but focus on the ideal you would like to be. Spend a few moments really thinking about this and trying to feel in contact with that ‘kind’ part of you Role focusing can be helpful to orientate people to access the psychological systems that can stimulate compassionate focusing. The Compassionate Mind Foundation  2010 Page 50

Some Process of Change to Consider Collaboration: However one chooses to engage in compassionate mind development, it is important at all times not to impose but work collaboratively, setting it up as an experiment, something that might be worth exploring and gaining the evidence as one goes of how it fits with, and for, the person. Share the Model: For many people, it is useful to clarify the principles of the work and then gradually work out a step by step process that is agreed as one proceeds. The principles are in many ways similar to behavioural work of developing a hierarchy of steps that one works through. The more the person understands and collaborates in designing the steps the more involved (and less threatened) they are likely to be. Change as Transition: Safety beliefs and behaviours have usually been a long time in the making and so people can be fearful of change. Thus we suggest that they can keep their safety beliefs and behaviours for as long as they feel they need them, but try out these compassionate alternatives and see how they go. Like building a new house we gradually choose to live in the ‘new place’ more and more. In other words self-criticism can be something we begin to notice and gradually shift our attention and over time it gradually fades and seems less appropriate. Assertiveness and Courage: Sometimes people like to ‘stand up’ to their self-criticism and be assertive – especially if their SC is modelled on (say) a parental figure (Hackmann, 2005). This can be very helpful for some people. Indeed some feeling of not being submissive but assertive may be essential before we can develop self-compassion. However, we should also suggest caution, as an aggressive response is still defensive and amygdale based and we want to activate a completely different affect system. Reliability of the critic’s views: In working with self-criticism we can explore the origins of the criticism. If this turns out to be a parent then we can explore if the parent is really a helpful or reliable source for judging the self and why would we submit to or accept their judgements (e.g., fear of betrayal or separating for them). Make it a self-identity pursuit: Compassion and self-compassion can built into a self identity as what one might aspire to work towards rather than a goal to be achieved quickly – indeed it can be an ongoing life goal.


Special Issues: Fear of Compassion is often the MAJOR work This workshop has outlined the basis of our approach. It is necessary to become familiar with the model with relatively straightforward cases before you engage with the more complex ones. Some therapists (understandably) want to use this approach with their most difficult patients, at once, when they haven’t become comfortable with the basics. The more complex your clients the more they may struggle with, and resist compassion. For some it will be a very unfamiliar feeling. They may have beliefs that compassion is self-indulgent, a weakness or they don't deserve it. Always look for the fear (i.e., having something you don't deserve can lead to a fear which will be taken away from you and you’ll be shamed). Some people cannot imagine being self-compassionate let alone feel it. For the more difficult cases you are working with a lot of anxiety and fear of compassion. Also as they begin to recognise how alone they have felt, they can become angry or feel overwhelmed by grief. The diagram shows how kindness can re-activate the attachment system and trigger different negative emotions linked to memories. Openly discuss this with your clients and generate and pull different ideas together. The compassion motto is, “always think with your patients not for them.” Kindness, attachment and threat Kindness fromtherapist or imagery

Fight, flight shut down

Activate attachment system Activate memories

Neglect aloneness

Activate learnt and current defences

Fight, flight shut down Abuse, shame vulnerable

- cortisol

Problems with Compassionate Imagery No clear image: This may just need normalising as clear images are rare. Focus on ‘sense of’. Can ask if there are other sensory qualities. Can they use a picture? They may have only a vague sense of something or an essence. That is fine. The images are more like daydreams and not sharp pictures in the mind. It is not the image quality that is key but the feelings coming to the self. It is having a ‘sense of.’ Image of a known person: Okay to start with but may come with unwanted associations – so try to create a unique aspect for one’s own compassionate mind. Critical dialogue: Some people find it difficult to be mindful and not caught in the critical voice of “not doing it right” “this will not work for you” “this is daft” etc. So more focusing on mindfulness and ‘non-judgement’ might be important.


Fear of Compassion: Compassion may feel strange or threatening; there may be negative beliefs or associations to feeling close, or cared for. Considers emotional conditioning history. Anger/Rage. A common block to developing compassion, is high anger, fear of anger and vengeful fantasies. Help clients see that compassion is not just soothing but can be assertive. One of the biggest mistakes is believing that to be compassionate is to get rid of anger, rather than how to cope with it. Compassion is often about developing courage to face up to our anger and work with it. They may need to do empty chair work and rescripting of memories of powerlessness to help with unprocessed or blocked anger. Research shows that self-critics can see self-compassion as a threat – be open and discuss this. The main strategy is holding on to your compassionate therapeutic relationship and chip-away – a little practice each day. Clarify the point of the work and the importance of practice – hence compassionate mind training.

Ways of working with blocked compassion

• Explore potential problems for blocked compassion; fear conditioning,

• • •

•

• •

•

basic beliefs, no experience of…. and share that with the patient. Is fear or contempt to feeling compassion or simply ‘a kind of blankness.’ Normalise and time line it. Ask questions such as “what do you think would happen if you began to feel compassion?” or “what might your worst fear be if you began to feel inner warmth?” “What might help you work on that?” Clarify that patient understands the model and the value of selfcompassion. Do NOT need to give up self criticism. You might need to keep it simple at first such as developing an inner voice of kindness, support and encouragement when things are difficult for the self. You might have to desensitise people to positive emotions, no different in principle to desensitizing them to negative emotions except that in the one case the emotion may be too much and in this case it's too little. But can activate pain too (sadness). Prepare for the long game, don't be put off by the difficulties. Sometimes it can be weeks or months before patients get to feel what you working on in the therapy. Explore which exercises patients find helpful: Generating alternative thoughts, behavioural experiments, compassionate imagery, letter writing etc. Regular practice, repetition and perseverance – with maintaining the collaborative focus.


• Note that even if the person does just 2 minutes a day on (say) the

compassionate self this can be helpful. Take any opportunity, lying in bed in the bath waiting for a bus. • Little and often is helpful – compassionate washing up!

Appendixes

Exercises and Worksheets


Exercise 1: Your Intuitive Wisdom of Shame To help you recognise the complex nature of shame and that you already have intuitive knowledge of shame, we would like to you to engage in a short imagery exercise. Let’s take a hypothetical situation: Imagine that as part of this workshop you will be asked to describe something you feel ashamed about, and would rather keep hidden, to the person sitting next to you. We would like you to explore this in a series of steps. Rest assured this is hypothetical, but try to imagine it as if it were to be the case. 1.

Can you think about a shame related event, feeling or fantasy and imagine it? Now think about speaking about this 2. My first automatic feelings would be? __________________________________________________________ 3. Fill in the spaces below Thoughts about what others will think/feel My own thoughts and feelings about about you and how they will behave myself towards you They will think/feel…… 1.

I think I am…. 1.

2.

2

3

3

My key fear is that they will:

My key fear is that I will

Given these key fears - what are your main coping behaviours – how might you cope with these? What might you do to stop any possible feared outcome? ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________ What have we learnt from this exercise? ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________


Exercise 2: The Power of Social Exclusion Imagine that you discover that you are not invited to a party that all your friends have been invited to and what is more, you also know the host quite well. You may experience this situation as a social threat, or one of social rejection/exclusion. How would you feel emotionally? How would your body feel? What would you want to do? What would you be thinking about; where would your attention be? You may experience a range of reactions such as anxiety, anger (emotion), physiological arousal such as flushness, heart pounding, butterflies (physiological response) a desire to hide away from everyone or not tell others that you are not invited (behaviour) and a mind that interprets the situation as a rejection rather than an oversight of the host (a cognitive bias of better safe than sorry). Many of these responses are automatic, defensive responses to a threatening situation such as social rejection. Interestingly, many psychopathologies are related to the activation of threat defence systems. For instance, avoidance behaviours, aggressive/antisocial behaviours, anxiety disorders, etc. are all examples of repeated activation of threat defence systems that have become highly sensitised and easily triggered.

Exercise 3: Living in the mind of high shame and social unsafeness The Compassionate Mind Foundation  2010 Page 56

Imagine for a moment what it must be like to live in a world where, at any moment, you fear that people could find out things about you or you could do things that make them rejecting and hostile, and/or your own feelings and thoughts about yourself are condemning, hostile and rejecting. Look around you and think that maybe you do not really fit here, you are an outsider and the more people got to know you the less they would want to know you. It is with this insight and understanding of the shamed mind that the therapist begins a journey into compassion as a way to try to find places of support, soothing and comfort. Debrief: now look around you and think of how pleased you are to be part of this journey where each of us are trying as best we can to understand compassion and how to apply it in our work, think of yourself as travelling with others. Note how you can shift positions and self-other roles via your focus.


Exercise 4: Imaging the Self-Critical Part of Self Compassionate mind training is based on social mentality theory. This suggests that many of our self-focused thoughts operate through systems that were evolved for social relationships. These negative self-focused thoughts are often dialogic and narrative in their form though, rather than logically sequenced. Also we can image in person form our self-focused thoughts and in doing this gain insight into the forms and emotions associated with them. To help you to explore how powerful our self-criticisms can be we would like you to look back on the self-criticism you came up with in the first task. Close your eyes or look down and for a moment and try to form some kind of picture of this part of you. For example, if your self-critical part could be thought about as a person what would they look like? Focus on their facial expression or if you can’t see a clear image focus on the symbolism of self-criticism. Focus on the emotions that it is directing at you. What are they? How powerful and domineering does this part feel? How easy is it to agree with it? Note these reactions down.

What have we learnt from this exercise?


Exercise 5: Functional Analysis of Self-Criticism Self-attacking can seem very dysfunctional and people and therapists who use this language may miss the threat-focused functions of it. They may not then be able to explore the multiple functions of self-criticism and the fear of giving up self-criticism 1.

For a minute or so we would like you to close your eyes or look down and think what your fear would be, if from this moment on, you were never self-critical again – somehow we could remove this from your mind.

2.

Now with these thoughts in mind what we would like you to do is look back on your own self-critical thoughts from the first task we did and consider in what way they might be helpful to you - what do they want you to do or be?

What have we learnt? Think about how you would feel if you had to challenge or counteract your self critic. (pros and cons). Think of how you would feel if you felt you could keep it as long as you wanted to but also learn how to re-focus on compassion (pros and cons).


Developing Qualities of Inner Compassion (Client Handout)

As we have seen from our work together, being self-critical can be very stressful and make us feel worse. One way of coping with disappointment and our ‘inner bully’ is to learn to be compassionate to the self. This requires a number of things of us: 1. Valuing Compassion. Compassion Some people are worried that if they are compassionate with themselves they may somehow be weak or lack the drive to succeed. Thus, they don’t really value compassion. However, people who are renowned for their compassion, such as Buddha, Jesus, Ghandi, Florence Nightingale, and Nelson Mandela, can hardly be regarded as weak or ‘unsuccessful’. Learning to be compassionate can actually make us stronger and feel more confident. 2. Empathy. Empathy means that we can understand how people feel and think, see things for their point of view. Similarly, when we have empathy for ourselves we can develop a better understanding for some of our painful feelings of disappointment, anxiety, anger or sadness. This can mean we may need to learn when to be gently sensitive to our feelings and distress – rather than try not to notice them or avoid them. Sometimes we tell ourselves that we shouldn’t feel or think as we do, and try to deny our feelings rather than working with them. The problem with this is that we don’t explore them to understand them and then they can be frightening to us. We can learn to understand how and why we became self-critical, often because we feel threatened in some way. Becoming empathic means coming to see the threats that lie behind self criticism. 3. Sympathy. Sympathy is less about our understanding and more about feeling and wanting to care, help and heal. When we feel sympathy for someone, we can feel sad or distressed with them. Learning to have sympathy for ourselves means that we can learn to be sad, without being depressed e.g. without telling ourselves that there is something wrong or bad about feeling sad. We can also focus on feelings of kindness in our sympathy. 4. Forgiveness. Our self-critical part is often very unforgiving, and will usually see any opportunity to attack or condemn as an opportunity not to be missed. The Compassionate Mind Foundation  2010 Page 60

Learning the art of forgiveness however, can be important. Forgiveness allows us to learn how to change; we are open to our mistakes and learn from them.

5. Acceptance/tolerance. There can be many things about ourselves that we might like to change, and sometimes it is helpful to do that. However, it is also important to develop acceptance of ourselves as human beings ‘as we are’ with a full range of positive and negative emotions. Acceptance isn’t passive resignation, such as feelings of being defeated, or not bothering with oneself. It is an openheartedness to all our fallibilities and efforts. It is like having the flu and accepting that you have to go to bed perhaps but also doing all you can to help your recovery. 6. Developing Feelings of Warmth. This requires us to begin to experience and practice generating feelings of warmth for the self. To do this we can use images and practice feeling warmth coming into us. When we are depressed this feeling may be very toned down and hard to generate – so we will have to practice. It can seem strange and sometimes even frightening – so we can go a step at a time. 7. Growth. Compassion is focused on helping people grow, change and develop. It is life enhancing in a way that bullying often is not. When we learn to be compassionate with ourselves, we are learning to deal with our fallible selves, such that we can grow and change. Compassion can also help us face some of the painful feelings we wish to avoid. 8. Taking responsibility. One element of compassionate mind work is taking responsibility for one’s self-critical thinking. To do this we can learn to recognise when it’s happening and then use our compassionate mind to provide alternative views and feelings. 9. Training. When we attack ourselves we stimulate certain pathways in our brain but when we learn to be compassionate and supportive to our efforts we stimulate different pathways. Sometimes we are so well practiced at stimulating inner attacks/criticisms that our ability to stimulate inner support and warmth is rather under-developed. Hence, now that we have seen how we can generate alternatives to our self-attacking thoughts, we can explore ways to help them have more emotional impact. It does not take away painful realities but it can help us to cope in a different way. The training part can be like going to a physiotherapist, where you learn to do exercises and build up certain strengths. The compassion systems in your brain are the ones we are trying to strengthen with our exercises. The Compassionate Mind Foundation  2010 Page 61

Compassion: The Exercises Preparing for Compassionate Exercises So, we have now looked at our basic model and some ideas about compassion and the different elements of compassion. That might seem quite a lot to take in but don't worry, just take a step at a time and practice. When you first come to learn to drive a car there are the gears to think about, and the pedals, and the steering wheel, and the indicators, and the handbrake, and the wing mirrors - gosh that is a lot isn't it! However, with practice you gently get the hang of it and it becomes smooth. So don't be put off at all if at first you think there's a bit too much here. Just go at your own pace, picking it up bit by bit and that's fine.

Mindfulness Developing mindfulness is very useful to help us with our compassionate exercises. Mindfulness is a way of “paying attention to the present moment without judgment”. So, for example, when walking down the street we are mindful when our mind is focused on our walking, where we are, enjoying the day and just being in that moment. In contrast, we could be walking and our head is full of other things, what we should have for dinner; how we could sort out financial problems; an argument you might have had. So we are living in our inner creations not in the moment that is surrounding us. Practicing mindfulness is a way of practicing directing our attention. Consider that we are a point of consciousness moving through time. Your consciousness does not exist in the moment just gone or in the moment to come, only now. Consciousness is interesting to think about for a number of reasons. It is like a spotlight. The power of the spotlight can light up many different things: a book on the table, a plant, a picture on the wall, an area of dirty carpet, but the spotlight is not the thing it lights up. Alternatively, consider water: it can contain poison or medicine but also it is just water, not what it contains. Or consider a boat on the sea that can sail in calm waters or in storms - but the boat is not the water. We can think of our minds like this and try to reside in the ‘spotlight’, in the nature of consciousness - notice what the spotlight lights up but not be carried away by it or identify with the ‘thing it lights up’. Or we are like the boat. Now, sometimes our The Compassionate Mind Foundation  2010 Page 62

consciousness will be filled with different feelings of anger or anxiety or unpleasant memories (we are sailing on stormy waters), but we can pull back from these and regain (and reside in) an awareness of simply being conscious. Don't worry if this seems a little tricky because we will practice as we go. Mindfulness is a way of understanding 'attention'. You can choose to give your attention a particular focus. For example, if I ask you to concentrate and 'attend' to the big toe on your left foot, you will suddenly have sensations from that part of the body. If you now switch your attention to the top of your head, you will experience different sensations again. So our attention can be thought of as a spotlight that can be moved around. It is learning how to be in that mechanism, in the attention, that is the key to mindfulness. Mindfulness is also about clarity of observation and attention. For instance, suppose you're going to eat an apple. How would you do this mindfully? First, look at the apple and note all of its colours and textures, and hold it in your hand and feel the quality of its skin. Don’t rush, spend time just observing. When your mind wanders from your focus on the apple (as it most likely will) gently bring your focus back to it. In this exploration, you're not judging the apple, you're simply exploring its properties. Then, take a knife and peel it or cut into it. Once again, notice the effect that you have on the apple, the colour and texture of the fruit beneath the skin. Take time to really observe. Next, take a bite of the apple. Now focus on your sense of taste and what the apple feels like in your mouth. Next, chew slowly, feeling the texture in your mouth, noticing how the juice is stimulating your salivary glands and how the saliva feels in your mouth. Really focus on the taste. As you chew, notice how the apple becomes mushier. As you swallow, pay attention to the sensations of swallowing. So, you have explored the apple visually, by touch and feel, by smell and texture and by taste. If you had dropped the apple, you would have been able to hear what it sounded like – but you don’t need to do that today! In this interaction, there's no judgement; there's only your experience of your interaction with the apple. This is mindful attention – being in the activity rather than distracted from it by other thoughts, and exploring all aspects of the

activity to the full. If you performed this activity, biting into an apple, without mindfulness, your mind would probably have wandered: “This isn't a good apple – where did I buy it? I ought to eat more fruit. Actually I don’t like apples … Oh, damn, I just cut my finger!” In mindfulness we learn to notice the distraction (the wandering off thoughts) and gently and kindly bring our minds back on task and focus. Mindfulness is important because most of our lives are spent doing one thing and thinking about something else, and we're never fully in the moment. Our minds are The Compassionate Mind Foundation  2010 Page 63

constantly distracted. Take driving, for example. We can get home and realise that we can't actually remember how we got there, because our minds were full of 101 other things. If something unexpected happened, say a group of naked motorbike riders flashed past us, our attention would have been awakened, or if the driver in front of us suddenly put on their brake lights, our attention would have been focused again. This is not an example of savouring the moment though, it's about being brought to alertness for a specific reason. Mindfulness is about being in the moment. Mindfulness is paying attention in a specific way and acknowledging the distractions. When our mind wanders we learn to note the distraction and gently and kindly re-focus the attention. There is a key thing to note here. You are not trying to achieve anything, so you cannot do this right or wrong. If you have thoughts of “I'm not doing this right” or “I should be able to focus better than this” or “my mind seems impossible to focus” note that this is typical of the thoughts we will have practicing this. Just notice these thoughts and kindly and gently bring your mind back to the focus of your attention. It really does not matter if your mind wanders 100 or 1000 times because all you're trying to do is notice this and return your attention. When we first try mindfulness, and also if we’re upset, our minds can feel chaotic with thoughts and feelings swirling around us; we feel like a pinball! This is typical but is not a problem that must be fixed or something done about. It may be distressing and undesirable but it is not a problem. If we are learning to swim we learn how to rest upon the water, to make our strokes - the water is not a problem to be solved. So if we find our minds rushing and difficult as we practice, we learn to rest it and simply observe our thoughts and feelings as best we can.


Exercise 1: Soothing Rhythm Breathing


We're now going to use the same idea of mindfully peeling and eating an apple, but this time concentrate on our breathing. This will become a focus around which we will do some compassionfocused exercises later. The most important thing here is simply to practise the breathing without worrying if you're doing it correctly. These thoughts are common and understandable, but distractions. If they arise in your mind, simply notice them, call them your 'judging and evaluative thoughts’, smile compassionately to yourself and bring your attention back to the task. There are many aspects to resting the mind and body so I’m going to take you through a few key and simple relaxing exercises. The first one is called ‘mindful relaxing’ and involves learning how to pay attention in a gentle and kind way. Once you are familiar with this you can do the exercise sitting down, lying down or even standing up and walking. It is, however, preferable to do it sitting down to begin with, so you get the idea of it. So find somewhere to sit comfortably. Okay, now that you are sitting comfortably, place both feet flat on the floor about shoulder’s width apart and rest your hands on your legs. Now what we can do is just gently focus on our breathing. As you breathe try to allow the air to come down into your diaphragm – that’s just at the bottom of your ribcage in the upside down ‘V’. Feel your diaphragm, the area underneath your ribs, move as you breathe in and out. Just notice your breathing and play an experiment with your breathing. Breathe a little faster or a little slower until you find a breathing pattern that, for you, seems to be your own soothing, comforting rhythm. It is like you are checking in, linking up, with the rhythm within your body that is soothing and calming to you. Now we can spend 30 seconds or so just focusing on our breathing, just noticing the breath coming down into the diaphragm, your diaphragm lifting and then the air moving out, through your nose. Sometimes it’s useful to focus on the point just inside the nose where the air enters. So, in through your mouth and out from your nose. Just focus on that for 30 seconds………………………… What did you notice? You may have noticed that actually, although it was only 30 seconds, your mind might have wandered off. You may have had thoughts like “What’s this about? Will this help me? Did I do my job correctly yesterday?” You may have heard various things outside the room; your attention may have been drawn to the postman pushing letters through the box, or whatever. The point about this is that our minds are indeed very unruly and the more you practise this short breathing exercise and the longer you can extend it, the more you will notice how much our mind simply bobs about all over the place. When you first do this kind of breathing focusing, it can be quite surprising just how much your mind does shift from one thing to another. This is all very normal, natural, and to be expected. So we need to train the mind and the only thing that is important in this training is not to try to create anything. You are not trying to create a state of relaxation. You are not trying to force your mind to clear itself of thoughts. All you are doing is allowing yourself to notice when your mind wanders and then, kindly and gently, bring your The Compassionate Mind Foundation  2010 Page 66


Compassion Focused Imagery Work Introducing Imagery Some Key Exercises Compassion focused exercises and imagery are designed to try and create feelings to stimulate a particular kind of brain system through your imagery. You can revisit the section about how our thought and images affect our minds and brains and remind yourself of the examples we used to highlight to power of imagery (e.g. of the meal). We can try to stimulate our soothing systems in a number of ways and so compassion focused exercises are focused in four main ways: • Developing the inner compassionate self: In these exercises we will be focusing on creating a sense of a compassionate self, just like actors do if they are trying to get into a role. •

Compassion flowing out from you to others: In these exercises we focus on the

feelings in our body when we fill our minds with compassionate feelings for other people. •

Compassion flowing into you: In these exercises we focus our minds on opening up

to the kindness of others. This is to open the mind and stimulate areas of our brain that are responsive to the kindness of others. • Compassion to yourself: This is linked to developing feelings, thoughts and experiences that are focused on compassion to your self. Life is often very difficult and learning how to generate self compassion can be very helpful during these times, particularly to help us with our emotions. Wandering Mind Whenever we try to do certain tasks using our mind a very common difficulty is that our mind wanders all over the place - particularly if we're agitated or restless. So remember that when you begin to do this work your mind is likely to wander and indeed you might not be able to hold it on task for more than a couple of seconds. That is normal - your intention is simply to try - that's the important thing. Some days you may find it easier than others. The key thing is not to worry about that but just to notice when your mind has wandered and to bring it back to the task at hand. No Clear Pictures Another common concern is that people often don't have clear pictures in their mind when they do imagery. Again this is perfectly normal as we very rarely do have clear pictures in our minds, they tend to be more fleeting impressions, a touch of colour here, or a sense of something there. Imagining hearing things can be easier sometimes especially imagining people speaking to us. The key focus of this imagery work is on the feelings that we try to generate and that is linked to our intention. The Compassionate Mind Foundation  2010 Page 68

So keep these things in mind when we get to the practice. So now our next exercise is going to be creating a safe place.

Exercise 2: Creating a Safe Place In this imagery we are going to try to create a place in our mind – a place that could give you the feeling of safeness, calmness. If you are depressed or distressed those might be difficult feelings to generate, but the act of trying, and the sense of it being the sort of place you would like to be, is the important thing. So remember, it is the act of trying the practice that is important, feelings may follow later. The place may be a beautiful wood where the leaves of the trees dance gently in the breeze. Powerful shafts of light caress the ground with brightness. Imagine a wind gently on your face and a sense of the light dancing in front of you. Hear the rustle of the leaves on the trees; imagine a smell of woodiness or a sweetness of the air. Your place may be a beautiful beach with a crystal blue sea stretching out to the horizon where it meets the ice blue sky. Under foot is soft, white, fine sand that is silky to the touch. You can hear the gentle hushing of the waves on the sand. Imagine the sun on your face, sense the light dancing in diamond spectacles on the water, imagine the soft sand under your feet as your toes dig into it and feel a light breeze gently touch your face. Your safe place may be by a log fire where you can hear the crackle of the logs burning and the smell of wood smoke. These are examples of possible pleasant places that will bring a sense of pleasure to you, which is good, but the key focus is on a feeling of safeness for you. These examples are only suggestions and yours might be different to these. It helps your attention if you practice focusing on each of your senses; what you can imagine seeing, feeling, hearing and any other sensory aspect. When you bring your safe place to mind allow your body to relax. Think about your facial expression; allow it to have a soft smile of pleasure at being there. It is also useful to imagine that as this is your own unique safe place, created by you so the place itself takes joy in you being here. Allow yourself to feel how your safe place has pleasure in you being here. Explore your feelings when you imagine this place is happy with you being there.


Exercise 3: Compassionate Colour(s) Engage in your soothing breathing rhythm and when ready imagine a colour that you associate with compassion, or a colour that conveys some sense of warmth and kindness. Again, it might only be a fleeting sense of colour but when ready, imagine your compassionate colour surrounding you. Then, imagine this entering through your heart area and slowly through your body. As this happens try to focus on this colour as having wisdom, strength and warmth/kindness with a key quality of total kindness. Create a facial expression of kindness on your own face as you do this exercise. Feel that the colour wants to help you.

Developing the Compassionate Self The different parts of you You might remember earlier that we talked about there being different parts of you. There is an angry part that thinks, feels and wants to act in a certain way; an anxious part; a ‘being in love’ and a ‘falling out of love’ part. All of these parts think, feel and want to act in different ways. We have many hundreds, perhaps thousands of different potential patterns within ourselves. Developing the compassionate self and the compassionate pattern within ourselves can be key to helping us deal with some of the other feelings and patterns that arise in us that are unpleasant or difficult. Compassion can have a soothing quality on our anger and anxiety, but it can also help us develop courage to face these, and then tolerate them and deal with them. So harnessing your compassionate pattern is about harnessing your wisdom, maturity and genuine desire to be helpful, within yourself. These might be just small seeds or glimmers of a possible self but by working with them they can grow. Now, there are many different exercises which can be used to develop the compassionate self and for any one person it's not always clear as to which are the best exercises to start with. So, to some extent, we have to experiment. However, a helpful place to start is to focus on developing the sense of compassion within oneself. There are many ways in which this can be done and there are many traditions that use these kinds of techniques. For example, certain schools of Buddhism suggest that the seeds of many types of self exist within ‘one self’ and it is how we nurture and focus on them that’s important. So, for example, if you want to be a musician, practice playing an instrument; or if you want to be a good driver, practice driving; or if you want to become a good gardener you would practice gardening. Each is a potential in us until we choose to cultivate this aspect of ourselves. The key then is to think about what we want to practice, The Compassionate Mind Foundation  2010 Page 70

what do we want to become within ourselves? You see, throughout much of life we never stop and think about this, we don't think that we can deliberately practice becoming a certain type of person, but we can, we just have to decide to and then put in the time to practice. Here we are suggesting that if you choose to develop your inner compassionate self this can help you in many ways. Because of the way our brains are built it will help us to become kinder and have a greater sense of well-being; it may help us to become calmer and more at peace with our feelings. So the first compassionate imagery exercise can be practiced playfully but also with intent - learning to practice being a compassionate person. Acting: Another way to think of this is using acting techniques. If you were an actor learning to act, you might pay attention to key elements of a character. This might be a character that is angry, depressed, anxious, happy, and joyful or, of course, compassionate. So, as a keen actor, what you would try to do would be to create those experiences within yourself, try to be or become that character – live it from the inside. To do this you might pay attention to the way this character thinks and sees the world, the tone of voice of the character, the postures and the general bearing of the character, the kinds of things they say and the way they say them. Okay, so the character we are going to become is a compassionate one, this is the part of us we want to feed, nurture and develop.

Exercise 4: The Compassionate Self Now consider all the key qualities you think make up a compassionate person. Here are four key qualities: •

Wisdom derived from personal experiences, maturity and gaining insight into the nature of things and life’s difficulties. •

Strength, as in fortitude and courage.

•

Great warmth and kindness.

•

Non-condemning or critically (self)-judgemental but also with a sense of responsibility (and desire) to help or for change.

A very useful thing to do is also to imagine yourself expanding as if your wisdom is making you bigger, more dominant or powerful, in a mature compassionate way. You may even think of yourself as older. Now you may want to practice focusing on each of these and imagine having these qualities, noting what they feel like and any effect this has on your body. So the practice is:


Find somewhere you can sit quietly and will not be disturbed and focus on your soothing breathing rhythm. When you feel that your body has slowed down (even slightly) and you are ready for your practice, imagine that you are a very deeply compassionate person. Think of all the qualities that you would ideally have as that compassionate person. Let’s go through them: •

Focus on your desires to become a compassionate person and think, act and feel compassionately. Next imagine yourself with each of the qualities noted: imagine being calm and having wisdom (spend time just on this). Imagine yourself being sensitive with an ability to tolerate difficulties (spend time on just that). Imagine being warm and kind (spend time on just that). Imagine being non-condemning but also wanting to help, relieve suffering and produce change and ‘flourishing’.

•

Try to create a facial expression of compassion, maybe a slight smile or maybe a different expression to suit you.

•

Imagine yourself expanding as if you are becoming more powerful, mature and wise.

•

•

Pay attention to your body as you bring this part of you to the fore.

•

Spend a moment just feeling this expansion and warmth in your body. Think about your tone of voice and the kind of things you’d say or the kind of things you would do or want to do.

•

Spend one minute, more if you are able, thinking about your pleasure in being able to be kind.

Remember, it doesn’t matter if you feel you have these qualities or not, just imagine that you have them. See in your mind yourself having them, and work through them steadily, playfully and slowly. Sometimes we notice how each quality can affect our bodies differently. Remember that you may just get glimmers of things because your mind wanders or you can't really focus. This is very typical of what happens, just like if we were trying to learn to play a piano - we’d be all fingers and thumbs to start with. Regular practice will help.

You at your best


Another way you can access and practice your compassionate self is to spend a moment and remind yourself of a time when you felt compassionate; that is, calm and wise and wanting to help. You can think of your compassionate self as “you at your best”, imagining that inner sense of calm and the supportive voice. Use a compassionate expression when you recall this. Don’t focus on a time when someone was very distressed because that might focus you on the distress. The aim is to focus on your feelings of wanting to help and your kindness. Compassion under the duvet Ideally try to practice ‘becoming the compassionate self’ each day. If our lives are busy we can start by learning what can be called ‘compassion under the duvet’. When you wake up in the morning, try to spend a few minutes practicing becoming your compassionate self. As you lie in bed, bring a compassionate expression to your face, focus on your real desire to be wise and compassionate; remember inside you, you have the capacity for wisdom and strength, but you have to create space for it. Even two minutes a day, if practiced every day, may have an effect. You can also practice when you stand at the bus stop or just lying in the bath. After all, how often do we lie in the warmth of a bath and not really notice because our mind is wandering over all kinds of things – mostly worries or things we need to do! This is not very relaxing! You may then find you’ll want to practice for longer periods of time or even perhaps find places where you can train more. Whenever you are aware of it, even sitting in a meeting, you can use soothing breathing and focus on becoming the wisest, compassionate, calm, mature self.


Exercise 5: Focusing the Compassionate Self We can now learn to focus our compassionate self and use that to look at, and work with, some of our more difficult feelings and self experiences. The idea here is to first try to create an inner experience of being the compassionate self (using your breathing, compassionate expression, feelings of strength, sitting up straight etc.) and then from that position, through the eyes of your compassionate self, look out at the part of you want to work with. So suppose you're very anxious about something. Sit quietly and engage in your breathing and then imagine yourself as a compassionate person. When you can feel that expanding and growing inside you, then imagine you can see your anxious self in front of you. Look at his or her facial expression; note the feelings rushing through them. Just sit and feel compassion, and send compassionate feelings out to that anxious self. Try to surround that anxious self in compassion and understanding of the torment of anxiety. Now, you are not trying to do anything other than experience compassion and acceptance for your anxiety. Imagine giving as much compassion and understanding is that anxious part needs. Over time you may want to imagine what happens to the anxious part - when it actually has all of the understanding and support it needs. Working with our troubled self In this exercise we will again spend a few moments engaging the compassionate self feeling a sense of strength, wisdom and kindness - remember it's the intention and desire to be kind and helpful that is important. When you feel that you have engaged with that part of you to some degree try the following. Imagine that you are watching a video of yourself, like watching a film. So you see yourself get up in the morning. Holding your position of kindness and compassion, watch your self moving around in your room and then slowly getting on with your day. Notice how the person that you're watching (i.e. you) is troubled by self-critical feelings or thoughts about themselves, perhaps fears of their relationships with others or of being criticised, or their feelings. Be in touch with the struggle of the person you're watching but just hold your position of inner calmness and wisdom with the intention of being kind and helpful. If that sense of the compassionate self wanders or you lose it in any way; just let the imagery fade, go back to your breathing rhythm, your compassionate expression, sitting up straight in a confident posture, and begin again. The Compassionate Mind Foundation  2010 Page 74

This exercise will help you take a more objective view of your difficulties and also begin to develop your own intuitive wisdom and abilities to heal. Once we no-longer fight with ourselves but become more accepting, and recognise the struggle that we can have in life (through no fault of our own), we might find it easier to gradually learn how to change.

Exercise 6: Compassion Flowing Out In this exercise we are going to imagine kindness and compassion flowing from you to others. Sit quietly where you won't be disturbed and focus on your breathing. When that's okay for you, try and recall a time when you felt very kind and caring towards someone (or, if you prefer, an animal). Try not to choose a time when that person (or animal) was very distressed because then you are likely to focus on that distress. The idea is to focus on the desire to help and feelings of kindness. Keep in mind that it is your behaviour and intentions that are important - and the feelings may follow on behind. Now bring to mind a time when you felt compassionate towards the person (or animal) you have in mind. •

Imagine yourself expanding as if you are becoming calmer, wiser, stronger and more mature, and able to help that person. • •

Pay attention to your body as you remember your feelings of kindness. Spend a moment expanding with warmth in your body. Note a real genuine desire for this other person to be free of suffering and to flourish.

•

Spend one minute, more if you are able, thinking about your tone of voice and the kind of things you said or the kind of things you did or wanted to do.

•

Spend one minute, more if you are able, thinking about your pleasure in being able to be kind. •

Now just focus on your desire to be helpful and kind; the sense of warmth; feelings of expansion; your tone of voice; the wisdom in your voice and in your make some

behaviour. When you have finished the exercise you might want to notes about how this felt for you.

Focusing the compassionate self on others The Compassionate Mind Foundation  2010 Page 75

We can move on to focusing and directing our compassionate self. To practice this find a time and place when you can sit quietly without being disturbed. Now try to create a sense of being a compassionate person, as best you can. Some days this will be easier than others – even just the slightest glimmer can be a start. Now focus and bring to mind someone you care about (e.g. a partner, friend, parent or child) or an animal, or even a plant. When you have them in mind focus on directing towards them three basic feelings and thoughts: •

May you be well

•

May you be happy

•

May you be free of suffering

Keep in mind that it is your behaviour and intentions that are important - and the feelings may follow on behind. Be gentle, take time and allow yourself to focus on desires and wishes you create in yourself for the other person/animal/plant. Maybe picture them smiling at you and sharing these feelings. Okay, that’s tricky if you are thinking of a plant, but imagine the plant as ‘happy’ to receive your compassionate wishes. Spend time focusing on this genuine desire of yours for ‘the other’. Remember to be mindful in the sense that if your mind wanders that is not a problem; just gently and kindly bring it back to your task. Try to notice any feelings you have in yourself and your body that emerge from this focusing exercise. Don’t worry if nothing much happens at a conscious level – the act of having a go is the important thing. Like getting fit – it may take some visits to the gym or training before you consciously notice feeling different, but your body will be responding straight away.


Exercise 7: Compassion flowing into oneself: Using Memory Engage in your soothing rhythm breathing for a minute or so or until you can just feel your body slowing down. As you feel your body slowing down, prepare for your compassionate imagery by allowing your body posture to become compassionate. Create your compassionate facial expression. This might involve a slight smile or relaxed posture, but it is a gentle facial expression. You may want to ‘play around’ with facial expressions and see which one fits for you. When you feel ready, bring to mind a memory of a time when someone was kind to you. This memory shouldn’t be of a time when you were very distressed, because you will then focus on the distress. The point of the exercise is to focus on a desire to help and be kind. Create a compassionate expression on your face and a body posture which gives you the sense of kindness as you recall. Spend one minute exploring the facial expressions of the person who was kind to you. Sometimes it helps if you see them moving towards you, or see their face breaking into a smile, or their head on one side. Focus on important sensory qualities of your memory in the following way: •

Just focus on the kinds of things this person said and the tone of their voice. Spend one minute on that.

•

Then focus on the feeling of the emotion in the person, what they really felt for you at that moment. Focus on that for one minute (longer if you wish/can).

•

Now focus on the whole experience, maybe whether they touched you or helped you in other ways, and notice your sense of gratitude and pleasure at being helped. Allow that experience of gratitude and joy in being helped to grow. Remember to keep your facial expression as compassionate as you can. Spend a few minutes with that memory. When you are ready, gently let the memory fade, come out of your exercise, make some notes on how you felt.

Contrasting memories You may note that bringing these memories to mind may create feelings inside of you even if they are just glimmers. To demonstrate this, consider what would happen if you focused on how other people have been unkind to you? You would clearly create very The Compassionate Mind Foundation  2010 Page 77

different feelings inside yourself. The funny thing is that because we don't really pay attention to what goes on in our minds we can allow ourselves to exist (ruminate and dwell) in places where we recall (or anticipate) other people being unkind or threatening to us. That means we spend time stimulating our threat system. When we do that we block out more helpful memories and brain patterns. The question is: What do we want to train our minds for? Where do we want to exist in the patterns we can create in our minds? Where do we want to shine the spotlight of our consciousness?

Exercise 8: Creating a Compassionate Ideal First, engage with your soothing breathing rhythm and compassionate expression; bring to mind your safe place, the sounds, the feel, and the sights. Remind yourself that this is your place and it delights in you being here. This may now be the place where you wish to create and meet your compassionate image. You can imagine your image being created out of a mist in front of you, for example or just appearing. The image may be walking towards you. [Note: In Buddhist practice the student imagines a clear blue sky from which various images emerge]. This exercise is to help you build up a compassionate image, for you to work with and develop (you can have more than one if you wish, and they can change over time). Whatever image comes to mind or you choose to work with, note that it is your creation and therefore your own personal ideal - what you would really like from feeling cared for/about. However, in this practice it is important that you try to give your image certain qualities. These are superhuman – complete and perfect compassionate qualities that are there for you to practice creating and bringing to mind. They include: A deep commitment to you – a desire to help you cope with and relieve your suffering, and take joy in your happiness. (Note: This is key from the evolutionary point of view) Strength of mind – it is not overwhelmed by your pain or distress, but remains present, enduring it with you. Wisdom - gained through experience - it truly understands the struggles we go through in life. We all ‘just find ourselves here’ doing the best we can. Warmth - conveyed by kindness, gentleness, caring and openness. Acceptance - it is never judgemental or critical, it understands your struggles and accepts you as you are. However remember too that it is deeply committed to help you and support you.


Please don’t worry about remembering all of these qualities and emotions because you will be guided through them again when we do the imagery. Here are some questions that might help people build an image: •

Would you want your ideal compassionate image to feel/look/seem old or young; to be male or female (or non-human looking e.g. an animal, sea or light)?

•

What colours and sounds are associated with the qualities of wisdom, strength, warmth and non-judgement? •

What would help you sense their commitment and kindness for you?

One of the key experiences is that your image really wants for you to be free of suffering, and/or to be able to deal with the difficulties, and to flourish. It knows that we all just find ourselves here, living as we do, trying the make the best of our minds and lives. It understands that our minds are difficult, that emotions can run riot in us and this is not our fault. Practice experiencing what it's like to focus on the feeling that another mind really values you and cares about you unconditionally. Now focus on the idea that your compassionate ideal is looking at you with great warmth. Imagine that they have the following deep desires for you: •

That you be well

•

That you be happy

•

That you be free of suffering

The key to the exercise is not the visual clarity. Indeed some people don't really see their images in any clear way at all. The key to the exercise is the focus and practice on the compassionate desires coming into you. Here the practice is to imagine another mind wishing for you to flourish. Now, you might have thought ‘yes but this is not real, I want somebody real to care for me’. That is, of course, very understandable and even doing this exercise could make you feel sad. That is because your intuitive wisdom recognises seeking for connectedness. The point to remember is that what we are trying to tackle is your own attitudes towards yourself, particularly feelings of shame or self-criticism. While it may indeed be desirable to find people who are caring, it's also very desirable that you create these feelings within you - so that you gradually learn to focus on compassion for yourself, rather than self-criticism. So try not to see it as an ‘either/all’, but as quite different processes between the compassion you give to yourself, and the compassion you'd like other people to give to you.


Worksheet for building your compassionate image Your absolute ideal in every way How would you like your ideal caring, compassionate image to look/appear – visual qualities?

How would you like your ideal caring, compassionate image to sound, e.g. tone of voice?

What other sensory qualities can you give to it?

How would you like your ideal caring, compassionate image to relate to you?

How would like to relate to your ideal caring, compassionate image?

The Skills of Compassion Compassionate Attention, Thinking, Behaviour and Feeling The Compassionate Mind Foundation  2010 Page 80

In our groups we will be exploring the use of imagery to develop feelings and ideas of compassion. If you look back to the section on “what is compassion” you will see that we talked about the skills of compassion in terms of learning how to pay attention compassionately, learning how to think compassionately, learning how to behave compassionately (which will help ourselves and others flourish and improve) and, of course, learning how to create feelings of compassion. So, we can see compassion as directing many of the ways in which we think and react. And we can contrast this with what happens if the threat system takes control. Then our attention, thoughts, behavioural urges and feelings will be linked to anger or anxiety etc. You can see this in the diagrams below.

Key Targets of Compassion Attention

Imagery Fantasy

Motivation

Thinking Reasoning

Compassion

Threatened mind can block Compassion Thinking Reasoning

Attention

Behaviour

Emotions

Imagery Fantasy

Motivation

Threat

Behaviour

Emotions

Our emotions can direct our thinking in many ways. So when we're angry we think in angry ways, and when we’re anxious we’ll think in anxious ways. Compassionate thinking requires us to think in a balanced way so that we are not too biased or emotionally controlled in our thinking. To help us we can ask ourselves some questions: •

Is this thinking helpful to me?

•

Would I think like this if I weren't upset?

•

Would I teach a child or friend to think like this?

•

If not, how would I like to teach them to think about these things?

•

How might I think about this when I am at my compassionate best?

The key point really is trying to be mindful of your thoughts and see how they can be pulled in certain ways, according to your feelings, but if you stand back and observe your thoughts with the intention of trying to find a compassionate, fair and balanced approach, with practice you may find this will come for you. So there's nothing magic in this and we will do various exercises together using your own wisdom and understanding of compassionate thinking.

Compassionate Letter Writing Keep in mind that all the exercises and work that we are doing is to develop a compassionate mind – and that the pattern within ourselves will help us find the courage to face up to the The Compassionate Mind Foundation  2010 Page 81

difficult things and/or self acceptance and self peacefulness. Everything is orientated for that the way we think, our behaviours and our intentions. We are training our minds. Learning to think and reason compassionately can sometimes be helped along by writing letters to ourselves. In this exercise we are going to write about difficulties, but from the perspective of the compassionate part of ourselves. There are different ways you can write this letter. One way is to take your pen and paper and then spend some moments engaged with your soothing breathing rhythm. Next move into your compassionate self; remembering you at your best - at your calmest, at your wisest – at your most caring. Imagine yourself as you would ideally like to be in terms of being mature and powerfully compassionate. Now try to feel your compassionate self. As you focus on it, feel yourself expanding slightly and feeling stronger. Imagine you are a compassionate person who is wise, kind, warm and understanding. Consider your general manner, tone of voice, and the feelings that come with your ‘caring compassionate self.’ Adopt a kind facial expression. Try to feel the kindness in your face before moving on. Think about the qualities you would like your compassionate self to have. Spend time feeling and gently exploring what those qualities are like when you focus on them. Remember, it does not matter if you actually feel you are like this, but focus on the ideal you would like to be. It is your intentions that are important – feelings may follow with practice. Spend at least one minute, longer if possible, thinking about those parts of yourself. Don’t worry if this is difficult, just do the best you can – have a go. When we are in a compassionate frame of mind (even just slightly), or in a pattern of trying to help a friend or someone we care for, we try to use our personal experiences of life wisely. We know that life can be hard; we offer our strength and support; we try to be warm and not judgemental or condemning. Now, just take a few breaths and try to sense and feel that wise, understanding, compassionate part of you arise in you. This is the part of you that will write the letter. So we try to write this kind of letter from a compassionate point of view. If thoughts of ‘am I doing it right?’ or ‘I can’t get much feeling here’ arise, just note or observe these thoughts as normal comments our minds like to make, but re-focus your attention and simply observe what happens as you write, as best you can. There is no right or wrong, only the effort of trying – it is the practice that helps. As you write, try to create as much emotional warmth and understanding as you can. You are practising writing these letters from your compassionate side. As you write your letter, try to allow yourself to understand and accept your distress. For example, your letter might start with: ‘I am sad. I feel distressed; my distress is understandable because…..’ Note the reasons. Realising your distress makes sense. Then, perhaps you could continue with: ‘I would like me to know that……’

For example, your letter might point out that as we become stressed or depressed, our depression or a distressed state can come with a powerful set of thoughts and feelings – so how you see things right now may be the depression view on things. Given this, we can try and step to the side of the distress and write and focus on how best to cope. So we can write: The Compassionate Mind Foundation  2010 Page 82

‘It might be helpful to consider. . .’ A second way of doing this is to imagine your compassionate image writing to you, imagining a dialogue with them, and what they will say to you. So, for example, my compassionate image might say something like: ‘Hi Paul, Gosh, the last few days have been tough. Isn’t it typical of life that problems arrive in groups rather than individually. It’s understandable why you’re feeling a bit down because . . . Hang in there because you are good at seeing these as the ups and downs of life. There have been times before when things have seemed dark but they pass and you have shown a lot of courage in dealing with this very tricky brain that is so tough at times. So you have developed abilities for getting through this and tolerating the painful things.’

You will note that the letter points to my strengths and my abilities. It doesn’t issue instructions such as: ‘You must see these things as the ups and downs of life’. This is important in compassionate writing. You don’t want your compassionate letters to seem as if they are written by some smart bod who is giving you lots of advice. There has to be a real appreciation for your suffering, a real appreciation for your struggle and a real appreciation for your efforts at getting through. The compassion is a kind arm round your shoulders, as well as re-focusing your attention on what is helpful for you.

An example Here is a letter from someone we’ll call Sally, about lying in bed feeling depressed. Before looking at this letter, let’s note an important point. In this letter we are going to refer to ‘you’ rather than ‘I’. Some people like to write their letters like that, as if writing to someone else. See what works for you, but over time try to use ‘I’. So, you could read this letter and substitute ‘I’ for ‘you’. ‘Good morning Sally, Last few days have been tough for you so no wonder you want to hide away in bed. Sometimes we just get to the point of shutdown, don’t we, and the thought of taking on things is overwhelming. You know you have been trying real hard but have felt exhausted through no fault of your own, I mean you haven’t put your feet up with a gin and tonic and the daily paper. I guess the thing now is to work out what helps you. You’ve shown a lot of courage in the past in pushing yourself to do things that you find difficult. Lie in bed if you think that it can help you, of course, but watch out for critical Sally who could be critical about this. Also you often feel better if you get up, tough as it is. What about a cup of tea? You often like that first cup of tea. Okay, so let’s get up, move around a bit and get going and then see how we feel. Tough, but let’s try . . .’ So you see the point here: it’s about understanding, being helpful, having a really caring focus, but at the same time working on what we need to do to help ourselves. Now you might write this one in your head – imagine a really kind and understanding part talking with you. At other times it is useful to actually use a pen and paper and write to yourself. The Compassionate Mind Foundation  2010 Page 83

Guides to letter writing When you have written your first few compassionate letters, go through them with an open mind and think whether they actually capture compassion for you. If they do, then see if you can spot the following qualities in your letter. •

It expresses concern and genuine caring.

•

It is sensitive to your distress and needs.

•

It is sympathetic and responds emotionally to your distress.

•

It helps you to face your feelings and become more tolerant of them.

•

It helps you become more understanding and reflective of your feelings, difficulties and dilemmas.

•

It is non-judgemental/non-condemning.

•

A genuine sense of warmth, understanding and caring permeates the whole

letter.

•

It helps you think about the behaviour you may need to adopt in order to get

better.

Self-critical people can struggle with this to begin with, and are not very good at writing compassionate letters. Their letters tend to be rather full of finger-wagging advice. So we have to work at this and practise. The point of these letters is not just to focus on difficult feelings but to help you reflect on your feelings and thoughts, be open with them, and develop a compassionate and balanced way of working with them. The letters should not offer advice or tell you what you should or shouldn’t do. It is not the advice you need, but the support to act on it.

Therapist Note: The letter will contain all of the helpful attention, thinking, behaviour and feeling that were noted above. This requires the person to really focus on trying to be helpful and kind to themselves. You will find, however, that to begin with self-critical people write quite cold letters. They will often have words in like ‘you don’t need to feel down because…’ or ‘you should…’. These are invalidations and more authoritarian suggestions than compassionate ones. However they will change over time. Some people really enjoy learning to write letters to themselves, but it takes practice.

Compassionate Thinking The Compassionate Mind Foundation  2010 Page 84

When we are stressed, harassed and worried and things go wrong, it is easy for our threat system to take control. Our thoughts are then focused on anxiety or anger. These are often unhelpful. Compassionate thinking involves slowing down, learning to become more aware of how our threat emotions, like anxiety or anger, are directing our thoughts. We then choose to intervene by standing back from those emotionally driven thoughts and, as kindly as we can, think about what is helpful. For example, we might think about what you would say or do to help a friend in the same situation. This learning to stand back from our emotional reactions, rather than let them dictate our thoughts and ruminations, is a key to training our minds. We can see a good example of this when we distinguish between shame-based selfcriticism and compassion-based self-correction. As we mentioned in the first part of this document, we all ‘just find ourselves here’, equipped with certain emotions that our genes have built for us, and our life experiences have shaped for us. So, much of what goes on in our minds is not our fault. However, people sometimes get the wrong idea about this and believe that nothing matters; it doesn’t matter how we treat ourselves or others. This is not the compassionate way. The compassionate way is to take responsibility and try to improve things as best we can by learning from, and building from, our mistakes. If we just get lost in self-criticism and feelings of anger and frustration or disappointment this is not going to be helpful. So that is why it is important to distinguish shame-based selfcriticism from compassion-based self-correction. Some people believe that self-criticism is the only way to make them do things, to succeed or be good. For example, a person might say, “If I didn’t kick myself, I’d never do anything”. Or they might believe that unless they are critical and keep themselves on their toes, they will become arrogant, selfish and lazy. They use their self-bullying and selfcriticism to drive them on – sometimes in rather unkind ways. In some cases, this view goes back to childhood where parents and teachers over-focused on the child’s errors and not their positives. As a result, the child becomes good at self-criticism and selfpunishment but poor at seeing their good points, self-rewarding and valuing.

These distinctions are outlined in more detail in the table below: Compassionate Self-Correction is Focused on:

Shame Based Self-Attacking is Focused on:

* * * *

* The desire to condemn and punish * Punishing past errors and is often backward looking * Given with anger, frustration contempt, disappointment * Focuses on deficits and fear of

The desire to improve Growth and enhancement Forward-looking Given with encouragement, support and kindness * Building on positives (e.g. seeing what


one did well and then considering learning points) * Focuses on attributes and specific qualities of self * Focus and hope for success * Increases the chances of engage

exposure * Focuses on self as a global sense of self * Focus on high fear of failure * Increases chances of avoidance and withdrawal

Consider the example of encouraging supportive Consider the example of critical teacher with a teacher with child who is struggling. child who is struggling.

You can see that self-criticism is associated with threat-based emotions. Letting go of this type of self-criticism will help you, especially if you focus on compassionate self correction; your real desires to do your best and improve. For example, consider two teachers teaching a young child. One focuses on their deficits and picks on them when they make mistakes. The other teacher focuses on what the child does well and encourages the child to improve and learn from their mistakes and offers clear guidance. Which one will help the child’s confidence? Which one do you really prefer? Compassionate self-correction is about being open to all our weaknesses, limitations and fallibilities (remember we did not design our brains) but with a genuine wish to improve. Hostile self-criticism is just unhelpful and can make us hide away. So practice compassionate self-correction when things go wrong for you or that frustration with yourself starts up. Compassionate self-correction is based on being open-hearted and honest about our mistakes with a genuine wish to improve and learn from them. No one wakes up in the morning and thinks to themselves, “Oh, I think I will make a real cock-up of things today, just for the hell of it”. Most of us would like to do well, most of us would like to avoid mistakes, most of us would like to avoid being out of control with our temper. We need to recognise that our genuine wish is to improve. Self-criticism, on the other hand, comes from a fear- and anger-based place. It is concerned with punishment and is usually backward-looking, related to things we have done in the past. The problem is you cannot change a single moment of the past, you can only change the future.

Compassionate Behaviour Okay so we have been looking at our thoughts, how we can use imagery and how we can write to ourselves, what about behaviour - how can we develop compassionate behaviour. As we have frequently mentioned, it is our intentions and our behaviours that matter even if we don't always have the feelings to go with them. Compassionate behaviour is doing things to help ourselves and/or others to deal with suffering or develop, flourish and improve. Remember that there will be times when you’re angry or frustrated and don't want to carry through on your commitment to looking after yourself properly. This is understandable of course, but, to the best of your ability, notice and be compassionate to your anger and frustration. Sometimes we just need to have some time to let things settle down; like sailing in the storm we The Compassionate Mind Foundation  2010 Page 86

just have to wait for it to blow itself out. So if the feeling is to give up on any commitment you've made, then allow yourself to settle and then rekindle your commitment. It can help too if we can think about our values and deciding on what it is you really want to work for - sometimes we are not clear - so it can be helpful to think about this over the long term. How would you like to be in six months or a year? Remember to keep a lightness of touch, to be playful and hopeful.

Practice Diaries Practice diaries are a way to keep notes about some of the exercises you will try, and can help you see how you are getting on. People often keep diaries to think and write about their thoughts, especially if they’re down. It can also be useful, however, to keep notes of your practice, your personal observations, what you're compassionate wise mind says, and your successes, no matter how small. In our group you will be keeping files and records of the notes from each session, and also of some of the practices that we have done.

Fear of, and Blocks to, Compassion Some people recognise that they are simply not used to this compassionate way of thinking and it seems odd to them, but they can understand its value and the importance of practice. However, other people can be much more resistant. For example, they may feel they do not deserve to be compassionate, they may see it as a weakness, or a self-indulgence, or even selfishness. If these beliefs are strongly held they can get in the way of practice. One way around this is to simply note these beliefs as common, but to practice anyway. Think about it like physiotherapy. If you had a weak muscle in your leg, perhaps as a result of injury, you wouldn’t tell yourself you don’t deserve to have a stronger muscle. So let’s build these qualities, and then if you decide you don’t want to use them, that’s up to you. However, you cannot make a choice of being non self-compassionate unless you also have the ability to be selfcompassionate. For some people kindness begins to touch them in a deep way and can make them sad and even tearful. This is because it touches an inner wisdom, which is that many of us wish to be cared for, cared about and want to feel connected to others. When we feel distressed, depressed, anxious or lonely, being kind to ourselves can open us to that loneliness and a yearning inside us for reconnection. If possible, just stay with these feelings and mindfully allow them to come through. If you find them a bit much for you then you may prefer to work first with the safe place imagery in ‘becoming the compassionate self’. However, always trying to create ‘kindness and helpfulness in our thinking’ is key. Some people are unsure about kindness because parents could be kind one day but horrible the next. So feelings of kindness and horribleness are kind of mixed up together. This means that as they begin to feel kindness they can also have the feelings of horribleness come back as well. Here you need to just keep your focus on the feelings of kindness, notice other feelings creeping The Compassionate Mind Foundation  2010 Page 87

in, smile compassionately and bring the attention back to exactly what it is you want to focus on. Again if these seem like a key problem for you, then stay with the processes that you find tolerable and build up from there. Only go with things you feel comfortable with. Another major block to compassion can be anger. Self-critical, depressed and anxious people can sometimes struggle with anger, and even admitting they feel angry about things. I have certainly met many people who have thoughts that it’s not compassion they want to develop, but to find a way to fight back, to stand up for themselves or even get their own back on people who have hurt them! Sometimes this anger is just a desire to be acknowledged and appreciated, and sometimes people are frightened of their anger, and that too can sometimes block compassion. So, for such folk, doing compassion exercises can actually make them feel a bit ashamed of their anger because they feel if they are compassionate they shouldn’t feel angry. This is a misunderstanding of compassion. Some people believe that in order to be compassionate, they have to be ‘nice people’ and nice people shouldn’t feel angry, or irritable or unreasonable. They come to compassion training thinking that they have got to practice being nice people and get rid of their anger. However, compassion is actually about being honest and open to our anger, without self-judgement, but at the same time taking responsibility for what we do with it. In fact, the ability to acknowledge that we have great anger or rage can itself be a compassionate thing to do because it’s taking ourselves seriously and with honesty. The Dalai Lama (the head of the Buddhist community and renowned for his compassion) tells a story of how he used to like to fix watches. One day after working on a watch that he was struggling with he found his frustration mounting, until he picked up a hammer and smashed the watch to pieces! It’s not so much whether or not we have frustration, anger or rage, it’s how we acknowledge it, our attitudes to it and how we express it that’s important. Recognising how painful rage can be is compassionate. Coming to terms with the fact that anger rumination is harmful to us is compassionate; learning what to do about our anger is compassionate. Compassion is not about trying to soothe everything or sweep things under the carpet! We have a very difficult brain and anger can be powerful, which is why we need compassion for it. Sometimes people think that the compassionate approach is letting them off the hook, that it’s a soft and easy option. It’s far from it. If you suffer from agoraphobia the compassionate approach is not to give up and sit in front of the television eating chocolate, as nice as that might be for a short time. The compassionate approach is to acknowledge that you are going to have to work with your anxiety and to practice getting out more and more each day. Compassion helps us to develop the courage we need to develop in order to confront and work with things we might be avoiding. So who ever told you compassion was a weakness or a simple option has misled you I'm afraid. Compassion is about honesty and developing courage, which is not always easy. So, rather than think of compassion as something fluffy, easy or soft, see it as how, through kindness, we can learn to face the powerful anxieties and rages, the difficulties and tragedies of our lives and gradually find some peace within. There is nothing soft or weak about this journey and sometimes it can move us in deep ways. The Compassionate Mind Foundation  2010 Page 88

Summary So in summary then we can see that we have a very difficult brain because of the way it has evolved over many millions of years. Within us are different patterns and potential states of mind. There is the angry self, the anxious self, the ‘wanting to be loved self’, the excited self, the proud self, the ashamed self - all coming with slightly different emotions, ways of thinking and desires to behave. These can also be affected by our background bodily states - whether we're exhausted or have a physical problem. And of course powerful emotional memories can be triggered in us that affect our bodies. If we come from difficult backgrounds some of the states of mind we typically experience are rooted in anxiety and anger – because we haven't had the chance to develop other patterns - so we've always been on the defensive.


The Consequences of Developing the Compassionate Self As one begins to develop the compassion focus it can be useful to explore how this will help a person change and become more as they would like to be. List how a compassion focus will: 1.

Affect how I feel and relate to ourselves – what will be different – how will I notice this happening and build on it?

2.

Affect how I deal with life problems - what will be different – how will I notice this happening and build on it?

3.

Affect how I interact with other people - what will be different – how will I notice this happening and build on it?

4.

Affect how I choose and work towards life goals - what will be different? How will I notice this happening and build on it? (A goal can be short-term – in the next few days, next weeks, months or over a life time)

5.

Affect how I deal with setback and life crises - what will be different – how will I notice this happening and build on it?

6.

Affect any other life issues that are important to me - what will be different – how will I notice this happening and build on it?

How can I build compassion into everyday life? How might I notice blocks to compassionate living and work compassionately with these?


Formulation 1: Threat/Safety Strategy Formulation for Shame and Self-criticism Historical Influences

Key Fears

Safety/Defensive Behaviour

Unintended Consequences

Pointers Try to keep it relatively simple to start with - Just the four of five headings Focus on sharing and understanding together and encourage client to do his or her own or add to it Avoid language of cognitive distortion or maladaptive schema as this can be shaming for high shame clients Focus on “your defence system has tried to keep you safe; better safe than sorry etc.” natural, but with unintentional drawbacks – e.g., little new learning, few opportunities for exploration


Forms for exploring unhelpful thoughts and generating compassionfocused alternative thoughts and ideas Triggering Events, Feelings or Images Key questions to help you identify your thoughts. What actually happened? What was the trigger?

Depressing, Upsetting Thoughts

Feelings

Compassion-focused Alternatives to Self-Critical Thoughts

What went through your mind? What are you thinking about others, and their thoughts about you? What are you thinking about yourself, and your future?

What are your main feelings and emotions?

What would you say to a friend? What compassionate alternatives might there be? What is the evidence for new view? (How) are these examples of compassion, care and support? Can you think these through with warmth?

External shame: (what I think others think about me)

Key Feared Consequences:

Empathy for own distress:

Compassionate Attention:

Internal shame: (what I think about me)

Compassionate Thinking:

Key feared Consequences:

Compassionate Behaviour:

Image and emotion:

Image and emotion:

Function:

Function:


Understanding and change in feelings Write down any change in your feelings.

Simplified form for exploring unhelpful thoughts and generating compassionfocused alternative thoughts and ideas Depressing, Upsetting Thoughts What went through your mind? What are you thinking about others, and their thoughts about you? What are you thinking about yourself, and your future?

Compassion-focused Alternatives to Self-Critical Thoughts What would you say to a friend? What compassionate alternatives might there be? What is the evidence for new view? (How) are these examples of compassion, care and support? Can you think these through with warmth? Empathy for own distress:

Compassionate Attention:

Compassionate Thinking:

Compassionate Behaviour:

Compassionate image and warmth focusing:


Prompts for helping us with distressing thoughts and generating helpful alternative thoughts, feelings, ideas and behaviours ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Distressing, Upsetting Events, Helpful, Compassionate Thoughts Helpful, Compassionate Behaviours Thought, Images or Feelings ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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Note how your thoughts are related to key fears. Now focus on creating your compassionate image or sense of self and think about how your could look at with understanding and warmth e.g., how might you speak to a friend or someone you really cared for; what might a more balanced view be. So what would be a helpful thing for you to do now – not what you think you should do but what in reality might be helpful for you. By focusing on what is helpful to you, you are finding your own way of working on these difficulties.


Reflection Sheets Consider with those around you the three key ideas you have picked up today.

1.

2.

3. Consider three ways these may help or change your practice. 1.

2.

3.


Reflection Sheets Consider with those around you the three key ideas you have picked up today. 1.

2.

3. Consider three ways these may help or change your practice. 1.

2.

3.


Notes


Notes


Workbook

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