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Compassion Focused TherapyCompassion Focused TherapyDerby December 2008Derby December 2008
Paul Gilbert PhD FBPsSPaul Gilbert PhD FBPsS
Mental Health Research UnitMental Health Research Unit, , Kingsway Hospital DerbyKingsway Hospital Derby
Mary Welford Mary Welford
Greater Manchester West Mental Health NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation Trust
Ken Goss, Ian Lowens, Chris Gillespie & Chris IronsKen Goss, Ian Lowens, Chris Gillespie & Chris Irons
www. compassionatemind.co.ukwww. compassionatemind.co.uk
If you wish to use this material please respect sourcesIf you wish to use this material please respect sources
Warm-up ExerciseWarm-up Exercise• In threes or small groups introduce yourself In threes or small groups introduce yourself
and then consider clients whose shame and self-and then consider clients whose shame and self-criticism have been hard to work withcriticism have been hard to work with
• What was the nature of the ‘stuckness’ how did What was the nature of the ‘stuckness’ how did you formulate this, and how did you try to you formulate this, and how did you try to resolve it?resolve it?
• What might have helped youWhat might have helped you
Workshop OutlineWorkshop Outline
First legFirst leg• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Identifying Critical Dialogues &
Associated AffectsAssociated Affects• The Diagrammatic Model / The Diagrammatic Model /
FormulationFormulation
Key Targets of TherapyKey Targets of Therapy
AttentionAttentionImageryImagery
ThinkingThinkingReasoningReasoning
BehaviourBehaviour
MotivationMotivation EmotionsEmotions
Evolved Dispositions and DesignsEvolved Dispositions and Designs
Basic Philosophy and ModelBasic Philosophy and Model
To derive models of psychopathology based on To derive models of psychopathology based on the science of mindthe science of mind
To derive models of psychotherapy based on the To derive models of psychotherapy based on the science of mindscience of mind
To derive models of both that integrate all the To derive models of both that integrate all the relevant sciences e.g., genetic neuroscience, relevant sciences e.g., genetic neuroscience, development, cognitive psychology through to development, cognitive psychology through to social and political psychology and beyondsocial and political psychology and beyond
Contextualise mind in it’s environmentContextualise mind in it’s environment
Innate and AcquiredInnate and Acquired(v) Genotype v) Genotype (v) Environment = (v) Phenotype (v) Environment = (v) Phenotype GenotypesGenotypes are potential competencies for -are potential competencies for -
Examples: Language, symbolic thought, Examples: Language, symbolic thought, attachment, defensive behavioursattachment, defensive behaviours
PhenotypesPhenotypes are the expressed or manifest are the expressed or manifest traits/outputs that are observable or measurabletraits/outputs that are observable or measurable
Examples: Styles of language, attachmentExamples: Styles of language, attachment
Basic Evolutionary OrientationBasic Evolutionary Orientation
Phenotypic vulnerabilitiesPhenotypic vulnerabilities
Normal reactions to abnormal/hostile’ environments e.g.,:Normal reactions to abnormal/hostile’ environments e.g.,: abusive environments develop threat focused phenotypes abusive environments develop threat focused phenotypes Safe environment develop trust, openness phenotypesSafe environment develop trust, openness phenotypes
Multiple systems Multiple systems specialisedspecialised ‘trying to do their best’ thus ‘trying to do their best’ thus protective but can conflictprotective but can conflict
Population variationPopulation variation
Co-constructionsCo-constructions
The ChallengesThe Challenges
1.1. Old brainOld brain
Motives:Motives: Safeness, food, shelter, socialSafeness, food, shelter, social
Emotions:Emotions: Anger, anxiety, sadness, joy, lust Anger, anxiety, sadness, joy, lust
Behaviours:Behaviours: Fight, flight, withdraw, engage Fight, flight, withdraw, engage
Relationships:Relationships: Sex, power, status, Sex, power, status, attachment, attachment, tribalism tribalism
The ChallengesThe ChallengesArchetypes and Social MentalitiesArchetypes and Social Mentalities
Innate tendencies for organising basic psychological Innate tendencies for organising basic psychological processes (motives, emotions, attention, thinking and processes (motives, emotions, attention, thinking and behaving) for the creation of social roles and behaving) for the creation of social roles and relationships relationships
Consider their organisation forConsider their organisation forCare-seekingCare-seekingCare providingCare providingCooperation Cooperation Competition Competition SexualSexual
KEY POINT: Different social mentalities organise our KEY POINT: Different social mentalities organise our minds in different waysminds in different ways
The ChallengesThe Challenges1.1.Old brain Old brain
Motives:Motives: Safeness, food, shelter, socialSafeness, food, shelter, social Emotions:Emotions: Anger, anxiety, sadness, joy, lust Anger, anxiety, sadness, joy, lustBehaviours:Behaviours: Fight, flight, withdraw, engage Fight, flight, withdraw, engageRelationships:Relationships: Sex, power, status, attachment, tribalism Sex, power, status, attachment, tribalism
2. 2. New BrainNew BrainImagination Imagination PlanningPlanningRuminationsRuminationsIntegration of mental abilitiesIntegration of mental abilities
What happens when new brain is recruited to pursue What happens when new brain is recruited to pursue old brain passions?old brain passions?
Sources of behaviourSources of behaviour
Old BrainOld Brain: emotions, behaviours, : emotions, behaviours, relationship seekingrelationship seeking
New BrainNew Brain:: Imagination, Imagination, Planning, Rumination, IntegrationPlanning, Rumination, Integration
The Evolved Brain
Humans are an Evolved SpeciesHumans are an Evolved Species
HumanHuman Symbolic thought and self,Symbolic thought and self,theory of mind, theory of mind, metacognitionmetacognition
MammalianMammalian Caring, group, alliance- Caring, group, alliance- building, play, statusbuilding, play, status
ReptilianReptilian Territory, aggression, Territory, aggression, sex, huntingsex, hunting
The ChallengesThe Challenges3.3. Curse of the selfCurse of the self
Aware and seeking to create a self-identityAware and seeking to create a self-identitySelf As: wants to be, does not want to be Self As: wants to be, does not want to be Shame, sense of personal failure, alienation Shame, sense of personal failure, alienation What you think about meWhat you think about me
4.4. Mammal brain requires nurturing, caring and Mammal brain requires nurturing, caring and kindnesskindness
Affects brain a maturationAffects brain a maturationExperience of safeness and pro-social Experience of safeness and pro-social
behaviourbehaviourPhysiological regulatingPhysiological regulatingHealth and well-beingHealth and well-being
The ChallengesThe Challenges55 Interconnectedness and interdependencyInterconnectedness and interdependency
Co-operation, sharing, trainingCo-operation, sharing, trainingTribalism, group loyalties, Tribalism, group loyalties, Submissive followingSubmissive following
6.6. Individual differencesIndividual differencesPersonalityPersonalityGenderGenderTalentsTalentsEthnicitiesEthnicities
77 Self-to-self-relatingSelf-to-self-relatingImaginationImaginationThinkingThinkingSelf-reflectionsSelf-reflections
Meal
Sexual Bully-threat
Limbic system
Stomach acid
SalviaArousal Fearful
Depressed
Stimulus-ResponseStimulus-Response
Kind, warm and caring
SoothedSafe
Meal Sex Bully- threat
Compassion
The ChallengesThe Challenges88 The Tragedies of LifeThe Tragedies of Life
Death, decay and an awareness of thisDeath, decay and an awareness of thisDiseases, famines, droughts and wars Diseases, famines, droughts and wars
99 MoralitiesMoralitiesJustice vs compassionJustice vs compassionMorality as feeling (and genes)Morality as feeling (and genes)Social conditioningSocial conditioningDevelopmental stageDevelopmental stage
1010 Fear of compassionFear of compassion WeaknessWeakness
IndulgenceIndulgence VulnerableVulnerable
The ChallengesThe Challenges
So basic philosophy is thatSo basic philosophy is that
We all We all just find ourselvesjust find ourselves here with a here with a brain, emotions and sense of self we did brain, emotions and sense of self we did not choose but have to figure outnot choose but have to figure out
‘‘Not our fault’ – all in the same boat –Not our fault’ – all in the same boat –clearly convey – de-pathologisingclearly convey – de-pathologising
Compassion SolutionsCompassion Solutions
Ancient wisdomAncient wisdom
Compassion is the road to happiness Compassion is the road to happiness (Buddhism(Buddhism))
EvolutionEvolution Evolution has made our brains highly Evolution has made our brains highly
sensitive to internal and external kindnesssensitive to internal and external kindness
NeuroscienceNeuroscienceSpecific brain areas are focused on detecting Specific brain areas are focused on detecting and responding to kindness and compassionand responding to kindness and compassion
Key Targets of TherapyKey Targets of Therapy
AttentionAttentionImageryImagery
ThinkingThinkingReasoningReasoning
BehaviourBehaviour
MotivationMotivation EmotionsEmotions
Evolved Dispositions and DesignsEvolved Dispositions and Designs
Types of Affect Regulator SystemsTypes of Affect Regulator Systems
Incentive/resource focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused safety seeking
Activating/inhibitingSerotonin (?)
Anger, anxiety, disgustAnger, anxiety, disgust
Drive, excite, vitalityDrive, excite, vitality Content, safe, connectContent, safe, connect
Key IdeaKey Idea
Various therapies have developed exposure and other Various therapies have developed exposure and other techniques for toning down negative emotions but techniques for toning down negative emotions but not fornot for toning uptoning up certain certain typestypes of positive ones of positive ones. Can’t assume that by . Can’t assume that by reducing negative emotion the positives will ‘come on line.’ reducing negative emotion the positives will ‘come on line.’
Two types of positive affect related to Two types of positive affect related to achievements/doing/excitementsachievements/doing/excitementsaffectionate, soothingaffectionate, soothing
Some clients have major difficulties in being able to access Some clients have major difficulties in being able to access the soothing system - the soothing system - implicationsimplications - so CMT/D targets this - so CMT/D targets this system.system.
Therapeutic PhilosophyTherapeutic PhilosophyWe use a variety of safety strategies, both We use a variety of safety strategies, both innate and learntinnate and learnt(e.g. avoidance, excessive submissiveness, striving to prove (e.g. avoidance, excessive submissiveness, striving to prove oneself) to try to help ourselves get though life’s challengesoneself) to try to help ourselves get though life’s challenges
We can get trapped and stuck in self-protective systems and We can get trapped and stuck in self-protective systems and strategiesstrategies
Compassion Focused TherapyCompassion Focused TherapyTo understand shame and self-attacking as threat and safety To understand shame and self-attacking as threat and safety focusedfocused
Compassion training/therapy is an opportunity to discover Compassion training/therapy is an opportunity to discover and develop our minds to be self soothing – as a way to tone and develop our minds to be self soothing – as a way to tone down and alleviate the impact of shame and self-criticism.down and alleviate the impact of shame and self-criticism.
What is Compassion Focused Therapy?What is Compassion Focused Therapy?
11. CFT draws on many branches of psychology (e.g., . CFT draws on many branches of psychology (e.g., developmental social and evolutionary) and neuroscience developmental social and evolutionary) and neuroscience sciencescience
2. It utilizes interventions derived from many western and 2. It utilizes interventions derived from many western and eastern therapies. eastern therapies.
3. The therapy is not 3. The therapy is not techniquetechnique driven but driven but processprocess driven. driven.
4. The focus is on developing capacities for compassion and 4. The focus is on developing capacities for compassion and balancing the affect regulation systemsbalancing the affect regulation systems
CFT Can InvolveCFT Can Involve
The therapeutic relationship,The therapeutic relationship, collaboration, guided discovery, collaboration, guided discovery,
personal meaning, Socratic dialogues, inference chains – personal meaning, Socratic dialogues, inference chains –
(bottom line/catastrophe/major fear/threat), functional (bottom line/catastrophe/major fear/threat), functional
analysis, chaining analysis, maturation awareness, shared analysis, chaining analysis, maturation awareness, shared
formulation, change through practice, behavioral experiments, formulation, change through practice, behavioral experiments,
exposure, developing emotional tolerance, mindfulness, guided exposure, developing emotional tolerance, mindfulness, guided
imagery, expressive writing, reframing, generating alternative imagery, expressive writing, reframing, generating alternative
thoughts thoughts and and independent out-of –session practice -- to name a independent out-of –session practice -- to name a
few!few!
There There should beshould be increasing overlaps in our therapies if we increasing overlaps in our therapies if we
are being science based.are being science based.
What is helpfulWhat is helpfulCognitive-Behavioural focused therapies help people Cognitive-Behavioural focused therapies help people
distinguish distinguish unhelpfulunhelpful thoughts and behaviours - that thoughts and behaviours - that
increase or accentuate negative feelings - and increase or accentuate negative feelings - and alternative alternative
helpful helpful thoughts and behaviours that do the opposite. thoughts and behaviours that do the opposite.
This approach works well when people experience these This approach works well when people experience these
alternatives alternatives as helpfulas helpful. However, suppose they say “I can . However, suppose they say “I can
see the logic and it should feel helpful but I cannot feel see the logic and it should feel helpful but I cannot feel
reassured by them” or “I reassured by them” or “I know know that I am not to blame but that I am not to blame but
still still feelfeel to blame.” to blame.”
What is helpfulWhat is helpful
This is called the cognition-emotion mismatch. In these This is called the cognition-emotion mismatch. In these
cases, the problem may be that their soothing systems cases, the problem may be that their soothing systems
simply do not register the alternative thoughts as simply do not register the alternative thoughts as
helpful i.e. the opiate / oxytocin system is insufficiently helpful i.e. the opiate / oxytocin system is insufficiently
stimulated and thus they do stimulated and thus they do not feelnot feel reassured. The reassured. The
emotional systems that give rise to emotional systems that give rise to feelings of feelings of
reassurancereassurance are not active enough -- or the threats are are not active enough -- or the threats are
so great that the threat system overrides them. Safeness so great that the threat system overrides them. Safeness
can feel unfamiliar or dangerouscan feel unfamiliar or dangerous
Key MessageKey Message
• We need to feel congruent affect in order for our thoughts to be We need to feel congruent affect in order for our thoughts to be meaningful to us. Thus emotions ‘tag’ meaning onto meaningful to us. Thus emotions ‘tag’ meaning onto experiences. In order for us to be reassured by a thought (say) experiences. In order for us to be reassured by a thought (say) ‘I am lovable’ this thought needs to link with the emotional ‘I am lovable’ this thought needs to link with the emotional experience of ‘being lovable’. If the positive affect system for experience of ‘being lovable’. If the positive affect system for such linkage is not activated there is little feeling to the thought. such linkage is not activated there is little feeling to the thought. People who have few memories/experiences of being lovable or People who have few memories/experiences of being lovable or soothed may thus struggle to feel reassured and safe by soothed may thus struggle to feel reassured and safe by alternative thoughtsalternative thoughts
• Compassion focused therapy therefore targets the activation of Compassion focused therapy therefore targets the activation of the soothing system so that it can be more readily accessed and the soothing system so that it can be more readily accessed and used to help regulate threat based emotions of anger, fear, and used to help regulate threat based emotions of anger, fear, and disgust and shame.disgust and shame. (page 12)
What is the Point of Change?What is the Point of Change?
Clarify the ‘direction of travel’ and the destination: Symptom reduction, achieve a goal, Clarify the ‘direction of travel’ and the destination: Symptom reduction, achieve a goal,
transformation of one’s being - the re-organisation of one’s mind.transformation of one’s being - the re-organisation of one’s mind.
Making a decision that suffering is not desirable – one’s own mind contributes to it (luxury Making a decision that suffering is not desirable – one’s own mind contributes to it (luxury
flat)flat)
If we loose the sense of direction then change process can seem overwhelming and lostIf we loose the sense of direction then change process can seem overwhelming and lost
The importance of cultivation (wild vs cultivated garden)The importance of cultivation (wild vs cultivated garden)
Knowing one’s mind – different levels and types of subject and objective knowing Knowing one’s mind – different levels and types of subject and objective knowing
Change requires courage - purposeful vs purposeless sufferingChange requires courage - purposeful vs purposeless suffering
BuddhistBuddhist
To investigate the nature of consciousness and reside thereTo investigate the nature of consciousness and reside there
The light is not what it illuminates: Water is water whether it The light is not what it illuminates: Water is water whether it
carries a poison or medicinecarries a poison or medicine
Mindfulness helps us reside in consciousness and not contentMindfulness helps us reside in consciousness and not content
Making a decision to reflect on the nature of suffering, it’s Making a decision to reflect on the nature of suffering, it’s
nature and consequencesnature and consequences
Compassionate KnowledgeCompassionate KnowledgeSome Basic ThemesSome Basic Themes
Understand how our minds were designedUnderstand how our minds were designed
If therapy involves psycho-education then what If therapy involves psycho-education then what do we teach clients about how our minds work?do we teach clients about how our minds work?
Evolution-informed and functional and focus Evolution-informed and functional and focus
Two Types of Processing SystemTwo Types of Processing System
ImplicitImplicitFast – AffectFast – Affect
Evolved MechanismsEvolved Mechanisms
Hard to VerbaliseHard to Verbalise
Emotional Memory / Emotional Memory / ConditioningConditioning
Specific Signals Specific Signals
(e.g. NVC)(e.g. NVC)
InvoluntaryInvoluntary
ExplicitExplicitSlowSlow
ReflectiveReflective
Easy to VerbaliseEasy to Verbalise
Emerges with Cognitive Emerges with Cognitive CompetenciesCompetencies
Learn (social) RulesLearn (social) Rules
VoluntaryVoluntary
These systems interact but can conflict. Therapy should work with both systems and may require different
interventions
Workshop OutlineWorkshop Outline
First legFirst leg• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Identifying Critical Dialogues &
Associated AffectsAssociated Affects• The Diagrammatic Model / The Diagrammatic Model /
FormulationFormulation
Self-Protection: A Design for LifeSelf-Protection: A Design for Life
All organisms are structured for self-All organisms are structured for self-protection: protection:
Safe --- Not safeSafe --- Not safe
Better safe than sorry: Our Minds are Better safe than sorry: Our Minds are designed to easily assume the worst -saferdesigned to easily assume the worst -safer
ThreatThreat No Yes
Run
Don’t Run
Act
ion
Self-ProtectionSelf-ProtectionIn species without attachment only 1-2% In species without attachment only 1-2%
makemake it to adulthood to reproduce. Threats it to adulthood to reproduce. Threats come from ecologies, food shortage, come from ecologies, food shortage, predation, injury, disease. At birth predation, injury, disease. At birth individuals must be able to “go it alone” be individuals must be able to “go it alone” be mobile and dispersemobile and disperse
Over millions of years a variety of Over millions of years a variety of fastfast detection and detection and response systems have been built into animal and human response systems have been built into animal and human minds to cope with a variety of threats and are the basis minds to cope with a variety of threats and are the basis for UCSs and UCRs for UCSs and UCRs
Threat responses need to match the stimuli and contextThreat responses need to match the stimuli and context
Menu of Defensive / Protective Menu of Defensive / Protective Strategies linked to Coordinated set Strategies linked to Coordinated set
of:of:
MotivesMotives
EmotionsEmotions
BehavioursBehaviours
Cognitive ProcessesCognitive Processes
Self-Protective Motivations/DrivesSelf-Protective Motivations/Drives
Get or stay safeGet or stay safe
Damage limitation vs enhancementDamage limitation vs enhancement
Hold on to what one hasHold on to what one has
Act to reduce future threatAct to reduce future threat
Menu of Implicit Threat - Protective Emotions Menu of Implicit Threat - Protective Emotions
Anger –Anger – increase effort and signal threatincrease effort and signal threat
Anxiety –Anxiety – alert to danger and select alert to danger and select defensive behaviour defensive behaviour
Disgust –Disgust – expel / keep away from noxious or expel / keep away from noxious or undesirable undesirable
Sadness –Sadness – acknowledge loss, signal distressacknowledge loss, signal distress
Jealousy –Jealousy – threaten and defendthreaten and defend
Envy –Envy – undermine / spoil benefits of the undermine / spoil benefits of the
otherother
Menu of Defensive / Protective BehavioursMenu of Defensive / Protective Behaviours
Stop - Hyper-alert/ hyper vigilance – predict threat earlyStop - Hyper-alert/ hyper vigilance – predict threat earlyFlight - Escape, prevent exposure (Cannon 1929)Flight - Escape, prevent exposure (Cannon 1929)Fight - Protection or deterrent – subdue others / exert Fight - Protection or deterrent – subdue others / exert
control control
Hiding and camouflageHiding and camouflageTonic immobility – ‘play dead’ (Bracha 2004)Tonic immobility – ‘play dead’ (Bracha 2004)Cut off - turning away fromCut off - turning away fromDemobilisation -- short-term and long-termDemobilisation -- short-term and long-term
Clinging ‘on to’Clinging ‘on to’Help seeking - hyper activation of proximity seekingHelp seeking - hyper activation of proximity seekingSubmission - appease, comply Submission - appease, comply
Menu of Defensive / ProtectiveMenu of Defensive / Protective Cognitive ProcessesCognitive Processes
Better Safe than Sorry requires rapid decisionsBetter Safe than Sorry requires rapid decisions
•Selective attention - scan for threatSelective attention - scan for threat
•Crude analysis Crude analysis
•Dichotomous thinkingDichotomous thinking
•Over-generalisationOver-generalisation
•Disqualify positive – can’t risk false hopeDisqualify positive – can’t risk false hope
•Sensitive to nonverbal signalsSensitive to nonverbal signals
Helps select automatic appropriate defence (e.g., flight, submit Helps select automatic appropriate defence (e.g., flight, submit or attack)or attack)
May be into process before conscious awareness e.g., we find May be into process before conscious awareness e.g., we find ourselves submitting and then make self-referent explanationourselves submitting and then make self-referent explanation
Neural Bases of Threat Processing Neural Bases of Threat Processing (LeDoux, 1994)(LeDoux, 1994)
Hippocampus
Amygdala
Cerebralcortex
The Complexity of the Threat The Complexity of the Threat SystemSystem
1) Different processing systems active1) Different processing systems active
2) Threat emotions can set up conflicts2) Threat emotions can set up conflicts
- The power of approach-avoidance - The power of approach-avoidance conflicts conflicts
3) One protection strategy creates another3) One protection strategy creates another
4) Emotional Conditioning4) Emotional Conditioning
2) Threat Emotions can set up Conflicts2) Threat Emotions can set up ConflictsThreat – boss criticises Threat – boss criticises
your workyour work
Rapid access of safety Rapid access of safety strategiesstrategies
Angry-attack Angry-attack revengerevenge
Anxious - flee Anxious - flee submitsubmit
Threat to self-identity and self as Threat to self-identity and self as social agent in social rolesocial agent in social role
Cry want to seek Cry want to seek reassurancereassurance
Fragmented and fragmenting, confused and secondary Fragmented and fragmenting, confused and secondary safety strategies at management of inner conflictssafety strategies at management of inner conflicts
Conflicts Conflicts (e.g. Approach-Avoidance)(e.g. Approach-Avoidance)
Experimental neurosis – trigger two different behaviours at Experimental neurosis – trigger two different behaviours at same time e.g., seek reward and avoid threat – Pavlov, Liddell same time e.g., seek reward and avoid threat – Pavlov, Liddell & Cooke etc& Cooke etc
Incompatible decisions – choosing one violates another: Incompatible decisions – choosing one violates another: Disorganisation of systems (also classic Sci-fi; Hale in 2001 a Disorganisation of systems (also classic Sci-fi; Hale in 2001 a Space Odyssey and 2010 the Return)Space Odyssey and 2010 the Return)
Dilemmas (e.g., risk change or trust vs stay safe); head heartDilemmas (e.g., risk change or trust vs stay safe); head heart
Increase in stress arousal and inhibits abilities to think – Increase in stress arousal and inhibits abilities to think – dissociation. Confusing to client and therapist (Liotti..)dissociation. Confusing to client and therapist (Liotti..)
Therapeutic task is to clearly articulate the conflict, explain Therapeutic task is to clearly articulate the conflict, explain how conflict affects the brain, and then brain storm – May how conflict affects the brain, and then brain storm – May take time to work through – resolution may not be easy – hard take time to work through – resolution may not be easy – hard life decisions.life decisions.
4) One Protection Strategy Creates Another4) One Protection Strategy Creates Another
Express feelingsExpress feelings Don’t express feelings Don’t express feelings
Others angryOthers angry Others ignore Others ignore
RejectReject my wishes my wishes
Feel badFeel bad Feel bad Feel bad
5) Emotional Conditioning5) Emotional Conditioning
How emotions and desires can become non-conscious How emotions and desires can become non-conscious (Ferster 1973)(Ferster 1973)
Anger PunishmentAnger Punishment
AnxietyAnxiety
Any emotion or motivation (urge) can become a CS of Any emotion or motivation (urge) can become a CS of any otherany other
ConditioningConditioning
Care seeking Care seeking PunishmentPunishment
AnxietyAnxiety
Care seeking systems can become conditioned Care seeking systems can become conditioned to threat rather than safeness. If happens to threat rather than safeness. If happens early, people may not recall specific memories early, people may not recall specific memories but experience confusing feelings in close but experience confusing feelings in close relationshipsrelationships
ConditioningConditioning
Care seeking Care seeking No responseNo response
shut downshut down
Own Behaviours as ThreatsOwn Behaviours as ThreatsAnxiety can be an alerting signal for not to do something –a Anxiety can be an alerting signal for not to do something –a ‘don’t’ signal.‘don’t’ signal.
Brain can also automatically change the balance of emotional Brain can also automatically change the balance of emotional regulation as in Protest-Despair. regulation as in Protest-Despair.
Infants separated from caregiver first shows protest (pining Infants separated from caregiver first shows protest (pining and anxiety) but then becomes quite and withdrawn – this and anxiety) but then becomes quite and withdrawn – this stops movement, getting lost, and attracting attention of stops movement, getting lost, and attracting attention of predatorspredators
Toning down of positive emotions most likely in poorly Toning down of positive emotions most likely in poorly supportive, low pay off and/or risky environments –supportive, low pay off and/or risky environments –
So what is the protective strategy underpinning low mood?So what is the protective strategy underpinning low mood?
Source of threatSource of threatExternalExternal
Shared with other animals focus on the outside and how to Shared with other animals focus on the outside and how to
behave in the outside world to minimise threat and harmbehave in the outside world to minimise threat and harm
InternalInternalCan be threatened by the emergence of internal emotions, Can be threatened by the emergence of internal emotions,
desires fantasies and memories desires fantasies and memories
Both can be very clear or very subtle threatsBoth can be very clear or very subtle threats
Emotions as Internal Threat StimuliEmotions as Internal Threat Stimuli
Emotions are evolved, specialised processing systems that provide Emotions are evolved, specialised processing systems that provide internal knowledge about our relationship to the outside world and internal knowledge about our relationship to the outside world and guide actions (Greenberg)guide actions (Greenberg)
Without emotions nothing matters, with them anything can (Tomkins). Without emotions nothing matters, with them anything can (Tomkins). Motives and emotions guide us to goals and are non-logical (e.g., falling Motives and emotions guide us to goals and are non-logical (e.g., falling in love, wanting children, grief).in love, wanting children, grief).
Human evolution has resulted in the fact that we cannot learn about Human evolution has resulted in the fact that we cannot learn about our emotions or develop integrated systems for emotional processing our emotions or develop integrated systems for emotional processing without the minds of others interacting with uswithout the minds of others interacting with us
Parent is the only regulator in first months and then becomes a coach, Parent is the only regulator in first months and then becomes a coach, source for social referencing and validator.source for social referencing and validator.
Emotional schemas (Leahy)Emotional schemas (Leahy)
Can develop threat based beliefs and coping strategies for Can develop threat based beliefs and coping strategies for emotions and desires that emerge from how we experience emotions and desires that emerge from how we experience our own emotions and others responses to themour own emotions and others responses to them
Emotions can become threats themselves related to beliefs Emotions can become threats themselves related to beliefs that one’s desires, fantasies and emotions are that one’s desires, fantasies and emotions are incomprehensible, unique to the self, shameful, can never be incomprehensible, unique to the self, shameful, can never be validated or expressed and /or that one’s emotions will go out validated or expressed and /or that one’s emotions will go out of control if experienced. Beliefs that one should be rational of control if experienced. Beliefs that one should be rational and logical all the time, never have conflicting feelings, and and logical all the time, never have conflicting feelings, and should ruminate in order to figure things out. Ruminations should ruminate in order to figure things out. Ruminations can be a way to try to work things out without needing help can be a way to try to work things out without needing help (soothing) from others (soothing) from others
Emotions: anger anxiety sexual sadness
Attention to emotion
Emotion is normalCognitive avoidance Negative Interpretations:
guilt lack of consensus with others simplistic view incomprehensible cannot accept emotion overly rational
accept, express, experience validation learn
lose control long duration
rumination worry avoid situations that elicit emotions blame others
Emotion is problematic
dissociation bingeing drinking drugs numbness
From Leahy 2001
Problems of balanceProblems of balance
Examples of Threat-protection focused difficultiesExamples of Threat-protection focused difficulties
Triggers, intensity, duration, frequency, copingTriggers, intensity, duration, frequency, coping
Emotion containmentEmotion containment
ImpulsivenessImpulsiveness
Emotional, cognitive and behavioral avoidanceEmotional, cognitive and behavioral avoidance
PredictionPrediction
RuminationRumination
Self-Protection Self-Protection
All organisms are structured for self-protection: Safe --- All organisms are structured for self-protection: Safe --- Not safe. Thus high priority and urgency are given to this Not safe. Thus high priority and urgency are given to this decision in all biological systemsdecision in all biological systems
Symptoms often arise from perceived threats and efforts to Symptoms often arise from perceived threats and efforts to cope defend and protectcope defend and protect
Some phenotypes have undesirable effects and are linked to Some phenotypes have undesirable effects and are linked to sufferingsuffering
Resistance is related to threat of change – fears of ‘new’ selfResistance is related to threat of change – fears of ‘new’ self
These are shared views of many therapiesThese are shared views of many therapies
Language of Language of self-protectionself-protection and and better safe than sorrybetter safe than sorry and and validation rather than pathologisingvalidation rather than pathologising
Workshop OutlineWorkshop Outline
• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems
• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Associated Identifying Critical Dialogues & Associated
AffectsAffects• The Diagrammatic Model / FormulationThe Diagrammatic Model / Formulation
Safeness: A missing Safeness: A missing Component?Component?
Feeling safe from physical, psychological and self- Feeling safe from physical, psychological and self- attack is essential for well-beingattack is essential for well-being
Consider process and mechanisms that create Consider process and mechanisms that create states of safenessstates of safeness
Overview of an EvolutionaryOverview of an EvolutionaryJourneyJourney
AttachmentAttachment
Threat SafenessSafeness Compassion
Mutual supportMutual support
Self -Regulation
Qualities of CareQualities of Care
Accessibility of the otherAccessibility of the other Availability of the otherAvailability of the other
Disposition of the other Disposition of the other Competencies of the otherCompetencies of the other
Interpersonal style of otherInterpersonal style of other How one exists in the How one exists in the mind of the othermind of the other
Self-vs-others protectionSelf-vs-others protection
Attachment as “looking after.” Individuals Attachment as “looking after.” Individuals obtain protection, food and care when ill. obtain protection, food and care when ill. Seeking closeness rather than dispersion. Key Seeking closeness rather than dispersion. Key also is also is soothing-calmingsoothing-calming and physiological and physiological
regulation.regulation. Few offspring but high survival rate Few offspring but high survival rate in comparison to species without attachment in comparison to species without attachment
Co-operative and mutual support when ‘your’ Co-operative and mutual support when ‘your’ prosperity impacts on mineprosperity impacts on mine
Safeness vs SafetySafeness vs Safety
Safety SeekingSafety Seeking is often about escaping, avoiding, is often about escaping, avoiding, hiding, preventing - when threat is the focus of attention hiding, preventing - when threat is the focus of attention (better thought of as defensive behaviour). Highly (better thought of as defensive behaviour). Highly conditionableconditionable
SafenessSafeness creates an inner state that organizes multiple creates an inner state that organizes multiple processesprocesses
Free(dom): Free(dom):
To move, to grow, explore, integrate, slow reflectiveTo move, to grow, explore, integrate, slow reflective
Open attentionOpen attention
Evolution of SafenessEvolution of SafenessMastery, De-sensitisation, Familiarization - mindfulnessMastery, De-sensitisation, Familiarization - mindfulness
Social Safeness Social Safeness Can be passive or active –freedom of movement, Can be passive or active –freedom of movement, explorativeexplorative
Attachments Attachments
Group living --- BelongingGroup living --- Belonging
ConnectednessConnectedness
Signal-sensitive systemsSignal-sensitive systems to detect presence and absenceto detect presence and absence
Soothing, calming or alerting of affiliative emotionSoothing, calming or alerting of affiliative emotion
Emotion System for CareEmotion System for Care
Evolved motivations to care, and competencies to Evolved motivations to care, and competencies to care, by attuning to needs of the other and care, by attuning to needs of the other and engaging behaviour that impacts on the object of engaging behaviour that impacts on the object of carecare
Being Cared ForBeing Cared ForInnate, signal sensitive systems that seek out and Innate, signal sensitive systems that seek out and are responsive to certain stimuli and cuesare responsive to certain stimuli and cues
These specialised physiological systems detect These specialised physiological systems detect (evolved form contentment) code for “safeness”(evolved form contentment) code for “safeness”
Types of Affect Regulator SystemsTypes of Affect Regulator Systems
Incentive/resource focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused safety seeking
Activating/inhibitingSerotonin (?)
Anger, anxiety disgustAnger, anxiety disgust
Drive, excite, vitalityDrive, excite, vitality Content, safe, connectContent, safe, connect
Functions of Caring-Attachments - Needs Functions of Caring-Attachments - Needs SensitivitySensitivity
The Carer-Provider offers……The Carer-Provider offers……
Protection:Protection: anticipating/preventing; build nest out of harms anticipating/preventing; build nest out of harms way, defending/standing up for – advocateway, defending/standing up for – advocateDistress call responsive:Distress call responsive: listening out for;listening out for; rescuing; coming to rescuing; coming to the aid of – responding to distressthe aid of – responding to distressProvision:Provision: physical care, hygiene, food, physical care, hygiene, food, AffectionAffection:: warmth positive affects that acts as key inputs for warmth positive affects that acts as key inputs for brain maturationbrain maturationEducation and Validation:Education and Validation: teach/learn life skills in family teach/learn life skills in family context: understanding one’s own mindcontext: understanding one’s own mindInteraction:Interaction: being present, stimulating and regulating being present, stimulating and regulating various affect systems: curiosity, play, soothing – socialising various affect systems: curiosity, play, soothing – socialising agent –shaping phenotypesagent –shaping phenotypes
Key Sources of SafenessKey Sources of Safeness
Safeness is Safeness is notnot just the absence of threat but there are specialised systems just the absence of threat but there are specialised systems in the brain linked to social cues. Thus soothing systems are regulated via in the brain linked to social cues. Thus soothing systems are regulated via differ pathways.differ pathways.
First are cues of First are cues of physicalphysical affection (facial, holding, touch comforting) – affection (facial, holding, touch comforting) – highly sensory basedhighly sensory based
Second needs can be meet, soothed and contentedSecond needs can be meet, soothed and contented
Third, learning how we Third, learning how we live in the minds of others – live in the minds of others – and learn about our and learn about our own mind -- ‘your reactions to my mind’own mind -- ‘your reactions to my mind’
Fourth social referencing for what is safe – the self to becomeFourth social referencing for what is safe – the self to become
Fifth create Fifth create internal memoriesinternal memories of others as soothing supportive, kind and of others as soothing supportive, kind and forgiving and self as lovableforgiving and self as lovable
All these play different roles in threat regulation and feeling safe/contentAll these play different roles in threat regulation and feeling safe/content
SafenessSafenessCarer creates a safe base – and provides inputs for working Carer creates a safe base – and provides inputs for working models of relationships (Bowlby)models of relationships (Bowlby)
Parent and peers regulate exposure to Parent and peers regulate exposure to external threatsexternal threats - and - and loss of access is itself a threat loss of access is itself a threat
Parent and peers regulate Parent and peers regulate internal threatinternal threat states – soothing - states – soothing - and facilitate internal self-regulationand facilitate internal self-regulation
Key to CFT however are the data on the neurophysiological Key to CFT however are the data on the neurophysiological systems responsive to care-focused and safeness signals from systems responsive to care-focused and safeness signals from othersothers
Workshop OutlineWorkshop Outline
• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component
• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Associated Identifying Critical Dialogues & Associated
AffectsAffects• The Diagrammatic Model / FormulationThe Diagrammatic Model / Formulation
Living in the Minds of OthersLiving in the Minds of OthersMajor evolved specialised processing systems and Major evolved specialised processing systems and abilities (linked to inter-subjectivity and theory of abilities (linked to inter-subjectivity and theory of mind)mind)
Long history of recognizing the importance of how Long history of recognizing the importance of how (we think) we exist in the minds of other (we think) we exist in the minds of other
Clear in play writers and novelists (e.g., Clear in play writers and novelists (e.g., Shakespeare) – and key for: Shakespeare) – and key for:
Cooley, Rogers, Bowlby, KohutCooley, Rogers, Bowlby, Kohut
Living in the Mind of OthersLiving in the Mind of Others
Colley 1902 Looking Glass Self:Colley 1902 Looking Glass Self:
Many people of balanced mind and congenial activity Many people of balanced mind and congenial activity scarcely know that they care about what others think scarcely know that they care about what others think of them, and will deny, perhaps with indignation, that of them, and will deny, perhaps with indignation, that such care is an important factor in what they are and such care is an important factor in what they are and do. But this is illusion. If failure or disgrace arrives, if do. But this is illusion. If failure or disgrace arrives, if one suddenly finds that the faces of men show one suddenly finds that the faces of men show coldness and contempt instead of the kindness and coldness and contempt instead of the kindness and deference that he is used to, he will perceive from deference that he is used to, he will perceive from shock, the fear, the sense of being outcast and shock, the fear, the sense of being outcast and helpless, that he was living in the minds of others helpless, that he was living in the minds of others without knowing it, just as we daily walk the solid without knowing it, just as we daily walk the solid ground without thinking of how it bears us upground without thinking of how it bears us up
Key Shame ConceptsKey Shame Concepts
Exercise 1Exercise 1
Insight ExerciseInsight Exercise• To help you recognise the complexities of To help you recognise the complexities of
shame and also see that shame and also see that you already have you already have intuitive knowledge of shameintuitive knowledge of shame, we would like to , we would like to you to engage in a short imagery exercise. you to engage in a short imagery exercise.
• Let’s take a Let’s take a hypotheticalhypothetical situation: Imagine that situation: Imagine that as part of this workshop you will be asked to as part of this workshop you will be asked to describe something you feel ashamed about, describe something you feel ashamed about, and would rather keep hidden, to the person and would rather keep hidden, to the person sitting next to you. We would like you to sitting next to you. We would like you to explore this is a series of steps. Rest assured explore this is a series of steps. Rest assured this is hypothetical, but try to imagine it as if it this is hypothetical, but try to imagine it as if it were to be the casewere to be the case..
Strategies for Gaining and Strategies for Gaining and Maintaining Rank and StatusMaintaining Rank and Status
StrategyStrategy AggressionAggression AttractivenessAttractivenessTactics usedTactics used CoerciveCoercive Show TalentShow Talent
ThreateningThreatening Show competenceShow competenceAuthoritarianAuthoritarian AffiliativeAffiliative
Outcome desiredOutcome desired To be obeyedTo be obeyed To be valuedTo be valuedTo be reckoned withTo be reckoned with To be chosenTo be chosenTo be submitted toTo be submitted to To be freely given toTo be freely given to
Purpose of strategyPurpose of strategy To inhibit othersTo inhibit others To inspire, attract To inspire, attract othersothers
To stimulate fearTo stimulate fear To stimulate positive To stimulate positive affectaffect
From Gilbert & McGuire 1998From Gilbert & McGuire 1998
Safeness and the minds of othersSafeness and the minds of othersCreating positive feelings and thoughts in the minds of others, about oneself, makes Creating positive feelings and thoughts in the minds of others, about oneself, makes
the world safethe world safe
safe and will not rejected or attackedsafe and will not rejected or attacked
likely to be available in time of needlikely to be available in time of need
co-create advantageous relationships (e.g., sexual, co-operative)co-create advantageous relationships (e.g., sexual, co-operative)
physiologically regulating (e.g. oxytocin, cortisol)physiologically regulating (e.g. oxytocin, cortisol)
stimulates positive feelings for self and otherstimulates positive feelings for self and other
lay down emotional memories of warmthlay down emotional memories of warmth
External shame is experiencing negative feelings (contempt, anger, ridicule) in the External shame is experiencing negative feelings (contempt, anger, ridicule) in the minds of others lead to attack, rejection or ‘un-included’minds of others lead to attack, rejection or ‘un-included’
major threatmajor threat --- --- generating defensive behaviours such as,generating defensive behaviours such as,
fight/flight/submitfight/flight/submit
Primary Emotions
Rage/anger
Fear/anxiety
Disgust sadness
Happiness
Joy Fun
From 2 yrs old - Self conscious competencies
recognise self as an object for others, theory of mind,
awareness of the contingencies for approval and disapproval,
role taking and understanding social rules, metacognition
Shame Guilt
Embarrassment
Humiliation
Pride
Self-Conscious Emotions
Attracting, Competition and Social RankAttracting, Competition and Social Rank
Competing for resources and social place and thus Competing for resources and social place and thus be able to engage others as be able to engage others as helpful partners in roleshelpful partners in roles
Helpful partners (expressing liking) also help Helpful partners (expressing liking) also help make make the world safe and stimulates soothing systemthe world safe and stimulates soothing system
Competing to stimulate positive affect (desires) in Competing to stimulate positive affect (desires) in the mind of others about the self is competitive the mind of others about the self is competitive because because an audience will choose in their best an audience will choose in their best interests toointerests too
The Undesired/Unattractive SelfThe Undesired/Unattractive Self
…….. .. when ashamed, participants talked about being who they did when ashamed, participants talked about being who they did
notnot want to be. That is, they experienced themselves as embodying want to be. That is, they experienced themselves as embodying
an anti-ideal, rather than simply not being who they wanted to be. an anti-ideal, rather than simply not being who they wanted to be.
The participants said things like. "I am fat and ugly," The participants said things like. "I am fat and ugly," not not "I "I
failed to be pretty;" or "I am bad and evil,"failed to be pretty;" or "I am bad and evil," not not "I am not as "I am not as
good as I want to be." This difference in emphasis is not simply good as I want to be." This difference in emphasis is not simply
semantic. Participants insisted that the distinction was semantic. Participants insisted that the distinction was
important...... important......
(Lindsay-Hartz, de Rivera and Mascolo (1995(Lindsay-Hartz, de Rivera and Mascolo (1995 p. 277 )p. 277 )
It is therefore not so much failing to meet standards but the It is therefore not so much failing to meet standards but the
meaning and experience of self from seeking and falling shortmeaning and experience of self from seeking and falling short
Types of Affect Regulator SystemsTypes of Affect Regulator Systems
Incentive/resource focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused safety seeking
Activating/inhibitingSerotonin (?)
Anger, anxiety disgustAnger, anxiety disgust
Drive, excite, vitalityDrive, excite, vitality Content, safe, connectContent, safe, connect
A Cost of Evolving Self-AwarenessA Cost of Evolving Self-Awareness The evolution of self-conscious and self-awareness is linked The evolution of self-conscious and self-awareness is linked to humans becoming more flexible, sharing, mutually to humans becoming more flexible, sharing, mutually influenced beings with ‘de-modularised, systems influenced beings with ‘de-modularised, systems intelligence's’. intelligence's’.
But it also means we live in a private world (alone). We can But it also means we live in a private world (alone). We can ‘only exist/be’ in our own minds - others can never actually ‘only exist/be’ in our own minds - others can never actually know us – and only relate to them as ‘other’ and outside. know us – and only relate to them as ‘other’ and outside.
So we must relay on signals, inference and trust. Thus the So we must relay on signals, inference and trust. Thus the importance of importance of
secure attachmentsecure attachmentinsecure attachmentinsecure attachment
Threat Responses in Social-ContextsThreat Responses in Social-Contexts
EmbarrassmentEmbarrassment
External shameExternal shame
Internal shameInternal shame
HumiliationHumiliation
GuiltGuilt
Types of Negative SelfTypes of Negative Self--ConsciousConscious Experience: EmbarrassmentExperience: Embarrassment
1.1. In embarrassment we focus on behavioural In embarrassment we focus on behavioural faux pasfaux pas not major flaws in the self. not major flaws in the self.
2.2. The experience is often transitory, and can The experience is often transitory, and can ignite a humorous response in observers – ignite a humorous response in observers – and even ourselves after the event.and even ourselves after the event.
3.3. We cover embarrassment with smiles and We cover embarrassment with smiles and displays of modesty and embarrassment.displays of modesty and embarrassment.
4.4. We ‘hang our head’ in shame.We ‘hang our head’ in shame.
Embarrassment
Shame is a self-conscious Shame is a self-conscious emotionemotion
It is an emotion It is an emotion aboutabout the self. It depends of the self. It depends of
certain types of mental abilities that include a form of certain types of mental abilities that include a form of
self-awareness and theory of mind of ‘how we exist in the self-awareness and theory of mind of ‘how we exist in the
minds of others’ – and our ability minds of others’ – and our ability to imagineto imagine a self and a a self and a
self as thought about by othersself as thought about by others
Shame recruits various negative and threat based Shame recruits various negative and threat based
emotions into the experience of self (e.g., anger, anxiety, emotions into the experience of self (e.g., anger, anxiety,
and disgust). It is not a separate emotion but a cognitive-and disgust). It is not a separate emotion but a cognitive-
emotion blend.emotion blend.
Components of ‘Shame’Components of ‘Shame’
1.1. Social and eternally focusedSocial and eternally focused – on self in the – on self in the mind of the other.mind of the other.
2.2. Internally focusedInternally focused – oneself as felt and judged – oneself as felt and judged by selfby self
3.3. Emotions Emotions – anger, anxiety and disgust We – anger, anxiety and disgust We ‘hang our head’ in shame.‘hang our head’ in shame.
4.4. BehavioursBehaviours –avoid, hide. shut-down, attack –avoid, hide. shut-down, attack
5.5. Physiological profiles – Physiological profiles – forms of arousal and forms of arousal and activation – high cortisol responseactivation – high cortisol response
Types of Negative SelfTypes of Negative Self--ConsciousConscious Experience: External ShameExperience: External Shame
What one thinks others think/feel about oneselfWhat one thinks others think/feel about oneself
Believes the self is looked down on by others, seen as inferior, Believes the self is looked down on by others, seen as inferior, inadequate or bad – as a socially unattractive/undesirableinadequate or bad – as a socially unattractive/undesirableagent/person.agent/person. Believes others may feel anger, anxiety, contempt, disgust or Believes others may feel anger, anxiety, contempt, disgust or ridiculing humour for the self.ridiculing humour for the self.
Shame feelings may blend with feeling socially anxious, depressedShame feelings may blend with feeling socially anxious, depressedor angry – but possible to have relative indifference.or angry – but possible to have relative indifference.
Types of Negative SelfTypes of Negative Self--ConsciousConscious Experience: Internal ShameExperience: Internal Shame
What one thinks/feels about oneselfWhat one thinks/feels about oneself
Believes the self is personally inferior, inadequate or Believes the self is personally inferior, inadequate or bad. Negative social comparison. Internal bad. Negative social comparison. Internal attributions attributions
A socially unattractive agent – an undesirable self.A socially unattractive agent – an undesirable self.
Internal shame blends with feeling angry, anxious, Internal shame blends with feeling angry, anxious, contempt or disgust with the self. Internal shamingcontempt or disgust with the self. Internal shaming
Types of Negative SelfTypes of Negative Self--ConsciousConscious Experience: HumiliationExperience: Humiliation
Feels attacked, devalued, put-down by othersFeels attacked, devalued, put-down by others
However, may However, may notnot focus on self as personally inferior, focus on self as personally inferior, nor as undesirable self. See the other as bad or nor as undesirable self. See the other as bad or unjustified for attacks, put-down. External unjustified for attacks, put-down. External attributionsattributions
May May feelfeel anger, anxiety, contempt, and disgust to the anger, anxiety, contempt, and disgust to the other – often strong sense of injustice with desire for other – often strong sense of injustice with desire for revenge.revenge.
..
Social-cultural contexts, cultural rules for honour/pride/shameSocial-cultural contexts, cultural rules for honour/pride/shame
PERSONAL EXPERIENCES OF SHAMING - PERSONAL EXPERIENCES OF SHAMING - STIGMASTIGMA
Family: Criticism, high expressed emotion, negative labelling, abuse
Social group: Bullying, discrimination, prejudice, stigma
External ShameExternal Shamedevalued by otherdevalued by otherExcluded, avoided Excluded, avoided criticised, NAMOscriticised, NAMOs
HumiliationHumiliation
other-devaluationother-devaluationexternal attributionexternal attribution
unjust - revenge/angerunjust - revenge/anger
Internalised ShameInternalised Shame
self-devaluationself-devaluation
internal attributioninternal attribution
depressed/anxiousdepressed/anxious
reflected stigma (to family or others)rejection by the community
Innate motives for attachment and group belonging; Innate motives for attachment and group belonging; needs to stimulate positive affect in the minds of others; needs to stimulate positive affect in the minds of others;
Unfolding cognitive competencies for self-evaluationsUnfolding cognitive competencies for self-evaluations
Comparing Shame and GuiltComparing Shame and Guilt(often fused to varying degrees)(often fused to varying degrees)
Shame is linked to the competitive mentality thus to social Shame is linked to the competitive mentality thus to social comparison, sensitivity to put down and rank linked comparison, sensitivity to put down and rank linked defences of attack or submission avoidance (high defences of attack or submission avoidance (high association to psychopathologyassociation to psychopathology))
Guilt is linked to the care-giving, cooperative mentalities Guilt is linked to the care-giving, cooperative mentalities and focused on specific behaviours and is thus linked to and focused on specific behaviours and is thus linked to harm avoidance, taking responsibility, reparations (often harm avoidance, taking responsibility, reparations (often negative relationship to psychopathology) negative relationship to psychopathology)
Repairing shame opens possibilities for guiltRepairing shame opens possibilities for guilt
THE FOCI OF SHAMETHE FOCI OF SHAMESHAME CAN HAVE A SPECIFIC OR SHAME CAN HAVE A SPECIFIC OR
GENERALISED FOCUSGENERALISED FOCUSThe bodyThe body The body in action and functionsThe body in action and functions
FailuresFailures Relationships/rolesRelationships/roles
Feelings/fantasises Feelings/fantasises Coping/needingCoping/needing
Past events Past events Group based (stigma Cons)Group based (stigma Cons)
Self asSelf as lacking, as different, bad, powerless , defined by otherlacking, as different, bad, powerless , defined by other
Examples of Coping with Examples of Coping with
Shame/InferiorityShame/Inferiority Compensation:Compensation: Making up for deficitsMaking up for deficits
Concealment:Concealment: Hiding things ‘from view’Hiding things ‘from view’
Aggression:Aggression: Threaten others to ‘never notice’ Threaten others to ‘never notice’ Externalise - ‘not on me’Externalise - ‘not on me’
Avoidance:Avoidance: Avoid situation/encounters where Avoid situation/encounters where shame affects may ariseshame affects may arise
Projection:Projection: Others see me as I see myself:Others see me as I see myself:Shame othersShame others
Dissociation:Dissociation: Acting without feeling, separating Acting without feeling, separating
Numbing Numbing Substance misuseSubstance misuse
Shame as a Distance RegulatorShame as a Distance Regulator
Need to hide or be alone when I feel badNeed to hide or be alone when I feel bad
Don’t want others to see me this wayDon’t want others to see me this way
Don’t want others to be the worst for seeing meDon’t want others to be the worst for seeing me
Bad to cry, lose control or be aggressiveBad to cry, lose control or be aggressive
But when he left the ward (safety behaviour)But when he left the ward (safety behaviour)
I’m isolated, feel alone misunderstood, no-one I’m isolated, feel alone misunderstood, no-one to help. It is pointless. Angry with self and to help. It is pointless. Angry with self and everyone. I hate feeling like thiseveryone. I hate feeling like this
What makes shame so aversive?What makes shame so aversive? ** Shame is a normal emotion and some degree of it is Shame is a normal emotion and some degree of it is helpful for everyday functioning (imagine a ‘shameless’ helpful for everyday functioning (imagine a ‘shameless’ person)person)
** Archetypal and innate threat of rejection and social Archetypal and innate threat of rejection and social exclusion – major survival risk -- so our brains are highly exclusion – major survival risk -- so our brains are highly sensitive to itsensitive to it
** Early experiences of being shamed often linked with Early experiences of being shamed often linked with powerful, hostile, rejecting others. The context of being powerful, hostile, rejecting others. The context of being shamed was one of threat –thus trauma memories.shamed was one of threat –thus trauma memories.
** Damage may be long-term (e.g., to a reputation). Damage may be long-term (e.g., to a reputation). Social contextsSocial contexts
** Different safety strategies for coping with shame (e.g., Different safety strategies for coping with shame (e.g., concealment, compensation, avoidance). Safety strategies concealment, compensation, avoidance). Safety strategies can inhibit learning helpful coping and acceptancecan inhibit learning helpful coping and acceptance
The Dance of ShameThe Dance of Shame When activated in interactions people shift to automatic When activated in interactions people shift to automatic threat-focused processing – little reflective thoughtthreat-focused processing – little reflective thought
Easily spiral out of control and then defences become more Easily spiral out of control and then defences become more extreme (dominate-subordinate). An interaction-amplifying extreme (dominate-subordinate). An interaction-amplifying spiralspiral
Feel damaged or have damaged relationship and now not Feel damaged or have damaged relationship and now not know how to repair and/or back to shame - so stay know how to repair and/or back to shame - so stay dissociated, avoid, minimise, externalise, ruminatedissociated, avoid, minimise, externalise, ruminate
Therapy: normalise then careful micro-analysis of Therapy: normalise then careful micro-analysis of behaviour - noting threat-self protection as focus. Role behaviour - noting threat-self protection as focus. Role switching – compassion focusing, forgiveness CH.switching – compassion focusing, forgiveness CH.
Types of Negative SelfTypes of Negative Self--ConsciousConscious Experience: GuiltExperience: Guilt
Harm done by specific behavioursHarm done by specific behaviours
Focus on effects of our behaviour on welfare of self, Focus on effects of our behaviour on welfare of self, others or objects. Internal attributionsothers or objects. Internal attributions
Must have empathic connection to harmMust have empathic connection to harm
Behaviours aimed to try to repair harm. Common Behaviours aimed to try to repair harm. Common affect is sadness/ remorse. Easily ‘fused’ with shameaffect is sadness/ remorse. Easily ‘fused’ with shame
Summary Soothing and ShameSummary Soothing and ShameSoothing system evolved with attachment system and is a Soothing system evolved with attachment system and is a threat-affect regulator (parent is protector/soother)threat-affect regulator (parent is protector/soother)Become safe by eliciting positive affect in the mind of others – Become safe by eliciting positive affect in the mind of others – ‘care’ cues are soothing ( from parent to peers)‘care’ cues are soothing ( from parent to peers)Access to soothing system enables reflective thinkingAccess to soothing system enables reflective thinking
Shame is the experience of becoming Shame is the experience of becoming the undesired and the undesired and undesirable self vulnerable to rejection, marginalistion and undesirable self vulnerable to rejection, marginalistion and involuntary subordinationinvoluntary subordination
A range of defensive strategies (links affect cognition and A range of defensive strategies (links affect cognition and behaviour) - internalising (low rank, submissive) and behaviour) - internalising (low rank, submissive) and externalising (dominant, aggressive)externalising (dominant, aggressive)
Therapist Feelings ScenarioTherapist Feelings Scenario
Client came for few weeks then said what we Client came for few weeks then said what we were doing was not helpful - actually she was were doing was not helpful - actually she was feeing worse and seemed angryfeeing worse and seemed angry
What cognitions and behaviours would go withWhat cognitions and behaviours would go with
External Shame, Internal shame, Humiliation External Shame, Internal shame, Humiliation Guilt, Indifference, Empathic-sympathy.Guilt, Indifference, Empathic-sympathy.
How might you respond for each?How might you respond for each?
ShameShame
And TraumaAnd Trauma
The Co-construction of Self and OtherThe Co-construction of Self and Other
Shame Memories Fuse Multiple Shame Memories Fuse Multiple Systems:Systems:
.
Experienced emotions (e.g., rage disgust) and intentions in the mind of the other directed at the self
Experienced arousal of own emotions (e.g., fear, paralysis) and defensive behaviours (e.g., blocked flight)
Verbal labels and personal self referent meaning (e.g., stupid, bad, disgusting)Draw out Draw out
with Clientwith Client
Associations of threat ‘meanings’ in shame-traumasAssociations of threat ‘meanings’ in shame-traumas
.
Emotion and intent flowing from the other e.g. Aggression/contempt
Alone – no help/rescue
Others are frightened or joining in (bullying)
Intense sense of fear-rage-contempt
Entrapment
Sense of having done something wrong/terrible
Verbal labels defining the self
stupid/bad
Acute sense of self as ‘under attack’ and
defined
THREAT
FROM OTHERFROM OTHER ARISING IN SELFARISING IN SELF
* Sensory stimulus triggers emotional response * Sensory stimulus triggers emotional response
(fear, anger, disgust, sadness) via the amygdala(fear, anger, disgust, sadness) via the amygdala
* Intrusive and prominent* Intrusive and prominent
* Reoccurring Flashback-like* Reoccurring Flashback-like
De-shaming is linked to working throughDe-shaming is linked to working through
1. Fear and anger1. Fear and anger
2. Acceptacne in the eyes of self and others2. Acceptacne in the eyes of self and others
Shame experiences - memories can be Shame experiences - memories can be work like ‘Traumawork like ‘Trauma’’
Therapy relationship – safe or shaming? Therapy relationship – safe or shaming?
(non-verbal, pacing, empathic (non-verbal, pacing, empathic + + therapist's shame area)therapist's shame area)
Shame during therapy (e.g., revealing, crying, losing Shame during therapy (e.g., revealing, crying, losing control)control)
Shame and safety behaviour/styles (related to past events)Shame and safety behaviour/styles (related to past events)
Shame and internal self-attacking (safety behaviours?)Shame and internal self-attacking (safety behaviours?)
Compassion as a shame antidoteCompassion as a shame antidote..
Shame and TherapyShame and Therapy
TherapyTherapyDiscuss multiple systems in our minds and it is normal to Discuss multiple systems in our minds and it is normal to feel conflictsfeel conflicts
Socratic explorations of what else might you have been Socratic explorations of what else might you have been feeling, thinking? What is dangerous to acknowledge –feeling, thinking? What is dangerous to acknowledge –threatened self-identity?threatened self-identity?
Mindfulness watching observingMindfulness watching observing
Mindfulness involves Mindfulness involves learninglearning to direct one’s attention in a to direct one’s attention in a nonjudgmental fashion in order to become aware of one’s nonjudgmental fashion in order to become aware of one’s thoughts, feelings, and actions as they emerge in a present thoughts, feelings, and actions as they emerge in a present moment. It involves moment. It involves cultivatingcultivating an attitude of intense an attitude of intense curiosity about one’s inner experience as it unfolds (Kabit curiosity about one’s inner experience as it unfolds (Kabit Zinn, 2005; Katzow & Safran in press) Zinn, 2005; Katzow & Safran in press)
Workshop OutlineWorkshop Outline
• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts
• Identifying Critical Dialogues Identifying Critical Dialogues & Associated Affects& Associated Affects
• The Diagrammatic Model / FormulationThe Diagrammatic Model / Formulation
Why Focus on Self-AttackingWhy Focus on Self-Attacking
Self-critics have poor social relationships Self-critics have poor social relationships (Zuroff et al., 1999)(Zuroff et al., 1999)
Depressed people become more self-critical as Depressed people become more self-critical as mood lowers (Teasdale & Cox, 2001)mood lowers (Teasdale & Cox, 2001)
Self-critics may do less well with standard Self-critics may do less well with standard CBT (Rector et al., 2002)CBT (Rector et al., 2002)
Self-Attacking in PsychosisSelf-Attacking in Psychosis
70% of voices are malevolent70% of voices are malevolent
Commands – sometimes with Commands – sometimes with threatsthreats
Insults (direct and indirect)Insults (direct and indirect)
Self-AttackersSelf-Attackers
Early abusive histories, inappropriate parenting,Early abusive histories, inappropriate parenting, high EE, high EE, criticism. Low or inconsistent affectioncriticism. Low or inconsistent affection
Internal Shame with highly critical internal dialoguesInternal Shame with highly critical internal dialoguesDeveloped from early experienceDeveloped from early experienceTrauma, culture, abuse, deprivationTrauma, culture, abuse, deprivationOften unaware of extent or power of SCOften unaware of extent or power of SCGenerate different intra personal and inter personal styles of interactionGenerate different intra personal and inter personal styles of interactionChronic long term difficultiesChronic long term difficulties
Concurrent cognitive/affective themesConcurrent cognitive/affective themesOngoing sense of external (the world) and internal (inside self) threat Ongoing sense of external (the world) and internal (inside self) threat
(amygdala and threat system sensitisations)(amygdala and threat system sensitisations)Lack of safeness –poor abilities to self-sootheLack of safeness –poor abilities to self-sootheEasily accessibly sensory based shame-trauma memories and scenesEasily accessibly sensory based shame-trauma memories and scenes
Internal RolesInternal Roles
Two key types of internal self self relationshipTwo key types of internal self self relationship
Hostile dominant self fearful, subordinated selfHostile dominant self fearful, subordinated self
Caring emphatic self cared for, soothed self Caring emphatic self cared for, soothed self
Mediated through and reflected in Mediated through and reflected in affect, behaviour affect, behaviour and and self-talkself-talk
Internalised Self-Attacking and Internalised Self-Attacking and Shame: Self as an object for Shame: Self as an object for
evaluationevaluation
Pre-modernPre-modern Inner demons; possessionInner demons; possessionFreudianFreudian Superego – related to internalised Superego – related to internalised
parental prohibitionsparental prohibitionsGestaltGestalt Top-dog versus under dogTop-dog versus under dogBehaviouralBehavioural Self-punishmentSelf-punishmentCognitiveCognitive Self-attacking, self-criticSelf-attacking, self-criticEvolutionaryEvolutionary Internalised hostile dominate Internalised hostile dominate
signalsignalIdeal mismatchIdeal mismatch Frustrated generated attacks – the Frustrated generated attacks – the
unattractive or undesirableunattractive or undesirable self
Meal
Sexual Bully-threat
Limbic system
Stomach acid
SalviaArousal Fearful
Depressed
Stimulus-ResponseStimulus-Response
Kind, warm and caring
SoothedSafe
Meal Sex Bully- threat
Compassion
Key QuestionsKey Questions
Need to ask:Need to ask:
1. Is it possible that some recent adaptations 1. Is it possible that some recent adaptations in the brain make us more vulnerable to mental in the brain make us more vulnerable to mental health difficulties health difficulties – e.g., self-awareness, – e.g., self-awareness, anticipation and rumination self criticism?anticipation and rumination self criticism?
2. Is it possible that some recent adaptations 2. Is it possible that some recent adaptations in the our social-cultural life styles make us more in the our social-cultural life styles make us more vulnerable to mental health difficulties e. g., vulnerable to mental health difficulties e. g., entrapments, domestic violence, mass media, social entrapments, domestic violence, mass media, social comparison.comparison.
Self-Critical Thinking StylesSelf-Critical Thinking Styles
Social ComparisonSocial ComparisonPersonalisation and Self-blamingPersonalisation and Self-blaming
Self-labelling/condemningSelf-labelling/condemning
FORMSFORMSSelf-attacking (frustration)Self-attacking (frustration)
Self-criticism (to improve/correct)Self-criticism (to improve/correct)Self-hatred/disgust (to hurt or destroy)Self-hatred/disgust (to hurt or destroy)
Affects and self-attackingAffects and self-attackingIdeal selfIdeal self Actual selfActual self
Disappointment GapDisappointment Gap
Self-attackingSelf-attacking
* Separate feeling of frustration from self-attacking* Separate feeling of frustration from self-attacking
* What are the key fears of failure * What are the key fears of failure
* What is the emotional focus (e.g., anger, sadness* What is the emotional focus (e.g., anger, sadness
hatred, contempt)hatred, contempt)
* Ability to experience and tolerate frustration * Ability to experience and tolerate frustration
without self-attack (conditioning)without self-attack (conditioning)
What are your fears or change?What are your fears or change?ExternalExternalOthers will not like or accept me –rejection or harmOthers will not like or accept me –rejection or harmLack of help or if they get close they will see bad tings, turn Lack of help or if they get close they will see bad tings, turn harmful or demandingharmful or demandingInternalInternalRelated to who I am… what I can do…. and who I want to beRelated to who I am… what I can do…. and who I want to beMust not have certain feelings/fantasies (metacognitive fears of) Must not have certain feelings/fantasies (metacognitive fears of) “they will overwhelm me, not be validated by others, too painful, “they will overwhelm me, not be validated by others, too painful, out of control, mean I am bad etc.” Avoid certain memoriesout of control, mean I am bad etc.” Avoid certain memories
Unable to accept my limitations; unable to recognise my potential Unable to accept my limitations; unable to recognise my potential Unrealistic goalsUnrealistic goals
Feedback onto external fears is often key ..“if then” Anger at Feedback onto external fears is often key ..“if then” Anger at others can be poorly processedothers can be poorly processed
SituationSituation Critical ThoughtsCritical Thoughts FeelingsFeelings
Not getting good Not getting good results with clientsresults with clients
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing. doing.
Others critical – will see me as not Others critical – will see me as not competent or unablecompetent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better results I should be getting better results Shouldn’t feel like this when I see Shouldn’t feel like this when I see themthem
My clients would do better with My clients would do better with someone elsesomeone else
Don’t know enough.Don’t know enough.
Not up to this jobNot up to this job
AnxiousAnxious
Low MoodLow Mood
Imagining the self critical part of selfImagining the self critical part of self
Now for a moment let’s imagine that this Now for a moment let’s imagine that this self-critical part self-critical part of youof you could be thought could be thought about about as a personas a person. If those self-critical . If those self-critical thoughts took on the appearance of an thoughts took on the appearance of an actual person what might they be like? actual person what might they be like? Maybe you could think about their facial Maybe you could think about their facial expressions, if they are big or small, the expressions, if they are big or small, the tone of their voice, the emotion. Just tone of their voice, the emotion. Just spend spend 3030 seconds imagining this. seconds imagining this.
Imagery: Self-critical part of selfImagery: Self-critical part of self
Can have properties of:Can have properties of:
Big rather than smallBig rather than small
Powerful-dominate rather than Powerful-dominate rather than subordinate-weaksubordinate-weak
Hostile, angry or contemptuous rather Hostile, angry or contemptuous rather than friendlythan friendly
Issues threatsIssues threats
Functional AnalysisFunctional Analysis
Safety (defensive) behavioursSafety (defensive) behaviours
as a warning of threatas a warning of threat
cuing from memory (eg. voice of parent)cuing from memory (eg. voice of parent)
habithabit
avoid aggression (who are you avoid aggression (who are you protecting?)protecting?)
identity linked (what kind of person identity linked (what kind of person would I be if I didn’t self-attack)would I be if I didn’t self-attack)
affect regulationaffect regulation
Experience of Self-CriticismExperience of Self-CriticismEmotional system sensitive to nonverbal communicationsEmotional system sensitive to nonverbal communications
Visualisation of NSC. The look, voice tone and affectVisualisation of NSC. The look, voice tone and affect
Does it attend to the evidence against? Does it attend to the evidence against?
Emotional awareness of the power and damageEmotional awareness of the power and damage
(automatic and ruminative)(automatic and ruminative)
Discuss rehearsal and harassmentDiscuss rehearsal and harassment
Name as part of self (e.g, inner bully –but good at what it Name as part of self (e.g, inner bully –but good at what it does?)does?)
Functional Analysis Functional Analysis NSCsNSCsExplore the relational and dialogic nature of self- Explore the relational and dialogic nature of self- cognitions (e.g., two chairs) bully-bulliedcognitions (e.g., two chairs) bully-bullied
Origins of bullying voice – their credentials Origins of bullying voice – their credentials
Why submissive acceptance response to self-attack?Why submissive acceptance response to self-attack?
(linked to history of submission to authority)(linked to history of submission to authority)
Submission as safety behaviour; self blame as safety Submission as safety behaviour; self blame as safety cognition –acknowledge desire for safenesscognition –acknowledge desire for safeness
Functional analysis of critic (improve, ridicule, Functional analysis of critic (improve, ridicule, destroy)destroy)
Working with S.CWorking with S.CExamples of self-blaming and self-condemning as Examples of self-blaming and self-condemning as safety-defensive behaviourssafety-defensive behaviours
What is hidden?What is hidden?
What is your worse fear in ‘giving up’ self-attackingWhat is your worse fear in ‘giving up’ self-attacking
So not (just) evidence based but:So not (just) evidence based but:
safenesssafeness
identityidentity
habithabit
loyaltyloyalty
Working with Working with SCsSCsWhat evidence would be a reasonable alternativeWhat evidence would be a reasonable alternative
Flash cardsFlash cards
Playing dominant role - to internal S.C image, two Playing dominant role - to internal S.C image, two chairs or in memory (fear/guilt/shame of chairs or in memory (fear/guilt/shame of assertiveness)assertiveness)
Mindfulness – just observing self-critical thoughts Mindfulness – just observing self-critical thoughts images.images.
Special problem of self-contemptSpecial problem of self-contempt
Linked to affect of disgust – Core sense of badness – Linked to affect of disgust – Core sense of badness – being being contaminatedcontaminated by …….. by ……..
Defensive (disgust) emotions and action tendencies Defensive (disgust) emotions and action tendencies are getting rid of, expelling, cutting out ‘destroying are getting rid of, expelling, cutting out ‘destroying the bad,’ cleansingthe bad,’ cleansing
Trying to ‘purify’ leads to splitting – common even in Trying to ‘purify’ leads to splitting – common even in religions and social groupsreligions and social groups
Transformation new meaning rather than Transformation new meaning rather than purification (nature of the universe)purification (nature of the universe)
Special problem of hatred rageSpecial problem of hatred rage
Rage and hatred are dangerous because (Rage and hatred are dangerous because (External threatExternal threat – destroy other or end up alone – destroy other or end up alone Internal threat Internal threat out of out of control)control)
Not that kind of person – unreasonable (meta-cognition)Not that kind of person – unreasonable (meta-cognition)
Feel alone and unlovable when expressedFeel alone and unlovable when expressed
How to handle it if felt in the therapeutic relationships?How to handle it if felt in the therapeutic relationships?
How might it be involved in self-harm – what fear or hurt How might it be involved in self-harm – what fear or hurt does it cover? does it cover?
Therapist PositionsTherapist Positions
Understand the evolved forms and automatic nature of Understand the evolved forms and automatic nature of basic threat systems processingbasic threat systems processing
Normalising contempt and rage as understandable though Normalising contempt and rage as understandable though not desirable - empathises with how unpleasant they arenot desirable - empathises with how unpleasant they are
Therapist contains it by open discussion of these as basic Therapist contains it by open discussion of these as basic to our nature and possibilities – notes points of hidden to our nature and possibilities – notes points of hidden anger – curiosity not interpretationanger – curiosity not interpretation
Think through together how to discuss and deal with Think through together how to discuss and deal with these feelings – how would patient like therapist to handle these feelings – how would patient like therapist to handle them (advantages and disadvantages)them (advantages and disadvantages)
Types of Affect SystemsTypes of Affect Systems
.Incentive/resource
focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focusedSoothing/safeness
Opiates (?)
Threat-focused Threat-focused safety seekingsafety seeking
Activating/inhibitingActivating/inhibitingSerotonin (?)Serotonin (?)
Summary of Self-CriticismSummary of Self-Criticism
Social threat THE major threat to humans – shame is Social threat THE major threat to humans – shame is becoming the undesired and undesirable selfbecoming the undesired and undesirable self
Self-criticism has multiple origins – abuse, neglect bullying, Self-criticism has multiple origins – abuse, neglect bullying, competitive relationships, trying to win approval - is usually competitive relationships, trying to win approval - is usually linked to feeling ‘socially unsafe’ – thus with external threatlinked to feeling ‘socially unsafe’ – thus with external threat
Velco-like trauma like memories – ‘threat first’ processingVelco-like trauma like memories – ‘threat first’ processing
Different functions of self-criticism: Self correcting and self-Different functions of self-criticism: Self correcting and self-persecuting can be linked to complex networks of meaning, persecuting can be linked to complex networks of meaning, self-identity and social relationshipsself-identity and social relationships
Workshop OutlineWorkshop Outline
• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Associated Identifying Critical Dialogues & Associated
AffectsAffects
• The Diagrammatic Model / The Diagrammatic Model / FormulationFormulation
The ModelThe Model
Our experiences together with our evolved brains Our experiences together with our evolved brains results in results in key fearskey fears around harms, injuries and loses around harms, injuries and loses
These can be external and internalThese can be external and internal
It is understandable that the individual engages in a It is understandable that the individual engages in a range of range of safety strategiessafety strategies aimed at protection aimed at protection
These safety strategies give rise in These safety strategies give rise in unintended unintended consequencesconsequences
The individual engages in (further) The individual engages in (further) self attacking,self attacking, experiences a range of experiences a range of emotions, ruminates and feel;s emotions, ruminates and feel;s trapped in thetrapped in the
BackgroundBackground
Others as Critical, Others as Critical, absent, frightening, absent, frightening, blamingblaming
Key fears/MemoriesKey fears/Memories
Hurt, rejection, ‘being Hurt, rejection, ‘being to blame’ alonenessto blame’ aloneness
Safety StrategiesSafety Strategies
Threat focusedThreat focused
Inhibit, submit avoid Inhibit, submit avoid angeranger
Be as others wantBe as others want
Unintended CsUnintended Cs
Feel worthlessFeel worthless
Controlled by othersControlled by others
Loose sense of self -aloneLoose sense of self -alone
Ruminate on emptinessRuminate on emptiness
Self-attack, access Self-attack, access shame memoriesshame memories
ConcealingConcealing
Confused, depressed Confused, depressed angry, dissociate angry, dissociate fragmentfragment
Develop Develop feelingfeeling compassion compassion for background and safety for background and safety strategiesstrategies
Understanding our Understanding our minds, not our faultminds, not our fault
Compassionate acceptance and Compassionate acceptance and integration of multi-selfintegration of multi-self
Compassion imagery, focus (e.g. Compassion imagery, focus (e.g.
attention, behaviour) and reframeattention, behaviour) and reframe
BackgroundBackground
Others as critical, Others as critical, overprotective, being overprotective, being treated as a victimtreated as a victim
Key fearsKey fears
Rejection, powerless, Rejection, powerless, being alonebeing alone
Safety StrategiesSafety Strategies
Threat focusedThreat focused
WithdrawWithdraw
Be as others wantBe as others want
Unintended CsUnintended Cs
Others don’t see me as a Others don’t see me as a personperson
Feel worthlessFeel worthless
Controlled by othersControlled by others
No sense of selfNo sense of self
Self-attackSelf-attack
ShameShame
Depressed, angry, Depressed, angry, anxiousanxious
Develop Develop feelingfeeling compassion for compassion for background and safety strategies via background and safety strategies via experience, explanation of the science & experience, explanation of the science & formulationformulation
Understanding our Understanding our minds, not our faultminds, not our fault
Compassionate acceptance and Compassionate acceptance and integration of multi-selfintegration of multi-self
Compassion imagery, focus (e.g. Compassion imagery, focus (e.g.
attention, behaviour) and reframeattention, behaviour) and reframe Well-being
TherapyTherapyDiscuss multiple systems in our minds and it is normal to Discuss multiple systems in our minds and it is normal to feel conflictsfeel conflicts
Socratic explorations of what else might you have been Socratic explorations of what else might you have been feeling, thinking? What is dangerous to acknowledge –feeling, thinking? What is dangerous to acknowledge –threatened self-identity?threatened self-identity?
Mindfulness watching observingMindfulness watching observing
Mindfulness involves Mindfulness involves learninglearning to direct one’s attention in a to direct one’s attention in a nonjudgmental fashion in order to become aware of one’s nonjudgmental fashion in order to become aware of one’s thoughts, feelings, and actions as they emerge in a present thoughts, feelings, and actions as they emerge in a present moment. It involves moment. It involves cultivatingcultivating an attitude of intense an attitude of intense curiosity about one’s inner experience as it unfolds (Kabit curiosity about one’s inner experience as it unfolds (Kabit Zinn, 2005; Katzow & Safran in press) Zinn, 2005; Katzow & Safran in press)
Rebellion model to changeRebellion model to change* Listening and considering possibilities that * Listening and considering possibilities that dominant (e.g. critical parent/teacher/bully) was/is dominant (e.g. critical parent/teacher/bully) was/is wrong (still high fear)wrong (still high fear)
* Externalising and voicing new ideas, beliefs of * Externalising and voicing new ideas, beliefs of rebellion (‘you’ (e., parent) are wrong about me)rebellion (‘you’ (e., parent) are wrong about me)
* Behaving against values and dictates of dominant * Behaving against values and dictates of dominant (e.g. acts of defiance) (Milgram 1974)(e.g. acts of defiance) (Milgram 1974)
* Distinguish helpful from destructive rebellions* Distinguish helpful from destructive rebellions
(Gilbert & Irons, 2005)(Gilbert & Irons, 2005)
Rebellion Model to changeRebellion Model to change
Don’t RushDon’t Rush Rather be aware of rebellion as fear of: Rather be aware of rebellion as fear of: disloyalty and loss or connectiondisloyalty and loss or connectioncoping with ambivalence, guiltcoping with ambivalence, guiltretaliation, retaliation, aloneness, aloneness, protect ‘them’ from my anger.protect ‘them’ from my anger.
Blaocks can also arise from desire to hold onto pain Blaocks can also arise from desire to hold onto pain for secondary gains (show them what they have for secondary gains (show them what they have made me do, induce guilt – wait for recognition of made me do, induce guilt – wait for recognition of rescue) – the trophies of suffering.rescue) – the trophies of suffering.
(Gilbert & Irons, 2005)(Gilbert & Irons, 2005)
TherapyTherapyExplain how our brains are set up to try to protect usExplain how our brains are set up to try to protect us
Explain how our threat-defense systems work -Explain how our threat-defense systems work -
that they are designed to be rapid and can emerge in us that they are designed to be rapid and can emerge in us before we are aware of it (NOT OUR FAULT) –common to before we are aware of it (NOT OUR FAULT) –common to us all and even animals; ask patients to generate examplesus all and even animals; ask patients to generate examples
Explain sensitization as relevant to that person –over and Explain sensitization as relevant to that person –over and over again come back to over again come back to protection strategies protection strategies –that can be –that can be involuntary ‘the better safe than sorry’ rule of the mindinvoluntary ‘the better safe than sorry’ rule of the mind
Avoid terms such as distorted thoughts or maladaptive Avoid terms such as distorted thoughts or maladaptive schema as these can be shaming and we are wanting to schema as these can be shaming and we are wanting to develop compassionate understanding for how our ‘mind develop compassionate understanding for how our ‘mind works’ rather than pathologise itworks’ rather than pathologise it
Therapist Feelings ScenarioTherapist Feelings Scenario
Client came for few weeks then said what we Client came for few weeks then said what we were doing was not helpful - actually she was were doing was not helpful - actually she was feeing worse and seemed angryfeeing worse and seemed angry
What cognitions and behaviours would go withWhat cognitions and behaviours would go with
External Shame, Internal shame, Humiliation External Shame, Internal shame, Humiliation Guilt, Indifference, Empathic-sympathy.Guilt, Indifference, Empathic-sympathy.
How might you respond for each?How might you respond for each?
Compassion Focused TherapyCompassion Focused TherapyDerby December 2008Derby December 2008
Paul Gilbert PhD FBPsSPaul Gilbert PhD FBPsS
Mental Health Research UnitMental Health Research Unit, , Kingsway Hospital DerbyKingsway Hospital Derby
Mary Welford Mary Welford
Greater Manchester West Mental Health NHS Foundation TrustGreater Manchester West Mental Health NHS Foundation Trust
Ken Goss, Ian Lowens, Chris Gillespie & Chris IronsKen Goss, Ian Lowens, Chris Gillespie & Chris Irons
www. compassionatemind.co.ukwww. compassionatemind.co.uk
If you wish to use this material please respect sourcesIf you wish to use this material please respect sources
Workshop OutlineWorkshop OutlineStage 1Stage 1• Introduction to the modelIntroduction to the model• Our Basic Threat-Defence SystemsOur Basic Threat-Defence Systems• Safeness: A Missing ComponentSafeness: A Missing Component• Key Shame ConceptsKey Shame Concepts• Identifying Critical Dialogues & Associated AffectsIdentifying Critical Dialogues & Associated Affects• FormulationFormulation
• Stage 2Stage 2• Considering the Nature of Self CompassionConsidering the Nature of Self Compassion• Compassionate Mind TrainingCompassionate Mind Training• Deepening Self CompassionDeepening Self Compassion• Fear of CompassionFear of Compassion
Stages of CMTStages of CMT Explanation of modelExplanation of model
Shared formulationShared formulation
Validation of fearsValidation of fears
Makes sense of protection strategiesMakes sense of protection strategies
Identify critic or inner bully as safety strategyIdentify critic or inner bully as safety strategy
Its not your faultIts not your fault
Promotion of grief reaction to sufferingPromotion of grief reaction to suffering
Development of compassion for selfDevelopment of compassion for self
Through relationship (NV communication)Through relationship (NV communication)
ImageryImagery
Attention, behaviour, thought, mindfulnessAttention, behaviour, thought, mindfulness
Visualise, practice, rehearse compassionate focus on self, Visualise, practice, rehearse compassionate focus on self, goals and futuregoals and future
Buddhist ConceptsBuddhist ConceptsMettaMetta:: is loving kindness or friendly care, which is an is loving kindness or friendly care, which is an
orientation to self and others. orientation to self and others.
MuditaMudita:: appreciating and taking joy from being alive ‘in appreciating and taking joy from being alive ‘in
this moment’ (e.g. the colours of the clouds, a rainbow or a this moment’ (e.g. the colours of the clouds, a rainbow or a
sunset, the taste of food). Sympathetic joy in the flourishing of sunset, the taste of food). Sympathetic joy in the flourishing of
others. It is a wellspring of feelings of peaceful well-being. others. It is a wellspring of feelings of peaceful well-being.
KarunaKaruna:: compassion that involves ethical behavior, compassion that involves ethical behavior,
patience and generosity with action. patience and generosity with action.
UpekkhaUpekkha:: equanimity and a sense of connectedness - equanimity and a sense of connectedness -
similarity to other humans and all living things – that all are similarity to other humans and all living things – that all are
seek happiness and none seek suffering, that we are all the same seek happiness and none seek suffering, that we are all the same
in our struggles in life.in our struggles in life.
Contrast self-compassion to self-esteemContrast self-compassion to self-esteem
Self-EsteemSelf-Esteem
Access when things going wellAccess when things going well
Individuality/differenceIndividuality/difference
Achievement/doing/driveAchievement/doing/drive
Competitive mentalityCompetitive mentality
Self-CompassionSelf-Compassion
Access when not going wellAccess when not going well
Common humanityCommon humanity
Acceptance/being/contentAcceptance/being/content
Caring mentalityCaring mentality
Compassion PracticeCompassion Practice
Mindful compassion involves learning to direct one’s Mindful compassion involves learning to direct one’s attention in a nonjudgmental fashion in order train one’s attention in a nonjudgmental fashion in order train one’s mind to organize itself via compassion and mind to organize itself via compassion and activate soothingactivate soothing systemsystem as a key affect regulator. as a key affect regulator.
It involves mindful practice of compassion focusing via It involves mindful practice of compassion focusing via attention, thinking, behaviour and feeling that involves:attention, thinking, behaviour and feeling that involves:
ProcessProcess
ImageryImagery
GoalsGoals
Compassion WorkCompassion Work
Uses many CBT, MI and other therapy ‘change Uses many CBT, MI and other therapy ‘change agents’ including: Socratic approach, guided agents’ including: Socratic approach, guided discovery, collaboration, psycho-education, discovery, collaboration, psycho-education, looking a things from different points of view, looking a things from different points of view, behavioral experiments, exposure, reflections behavioral experiments, exposure, reflections ‘homeworks’ but with a focus on ‘homeworks’ but with a focus on development development and becoming – compassion (mentality) focusedand becoming – compassion (mentality) focused
Much ‘in vivo’ work and experiencing via Much ‘in vivo’ work and experiencing via exercisesexercises
Types of Affect SystemsTypes of Affect Systems
.Incentive/resource
focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused safety seeking
Activating/inhibitingSerotonin (?)
Types of Affect SystemsTypes of Affect Systems
.Incentive/resource
focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focusedSoothing/safeness
Opiates (?)
Threat-focused Threat-focused safety seekingsafety seeking
Activating/inhibitingActivating/inhibitingSerotonin (?)Serotonin (?)
Definitions of CompassionDefinitions of CompassionBuddhist Buddhist As loving kindness; open heartednessAs loving kindness; open heartedness‘‘deep feeling and understanding of the suffering of others deep feeling and understanding of the suffering of others associated with a deep commitment and responsibility to try associated with a deep commitment and responsibility to try to alleviate it’to alleviate it’
Develop the Perfections (Paramitas - to carry across –oceans Develop the Perfections (Paramitas - to carry across –oceans of suffering to enlightenment)of suffering to enlightenment)
GenerosityGenerosity
Ethical BehaviourEthical Behaviour PatiencePatience
ConcentratioConcentrationn
EffortEffortWisdomWisdom
CompassionCompassion
Definitions of CompassionDefinitions of Compassion
Buddhist Buddhist As loving kindness; open heartednessAs loving kindness; open heartedness‘‘deep feeling and understanding of the suffering of deep feeling and understanding of the suffering of others associated with a deep commitment and others associated with a deep commitment and responsibility to try to alleviate it’responsibility to try to alleviate it’
Aristotle’sAristotle’s view suggested three key cognitive elements view suggested three key cognitive elements to summarised as: to summarised as:
The first cognitive element of compassion is a belief The first cognitive element of compassion is a belief or appraisal that the suffering is serious rather than or appraisal that the suffering is serious rather than trivial. The second is the belief that the person does trivial. The second is the belief that the person does not deserve the suffering. The third is the belief that not deserve the suffering. The third is the belief that the possibilities of the person who experiences the the possibilities of the person who experiences the emotions are similar to the sufferer (Nassbaum 2003 emotions are similar to the sufferer (Nassbaum 2003 p. 36)p. 36)
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Other Views of CompassionOther Views of Compassion
Definitions stretch back to Buddhism and Aristotle: suffering as non- Definitions stretch back to Buddhism and Aristotle: suffering as non- trivial; non-deserved. and one can have empathytrivial; non-deserved. and one can have empathy
McKay & Fanning (1992)McKay & Fanning (1992) understanding, acceptance and forgivenessunderstanding, acceptance and forgiveness
Neff (2003)Neff (2003)Kindness-warmthKindness-warmthCommon humanityCommon humanityMindfulness-Non-judgementalMindfulness-Non-judgemental
Gilbert (1989, 2000, 2005)Gilbert (1989, 2000, 2005)A mental orientation that combines various, care focused A mental orientation that combines various, care focused qualities of mind and is dependent on those qualitiesqualities of mind and is dependent on those qualities
Compassion as FlowCompassion as Flow
Different practices for eachDifferent practices for each
Other Other SelfSelf
SelfSelf OtherOther
Self Self SelfSelf
Non linear empathy for other begins early in lifeNon linear empathy for other begins early in life
Compassion and the promotion of Compassion and the promotion of well-being and growthwell-being and growth
Caring focused on well beingCaring focused on well being
The provision of guidance, protection and care for The provision of guidance, protection and care for the purpose of fostering developmental change the purpose of fostering developmental change congruent with the expected potential of the object of congruent with the expected potential of the object of nurturance (Fogel et al., 1986)nurturance (Fogel et al., 1986)
Awareness of need to nurtureAwareness of need to nurture
Motivation to nurtureMotivation to nurture
Expression of nurturanceExpression of nurturance
Choice of objectChoice of object
Fluid alteration of nurturance to fit object of Fluid alteration of nurturance to fit object of nurturancenurturance
Components of compassionComponents of compassionfrom the care giving mentalityfrom the care giving mentality
CompassionCompassion
SympathySympathy
EmpathyEmpathyNon-judgementNon-judgement
Care for well Care for well being being
Distress sensitiveDistress sensitive
Distress tolerantDistress tolerant
Create opportunities for growth and change Create opportunities for growth and change With Warmth With Warmth
Opening to CompassionOpening to Compassion
Care for well-beingCare for well-being Desire to heal, commitment and Desire to heal, commitment and responsibility. Consider benefits of “if I could.” responsibility. Consider benefits of “if I could.” Kind of self one would like to be (self-identity). Kind of self one would like to be (self-identity). Focus on feelings of kindness and warmth as Focus on feelings of kindness and warmth as emotions to develop and practiceemotions to develop and practice
Distress sensitivity:Distress sensitivity: Often blocked by fear of distress Often blocked by fear of distress or hostile emotions, and depth of distress and or hostile emotions, and depth of distress and negative beliefs about emotions (see Leahy paper)negative beliefs about emotions (see Leahy paper)
Explore and educate on the power of ruminationExplore and educate on the power of rumination
Opening to CompassionOpening to CompassionSympathySympathy explain sympathy, explore fear of being explain sympathy, explore fear of being emotionally emotionally moved moved by (one’s) distress and fear of by (one’s) distress and fear of grieving, or acknowledging hostile emotions. Explore grieving, or acknowledging hostile emotions. Explore negative beliefs about sympathynegative beliefs about sympathy
Distress toleranceDistress tolerance de-shame distress, not one’s fault, de-shame distress, not one’s fault, common humanity. Address fear of emotions, Practice common humanity. Address fear of emotions, Practice mindfulness and acceptance. Forgivenessmindfulness and acceptance. Forgiveness
EmpathyEmpathy Deepening one’s understanding of our minds. Deepening one’s understanding of our minds. Common humanity. Problems as unintended efforts at Common humanity. Problems as unintended efforts at self-protection - automatic nature. Linking to personal self-protection - automatic nature. Linking to personal history and making sense of feelings and self-attackinghistory and making sense of feelings and self-attacking
Opening to CompassionOpening to Compassion
Non judgement:Non judgement: to give up self-condemning, to give up self-condemning, shift from shame and submissiveness to shift from shame and submissiveness to acceptance and responsibility. Articulate acceptance and responsibility. Articulate preferencespreferences
What are the Greatest fears in making the What are the Greatest fears in making the shift in each componentshift in each component
Multi-Modal Compassionate Mind TrainingMulti-Modal Compassionate Mind Training
Imagery
Attention Reasoning
Feeling Behaviour
Sensory
Care for well-being
Sensitivity Sympathy
Distress tolerance
EmpathyNon-Judgement
CompassionCompassion
ATTRIBUTES
SKILLS -TRAININGWarmthWarmth
WarmthWarmth
WarmthWarmth
WarmthWarmth
Types of Affect Regulator SystemsTypes of Affect Regulator Systems
Incentive/resource focused
Seeking and behaviour activating
Dopamine (?)
Affiliative focused
Soothing/safeness
Opiates (?)
Threat-focused safety seeking
Activating/inhibitingSerotonin (?)
Anger, anxiety, disgustAnger, anxiety, disgust
Drive, excite, vitalityDrive, excite, vitality Content, safe, connectContent, safe, connect
Compassion and The Three CirclesCompassion and The Three CirclesBalancing the mind – insight – kindness and Balancing the mind – insight – kindness and couragecourage
Understanding sources of suffering and the Understanding sources of suffering and the path to the alleviation of suffering (broken leg)path to the alleviation of suffering (broken leg)
Understand the sources of flourishing and the Understand the sources of flourishing and the path to contentment - joyful giving, facilitating, path to contentment - joyful giving, facilitating, charity charity
Father Christmas and boundary settingFather Christmas and boundary setting
Understanding soothing – what we can Understanding soothing – what we can do for each other and ourselvesdo for each other and ourselves
Social referencingSocial referencing - - able to trust othersable to trust others
Existing positively in the minds of others Existing positively in the minds of others
Being heard and understoodBeing heard and understood
ValidationValidation
Reasoning Reasoning
Desensitisation to the feared – enhancing courageDesensitisation to the feared – enhancing courage
Starting Basic SkillsStarting Basic Skills
Clarify direction of travel Clarify direction of travel
Doing what for whyDoing what for why
Compassionate motivations, compassionate attention, Compassionate motivations, compassionate attention,
compassionate thinking, compassionate behaviour, and compassionate thinking, compassionate behaviour, and
compassionate feelingcompassionate feeling
SituationSituation Critical ThoughtsCritical Thoughts FeelingsFeelings
Not getting good Not getting good results with clientsresults with clients
External ShameExternal Shame
Internal ShameInternal Shame
AnxiousAnxious
Low MoodLow Mood
SituationSituation Critical ThoughtsCritical Thoughts FeelingsFeelings
Not getting good Not getting good results with clientsresults with clients
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing. doing.
Others critical – will see me as not Others critical – will see me as not competent or unablecompetent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better results I should be getting better results Shouldn’t feel like this when I see Shouldn’t feel like this when I see themthem
My clients would do better with My clients would do better with someone elsesomeone else
Don’t know enough.Don’t know enough.
Not up to this jobNot up to this job
AnxiousAnxious
Low MoodLow Mood
CompassionCompassionDiscuss the components of compassion and that each one Discuss the components of compassion and that each one might take practice ( maybe in stages)might take practice ( maybe in stages)
Emphasise the importance of Emphasise the importance of empathyempathy for distress for distress including self-attacking. Acceptance and compassion grow including self-attacking. Acceptance and compassion grow from genuine understanding - especially of safety from genuine understanding - especially of safety behaviours –Recognise when patient tries to minimise behaviours –Recognise when patient tries to minimise distress with rationalisationdistress with rationalisation
Empathy for distressEmpathy for distress often grows naturally from the work often grows naturally from the work you have done on safety behavioursyou have done on safety behaviours
Compassionate FocusCompassionate Focus
When generating alternatives one is trying to work When generating alternatives one is trying to work with different processing systems –stimulating a with different processing systems –stimulating a care-focused mentalitycare-focused mentality
Empathy for distress – standing backEmpathy for distress – standing back
* What would compassionate motives look like?* What would compassionate motives look like?
* What would compassionate ‘attention’ attend to or* What would compassionate ‘attention’ attend to or
focus on?focus on?
* What would compassionate ‘thinking’ ‘think/reflect?* What would compassionate ‘thinking’ ‘think/reflect?
* How could you take compassion into behaviour?* How could you take compassion into behaviour?
* Reflecting on these ideas and actions; how could you* Reflecting on these ideas and actions; how could you
bring warmth into the experience of them?bring warmth into the experience of them?
Compassion FocusCompassion FocusLooking at a person’s alternative thoughts or Looking at a person’s alternative thoughts or
behaviours or choice of homeworkbehaviours or choice of homework
Ask Ask * How might this be an example of * How might this be an example of
compassionate motivation, attention, thinking, compassionate motivation, attention, thinking, behaviour and give it feelingbehaviour and give it feeling
* Stay with alternative(s) until a new feeling * Stay with alternative(s) until a new feeling emergesemerges
* What might be (was) difficult to do* What might be (was) difficult to do
* How might the self critic respond?* How might the self critic respond?
Compassionate FocusCompassionate Focus
Designed to stimulate different (care-based) Designed to stimulate different (care-based) affects, thoughts and role relationships with selfaffects, thoughts and role relationships with self
What would help you feel supportedWhat would help you feel supported
What would you say/do to someone you care forWhat would you say/do to someone you care for
What would like some who cared for you to say/doWhat would like some who cared for you to say/do
Use examples and education to build insight and Use examples and education to build insight and desire to use rational compassionate approach –desire to use rational compassionate approach –can see the pointcan see the point
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing.doing.
Others critical – will see me as Others critical – will see me as not competent or unablenot competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better results.I should be getting better results.
My clients would do better with My clients would do better with someone else.someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this jobNot up to this job
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing.doing.
Others critical – will see me as Others critical – will see me as not competent or unablenot competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better I should be getting better results.results.
My clients would do better with My clients would do better with someone else.someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this job.Not up to this job.
Empathy to one’s own distress: Empathy to one’s own distress: Understandable Understandable to feel disappointed and thwarted – this is hard.to feel disappointed and thwarted – this is hard.
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing.doing.
Others critical – will see me Others critical – will see me as not competent or unableas not competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better I should be getting better results.results.
My clients would do better My clients would do better with someone else.with someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this job.Not up to this job.
Empathy for one’s own distress: Empathy for one’s own distress: Understandable Understandable to feel disappointed and thwarted – this is hard. to feel disappointed and thwarted – this is hard. Compassionate Motivation: Compassionate Motivation: Understand functions Understand functions and origins of SC – what is critic frightened of? and origins of SC – what is critic frightened of? Want to develop self-kindnessWant to develop self-kindness
External Shame
Others will wonder what I am Others will wonder what I am doing.doing.
Others critical – will see me as Others critical – will see me as not competent or unablenot competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better I should be getting better results.results.
My clients would do better My clients would do better with someone else.with someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this job.Not up to this job.
Empathy for one’s own distress: Empathy for one’s own distress: Understandable Understandable to feel disappointed and thwarted – this is hard. to feel disappointed and thwarted – this is hard.
C M: C M: Understand functions and origins of SC – Understand functions and origins of SC – what is critic frightened of? Want to develop self-what is critic frightened of? Want to develop self-kindnesskindness
CA: Attention:CA: Attention: focus on what I can do rather focus on what I can do rather than what I can’tthan what I can’t – recall times successful or – recall times successful or others who were helpful –and or I helped.others who were helpful –and or I helped.
External ShameExternal Shame
Others will wonder what I Others will wonder what I am doing.am doing.
Others critical – will see me Others critical – will see me as not competent or unableas not competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better I should be getting better results.results.
My clients would do better My clients would do better with someone else.with someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this jobNot up to this job.
Empathy for one’s own distress: Empathy for one’s own distress: Understandable to Understandable to feel disappointed and thwarted – this is hard. feel disappointed and thwarted – this is hard.
C M: C M: Understand functions and origins of SC – Understand functions and origins of SC – what is critic frightened of? Want to develop self-what is critic frightened of? Want to develop self-kindnesskindness
CA: Attention:CA: Attention: focus on what I can do rather than focus on what I can do rather than what I can’twhat I can’t – recall times successful or others who – recall times successful or others who were helpfulwere helpful
CT:What is helpful:CT:What is helpful: Ability to be with patients Ability to be with patients and listen and ‘bear’ feelings of stuckness is itself and listen and ‘bear’ feelings of stuckness is itself helpful. helpful.
CT:Not black/white:CT:Not black/white: Will learn more as I gain Will learn more as I gain experience but this does not make me incompetent experience but this does not make me incompetent
CT:Accept limitations:CT:Accept limitations: Would like to see progress, Would like to see progress, but can only do my bestbut can only do my best
CT:Like others:CT:Like others: Experienced therapists often have Experienced therapists often have these kinds of problemsthese kinds of problems
External ShameExternal Shame
Others will wonder what I am Others will wonder what I am doing.doing.
Others critical – will see me Others critical – will see me as not competent or unableas not competent or unable
Consequence - Consequence - disconnectiondisconnection
Internal ShameInternal Shame
I should be getting better I should be getting better results.results.
My clients would do better My clients would do better with someone else.with someone else.
Don’t know enough.Don’t know enough.
Maybe I am incompetent.Maybe I am incompetent.
Not up to this job.Not up to this job.
Empathy for one’s own distress: Empathy for one’s own distress: Understandable Understandable to feel disappointed and thwarted – this is hard. to feel disappointed and thwarted – this is hard.
C M: C M: Understand functions and origins of SC – Understand functions and origins of SC – what is critic frightened of? Want to develop self-what is critic frightened of? Want to develop self-kindnesskindness
CA: Attention:CA: Attention: focus on what I can do rather than focus on what I can do rather than what I can’twhat I can’t – recall times successful or others – recall times successful or others who were helpfulwho were helpful
CT:What is helpful:CT:What is helpful: Ability to be with patients Ability to be with patients and listen and ‘bear’ feelings of stuckness is itself and listen and ‘bear’ feelings of stuckness is itself helpful. helpful.
CT:Not black/white:CT:Not black/white: Will learn more as I gain Will learn more as I gain experience but this does not make me incompetent experience but this does not make me incompetent
CT:Accept limitations:CT:Accept limitations: Would like to see Would like to see progress, but can only do my bestprogress, but can only do my best
CT:Like others:CT:Like others: Experienced therapists often have Experienced therapists often have these kinds of problemsthese kinds of problems
CBehaviour:Help seeking:CBehaviour:Help seeking: Can share my Can share my difficulties, seek supervision/help, talk to othersdifficulties, seek supervision/help, talk to others
Compassionate Feeling Compassionate Feeling Using imagery and Using imagery and refocusingrefocusing
Thought-feeling focusingThought-feeling focusing
When you have generated some alternatives - focus on When you have generated some alternatives - focus on staying with them until affect changes – staying with them until affect changes –
DO NOT rely on logic/evidence alone to produce changeDO NOT rely on logic/evidence alone to produce change
Give plenty of time Give plenty of time for feelingfor feeling the difference the difference
You can stay with visualising You can stay with visualising eacheach alternative and alternative and imagine how that feelsimagine how that feels
Dissolving - fading via practice rather than challenging-Dissolving - fading via practice rather than challenging-convincingconvincing
Workshop OutlineWorkshop Outline
Stage 2Stage 2• Considering the Nature of Self CompassionConsidering the Nature of Self Compassion• Compassionate Mind TrainingCompassionate Mind Training• Deepening Self-CompassionDeepening Self-Compassion• Fear of CompassionFear of Compassion
Compassion ImageryCompassion Imagery
Using imagery to access and work Using imagery to access and work with soothing systems and the with soothing systems and the
interactions between threat and interactions between threat and soothing systemssoothing systems
Why Develop Compassionate ImageryWhy Develop Compassionate Imagery Powerful way to access affect systemsPowerful way to access affect systems
Quickly reveals affect blocks and fears (but should be Quickly reveals affect blocks and fears (but should be helpful not overwhelming)helpful not overwhelming)
Provides new sensory based experiences to work with Provides new sensory based experiences to work with other, threat-based onesother, threat-based ones
Uses a form of theory of mind – another mind ‘with you’Uses a form of theory of mind – another mind ‘with you’
Re-focuses attentionRe-focuses attention
A different way of ‘thinking’ of alternatives as co-A different way of ‘thinking’ of alternatives as co-constructed, and affect/compassion focusedconstructed, and affect/compassion focused
Preparing for ImageryPreparing for Imagery
Preparing the body – breathing – find the rhythm of Preparing the body – breathing – find the rhythm of one’s own soothing - not that long – minute or so – then one’s own soothing - not that long – minute or so – then longer if possible. longer if possible.
Body posture Body posture
Fear of engaging may need to switch to sensory focus Fear of engaging may need to switch to sensory focus (e.g., tennis ball)(e.g., tennis ball)
Intrusions of thoughts and feelings – normalise and Intrusions of thoughts and feelings – normalise and teach ‘with kindness to just return the attention’teach ‘with kindness to just return the attention’
Safe Place ImagerySafe Place Imagery
Explain that imagery is fleeting - offering glimpses Explain that imagery is fleeting - offering glimpses and fragments - it is the feelings that are importantand fragments - it is the feelings that are important
The focus on feeling safe and soothed in a place The focus on feeling safe and soothed in a place (also to feel ‘joyful’ if the person finds that helpful)(also to feel ‘joyful’ if the person finds that helpful)
Focus on all the senses Focus on all the senses
Imagine the place is pleased/happy to see you and Imagine the place is pleased/happy to see you and you have sense of welcome and belongingyou have sense of welcome and belonging
Long history to use of Long history to use of compassionate imagerycompassionate imagery
Buddhist loving kindness imageryBuddhist loving kindness imagery
Sequences: Bodhisavattas having developed the ideal qualities Sequences: Bodhisavattas having developed the ideal qualities of compassion – to identify with and copy – non judgement just of compassion – to identify with and copy – non judgement just observation (see observation (see Vessantara (1993) Meeting the Buddha'sVessantara (1993) Meeting the Buddha's)
Compassion Mediation cycleCompassion Mediation cycle Imaging the Compassion Buddha; harnessing the Imaging the Compassion Buddha; harnessing the compassionate energies of the universe; directing the compassionate energies of the universe; directing the compassion to you; the Buddha merging with you – becoming compassion to you; the Buddha merging with you – becoming the Compassion Buddha - directing compassion back into the the Compassion Buddha - directing compassion back into the universe for all living things – To explore each position and universe for all living things – To explore each position and what ‘comes up’ in one’s mind, reflect and develop one’s mindwhat ‘comes up’ in one’s mind, reflect and develop one’s mind
(See chapter in by Rimpoche and Mullen in Gilbert 2005; )(See chapter in by Rimpoche and Mullen in Gilbert 2005; )
Types of Compassionate ImageryTypes of Compassionate Imagery Guided MemoryGuided Memory
Recall feelings when someone was kind to you Recall feelings when someone was kind to you
Recall feelings of you being kind to othersRecall feelings of you being kind to others
Guided FantasyGuided Fantasy
The ideal compassionate self The ideal compassionate self
The ideal compassionate other (unique vs given) The ideal compassionate other (unique vs given)
human verse non-humanhuman verse non-human
Keep in mind all the time: Fear of feeling Keep in mind all the time: Fear of feeling compassion for selfcompassion for self
Imagining the self-compassionate part Imagining the self-compassionate part of self - Assuming a roleof self - Assuming a role
Now for a moment, imagine that a selfNow for a moment, imagine that a self--supporting, or supporting, or compassionate part of yourself could be thought compassionate part of yourself could be thought about as a person. Imagine becoming that person. about as a person. Imagine becoming that person. Think of the Think of the idealideal qualities you would like to have as qualities you would like to have as a compassionate person. It does not matter if you are a compassionate person. It does not matter if you are actually like this. Think about your age and actually like this. Think about your age and appearance, your facial expressions and postures, appearance, your facial expressions and postures, you inner emotions of say gentleness – create a half you inner emotions of say gentleness – create a half or slight smile that conveys this. Now like an actor or slight smile that conveys this. Now like an actor about to take on a part feel yourself into these. For about to take on a part feel yourself into these. For this moment you this moment you areare a compassionate person a compassionate person
Imagery: Self-Compassionate Part Imagery: Self-Compassionate Part of Selfof Self
Can have properties of:Can have properties of:
FriendlinessFriendliness
Soft - lightSoft - light
Acceptance, warmth, supportAcceptance, warmth, support
Focus on what is helpfulFocus on what is helpful
Imagining the self-compassionate part Imagining the self-compassionate part of self - Assuming a roleof self - Assuming a role
Learn to practice each dayLearn to practice each day
Remind oneself of the self one would like to be or Remind oneself of the self one would like to be or become today.become today.
Compassionate walking, breathing voice tones, facial Compassionate walking, breathing voice tones, facial expression, thoughtsexpression, thoughts
Smile and forgiveness when one’s anger, in-patience Smile and forgiveness when one’s anger, in-patience and anxiety gets the upper hand – back to principle and anxiety gets the upper hand – back to principle propose is ‘to be happy and free from suffering and propose is ‘to be happy and free from suffering and help others be happy and free from suffering’help others be happy and free from suffering’
Other-Focused CompassionOther-Focused Compassion
Sit comfortably in chair with soothing rhythm breathing. Sit comfortably in chair with soothing rhythm breathing. Work on getting into the compassion role. Now imagine Work on getting into the compassion role. Now imagine focusing on ‘desire for others to be happy and free from focusing on ‘desire for others to be happy and free from suffering’. (This can start off with people one knows and suffering’. (This can start off with people one knows and then extend outwards to eventually all sentient beings). then extend outwards to eventually all sentient beings). Imagine facial expressions and voice tones.Imagine facial expressions and voice tones.
Explore people’s experience - reflection/meditation.Explore people’s experience - reflection/meditation.
Explore the value of compassionate self or compassionate Explore the value of compassionate self or compassionate imagery in generating and feeling the desire within oneself imagery in generating and feeling the desire within oneself for others ‘to be happy and free from suffering’.for others ‘to be happy and free from suffering’.
Explore blocks, fears and facilitators.Explore blocks, fears and facilitators.
Self-focused CompassionSelf-focused Compassion
Sit comfortably in a chair with soothing rhythm breathing Sit comfortably in a chair with soothing rhythm breathing and imagine focusing on ‘desire to be happy and free from and imagine focusing on ‘desire to be happy and free from suffering’.suffering’.
Explore people’s experience of that reflection/meditation.Explore people’s experience of that reflection/meditation.
Explore the value of compassionate self or compassionate Explore the value of compassionate self or compassionate imagery in experiencing the desire within oneself ‘to be imagery in experiencing the desire within oneself ‘to be happy and free from suffering’.happy and free from suffering’.
Explore blocks, fears and facilitators.Explore blocks, fears and facilitators.
Imagining the Compassionate OtherImagining the Compassionate Other
Explain point of Compassionate-other imagery workExplain point of Compassionate-other imagery work
Inner helper, perfect nurturer (D.Lee), inner guide, access to Inner helper, perfect nurturer (D.Lee), inner guide, access to self-soothing system through relating self-soothing system through relating (no different in principle to (no different in principle to activating any other system e.g., sexual – these systems were designed for social activating any other system e.g., sexual – these systems were designed for social
interactions – social mentality theoryinteractions – social mentality theory))
““Now for a moment, focus on your breathing and try to feel Now for a moment, focus on your breathing and try to feel body rhythm. Can you look down or close your eyes and body rhythm. Can you look down or close your eyes and imagine your imagine your idealideal caring other for you.” caring other for you.”
Or build for someone else - a child: Or build for someone else - a child:
Useful specific questions: would they be old or young, male Useful specific questions: would they be old or young, male or female colour of their eyes, tall or short – more than oneor female colour of their eyes, tall or short – more than one
Relational ProcessRelational Process.
Qualities of SourceQualities of Source SelfSelf
KindnessKindness
WarmthWarmth
AcceptanceAcceptance
UnderstandingUnderstandingWisdomWisdom
StrengthStrength
WarmthWarmth
Non-judgementNon-judgement(Common-humanity(Common-humanity)
DistressDistress
GrowthGrowth
Other-Focused CompassionOther-Focused Compassion
Act of creating one (what one would like for one) is a step on Act of creating one (what one would like for one) is a step on compassion focusingcompassion focusing
Find the type of image and form of relationship that fits for Find the type of image and form of relationship that fits for the person – images usually changethe person – images usually change
This can be an Inner: Nurturer, Guide, Friend, Mentor, This can be an Inner: Nurturer, Guide, Friend, Mentor, Fellow Traveller; Bodhisattva, Ideal Compassionate OtherFellow Traveller; Bodhisattva, Ideal Compassionate Other
Exercise: to focus on, write about, paint - create image or Exercise: to focus on, write about, paint - create image or ‘sense of’ ideal compassionate other’ Notice feelings and ‘sense of’ ideal compassionate other’ Notice feelings and thoughts arising during the exercise. Mindful approachthoughts arising during the exercise. Mindful approach
Developing image –with half smile –soothing Developing image –with half smile –soothing breathingbreathing
IdealIdeal caring and compassionate image --- define ideal as caring and compassionate image --- define ideal as everything you would want, need everything you would want, need
Caring Caring as a genuine desire for one’s well-beingas a genuine desire for one’s well-being
WisdomWisdom a sentient mind who understands the struggles a sentient mind who understands the struggles of humanity and self. Empathic stance, self-transcendentof humanity and self. Empathic stance, self-transcendent
StrengthStrength as fortitude, endurance but can be power too as fortitude, endurance but can be power too
WarmthWarmth affiliation, genuine care, gentle smile affiliation, genuine care, gentle smile
Non-JudgementNon-Judgement as no criticismas no criticism , curiosity
Hand on Heart and SoothingHand on Heart and SoothingWhen distressed or at other times - sitting or standingWhen distressed or at other times - sitting or standing
take a few breaths to notice soothing rhythm take a few breaths to notice soothing rhythm
Place hand over centre of the chestPlace hand over centre of the chest
Imagine caring compassionate energy for one’s hand Imagine caring compassionate energy for one’s hand going through one’s chest fill that area and soothing the going through one’s chest fill that area and soothing the heart are heart are
As the person focuses on this they may find their hand As the person focuses on this they may find their hand feels hotfeels hot
The is an attention reallocation and affect switching The is an attention reallocation and affect switching techniquetechnique
Imagining ConnetednessImagining Connetedness
Some people have problems with imaging other people in a Some people have problems with imaging other people in a compassionate role –can’t trust them – so you can use a compassionate role –can’t trust them – so you can use a non-personal image. For examplenon-personal image. For example
imagine a sea in front of you that is a beautiful blue, is imagine a sea in front of you that is a beautiful blue, is warm and calm, lapping on a sandy shore. Imagine that warm and calm, lapping on a sandy shore. Imagine that you are standing just in the water with the water lapping you are standing just in the water with the water lapping gently at your feet. Now as you look out over the sea to the gently at your feet. Now as you look out over the sea to the horizon imagine that this sea has been here for millions of horizon imagine that this sea has been here for millions of years, was a source of life. It has seen many things in the years, was a source of life. It has seen many things in the history of life and knows many things. Now imagine the history of life and knows many things. Now imagine the sea has complete acceptance for you, that is knows of your sea has complete acceptance for you, that is knows of your struggles and pain. Allow yourself to feel connected to the struggles and pain. Allow yourself to feel connected to the
sea, its power and wisdom in complete acceptance of yousea, its power and wisdom in complete acceptance of you
Point of ImageryPoint of Imagery Powerful way to access affect systemsPowerful way to access affect systems
Quickly reveals affect blocks and fearsQuickly reveals affect blocks and fears
Provides new sensory based experiences to work with Provides new sensory based experiences to work with other, threat-based, onesother, threat-based, ones
Uses a form of theory of mind – another mind ‘with you’Uses a form of theory of mind – another mind ‘with you’
Re-focuses attention (work on sensory qualities)Re-focuses attention (work on sensory qualities)
A different way of ‘thinking’ of alternatives as co-A different way of ‘thinking’ of alternatives as co-constructed and affect/compassion focusedconstructed and affect/compassion focused
Use of compassionate imageryUse of compassionate imagery
Able to teach basic relaxation as a preparation for imageryAble to teach basic relaxation as a preparation for imagery
As it can involve working of inner ‘productions’ of the mind As it can involve working of inner ‘productions’ of the mind need to be away of:need to be away of:
Passive/overwhelmedPassive/overwhelmedEngaging with but used for controlling and regulatingEngaging with but used for controlling and regulatingEngaging with accepting and exploringEngaging with accepting and exploring
Engaging in order to develop new insights and Engaging in order to develop new insights and practice for activating different parts of the selfpractice for activating different parts of the self
Taylor it for individual patient – Taylor it for individual patient – especially in regard to self practiceespecially in regard to self practice
Compassionate ReframeCompassionate ReframeFocus on your breathingFocus on your breathing
Now bring compassionate image to mindNow bring compassionate image to mind
Focus on sensory qualities (trying to access care-Focus on sensory qualities (trying to access care-focused mentality)focused mentality)
What would your compassion part/image say?What would your compassion part/image say?
How do they see this situation?How do they see this situation?
What opportunities for growth and change might be What opportunities for growth and change might be here?here?
What is a compassionate thing to do now?What is a compassionate thing to do now?
Imagery Practice ExperienceImagery Practice ExperienceFocusing on your imageFocusing on your image
can you feel warmth for you – what does that feel like? can you feel warmth for you – what does that feel like?
can you feel empathic understanding for you – what does that can you feel empathic understanding for you – what does that feel like?feel like?
can you feel acceptance for you – what does that feel like?can you feel acceptance for you – what does that feel like?
can you feel strength for you – what does that feel like?can you feel strength for you – what does that feel like?
Really focus on image generating and Really focus on image generating and stayingstaying with with affectaffect
Imagery ExperienceImagery ExperienceImages are created within one’s own mind. They are Images are created within one’s own mind. They are therefore part of us and by practicing them we may therefore part of us and by practicing them we may practice developing part of uspractice developing part of us
Note the arising and the fading of the image as Note the arising and the fading of the image as products of our minds. Letting go the image.products of our minds. Letting go the image.
But like a muscle, because we are unaware of it or But like a muscle, because we are unaware of it or are not using it does not mean it is not there.are not using it does not mean it is not there.
Can build mindfulness around compassionate Can build mindfulness around compassionate focusing – noticing, observing, not tryingfocusing – noticing, observing, not trying
Re-EvaluatingRe-EvaluatingThird chair practisingThird chair practising
Compassionate thinkingCompassionate thinking
Compassionate attentionCompassionate attention
Compassionate behaviourCompassionate behaviour
Compassionate letter writingCompassionate letter writing
Compassionate Letter WritingCompassionate Letter Writing
Ideal caring self (even if one does not have those Ideal caring self (even if one does not have those qualities) – or compassionate ideal imagequalities) – or compassionate ideal image
Clarify point of the exercise and why its worth a Clarify point of the exercise and why its worth a go – as a behavioural experiment,go – as a behavioural experiment,
Focus on caring part of self – to put in that Focus on caring part of self – to put in that mode or frame of mind for ‘thinking/feeling’mode or frame of mind for ‘thinking/feeling’
Work through guided letter outlineWork through guided letter outline
Note: many letters will not be very compassionate an first so Note: many letters will not be very compassionate an first so discuss and explore how they are feltdiscuss and explore how they are felt
• Expresses concern and genuine caring,• Sensitive to the person’s distress and needs• Sympathetic and is emotionally moved by, in tune with their
distress• Helps them to become more mindful and tolerant of their feelings • Helps them become more understanding and reflective of their
feelings, behaviours, difficulties and dilemmas• It is non-judgment/condemning • A genuine sense of warmth understanding and caring permeate
the whole letter• Generates genuinely compassionate helpful encouraging attention
memories thinking and feelings – what do they feel like? Are the “experienced as helpful”
• Helps them think about the behaviour they may need to attempt in order to move forward
The point of these letters is not just to focus on difficult feelings but to help people stand back and reflect empathically on, be open with feelings and thoughts, and develop a compassionate and balanced ways of working with them. They will not offer advice or should etc.
Example 1: Compassionate LetterExample 1: Compassionate Letter
It is understandable that you been having a difficult It is understandable that you been having a difficult time and continue to do so, things have been tough. You time and continue to do so, things have been tough. You have had more of your share of negative things happen to have had more of your share of negative things happen to you but it is time to change things for the better. You can’t you but it is time to change things for the better. You can’t suffer like this forever. You have a nice flat, a loving family suffer like this forever. You have a nice flat, a loving family and a couple of good friends. You have support from people and a couple of good friends. You have support from people , more than other people. Remember there are so many , more than other people. Remember there are so many people worse off than you. Some people in Africa have people worse off than you. Some people in Africa have nothing. They don’t expect to have anything they just accept nothing. They don’t expect to have anything they just accept things. Learn from them. Remember you have a lot to be things. Learn from them. Remember you have a lot to be grateful for. You are a kind person and that will never grateful for. You are a kind person and that will never change. You need to look after yourselfchange. You need to look after yourself
Example 2A: Compassionate LetterExample 2A: Compassionate Letter
I am so sad you have had a difficult time and continue to struggle. am so sad you have had a difficult time and continue to struggle.
Your sadness is understandable. You have had many negative Your sadness is understandable. You have had many negative
experiences. This has resulted in anxieties and thoughts about experiences. This has resulted in anxieties and thoughts about
being different. You then became depressed.being different. You then became depressed.
When you have a difficult time I understand why you want to When you have a difficult time I understand why you want to
hide away, but although this helps it also makes you feel more hide away, but although this helps it also makes you feel more
isolated. It is going to be really difficult but it may be a help to talk isolated. It is going to be really difficult but it may be a help to talk
to other people and connect with them. This may help your mood.to other people and connect with them. This may help your mood.
Example 2B: Compassionate LetterExample 2B: Compassionate Letter
Other people get like this, you are not alone and shouldn’t Other people get like this, you are not alone and shouldn’t
feel as though you need to hide away. You have an inner feel as though you need to hide away. You have an inner
strength and should remember that. You are kind and strength and should remember that. You are kind and
caring and maybe it would help to practice to turn that caring and maybe it would help to practice to turn that
kindness on yourself so you can feel the warmth.kindness on yourself so you can feel the warmth.
NOTE: Sometimes people will write as if from someone else NOTE: Sometimes people will write as if from someone else
using ‘you’. Sometimes they will write as ‘I’. Clarify that using ‘you’. Sometimes they will write as ‘I’. Clarify that
with people and what they would find helpful and why.with people and what they would find helpful and why.
Compassion for self-attacking 1Compassion for self-attacking 1Sit quietly for a few moments with soothing breathing and focus Sit quietly for a few moments with soothing breathing and focus on becoming your compassionate self (e.g, with the facial on becoming your compassionate self (e.g, with the facial expressions and sense self expanding)expressions and sense self expanding)
Now with that sense of you, your wisdom, strength and warmth, Now with that sense of you, your wisdom, strength and warmth, imagine your self-critical part in front of you.imagine your self-critical part in front of you.
See its facial expression and note the feeling arising in it -now See its facial expression and note the feeling arising in it -now just feel compassion for that self-critical part of your _hold you just feel compassion for that self-critical part of your _hold you own self compassionate facial expressionown self compassionate facial expression
Watch what happensWatch what happensIf you feel you (or client) are being pulled into the thinking an feeling of the If you feel you (or client) are being pulled into the thinking an feeling of the critic just pull back an refocus on the feelings of the compassionate selfcritic just pull back an refocus on the feelings of the compassionate self
Compassion for self-attacking 2Compassion for self-attacking 2Sit quietly for a few moments and allow your Sit quietly for a few moments and allow your compassionate compassionate imageimage and sense of self to come to mind and sense of self to come to mind
Now with that image with you, with its wisdom, Now with that image with you, with its wisdom, strength and warmth, imagine yourself as linked - as if strength and warmth, imagine yourself as linked - as if on the same team with the same desires and qualities –on the same team with the same desires and qualities –linking to self-identity –hold the compassionate linking to self-identity –hold the compassionate expressionexpression
Now imagine you both seek to heal your threatened or Now imagine you both seek to heal your threatened or self-attacking part of you. Be mindful of your self self-attacking part of you. Be mindful of your self attacking thoughts, just allowing them, and try as best attacking thoughts, just allowing them, and try as best you can to stay in your compassionate positionyou can to stay in your compassionate position
Cautions of Attacking CriticCautions of Attacking CriticStanding up to inner-critic and working with memories of Standing up to inner-critic and working with memories of
‘critical other’ can be very helpful (especially if linked to ‘critical other’ can be very helpful (especially if linked to memories of critical others Hackmann, 2005)memories of critical others Hackmann, 2005)
However if just internalHowever if just internal* Can model a ‘power solution’ –amygdala focused* Can model a ‘power solution’ –amygdala focused* Often less need to directly ‘take on’ critic – but build new * Often less need to directly ‘take on’ critic – but build new
focus of selffocus of self* People can keep (SC) safety behaviours for as long as they * People can keep (SC) safety behaviours for as long as they
think they need them – no pressure to changethink they need them – no pressure to change* Compassion for fear behind, and function of, critic will * Compassion for fear behind, and function of, critic will
often help to change/soften it.often help to change/soften it.
Fear of CompassionFear of Compassionvery commonvery common
Operates at implicit and explicit Operates at implicit and explicit levelslevels
ConditioningConditioning Care seeking systems can become conditioned to threat Care seeking systems can become conditioned to threat
rather than safeness. If it happens early people may not rather than safeness. If it happens early people may not recall specific memories but experience confusing recall specific memories but experience confusing feelings in close relationshipsfeelings in close relationships
Care seeking Care seeking PunishmentPunishment
AnxietyAnxiety
Implications for sensory memories and co-ordination of Implications for sensory memories and co-ordination of soothing systems soothing systems
ConditioningConditioningCare seeking systems can become conditioned to threat Care seeking systems can become conditioned to threat rather than safeness. If happens early, people may not rather than safeness. If happens early, people may not recall specific memories but experience confusing feelings recall specific memories but experience confusing feelings in close relationshipsin close relationships
Care seeking Care seeking No responseNo response
shut downshut down
Implications for sensory Implications for sensory memoriesmemories and co-ordination of and co-ordination of soothing systems soothing systems
Threatening CompassionThreatening Compassion FocusFocus
KindnessKindness
Attachment systemAttachment system
Emotion-memoryEmotion-memorySelf –other roles/scenesSelf –other roles/scenes
AngerAnger AnxietyAnxiety Shut downShut down
Kindness, Attachment and ThreatKindness, Attachment and Threat
Kindness from therapist or imageryKindness from therapist or imagery
Activate attachment systemActivate attachment systemActivate memoriesActivate memories
NeglectNeglectalonenessaloneness
Abuse, shame Abuse, shame vulnerablevulnerable
ActivateActivate learnt and current defences - cortisollearnt and current defences - cortisol
Fight, flightFight, flightshut downshut down
Fight, flightFight, flightshut downshut down
Blocks to Compassion Focus occur at both Blocks to Compassion Focus occur at both the automatic and metacognitive levelthe automatic and metacognitive levelOverwhelming sadness or panic-- so may need to spend Overwhelming sadness or panic-- so may need to spend
a long time developing capacity to tolerate grief and feelings of a long time developing capacity to tolerate grief and feelings of warmthwarmth
Can’t create or hold image – mindful/allowingCan’t create or hold image – mindful/allowing
Meta-cognitive blocksMeta-cognitive blocks
Compassion is weak, easily beaten down, or dangerousCompassion is weak, easily beaten down, or dangerous
Forgiveness is weak, wont achieve anythingForgiveness is weak, wont achieve anything
Bullies are resistant – address their safety agendasBullies are resistant – address their safety agendas
Responsibility for Responsibility for practice, practice practicepractice, practice practice
Empowerment and CourageEmpowerment and Courage
Common blocks when client struggles or does not really Common blocks when client struggles or does not really want to be compassionate May want to fight or gain want to be compassionate May want to fight or gain revenge but is fearfulrevenge but is fearful
Can use rescripting with assertive enactments Can use rescripting with assertive enactments
((See Hackmann 2005, in Gilbert 2005 )See Hackmann 2005, in Gilbert 2005 )
Compassion my get stuck if the anger and needs for Compassion my get stuck if the anger and needs for working through all the issues with anger are not working through all the issues with anger are not addressed – so we back to addressed – so we back to compassion as couragecompassion as courage and and not submissive – Some compassion Buddha’s not submissive – Some compassion Buddha’s
and images are actuallyand images are actually quite fierce!quite fierce!
(Vessantara (1993) Meeting the Buddha's. See also Leighton, 2003(Vessantara (1993) Meeting the Buddha's. See also Leighton, 2003
Courage and traumaCourage and trauma
When shame and self-criticism are linked to trauma When shame and self-criticism are linked to trauma memory then there are a variety of interventions for memory then there are a variety of interventions for rescripting (see Lee 2005 in Gilbert 2005)rescripting (see Lee 2005 in Gilbert 2005)
You can adapt these with using the compassionate self You can adapt these with using the compassionate self and compassionate images – but do not under-estimate and compassionate images – but do not under-estimate the need for courageous and assertive response-the need for courageous and assertive response-developmentdevelopment
Discuss with client - be open about courage and how to Discuss with client - be open about courage and how to develop it – the advantages of ‘direction of travel and develop it – the advantages of ‘direction of travel and goal – the ‘point of the work’goal – the ‘point of the work’
What have we learnt?What have we learnt?
How might this workshop affect your practice?How might this workshop affect your practice?
What are your take home key points?What are your take home key points?
What would you like to develop?What would you like to develop?
Affect self-identity as a person and therapistAffect self-identity as a person and therapist
Beyond techniques – way of being with self and Beyond techniques – way of being with self and others others
Conclusion and Key pointsConclusion and Key points•CFT is an integrated biopsychosocial model – not a specific process modelCFT is an integrated biopsychosocial model – not a specific process model •Basic structure is around the three affect regulation systemsBasic structure is around the three affect regulation systems
•Without the ability to access the sense of soothing -safeness (calm mind) various interventions Without the ability to access the sense of soothing -safeness (calm mind) various interventions might lack emotional impact in the long termmight lack emotional impact in the long term
•Each system is complex and can be a target for a range interventionsEach system is complex and can be a target for a range interventions
•Understand the power of shame to disrupt the balance of the three affect regulation system -Understand the power of shame to disrupt the balance of the three affect regulation system -and focus sense of ‘self as a social agent’ on threatand focus sense of ‘self as a social agent’ on threat
CFT uses stress the role of compassion in the multiple interventions (motivational emotional CFT uses stress the role of compassion in the multiple interventions (motivational emotional attention cognitive and behavioural) derived from Western and Easter approaches to change attention cognitive and behavioural) derived from Western and Easter approaches to change and developmentand development
•Neuro physiotherapy for the mind – key is top practice the exercises – therapists would ideally Neuro physiotherapy for the mind – key is top practice the exercises – therapists would ideally have their own practicehave their own practice
• CMT can be more than symptom reduction but can also become a focus for long term CMT can be more than symptom reduction but can also become a focus for long term development and sense of selfdevelopment and sense of self
