Secrets of Compassion Focused Therapy

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox Today's presentation is going to be focused on compassion focused therapy. So over the next hour, we're going to define compassion focused therapy. We'll explore the underlying theory. Because cft, which I'm going to call it from now on, because compassion Focused therapy is kind of a big mouthful. This is sort of a new approach for most people. So we're going to look at the theory underlying it and figure out how it might be a nice addition to our toolbox when we're working with clients. Then we'll move on to identifying techniques used in CFT and their rationale. And finally, we'll theorize about how CFT might be helpful to your clients. And again, we want to look at the underlying theory as we go. And I want you to think about clients that seem to have not done as well as you would have hoped in counseling, especially if you use a cognitive behavioral approach, and think about whether any of the techniques that we're talking about or any of the theories that we're talking about here might ring true. I found working with clients over the years, sometimes the same information presented in a slightly different form, compassion will all of a sudden send off a light bulb. So just because you've talked about being compassionate or being kind to yourself with your clients doesn't mean they necessarily wrap their head around it and doesn't necessarily mean they get it. At the end of the presentation, we're also going to talk about some of the reasons that people might be afraid to be compassionate to themselves or to other people. The healing properties of compassion have been written about for centuries. The Dalai Lama stresses that if you want others to be happy or to be happy yourself, you need to focus on compassion. So this is one of those things that we really want to drive home. And when we went into counseling, or at least for most of us, compassion is one of the things that we knew we had. We're like, I'm compassionate. You know, I see suffering. I want people to help people stop their suffering. And you know, great. And it underpins a lot of the things that we talk about in counseling 101, when you were going through your intro classes about being attentive and focused and non judgmental and all that other kind of stuff. But what we do in session doesn't necessarily translate to skills that the clients can take and use so there's some techniques that we can talk about that will help them learn to be more self compassionate. Compassion can be thought of as a skill that one can train in. Not everybody is super compassionate from the get go. And some people have had negative experiences growing up. Some people have had harsh upbringings, so they tend to be more not compassionate. We can help people look for the silver lining. We can help people look for the compassionate way of viewing certain things. We want to help people focus on and practice compassion in order to influence their neurophysiological and immune systems. So you know, those are big words, but basically if people are compassionate, and we've talked about this in other classes, they can trigger certain neurochemicals that can help calm this fight or flight reaction. Likewise, if they are harsh and aggressive and critical of themselves, they can trigger neurophysiological responses that trigger the fight or flight reaction. So we want to help people trigger the calming chemicals. Compassionate mind training refers to specific activities designed to develop compassionate attributes and skills, particularly those that influence affect regulation. Now if you go in and you read some of the articles that I included in your class, you'll find that there are some names that pop up so specifically Marsha Linehan when talking about compassion and distress tolerance. So some of the skills that are used in compassion focused therapy or CFT really build upon a lot of the skills you may already have. So what are some observations? Compassion focused therapy and compassionate mind training arose from a number of them. First, people with high levels of shame and criticism have enormous difficulty being kind to themselves, feeling warmth or being self compassionate. So I want you to think for a minute, what are the psychological consequences for someone? And maybe think about a client who has difficulty being kind to themselves, feeling warm to themselves, or being compassionate again with themselves. How does that affect their psyche? How does that affect how they approach life? And how does that affect their relationship with others? Likewise, how does that affect if you can't ever be kind to yourself, if you're always being critical, what are the physiological consequences? You know, like we talked about a minute ago, there's probably going to be a fair amount of cortisol and a fair amount of fight or flight stuff and hypervigilance going on all the time. If the internal voices or the internal messages that people are giving themselves are always critical and telling them that they're not good enough. Problems of shame and self criticism are often rooted in histories of abuse, bullying, high expressed emotion in the family, neglect and or lack of affection. So again, imagine growing up in this family and we've talked about the fact that children, you know, young children don't have the ability to look at multiple explanations for something. They see things as all or nothing, black or white. So growing up in a family where there's abuse, a lot of times kids take it and say, I must have done something, I must be bad. They internalize those messages as they get older. Even if they had a good upbringing growing up. We all remember how difficult middle school and high school can be where there's a lot of bullying, there's a lot of trying to figure out your place in the world. And if you're not getting a lot of support, there's a lot of uncertainty and lack of affection in a family. So any of these can contribute to someone sort of walling off and trying to protect themselves. And it also contributes to people being somewhat self critical. If I were only better at, or if I could only do this, then maybe I would not be making mom angry, maybe I would not be causing all the chaos in the family. Maybe I would be worthy of affection. And that's what's going through the kid's mind. As they're growing up, this kind of gets entrenched. If you tell yourself that for long enough, it's hard to turn that voice off. So thinking about growing up in this family, what do you, the child want but you're not getting it. So if you're growing up in a family where there's abuse, high expressed emotion, and there's neglect or lack of affection, you know, that describes a lot of the families that I've worked with where there's one or both parents having co occurring disorders. So what is it that the child wants? What are they looking for? And you know, you can go back and go, well, affection, compassion, and you know, a parent like, you know, June Cleaver, they didn't get that. So what does that teach you about the world, about safety, about whether you can trust other people to be there and support you even if you don't do the right thing. And the answer is it teaches you that there's not a lot of people you can count on but yourself. But it also often teaches the child, because they experience distress, that maybe they aren't even enough and they can't self soothe. Individuals subjected to early experiences of this type can be highly sensitive to threats of rejection or criticism from the outside world and can quickly become self attacking, like the egocentric child, or defensive and aggressive. So the child who's internalized it, if something starts to go wrong, they Start saying, well, I'm stupid or I'm not good enough. Someone who may have experienced this a little later than in life may have been able to sort of throw responsibility onto the other person and become defensive or aggressive. It's been recognized that working with shame and self criticism requires a therapeutic focus on memories of early experiences. And this is very similar to trauma work. So it's important to look at what happened and the history of what led up to now and why people may be having difficulty being self compassionate. And the thing that really struck me when I started learning about CFT was the fact that some clients become skilled at generating alternatives for their negative thoughts and beliefs, but still do poorly in therapy. So they can be just super high achievers at cognitive behavioral, but still be stuck in a depressive state, still have high levels of anxiety, still have high levels of anger. So why is that? And basically the person is saying, I can identify the logical fallacy or the unhelpfulness of my thoughts and even identify helpful alternatives, but it still doesn't make me feel any better. The words are hollow. And I think most of us have had clients that were that kind of fit into this category. Individuals prone to high levels of shame and self criticism can find it very difficult to generate feelings of contentment, safeness or warmth in their relationships with others or themselves. So again, think about what are the psychological consequences for someone who can't find the feelings. It's not that they don't want to, it's not that they're rejecting it. They just can't. They don't know how to feel content. They don't even, can't even describe what that's like. They don't know what it's like to feel safe. And warmth is just a concept that goes way past them because they've always been in unaffectionate or cold, distant, chaotic relationships and even with their parents and their caregivers, so they weren't safe. The psychological consequences you can see can lead to depression, a sense of hopelessness and helplessness because you're never content and you're never safe. High levels of anxiety and it can also lead to high levels of anger because, you know, I get frustrated, angry, you know, really angry after a while. If I never felt like I could feel safe, what are the physical consequences? Again, probably poor sleep if you're not feeling safe, if you can never get turn off those drives to protect yourself, you're probably going to be in a state of pseudo hypervigilance or hyper vigilance. Most of the time, waiting for the next shoe to drop. So the physical consequences can lead to, you know, draining of energy, just sort of by being awake and being in existence, but also not getting enough sleep and having difficulty forming social relationships with which help buffer stress. So that means you're probably carrying the weight of the world on your shoulders by yourself. CFT proposes that there are three basic brain systems, and the first one is threat and protection. All living things have evolved with a basic protection or survival mechanism. And we're all going, well, yeah, of course, the behavioral outputs of the protection system include fighting, flight, and submission. And we can all think of times where we've done one of those three. The key is that sensitized schemas. So people have this schema that they use kind of too often sometimes because they've become hypersensitive to any inkling that there might be a threat. So they've over generalized threats and threats are all around them, which means life is exhausting and it can create high levels of anxiety. But these sensitized schemas and strategies for threat detection become major influences in the way they perceive and navigate their world. They see the destruction, they see the threats around every corner, but they're not seeing the balances, the checks and balances of the good things that are there too. Yes, there are threats. You know, that's just kind of life. But there are also really good things. And one of the things CFT wants to do is help people balance their perception of threat versus positive things. The clinician will identify historically, plot and validate the functions and origins of safety strategies, partly to de shame them. And this is something that I've done in a lot of my classes with clients and a lot of my individual sessions. We look at their coping behaviors, we look at their self talk, we look at any of those behaviors that they identify as not helpful. And we say, why did you develop these? Because I believe that people do the best they can with the tools they have at any given time in order to survive. Which kind of takes us back to the beginning. This is your survival mechanism, helping people understand how their behaviors and their reactions were basically creative survival strategies. Does it mean that they have to continue to use them? No. But instead of saying, you know, that was a stupid choice or that was just a devastating thing to do, let's look at why you did that. In compassion focused therapy, the focus is on understanding the first function of a person's symptoms and difficulties in terms of safety strategies. And, you know, y' all know I work a lot with people with addictions and co occurring disorders. And this comes up a lot with addiction. When people start saying, well, you know, I'm weak, it's a moral issue, I should be able to just quit. We look at the function. What is it that this drug or this addictive behavior is doing for you? It's serving a purpose. We can find other ways to meet that need, hopefully. But you know, it is serving a purpose right now. So let's look at it in terms of you are doing the best you could with what you had before you came to counseling. And now let's explore some other tools in the toolbox. The next system is the drive and excitement animals and humans need. Need emotion and motivational systems that direct them toward important rewards and resources. From the time we're born, we have this desire for affiliation. From the time we're born, there's a release of oxytocin when there is, you know, mother, baby or dad, baby, person to baby, contact. And this is a calming, rewarding interaction. The function of drive and excitement system in humans is to give us positive feelings that energize and motivate us to seek out the basic things for survival. You know, think about that Maslovian hierarchy, food, sex and friendships. We need to have our biological needs met and to a certain extent our relational needs met. If people take cocaine, amphetamine or any other sort of stimulant, this is the system they're likely to stimulate. Why? Because it's ramping them up. It's getting them excited about doing something. The drive system and the threat protection system can be linked in complex ways and unfortunately, sometimes they are contradictory. The drive system may say we need to avoid rejection, which means we may need to put ourselves out there in a way that we could experience rejection. So the drive and threat protection system are constantly in this sort of little battle saying we need to do what we need to do to get what we need. But how much risk are we willing to take? Some ways that this can be seen are in the way we work to avoid rejection, doing things we shouldn't to please other people or status seeking. A lot of our clients who are highly critical of themselves think they should be able to show more, think they should be able to demonstrate to the world how worthy they are of everything else. They're trying to prove to themselves at the same time that they are worthy and competent, etc. Instead of and focusing on those external examples of their worthiness. And the third system is the contentment system. When a person or an animal thinking of sentient beings are not threatened or seeking resources. They can become, not they do, but they can become content. Contentment is associated with a positive calm, positive aspects and sense of well being. It's not just the absence of threat. So when we talk about relaxation, when we talk about meditation, when we talk about mindfulness, it's about getting to the state of calm where you're not in a state where you're trying to seek something, you're not in a state where you're trying to protect yourself from something you are good in the moment with whatever it is. The evolution of attachment behavior utilized the contentment system and, and enabled signals of caring and kindness to have soothing qualities that activated positive effects linked to feelings of well being, safety, social connectedness. This is sort of the social safeness system within contentment. And like I said earlier, the infant is born with this social safeness system. When the mother and child are together, there's a release of oxytocin. This is one of the reasons that kangaroo care is so important, especially in premature and sick infants, because it helps them calm and soothe themselves. Compassion focused therapy and compassionate mind training are directed at facilitating development of the soothing and social safeness system. What we're doing is trying to get people to release their adherence to the threat system where they're constantly looking for threats, focus a little bit more on self soothing and being content with where they are. Instead of saying, I have to be over here or I have to earn more, or I have to run faster or I have to do this, just being content in the moment. The contentment system has been significantly developed with the evolution of attachment behavior. The key point is to recognize the importance of caring behavior in stimulating the, the soothing and safeness system and thus soothing over arousal and distress in the individual, which, you know, I've said several times, releases oxytocin. When someone experiences being cared about either by themselves or by another person, it helps them actually calm down. It releases some chemicals, opiates and oxytocin that can help them turn down, maybe not turn off, but turn down that fight or flight reaction. So they can say, you know, it's okay that I'm not going to reach this particular goal today. There's increasing evidence that it reduces sensitivity, especially to socially threatening stimuli and fear circuits in the amygdala. So if people can learn to be kind and supportive of themselves instead of judging and saying, well, you shouldn't be afraid of this, you know, repeating to themselves the shoulds, the coulds, it's really helpful in helping them self soothe so they can turn down those fear circuits and they can say, you know what? I can do this. I've got this. Heightened sensitivity and overactivity of the threat protection and or drive systems is a common problem in people with high shame and criticism. So let's think about that. High shame means they feel guilty for some things that they've done, so they're telling themselves they're bad. The threat is the threat of rejection. And self criticism is again, that threat of rejection, but also self rejection, almost in a protective way to reject yourself before anybody else can reject you, but also to motivate, if you will, and I use that term very loosely, motivate yourself to try to do better, to avoid rejection. The soothing system provides relief and calming, but it's insufficiently accessible to people who have a high threat system. So you can't be soothing and hyper aware at the same time, which makes it difficult for the person to feel reassured, calmed or soothed when they generate believable alternative thoughts or engage in helpful behaviors. So this is that person again who does really well in cbt. And they're like, I got this. I understand the logic behind it, but it doesn't change how I feel, doesn't change what my emotions are. It doesn't turn off the critic in my head because there's the critic still going. Yes, but this system is particularly sensitive to interpersonal cues of social safeness, acceptance, and being cared for. This is what we're modeling. This is what we've been taught through our entire career to model a situation where someone can feel safe, accepted and cared for in the therapeutic environment. We also want to help clients replace self criticism with self kindness. So when we hear the negative self talk, or when we hear them going down that road where they're looking at the threats, we want to ask them to step back and take a broader look at it in terms of self kindness and looking for the positives. Attributes of compassion. In compassion Focused therapy, compassion is understood in terms of specific attributes and skills. Care for well being, which means the person really actually wants to feel better. They want to care for themselves. They just don't know how yet. Sensitivity. Yeah, well, we've got to be sensitive to ourselves as well as others, but not hypersensitive. As a therapist, we need to have sympathy for and be moved by someone's plight, but they also have to have sympathy for themselves. They need to have sympathy for themselves and go, you know what? That was really hard. I sympathize with the Fact that I didn't like that. Distress tolerance. Clients have to build distress tolerance. They also have to build empathy. Now the difference between sympathy and empathy. Sympathy is being moved by someone else's experience or part of us being moved by the other part of our experience. Empathy is being able to kind of get down in there in the trenches with the person and go, I'm here to support you and you've got this and non judgment. Yeah, I think that's self explanatory. The skills of compassion involve creating feelings of warmth, kindness and support in a range of activities. And for the rest of the presentation, we'll be talking a little bit more about some of the techniques that we can use in cft. If we're in conflict with someone or ourselves, we often overlook the things that we like about them. By refocusing our attention, we can create a sense of warmth, support and kindness. Encouraging clients, if they're talking about a disagreement with someone else, to focus on what is it about that person that you like? Because clearly that person is meaningful in some way or they wouldn't be stirring up the upsettedness, if you will. Likewise, if someone is being ugly to themselves, if they're in conflict with themselves about something, if they're being self critical. Critical. We want to help them look at what are the good things about you? Yes, you have some flaws. Everybody's got flaws. So what are some good things about you? It's not negating what you're talking about right now, but let's look at it with a more balanced perspective instead of focusing only on the negative. In cft, the focus is on identifying the client's strengths, positive attributes or skills. Paying attention and bringing to mind their positive qualities can be done by helping them revisit positive memories and working on those aspects of the self. So once we identify those strengths, positive attributes and skills. You know, I'm big on journals, so I would have write it down in a journal and I would have them identify times in their life where they have modeled those strengths, where they have used those strengths, where those positive attributes have come in handy. Or just how do they express those positive attributes? Maybe they say that they are a caring person. Well, that's great. So, you know, that's actually a step ahead of where we, where we thought we were. Because if you're a caring person and if you can be compassionate for someone or something else, even if it's, you know, animals and rescue, maybe it's not other human beings right now because there's too much stuff there but if you can be compassionate towards anything else, then you know what compassion looks like and you know what compassion feels like. So let's start talking about what it looks like and what it feels like and what it might be like to give it to yourself. Attention directing exercises linked to the savoring of experiences. Mindfulness to develop appreciation and gratitude. For example, have them appreciate a meal that they're eating or just look around and appreciate their environment. Sometimes you just stop. Well, maybe not everybody does, but I actually take it literally. I stop and smell the roses. If I see a flower or a butterfly, I will stop, go over and look at it. And the poor little critters probably going, oh my gosh, a monster has come to kill me because I get all up in their business. But noticing the little things, appreciating the little things and the gratitude of being able to just experience it in that moment is something a lot of self critical people don't do because they're so driven to try to reach a state where they don't have to be self critical. But what's the catch? They're never going to be satisfied. Because being satisfied is scary. And we'll talk about that in a few minutes. But hold on to that thought for a minute. They will never be satisfied because if they are, that's a terrifying concept. When the threat protection system is focused on problems and potential difficulties, it's beneficial to practice refocusing attention and liberating it from this dominance. So if somebody's focusing on problems, we've all had those days, we get up on the wrong side of the bed, it just happens, and you wake up and you stumble out of bed and you stub your toe and you're focused on all of the things that are going wrong. Encouraging clients to stop, take a breath and go, okay, yeah, they were not the best way to start off this morning. But let's look at some of the positive things that are going on. And I tell my clients, put on their obnoxious rose colored glasses, you know, I want you to find at least as many positive things as there are things for that you're upset about right now. Compassionate reasoning involves how we think about the world, ourselves and others. There are people who think the world is a very scary, unfriendly, unwelcoming place and there's a reason they feel that way. You know, that behavior, those thoughts, those schemas have been shaped over time. So I'm not going to tell them they're wrong because in their perception, that's how the world is compassionate reasoning helps them explore different alternatives. Logic is not enough. Evidence is secondary to the experience of being helped and supported. So when we're doing compassionate reasoning, you know, you can come up with all those reasons that life isn't so bad. But if you don't feel helped and supported, if you can't feel content, if you can't feel nurtured, then it's probably not compassionate reasoning, it's just reasoning. Many of our clients need to start learning that compassionate part to actually feel in addition to thinking. How many clients have you worked with that? I mean, they could spit out a textbook on psychology. They had the stuff down. They knew pretty much anything you were going to say before you had to say it, but they were still in your office because they were still depressed, they were still using, they were still anxious, whatever their issue was. That's where we go to the issue of feeling. They can think it all day long, they can intellectualize all day long, but until they tap into the feelings underlying it, where the thoughts mean something, where the thoughts are validating and supportive and kind, they're probably not going to get unstuck. Particularly important is how people reason, ruminate and reflect on. On their current mood states, their future, and their sense of self. So that's three right there. Their current mood states. If you ruminate about being depressed and think you're going to be always depressed, and you focus on all the reasons you're depressed, guess what? You're going to stay depressed. So looking at how that rumination goes and why it's there, what function is it serving? What function is it serving to kind of continue to focus on all the reasons you're depressed or all the reasons you're anxious. And the answer is, in short, it's safer. You know what to expect, their future. If they ruminate about their future never getting any better, then they're not going to be disappointed. They're not going to be let down if something doesn't happen. They're not going to be critical if they don't achieve a goal. And their sense of self. If they think, if they ruminate on all of their faults, then guess where their sense of self is going to be if they ruminate on. Yes, I'm not so good at that. Remember, we've talked before about global versus specific attributions. If they focus on things as being specific. So, yeah, I may not be good at xyz, but I am wonderful at the whole rest of the Alphabet. That's a whole different perspective. And it really affects how people feel in terms of their sense of self. Shame and critical thinking are clearly targets in compassion focused therapy. But it's important to understand the functions of the self critical thinking and why people may feel fear giving it up. And I know I've brought that up four or five times now, but you know, we're kind of priming you for getting to that point of why wouldn't somebody want to give up being self critical? As a therapist, we want to teach the problems of certain types of rumination. Why is it problematic to focus on all the things that are going wrong? Why is it problematic to focus on all of our faults? You know, a self critical person would say, if I focus on my faults, then I know what I need to improve on. Well, true, but you're also not focusing. It's an imbalanced look at who you are. You're focusing on three or four faults as opposed to the 30 positive attributes. And then we want to talk about how to substitute compassionate refocusing in their thinking. How do you switch from focusing on your faults or focusing on your fear of the future, or focusing on your frustration and sense of helplessness about your current mood state? How do you switch from that to focusing on compassion and self support? Compassionate behavior is focused on alleviating distress and facilitating development and growth. For example, when the person has to engage in a difficult or frightening behavior, they'll try to create an encouraging, warm tone in their minds with supportive thoughts. A lot of our clients hate public speaking and this is the best example that I can give because so many people have experienced it. Even if it's only speaking to five or six people. A lot of people can relate to a time where they've had to get up in front of others and it's just been terrifying. So helping them imagine that situation and then helping them figure out how to create encouraging warm tone, what's it going to be like? You can walk out there and you can anticipate people to be critical. You can anticipate people to heckle, you can anticipate people to laugh at you. You can anticipate people to fall asleep, or you can walk out there, focus on the people who are really excited to be there and interested in what you have to say. Because in any group there are going to be some who are there because they want to be and some who are there because they have to be. And their attitude may have nothing to do with you. So talking about different interpretations of any stressful situation and having someone figure out basically, if you Were a cheerleader for somebody and they were getting ready to do something that was anxiety provoking, what would they say? What would you want them to do? If you were in a recital when you were little, you know, maybe you took ballet or tap or sang or whatever it was. How did it feel if your parent was backstage and encouraging and, you know, welcoming to you when you came back no matter how you did, versus being there and being critical as soon as you walk off the stage, getting all up in your face and telling you all the things you did wrong. We want to create that warm environment. This is a repetition of what would normally happen within a parent child relationship where the parent's encouraging and supportive. Even before looking at cft, One of the things that I often asked my clients, when they would start holding themselves to this standard that was far above anything that they would hold anyone else to, when they would start being self critical, I would say, you know, if this was your child, what would you say to them? Or would you hold your child or your best friend to that standard? 99 times out of a hundred, they say no. So then we talk about why they think it's necessary to hold themselves to that high standard. CFT seeks to stimulate positive affect processing, which means we've got to have positive affect. So we need to figure out how to create that warm, inviting, welcoming, supportive situation. Behavioral tasks encouraging exposure to positive emotions can help the client learn to enjoy experiencing them. The caveat is some clients are not able or willing to experience pleasure. Why? Well, maybe they don't know how. Maybe they grew up in an addicted family where it was don't talk, don't trust, don't feel, and heaven forbid you should be happy. When the addict was in a bad mood, maybe they experienced abuse so they're afraid that something's bad's gonna happen if they experience pleasure. So there are a lot of reasons, and you have to look within your particular client's history to figure out what may be preventing them from experiencing pleasure. We want to help people become more process focused rather than task focused. So if they do something, instead of focusing on how far short they fell of their goal, focus on the effort. This is true, you know, with mental health or addiction. But addiction tends to be a little bit more rapid cycling, if you will, if it's going to cycle. When people go out and then they relapse and they're like, some people will be very focused on the fact that they relapsed. Other people will be focused on the fact that I stayed clean for six months before I relapsed. So they focus on the effort and the progress instead of focusing on not meeting some arbitrary goal. Clients explore the image of their ideal of compassion. The therapist can guide the client through imagery exercises, exploring feelings associated with various images. So what would it look like, what would it sound like? If someone were being compassionate to you, what do their facial expressions look like? It's important that we tell the clients that these images are usually fleeting and not clear in the mind so they don't get frustrated that they're not doing it right. Because a self critical client is going to want to do it exactly right. And if they can't see it, if they can't feel it, they may get even more frustrated. If they can't do it right now, that's okay. If, like I said before, they've had an experience of being compassionate, you know, maybe have them take that situation and go, okay, what did your face look like? What did it feel like? What was your tone of voice when you were being compassionate? Friend of mine can be very demanding, can be very harsh, you know, former military, all that kind of stuff. But it is fascinating to watch his demeanor change when he's talking to his kids or when he's talking to his dogs. He is infinitely compassionate with them, but he is very, very critical of both himself and other people. There's definitely a switch that people will see. Sometimes clients prefer non human images such as an animal, a tree or a mountain. These must be imagined as sentient with specific qualities of wisdom, strength, warmth and non judgment. Basically what you envision your parent being, or the ideal parent being. We also can have the client imagine themselves as highly compassionate and explore their sense of age, facial expression, body posture, voice tones and styles of thinking. So encouraging people to go, is there a time? Or if you are compassionate, what would it look like? One thing we want to do is encourage clients to practice each day at becoming their compassionate self. When they're using appropriate facial expressions, voice tones and ways of thinking. And one of the things we talk about in addiction recovery is fake it till you make it. Now they're not going to be able to be their compassionate self all day long, probably at first. Encourage them to do it for an hour, maybe an hour in the morning and an hour at night. Being compassionate with themselves and not pushing, listening to where they are. That also increases mindfulness. You know, if they're being compassionate, then they're aware of themselves in the moment in a non judgmental fashion. This is very good with kids who are or People who have been victims of of sexual abuse or any kind of abuse, because a lot of them have very negative associations. Remember we talked about the interpersonal relationship being calming and soothing, but if you have been victimized by someone who you're supposed to trust, then that gets rewired so you don't have that calming and soothing. And if you blame yourself, which a lot of survivors of abuse do, for what happened, then there's that self critical also going on. So there is a huge amount of overlap between CFT and trauma work. Clients explore feelings in their bodies when they focus on being compassionate, experiencing compassion from others, and being self compassionate. So these are three different activities. Going through and feeling how it feels. If they're focusing on being compassionate on something non threatening, like their puppy, that will feel one way. Experiencing compassion from others, how does it feel if other people are compassionate towards you? What are you telling yourself? What are you feeling? Are you feeling vulnerable? Are you feeling suspicious? Or are you feeling soothed and comfortable? And how does it feel if you're self compassionate? What goes on in your body? What kind of things are you telling yourself if you're trying to basically cut yourself a break? CFT suggests that internal thoughts and images can act just as external stimuli do, activating different parts of the brain. Again, we've talked about this. If you see food and it smells really good, you're probably going to start to salivate. But you can also think about your favorite meal to eat without even seeing it or smelling it. And likely you will start to salivate. The same thing happens if you imagine yourself being in a hostile environment or if you create a hostile environment in your own mind. The abuse, the negativity, is still the same. Therapists can ask clients to consider how they would feel if someone kept putting them down, undermining their confidence and becoming angry with them when things didn't go well. Usually, clients can identify the feelings of anxiety and depression and can recognize that this is because critical signals stimulate their threat protection system so they know when they're bullied, they're going to feel threatened. Then we can take them all the way back around and help them see how bullying themselves, being self critical, not being compassionate to themselves, triggers those same feelings of anxiety and depression. And I told you we were going to get here. Fear of compassion. Many clients cannot easily access the soothing and social safety system that underpins compassion. Much of the work that you would do in CFT addresses people's fears and resistances to becoming self compassionate and compassionate to others. Now, some clients will be able to do one or the other, but not both. And some clients won't be able to do either one at the beginning. So figuring out what they can do and working from there, signals of kindness and compassion from another person will reactivate the attachment system and memories and feelings within that system, which may trigger considerable sadness and grief. And this is the key part. If a person starts to feel cared for, if a person starts to feel like there's a relationship, the attachment system is triggered. But if they have been abandoned before, if they have been hurt by those who are supposed to take care of them, then it's going to be traumatic to start feeling those feelings again. Because as soon as they feel it, they will remember what happened the last time they felt that way and it didn't end up so well. The compassion focused therapist will help to normalize, validate, contain and work on those feelings. So when someone starts to feel anxious as they are experiencing compassion, our job is to help them work through it. Some people find compassion focused imagery physiologically stressful due to prior trauma, abuse, or abandonment history. Some systematic desensitization can really be useful in working with this because as people start to feel that compassion, that fight or flight system gets triggered. They're trying to protect themselves from a threat. They don't want to feel that abandonment or abuse again. So using systematic desensitization, we can help them calm themselves down, get refocused using mindfulness in the present moment, and learn to tolerate the distress as well as balance out those systems and look at what's going on now, recognize the artifacts from their past. Some clients have negative beliefs about compassion as being soft, self indulgent, or not deserved. I can imagine a parent telling a child that. I can imagine a child internalizing that. If they, when they're growing up, if they're always being pushed, if they're always being driven to be number one. And any rewards they get, any support they get, is predicated on them being the best. Exploration might reveal that the individual is afraid that if they give up self criticism, they'll become lazy, unpleasant or unlovable. Well, they probably got that message from somewhere. Or they may be punished for self compassion by paying for it later or having it taken away. Everything ends. Everyone leaves. We've probably heard that from our clients at one time or another, depending on what causes or where these thoughts came from, you know, will really affect how you work with it in therapy. But understanding why they're afraid, why they're resistant to being self compassionate is a huge step. And they'll probably get to the point where they logically understand it before they can emotionally commit to it and go, you know, it's okay to be kind to myself. The therapist is constantly exploring the interactions between the functions of self criticism and avoidance of self compassion. So how does self criticism and fear of self compassion work together or work against each other? Many clients struggle not only with low self esteem, but also a highly critical negative internal voice. In cft, the therapist explores the roots and functions of self criticism, helping clients understand how it might have been a survival response. They help clients explore what a compassionate other would look like. What would it have looked like if you had that compassionate person in your life? Help clients describe and rehearse being self compassionate. Maybe you can start out with when you've been compassionate with someone else, maybe it's your child, maybe it's your dog, maybe it's, you know, who knows what it is? How did you look? What were your facial expressions? What was your body posture? What, what did you do differently? Now I want you to take that and practice it the next time you hear yourself being self critical. It explores the interaction between self criticism and avoidance or fear of self compassion. So if you're being self critical, it's going to be hard to be compassionate at the same time. I mean, they're kind of opposite ends of the spectrum. We will explore the sensations and fears associated with self compassion. Some of the sensations can be as strong as making someone nauseous. Other times it can trigger a panic attack. I mean, this is a really strong ingrained drive that we have. So uprooting that and, you know, kind of basically saying, well, let's take how you perceive the world and turn it on its head is really anxiety provoking for some people. So go, start low, go slow and help people explore the sensations so they can de escalate as their anxiety starts to go up before it gets out of control. And we'll help clients understand why compassion in the present may cause so much distress due to unresolved attachment issues from childhood. So these are just a few of the things that the CFT therapist will do. Obviously, we're almost at the end of our time, so an hour wasn't nearly enough time to cover CFT in depth. There are a lot more readings. You can get them either from the center for Compassion Focused Therapy or Neuharbinger Publications. And you know, I would recommend a lot of these books. They're highly recommended, highly rated, and Paul Gilbert himself wrote and I don't know if you can see my cursor the Compassionate Mind. So that's one Obviously, if you're really interested in cft, I would probably recommend starting with some questions that came in. Do you find it's helpful or hinders the process when the client is on medications for depression or anxiety? You know, I really think that if the medications are being used correctly and the person's not just using so many meds that they're just completely numb, the psychotropic meds often help take the edge off so people have the energy and the ability to focus without having it get out of control. The Books for the Clients CFT Made simple is a really good Any of the Made simple books by New Harbinger, for example, are good primer texts for clients to use because they're workbooks. I would definitely suggest looking at Amazon and some other places to see if you can get some ideas. I've included in your in your classroom there's a link to like I think it's an 82 page text that is written and geared toward client usage. So actually I would start there before I start buying any books and see what it has, what activities are in it. You can also google Compassion Focused Therapy activities or worksheets. And just like most other theories, there's a lot of worksheets that people have made and put online for free so you can go and see what seems like it would work for your clients or send them to go look at it and see if they can find or see what they find that appeals to their particular learning style and preferences. One of the nice things with Compassion Focused Therapy is it can be incorporated with other techniques. It's not something that you just have to be a CFT therapist and that's it. There are trainings. The center for Compassion Focused Therapy is actually based in New York and you can become a certified CFT therapist if that is something that appeals to you so that you know you can go online and look at what they have to offer as well as reading the journal articles. I will have a an in depth 15 hour multimedia course. You know, some video, some text ready by the beginning of next week on CFT that will give you credit, if you will, for doing additional readings and doing more in depth study. This is a theory that you think you want to pursue for your practice and with your clients. When working with adolescents. You know, adolescents span such a broad range. Obviously if you're working with your younger adolescents, they're not going to have the frame of reference necessarily as others. But most adolescents know what kind of parent they wish they had or what kind what it feels like if someone's ever been compassionate to them. And you know, most people have had someone somewhere in their life be compassionate to them, they may have rejected that person because it felt so scary and felt so strange, but they'll probably be able to go, yeah, that person was kind of nice to me. Having them play off of that, having them really explore what compassion means, because a lot of adolescents are going to kind of roll their eyes as soon as you start saying compassion because they're like, oh boy, let's give ourselves a hug and just move on. And that's actually kind of what my daughter said when I was telling her about this presentation today. So, you know, helping them conceptualize it in terms of that are meaningful to them so they can be less self critical, focusing on their strengths and that goes a long way to helping them get into that compassionate state of mind. Okay, if there's no other questions, the quiz is available for you in your class and I will see you next week. 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