Transcript Multiple Selves for Multiple Roles

Compassion Focused Therapy
Derby December 2008
Paul Gilbert PhD FBPsS
Mental Health Research Unit, Kingsway Hospital Derby
[email protected]
Mary Welford
Greater Manchester West Mental Health NHS Foundation Trust
[email protected]
Ken Goss, Ian Lowens, Chris Gillespie & Chris Irons
www. compassionatemind.co.uk
If you wish to use this material please respect sources
Warm-up Exercise
• In threes or small groups introduce yourself
and then consider clients whose shame and selfcriticism have been hard to work with
• What was the nature of the ‘stuckness’ how did
you formulate this, and how did you try to
resolve it?
• What might have helped you
Workshop Outline
First leg
• Introduction to the model
• Our Basic Threat-Defence Systems
• Safeness: A Missing Component
• Key Shame Concepts
• Identifying Critical Dialogues &
Associated Affects
• The Diagrammatic Model /
Formulation
Key Targets of Therapy
Attention
Imagery
Thinking
Reasoning
Behaviour
Motivation
Emotions
Evolved Dispositions and Designs
Basic Philosophy and Model
To derive models of psychopathology based on
the science of mind
To derive models of psychotherapy based on the
science of mind
To derive models of both that integrate all the
relevant sciences e.g., genetic neuroscience,
development, cognitive psychology through to
social and political psychology and beyond
Contextualise mind in it’s environment
Innate and Acquired
(v) Genotype  (v) Environment = (v) Phenotype
Genotypes are potential competencies for Examples: Language, symbolic thought,
attachment, defensive behaviours
Phenotypes are the expressed or manifest
traits/outputs that are observable or measurable
Examples: Styles of language, attachment
Basic Evolutionary Orientation
Phenotypic vulnerabilities
Normal reactions to abnormal/hostile’ environments e.g.,:
abusive environments develop threat focused phenotypes
Safe environment develop trust, openness phenotypes
Multiple systems specialised ‘trying to do their best’ thus
protective but can conflict
Population variation
Co-constructions
The Challenges
1. Old brain
Motives:
Emotions:
Behaviours:
Safeness, food, shelter, social
Anger, anxiety, sadness, joy, lust
Fight, flight, withdraw, engage
Relationships: Sex, power, status, attachment,
tribalism
The Challenges
Archetypes and Social Mentalities
Innate tendencies for organising basic psychological
processes (motives, emotions, attention, thinking and
behaving) for the creation of social roles and
relationships
Consider their organisation for
Care-seeking
Care providing
Cooperation
Competition
Sexual
KEY POINT: Different social mentalities organise our
minds in different ways
The Challenges
1.Old brain
Motives:
Safeness, food, shelter, social
Emotions:
Anger, anxiety, sadness, joy, lust
Behaviours: Fight, flight, withdraw, engage
Relationships: Sex, power, status, attachment, tribalism
2. New Brain
Imagination
Planning
Ruminations
Integration of mental abilities
What happens when new brain is recruited to pursue
old brain passions?
The Evolved
Brain
Sources
of behaviour
New Brain: Imagination,
Planning, Rumination, Integration
Old Brain: emotions, behaviours,
relationship seeking
Humans are an Evolved Species
Human
Symbolic thought and self,
theory of mind,
metacognition
Mammalian
Caring, group, alliancebuilding, play, status
Reptilian
Territory, aggression,
sex, hunting
The Challenges
3.
Curse of the self
Aware and seeking to create a self-identity
Self As: wants to be, does not want to be
Shame, sense of personal failure, alienation
What you think about me
4.
Mammal brain requires nurturing, caring and
kindness
Affects brain a maturation
Experience of safeness and pro-social behaviour
Physiological regulating
Health and well-being
The Challenges
5
Interconnectedness and interdependency
Co-operation, sharing, training
Tribalism, group loyalties,
Submissive following
6.
Individual differences
Personality
Gender
Talents
Ethnicities
7
Self-to-self-relating
Imagination
Thinking
Self-reflections
Stimulus-Response
Sexual
Bully-threat
Meal
Meal
Sex
Limbic system
Bullythreat
Kind, warm
and caring
Compassion
Soothed
Safe
Stomach acid
Salvia
Arousal
Fearful
Depressed
The Challenges
8
The Tragedies of Life
Death, decay and an awareness of this
Diseases, famines, droughts and wars
9
Moralities
Justice vs compassion
Morality as feeling (and genes)
Social conditioning
Developmental stage
10
Fear of compassion
Weakness
Indulgence
Vulnerable
The Challenges
So basic philosophy is that
We all just find ourselves here with a
brain, emotions and sense of self we did
not choose but have to figure out
‘Not our fault’ – all in the same boat –
clearly convey – de-pathologising
Compassion Solutions
Ancient wisdom
Compassion is the road to happiness
(Buddhism)
Evolution
Evolution has made our brains highly
sensitive to internal and external kindness
Neuroscience
Specific brain areas are focused on detecting
and responding to kindness and compassion
Key Targets of Therapy
Attention
Imagery
Thinking
Reasoning
Behaviour
Motivation
Emotions
Evolved Dispositions and Designs
Types of Affect Regulator Systems
Content, safe, connect
Drive, excite, vitality
Affiliative focused
Incentive/resource
focused
Soothing/safeness
Seeking and behaviour
activating
Opiates (?)
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Anger, anxiety, disgust
Key Idea
Various therapies have developed exposure and other
techniques for toning down negative emotions but not for
toning up certain types of positive ones. Can’t assume that by
reducing negative emotion the positives will ‘come on line.’
Two types of positive affect related to
achievements/doing/excitements
affectionate, soothing
Some clients have major difficulties in being able to access
the soothing system - implications - so CMT/D targets this
system.
Therapeutic Philosophy
We use a variety of safety strategies, both innate and learnt
(e.g. avoidance, excessive submissiveness, striving to prove
oneself) to try to help ourselves get though life’s challenges
We can get trapped and stuck in self-protective systems and
strategies
Compassion Focused Therapy
To understand shame and self-attacking as threat and safety
focused
Compassion training/therapy is an opportunity to discover
and develop our minds to be self soothing – as a way to tone
down and alleviate the impact of shame and self-criticism.
What is Compassion Focused Therapy?
1. CFT
draws on many branches of psychology (e.g.,
developmental social and evolutionary) and neuroscience
science
2. It utilizes interventions derived from many western and
eastern therapies.
3. The therapy is not technique driven but process driven.
4. The focus is on developing capacities for compassion and
balancing the affect regulation systems
CFT Can Involve
The therapeutic relationship, collaboration, guided discovery,
personal meaning, Socratic dialogues, inference chains –
(bottom line/catastrophe/major fear/threat), functional analysis,
chaining analysis, maturation awareness, shared formulation,
change through practice, behavioral experiments, exposure,
developing emotional tolerance, mindfulness, guided imagery,
expressive writing, reframing, generating alternative thoughts
and independent out-of –session practice -- to name a few!
There should
be increasing overlaps in our therapies if we
are being science based.
What is helpful
Cognitive-Behavioural focused therapies help people
distinguish unhelpful thoughts and behaviours - that
increase or accentuate negative feelings - and alternative
helpful thoughts and behaviours that do the opposite.
This approach works well when people experience these
alternatives as helpful. However, suppose they say “I can
see the logic and it should feel helpful but I cannot feel
reassured by them” or “I know that I am not to blame but
still feel to blame.”
What is helpful
This is called the cognition-emotion mismatch. In these
cases, the problem may be that their soothing systems
simply do not register the alternative thoughts as helpful
i.e. the opiate / oxytocin system is insufficiently
stimulated and thus they do not feel reassured. The
emotional systems that give rise to feelings of
reassurance are not active enough -- or the threats are so
great that the threat system overrides them. Safeness
can feel unfamiliar or dangerous
Key Message
• We need to feel congruent affect in order for our thoughts
to be meaningful to us. Thus emotions ‘tag’ meaning onto
experiences. In order for us to be reassured by a thought
(say) ‘I am lovable’ this thought needs to link with the
emotional experience of ‘being lovable’. If the positive
affect system for such linkage is not activated there is little
feeling to the thought. People who have few
memories/experiences of being lovable or soothed may thus
struggle to feel reassured and safe by alternative thoughts
• Compassion focused therapy therefore targets the
activation of the soothing system so that it can be more
readily accessed and used to help regulate threat based
emotions of anger, fear, and disgust and shame. (page 12)
What is the Point of Change?
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.
Making a decision that suffering is not desirable – one’s own mind contributes to it (luxury
flat)
If we loose the sense of direction then change process can seem overwhelming and lost
The importance of cultivation (wild vs cultivated garden)
Knowing one’s mind – different levels and types of subject and objective knowing
Change requires courage - purposeful vs purposeless suffering
Buddhist
To investigate the nature of consciousness and reside there
The light is not what it illuminates: Water is water whether it
carries a poison or medicine
Mindfulness helps us reside in consciousness and not content
Making a decision to reflect on the nature of suffering, it’s
nature and consequences
Compassionate Knowledge
Some Basic Themes
Understand how our minds were designed
If therapy involves psycho-education then what
do we teach clients about how our minds work?
Evolution-informed and functional and focus
Two Types of Processing System
Implicit
Explicit
Fast – Affect
Evolved Mechanisms
Hard to Verbalise
Emotional Memory /
Conditioning
Specific Signals
(e.g. NVC)
Involuntary
Slow
Reflective
Easy to Verbalise
Emerges with Cognitive
Competencies
Learn (social) Rules
Voluntary
These systems interact but can conflict. Therapy should
work with both systems and may require different
interventions
Workshop Outline
First leg
• Introduction to the model
• Our Basic Threat-Defence Systems
• Safeness: A Missing Component
• Key Shame Concepts
• Identifying Critical Dialogues &
Associated Affects
• The Diagrammatic Model /
Formulation
Self-Protection: A Design for Life
All organisms are structured for selfprotection:
Safe --- Not safe
Action
Better safe than sorry: Our Minds are
designed to easily assume the worst -safer
Threat
No
Yes
Run
Don’t Run
Self-Protection
In species without attachment only 1-2%
make it to adulthood to reproduce. Threats
come from ecologies, food shortage,
predation, injury, disease. At birth
individuals must be able to “go it alone” be
mobile and disperse
Over millions of years a variety of fast detection and
response systems have been built into animal and human
minds to cope with a variety of threats and are the basis
for UCSs and UCRs
Threat responses need to match the stimuli and context
Menu of Defensive / Protective
Strategies linked to Coordinated set
of:
Motives
Emotions
Behaviours
Cognitive Processes
Self-Protective Motivations/Drives
Get or stay safe
Damage limitation vs enhancement
Hold on to what one has
Act to reduce future threat
Menu of Implicit Threat - Protective Emotions
Anger –
increase effort and signal threat
Anxiety – alert to danger and select
defensive behaviour
Disgust – expel / keep away from noxious or
undesirable
Sadness – acknowledge loss, signal distress
Jealousy – threaten and defend
Envy –
undermine / spoil benefits of the
other
Menu of Defensive / Protective Behaviours
Stop - Hyper-alert/ hyper vigilance – predict threat early
Flight - Escape, prevent exposure (Cannon 1929)
Fight - Protection or deterrent – subdue others / exert
control
Hiding and camouflage
Tonic immobility – ‘play dead’ (Bracha 2004)
Cut off - turning away from
Demobilisation -- short-term and long-term
Clinging ‘on to’
Help seeking - hyper activation of proximity seeking
Submission - appease, comply
Menu of Defensive / Protective Cognitive Processes
Better Safe than Sorry requires rapid decisions
•Selective attention - scan for threat
•Crude analysis
•Dichotomous thinking
•Over-generalisation
•Disqualify positive – can’t risk false hope
•Sensitive to nonverbal signals
Helps select automatic appropriate defence (e.g., flight, submit
or attack)
May be into process before conscious awareness e.g., we find
ourselves submitting and then make self-referent explanation
Neural Bases of Threat Processing
(LeDoux, 1994)
Cerebral
cortex
Amygdala
Hippocampus
The Complexity of the Threat
System
1) Different processing systems active
2) Threat emotions can set up conflicts
- The power of approach-avoidance
conflicts
3) One protection strategy creates another
4) Emotional Conditioning
2) Threat Emotions can set up Conflicts
Threat – boss criticises
your work
Rapid access of safety
strategies
Angry-attack
revenge
Anxious - flee
submit
Cry want to seek
reassurance
Threat to self-identity and self as social
agent in social role
Fragmented and fragmenting, confused and secondary
safety strategies at management of inner conflicts
Conflicts
(e.g. Approach-Avoidance)
Experimental neurosis – trigger two different behaviours at
same time e.g., seek reward and avoid threat – Pavlov, Liddell
& Cooke etc
Incompatible decisions – choosing one violates another:
Disorganisation of systems (also classic Sci-fi; Hale in 2001 a
Space Odyssey and 2010 the Return)
Dilemmas (e.g., risk change or trust vs stay safe); head heart
Increase in stress arousal and inhibits abilities to think –
dissociation. Confusing to client and therapist (Liotti..)
Therapeutic task is to clearly articulate the conflict, explain
how conflict affects the brain, and then brain storm – May
take time to work through – resolution may not be easy – hard
life decisions.
4) One Protection Strategy Creates Another
Express feelings
Don’t express feelings
Others angry
Reject
Others ignore
my wishes
Feel bad
Feel bad
5) Emotional Conditioning
How emotions and desires can become non-conscious
(Ferster 1973)
Anger
Punishment
Anxiety
Any emotion or motivation (urge) can become a CS of
any other
Conditioning
Care seeking
Punishment
Anxiety
Care seeking systems can become conditioned
to threat rather than safeness. If happens
early, people may not recall specific memories
but experience confusing feelings in close
relationships
Conditioning
Care seeking
No response
shut down
Own Behaviours as Threats
Anxiety can be an alerting signal for not to do something –a
‘don’t’ signal.
Brain can also automatically change the balance of emotional
regulation as in Protest-Despair.
Infants separated from caregiver first shows protest (pining
and anxiety) but then becomes quite and withdrawn – this
stops movement, getting lost, and attracting attention of
predators
Toning down of positive emotions most likely in poorly
supportive, low pay off and/or risky environments –
So what is the protective strategy underpinning low mood?
Source of threat
External
Shared with other animals focus on the outside and how to
behave in the outside world to minimise threat and harm
Internal
Can be threatened by the emergence of internal emotions,
desires fantasies and memories
Both can be very clear or very subtle threats
Emotions as Internal Threat Stimuli
Emotions are evolved, specialised processing systems that
provide internal knowledge about our relationship to the outside
world and guide actions (Greenberg)
Without emotions nothing matters, with them anything can
(Tomkins). Motives and emotions guide us to goals and are nonlogical (e.g., falling in love, wanting children, grief).
Human evolution has resulted in the fact that we cannot learn
about our emotions or develop integrated systems for emotional
processing without the minds of others interacting with us
Parent is the only regulator in first months and then becomes a
coach, source for social referencing and validator.
Emotional schemas (Leahy)
Can develop threat based beliefs and coping strategies for
emotions and desires that emerge from how we experience
our own emotions and others responses to them
Emotions can become threats themselves related to beliefs
that one’s desires, fantasies and emotions are
incomprehensible, unique to the self, shameful, can never be
validated or expressed and /or that one’s emotions will go out
of control if experienced. Beliefs that one should be rational
and logical all the time, never have conflicting feelings, and
should ruminate in order to figure things out. Ruminations
can be a way to try to work things out without needing help
(soothing) from others
Emotions:
anger
anxiety
sexual
sadness
Emotion is normal
Attention to emotion
Cognitive
avoidance
Negative Interpretations:
guilt
lack of consensus with others
simplistic view
incomprehensible
cannot accept emotion
overly rational
dissociation
bingeing
drinking
drugs
numbness
Emotion is problematic
accept,
express,
experience validation
learn
lose control
long duration
rumination
worry
avoid situations that elicit emotions blame
others
From Leahy 2001
Problems of balance
Examples of Threat-protection focused difficulties
Triggers, intensity, duration, frequency, coping
Emotion containment
Impulsiveness
Emotional, cognitive and behavioral avoidance
Prediction
Rumination
Self-Protection
All organisms are structured for self-protection: Safe --Not safe. Thus high priority and urgency are given to this
decision in all biological systems
Symptoms often arise from perceived threats and efforts to
cope defend and protect
Some phenotypes have undesirable effects and are linked to
suffering
Resistance is related to threat of change – fears of ‘new’ self
These are shared views of many therapies
Language of self-protection and better safe than sorry and
validation rather than pathologising
Workshop Outline
• Introduction to the model
• Our Basic Threat-Defence Systems
• Safeness: A Missing Component
• Key Shame Concepts
• Identifying Critical Dialogues & Associated
Affects
• The Diagrammatic Model / Formulation
Safeness: A missing
Component?
Feeling safe from physical, psychological and selfattack is essential for well-being
Consider process and mechanisms that create
states of safeness
Overview of an Evolutionary
Journey
Attachment
Threat
Safeness
Compassion
Mutual support
Self -Regulation
Qualities of Care
Accessibility of the other
Availability of the other
Disposition of the other
Competencies of the other
Interpersonal style of other
How one exists in the
mind of the other
Self-vs-others protection
Attachment as “looking after.” Individuals
obtain protection, food and care when ill.
Seeking closeness rather than dispersion. Key
also is soothing-calming and physiological
regulation. Few offspring but high survival rate
in comparison to species without attachment
Co-operative and mutual support when ‘your’
prosperity impacts on mine
Safeness vs Safety
Safety Seeking is often about escaping, avoiding,
hiding, preventing - when threat is the focus of attention
(better thought of as defensive behaviour). Highly
conditionable
Safeness creates an inner state that organizes multiple
processes
Free(dom):
To move, to grow, explore, integrate, slow reflective
Open attention
Evolution of Safeness
Mastery, De-sensitisation, Familiarization - mindfulness
Social Safeness
Can be passive or active –freedom of movement, explorative
Attachments
Group living --- Belonging
Connectedness
Signal-sensitive systems to detect presence and absence
Soothing, calming or alerting of affiliative emotion
Emotion System for Care
Evolved motivations to care, and competencies to
care, by attuning to needs of the other and
engaging behaviour that impacts on the object of
care
Being Cared For
Innate, signal sensitive systems that seek out and
are responsive to certain stimuli and cues
These specialised physiological systems detect
(evolved form contentment) code for “safeness”
Types of Affect Regulator Systems
Content, safe, connect
Drive, excite, vitality
Affiliative focused
Incentive/resource
focused
Soothing/safeness
Seeking and behaviour
activating
Opiates (?)
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Anger, anxiety disgust
Functions of Caring-Attachments - Needs
Sensitivity
The Carer-Provider offers……
Protection: anticipating/preventing; build nest out of harms
way, defending/standing up for – advocate
Distress call responsive: listening out for; rescuing; coming to
the aid of – responding to distress
Provision: physical care, hygiene, food,
Affection: warmth positive affects that acts as key inputs for
brain maturation
Education and Validation: teach/learn life skills in family
context: understanding one’s own mind
Interaction: being present, stimulating and regulating various
affect systems: curiosity, play, soothing – socialising agent –
shaping phenotypes
Key Sources of Safeness
Safeness is not just the absence of threat but there are specialised systems
in the brain linked to social cues. Thus soothing systems are regulated via
differ pathways.
First are cues of physical affection (facial, holding, touch comforting) –
highly sensory based
Second needs can be meet, soothed and contented
Third, learning how we live in the minds of others – and learn about our
own mind -- ‘your reactions to my mind’
Fourth social referencing for what is safe – the self to become
Fifth create internal memories of others as soothing supportive, kind and
forgiving and self as lovable
All these play different roles in threat regulation and feeling safe/content
Safeness
Carer creates a safe base – and provides inputs for working
models of relationships (Bowlby)
Parent and peers regulate exposure to external threats - and
loss of access is itself a threat
Parent and peers regulate internal threat states – soothing and facilitate internal self-regulation
Key to CFT however are the data on the neurophysiological
systems responsive to care-focused and safeness signals from
others
Workshop Outline
• Introduction to the model
• Our Basic Threat-Defence Systems
• Safeness: A Missing Component
• Key Shame Concepts
• Identifying Critical Dialogues & Associated
Affects
• The Diagrammatic Model / Formulation
Living in the Minds of Others
Major evolved specialised processing systems and
abilities (linked to inter-subjectivity and theory of
mind)
Long history of recognizing the importance of how
(we think) we exist in the minds of other
Clear in play writers and novelists (e.g.,
Shakespeare) – and key for:
Cooley, Rogers, Bowlby, Kohut
Living in the Mind of Others
Colley 1902 Looking Glass Self:
Many people of balanced mind and congenial activity
scarcely know that they care about what others think
of them, and will deny, perhaps with indignation, that
such care is an important factor in what they are and
do. But this is illusion. If failure or disgrace arrives, if
one suddenly finds that the faces of men show
coldness and contempt instead of the kindness and
deference that he is used to, he will perceive from
shock, the fear, the sense of being outcast and
helpless, that he was living in the minds of others
without knowing it, just as we daily walk the solid
ground without thinking of how it bears us up
Key Shame Concepts
Exercise 1
Insight Exercise
• To help you recognise the complexities of shame
and also see that you already have intuitive
knowledge of shame, we would like to you to
engage in a short imagery exercise.
• Let’s take a hypothetical situation: Imagine that
as part of this workshop you will be asked to
describe something you feel ashamed about,
and would rather keep hidden, to the person
sitting next to you. We would like you to
explore this is a series of steps. Rest assured
this is hypothetical, but try to imagine it as if it
were to be the case.
Strategies for Gaining and
Maintaining Rank and Status
Strategy
Aggression
Attractiveness
Tactics used
Coercive
Threatening
Authoritarian
Show Talent
Show competence
Affiliative
Outcome desired
To be obeyed
To be reckoned with
To be submitted to
To be valued
To be chosen
To be freely given to
Purpose of strategy
others
To inhibit others
To inspire, attract
To stimulate fear
To stimulate positive
affect
From Gilbert & McGuire 1998
Safeness and the minds of others
Creating positive feelings and thoughts in the minds of others, about oneself, makes
the world safe
safe and will not rejected or attacked
likely to be available in time of need
co-create advantageous relationships (e.g., sexual, co-operative)
physiologically regulating (e.g. oxytocin, cortisol)
stimulates positive feelings for self and other
lay down emotional memories of warmth
External shame is experiencing negative feelings (contempt, anger, ridicule) in the
minds of others lead to attack, rejection or ‘un-included’
major threat --- generating defensive behaviours such as,
fight/flight/submit
Self-Conscious Emotions
Shame Guilt
Pride
Embarrassment
Humiliation
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
Rage/anger
Happiness
Fear/anxiety
Joy Fun
Disgust sadness
Primary Emotions
Attracting, Competition and Social Rank
Competing for resources and social place and thus
be able to engage others as helpful partners in roles
Helpful partners (expressing liking) also help make
the world safe and stimulates soothing system
Competing to stimulate positive affect (desires) in
the mind of others about the self is competitive
because an audience will choose in their best
interests too
The Undesired/Unattractive Self
when ashamed, participants talked about being who they did
not want to be. That is, they experienced themselves as embodying
an anti-ideal, rather than simply not being who they wanted to be.
The participants said things like. "I am fat and ugly," not "I
failed to be pretty;" or "I am bad and evil," not "I am not as good
as I want to be." This difference in emphasis is not simply
semantic. Participants insisted that the distinction was
important......
(Lindsay-Hartz, de Rivera and Mascolo (1995 p. 277 )
…..
It is therefore not so much failing to meet standards but the
meaning and experience of self from seeking and falling short
Types of Affect Regulator Systems
Content, safe, connect
Drive, excite, vitality
Affiliative focused
Incentive/resource
focused
Soothing/safeness
Seeking and behaviour
activating
Opiates (?)
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Anger, anxiety disgust
A Cost of Evolving Self-Awareness
The evolution of self-conscious and self-awareness is linked
to humans becoming more flexible, sharing, mutually
influenced
beings
with
‘de-modularised,
systems
intelligence's’.
But it also means we live in a private world (alone). We can
‘only exist/be’ in our own minds - others can never actually
know us – and only relate to them as ‘other’ and outside.
So we must relay on signals, inference and trust. Thus the
importance of
secure attachment
insecure attachment
Threat Responses in Social-Contexts
Embarrassment
External shame
Internal shame
Humiliation
Guilt
Types of Negative Self-Conscious
Experience: Embarrassment
1. In embarrassment we focus on behavioural
faux pas not major flaws in the self.
2. The experience is often transitory, and can
ignite a humorous response in observers –
and even ourselves after the event.
3. We cover embarrassment with smiles and
displays of modesty and embarrassment.
4. We ‘hang our head’ in shame.
Embarrassment
Shame is a self-conscious
emotion
It is an emotion about the self. It depends of
certain types of mental abilities that include a form of
self-awareness and theory of mind of ‘how we exist in the
minds of others’ – and our ability to imagine a self and a
self as thought about by others
Shame recruits various negative and threat based
emotions into the experience of self (e.g., anger, anxiety,
and disgust). It is not a separate emotion but a cognitiveemotion blend.
Components of ‘Shame’
1. Social and eternally focused – on self in the
mind of the other.
2. Internally focused – oneself as felt and judged
by self
3. Emotions – anger, anxiety and disgust We
‘hang our head’ in shame.
4. Behaviours –avoid, hide. shut-down, attack
5. Physiological profiles – forms of arousal and
activation – high cortisol response
Types of Negative Self-Conscious
Experience: External Shame
What one thinks others think/feel about oneself
Believes the self is looked down on by others, seen as inferior,
inadequate or bad – as a socially unattractive/undesirable
agent/person.
Believes others may feel anger, anxiety, contempt, disgust or
ridiculing humour for the self.
Shame feelings may blend with feeling socially anxious, depressed
or angry – but possible to have relative indifference.
Types of Negative Self-Conscious
Experience: Internal Shame
What one thinks/feels about oneself
Believes the self is personally inferior, inadequate or
bad. Negative social comparison. Internal
attributions
A socially unattractive agent – an undesirable self.
Internal shame blends with feeling angry, anxious,
contempt or disgust with the self. Internal shaming
Types of Negative Self-Conscious
Experience: Humiliation
Feels attacked, devalued, put-down by others
However, may not focus on self as personally inferior,
nor as undesirable self. See the other as bad or
unjustified for attacks, put-down. External
attributions
May feel anger, anxiety, contempt, and disgust to the
other – often strong sense of injustice with desire for
revenge.
.
Innate motives for attachment and group belonging;
needs to stimulate positive affect in the minds of others;
Unfolding cognitive competencies for self-evaluations
Social-cultural contexts, cultural rules for honour/pride/shame
PERSONAL EXPERIENCES OF SHAMING - STIGMA
Family:
Criticism, high expressed emotion, negative labelling, abuse
Social group:
Bullying, discrimination, prejudice, stigma
Internalised Shame
self-devaluation
internal attribution
depressed/anxious
External Shame
devalued by other
Excluded, avoided
criticised, NAMOs
reflected stigma (to family or others)
rejection by the community
Humiliation
other-devaluation
external attribution
unjust - revenge/anger
Comparing Shame and Guilt
(often fused to varying degrees)
Shame is linked to the competitive mentality thus to social
comparison, sensitivity to put down and rank linked
defences of attack or submission avoidance (high
association to psychopathology)
Guilt is linked to the care-giving, cooperative mentalities
and focused on specific behaviours and is thus linked to
harm avoidance, taking responsibility, reparations (often
negative relationship to psychopathology)
Repairing shame opens possibilities for guilt
THE FOCI OF SHAME
SHAME CAN HAVE A SPECIFIC OR
GENERALISED FOCUS
The body
The body in action and functions
Failures
Relationships/roles
Feelings/fantasises
Coping/needing
Past events
Group based (stigma Cons)
Self as
lacking, as different, bad, powerless , defined by other
Examples of Coping with Shame/Inferiority
Compensation:
Making up for deficits
Concealment:
Hiding things ‘from view’
Aggression:
Threaten others to ‘never notice’
Externalise - ‘not on me’
Avoidance:
Avoid situation/encounters where
shame affects may arise
Projection:
Others see me as I see myself:
Shame others
Dissociation:
Acting without feeling, separating
Numbing
Substance misuse
Shame as a Distance Regulator
Need to hide or be alone when I feel bad
Don’t want others to see me this way
Don’t want others to be the worst for seeing me
Bad to cry, lose control or be aggressive
But when he left the ward (safety behaviour)
I’m isolated, feel alone misunderstood, no-one
to help. It is pointless. Angry with self and
everyone. I hate feeling like this
What makes shame so aversive?
*
Shame is a normal emotion and some degree of it is
helpful for everyday functioning (imagine a ‘shameless’
person)
* Archetypal and innate threat of rejection and social
exclusion – major survival risk -- so our brains are highly
sensitive to it
* Early experiences of being shamed often linked with
powerful, hostile, rejecting others. The context of being
shamed was one of threat –thus trauma memories.
* Damage may be long-term (e.g., to a reputation).
Social contexts
* Different safety strategies for coping with shame (e.g.,
concealment, compensation, avoidance). Safety strategies
can inhibit learning helpful coping and acceptance
The Dance of Shame
When activated in interactions people shift to automatic
threat-focused processing – little reflective thought
Easily spiral out of control and then defences become
more extreme (dominate-subordinate). An interactionamplifying spiral
Feel damaged or have damaged relationship and now not
know how to repair and/or back to shame - so stay
dissociated, avoid, minimise, externalise, ruminate
Therapy: normalise then careful micro-analysis of
behaviour - noting threat-self protection as focus. Role
switching – compassion focusing, forgiveness CH.
Types of Negative Self-Conscious
Experience: Guilt
Harm done by specific behaviours
Focus on effects of our behaviour on welfare of self,
others or objects. Internal attributions
Must have empathic connection to harm
Behaviours aimed to try to repair harm. Common
affect is sadness/ remorse. Easily ‘fused’ with shame
Summary Soothing and Shame
Soothing system evolved with attachment system and is a
threat-affect regulator (parent is protector/soother)
Become safe by eliciting positive affect in the mind of others –
‘care’ cues are soothing ( from parent to peers)
Access to soothing system enables reflective thinking
Shame is the experience of becoming the undesired and
undesirable self vulnerable to rejection, marginalistion and
involuntary subordination
A range of defensive strategies (links affect cognition and
behaviour) - internalising (low rank, submissive) and
externalising (dominant, aggressive)
Therapist Feelings Scenario
Client came for few weeks then said what we
were doing was not helpful - actually she was
feeing worse and seemed angry
What cognitions and behaviours would go with
External Shame, Internal shame, Humiliation
Guilt, Indifference, Empathic-sympathy.
How might you respond for each?
Shame
And Trauma
The Co-construction of Self and Other
Shame Memories Fuse Multiple
Systems:
.
Experienced emotions
(e.g., rage disgust) and
intentions in the mind
of the other directed at
the self
Draw out
with Client
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)
Associations of threat ‘meanings’ in shame-traumas
FROM OTHER
ARISING IN SELF
Emotion and intent
flowing from the other
e.g. Aggression/contempt
Alone – no help/rescue
Others are frightened
or joining in (bullying)
.
Verbal labels
defining the self
stupid/bad
THREAT
Acute sense of self as
‘under attack’ and
defined
Intense sense of fearrage-contempt
Entrapment
Sense of having
done something
wrong/terrible
Shame experiences - memories can be
work like ‘Trauma’
* Sensory stimulus triggers emotional response
(fear, anger, disgust, sadness) via the amygdala
* Intrusive and prominent
* Reoccurring
Flashback-like
De-shaming is linked to working through
1. Fear and anger
2. Acceptacne in the eyes of self and others
Shame and Therapy
Therapy relationship – safe or shaming?
(non-verbal, pacing, empathic + therapist's shame area)
Shame during therapy (e.g., revealing, crying, losing
control)
Shame and safety behaviour/styles (related to past events)
Shame and internal self-attacking (safety behaviours?)
Compassion as a shame antidote.
Therapy
Discuss multiple systems in our minds and it is normal to
feel conflicts
Socratic explorations of what else might you have been
feeling, thinking? What is dangerous to acknowledge –
threatened self-identity?
Mindfulness watching observing
Mindfulness involves learning to direct one’s attention in a
nonjudgmental fashion in order to become aware of one’s
thoughts, feelings, and actions as they emerge in a present
moment. It involves cultivating an attitude of intense
curiosity about one’s inner experience as it unfolds (Kabit
Zinn, 2005; Katzow & Safran in press)
Workshop Outline
•
•
•
•
Introduction to the model
Our Basic Threat-Defence Systems
Safeness: A Missing Component
Key Shame Concepts
• Identifying Critical Dialogues
& Associated Affects
• The Diagrammatic Model / Formulation
Why Focus on Self-Attacking
Self-critics have poor social relationships
(Zuroff et al., 1999)
Depressed people become more self-critical as
mood lowers (Teasdale & Cox, 2001)
Self-critics may do less well with standard
CBT (Rector et al., 2002)
Self-Attacking in Psychosis
70% of voices are malevolent
Commands – sometimes with
threats
Insults (direct and indirect)
Self-Attackers
Early abusive histories, inappropriate parenting, high EE,
criticism. Low or inconsistent affection
Internal Shame with highly critical internal dialogues
Developed from early experience
Trauma, culture, abuse, deprivation
Often unaware of extent or power of SC
Generate different intra personal and inter personal styles of
interaction
Chronic long term difficulties
Concurrent cognitive/affective themes
Ongoing sense of external (the world) and internal (inside self) threat
(amygdala and threat system sensitisations)
Lack of safeness –poor abilities to self-soothe
Easily accessibly sensory based shame-trauma memories and scenes
Internal Roles
Two key types of internal self
self relationship
Hostile dominant self
fearful, subordinated self
Caring emphatic self
cared for, soothed self
Mediated through and reflected in affect, behaviour
and self-talk
Internalised Self-Attacking and
Shame: Self as an object for
evaluation
Pre-modern
Freudian
Gestalt
Behavioural
Cognitive
Evolutionary
Ideal mismatch
Inner demons; possession
Superego – related to internalised
parental prohibitions
Top-dog versus under dog
Self-punishment
Self-attacking, self-critic
Internalised hostile dominate
signal
Frustrated generated attacks – the
unattractive or undesirable self
Stimulus-Response
Sexual
Bully-threat
Meal
Meal
Sex
Limbic system
Bullythreat
Kind, warm
and caring
Compassion
Soothed
Safe
Stomach acid
Salvia
Arousal
Fearful
Depressed
Key Questions
Need to ask:
1. Is it possible that some recent adaptations
in the brain make us more vulnerable to mental
health difficulties –
e.g.,
self-awareness,
anticipation and rumination self criticism?
2. Is it possible that some recent adaptations
in the our social-cultural life styles make us more
vulnerable to mental health difficulties e. g.,
entrapments, domestic violence, mass media, social
comparison.
Self-Critical Thinking Styles
Social Comparison
Personalisation and Self-blaming
Self-labelling/condemning
FORMS
Self-attacking (frustration)
Self-criticism (to improve/correct)
Self-hatred/disgust (to hurt or destroy)
Affects and self-attacking
Ideal self
Actual self
Disappointment Gap
Self-attacking
* Separate feeling of frustration from self-attacking
* What are the key fears of failure
* What is the emotional focus (e.g., anger, sadness
hatred, contempt)
* Ability to experience and tolerate frustration
without self-attack (conditioning)
What are your fears or change?
External
Others will not like or accept me –rejection or harm
Lack of help or if they get close they will see bad tings, turn harmful
or demanding
Internal
Related to who I am… what I can do…. and who I want to be
Must not have certain feelings/fantasies (metacognitive fears of)
“they will overwhelm me, not be validated by others, too painful,
out of control, mean I am bad etc.” Avoid certain memories
Unable to accept my limitations; unable to recognise my potential
Unrealistic goals
Feedback onto external fears is often key ..“if then” Anger at
others can be poorly processed
Situation
Critical Thoughts
Feelings
Not getting good
results with clients
External Shame
Others will wonder what I am
doing.
Others critical – will see me as not
competent or unable
Consequence - disconnection
Anxious
Low Mood
Internal Shame
I should be getting better results
Shouldn’t feel like this when I see
them
My clients would do better with
someone else
Don’t know enough.
Not up to this job
Imagining the self critical part of self
Now for a moment let’s imagine that this
self-critical part of you could be thought
about as a person. If those self-critical
thoughts took on the appearance of an
actual person what might they be like?
Maybe you could think about their facial
expressions, if they are big or small, the
tone of their voice, the emotion. Just
spend 30 seconds imagining this.
Imagery: Self-critical part of self
Can have properties of:
Big rather than small
Powerful-dominate rather than
subordinate-weak
Hostile, angry or contemptuous rather
than friendly
Issues threats
Functional Analysis
Safety (defensive) behaviours
as a warning of threat
cuing from memory (eg. voice of parent)
habit
avoid aggression (who are you
protecting?)
identity linked (what kind of person
would I be if I didn’t self-attack)
affect regulation
Experience of Self-Criticism
Emotional system sensitive to nonverbal communications
Visualisation of NSC. The look, voice tone and affect
Does it attend to the evidence against?
Emotional awareness of the power and damage
(automatic and ruminative)
Discuss rehearsal and harassment
Name as part of self (e.g, inner bully –but good at what it
does?)
Functional Analysis NSCs
Explore the relational and dialogic nature of selfcognitions (e.g., two chairs) bully-bullied
Origins of bullying voice – their credentials
Why submissive acceptance response to self-attack?
(linked to history of submission to authority)
Submission as safety behaviour; self blame as safety
cognition –acknowledge desire for safeness
Functional analysis of critic (improve, ridicule,
destroy)
Working with S.C
Examples of self-blaming and self-condemning as
safety-defensive behaviours
What is hidden?
What is your worse fear in ‘giving up’ self-attacking
So not (just) evidence based but:
safeness
identity
habit
loyalty
Working with SCs
What evidence would be a reasonable alternative
Flash cards
Playing dominant role - to internal S.C image, two
chairs or in memory (fear/guilt/shame of
assertiveness)
Mindfulness – just observing self-critical thoughts
images.
Special problem of self-contempt
Linked to affect of disgust – Core sense of badness –
being contaminated by ……..
Defensive (disgust) emotions and action tendencies
are getting rid of, expelling, cutting out ‘destroying
the bad,’ cleansing
Trying to ‘purify’ leads to splitting – common even in
religions and social groups
Transformation new meaning rather than
purification (nature of the universe)
Special problem of hatred rage
Rage and hatred are dangerous because (External threat
– destroy other or end up alone Internal threat out of
control)
Not that kind of person – unreasonable (meta-cognition)
Feel alone and unlovable when expressed
How to handle it if felt in the therapeutic relationships?
How might it be involved in self-harm – what fear or hurt
does it cover?
Therapist Positions
Understand the evolved forms and automatic nature of
basic threat systems processing
Normalising contempt and rage as understandable though
not desirable - empathises with how unpleasant they are
Therapist contains it by open discussion of these as basic
to our nature and possibilities – notes points of hidden
anger – curiosity not interpretation
Think through together how to discuss and deal with
these feelings – how would patient like therapist to handle
them (advantages and disadvantages)
Types of Affect Systems
.
Affiliative focused
Soothing/safeness
Opiates (?)
Incentive/resource
focused
Seeking and behaviour
activating
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Summary of Self-Criticism
Social threat THE major threat to humans – shame is
becoming the undesired and undesirable self
Self-criticism has multiple origins – abuse, neglect bullying,
competitive relationships, trying to win approval - is usually
linked to feeling ‘socially unsafe’ – thus with external threat
Velco-like trauma like memories – ‘threat first’ processing
Different functions of self-criticism: Self correcting and selfpersecuting can be linked to complex networks of meaning,
self-identity and social relationships
Workshop Outline
•
•
•
•
•
Introduction to the model
Our Basic Threat-Defence Systems
Safeness: A Missing Component
Key Shame Concepts
Identifying Critical Dialogues & Associated
Affects
• The Diagrammatic Model /
Formulation
The Model
Our experiences together with our evolved brains results
in key fears around harms, injuries and loses
These can be external and internal
It is understandable that the individual engages in a
range of safety strategies aimed at protection
These safety strategies give rise in unintended
consequences
The individual engages in (further) self attacking,
experiences a range of emotions, ruminates and feel;s
trapped in the
Background
Safety Strategies
Unintended Cs
Others as Critical,
absent, frightening,
blaming
Threat focused
Feel worthless
Inhibit, submit avoid
anger
Controlled by others
Be as others want
Ruminate on emptiness
Key fears/Memories
Loose sense of self -alone
Hurt, rejection, ‘being
to blame’ aloneness
Develop feeling compassion
for background and safety
strategies
Self-attack, access
shame memories
Concealing
Understanding our
minds, not our fault
Compassionate acceptance and
integration of multi-self
Confused, depressed
angry, dissociate
fragment
Compassion imagery, focus (e.g.
attention, behaviour) and reframe
Background
Safety Strategies
Unintended Cs
Others as critical,
overprotective, being
treated as a victim
Threat focused
Others don’t see me as a
person
Key fears
Withdraw
Be as others want
Feel worthless
Controlled by others
No sense of self
Rejection, powerless,
being alone
Develop feeling compassion for
background and safety strategies via
experience, explanation of the science &
formulation
Understanding our
minds, not our fault
Compassionate acceptance and
integration of multi-self
Self-attack
Shame
Depressed, angry,
anxious
Compassion imagery, focus (e.g.
attention, behaviour) and reframe
Well-being
Therapy
Discuss multiple systems in our minds and it is normal to
feel conflicts
Socratic explorations of what else might you have been
feeling, thinking? What is dangerous to acknowledge –
threatened self-identity?
Mindfulness watching observing
Mindfulness involves learning to direct one’s attention in a
nonjudgmental fashion in order to become aware of one’s
thoughts, feelings, and actions as they emerge in a present
moment. It involves cultivating an attitude of intense
curiosity about one’s inner experience as it unfolds (Kabit
Zinn, 2005; Katzow & Safran in press)
Rebellion model to change
* Listening and considering possibilities that
dominant (e.g. critical parent/teacher/bully) was/is
wrong (still high fear)
* Externalising and voicing new ideas, beliefs of
rebellion (‘you’ (e., parent) are wrong about me)
* Behaving against values and dictates of dominant
(e.g. acts of defiance) (Milgram 1974)
* Distinguish helpful from destructive rebellions
(Gilbert & Irons, 2005)
Rebellion Model to change
Don’t Rush Rather be aware of rebellion as fear of:
disloyalty and loss or connection
coping with ambivalence, guilt
retaliation,
aloneness,
protect ‘them’ from my anger.
Blaocks can also arise from desire to hold onto pain
for secondary gains (show them what they have
made me do, induce guilt – wait for recognition of
rescue) – the trophies of suffering.
(Gilbert & Irons, 2005)
Therapy
Explain how our brains are set up to try to protect us
Explain how our threat-defense systems work that they are designed to be rapid and can emerge in us
before we are aware of it (NOT OUR FAULT) –common to
us all and even animals; ask patients to generate examples
Explain sensitization as relevant to that person –over and
over again come back to protection strategies –that can be
involuntary ‘the better safe than sorry’ rule of the mind
Avoid terms such as distorted thoughts or maladaptive
schema as these can be shaming and we are wanting to
develop compassionate understanding for how our ‘mind
works’ rather than pathologise it
Therapist Feelings Scenario
Client came for few weeks then said what we
were doing was not helpful - actually she was
feeing worse and seemed angry
What cognitions and behaviours would go with
External Shame, Internal shame, Humiliation
Guilt, Indifference, Empathic-sympathy.
How might you respond for each?
Compassion Focused Therapy
Derby December 2008
Paul Gilbert PhD FBPsS
Mental Health Research Unit, Kingsway Hospital Derby
[email protected]
Mary Welford
Greater Manchester West Mental Health NHS Foundation Trust
[email protected]
Ken Goss, Ian Lowens, Chris Gillespie & Chris Irons
www. compassionatemind.co.uk
If you wish to use this material please respect sources
Workshop Outline
Stage 1
• Introduction to the model
• Our Basic Threat-Defence Systems
• Safeness: A Missing Component
• Key Shame Concepts
• Identifying Critical Dialogues & Associated Affects
• Formulation
•
•
•
•
•
Stage 2
Considering the Nature of Self Compassion
Compassionate Mind Training
Deepening Self Compassion
Fear of Compassion
Stages of CMT
Explanation of model
Shared formulation
Validation of fears
Makes sense of protection strategies
Identify critic or inner bully as safety strategy
Its not your fault
Promotion of grief reaction to suffering
Development of compassion for self
Through relationship (NV communication)
Imagery
Attention, behaviour, thought, mindfulness
Visualise, practice, rehearse compassionate focus on self,
goals and future
Buddhist Concepts
Metta: is loving kindness or friendly care, which is an
orientation to self and others.
Mudita: appreciating and taking joy from being alive ‘in
this moment’ (e.g. the colours of the clouds, a rainbow or a
sunset, the taste of food). Sympathetic joy in the flourishing of
others. It is a wellspring of feelings of peaceful well-being.
Karuna: compassion that involves ethical behavior,
patience and generosity with action.
Upekkha: equanimity and a sense of connectedness similarity to other humans and all living things – that all are
seek happiness and none seek suffering, that we are all the same
in our struggles in life.
Contrast self-compassion to self-esteem
Self-Esteem
Self-Compassion
Access when things going well
Access when not going well
Individuality/difference
Common humanity
Achievement/doing/drive
Acceptance/being/content
Competitive mentality
Caring mentality
Compassion Practice
Mindful compassion involves learning to direct one’s
attention in a nonjudgmental fashion in order train one’s
mind to organize itself via compassion and activate soothing
system as a key affect regulator.
It involves mindful practice of compassion focusing via
attention, thinking, behaviour and feeling that involves:
Process
Imagery
Goals
Compassion Work
Uses many CBT, MI and other therapy ‘change
agents’ including: Socratic approach, guided
discovery,
collaboration,
psycho-education,
looking a things from different points of view,
behavioral experiments, exposure, reflections
‘homeworks’ but with a focus on development
and becoming – compassion (mentality) focused
Much ‘in vivo’ work and experiencing
exercises
via
Types of Affect Systems
.
Affiliative focused
Incentive/resource
focused
Soothing/safeness
Seeking and behaviour
activating
Opiates (?)
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Types of Affect Systems
.
Affiliative focused
Soothing/safeness
Opiates (?)
Incentive/resource
focused
Seeking and behaviour
activating
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Definitions of Compassion
Buddhist As loving kindness; open heartedness
‘deep feeling and understanding of the suffering of others
associated with a deep commitment and responsibility to try
to alleviate it’
Ethical Behaviour
Generosity
Wisdom
Patience
Compassion
Concentration
Effort
Develop the Perfections (Paramitas - to carry across –oceans
of suffering to enlightenment)
Definitions of Compassion
Buddhist As loving kindness; open heartedness
‘deep feeling and understanding of the suffering of
others associated with a deep commitment and
responsibility to try to alleviate it’
Aristotle’s view suggested three key cognitive elements
to summarised as:
The first cognitive element of compassion is a belief
or appraisal that the suffering is serious rather than
trivial. The second is the belief that the person does
not deserve the suffering. The third is the belief that
the possibilities of the person who experiences the
emotions are similar to the sufferer (Nassbaum 2003
p. 36)
Page33
Other Views of Compassion
Definitions stretch back to Buddhism and Aristotle: suffering as nontrivial; non-deserved. and one can have empathy
McKay & Fanning (1992)
understanding, acceptance and forgiveness
Neff (2003)
Kindness-warmth
Common humanity
Mindfulness-Non-judgemental
Gilbert (1989, 2000, 2005)
A mental orientation that combines various, care focused
qualities of mind and is dependent on those qualities
Compassion as Flow
Different practices for each
Other
Self
Self
Other
Self
Self
Non linear empathy for other begins early in life
Compassion and the promotion of
well-being and growth
Caring focused on well being
The provision of guidance, protection and care for the
purpose of fostering developmental change congruent
with the expected potential of the object of
nurturance (Fogel et al., 1986)
Awareness of need to nurture
Motivation to nurture
Expression of nurturance
Choice of object
Fluid alteration of nurturance to fit object of
nurturance
Components of compassion
from the care giving mentality
Sympathy
Distress sensitive
Care for well
being
Non-judgement
Compassion
Distress tolerant
Empathy
Create opportunities for growth and change
With Warmth
Opening to Compassion
Care for well-being Desire to heal, commitment and
responsibility. Consider benefits of “if I could.”
Kind of self one would like to be (self-identity).
Focus on feelings of kindness and warmth as
emotions to develop and practice
Distress sensitivity: Often blocked by fear of distress
or hostile emotions, and depth of distress and
negative beliefs about emotions (see Leahy paper)
Explore and educate on the power of rumination
Opening to Compassion
Sympathy explain sympathy, explore fear of being
emotionally moved by (one’s) distress and fear of
grieving, or acknowledging hostile emotions. Explore
negative beliefs about sympathy
Distress tolerance de-shame distress, not one’s fault,
common humanity. Address fear of emotions, Practice
mindfulness and acceptance. Forgiveness
Empathy Deepening one’s understanding of our minds.
Common humanity. Problems as unintended efforts at
self-protection - automatic nature. Linking to personal
history and making sense of feelings and self-attacking
Opening to Compassion
Non judgement: to give up self-condemning,
shift from shame and submissiveness to
acceptance and responsibility. Articulate
preferences
What are the Greatest fears in making the
shift in each component
Multi-Modal Compassionate Mind Training
SKILLS -TRAINING
Warmth
Imagery
ATTRIBUTES
Attention
Sympathy
Sensitivity
Care for
well-being
Feeling
Warmth
Compassion
Non-Judgement
Reasoning
Distress
tolerance
Empathy
Behaviour
Sensory
Warmth
Warmth
Types of Affect Regulator Systems
Content, safe, connect
Drive, excite, vitality
Affiliative focused
Incentive/resource
focused
Soothing/safeness
Seeking and behaviour
activating
Opiates (?)
Dopamine (?)
Threat-focused
safety seeking
Activating/inhibiting
Serotonin (?)
Anger, anxiety, disgust
Compassion and The Three Circles
Balancing the mind – insight – kindness and
courage
Understanding sources of suffering and the
path to the alleviation of suffering (broken leg)
Understand the sources of flourishing and the
path to contentment - joyful giving, facilitating,
charity
Father Christmas and boundary setting
Understanding soothing – what we can
do for each other and ourselves
Social referencing - able to trust others
Existing positively in the minds of others
Being heard and understood
Validation
Reasoning
Desensitisation to the feared – enhancing courage
Starting Basic Skills
Clarify direction of travel
Doing what for why
Compassionate motivations, compassionate attention,
compassionate thinking, compassionate behaviour, and
compassionate feeling
Situation
Critical Thoughts
Feelings
External Shame
Anxious
Low Mood
Not getting good
results with clients
Internal Shame
Situation
Critical Thoughts
Feelings
Not getting good
results with clients
External Shame
Others will wonder what I am
doing.
Others critical – will see me as not
competent or unable
Consequence - disconnection
Anxious
Low Mood
Internal Shame
I should be getting better results
Shouldn’t feel like this when I see
them
My clients would do better with
someone else
Don’t know enough.
Not up to this job
Compassion
Discuss the components of compassion and that each one
might take practice ( maybe in stages)
Emphasise the importance of empathy for distress
including self-attacking. Acceptance and compassion grow
from genuine understanding - especially of safety
behaviours –Recognise when patient tries to minimise
distress with rationalisation
Empathy for distress often grows naturally from the work
you have done on safety behaviours
Compassionate Focus
When generating alternatives one is trying to work
with different processing systems –stimulating a
care-focused mentality
Empathy for distress – standing back
* What would compassionate motives look like?
* What would compassionate ‘attention’ attend to or
focus on?
* What would compassionate ‘thinking’ ‘think/reflect?
* How could you take compassion into behaviour?
* Reflecting on these ideas and actions; how could you
bring warmth into the experience of them?
Compassion Focus
Looking at a person’s alternative thoughts or
behaviours or choice of homework
Ask
* How might this be an example of
compassionate motivation, attention, thinking,
behaviour and give it feeling
* Stay with alternative(s) until a new feeling
emerges
* What might be (was) difficult to do
* How might the self critic respond?
Compassionate Focus
Designed to stimulate different (care-based)
affects, thoughts and role relationships with self
What would help you feel supported
What would you say/do to someone you care for
What would like some who cared for you to say/do
Use examples and education to build insight and
desire to use rational compassionate approach –
can see the point
External Shame
Others will wonder what I am
doing.
Others critical – will see me as
not competent or unable
Consequence - disconnection
Internal Shame
I should be getting better results.
My clients would do better with
someone else.
Don’t know enough.
Maybe I am incompetent.
Not up to this job
External Shame
Others will wonder what I am
doing.
Others critical – will see me as
not competent or unable
Consequence - disconnection
Internal Shame
I should be getting better
results.
My clients would do better with
someone else.
Don’t know enough.
Maybe I am incompetent.
Not up to this job.
Empathy to one’s own distress: Understandable
to feel disappointed and thwarted – this is hard.
Empathy for one’s own distress: Understandable
to feel disappointed and thwarted – this is hard.
Compassionate Motivation: Understand functions
Others will wonder what I am and origins of SC – what is critic frightened of?
doing.
Want to develop self-kindness
External Shame
Others critical – will see me as
not competent or unable
Consequence - disconnection
Internal Shame
I should be getting better
results.
My clients would do better
with someone else.
Don’t know enough.
Maybe I am incompetent.
Not up to this job.
External Shame
Others will wonder what I am
doing.
Others critical – will see me as
not competent or unable
Consequence - disconnection
Internal Shame
I should be getting better
results.
My clients would do better
with someone else.
Don’t know enough.
Maybe I am incompetent.
Not up to this job.
Empathy for one’s own distress: Understandable
to feel disappointed and thwarted – this is hard.
C M: Understand functions and origins of SC –
what is critic frightened of? Want to develop selfkindness
CA: Attention: focus on what I can do rather than
what I can’t – recall times successful or others
who were helpful –and or I helped.
External Shame
Others will wonder what I
am doing.
Others critical – will see me
as not competent or unable
Consequence - disconnection
Internal Shame
I should be getting better
results.
My clients would do better
with someone else.
Don’t know enough.
Maybe I am incompetent.
Not up to this job.
Empathy for one’s own distress: Understandable to
feel disappointed and thwarted – this is hard.
C M: Understand functions and origins of SC –
what is critic frightened of? Want to develop selfkindness
CA: Attention: focus on what I can do rather than
what I can’t – recall times successful or others who
were helpful
CT:What is helpful: Ability to be with patients and
listen and ‘bear’ feelings of stuckness is itself
helpful.
CT:Not black/white: Will learn more as I gain
experience but this does not make me incompetent
CT:Accept limitations: Would like to see progress,
but can only do my best
CT:Like others: Experienced therapists often have
these kinds of problems
Empathy for one’s own distress: Understandable
to feel disappointed and thwarted – this is hard.
C M: Understand functions and origins of SC –
Others will wonder what I am what is critic frightened of? Want to develop selfdoing.
kindness
Others critical – will see me as CA: Attention: focus on what I can do rather than
not competent or unable
what I can’t – recall times successful or others
Consequence - disconnection who were helpful
CT:What is helpful: Ability to be with patients
and listen and ‘bear’ feelings of stuckness is itself
Internal Shame
helpful.
CT:Not black/white: Will learn more as I gain
experience but this does not make me incompetent
I should be getting better
CT:Accept limitations: Would like to see progress,
results.
but can only do my best
My clients would do better
CT:Like others: Experienced therapists often have
with someone else.
these kinds of problems
Don’t know enough.
CBehaviour:Help seeking: Can share my
Maybe I am incompetent.
difficulties, seek supervision/help, talk to others
Not up to this job.
Compassionate Feeling Using imagery and
refocusing
External Shame
Thought-feeling focusing
When you have generated some alternatives - focus on
staying with them until affect changes –
DO NOT rely on logic/evidence alone to produce change
Give plenty of time for feeling the difference
You can stay with visualising each alternative and imagine
how that feels
Dissolving - fading via practice rather than challengingconvincing
Workshop Outline
Stage 2
• Considering the Nature of Self Compassion
• Compassionate Mind Training
• Deepening Self-Compassion
• Fear of Compassion
Compassion Imagery
Using imagery to access and work
with soothing systems and the
interactions between threat and
soothing systems
Why Develop Compassionate Imagery
Powerful way to access affect systems
Quickly reveals affect blocks and fears (but should be
helpful not overwhelming)
Provides new sensory based experiences to work with
other, threat-based ones
Uses a form of theory of mind – another mind ‘with you’
Re-focuses attention
A different way of ‘thinking’ of alternatives as coconstructed, and affect/compassion focused
Preparing for Imagery
Preparing the body – breathing – find the rhythm of
one’s own soothing - not that long – minute or so – then
longer if possible.
Body posture
Fear of engaging may need to switch to sensory focus
(e.g., tennis ball)
Intrusions of thoughts and feelings – normalise and
teach ‘with kindness to just return the attention’
Safe Place Imagery
Explain that imagery is fleeting - offering glimpses
and fragments - it is the feelings that are important
The focus on feeling safe and soothed in a place
(also to feel ‘joyful’ if the person finds that helpful)
Focus on all the senses
Imagine the place is pleased/happy to see you and
you have sense of welcome and belonging
Long history to use of
compassionate imagery
Buddhist loving kindness imagery
Sequences: Bodhisavattas having developed the ideal qualities
of compassion – to identify with and copy – non judgement just
observation (see Vessantara (1993) Meeting the Buddha's)
Compassion Mediation cycle
Imaging the Compassion Buddha;
harnessing the
compassionate energies of the universe; directing the
compassion to you; the Buddha merging with you – becoming
the Compassion Buddha - directing compassion back into the
universe for all living things – To explore each position and
what ‘comes up’ in one’s mind, reflect and develop one’s mind
(See chapter in by Rimpoche and Mullen in Gilbert 2005; )
Types of Compassionate Imagery
Guided Memory
Recall feelings when someone was kind to you
Recall feelings of you being kind to others
Guided Fantasy
The ideal compassionate self
The ideal compassionate other (unique vs given)
human verse non-human
Keep in mind all the time: Fear of feeling
compassion for self
Imagining the self-compassionate part
of self - Assuming a role
Now for a moment, imagine that a self-supporting, or
compassionate part of yourself could be thought
about as a person. Imagine becoming that person.
Think of the ideal qualities you would like to have as
a compassionate person. It does not matter if you are
actually like this. Think about your age and
appearance, your facial expressions and postures,
you inner emotions of say gentleness – create a half
or slight smile that conveys this. Now like an actor
about to take on a part feel yourself into these. For
this moment you are a compassionate person
Imagery: Self-Compassionate Part
of Self
Can have properties of:
Friendliness
Soft - light
Acceptance, warmth, support
Focus on what is helpful
Imagining the self-compassionate part
of self - Assuming a role
Learn to practice each day
Remind oneself of the self one would like to be or
become today.
Compassionate walking, breathing voice tones, facial
expression, thoughts
Smile and forgiveness when one’s anger, in-patience
and anxiety gets the upper hand – back to principle
propose is ‘to be happy and free from suffering and
help others be happy and free from suffering’
Other-Focused Compassion
Sit comfortably in chair with soothing rhythm breathing.
Work on getting into the compassion role. Now imagine
focusing on ‘desire for others to be happy and free from
suffering’. (This can start off with people one knows and
then extend outwards to eventually all sentient beings).
Imagine facial expressions and voice tones.
Explore people’s experience - reflection/meditation.
Explore the value of compassionate self or compassionate
imagery in generating and feeling the desire within oneself
for others ‘to be happy and free from suffering’.
Explore blocks, fears and facilitators.
Self-focused Compassion
Sit comfortably in a chair with soothing rhythm breathing
and imagine focusing on ‘desire to be happy and free from
suffering’.
Explore people’s experience of that reflection/meditation.
Explore the value of compassionate self or compassionate
imagery in experiencing the desire within oneself ‘to be
happy and free from suffering’.
Explore blocks, fears and facilitators.
Imagining the Compassionate Other
Explain point of Compassionate-other imagery work
Inner helper, perfect nurturer (D.Lee), inner guide, access to
self-soothing system through relating (no different in principle to
activating any other system e.g., sexual – these systems were designed for social
interactions – social mentality theory)
“Now for a moment, focus on your breathing and try to feel
body rhythm. Can you look down or close your eyes and
imagine your ideal caring other for you.”
Or build for someone else - a child:
Useful specific questions: would they be old or young, male
or female colour of their eyes, tall or short – more than one
Relational Process
.
Self
Qualities of Source
Kindness
Wisdom
Strength
Understanding
Distress
Warmth
Non-judgement
(Common-humanity)
Warmth
Growth
Acceptance
Other-Focused Compassion
Act of creating one (what one would like for one) is a step on
compassion focusing
Find the type of image and form of relationship that fits for
the person – images usually change
This can be an Inner: Nurturer, Guide, Friend, Mentor,
Fellow Traveller; Bodhisattva, Ideal Compassionate Other
Exercise: to focus on, write about, paint - create image or
‘sense of’ ideal compassionate other’ Notice feelings and
thoughts arising during the exercise. Mindful approach
Developing image –with half smile –soothing
breathing
Ideal caring and compassionate image --- define ideal as
everything you would want, need
Caring as a genuine desire for one’s well-being
Wisdom a sentient mind who understands the struggles
of humanity and self. Empathic stance, self-transcendent
Strength as fortitude, endurance but can be power too
Warmth affiliation, genuine care, gentle smile
Non-Judgement as no criticism , curiosity
Hand on Heart and Soothing
When distressed or at other times - sitting or standing
take a few breaths to notice soothing rhythm
Place hand over centre of the chest
Imagine caring compassionate energy for one’s hand
going through one’s chest fill that area and soothing the
heart are
As the person focuses on this they may find their hand
feels hot
The is an attention reallocation and affect switching
technique
Imagining Connetedness
Some people have problems with imaging other people in a
compassionate role –can’t trust them – so you can use a
non-personal image. For example
imagine a sea in front of you that is a beautiful blue, is
warm and calm, lapping on a sandy shore. Imagine that
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
horizon imagine that this sea has been here for millions of
years, was a source of life. It has seen many things in the
history of life and knows many things. Now imagine the
sea has complete acceptance for you, that is knows of your
struggles and pain. Allow yourself to feel connected to the
sea, its power and wisdom in complete acceptance of you
Point of Imagery
Powerful way to access affect systems
Quickly reveals affect blocks and fears
Provides new sensory based experiences to work with
other, threat-based, ones
Uses a form of theory of mind – another mind ‘with you’
Re-focuses attention (work on sensory qualities)
A different way of ‘thinking’ of alternatives as coconstructed and affect/compassion focused
Use of compassionate imagery
Able to teach basic relaxation as a preparation for imagery
As it can involve working of inner ‘productions’ of the mind
need to be away of:
Passive/overwhelmed
Engaging with but used for controlling and regulating
Engaging with accepting and exploring
Engaging in order to develop new insights and
practice for activating different parts of the self
Taylor it for individual patient –
especially in regard to self practice
Compassionate Reframe
Focus on your breathing
Now bring compassionate image to mind
Focus on sensory qualities (trying to access carefocused mentality)
What would your compassion part/image say?
How do they see this situation?
What opportunities for growth and change might be
here?
What is a compassionate thing to do now?
Imagery Practice Experience
Focusing on your image
can you feel warmth for you – what does that feel like?
can you feel empathic understanding 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?
Really focus on image generating and staying with
affect
Imagery Experience
Images are created within one’s own mind. They are
therefore part of us and by practicing them we may
practice developing part of us
Note the arising and the fading of the image as
products of our minds. Letting go the image.
But like a muscle, because we are unaware of it or
are not using it does not mean it is not there.
Can build mindfulness around compassionate
focusing – noticing, observing, not trying
Re-Evaluating
Third chair practising
Compassionate thinking
Compassionate attention
Compassionate behaviour
Compassionate letter writing
Compassionate Letter Writing
Ideal caring self (even if one does not have those
qualities) – or compassionate ideal image
Clarify point of the exercise and why its worth a
go – as a behavioural experiment,
Focus on caring part of self – to put in that
mode or frame of mind for ‘thinking/feeling’
Work through guided letter outline
Note: many letters will not be very compassionate an first so discuss
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 Letter
It is understandable that you been having a difficult
time and continue to do so, things have been tough. You
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
suffer like this forever. You have a nice flat, a loving family
and a couple of good friends. You have support from
people , more than other people. Remember there are so
many people worse off than you. Some people in Africa
have nothing. They don’t expect to have anything they just
accept things. Learn from them. Remember you have a lot
to be grateful for. You are a kind person and that will
never change. You need to look after yourself
Example 2A: Compassionate Letter
I am so sad you have had a difficult time and continue to
struggle. Your sadness is understandable. You have had
many negative experiences. This has resulted in anxieties and
thoughts about being different. You then became depressed.
When you have a difficult time I understand why you want to
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 to other people and connect with them. This may help
your mood.
Example 2B: Compassionate Letter
Other people get like this, you are not alone and shouldn’t
feel as though you need to hide away. You have an inner
strength and should remember that. You are kind and
caring and maybe it would help to practice to turn that
kindness on yourself so you can feel the warmth.
NOTE: Sometimes people will write as if from someone else
using ‘you’. Sometimes they will write as ‘I’. Clarify that
with people and what they would find helpful and why.
Compassion for self-attacking 1
Sit quietly for a few moments with soothing breathing and focus
on becoming your compassionate self (e.g, with the facial
expressions and sense self expanding)
Now with that sense of you, your wisdom, strength and warmth,
imagine your self-critical part in front of you.
See its facial expression and note the feeling arising in it -now
just feel compassion for that self-critical part of your _hold you
own self compassionate facial expression
Watch what happens
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 self
Compassion for self-attacking 2
Sit quietly for a few moments and allow your
compassionate image and sense of self to come to mind
Now with that image with you, with its wisdom,
strength and warmth, imagine yourself as linked - as if
on the same team with the same desires and qualities –
linking to self-identity –hold the compassionate
expression
Now imagine you both seek to heal your threatened or
self-attacking part of you. Be mindful of your self
attacking thoughts, just allowing them, and try as best
you can to stay in your compassionate position
Cautions of Attacking Critic
Standing up to inner-critic and working with memories of
‘critical other’ can be very helpful (especially if linked to
memories of critical others Hackmann, 2005)
However if just internal
* Can model a ‘power solution’ –amygdala focused
* Often less need to directly ‘take on’ critic – but build new
focus of self
* People can keep (SC) safety behaviours for as long as they
think they need them – no pressure to change
* Compassion for fear behind, and function of, critic will
often help to change/soften it.
Fear of Compassion
very common
Operates at implicit and explicit
levels
Conditioning
Care seeking systems can become conditioned to threat
rather than safeness. If it happens early people may not
recall specific memories but experience confusing
feelings in close relationships
Care seeking
Punishment
Anxiety
Implications for sensory memories and co-ordination of
soothing systems
Conditioning
Care seeking systems can become conditioned to threat
rather than safeness. If happens early, people may not
recall specific memories but experience confusing feelings
in close relationships
Care seeking
No response
shut down
Implications for sensory memories and co-ordination of
soothing systems
Threatening Compassion Focus
Kindness
Attachment system
Emotion-memory
Self –other roles/scenes
Anger
Anxiety
Shut down
Kindness, Attachment and Threat
Kindness from therapist or imagery
Fight, flight
shut down
Activate attachment system
Activate memories
Neglect
aloneness
Abuse, shame
vulnerable
Activate learnt and current defences - cortisol
Fight, flight
shut down
Blocks to Compassion Focus occur at both
the automatic and metacognitive level
Overwhelming sadness or panic-- so may need to spend
a long time developing capacity to tolerate grief and feelings of
warmth
Can’t create or hold image – mindful/allowing
Meta-cognitive blocks
Compassion is weak, easily beaten down, or dangerous
Forgiveness is weak, wont achieve anything
Bullies are resistant – address their safety agendas
Responsibility for practice, practice practice
Empowerment and Courage
Common blocks when client struggles or does not really
want to be compassionate May want to fight or gain
revenge but is fearful
Can use rescripting with assertive enactments
(See Hackmann 2005, in Gilbert 2005 )
Compassion my get stuck if the anger and needs for
working through all the issues with anger are not
addressed – so we back to compassion as courage and
not submissive – Some compassion Buddha’s
and images are actually quite fierce!
(Vessantara (1993) Meeting the Buddha's. See also Leighton, 2003
Courage and trauma
When shame and self-criticism are linked to trauma
memory then there are a variety of interventions for
rescripting (see Lee 2005 in Gilbert 2005)
You can adapt these with using the compassionate self
and compassionate images – but do not under-estimate
the need for courageous and assertive responsedevelopment
Discuss with client - be open about courage and how to
develop it – the advantages of ‘direction of travel and
goal – the ‘point of the work’
What have we learnt?
How might this workshop affect your practice?
What are your take home key points?
What would you like to develop?
Affect self-identity as a person and therapist
Beyond techniques – way of being with self and
others
Conclusion and Key points
•CFT is an integrated biopsychosocial model – not a specific process model
•Basic structure is around the three affect regulation systems
•Without the ability to access the sense of soothing -safeness (calm mind) various interventions
might lack emotional impact in the long term
•Each 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 and focus sense of ‘self as a social agent’ on threat
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
and development
•Neuro physiotherapy for the mind – key is top practice the exercises – therapists would ideally
have their own practice
• CMT can be more than symptom reduction but can also become a focus for long term
development and sense of self