Compassion Focused Therapy
Compassion Focused Therapy (CFT) is an integrated psychotherapy approach developed by Professor Paul Gilbert. It is based on evolutionary theory, neuroscience, social and developmental psychology, cognitive-behavioral therapy and mindfulness.
Compassion Focused Therapy (CFT) is an integrated psychotherapy approach developed by Professor Paul Gilbert. It is based on evolutionary theory, neuroscience, social and developmental psychology, cognitive-behavioural therapy and mindfulness.CFT has been the subject of increasing interest worldwide in recent years, and many clinicians have found this method to be truly effective and useful in their work.
CFT was originally developed for people who, due to a high degree of self-criticism and shame, derive less benefit from traditional treatment methods. Shame, self-criticism and difficulties in regulating emotions are known to play an important role in the genesis and maintenance of emotional disorders, and the CFT approach to developing compassion and self-care has been shown to be effective in psychological treatment.
CFT is in the realm of third generation cognitive-behavioral therapiesand is applied to a wide variety of mental health problems (depression, anxiety, social avoidance, eating disorders, post-traumatic stress disorder, personality disorders, general psychological maladjustment, and experiential avoidance, among others).
Origin of Compassion Focused Therapy
In Paul Gilbert's own words, CFT began in a relatively simple and direct way in the 1980s, when he became aware of how important the emotional tone that people create within themselves is when they try to help themselves. In this sense, an encouraging phrase such as "you can do it", becomes poisonous when communicated with a hostile "tone of voice" (Gilbert, 2015).
CFT began with the clinical observation that cognitive restructuring did not work well in many of the clients who harbored self-criticism, shame and deep-seated self-deprecation due to a lack of congruence or mismatch between the cognitive (clients, by observing the reality of their lives were able to identify their maladaptive thoughts as irrational or even distortions of reality; and consequently were able to generate more rational, evidence-based alternative thoughts) and the emotional (clients displayed a harsh, critical mental tone of voice to generate such thoughts).
CFT is an integrative therapy that, through a guided discovery process aimed at diminishing emotional suffering, uses evidence-based intervention strategies such as Socratic dialogue, guided discovery, identification of safety behaviors, awareness of avoidance and exposure, thought experiments, chaining of inferences, perspective taking, reevaluation, behavioral experiments, mindfulness, body and emotional awareness, breath training, compassionate imagination practices, generation of compassionate behavior, among others.
In the unforgiving world in which our ancestors lived, the emotions related to the threat (fear, anger or disgust) had the function of identifying present and imminent dangers (associated with the activation of our ancient brain)and responding quickly to ensure survival. Today, our new brain 's ability to think, anticipate, fantasize or remember dangers (not imminent or present) causes our attention, thoughts, imagination and memories to be continually focused on possible threats and can generate thought-emotion loops that cause a great deal of suffering.
- CFT helps us understand that the way our nervous system has evolved (and that we have not chosen it) can create difficulties for us. More specifically, the way our mind works (emotions, motivations, thoughts, images, memories and memory systems, as well as behaviors that we do not choose or plan and that we find unpleasant, threatening or disconcerting) makes sense in terms of its evolutionary function, which is fundamentally oriented to survival. From this understanding it is possible to "depathologize" emotions and experiences that, when we consider them in an isolated way can lead us to conclude that "something is wrong with us", but that it really is part of what it means to be human today.
- CFT underlines the fundamental role that emotions play in our lives. Specifically, they provide colour, texture, richness and meaning to different experiences; they inform us about how our lives are going; they provide the energy and motivation needed to adapt to various situations and thus to adapt and survive, a fundamental objective for which they were designed by evolution.
- CFT allows us to know, understand and find balance between the different evolutionary systems of emotional-motivational regulation that structure our mind and body through the formation of patterns of attention, reasoning, physical response, etc. Specifically: the threat detection system, the goal-oriented system, and the system related to feelings of peace and security. In this sense, CFT helps to activate the parasympathetic nervous system, thus cultivating the ability to take root, calm down, connect with security and from there, regulate emotions.
Social configuration of the self through attachment theory
CFT helps us to understand and recognize that many of our conflicts have their origin in early experiences of attachment that we did not choose or plan for (we were powerless over them), but which shape our experience and the kind of person we end up being (we may feel safe or threatened; we may expect support and care from others, or expect harm or neglect; and so we learn to relate to ourselves and others with kindness, toughness or isolation). The compassionate (warm and sensitive) acknowledgement of painful or traumatic attachment experiences is the key factor that makes it possible to shift from a guilt and shame based perspective to a compassionate stance from which to safely confront personal history.
- CFT allows us to understand that our cognitive patterns, as well as the underlying neuronal architecture, derived from early relationships, and especially attachment figures(primary caregivers)influence whether or not we feel safe, whether or not we regulate our emotions, as well as attachment styles and neuronal function in adulthood.
- CFT allows the development of a relationship of friendly and supportive internal affiliation (stripped of self-criticism and feelings of shame, guilt or inadequacy) that makes it possible to connect, develop, internalize with this type of refuge and safe internal base from which to gather the necessary courage to involve oneself in the experiences feared and avoided.
Social regulation of emotions
CFT allows us to know and understand the different motivational and emotional states that model the way our mind works (thoughts, schemes, beliefs, what we pay attention to and how we behave) as well as to cultivate the balance balance between them. Specifically, the competitive social rank system characterized by self-criticism and concern for the perception of competence), the power or dominance system (characterized by the desire to take control) and the care or friendship system (characterized by shared values).
Processes of Compassion Focused Therapy
As we have seen, a generally accepted definition of compassion is"sensitivity to the suffering of oneself and others with a commitment to alleviate and prevent it"” (Gilbert, 2015). Compassion is also characterized by its warmth, that is, by the gentle affective tone when faced with difficulties. In this way, we can feel more secure and move from a threat-centred perspective to an open, reflective and flexible state of mind.
- At CFT, compassion is an orientation that enables us to approach suffering with a useful motivation to approach and alleviate it, while providing us with the context and scenario necessary for change (Kolts, 2016). The therapist provides this context by flexibly assuming the roles of facilitator, teacher-guide, figure of secure attachment and model (human and imperfect) of compassion.
- CFT emphasizes the knowledge and understanding of those factors that, although we have not chosen or planned, play a crucial role in our conflicts. In this way, we can stop being ashamed and blaming ourselves for everything that is not our fault.This process of freeing ourselves from shame and guilt is accompanied by a simultaneous strengthening of responsibility and emotional courage to develop adaptive and compassionate strategies and skills to work with emotions, relationships and difficult situations and thus build satisfying and meaningful lives.
- At CFT, from the beginning of therapy, we cultivate a meaningful and values-consistent version of self, not trying to eradicate the other more vulnerable parts of self, but seeking to understand them deeply. We build, from vulnerability, the authentic"compassionate self",which harbours qualities of strength, wisdom, courage and goodness.
This approach allows us to understand and recognize that much of what we feel (emotions, motivations, images and memories that arise without being called; automatic thoughts that go against our own values) as well as how we have learned to respond (habits that we have tried to change without success) is not our fault, since we have not chosen that evolution has provided us with a brain and a mind designed to survive. However we are not exempt from the responsibility of learning to work and act effectively with these situations, behaviors and feelings.
In short, CFT:
- It facilitates the empathic and kind (non-judgmental and non-judgmental) approach and recognition of emotional suffering;
- It validates, supports and gives meaning to the deepest causes of suffering in personal history and in social relationships and interactions (early and/or late);
- It activates evolved affective systems to create feelings of safeness, confidence, strength and courage that promote the intention and ability to directly address and work with emotional suffering and difficult situations.
- Through the warm, sensitive and helpful approach that compassion provides, it allows one to work with suffering (which is the content central to the therapy) from the felt experience of safety, thus strengthening the underlying neural systems that support safe and calm mental experiences in the future. On the other hand, the therapeutic relationship and environment(process of therapy) of the CFT are designed to help the client generate feelings of safety and emotional balance in which the therapist engages with the client in a warm and encouraging way.
Scientific evidence supporting the CFT
There is a growing body of research that supports the effectiveness of interventions. Several studies have shown that CFT is effective in reducing self-criticism, shame, stress, depression (Gilbert, 2009), anxiety (Gilbert and Proctor, 2006; Judge, Cleghorn, McEwan and Gilbert, 2012; Tirch, 2012); and shows positive results in people with psychotic disorders (Braehler et al, 2013; Laithwaite et al., 2009), eating disorders (Kelly & Carter, 2014; Gale, Gilbert, Read & Goss, 2014), personality disorders (Lucre & Corten, 2013), problem anger (Kolts, 2012), trauma (Lee & James, 2011), and traumatic brain injury (Ashworth, Gracey & Gilbert, 2011).
CFT is currently used for a wide range of clinical conditions. Although we must stress, as therapists, the importance of how we apply our knowledge of human suffering and compassionate approaches to our own personal development. In working with people with mental disorders, we must not only be able to approach their pain, shame, and self-criticism, but we must also deal with our own self-criticism and our own self-demand by engaging in the relief of others' suffering. This work requires a difficult balance between sensitivity to one's own and others' pain, and the resilience needed to be able to help development and change effectively. Therefore, the training of the CFT therapist must include internal work with exercises and reflections that support his/her personal development as a therapist (see Kolts et al. 2018).
Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J., y Gilbert, P. (2013). Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 52, 199–214.
Gilbert, P. (2015). Terapia Centrada en la Compasión. Características Distintivas. Bilbao, Desclée de Brouwer.
Gilbert, P. (2009). The Compassionate Mind. London, Constable & Robinson.
Gilbert, P. y Proctor, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353–379.
Judge, L., Cleghorn, A., McEwan, K., y Gilbert, P. (2012). An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5, 420–429.
Kelly, A. C., y Carter, J. C. (2014). Self-compassion training for binge eating disorder: a pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research, and Practice. doi:10.1111/papt.12044.
Kolts, R. L. (2012). The Compassionate-Mind Guide to Managing Your Anger: Using Compassion-Focused Therapy to Calm Your Rage and Heal Your Relationships. London: Constable & Robinson.
Kolts, R. L. (2016). CFT Made Simple: A Clinician’s Guide to Practicing Compassion-Focused Therapy. New Harbinger Publications.
Kolts, R. L., Bell, T., Bennett-Levy, J., y Irons, C. (2018). Experiencing compassion-focused therapy from the inside out: A self-practice/self-reflection workbook for therapists. Guilford Press.
Laithwaite, H., O’Hanlon, M., Collins, P., Doyle, P., Abraham, L., Porter, S., y Gumley, A. (2009). Recovery after psychosis (RAP): A compassion focused programme for individuals residing in high security settings. Behavioural and Cognitive Psychotherapy, 37(05), 511–526.
Lee, D. A., y James, S. (2011). The Compassionate-Mind Guide to Recovering from Trauma and PTSD: Using Compassion-Focused Therapy to Overcome Flashbacks, Shame, Guilt, and Fear. London: Constable & Robinson.
Tirch, D. (2012): The Compassionate Mind Guide to Overcoming anxiety. New Harbinger.