Compassion Focused Therapy: Counteracting shame and self criticism

Compassion Focused Therapy (CFT) developed by Paul Gilbert in 2000 is considered part of the “third wave” of Cognitive Behavioral Therapies emphasizing mindfulness, acceptance, values and goals. It was developed primarily for individuals who struggle with shame and self-criticism seen in a range of psychological difficulties (Gilbert and Irons, 2004) and is an integrative therapy drawing from various approaches like neuroscience, developmental, social, evolutionary psychology and Buddhist traditions. It has gained more popularity with increased research over the last ten years( Craig et al., 2020) demonstrating its contribution to developing compassion that reduces clinical symptomatology (Millard et al.,2023).

The soothing system and its relationship to compassion

CFT is based on neuroscientific evidence and highlights the importance of establishing a healthy balance between three emotional regulatory systems namely, the threat system (safety seeking), the drive system (incentives) and the soothing system (soothing/safeness). Individuals with high shame and self criticism have an overactive threat system which suppresses their soothing system (Gilbert , 2009). Therefore, by training them to cultivate compassion for the self, compassion towards others and learning how to receive it reduces suffering and increases well-being (Kirby et al., 2017) because the soothing system is developed and can be accessed in response to threat.

Psychoeducation and the compassion enhancing tools

Psychoeducation of the concept of compassion in conjunction to explaining to individuals through an evolutionary perspective why people suffer and the role of self criticism and shame are of primary importance in CFT(Gibert, 2009). More specifically as the therapist explains that understimulation of the soothing system in early life can contribute to the difficulties that individuals face (Gilbert 2014), it becomes possible for clients to recognize that they may have been deprived of early life experiences providing affect regulation. Ultimately through meaning making and normalization of their experience, they can begin to counteract their tendency to pathologize their soothing needs. Helping individuals understand that many cognitive distortions/biases are built-in biological processes, constructed by genetics and the environment is an important part of the process. Explaining that it is not our fault that we all have emotions like anxiety or fear built into us, fueling the way the new “tricky” brain gets shaped through evolution, perpetuating unhelpful vicious cycles and self criticism, creates a “de-shaming” experience for clients. People often report feeling empowered when they understand that they have a choice in learning which parts of the brain to activate/train, so as to regulate the threat based destabilizing emotions.

There are many useful compassion enhancing tools that facilitate accessing the soothing system such as Mindfulness and various Compassionate Mind Training techniques ( Gilber, 2014) .An interesting tool is that of “compassionate letter writing” (Gilbert, 2014),which allows patients to develop/strengthen the compassionate self to act as a mediator in responding to self criticism so as to resolve inner conflict between different self states. Through this process individuals can acknowledge their efforts to cope given restricted circumstances as opposed to blaming oneself for various things like poor performance. This can help them engage in and sustain a supportive action plan characterized by self care.

Compassion: Where all therapies meet

CFT can be used on its own or to enhance more traditional therapies like Cognitive Behavioural Therapy. More specifically, the development of an inner kind supportive voice and the accompanying positive emotions can encourage and motivate people to engage more effectively in cognitive tasks like identifying and challenging unhelpful core beliefs as well as behavioral tasks like experiments which can help them test out predictions. CFT can also be combined with other third wave therapies like Acceptance and Commitment Therapy developed by Steven Hayes in 1982. More specifically CFT can target shame, self criticism and self-blame, facilitating clients to pursue a values-driven meaningful life, which is the focus of ACT.

Empathy, along with compassion, are the building blocks and foundation of every type of psychotherapy. Without these little progress can be made and no therapeutic relationship can truly be established or thrive. Moreover, the therapist’s ability to be a self-compassionate presence within therapy not only decreases his/her own distress but also allows clients to feel his/her compassion through emotional attunement and helps them become more compassionate themselves (Neff & Germer,2022).

Being aware of the theory behind CFT and some of its tools and current research on it can help us all remember what we already know regarding the fundamental importance and power of compassionate soothing experiences (towards oneself and others) that inspire trust, safety and positive emotions. These are the experiences that can make one feel held and contained so as to meet one’s needs for connection and counteract self defeating cognitions and behaviors. At the end of the day all types of therapists want to see their clients develop a healthier relationship with themselves and others. Whether that is done through the active use of CFT or by providing new relational soothing experiences that one can internalize through some other form of therapy, just highlights how fortunate we are to have many therapeutic options to choose from that can strengthen one’s compassionate self.

References

• Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Review of Neurotherapeutics, 20, 385 - 400.
• Gilbert, P. (2009). Introducing compassion focused therapy. Advances in Psychiatric Treatment, 15, 199–208.
• Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53, 6–41
• Gilbert, P., & Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (Ed.), Compassion: Conceptualisations, research and use in psychotherapy (pp. 263–325). Routledge. https://doi.org/10.4324/9780203003459
• Kirby, J.N., Tellegen, C.L., & Steindl, S.R. (2017). A Meta-Analysis of Compassion-Based Interventions: Current State of Knowledge and Future Directions. Behavior therapy, 48 6, 778-792.
• Millard, L., Wan, M.,  Smith, D., & Wittkowski, A. (2023). The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis. Journal of Affective Disorders. 326. 10.1016/j.jad.2023.01.010.
• Neff, K.,& Germer, C.( 2022). The role of self-compassion in psychotherapy. Journal of World Psychiatry, 21, 58-59