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Stress and supervision - their role in complex people work

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Presentations from Making Research Count event on 24th May 2016.

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Stress and supervision - their role in complex people work

  1. 1. Stress & Supervision – their role in complex people work Tuesday 24th May 2016 #mrcsalford
  2. 2. Professor Philip Brown Making Research Count at The University of Salford #mrcsalford
  3. 3. • National initiative across ten universities in England • A knowledge broker • Bringing together academics, practitioners, carers and users to facilitate the dissemination of social care research and theory • The University of Salford is the regional hub for MRC in Greater Manchester • Support the learning needs of a range of organisations in the sub- region Making Research Count (MRC) #mrcsalford
  4. 4. Michael Murphy Introduction from chair #mrcsalford
  5. 5. STRESS AND EMOTIONAL RESILIENCE Dr Neil Thompson
  6. 6. STRESS • More than pressure
  7. 7. STRESS • More than pressure • Damaging to: • Health • Well-being • Relationships • Confidence • Quality of work / effectiveness • Quantity of work / productivity
  8. 8. EMOTIONAL RESILIENCE • ‘Bouncebackability’
  9. 9. EMOTIONAL RESILIENCE • ‘Bouncebackability’ • The three Rs • Resourcefulness • Robustness • Resilience
  10. 10. EMOTIONAL INTELLIGENCE • Reading emotions effectively • Conveying emotions effectively
  11. 11. EMOTIONAL INTELLIGENCE • Emotional resilience + emotional intelligence = emotional competence
  12. 12. THE IMPORTANCE OF CONTEXT • Emotional competence reduces the chance of stress and helps to recover from it
  13. 13. THE IMPORTANCE OF CONTEXT • Emotional competence reduces the chance of stress and helps to recover from it • BUT …
  14. 14. THE IMPORTANCE OF CONTEXT • Emotional competence reduces the chance of stress and helps to recover from it • BUT … • We need to think more holistically
  15. 15. THE IMPORTANCE OF CONTEXT • Emotional competence reduces the chance of stress and helps to recover from it • BUT … • We need to think more holistically • Organisational culture • Macho vs supportive • Open vs closed • Problem avoidance vs problem solving
  16. 16. THE IMPORTANCE OF CONTEXT • Emotional competence reduces the chance of stress and helps to recover from it • BUT … • We need to think more holistically • Organisational culture • Macho vs supportive • Open vs closed • Problem avoidance vs problem solving • Quality of leadership
  17. 17. AUTHENTIC LEADERSHIP
  18. 18. Relationship-Based Self- Care Maurice Fenton MRC University of Salford May 2016
  19. 19. http://www.empowerireland.ie/uncategorized/congruent-care- care-on-the-edge/ http://www.empowerireland.ie/uncategorized/self-care-in- social-care-vicarious-trauma-vicarious-resilience-and-self- compassion/ http://www.empowerireland.ie/uncategorized/the-stolen-child/
  20. 20. The most protective and empowering factor is social care work is, in my opinion, beyond doubt the worker themselves. Therefore, how workers make use of ‘self’ in their work is of critical importance. There are many aspects to the use of self and in this presentation I intend to address some vicarious processes inherent in the work with regard to two of these self- processes – the importance of self-awareness and self-care.
  21. 21. Traditional Approaches to Self-Care Require degrees of self-discipline and are predominately focused on the self.
  22. 22. Relationship-Based Self-Care • Relationship with one’s self • Relationship with the young person/recipient of care • Relationship with the professional ecology The relationship-based model is an ecologically informed model of self-care
  23. 23. To accomplish this we shall first consider the importance of Feelings, Connection, Boundaries, Vulnerability and Compassion and then some associated vicarious processes and relevant conditions such as vicarious trauma and resilience as well as the role of compassion and burnout.
  24. 24. The capacity to be in touch with the client’s feelings is related to the worker’s ability to acknowledge his or her own. Before a worker can understand the power of emotion in the life of the client, it is necessary to discover its importance in the worker’s own experience. (Shulman, 1999:156)
  25. 25. This can be a place of vulnerability yet a worker who is competent with their own vulnerability is also emotionally competent. We know Emotional Intelligence (EQ or EI) is increasingly valued above Intellectual Quotient (IQ) in many professions, yet in a profession which is fundamentally relational, social care/work we still privilege the techno-rational.
  26. 26. Connection – Care ‘On the Edge’
  27. 27. Experience is the hardest kind of teacher. It gives you the test first and the lesson afterwards. Oscar Wilde
  28. 28. The European approach of Social Pedagogy has much to offer practice in the Republic of Ireland and the UK in many areas, not the least within this boundaries area. The 3 P’s acknowledged within social pedagogy of the personal, professional and private aspects of the worker’s persona allow for the professional as well as the personal to be brought into practice and this affords a much improved approach to practice.
  29. 29. Bearing witness to another’s vulnerability can be an uncomfortable and challenging experience, which can evoke our own vulnerability, emotions, feelings and past experiences. We can also experience some of the other’s pain if we connect to and ‘therapeutically hold’ them (Winnicott, 1975), or ‘hold the child in mind’ (Ruch, 2005), during these times of distress. By recognising that we ‘hold’ something it can be seen that some degree of possession is implied on the part of the carer.
  30. 30. This means we also can become affected by their trauma and pain and we can experience vicarious trauma, what Hatfield et al., (1994) describe as a form of emotional contagion that causes the carer to ‘catch the emotions’ of those they care for.
  31. 31. Secondary Traumatic Stress, Indirect Trauma or Vicarious PTS is more closely associated with Post Traumatic Stress except that the stress is experienced through another person, i.e. vicariously, rather than first hand. A difference between secondary trauma and vicarious trauma is that secondary trauma can happen suddenly, in one session, while vicarious trauma is a response to an accumulation of exposure to the pain of others (Figley, 1995). The symptoms of secondary trauma are nearly identical to those of vicarious trauma.
  32. 32. Vicarious trauma is a permanent change in the service provider resulting from empathetic engagement with a client’s/patient’s traumatic background (Pearlman & Saakvitne, 1995). Although there are some parallels to burnout, including symptoms such as exhaustion, feeling overwhelmed, isolated and disconnected, vicarious trauma is much more pervasive, impacting all facets of life, including the body, mind, character and belief systems. It alters the persona.
  33. 33. Whilst these conditions may be contested, Professor Dinesh Bhugra for example, what is incontestable is that working with others can and does have an impact on the worker and that this needs to be acknowledged and managed.
  34. 34. Compassion Fatigue, Empathy Fatigue, Carer Burden This is different to Vicarious Trauma in that the it is not the trauma of the other being cared for that is the causation of the fatigue but rather the capacity of the carer to continue to provide care for the other. The milk of human kindness has not yet been lost but it is getting harder for the worker to care, their resilience is depleting .
  35. 35. BROKEN Self-Compassion and Burnout Self-Tests http://www.compassionfatigue.org/pages/selftest.html http://self-compassion.org/test-how-self-compassionate-you-are/
  36. 36. Vicarious Vulnerability - Trauma implies harm, which in turn could be said to imply that the young person has caused harm to the worker, even if unintentionally. Equally, Compassion Fatigue could be seen to imply that the needy or demanding young person invokes fatigue on the part of the worker thus casting the young person as the cause of this fatigue. This, then, could lead to the young person becoming perceived as the cause of the harm, the problem, when clearly they are not. It is the harm that has been caused to them by others that is the cause of the problem.
  37. 37. Carl Jung (1875-1961) theorised that many carers and helpers are motivated to enter caring professions as a result of their own ‘wounds’ from prior life experiences. He coined the term ‘wounded healers’. Jackson (2001) identifies the ‘wounded healer’ not as a flawed professional rather one whose past experiences can be utilised to better attune them to caring for others.
  38. 38. Maeder (1998), Regehr et al. (2001) and Rizq & Target (2010) identified that high percentages of workers in social work, counselling, and psychotherapy professions had experienced prior ‘wounding’ experiences which motivated them to enter these professions. This illustrates the magnitude of the potential for workers’ having pre-existing vulnerabilities that may be impacted on by children’s and young people’s vulnerabilities but that correctly managed this need not be a negative phenomenon. Clearly, workers to be aware of their own vulnerabilities and to manage them.
  39. 39. In the event that the worker does experience vicarious trauma it “is important to recognise that neither clients nor the negligent helpers are responsible for VT. Rather it is an occupational hazard, a cost of doing the work” (Pearlman & Caringi in Courtois & Ford, 2009:205).
  40. 40. Burnout is usually the result of prolonged stress or frustration, resulting in exhaustion of physical strength, emotional strength and/or motivation (Maslach, 2003). One of the characteristics of burnout is that it occurs over a fairly long period of time and is cumulative. It does not afflict a person after one bad day. There can be a detachment from feelings where people become depersonalised and the worker cynical and therefore potentially more liable to be callous or over-reactive in their actions. The milk of human kindness has been lost. (Ochberg, 2011)
  41. 41. It is important to recognise that vicarious trauma and compassion fatigue are very treatable conditions and can be resolved successfully with self-care practices and/or professional support should the worker experience them. The role of supervision is critical within this area.
  42. 42. Vicarious Resilience (VR) has only relatively recently been identified. Hernández et al. (2007) argue that “this process is a common and natural phenomenon illuminating further the complex potential of therapeutic work to both to fatigue and to heal” (2007:237). They also highlight that vicarious resilience offers a mechanism to counterbalance vicarious trauma and, crucially, that practitioners’ awareness of the potential of vicarious resilience boosts its potential benefits for these practitioners.
  43. 43. Both processes can be managed: VT can be identified and decreased, and VR can be identified and increased, by developing awareness, purposefully cultivating and expanding it. (Hernández et al., 2007:239) Silveira & Boyer (2015) found that in addition to experiencing vicarious resilience counsellors of traumatised children were also imbued with increased levels of optimism which they attribute to the vicarious mechanisms of engaging with children overcoming trauma.
  44. 44. Silveria and Boyer recommend, and I concur, that vicarious resilience be brought into discussions within supervision and professional development workshops. “We propose here that helpers’ personal distress and emphatic responses, if processed adequately, can result in growth for both client and helper.” (Pearlman & Caringi in Courtois & Ford, 2009:205)
  45. 45. Post Traumatic Growth ”The experience of positive change the individual experiences as a result of the struggle with a traumatic event” No guarantee that post traumatic growth will occur yet for those where it does the paradox is they may be more vulnerable, yet they are stronger It is not necessarily an experience that leads people to feel less pain from tragedies they have experienced, nor does it necessarily lead to an increase in positive emotion. (Calhoun & Tedeschi, 2013:8,23) Smooth seas do not make skilful sailors
  46. 46. With regard to compassion there is also the concept of Self- Compassion which has been gaining purchase in the social profession in recent years for its potential to enhance practitioners’ mental health within a framework that avoids the self-evaluation and self-judgement that is inherent in many other models.
  47. 47. Self-compassion entails seeing one’s own experiences in light of the common human experience, acknowledging that failure, suffering and inadequacies are part of the human condition, and that all people – oneself included – are worthy of compassion. (Neff, 2003:87)
  48. 48. Neff identifies the three elements of self-compassion as: (a) self-kindness – extending kindness and understanding to oneself rather than harsh judgements and self-criticism, (b) common humanity – seeing one’s experiences as part of the larger human experience rather than seeing them as separating and isolating, (c) mindfulness – holding one’s painful thoughts and feelings in balanced awareness rather than over-identifying with them. (Neff, 2003:89)
  49. 49. Compassion Satisfaction According to Phelps et al. (2009), compassion satisfaction (CS) refers to the positivity involved in caring and it is often gauged by the Compassion Fatigue and Satisfaction Test (Stamm, 2005). Simply put, CS involves “the ability to receive gratification from caregiving” (Simon, Pryce, Roff, & Klemmack, 2006:6).
  50. 50. We must also recognise that systems which facilitate practices such as the expectation of individual accountability without sufficient resources can be seen to be dysfunctional in terms of providing basic support for both workers and children and young people. It is entirely plausible to perceive of such systems as posing a real threat of harm to workers. Here, the risk of what can be termed ‘system trauma’, where the lack of support, resources and services afforded by the system of care, is equally, if not more of a reality for workers than vicarious trauma.
  51. 51. My coping mechanisms are talking to trusted colleagues and professional activism with liked-minded others. This includes writing and advocating for change. The connection with those I support I find vital also. Connections protect against isolation and are a protective factor against burnout. “It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself” Ralph Waldo Emerson Coping with System Trauma
  52. 52. Connecting with children and young people and thereby boosting my own optimism, resilience and self-care through recognising their resilience is congruent with my motivation to enter this profession in the first place i.e. the desire to make a difference in a hurt child's life. This is also a strengths-based approach and acts complimentary to other self-care strategies.
  53. 53. Self-care is a critical component of professional competence in social care. To have the capacity and capability to care for others we must first take care of ourselves.
  54. 54. As with caring for children and young people Thank you
  55. 55. Refreshments and Networking Break
  56. 56. Healing the Wounds of Trauma Making Research Count Conference 24/5/2016
  57. 57. Elaine Beaumont BABCP Accredited Cognitive Behavioural Psychotherapist EMDR Europe Approved Practitioner Lecturer at the University of Salford
  58. 58. Overview  To discuss psychotherapeutic interventions for trauma  To discuss the research evidence and rationale for Compassion Focused Therapy and Compassionate Mind Training  To explore practical ways to develop self-compassion (experiential exercises)  To discuss compassion fatigue and burnout within the healthcare professions
  59. 59. Trauma Therapies Cognitive Behavioural Therapy • Challenges thoughts and behaviour. Eye Movement Desensitisation and Reprocessing (EMDR) • If we suffer from a traumatic experience we may not process information which can lead to a disturbing memory. • EMDR helps individual’s process information (upsetting memories) and can help replace negative cognitions with positive cognitions.
  60. 60. Brief overview - CBT • CBT is a collaborative process between client and therapist to achieve goals and objectives. • These goals and objectives will result in alleviating client’s symptoms. • CBT offers structure for clients to help them learn more about themselves and their perceptions and reactions to events. • The aim is for clients to develop skills and new ways of thinking and reacting • A reported weakness of CBT is that individuals may say that they understand the logic of the approach but report that they do not feel any better (Leahy, 2001; Gilbert, 2010). • Challenge the ‘bully within’ – guilt, shame, blame
  61. 61. What is compassion? “A sensitivity to the suffering of self and others with a deep wish and commitment to relieve the suffering” (Dalai Lama) “Deep awareness of the suffering of oneself and other living beings, coupled with the wish and effort to alleviate it” (Paul Gilbert) “Compassion is the emotional attitude that accompanies mindfulness when suffering is encountered” (Chris Germer and Kirstin Neff)
  62. 62. Compassion Focused Therapy Self-critical thinking and emotions such as fear and shame play a role in maintaining symptoms. Developing strategies that increase inner caring and self- compassion can help the individual recover. (Beaumont & Hollins-Martin 2015; Beaumont & Hollins-Martin 2013; Beaumont et al 2012; Harmen & Lee 2010). Individuals suffering with PTSD often have high levels of shame and self-blame and tend to be overly critical of themselves in therapy. 66
  63. 63. Guilt, shame and anger - trauma Examples from Fire Brigade Guilt – “I survived others didn’t” What did you do that was helpful? Draw a pie chart exploring responsibility. Examine what they would say to a friend was telling you this story Anger – “no one helped me...” Challenge thinking distortions/black and white thinking. Anger management training (coping strategies/flash cards). Also explore sadness – “what does anger stop you from exploring/feeling”. Shame – challenge internal shame cycle Identify internal bully and use Compassionate Mind Techniques (Gilbert, 2006).
  64. 64. Development of CFT • Prof Paul Gilbert • Severe and chronic depression • Particular client- “I can understand the logic, I just don’t feel it” • “What would help you feel it?”
  65. 65. Evolution – Overview of Paul Gilbert’s model Old brain – share competencies with other mammals, and includes:  Motives: Safety, food, shelter  Emotions: Anger, anxiety, sadness, joy, lust  Behaviours: Fight, flight, withdraw, engage  Relationships: Sex, power, status, attachment, tribalism New Brain – relatively ‘recent’ in evolutionary development, includes abilities for:  Imagination  Planning  Rumination  Mentalisation, Theory of Mind  Self-awareness and Identity Social Brain:  Need for affection and care  Socially responsive, self-experience and motives
  66. 66. Affect Regulator Systems Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust Drive, excite, vitality Content, safe, connected
  67. 67. CMT/CFT Self-compassion taps into our internal care-giving system, so that we feel less frightened and alone. Self-compassion helps us feel safe and accepted, so that we can mindfully turn toward and accept our painful experience with greater ease. Many different parts of us….angry self, anxious self, sad self, critical self, compassionate-self By including CFT techniques individuals can be taught not just to challenge thoughts and behaviour but to develop self-soothing techniques, challenge self -criticism and accept themselves in a non-judgemental way (Gilbert, 2010).
  68. 68. How can I increase self-compassion? Develop sensitivity, sympathy, acceptance and insight into one’s own difficulties through self-reflection Refocus attention - reflecting on what would be helpful and supportive in a situation as opposed to judging oneself harshly and critically Thought balancing/self-monitoring The empty chair technique Exploring self-critical rumination Examining positives Use of Self-compassion diary Use of imagery Developing a compassionate ideal Compassionate colour Compassionate object Compassionate letter writing Mindfulness What do I need in this moment of pain and suffering?
  69. 69. Self-Compassionate Language Self-critical thinking and emotions such as fear and shame play a role in maintaining symptoms. Why do we criticise? Role/purpose of our self-critic? What types of things do you typically judge and criticise yourself for? What tone do you use? What language do you use when you make a mistake? How could you reframe your language to be more kind, supportive and understanding. Is there a reason why your inner critic is doing this? What purpose does it serve?
  70. 70. Self-Compassion-Example exercises • Soothing Rhythm Breathing • Hand on heart exercises • Loving kindness and self-compassion meditation • Compassionate body scan • Compassionate friend • Compassionate Behaviour • Letter writing • Method Acting – wisdom, courage, strength, motivation Overriding principle – what do I need now (in this very moment) to care for myself in this painful situation?
  71. 71. Providing mental health services to victims of primary and secondary trauma…… • Self-compassion can be trained and cultivated • Utilising practical exercises that may cultivate a compassionate mind may help individuals respond to their ‘bully within’ with care and kindness rather than criticism and blame
  72. 72. What is compassion fatigue? “The cost of caring”(Figley, 1995. pg1) Secondary Traumatic Stress/Vicarious Trauma Who does it affect? How does it affect them? What causes it? What is burnout? Mental and physical exhaustion How does it link to compassion fatigue? What causes it? What can we do to protect ourselves? Compassion fatigue and burnout
  73. 73. The Compassionate Mind Workbook – Dec 2016……
  74. 74. Beaumont et al. (2012) CBT/CMT & trauma • Two groups – CBT vs CBT/CMT Both groups sig reduction in depression, anxiety, avoidance, hyper- arousal and intrusion post-therapy. No sign difference between groups. CBT/CMT group significantly improved self-compassion post-therapy Beaumont & Hollins-Martin (2015) • A narrative review. How effective is Compassion-Focused Therapy (CFT)? Twelve studies were identified which showed significant psychological improvements in clients with diagnosed trauma symptoms, brain injury, eating disorders, personality disorders, schizophrenia-spectrum disorder, chronic mental health problems and psychosis, both within groups and during one-to-one therapy.
  75. 75. Beaumont & Hollins-Martin (2013) EMDR/CMT Case study 58-year old man. Signature-signing phobia following a traumatic accident • 8 sessions of Compassionate Mind Training/EMDR resulted in an elimination of the client’s phobia, increase in mood, reduction in trauma-related symptoms and recall of forgotten early memories about his sisters traumatic death “If the only tool you have is a hammer you will treat everything as if it were a nail“ (Maslow)
  76. 76. Compassion fatigue, burnout and well-being Beaumont, Durkin, Hollins-Martin, Carsen (2015). Measuring relationships between self-compassion, compassion fatigue, burnout and well-being in trainee counsellors and trainee cognitive behavioural psychotherapists Student counsellors/psychotherapists who reported high on measures of self-compassion and well-being, also reported less compassion fatigue and burnout Beaumont, Durkin, Hollins-Martin, Carsen (2015). Compassion for others, self- compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives Over half of the sample reported above average scores for burnout. The results indicate that student midwives who report higher scores on the self-judgment sub- scale are less compassionate for themselves and others, have reduced wellbeing, and report greater burnout and compassion fatigue. Student midwives who report high on measures of self-compassion and well-being report less compassion fatigue and burnout.
  77. 77. CFT for Healthcare Staff Beaumont, E., Irons, C., Rayner, G., & Dagnall, N. (2016) Does Compassion Focused Therapy Training for Healthcare Educators and Providers increase self- compassion, and reduce self-persecution and self-criticism? The aim of the research was to explore whether the training would increase self- compassion and reduce self-criticism and self-persecution. Results reveal an overall statistically significant increase in self-compassion and statistically significant reduction in self-critical judgement post-training. There was no statistically significant reduction in self-persecution or self-correction scores post- training. Compassionately responding to our own ‘self-critic’ may lead the way forward in the development of more compassionate care amongst healthcare professionals. Training people in compassion based exercises may bring changes in levels of self- compassion and self-critical judgement. The findings suggest the potential benefits of training healthcare providers and educators in compassion focused practices.
  78. 78. Contact details e.a.beaumont@salford.ac.uk www.beaumontpsychotherapy.co.uk elaine@beaumontpsychotherapy.co.uk
  79. 79. References  Ashworth, Gracey, & Gilbert (2011). CFT to be a helpful addition and focus for people with acquired brain injury.  Beaumont, E., Irons, C., Rayner, G., & Dagnall, N. (2016). “Does Compassion Focused Therapy Training for Healthcare Educators and Providers increase self-compassion, and reduce self-persecution and self-criticism?”, The Journal of Continuing Education in the Health Professions, Vol. 36, No. 1, pp. 4-10.  Beaumont, E., Durkin, M., Hollins Martin, C. J., Carson, J., (2015) Measuring relationships between self- compassion, compassion fatigue, burnout and well-being in trainee counsellors and trainee cognitive behavioural psychotherapists: a quantitative survey. Counselling and Psychotherapy Research, Vol. 16, No. 1, pp.15-23.  Beaumont, E., Durkin, M., Hollins Martin, C. J., & Carson, J., 2015. Compassion for others, self-compassion, quality of life and mental well-being measures and their association with compassion fatigue and burnout in student midwives: A quantitative survey. Midwifery. http://dx.doi.org/10.1016/j.midw.2015.11.002i  Beaumont, E., Hollins Martin, C.J. (2015). A narrative review exploring the effectiveness of Compassion-Focused Therapy. Counselling Psychology Review, 30 (1), 21-32.  Beaumont, E. (2014). 'Healing the wounds of trauma, shame and grief', Healthcare Counselling and Psychotherapy Journal, 14(2), pp.14-20.  Beaumont, E., & Martin, C. H. (2013). 'Using Compassionate Mind Training as a Resource in EMDR', Journal of EMDR Research and Practice, 7(4), pp.186-199.  Beaumont, E., Galpin. A. & Jenkins, P. (2012). ‘Being kinder to myself’: A prospective comparative study exploring post-trauma therapy outcomes measures, for two groups of clients, receiving either Cognitive Behaviour Therapy or Cognitive Behaviour Therapy and Compassionate Mind Training. Counselling Psychology Review, Vol. 27, No 1, 31-43.  Beaumont, E. (2012). Compassionate Mind Training. Self-soothing after trauma. Healthcare Counselling and Psychotherapy Journal, 18-22.  Bisson, J., & Ehlers, A. (2007). Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. The British Journal of Psychiatry 190: 97-104.  Carlson, J., Chemtob, C. M., & Rusnak, K. (1998). Eye movement desensitization and reprocessing (EMDR): treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3 –24
  80. 80. References  Gale, C., Gilbert, P., Read, N., & Goss, K. (2012). An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clinical Psychology & Psychotherapy, http://dx. doi.org/10.1002/cpp.1806.  Germer, C. K., & Neff, K. D. (2013). Self‐compassion in clinical practice. Journal Of Clinical Psychology, 69(8), 856-867. doi:10.1002/jclp.22021 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. London: Routledge.  Gilbert, P. (2010). Compassion Focused Therapy. London: Routledge.  Gilbert. P. (2009). The Compassionate Mind. London: Constable.  Gilbert, P & Leahy, R (2007). The Therapeutic Relationship in the Cognitive Behavioural Psychotherapies. London: Routledge.  Gilbert, P., & 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.  Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: A treatment for peri-traumatic emotional ‘hotspots’ in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30,37–56.  Harman, R., & Lee, D. (2010). The Role of Shame and Self-Critical Thinking in the Development and Maintenance of Current Threat in Post Traumatic Stress Disorder. Clinical Psychology and Psychotherapy, 17 13-24.  Heriot-Maitland, C., Vidal, J. B., Ball, S., & Irons. C. (2014). A compassionate-focused therapy group approach for acute inpatients: Feasibility, initial pilot outcome data, and recommendations. British Journal of Clinical Psychology, 53, 78–94.
  81. 81. References  Hutcherson, Seppala &Gross (2008). Loving-kindness meditation increases feelings of social connectedness and affiliation towards strangers.  Laithwaite, H., O’Hanlon, M., Collins, P., Doyle, P., Abraham, L., Porter, S., et al. (2009). Recovery after psychosis (rap): A compassion focused programme for individuals residing in high security settings. Behavioural and Cognitive Psychotherapy, 37, 511.  Leary, Tate, Adams, et al., (2007). Compassionate letter writing to oneself improves coping with life events and reduces depression.  Lee, D.A (2009). Compassion Focused Cognitive Therapy For Shame-based Trauma Memories and Flashbacks in PTSD. In Grey, N. (eds) A Casebook of Cognitive Therapy for Traumatic Stress Reactions. Chapter 15. London: Routledge.  Lutz, Brefczynski-Lewis, Johnstone, & Davidson (2008). Practices of imagining compassion for others produce changes in frontal cortex and immune system  Mayhew S. & Gilbert P. (2008) Compassionate mind training with people who hear malevolent voices. A case series report. Clinical Psychology and Psychotherapy, 15, 113–38.  Neff, Hsieh, & Dejitterat (2005). Self-compassion aids in coping with academic failure .  Thompson, B., & Waltz, J. (2008). Self Compassion and PTSD Symptom Severity. Journal of Traumatic Stress, Vol 21, No. 6, 556 -558.  Van der Kolk, B. (1994) The Body Keeps The Score Trauma Information Pages
  82. 82. Panel discussion • Elaine Beaumont • Maurice Fenton • Michael Murphy (chair) • Dr Neil Thompson #mrcsalford
  83. 83. Michael Murphy, University of Salford Conference Close #mrcsalford

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