The video for this presentation is available on our Youtube channel: https://youtube.com/docsnipes A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c= Using the compassionate mind to help clients who struggle with guild and self-criticism overcome

1. Compassion Focused
Therapy
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
AllCEUs.com Unlimited CEUs and Specialty Certifications $59

2. Objectives
 Define CFT
 Explore the underlying theory
 Identify techniques used in CFT and their
rationale
 Theorize about how CFT might be helpful to your
clients

3. Compassion
 The healing properties of compassion have been written
about for centuries.
 The Dalai Lama stresses that if you want others to be happy,
or to be happy yourself – focus on compassion
 Compassion can be thought of as a skill that one can train in.
 Focusing on and practicing compassion can influence
neurophysiological and immune systems
 Compassionate mind training refers to specific activities
designed to develop compassionate attributes and skills,
particularly those that influence affect regulation

4. Observations About Compassion
 Compassion-focused therapy and compassionate mind
training arose from a number of observations.
 First, people with high levels of shame and self-criticism
can have enormous difficulty in being kind to
themselves, feeling self-warmth or being self-
compassionate.
 Psychological consequences?
 Physical consequences
 Social consequences?

5. Observations About Compassion
 Second
 Problems of shame and self-criticism are often rooted in
histories of abuse, bullying, high expressed emotion in the
family, neglect and/or lack of affection
Imagine growing up in this family
What do you, the child want? ---But you don’t get it.
What does this teach you about the world
 Individuals subjected to early experiences of this type can
become highly sensitive to threats of rejection or criticism
from the outside world and can quickly become self-attacking
(egocentric child) or defensive and aggressive

6. Observations About Compassion
 Third, it has been recognized that working with shame and self-
criticism requires a therapeutic focus on memories of such early
experiences (similar to trauma work)
 Fourth, some clients become skilled at generating alternatives for
their negative thoughts and beliefs, but still do poorly in therapy.
 I identify the logical fallacy, but it doesn’t make me feel any better

7. Key Element
 Individuals prone to high levels of shame and self-
criticism can find it very difficult to generate feelings of
contentment, safeness or warmth in their relationships
with others and themselves.
Psychological consequences?
Physical consequences
Social consequences?

8. Brain Systems
 Threat and protection
 All living things have evolved with basic threat-detection/protection
systems (survival)
 The behavioral outputs include fight, flight and submission
 Sensitized schemas and strategies for threat detection and protection
can become major influences on the ways in which a person perceives
and navigates their world.
 The clinician will identify, historically plot and validate the functions
and origins of safety strategies (partly to de-shame them)
 In compassion-focused therapy the focus is on understanding the
functions of a person’s symptoms and difficulties in terms of safety
strategies

9. Brain Systems
 Drive and excitement
 Animals need emotion and motivational systems that direct them
towards important rewards and resources.
 The function of the drive and excitement system in humans is to
give us positive feelings that energize and motivate us to seek out
things (e.g. food, sex, friendships)
 If people take cocaine or amphetamine this is the system they are
likely to stimulate.

10. Brain System Conflict
 The drive system and the threat protection system can be linked
in complex ways
 Avoid negative events, which shows up in thoughts of ‘shoulds’,
‘oughts’ and ‘musts’.
 Working to avoid rejection
 Doing things we shouldn’t
 Status Seeking (Wealth, power, (status))

11. Brain Systems
 The contentment system
 When animals are not threatened and not seeking resources they can
become content
 Contentment is associated with a positive ‘calm’, positive affects and sense
of well-being; contentment is not just the absence of threat
 The evolution of attachment behaviour utilised the contentment system,
and enabled signals of caring and kindness to have soothing qualities that
activate positive affects linked to feelings of well-being, safeness and social-
connectedness. This aspect of the system may be called ‘social safeness’
 The contentment/social safeness system is internally wired to act as a
regulator of the threat protection and drive systems
 Compassion-focused therapy and compassionate mind training are
directed at facilitating development of the soothing and social safeness
system

12. Contentment cont…
 The contentment system has been significantly developed with
the evolution of attachment behaviour
 The key point is to recognise the importance of caring behaviour
in stimulating the soothing and safeness system, and thus
soothing overarousal and threat (dis)stress in the individual
receiving care. Caring-affiliation operates through an opiate and
oxytocin system.
 there is increasing evidence that it reduces sensitivity, especially
to socially threatening stimuli, in fear circuits of the amygdala

13. Balancing the Systems
 Heightened sensitivity and overactivity of the threat protection
and/or drive systems is a common problem in people with high
shame and self-criticism
 The soothing system, which provides relief and calming, is
insufficiently accessible to them, making it difficult to feel
reassured or calmed/soothed when they generate (believable)
alternative thoughts or engage in helpful behaviors.
 This system is particularly sensitive to interpersonal cues of social
safeness, acceptance and being cared for.
 The role of the therapist is to help the client experience safety in
their interactions with them, and to replace self-criticism with
self-kindness

14. The attributes of compassion
 In compassion-focused therapy compassion is understood in
terms of specific attributes and skills
 Care for well-being
 Sensitivity
 Sympathy
 Distress tolerance
 Empathy
 Non-judgement

15. The skills of compassion
The skills of compassion involve creating feelings of warmth,
kindness and support in a range of activities

16. Compassionate Attention
 If we are in conflict with someone (or ourselves), we often
overlook the things that we like about them: by refocusing our
attention we can create a sense of warmth, support and kindness.
 In CFT, the focuses is on:
 Identifying the client’s strengths, positive attributes or skills
 Pay attention and bring to mind their positive qualities, perhaps by
revisiting positive memories, and working on those aspects of self.
 Attention-directing exercises linked to the savoring of experiences,
to develop appreciation and gratitude. For example, an individual
may be encouraged to appreciate their food, environment…
 When the threat protection system is focused on problems and
potential difficulties, it is beneficial to practice refocusing
attention and liberating it from this dominance.

17. Compassionate Reasoning
 Compassionate reasoning involves how we think about the world,
ourselves and others.
 Logic is not enough. ‘Evidence’ is secondary to the experience of
being helped and supported.
 Particularly important is how people reason, ruminate and reflect
on their current mood states, their future and their sense of self.
 Shame and self-critical thinking are clearly targets in compassion-
focused therapy, but it is important to understand the functions
of self-critical thinking and why people may fear giving it up.
 The therapist teaches the problems of certain types of rumination
and how to substitute compassionate refocusing in one’s thinking.

18. Compassionate Behavior
 Compassionate behavior is focused on alleviating distress and
facilitating development and growth
 for example, when the individual has to engage in difficult or
frightening behavior they will try to create an encouraging, warm
tone in their minds associated with the supportive thoughts
 This is a repetition of what would normally happen within a
parent–child relationship, where the parent is encouraging and
supportive

19. Compassion-Focused Therapy
 Seeks to stimulate positive affect processing
 Behavioral tasks encouraging exposure to positive emotions can
help the client to learn to enjoy experiencing them.
 Why might a client not be able/willing to experience pleasure?
 Helping people become more process-focused (efforts) rather
than task-focused (results).

20. Compassionate Imagery
 Clients explore their image of their ‘ideal’ of compassion. The therapist
guides the client through imagery exercises, exploring feelings associated
with various images.
 These images are usually fleeting and never clear in the mind, and the
therapist advises the client of this
 Sometimes clients prefer non-human images such as an animal, a tree or a
mountain. These too must be imagined as sentient, with specific qualities
of wisdom, strength, warmth and non-judgement.
 The client imagines themselves as a highly compassionate person and
explores their sense of age, facial expressions, body postures, voice tones
and styles of thinking
 Clients can be encouraged to practice each day at becoming ‘the
compassionate self’, with the appropriate facial expressions, voice tones
and ways of thinking.

21. Compassionate Sensation
 Clients explore feelings in their bodies when they focus on being
compassionate, experiencing compassion from others and being
self-compassionate
 CFT suggests that internal thoughts and images can act just as
external stimuli do, activating different parts of the brain.
 For example, if we are hungry and we see a tasty meal (external
signal) this can start our saliva and stomach acids flowing. Equally,
just imagining the tasty meal (internal signal) can have the same
physiological effect

22. Compassionate Sensation
 The therapist asks the client to consider how they would feel if
someone kept putting them down, undermining their confidence,
becoming angry with them when things did not go well.
 Usually, clients are able to identify feelings of anxiety and
depression and can recognize that this is because critical signals
stimulate their threat protection system
 From there the therapist can help the client understand how self-
criticism can be so constant in a person’s mind that it literally
harasses them into depressed and anxious states.

23. Fear of compassion
 Many clients cannot easily access the soothing and social safety
system that underpins compassion.
 Much of the work in CFT addresses people’s fears and resistances
to becoming
 self-compassionate
 compassionate to others.
 Signals of kindness and compassion from another person
(especially a therapist) will reactivate the attachment system and
memories and feelings within the attachment system triggering
considerable sadness and grief
 The compassion-focused therapist will help to normalize, validate,
contain and work with those feelings

24. Fear of Compassion
 Some people find compassion-focused imagery physiologically
stressful due to prior trauma, abuse or abandonment history
 Some clients have negative beliefs about compassion as being soft,
self-indulgent or not deserved.
 Exploration might reveal that the individual is afraid that if they give
up self-criticism they will
 become lazy, unpleasant or unlovable.
 be punished for self-compassion by ‘paying for it later’ or having
it taken away
 The therapist is constantly exploring the interactions between the
functions of self-criticism and the fear and avoidance of self-
compassion.

25. Summary
 Many clients struggle not only with low self esteem, but also a
highly critical negative internal voice
 In CFT the therapist
 Explores the roots and function of the self-criticism, helping clients see it
was a survival response
 Helps clients explore what a compassionate other would look like
 Helps clients describe (and rehearse) being self compassionate
 Explores the interaction between self-criticism and avoidance/fear of self-
compassion
 Explores the sensations and fears associated with self-compassion
 Helps clients understand why compassion in the present may cause so
much distress due to unresolved attachment issues from childhood

26. For More Guidance
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