Experiencing Compassion-Focused Therapy from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists) - Softcover

Kolts, Russell L; Irons, Chris; Bell, Tobyn; Bennett-Levy, James

Softcover

ISBN 10: 1462535259 ISBN 13: 9781462535255

Publisher: Guilford Press, 2018

Synopsis

For therapists wishing to build their skills in compassion-focused therapy (CFT), this powerful workbook presents a unique evidence-based training approach. Self-practice/self-reflection (SP/SR) enables therapists to apply CFT techniques to themselves and reflect on the experience as they work through 34 brief, carefully crafted modules. The authors are master trainers who elucidate the multiple layers of CFT, which integrates cognitive-behavioral therapy, evolutionary science, mindfulness, and other approaches. Three extended therapist examples serve as companions throughout the SP/SR journey. In a large-size format for easy photocopying, the volume includes 24 reproducible forms. Purchasers get access to a Web page where they can download and print most of the reproducible materials.

About this title

About the Author

Russell L. Kolts, PhD, is Professor of Psychology at Eastern Washington University. An internationally recognized trainer in compassion-focused therapy (CFT), Dr. Kolts has pioneered the use of CFT in the treatment of problematic anger. He has authored or coauthored numerous scholarly articles and books for both professionals and general readers, including Buddhist Psychology and CBT: A Practitioner’s Guide. Dr. Kolts has given a TEDx talk entitled "Anger, Compassion, and What it Means to be Strong," and is founding director of the Inland Northwest Compassionate Mind Center in Spokane, Washington.

Tobyn Bell, MSc, is a practitioner of compassion-focused therapy (CFT) and cognitive-behavioral therapy (CBT) based in Greater Manchester, United Kingdom. He is a CFT trainer for the Compassionate Mind Foundation and a CBT trainer, supervisor, and program lead at the Greater Manchester CBT Training Centre (National Health Service), which is associated with Manchester University. Mr. Bell has published research on mental imagery and compassion and is a registered mental health nurse and trained mindfulness teacher.

James Bennett-Levy, PhD, is Professor of Mental Health and Psychological Well-Being at the University of Sydney, Australia. As a psychotherapy trainer, he has taught in 22 countries, and is one of the most published researchers in the field of therapist training. In particular, he has pioneered and written extensively about self-practice/self-reflection. Dr. Bennett-Levy is coauthor or coeditor of several widely cited books on cognitive-behavioral therapy (CBT), including Experiencing CBT from the Inside Out. He is Editor of the Guilford series Self-Practice/Self-Reflection Guides for Psychotherapists.

Chris Irons, PhD, DClinPsych, is Co-Director of Balanced Minds, an organization that provides compassion-focused therapy (CFT) services, training, and resources in London, United Kingdom. He is a board member of the Compassionate Mind Foundation and a Visiting Lecturer at the University of Derby. Since the early 2000s, Dr. Irons has worked with Paul Gilbert and other colleagues on research and clinical developments linked to CFT. He has published numerous articles, book chapters, and books on compassion, attachment, shame, and self-criticism, and regularly provides CFT teaching, training, workshops, and retreats around the world.

Excerpt. © Reprinted by permission. All rights reserved.

Experiencing Compassion-Focused Therapy from the Inside Out

A Self-Practice/Self-Reflection Workbook for Therapists

By Russell L. Kolts, Tobyn Bell, James Bennett-Levy, Chris Irons

The Guilford Press

Copyright © 2018 The Guilford Press
All rights reserved.

ISBN: 978-1-4625-3525-5

Contents

CHAPTER 1 • Introducing Experiencing Compassion-Focused Therapy from the Inside Out, 3, 
CHAPTER 2 • A Brief Roadmap to CFT, 7, 
CHAPTER 3 • Why Do SP/SR?, 11, 
CHAPTER 4 • Getting the Most from SP/SR, 18, 
CHAPTER 5 • A Trio of Companions, 28, 
PART I • Developing Compassionate Understanding, 
MODULE 1 • Initial Assessment and Identifying a Challenge, 33, 
MODULE 2 • Three Systems of Emotion, 43, 
MODULE 3 • Soothing Rhythm Breathing, 51, 
MODULE 4 • Understanding the Tricky Brain, 58, 
MODULE 5 • Exploring Old Brain–New Brain Loops, 66, 
MODULE 6 • Mindful Breathing, 72, 
MODULE 7 • Shaped by Our Experiences, 79, 
MODULE 8 • Compassionate Functional Analysis, 87, 
MODULE 9 • Safe-Place Imagery, 94, 
MODULE 10 • Exploring Attachment Style, 102, 
MODULE 11 • Exploring Fears of Compassion, 112, 
MODULE 12 • Threat-Focused Formulation in CFT: Historical Influences and Key Fears, 118, 
MODULE 13 • Threat-Focused Formulation in CFT: Safety Strategies and Unintended Consequences, 129, 
MODULE 14 • The Mindful Check-In, 141, 
MODULE 15 • Unpacking Compassion, 149, 
MODULE 16 • Mindfulness of Self-Criticism Diary, 157, 
MODULE 17 • Midprogram Assessment, 165, 
PART II • Cultivating Compassionate Ways of Being, 
MODULE 18 • Different Versions of the Self: The Threat-Based Self, 177, 
MODULE 19 • Cultivating the Compassionate Self, 186, 
MODULE 20 • The Compassionate Self in Action, 193, 
MODULE 21 • Deepening the Compassionate Self, 202, 
MODULE 22 • Behavioral Experiments in CFT, 214, 
PART III • Developing the Flows of Compassion, 
MODULE 23 • Compassion from Self to Others: Skill Building Using Memory, 225, 
MODULE 24 • Compassion from Self to Others: Skill Building Using Imagery, 230, 
MODULE 25 • Compassion from Self to Others: Compassionate Behavior, 238, 
MODULE 26 • Compassion from Others to Self: Skill-Building Using Memory, 244, 
MODULE 27 • Compassion from Others to Self: Opening to Kindness from Others, 250, 
MODULE 28 • Compassion Flowing to the Self: Compassionate Letter Writing, 257, 
PART IV • Engaging Compassionately with Our Multiple Selves, 
MODULE 29 • Getting to Know Our Multiple Selves, 269, 
MODULE 30 • Writing from the Multiple Selves, 277, 
MODULE 31 • Attachment and the Professional Self, 286, 
MODULE 32 • The Internal Compassionate Supervisor, 295, 
MODULE 33 • Using Your Internal Compassionate Supervisor to Work with a Difficulty, 301, 
PART V • Reflecting on Your CFT SP/SR Journey, 
MODULE 34 • Maintaining and Enhancing Compassionate Growth, 311, 
• References, 321, 
• Index, 328, 

CHAPTER 1

Introducing Experiencing Compassion-Focused Therapy from the Inside Out

If you want others to be happy, practice compassion. If you want to be happy, practice compassion.

— His Holiness the 14th Dalai Lama

We (Russell, Tobyn, and Chris) were excited when James invited us to join him in creating a self-practice/self-reflection (SP/SR) book focused on compassion-focused therapy (CFT). A growing body of scientific research supports the value of compassion in working with mental health issues and in building happy lives, so naturally there is also a rapidly growing increase in clinicians who want to learn how to integrate compassion practices into their work with clients. Recent years have seen the development of resources to help therapists do just this. However, if you spend much time chatting with CFT therapists or others whose work focuses on compassion or mindfulness, you will hear them say time and time again, "If you're going to teach compassion or mindfulness, you need to practice it yourself." This statement conveys an increasing awareness — reflected in a growing body of scientific literature — that therapist SP/SR can deepen and enhance therapeutic work in a number of important ways across therapy models. The goal of this book is exactly that: to help you learn the fundamental experiences of CFT from the inside out, by cultivating, applying, and reflecting upon them in your own life.

A Brief Orientation to CFT

When you tell people that your area of therapist specialization is compassion-focused therapy, you're likely to get one of two reactions. The first (often spoken with raised eyebrows) is "Compassion ... that's nice. We all need more compassion, don't we?" The second sort of response (often spoken in a really excited voice) sounds more like this: "Compassion-focused therapy! Me too! I've been doing that my whole career. Compassion is soooo important!" Both of these responses are based in the assumption that compassion-focused therapy, abbreviated CFT, simply involves doing therapy, well, compassionately.

Although embodying compassion in the therapy room certainly is a part of CFT (as we hope it would be in any therapy), it is much more than this. CFT was developed by Paul Gilbert in response to observations that many patients who struggled to benefit from traditional cognitive-behavioral therapy (CBT) approaches seemed to spend lots of time captured in patterns of shame and self-attacking. We can think of CFT as a "therapy model," but it's really more of an attempt to integrate what science tells us about what it means to be a human being, how and why we struggle, and how we can help people relate to their struggles in helpful, effective ways. In doing so, CFT draws heavily on multiple bodies of science as well as on wisdom traditions such as Buddhism. We draw from evolutionary psychology approaches in understanding the tricky ways that evolution has shaped our brains — ways that set us up for certain difficulties almost from the start. We draw from the evidence indicating that early attachment experiences can powerfully shape how we develop and how we learn to relate to ourselves and other people. We draw from affective neuroscience research that informs us about how our emotions and motives operate in our brains and minds, powerfully shaping our experience of life. We draw from behavioral and cognitive traditions that inform powerful technologies of change. And we also draw directly from traditions such as Buddhism, which have spent thousands of years exploring how practices of compassion and mindfulness can be cultivated in the service of building happy, healthy lives, communities, and civilizations (Gilbert, 2010).

Our Approach

A number of valuable books have been written on how these various influences are made manifest in CFT. The art of CFT involves bringing these influences alive in the form of basic human realizations and understandings, inspiring the courage our clients need to turn toward their struggles with kindness and commitment, and helping them cultivate a repertoire of compassionate strengths to draw upon in working with the inevitable challenges of having a human life. That's the focus of this book: not to tell you about CFT, but to bring CFT to life for you through your own experience of the therapy. You'll see all of these influences unfolding in the modules to come, in ways we hope will relate to both your personal and professional lives.

As we've already mentioned, the goal of this workbook is to give you an experience of practicing and reflecting upon the various ways that CFT seeks to help our clients develop compassion for themselves and others. As this process plays out, you'll be prompted to consider certain aspects of your experience and how your mind works. You'll also be asked to consider the ways in which you relate to yourself and to others, and how these strategies were shaped by your life experiences. You'll be exposed to a variety of compassion practices that you can try out in the context of your life. You'll then be given the opportunity to reflect upon these practices.

How This Book Is Organized

The next four chapters of Experiencing Compassion-Focused Therapy from the Inside Out prepare and orient you for the SP/SR modules in the rest of the book. Chapter 2 introduces some basic CFT concepts. It is not designed to be a comprehensive account — for that, you should read other books, such as those of Paul Gilbert (2009, 2010, 2014) and other CFT authors (e.g., Kolts, 2016; Welford, 2016; Irons & Beaumont, 2017). Rather, Chapter 2 provides a foretaste of some of the concepts introduced in the modules.

Chapter 3 provides the rationale and background for the SP/SR approach. It isn't necessary to read this chapter to use the book, but if you'd like to understand why we've chosen to design this book in a self-experiential way, you'll find the reasons here.

Chapter 4 is a long chapter, but an important one. We suggest that you read this chapter to get the most from the book. In the first half of the chapter, we discuss the pros and cons of the various contexts in which SP/SR can be undertaken — on your own, in a group, in "limited co-therapy pairs," in supervision, and in workshops. If you are doing SP/SR on your own, you can skip over the other contexts, but if you have the possibility to join with a colleague or group of colleagues to do SP/SR, the different ways that this can be done are worth considering. In the second half of Chapter 4, we suggest a variety of strategies, including creating a strong sense of safeness, to ensure you get the most benefit from SP/SR.

Chapter 5 is a brief chapter, but again an important one. It introduces you to your three "companion" therapists, whose self-practice exercises and self-reflections are peppered throughout the modules. All of these therapists struggle with issues we've adapted from our own experience as people and therapists, and those our colleagues have shared with us.

Following the opening five chapters are the SP/SR modules. These are purposely brief — designed to take you about 30–45 minutes apiece — in which you'll have the opportunity to work from the inside out, seeing how various CFT practices are applied by your companion therapists, and then trying them out yourself. You may find that you don't have time to do all the modules. Chapter 4 provides some suggestions for selecting modules if you only have limited time.

In preparing for SP/SR, you might consider issues in your professional or personal life to which bringing compassion might be of value: For instance, there may be contexts in which you tend to experience shame, criticize yourself, experience threatening emotions, or perhaps just have a lack of confidence. The point is to highlight an area of struggle or difficulty in your life that you can turn toward with courage, kindness, and a compassionate commitment to help.

It's also important to keep in mind that with SP/SR, the purpose is to use the approach with ourselves as a vehicle for learning the therapy, so that we can better serve our clients. In this way, it might be useful for you to choose an issue that relates to your work with clients. This also means that whereas you want to choose an issue that is substantive enough for you to "get" the processes involved, you don't want to choose a severe problem that can activate intense levels of distress in you, such as very recent and intense grief experiences. Chapter 4 will help you to select an issue which will work best in the context of this SP/SR workbook.

CHAPTER 2

A Brief Roadmap to CFT

Defining Compassion

Just as there is sometimes confusion about what CFT is, there can also be a lack of clarity about what is meant by the word compassion. In this book, we work from the standard definition used in CFT: sensitivity to suffering in self and others combined with the commitment to try to alleviate and prevent it (Gilbert & Choden, 2013). This definition contains two fundamental components, or as Paul Gilbert says, two "psychologies of compassion." The first is sensitivity and engagement: that is, the ability to notice, attend to, and be moved by suffering, as well as the willingness to turn toward the suffering, tolerate the distress associated with doing so, and look deeply into the causes and conditions that maintain it. Once we are aware of this suffering and experience a sympathetic response to the person who is suffering, this sensitivity can give rise to the motivation and commitment to act to alleviate current suffering in the self and others, and to prevent it in the future. This motivation and commitment contains both a felt desire to work to address the suffering, as well as the conscious decision and the skills required to do so.

In considering this definition of compassion, it's important to note that it contains both kindness and courage; at its heart, compassion is defined by the courageous willingness to approach the things that scare us and make us uncomfortable — about the world, and about ourselves (Gilbert, 2015). This compassionate approach is defined by the motive to help and characterized by caring, warmth, and commitment rather than judgment and condemnation. For many of our clients (and ourselves) this simple definition represents a very different way of relating to our ourselves and to suffering, particularly if we've learned to criticize ourselves when we see ourselves struggling, or to manage difficult emotions by avoiding them or distracting ourselves from pain or discomfort when we become aware of it.

CFT practitioners also commonly talk about three flows of compassion: the compassion we direct from ourselves to others, the compassion we receive from other people, and the compassion we direct toward ourselves. Recent research has shown that these different flows seem to work in somewhat different ways (Gilbert et al., 2017), which raises the likelihood that one may be very high in one form of compassion, but struggle greatly with another form. For example, most therapists have great compassion for their clients, but some may be virtually unable to allow themselves to feel vulnerable in receiving it from others, or to relate compassionately to themselves when they need it.

Cultivating Compassion: The CFT Perspective

In CFT, compassion is seen as being rooted in motivation — the motivation to alleviate and prevent suffering (Gilbert, 2015). This experience begins with an awareness of what it means to have a human life in this day and age. The idea is that once we take a deep look at the reality of what it means to have a human life — the amount of struggle and difficulty we all face eventually as a result of simply being born human — compassion is the only response that makes sense (Gilbert, 2009). If we look at the life of even a relatively privileged human being — someone who has regular access to food, shelter, health care, education, and caring relatives and friends — we can see almost countless sources of pain and potential suffering. We will all get sick. We will all eventually die. Along the way, we will lose people we love, will try our best and fail, and will face disappointment, tragedy, and struggle time and time again. And depending on the conditions of our birth — whether we were born with a hearty or vulnerable body, and whether we were born to people who were (or were not) capable of caring for us in ways that helped us grow up happy and healthy — some of us will face considerably more pain and struggle.

Some readers may be surprised to learn that in CFT, we don't immediately start out with the compassion meditations. We've found that for individuals with deeply entrenched habits of shame and self-criticism, promoting compassion (and self-compassion, in particular) can be very tricky, sometimes even stimulating feelings of threat. For some of us, even thinking about treating ourselves with compassion and kindness (or being treated this way by others) can be very scary and contrary to how we've learned to exist in the world. In CFT, efforts have been made to assess and explore these "fears of compassion" (Gilbert, McEwan, Matos, & Rivis, 2011), which have been linked with depression, anxiety, alexithymia, and insecure attachment styles (Gilbert, McEwan, Catarino, Baião, & Palmeira, 2014).

For this reason, CFT involves "preparing the ground" by helping ourselves and our clients gain certain realizations about what it means to have a human life — realizations that can soften the coarse ground of shame and self-criticism so that the seeds of self-compassion can take root and grow. Many of these realizations have to do with the challenges presented by our evolved brain systems and the social shaping we've received, particularly in our earliest environments. With such reflection, we can begin to become aware that many of our struggles are rooted in factors that we didn't get to choose or design, and it can be liberating to realize that they are not our fault. In CFT, we emphasize recognizing the unchosen factors that have shaped us in ways we wouldn't have chosen, so we can stop beating ourselves up for things that aren't our fault and take responsibility for working actively and effectively to improve our lives in the present and in the future.

In this perspective, CFT emphasizes the cultivation of mindful, accepting awareness, so we can learn to observe the thoughts, emotions, and experiences that define our struggles without judgment. This awareness then leads to another core component of CFT: learning to directly cultivate compassion in order to alleviate and prevent suffering in ourselves and others. In this book, you'll gain experience with a number of compassion practices — some shared with other approaches and some unique to CFT — that will help you do just that.

In summary, we can consider the process of CFT as one in which we work to develop a number of compassionate capacities. We want to build the caring motivation and courage to work directly with the sources of suffering in our lives. We want to develop the wisdom to understand the sources of this suffering, rooted in the intersection between our biological inheritance and our life experiences. We want to cultivate a discerning awareness of how this suffering plays out in our lives and in our mental experiences. And finally, we want to engage in committed compassionate action to work with this suffering and its causes.

Preparing the Ground for Compassion

Although there are a number of programs aimed at helping people to cultivate compassion in their lives — most notably Neff and Germer's mindful self-compassion program (Germer & Neff, 2017) and Stanford's compassion cultivation training (Jazaieri et al., 2013) — CFT is the only model of psychotherapy with an explicit focus on compassion. Whereas these other models focus primarily on compassion cultivation practices adapted from Buddhist compassion meditations (which CFT utilizes as well), as mentioned above, CFT also includes an explicit focus on helping clients develop an inherently de-shaming way of understanding the human experience. One way of doing this is by helping clients understand their experience in the context of how evolution has shaped human brains, and through this, shaped our basic motives and emotional functioning in ways that can sometimes be tricky to manage. A core realization in CFT is that our emotions and motivations aren't something that are wrong with us, but are products of brains that evolved to help our ancestors survive in a world that was very different from the one we currently face. In our ancestors' world in which most threats were physical in nature, the felt urgency and pure focus of threat-related emotions such as fear, anxiety, and anger made a lot of sense — even as they're a poor fit with most of the difficult situations we face in modern life.

(Continues...)

Excerpted from Experiencing Compassion-Focused Therapy from the Inside Out by Russell L. Kolts, Tobyn Bell, James Bennett-Levy, Chris Irons. Copyright © 2018 The Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Edition details

• Publisher: Guilford Press
• Publication date: 2018
• ISBN 10: 1462535259
• ISBN 13: 9781462535255
• Binding: Paperback
• Language: English
• Edition number: 1
• Number of pages: 332