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Compassion Focused Therapy for Psychosis
What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the suffering of oneself and of other living things, coupled with the wish and effort to relieve it” (2009, p. xiii).
Compassion also includes the idea of balance, which can be tricky:
Compassion for those who need care, and for the caretakerCompassion for the parts of the self that feel
attacked, and for the attacker
Slide by Paul Gilbert
Contrast self-compassion to self-esteem
Self-Esteem
Access when things going well
Individuality/difference
Achievement/doing/drive
Competitive mentality
Self-Compassion
Access when not going well
Common humanity
Acceptance/being/content
Caring mentality
Slide by Paul Gilbert
Key Idea Various therapies have developed exposure and other techniques for toning down negative emotions but not for toning up certain types of positive ones. Can’t assume that by reducing negative emotion the positives will ‘come on line.’
Two types of positive affect related to achievements/doing/excitementsaffectionate, soothing
Some clients have major difficulties in being able to access the soothing system - implications - so CMT/D targets this system.
Slide by Paul Gilbert
Key Message
• We need to feel congruent affect in order for our thoughts to be meaningful to us. Thus emotions ‘tag’ meaning onto experiences. In order for us to be reassured by a thought (say) ‘I am lovable’ this thought needs to link with the emotional experience of ‘being lovable’. If the positive affect system for such linkage is not activated there is little feeling to the thought. People who have few memories/experiences of being lovable or soothed may thus struggle to feel reassured and safe by alternative thoughts
• Compassion focused therapy therefore targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat based emotions of anger, fear, and disgust and shame. (page 12)
Slide by Paul Gilbert
Slide by Christine Braehler
Slide by Christine Braehler
Threat Relations
Conflicts of Strategies
Dominant Submissive
Care-Seeking
blocksblock
s
blocks
Each strategy can have a variety of forms, functions, behaviours and memories
Slide by Paul Gilbert
Therapeutic PhilosophyWe use a variety of safety strategies, both innate and learnt(e.g. avoidance, excessive submissiveness, striving to prove oneself) to try to help ourselves get though life’s challenges
We can get trapped and stuck in self-protective systems and strategies
Compassion Focused TherapyTo understand shame and self-attacking as threat and safety focused
Compassion training/therapy is an opportunity to discover and develop our minds to be self soothing – as a way to tone down and alleviate the impact of shame and self-criticism.
Slide by Paul Gilbert
Background
Others as Critical, absent, frightening, blaming
Key fears/Memories
Hurt, rejection, ‘being to blame’ aloneness
Safety Strategies
Threat focused
Inhibit, submit avoid anger
Be as others want
Unintended Cs
Feel worthless
Controlled by others
Loose sense of self -alone
Ruminate on emptiness
Self-attack, access shame memories
Concealing
Confused, depressed angry, dissociate fragment
Develop feeling compassion for background and safety strategies
Understanding our minds, not our fault
Compassionate acceptance and integration of multi-self
Compassion imagery, focus (e.g. attention, behaviour) and reframe
Slide by Paul Gilbert
The Core of Recovery from Psychosis
“unbearable affect is at the
core of psychosis and …. recovery involves the processes of acknowledging, bearing,
and putting in perspective the intolerable emotions which often have their origins in
early development.”
From Gumley, A., Braehler, C., Laithwaite, H., MacBeth, A., & Gilbert, P. A Compassion Focused Model of Recovery
after Psychosis. International Journal of Cognitive Therapy, 3(2), 186-201. doi: 10.1521/ijct.2010.3.2.186
Slide by Paul Gilbert
Slide by Christine Braehler
Slide by Christine Braehler
Slide by Christine Braehler
Slide by Christine Braehler
Imagining the self critical part of self
Now for a moment let’s imagine that this self-critical part of you could be thought about as a person. If those self-critical thoughts took on the appearance of an actual person what might they be like? Maybe you could think about their facial expressions, if they are big or small, the tone of their voice, the emotion. Just spend 30 seconds imagining this.
Slide by Paul Gilbert
Slide by Christine Braehler
Slide by Christine Braehler
Internal Roles
Two key types of internal self self relationship
Hostile dominant self fearful, subordinated self
Caring emphatic self cared for, soothed self
Mediated through and reflected in affect, behaviour and self-talk
Slide by Paul Gilbert
Turning It Around
• When we suffer, we often feel more separate from others– But if we turn it around, we can see the suffering itself as
evidence of our common humanity– People have learned to see their suffering as evidence of shameful
differences, for example of having a “mental illness” that separates them from others• Normalizing helps reconnect with common humanity, reduce shame
So, Basic Philosophy is That:We all just find ourselves here with a brain, emotions and sense of (socially made) self we did not choose but have to figure out
Life involves dealing with tragedies (threats, losses, diseases, decay, death) and people do the best they can
Much of what goes on in our minds is not of ‘our design’ and not our fault
We are all in the same boat
De-pathologising and de-labelling – understanding unique coping processes
Slide by Paul Gilbert
A Few Questions
• When can compassion and soothing be a threat, rather than helpful?
• Who are those most likely to see compassion and soothing as a threat?
• Does compassion always feel good, or can it lead to feeling increased pain and distress?
• What can be done when compassion itself is experienced as a threat?
Kindness, Attachment and Threat
Kindness from therapist or imagery
Activate attachment systemActivate memories
Neglectaloneness
Abuse, shame vulnerable
Activate learnt and current defences - cortisol
Fight, flightshut down
Fight, flightshut down
Slide by Paul Gilbert
Integrating Compassion with Wisdom
• Wisdom involves developing discretion around when to let the threat system do its job, and when to invoke soothing
• Compassion supports wise choices about when to invoke which system
• Appreciate limits to knowledge, uncertainty– Frame attempts to create more compassion as experiments
• Because people are unique, can’t be sure what will be helpful
“Experience the Practice for Yourself
First!”
Long history to use of compassionate imagery
Buddhist loving kindness imagery
Sequences: Bodhisavattas having developed the ideal qualities of compassion – to identify with and copy – non judgement just observation (see Vessantara (1993) Meeting the Buddha's)
Compassion Mediation cycle Imaging the Compassion Buddha; harnessing the compassionate energies of the universe; directing the compassion to you; the Buddha merging with you – becoming the Compassion Buddha - directing compassion back into the universe for all living things – To explore each position and what ‘comes up’ in one’s mind, reflect and develop one’s mind
(See chapter in by Rimpoche and Mullen in Gilbert 2005; )
Slide by Paul Gilbert
Developing Compassion Images
Ideal caring and compassionate self and/or image --- define ideal as everything you would want, need
• Wisdom a sentient mind who understands the struggles of humanity and self. Empathic stance, self-transcendent
• Strength as ‘calm authority’ fortitude, endurance, complete benevolence
• Caring as a genuine desire for one’s well-being –Commitment and motivation Slide by Paul
Gilbert
Other-Focused Compassion
Sit comfortably in chair with soothing rhythm breathing. Work on getting into the compassion role. Now imagine focusing on ‘desire for others to be happy and free from suffering’. (This can start off with people one knows and then extend outwards to eventually all sentient beings). Imagine facial expressions and voice tones.
Explore people’s experience - reflection/meditation.
Explore the value of compassionate self or compassionate imagery in generating and feeling the desire within oneself for others ‘to be happy and free from suffering’.
Explore blocks, fears and facilitators.Slide by Paul Gilbert
Imagining the self-compassionate part of self - Assuming a role
Now for a moment, imagine that a self-supporting, or compassionate part of yourself could be thought about as a person. Imagine becoming that person. Think of the ideal qualities you would like to have as a compassionate person. It does not matter if you are actually like this. Think about your age and appearance, your facial expressions and postures, you inner emotions of say gentleness – create a half or slight smile that conveys this. Now like an actor about to take on a part feel yourself into these. For this moment you are a compassionate person Slide by Paul
Gilbert
Extending Compassion to “Enemies”
• Enemies can be internal, like voices, critical parts• Distinguish compassion from submission, or “losing”• One way of framing this:
– Desiring the other to be happy and free from suffering “in a good way”• This carries with it the idea of balance,
– aiming for the other to be well but not at the expense of oneself
Compassionate Writing Exercises
• Pick a difficult event or issue– Write about it from a compassionate frame
• Focus on your breathing• Now bring compassionate image to mind• Focus on sensory qualities (trying to access care-focused mentality)
• What would your compassion part/image say?• How do they see this situation?
• What opportunities for growth and change might be here?
• What is a compassionate thing to do now?
Compassionate ReframeFocus on your breathing
Now bring compassionate image to mind
Focus on sensory qualities (trying to access care-focused mentality)
What would your compassion part/image say?
How do they see this situation?
What opportunities for growth and change might be here?
What is a compassionate thing to do now?Slide by Paul Gilbert
Slide by Christine Braehler
Slide by Christine Braehler