This series is based on the model of Compassion Focused Therapy developed by Professor Paul Gilbert and others at the Compassionate Mind Foundation, including Dr Dennis Tirch et al.’s work integrating compassion with CBS. Thank you to them, and a grateful thank you to Professor Russell Kolts and Dr Tobyn Bell for their support and editorial guidance in putting this together. Thank you also to Jim Lucas and Dr Kate Lucre, from whom I’ve learned so much. I offer this, not as a definitive answer, but to contribute to the collective conversation, and hopefully as food for thought in your process of exploring what works for you.
We all have times when we feel confused, stuck, or overwhelmed in treatment planning.
With our own tricky brains, this is often a point when our self-critic shows up and give us a kicking (‘I’m not a good enough therapist!’). We might feel anxious and seek certainty from supervision or over-preparation (‘Please tell me what to do!’), or maybe we experience hopelessness or frustration with the client or therapy (‘They are a difficult client!’). Our own fears, blocks and resistances (FBRs) to compassion can be triggered or it might hook into our personal material.
You’re not alone. I felt it too when first coming to Compassion Focused Therapy[1], and then again to Compassion Focused – Acceptance & Commitment Therapy (CFACT[2][3]), as a normal part of the learning process. However, I find that no matter how experienced we get, it can still show up – particularly when we’re with very blocked clients or when transference shows up in the therapeutic relationship.
It makes sense that this happens. Firstly, I think it’s a common feature of working with process-based therapies like CFT or CFACT, because there are no rigid protocols telling us what to do. On the one hand, this gives us a beautiful gift: freedom to use our clinical intuition and style, and work in a deeper, idiosyncratic way. On the other hand, it can feel wobbly.
Secondly, it’s an inevitable part of deeply caring about the work that we do and our courage to learn – which reflects something precious about who we are and what we stand for. We continue to feel into the unique suffering and histories of our clients, encountering new challenges, and evolving interplays with our own processes of professional and personal development. The day that we stop caring is the day we should stop this work.
So, how do we navigate this?
I offer some thoughts about how I personally work through it, from what I’ve learned from training and reading by Prof Paul Gilbert and others at the Compassionate Mind Foundation[4], including my own wonderful supervisors, and my own practice and supervision experience. As I said before, I offer this, not as a definitive answer, but to contribute to the collective conversation, and hopefully as food for thought in your process of exploring what works for you.
This is a 5-part series, designed to work sequentially as we build a formulation-driven, process-oriented approach. Don’t skip to Part 3 or you’ll miss the good stuff!
Here’s Part 1 below. Parts 2&3 are coming in the next few weeks, and 4&5 later in the year (you can sign up to the mailing list at the bottom of this page if you’d like to be notified). Here’s what’s coming up:
- 1. Start with Self-Compassion: Self-care and cultivating our capacity and wisdom to work with our clients,
- 2. Compassion as a Guiding Principle: Formulation and selecting interventions,
- 3. Use a Framework: Treatment planning guides,
- 4. ‘The Blocks are the Work’: Working with interpersonal processes and FBRs,
- 5. Case Examples.
Part 1. Start with Self-Compassion
Before thinking about others, I find it helpful to get my own house in order. If you’re like me, it’s easy to get caught up in the other and skip this step, but it’s something my supervisors helpfully bring me back to, and in turn something I bring my supervisees back to. An increasing body of work suggests that best practice often starts with self-practice[5].
You might notice that I’ve deliberately started this post by working into this process with you. How does it land in you? Does it feel helpful?
It’s important because:
- We’re human first, and sometimes this job can be really difficult, so we need caring for our own sake – along with safeguarding our capacity for our clients.
- Engaging our Compassionate Self helps to shift our physiology, like we do in Compassionate Mind Training (CMT), so we can work through our own material/FBRs, think more clearly, and cultivate our caring commitment, courage and wisdom for our clients.
- It helps us to open up to the wisdom in our reactions. When we soften up around them, we can start to approach them with curiosity, detangling what is ours from what is our client’s. Here is a wellspring of important interpersonal information.
Activating Self-Compassion
Here are some questions that may guide you…
- What is this triggering in you?
- Does it make sense? Given what you know about your own tricky brain, history, fears/blocks/resistances, or learning stage, is it understandable that this would feel hard for you?
- What do you need? What do want? What do you really need? Do you need anything emotionally, such as a comfort and soothing, or do you need anything practical?
- What would be helpful? Are there any actions you could take to meet your needs? Is there something you could implement or supportive imagery you could hold in mind?
Wisdom of our Reactions
When we stop beating ourselves up for our reactions, we can then approach them with curiosity, asking ‘Are they telling us something important?’
Is our discomfort letting us know we need some more training, support and practice – or patience? Is it inviting us to attend to our own unresolved material? Or, is there something about a specific client or group of clients?
The way we answer these questions may depend on our learning stage. If we’re taking our first steps, then our main need is likely to be some scaffolding, and we might focus on learning and self-practice.
As we become more familiar, we can begin to explore ‘Do I react this way with all clients, and if not, why is it showing up now?’ This leads us to a source of clinical information. I’ll come back to this point in Part 4.
In this way, rather than something to be overcome, learning to turn towards our reactions can become central to our work.
Let’s hold that in mind as we move towards Part 2: Compassion as a Guiding Principle.
[1] Gilbert, P. and Simos, G. eds., 2022. Compassion focused therapy: Clinical practice and applications. Routledge.
[2] Tirch, D., Schoendorff, B. and Silberstein, L.R., 2014. The ACT practitioner’s guide to the science of compassion: Tools for fostering psychological flexibility. New Harbinger Publications.
[3] Hayes, S.C., Strosahl, K.D. and Wilson, K.G., 2011. Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.
[4] The Compassionate Mind Foundation
[5] Kolts, R.L., Bell, T., Bennett-Levy, J. and Irons, C., 2018. Experiencing compassion-focused therapy from the inside out: A self-practice/self-reflection workbook for therapists. Guilford Publications.
