Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Difficulties
Paul Gilbert
2010
This Copy belongs to: ___________________________________________________________
www.compassionatemind.co.uk
Workshop Outline
Introduction to the basic model: The nature of shame and compassion
Basic philosophy of this approach and model The reasons for our focus on shame and self-attacking Considering three interacting emotion systems of: Drive, Safeness and Threat Linking shame to threat, and compassion to safeness and affect system balancing Distinguishing safeness from defensive safety-seeking Distinguishing external and internal threats Exploring different types of shame and how shame is linked to self-criticism Exploring how self-criticism is linked to threat and safety behaviours
Overview
Shame and self-criticism are associated with a range of psychological difficulties, including depression, social anxiety, eating disorders, various personality disorders, and post-traumatic stress disorder. This workshop offers a way of understanding the nature and functions of shame & self-criticism and why and how to use a compassion-focus for your therapy. We will consider shame as related to threat processing and distinguish two types of threat: External and internal. External threats are threats that are perceived to lie outside of the self (e.g., from the actions of others towards the self). Internal threats relate to the emergence of internal experiences (e.g., emotions, thoughts, fantasies and dreams) that negatively impact on self-evaluations, self-identity and selfpresentations. Shame based self-critical dialogues are responses both to threats and sources of threat. This workshop will therefore consider some of the complexities of threat processing and how to derive formulations based on threat processing and safety strategies. Understanding shame and self-criticism as ways to try to defend ourselves via safety strategies such as avoidance, compensation or concealment are key to compassionfocused formulations. Based on new research in areas such as attachment and the nature of different types of positive emotions, we will explore how and why developing various components of self-compassion can reduce shame and self-attacking. Orientating the self towards self-compassion uses a range of cognitive, behavioural, emotional and imagery-based interventions. Through a variety of experiential exercises we will explore how to help clients recognise the value of self-compassion over self-attacking and how to develop a compassionate approach to the self that will enable them to become self-soothing and self-nurturing.
PLEASE NOTE YOUR PERSONAL SAFENESS We shall be exploring some of our own thoughts and feelings. Please be aware that very occasionally this might tap something painful for you, so only focus on examples that you feel are suitable to work with in this public workshop. Everything is voluntary so only go where you feel comfortable. Your emotional reactions in this workshop are your own responsibility.
The Compassionate Mind Foundation 2010 Page 3
A Compassion-Focused Workshop
Dear Delegate, We are delighted to be able to share with you some new ideas about working with complex and challenging difficulties, especially those linked to high levels of shame and self-criticism. Coming along today suggests you have recognised that helping people who have high shame and self-attacking can be difficult. So we are going to explore ways to think about shame, why and how shame is linked to self-criticism and why these can be so difficult to work with. Importantly of course we will outline what Compassion-Focused Therapy and Compassionate Mind Training are and why and how they can be helpful for people with these difficulties. The principles behind this work are drawn from a wide range of fields including evolutionary psychology, neuroscience, models of emotions and cognitive and behaviour approaches. We hope you will enjoy this workshop and be able take away ideas to integrate into your current practice. We also hope it may be personally useful. Developing ways to understand compassion and how to apply it to self and others is an ongoing scientific endeavour. To help facilitate these endeavours we have established the Compassionate Mind Foundation (www.compassionatemind.co.uk).
Our mission statement is: Promoting well-being through the scientific understanding and application of compassion
Summary
We are an emergent species in the flow of life So our brains, with their motives, emotions and thinking abilities are products of evolution, and are designed to function in certain ways Our lives are short (25,000-30,000 days), destined to decay and end, and are subject to various malfunctions and diseases - in a genetic lottery. In addition the Buddha pointed out that everything changes, nothing lasts and this is a source of tragedy. The social circumstances of our lives, over which we have little control, have major implications for the kinds of minds we have, the kind of person we become, the values we endorse, and the lives we live. Genotype + Environment = Phenotype Mental Health is related to phenotypic variation - people doing the best they can 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 (abuse, 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 - all in the same boat First steps to compassion is to be open to suffering, what we are caught up in, with a desire to relieve suffering - drive for scientific knowledge
1. Those that focus on threat and self-protection 2. Those that focus on doing and achieving 3. Those that focus on contentment and feeling safe
The Compassionate Mind Foundation 2010 Page 6
The Three Circles Diagram Depicting the interaction between three affect systems
Three Types of Affect Regulation System
Driven, excited, vitality Content, safe, connected
Non -wanting/ Affiliative -focused Safeness -kindness Soothing Threat -focused Protection and safety -seeking Activating/inhibiting
(See Depue & Morrone-Strupinsky 2005 and Gilbert 2009 for details). These are, of course, very simplified ways of thinking about complex systems. Moreover, these systems are in constant interaction, generating various patterns of activity in our minds. So think of these systems as rules of thumb. This threecircle model can be useful in thinking about and guiding your therapy. CFT uses a lot of psychoeducation, including sharing this model with clients and inviting their reflections. With clients go though each circle and ask: How does this affect your body; How does this system affect you attention and thoughts; What does your body want to do when this emotion is aroused; How easy is to stop if being activated Use examples.
The Compassionate Mind Foundation 2010 Page 7
Compassion as a Mentality
A social mentality is: the organisation of abilities, competencies and modules guided by motives to achieve social outcomes and roles (status, friendship, care, sexual)
Compassion evolved from the care-giving mentality Compassion can be defined in many ways and as combinations of attributes: As a sensitivity to the suffering of self and others with a deep commitment to try to relieve it Dalai Lama. Compare the organisation of our minds with different motives guiding them
C a r in g e n ta lity M
A t te n ti o n tt e tio T hin k ing in R easoning
Im a ge ry age F an tasy a n ta sy
C o m p e ting et ing
B eh a viou r vio u
Im ag er y F a n ta s y sy
C a r in g ar
B eh a vio u r
E m otio n s otion
M o tiv a ti o n otiv
E m o ti o n s
The key attributes of compassion (inner ring) and the skills to develop them (outer ring)
Imagery
ATTRIBUTES Sympathy
Warmth
Reasoning
Compassion
Feeling
Non -Judgement
Behaviour
Sensory
Warmth
Warmth
Competitive Mind
SKILLS -TRAINING
Imagery Attention
ATTRIBUTES Sensitivity Compete Envy
Reasoning
Distress tolerance
Competition
Feeling
Empathy
Behaviour
Sensory
Experiencing Helpfulness?
Cognitive-behavioural focused therapies help people distinguish unhelpful thoughts and behaviours - that increase or accentuate negative feelings - and alternative helpful thoughts and behaviours that do the opposite. This approach works well when people experience these alternatives as helpful. However, suppose a client says, I can see the logic and I know these alternative thoughts make sense and I should feel they are helpful but I cannot feel reassured by them or I know that I am not to blame but still feel to blame. This is called a cognition-emotion mismatch. In fact many of our feelings (such as falling in love) do not emerge from logic. There are many forms of cognitionemotion mismatch when feelings and thoughts do not seem to fit together (Haidt, 2001; Lee, 2005). For example, research has shown that you can prime an emotion non-consciously and lead people into false beliefs about why they are feeling what they are feeling (Haidt, 2001). There can be many reasons for why people know one thing but feel another. For example changing ones mind is seen as too threatening or there may be powerful, classically conditioned threat responses; or there may be unresolved traumatic memories. A related reason is that the opiate/oxytocin soothing system that codes for safeness is insufficiently stimulated and thus people do not feel reassured. Some people who have never really felt safe, can find those feelings odd, threatening or not to be trusted. The emotional systems that give rise to feelings of reassurance are not active enough - or the threats seem so great that the threat system overrides them. Clinical and research work suggests that some people, especially those who have experienced early histories characterised by abuse and neglect, can have great difficulty in being able to access the soothing system. Not only may people have many experiences of being under great threat from others, but have had few experiences of being or feeling protected, safe and/or soothed by others. In consequence they are unable to self-sooth (Gilbert & Irons, 2005, Gilbert & Procter, 2006.)
Compassion focused therapy was developed to help people develop emotionfocused experiences of self-soothing, i.e., to tone up these positive affects so that they can be readily accessed, and help regulate threat based emotions of anger, fear, and disgust. These negative self-protective emotions also provide the distressing, emotional basis of shame and self-criticism (Gilbert 1989, 2000, 2005, 2007).
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 may be little feeling to the thought. People who have few memories/experiences of being lovable or soothed and safe 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.
Two Types of Processing Systems Implicit Fast - Affect Evolved mechanisms Hard to verbalise Emotional memory /conditioning Specific signals (e.g., facial expressions and NVC) Involuntary Explicit Slow Reflective Easy to verbalise Emerges with cognitive competencies Learn (social) rules Voluntary
These systems interact and can conflict Use different brain systems Therapy should work with both systems
We have a number of responses that can be activated quickly and automatically which are designed to protect us from threat. These systems interact with each other and include emotional, behavioural, cognitive and physiological responses. Some examples of defensive reactions are: Emotions (anger, anxiety, disgust) Behaviours (fight, flight, freeze, submit) Cognitive systems (as better safe than sorry) Physiological systems (role of the amygdala, FC, HPA system) Collectively these responses can be regarded as a menu of safety strategies.
Cerebral Cortex
Amygdala
Hippocampus Cerebellum Potentially threatening stimuli are picked up and identified by the amygdala: the left
amygdala is more responsive to vocal expression (the rasp of an angry voice, the contempt in a critical voice, a calm soothing voice) whereas the right amygdala is more responsive to facial expression (a look of scorn, a smile). Areas of the frontal cortex (FC) will then help regulate the alarm response of the amygdala. The maturation and effectiveness of the FC to perform this function is related to early developmental experiences (Gerhardt, 2004; Schore, 1994; Siegel, 2001).
Because our approach has three emotion regulation systems it's important to understand how each systems works. In particular it's important to understand how the threat self-protection system works. We must base this on a scientific understanding. So if anything that is written here turns out not to be validated in research then we must change it. Here are some key points: 1 Different processing systems We have different memory systems for processing threatening events. The amygdala is related to body memory, whereas the hippocampus relates to event and time memory. (Recall the example of a beer or cheesecake that makes you very ill and how sensory cues some days later can reactivate the feeling of nausea). Conditioning models are very helpful in understanding how people can react physiologically very quickly to threat cues. Explain this to your patients. 2 Threat emotions can set up conflicts We are all familiar with the fightflight system. But note that you cant fight and take flight at the same time! In humans and animals problems can arise when both these emotions are generated with competing action tendencies. It can be helpful to explain this carefully to patients. Sometimes we will have one stream of feelings and thoughts to a threat but often there are multiple streams. Here is an example you can use: Imagine a boss with whom you get on reasonably well - strongly criticises your work. Note how you might feel: Anger (how unfair), anxiety (oh no I have made a mistake) or tearful (I tried so hard). Now you will try to control these because expressing them could make the situation worse. But you may also have reactions to your own reactions. You might be angry with yourself if you are anxious and submissive, or anxious if you were angry, or feel shame if you collapsed in tears. Because threat emotions often come in multiples some people can be overwhelmed and shut down. They may say I do not know what I feel because they are too confused too many competing/conflicting defences. The following diagram illustrates this further:
Fragmented and fragmenting, confused and secondary safety strategies at management of inner conflicts
FEEL SHIT
4. Recognise the power of approach (reward) and avoidance (aversive) conflicts It was recognised well over a hundred years ago - even by Pavlov of salivating dog fame- that when animals are presented with signals indicating a reward and signals indicating punishment they can learn how to respond to each (Gray, 1979). But if they are presented both types of signal at the same time or the signal is ambivalent they show high arousal, fear and disorganised behaviour. Their capacity for thinking and solving problems seriously deteriorates. There are all kinds of science fiction
The Compassionate Mind Foundation 2010 Page 15
stories where the computer blows up because it's given two incompatible directives. Humans too can become very aroused, disorganized and even dissociated in the face of strong approach avoidance conflicts. For example, Tom earned good money and felt he was supporting his family well. However, when a bullying boss arrived he became very stressed. The conflict of wanting to leave and wanting to stay (because of the good salary) created high arousal, rumination on what to do, confusion and depression. It is important to share with patients an understanding of how conflicts create disturbances in the threat system. Researchers studying children have also noted that a parent can be a source of both safeness and threat. This can set up strong conflicts and dilemmas in the child that can lead to disorganisation in their ability to process interpersonal information. Think about how for some people this can be re-experienced in the therapy. What you see from these ways of thinking is that we cant over rely on cognitive explanations. We also find that this understanding helps patients make sense of why for example the stress of a conflict in one's life can disrupt thinking and create fatigue and confusion. 5. One protection strategy creates another. Individuals can find themselves caught between two different threats. For example Sam often felt he wanted to express his feelings to others especially when they hurt him. However, to do this activated the fear of rejection or counter-attack. So he stayed quiet, but would then ruminate on feeling stepped on which in turn would reactivate his desire to express his feelings, which would reactivate his fears of rejection and so on. It is very useful to draw these loops and feedback systems for people. 6. Emotional Conditioning. Some people struggle to feel, tolerate and express emotions because of various beliefs they have about those emotions. It's also possible that some individuals have conditioned responses to their emotions. In the 1970s behaviourists suggested that if a child expresses anger and the parent constantly punishes that, the child will respond with anxiety, upset and alarm to the punishment. After a time the child's feelings of anger will automatically activate feelings of anxiety and fear of punishment. If this is repeated the child may become unable to express his anger, even finding it difficult to acknowledge it, and does not develop a mature ability to work with the feelings of anger. In my experience explaining conditioning models to patients is very useful and often makes sense to them.
Reducing Threat via Attachment and Mutual Support The Sources of Safeness
Safeness is a state of mind where threat is (relatively) absent from the attentional field and from affect. The processing of information is open and more integrative. Certain cues innately signal the presence of safe protective others linked to the attachment system, and stimulate feelings of safeness (Bowlby 1969, 1980). When we feel safe we process situations and events in different ways than when we feel threatened. Experiences of safeness tone up the FCs regulation of threat systems abilities. This has evolved because care from others is a major way to improve survival chances, defend and protect self, (and prosper). So infants and children rely on others to regulate threat arousal and distress. Key signals that do this include holding, stroking, voice tones, attending and interpersonal style (Field, 2000; Trevarthen & Aitken, 2001). Threat and safeness then are affected by: Accessibility of the other Disposition of the other Interpersonal style of the other Availability of the other Competencies of the other How one exists in the mind of the other
Soothing parents provide the experience of soothing when confronted with feared or hurtful stimuli and model coping. A parent who tries to sooth a child but is also alarmed him/herself and is highly distressed may inadvertently send mixed messages to the child. The child may experience feelings of anxiety in this context. Consider the special problems for children, whose soothing systems are innately waiting for care signals, but obtain few such signals or even abusive ones.
Mutual Support
In addition to the attachment system human survival has depended on other peoples support, help and co-operation and sense of belonging. So we have evolved to be attentive to how others feel towards us. When we think we exist as a positive being in the mind of others we have a sense of safeness. These are also key qualities in the therapeutic relationships.
Creating Positive Feelings in the Minds of Others About the Self: The Attracting Self
Humans differ from animals in many ways. Although animals are sensitive to many types of threat they do not have the capacity for the kind of self-awareness that creates a sense of self-identity. A range of cognitive abilities (evolved in the human mind) are thought to contribute towards a sense of self-identity. Our self-identity and our status and acceptance in the eyes of others are important in contributing to our capacity to engage in group belonging and in the formation of adult attachments. These help us feel safe. There are two key social strategies that we engage in to create and maintain our status/position in our social groups and in the eyes of others (i.e. interpersonal relationships) - those of aggression and of demonstrating attractiveness. The table below outlines the differences in behaviour and desired outcomes. Main Strategies for Gaining and Maintaining Status in Interpersonal Relationships (Gilbert & McGuire 1998) Strategy Tactics used Aggression Coercive Threatening Authoritarian To be obeyed To be reckoned with To be submitted to To inhibit others To stimulate fear Attractiveness Showing talent Show competence Affiliative To be valued To be chosen To be freely given to To inspire, attract others To stimulate positive affect
Outcome desired
Purpose of strategy
Social acceptance, belonging, mutual support and feeling that in the mind of others we are seen positively help us to feel safe. These outcomes have been linked to our survival for millions of years and we know they affect our physiological states. A first clue to shame is therefore that in the mind of others we are not attractive but unattractive in some way - we are at risk of put-down, exclusion or rejection - these are coded by the brain as major threats.
A social or external evaluative component: This relates to what we think is in the mind of others about ourselves, what we think others think about us. In shame, we believe that others see us as inferior, bad, inadequate and/or flawed; and because they think that - they look down on us with a condemning or contemptuous view and feeling. As a consequence they may wish to avoid, reject, or hurt us (Gilbert, 1998a). An internal self-evaluative component: This relates to judgements of the self and feelings that one is inferior, inadequate or flawed. These judgements are typically experienced as a stream of self-attacking thoughts (e.g. I am useless, no good, a bad person, a failure). They are in essence shaming thoughts and negative self-evaluations (Gilbert, 1998a; Tangney and Fischer, 1995). emotional component: Various emotions and feelings accompany the experience of shame. These include anxiety, anger and disgust and (self)-contempt. These emotions are part of our evolved brain systems for responding to threat with a defensive behaviour. For example, at times we have all felt excluded from a social group. In this example the exclusion can be seen as a social threat and our consequent anxiety or anger is our defensive response to this threat. behavioural component: The experience of shame is typically associated with a strong urge to hide, avoid exposure, run away or (when anger is the emotion) retaliate against the one who is exposing the self as inferior, weak or bad (Lewis 1992, 2003; Tangney and Fischer, 1995) e.g., How dare you make me feel like this. physiological component: Shame is now known to be one of the most powerful activators of stress responses (e.g., heart rate, cortisol) in social interactions (Dickerson and Kemeny, 2004).
2.
3. An
4. A
5. A
Key message: Shame is not a single emotion like anxiety but involves the selfawareness system and self-identity. Thus it involves complex dynamic processes between externally focused fears of what others will think, feel and may do and internally focused fears of what will be activated in our own minds e.g., overwhelming emotions or our own self-evaluations.
Our bodies: This is common in some eating disorders, but also more typically can be associated with thoughts of being too fat, the wrong shape, getting old and disfigurements (Gilbert & Miles, 2002). We can also feel shame of bodily functions or diseases. Our feelings or fantasises: e.g. anger or sexual desires. Our traits or abilities: e.g. not being competent, lacking confidence. Our behaviours: e.g. making mistakes, saying something inappropriate, losing control, being submissive or running away and avoiding things out of fear. Our past: e.g. abuse, feeling damaged, ruined or scared. In regard to the therapeutic relationship, because shame can be so prominent in social interactions it can significantly interfere with therapeutic relationships, especially when people try to cover up what they feel ashamed about, or have been unable to process or work through painful shaming experiences. Note therefore the importance of safeness!
2.
3.
4.
rejecting others. The context of being shamed was one of threat thus shame experiences can be coded like trauma memories.
4.
Damage may be long-term within social contexts (e.g., to a reputation). 5. We have different safety strategies for coping with shame (e.g., concealment, compensation, avoidance). Safety strategies can inhibit learning helpful coping and acceptance.
Em otion and intent flow fromth other ing e e.g. A ggression /contem pt
A lone no help /rescue O thers are frightened or join in(bully ing ing) Intense sense of fear rage -con pt tem Entrapm ent Sense of having done som in eth g wron g/terrib le -
TH EA R T
Involve scenes in the mind of being shamed and/or feeling ashamed being replayed (Kaufman, 1989). Can operate like a conditioned, emotional memory such that when activate generates high arousal and fear that interferes with processing. Different types of memory, e.g. semantic, episodic, somatic and emotional can give rise to different internal experiences. Fragmented memories of various forms of abuse and/or other experiences of trauma can be experienced as shame fuelled flashbacks and intrusive thoughts/feelings. These are highly distressing experiences.
How we understand shame memories by drawing on our knowledge of theory from PTSD and memory processes
Flashbacks are fragmented sensory memories.
They can be experienced with the full force of the emotion experienced at the time of trauma. They are thought to be generated by the amygdala, which is an emotional memory bank, but also a primitive memory structure. Thus it may have no access to temporal context or contemporary meaning. When someone experiences a shame fuelled flashback, they can experience the memory as if it were happening now and with the full impact of sensory, emotional meaning assigned at the time of the experience.
The Compassionate Mind Foundation 2010 Page 24
Clinical example: An adult, who experiences a conditioned, emotional memory of a hostile critical parent in the form of a flashback, will relive the memory and feel as if it were happening again as the memory is being generated by the amygdala. Given this, the adult will feel fearful and others as powerful, hostile and overwhelming. Also always look for and discuss the feelings of aloneness because when the memory was laid down the child was alone there as no rescue. The childhood feelings, compared to those of adults who can now defend themselves, may not be updated. Hence the emotional feelings experienced at the time of shaming are not updated. So implicit emotions/feelings can be of fear and aloneness. Furthermore, once shame memories are activated, then other shame memories are more likely to be activated leading to a bombardment of painful memories in the mind.
Key Message: People who experience high levels of shame live in a mind that is condemning/critical, and live in a world where people are viewed as hostile/rejecting.
Example of working with externally-focused fears and internally-focused ones: Sally had just moved to a new area and had organised a dinner party for work colleagues and local neighbours. However she forgets a key ingredient and burnt the food. How I think others feel and view me What I feel and think about myself These new people will see that I'm I'm so annoyed with myself for forgetting such as disorganised. basic ingredient. They'll not be very impressed with my cooking abilities or my organisation. They'll feel let down at having to eat a takeaway. I've probably blown it with them. They'll now always see me as a bit scatty and not take me seriously. My key fear is: I'll not be able to make close friendships with people who respect me. What's the matter with me? Why can't I get my head in gear? The meal I cooked would have been so nice and impressed them. Ive really let myself down again by being careless and not paying attention. My key fear is: I'll not be able to make close friendships with people who respect me. I'll be marginalized and lonely.
A Shame Model
This model outlines the flow of shame and how shame is related to both evolved needs for social relating and socio-cultural experiences. The core of this model is external shame this is because our survival and prosperity has depended on the good will of others via creating positive feelings in the mind of others about the self - and if we lose that then defensive actions are called for.
Innate motives for attachment and group belonging; needs to stimulate positive affect in the minds of others; Unfolding cognitive competencies for -self evaluations
Social cultural contexts relating to economic opportunities, group conflicts, political structure, cultural rules for honour/pride/ shame PERSONAL EXPERIENCES OF SHAME - STIGMA
Fam ily: Social group: Criticism , high expressed em otion, negative labelling, abuse Bullying discrim ination, prejudice, stigma ,
reflected stigm a (to fam ily or others) rejection by the com munity
Stimulus-Response
Sexual Meal Meal Sex Bully Bully Kind, warm and caring
Limbic system
Sexual
Fearful Depressed
defence) To push us on to achieve To be rid of unwanted things in ourselves Habit To protect someone else Criticise ourselves before others do seek atonement
Various major forms of self criticism Frustration and impulsive related Self-correcting, driving and improving Self-hating, self-contempt, commonly linked to the affect of disgust and to selfharming Self-critical focused shame can also have various ruminative qualities
S -C elf ritical M dis also T reat in h M d in
F orm s Fun u ction n s
-focu fo sed cu
S elf C ritical
E ffects
Process
Validating a persons narrated experience with clear statements of feeling in you e.g., that sounds horrible for you Deepening the shared understanding (empathy) and validating process. Feelings are understandable and not shame-worthy Working out, and on the key task and practices for the therapy (e.g., Compassionate letter writing, imagery)
Focusing Self-disclosure Feedback Moderate Open and Socratic (Swing Skills) questions Information/education Logical consequences Directive training Confrontation/ boundaries
Threat-Focused Formulations
Clinical formulations are a key element of therapeutic practice and are used by therapists to convey a mutual understanding of the clients problems. The nature and focus of the formulations are informed by the theoretical underpinnings of the therapy. In threat-focused formulations we help people see that problems arise from key fears that generate both automatic and planned safety behaviours, and we seek to de-shame them. This requires a good history that will give rise to key themes in a persons life including trauma and threats. There are four main domains for discussion: 1) Early background experiences (e.g., attachment and peers). 2) Key emotional memories with fears, threats and concerns. 3) Safety strategies that have developed to cope with external and internal threats. 4) Unintended consequences. Hence, during the history taking and formulation there are some questions that can be embedded in the general style and narrative of the therapy. The questions you may ask to elicit this information may take the following form: What kinds of threats do you think have affected you while growing up? Consider how these have coded the experience of self and of others and the relationship of self to other. Some people will be able to articulate key emotional memories others may not, especially if there are problems of dissociation (see Liotti, 2007 in Gilbert & Leahys volume). What key fears have these left you with? Now here you want to get a handle on both external threats what the world or others can do and internal threats or more specifically things arising in the self as well as coping behaviours. How have you tried to protect yourself - what kinds of safety strategies do you have for preventing these fears from occurring today? Give validation to these as understandable and best efforts to stay safe. This is very important and is not phrased as dysfunctional. Although these safety strategies can be more than understandable they may have unforeseen and undesired consequences. What do you think these may be? How do you think and feel about yourself when you engage in your safety strategies and if the unintended and undesired consequences occur?
Key Fears
External: Rejection/shame Sensitive to peoples voice tones, facial expressions, moods Internal: Feeling alone desperate, vulnerable
Safety/defensive behaviour
External Non-assertive/appeasing Try to please others/standards Focus on mind of the other Internal Suppress own feelings and needs
Unintended Consequences
External: needs ignored Put upon and angry Not achieve person goals Internal Lose sense of self Threatened/fragile self angry resentful Self-attacking I am weak and unlovable so revert to safety behaviours
Pointers
Try to keep it relatively simple to start with - Just the four of five headings Focus on sharing and understanding together and encourage client to do his or her own or add to it Avoid language of cognitive distortion or maladaptive schema as this can be shaming for high shame clients Focus on your defence system has tried to keep you safe; better safe than sorry etc natural, but with unintentional drawbacks e.g., little new learning, few opportunities for exploration.
Shared formulation
Validation of fears, painful experiences, threat sensitivities Make sense of safety behaviours/strategies and core beliefs Identify critic or inner bully as safety strategy (i.e. functions) Explain the three circles model and how thoughts, memories and images affect the brain
Visualise, practice, and rehearse compassionate focus on self, goals and future. Must find a practice for each day
Responsibility vs Blame
It is important to clarify this distinction, especially the key differences between shame and guilt, but all can be present to same event.
* Building on positives (e.g. seeing what one did well and then considering learning points) * Focuses on attributes and specific qualities of self * Focus and hope for success * Increases the chances of engagement For transgression Guilt, engage Sorrow, remorse Reparation Use the example of encouraging supportive teacher with child who is struggling.
Compassion Circles
Compassion can be defined in many ways: As a sensitivity to the suffering of self and others with a deep commitment to try to relieve it Dalai Lama Eight fold path - represents a multi-modal approach for training ones mind Compassionate Mind Training: The key attributes of compassion (inner ring) and the skills to develop them (outer ring)
M ultiM odal C om passionate M ind Training W arm th
A ttention SKILLS -TRAINING Imag ery ATTRIBUTES
Sens itiv ity Care for well being Sym pathy D is tress tole rance
Kindness
Reason in g
C om passion
F eelin g
Non-Judgem en t
E m path y
B ehaviour
Sen sory
Kindness
W arm th
Imagery
ATTRIBUTES Appreciation
Playfulness
Reasoning
Compassion
Happiness tolerance
Feeling
Strengths
Empathy
Behaviour
Sensory
Playfulness
The Compassionate Mind Foundation 2010 Page 34
Warmth
Compassion Skills
CMT will then try to recruit attention, memory, meta-cognitive reasoning, behaviour and emotion systems. CMT tries to integrate these different elements and focus them all on the development of compassion. Compassionate attention involves the way in which we focus our minds; what we choose to attend to. The exact focus of attention will be worked out with the client but it may involve a focus on a compassionate image, an object, a smell, a smiling face of someone who was caring, a compassionate memory. Compassionate attention focuses on the sensory modalities. We will often use a short mindfulness exercise to help people think about the nature and importance of forms of attention (see exercise). Compassionate thinking/reasoning is related to the process of reasoning. The kinds of thoughts that crop up in automatic reactions can be a target for it but most of the work done in therapy is post the immediate reaction. A lot of the reasoning is what is called metacognitive. Thus compassionate thinking will focus on many cognitive therapy elements such as bringing balance to thinking, de-personalising and de-shaming, developing multi-causal ideas of responsibility, seeing each event as unique rather than overgeneralising, and common humanity thinking (to tackle negative social comparisons). When compassionate thinking is fused with compassionate feeling we move towards the position of wisdom. Wisdom emerges as we develop deep insight into the nature of things. Compassionate behaviour focuses on what people feel would be the most helpful, nurturing, supportive or encouraging thing to do. As noted by behavioural and Buddhist approaches actions are important. There needs to be clarity on the distinction between compassionate behaviour and submissiveness. Compassionate behaviour is also more than being nice to oneself - it must focus on the quality for growth, development and flourishing. Compassionate behaviour can focus on immediate behaviours or on longer-term goals. Compassion behaviour is often about developing courage. Compassionate emotion and feeling focuses on trying to generate a certain emotional tone in the whole process of change and growth. The emotions that we are interested in are therefore warmth, kindness, gentleness and soothing. Hence when we create thoughts in our mind we try to deliberately make them warm, gentle and soft in tone. This of course does not in any way preclude more excitement emotions and feelings of joy when we succeed or our children succeed at certain things. Joy is a part of compassion too, although probably has more activation in it. The key of the compassionate emotions is that they are focused on well-being and flourishing. Cultivating
The Compassionate Mind Foundation 2010 Page 35
these qualities of mind develops the emotion system which is important for self-soothing and contentment.
Compassionate Mind
We can see that compassion is not a schema but rather a way various components of our minds are organised. This is why we call it compassionate mind. If you are (say) relating to those who you see as harmful to you or as enemies these various components of our mind are likely to be turned off, and instead your mind has patterns, motives, feelings and ways of thinking that are about subduing others rather than helping them. To develop compassion and self-compassion is to try to activate various components of compassion such that these organise and pattern our minds in certain ways.
Key points with Compassionate Mind Interventions
Compassionate attributes and compassionate skills are used to counteract the feelings, styles of thinking and behavior that arise in depression
Compassionate Attributes
1. Developing a motivation to be more caring of self and others 2. Developing sensitivity to our feelings and needs of self and others emotionally in tune with our feelings, distress and needs 4. Developing abilities to tolerate rather than avoid difficult feelings, memories or situations 5. Developing our understanding of how our mind works, why we feel what we feel; how our thoughts are as they are 6. Developing an accepting, noncondemning, and non-submissive orientation to ourselves and others
Compassionate Skills
1. Learning to deliberately focus our attention on things that are helpful and bring a balanced perspective. Developing mindful attention and using our attention to bring to sense of self. 2. Learning to think and reason, use our rational mind, looking at the evidence and bring a balanced perspective. Writing down and reflecting on our styles of thinking and reasoning 3. Learning to plan and engage in behavior that acts to relieve distress, against the depression and moves us (and others) forward to our (or their) life goals to flourish. Developing courage
3. Developing sympathy, being moved and mind helpful compassionate images and/or a
to the process of developing self-soothing. Thus we often draw out the three circles and demonstrate how they work. We then are able to build a therapeutic alliance and agree to goals to try to become more selfcompassionate. We note, acknowledge and work with the threats-fears of becoming self-compassionate. Self-compassion can become a source for a new self-identity.
themes as this has an impact on our own feelings. Keep in mind all the time that clients can easily slip into shoulds, or become self evaluative if they struggle and this is not helpful. * Contrast body states: To help people recognise the difference between compassionate body states and other body states one can use contrast states. Here one asks the person to remember and put themselves into the postures and feeling states of anger or anxiety. We then direct attention to the facial expressions, the tone of the voice if it were spoken, the body posture, the flow of thoughts and attention and the basic emotion. If people are enacting anger they can usually notice a tightening of the muscles, a harshness in the voice a hostile/blaming stream of thinking. One can then switch them back to the compassion stance, with the relaxed musculature facial expressions, a slight smile and so forth and reflect on the differences. * Appreciation exercises: Behavioural psychotherapy has long focused on the importance of increasing positive rewarding behaviours, especially for depressed people who have disengaged from various activities. There is also increasing interest within positive psychology to help people build on their strengths and also to engage in gratitude and appreciation exercises. The key here is again the motive and spirit of the exercise. If clients are likely to do this exercise with thoughts of I should appreciate things more; I am quite lucky really and therefore have no right to be depressed or anxious this is completely the wrong tone and motivation and is therefore not helpful. If, on the other hand, the person recognises that appreciation exercises are about attention training and stimulating positive emotions systems, (again a kind of physiotherapy for the mind) then this exercise can be very helpful. Here the client is asked to keep a note of things they have liked and enjoyed and appreciated during the day. This can be quite small things such as the first cup of tea, taking a shower, the smell of a spring day. We invite people to spend time when they notice something that they quite like. Sometimes you can have sensory focused days. On Mondays we will focus on the things we like to see. This may be types of sky, colours of trees, and even going to a supermarket and noticing the colours on labels and thinking about the colours one likes. It's all about attention to the details of one's life. Then we can have a hearing day where we focus on things we like to listen to this might be the birds or music and engage with these activities. Another form of appreciation exercises is to focus on the things one likes in a relationship or in oneself. Many patients will say that type of letter will be a short letter and so the therapist will be able to help them refocus their attention on things they can appreciate within themselves and the importance of doing this. We stress here that shame, depression and so on tend to skew our focus towards threat. Quite understandably therefore we have to train the mind to become more balanced so we get some nourishment into the positive affect systems that the threat system is starving. The dominance of the threat system is not letting information get through to the positive affect systems.
Understanding Soothing
Soothing is a complex and multi-component process involving complex interactions between soothing systems and threat systems. Hence feeling safe, reassured and soothed can arise, not just via the absence of threat cues that suggest a threat is absent or moving away, but from more specific cues that activate the soothing system. The focus is thus on cues that help us feel safe and that threats are manageable. Intimate soothing cues relate to affection cues such as physical touch, cuddling and hand holding, with evidence that these can affect the opiate systems. More general soothing cues of safeness relate to non-verbal communication (facial expressions, voice tones and postures), reflective attentiveness and empathy. As children grow they increasing feel soothed by others via what they think in is the minds of others. Here are some key aspects: Social referencing. A child may be anxious about approaching a potential threatening or novel stimulus and looks to the parent to see how they are feeling about the stimulus. The parent displays interest and approaches the stimulus, or may interact with the stimulus in a positive, low fear way. They may encourage the child to explore the stimulus. Thus reassurance here arises from a form of social referencing and modelling. A more complex example is when a person is able to socially reference their own feelings and discovers that others either have the same types of feelings as they do and are not alarmed by them. Living in the mind of others. Our abilities to feel safe in the social world often come from experiences of how we feel or think others feel and think about us. When we interact with others, so that they show pleasure in our presentations and liking, then we can feel safe. In fact people spend much of their time thinking about other peoples feelings towards them, have special cognitive systems for thinking about what others are thinking (called theory of mind) and many of our goals are orientated to try to earn other peoples approval and respect, and be accepted in groups. If you think about how you would like your lovers, close friends, counselling peers, clients and bosses to see you it will mainly be to value you and see you as desirable, helpful, talented and able. If you can create these feelings in the mind of others then three things happen. First, the world is safe and you can know others will not attack or reject you because they value you. Second, you will be able to co-create meaningful roles for mutual support, sexual relationships and sharing. Third, receiving signals of others as valuing and caring of you has direct effects on your physiology and soothing system. Many clients can be frightened of how they live in the mind of others and that others may view them as odd, weak, inadequate or bad. Working with these internal representations of how one exists in your mind can be experienced as soothing. Being heard and understood. People can feel threatened and become defensive when they think that others do not understand them and/or have little interest in hearing them or taking their point of view into serious account. We can feel soothed when we feel the opposite that others sees our views as something to be articulated and are valid and important not to be overridden or dismissed. This need can take precedence over more physical acts of soothing. For example a client became upset and tearful. To this her husband would often try to sooth her by putting his arm
The Compassionate Mind Foundation 2010 Page 43
around her. He felt hurt when she tried to push him away. Her account was that she felt he was saying there, there and trying to quieten her feelings rather than actively listening to her concerns and giving her a chance to express herself and be understood. For her, to have someone really listen, and be with her in her distress, and tolerate that distress was soothing. Being listened to can also aid our own understanding and working through (hence mircroskills). Empathic validation. This involves the experience that another mind/person understands our mind our feelings, thoughts and points of view - and validates them. Thus a therapist might say losing your husband like that must have been a horrible experience for you; your feelings make a lot of sense because Empathic validation means that a) we have understanding of the other persons point of view and connect to it because we can connect to our own basic human psychology the other is not an unfathomable alien and; b) validation means that we validate their lived experience as genuine, and makes sense as part of the human condition. Thus empathic validation is more than reflection (e.g., you feel sad or angry about this), but acknowledges this as an understandable and valid experience. Once again however empathic validation begins via our experience of how we exist in the mind of others. Invalidation can be this is neurotic, you are exaggerating; you have no need to feel like this; you are being irrational etc. Many conflicts can arise when people feel others are invalidating them through lack of interest efforts to understand or care, or are pathologising them. Many people have a complex of feelings that may be difficult to understand and of which they may be fearful (Leahy, 2002). They may cope with these via avoidance, denial, dissociation or replacing one feeling with another. Socially referencing, being listened to and empathic validation are important experiences of what is going on in the mind of the other that helps a person come to terms with, and understand, their own feelings. Client and therapist work together on the basic feeling issues and help the person be aware of and address emotional memories, unmet needs or key fears that might make feelings frightening (see Gilbert and Leahy, 2007). Reasoning. CBT puts a lot of emphasis on reasoning. When we feel threatened the attention narrows down onto the threat and we shift to better safe than sorry thinking. We can feel soothed when we are able to stand back and examine our thoughts in detail and come to a different perspective. As children we can learn how to reason by observing others, (e.g. parents and teachers), adopting their explanations, values and styles of reasoning to be in line with their values, and via direct instructions on how to think about this or that. In many ways CBT therapists are helping people with these processes of thinking and reasoning in the face of strong emotions or fears. Thus the degree of change may be how far the therapist can persuade or encourage a person to look more deeply at their reasoning and experiment with alternative views and behaviours. Processes that help us de-escalate threats or cope in new ways can affect soothing and reassurance. So reasoning is obviously very helpful and important to how safe or threatened in the world we feel. Keep in mind though that people need to be able to feel reassured by their alternative thoughts and that there are various reasons why these feelings may be problematic. Desensitisation. Key to many behavioural approaches are those linked to forms of exposure and desensitisation. In some cases coming to feel safe requires that we are
The Compassionate Mind Foundation 2010 Page 44
able to experience both internal and external fears in new ways. Thus in CFT the ability to stay with and learn to tolerate frightening feelings or situations can be key to soothing. However, just as the child may use a parent to navigate these domains so may a client need to feel held and contained by the therapist during the process. An inability to trust others may be a key reason why people become resistant to engaging in these processes because they feel they have no safe base. In fact a key ingredient of successful behaviour therapy may be the way the therapist is able to encourage, hold and contain the anxieties of their clients as they engage in various exposures. Overview: There are many other processes that can help to settle the threat systems and engage soothing (e.g. mindfulness). Here however we note that therapeutic soothing arises from a range of different types of interaction related to the enacting of the compassion circle (e.g., the therapist expresses sensitivity, sympathy, distress tolerance, empathy and non-judgement). In addition the therapist acts as a social reference point, encourager, teacher and coach. The full and active presence of the therapist is key rather than a detached, technical or over controlled therapeutic persona. CFT is thus not to be confused with just being nice to people or love. CFT builds on many other therapeutic approaches and traditions that include Rogerian, a variety of cognitive behavioural approaches and emotion focused approaches. However, the underlying theory of CFT is rooted in understanding our evolved social needs (e.g., attachment and social affiliation), our social competencies (e.g., theory of mind), and the neuroscience of information prepossessing (types of affect systems).
Facilitating Flourishing
The main focus of CFT is a balancing of the three affect systems not just stimulating the soothing system. Sometimes it is important to work on the drive system as well. Compassionate behaviour can actually involve providing people with things that are important for their flourishing in life. For example, at Christmas time providing a child with a long-wanted bicycle so that he or she can be like his or her friends could be an act of compassion. If we have a self deprivation psychology then learning how to enjoy and provide for ourselves can be important. Learning to take joy from our and other peoples achievements is also important for balancing our emotions. Indeed, in Buddhism the nurturing of joyfulness is very important. However, as in other therapies, there is a distinction between taking joy in having and the more feeling need and must have. Therefore therapist and patient need to think through whether pursuing achievements or possessions can be experienced compassionately and joyfully. Again, we come back to the balancing of the different systems. See the work of Martin Seligman and others (www.authentichappiness.sas.upenn.edu)
A Clinical Example
We offer a rather complex thought form that you would simplify for certain people. The one here emerged from many hours of work and as an overview. You will need to use your clinical sensitivity and judgement here. The idea is to give you a certain flavour of the whole process put together. You will note that we include images and functions of self-criticisms and the images and functions of self-compassion. The Story of Jack Jack was a high executive and then became very depressed and had to go off work. Hed become overloaded with too much work, started to miss things and one day forgot an important meeting. So, his key worry became not getting work finished. As this built up he had more and more self-critical thoughts and feelings. We did a lot of normalising of the way in which stress does effect concentration and abilities, and the need for recuperation and time out. However, that recuperation will be compromised if he ruminates in a self-critical way. Our competitive society may be producing more and more people who suffer like this. He came from a high flyer family who were also relatively emotionally distant and he had been at boarding school from a young age. You will also notice under compassionate thinking entry that part of him is also quite angry at having been put under this level of strain, which at one level is very unfair. Recognising and acknowledging the power of anger and the fear of anger/rage is important in CFT. He is rather inhibited and invalidates this anger, however, because he feels others have coped better with the stresses at work (negative social comparison), although in reality they were less conscientious and less in need of proving themselves.ms
Anxious and hurried and angry Stress with physical changes, ruminating and sleep problems
Feel calmer and able to refocus my feelings towards being warm with self. In my heart I know I can get through this if I can accept and work with my fatigue and anger.
before. Laid back. Concerned for me and values me. Function: To help me cope with difficult situations and the return of my fears. Helps me feel supported, keep it in perspective.
Guided Memory
Recall feelings when someone was kind to you Recall feelings of you being kind to others
Guided Fantasy
The ideal compassionate self The ideal compassionate other (unique v given, human v non-human) Loving kindness meditations often involve the person imaging themselves looking back on themselves with loving kindness. High shame individuals however struggle to do this, so we have developed another way of developing a compassion focus called Compassionate Letter Writing. This is like a focused task for stimulating ones own inner abilities for compassion and directing them at the self.
- co rtiso l
Fear of Compassion: Compassion may feel strange or threatening; there may be negative beliefs or associations to feeling close, or cared for. Considers emotional conditioning history. Anger/Rage. A common block to developing compassion, is high anger, fear of anger and vengeful fantasies. Help clients see that compassion is not just soothing but can be assertive. One of the biggest mistakes is believing that to be compassionate is to get rid of anger, rather than how to cope with it. Compassion is often about developing courage to face up to our anger and work with it. They may need to do empty chair work and rescripting of memories of powerlessness to help with unprocessed or blocked anger. Research shows that self-critics can see self-compassion as a threat be open and discuss this. The main strategy is holding on to your compassionate therapeutic relationship and chip-away a little practice each day. Clarify the point of the work and the importance of practice hence compassionate mind training.
basic beliefs, no experience of. and share that with the patient. Is fear or contempt to feeling compassion or simply a kind of blankness. Normalise and time line it. Ask questions such as what do you think would happen if you began to feel compassion? or what might your worst fear be if you began to feel inner warmth? What might help you work on that? Clarify that patient understands the model and the value of selfcompassion. Do NOT need to give up self criticism. You might need to keep it simple at first such as developing an inner voice of kindness, support and encouragement when things are difficult for the self. You might have to desensitise people to positive emotions, no different in principle to desensitizing them to negative emotions except that in the one case the emotion may be too much and in this case it's too little. But can activate pain too (sadness). Prepare for the long game, don't be put off by the difficulties. Sometimes it can be weeks or months before patients get to feel what you working on in the therapy. Explore which exercises patients find helpful: Generating alternative thoughts, behavioural experiments, compassionate imagery, letter writing etc. Regular practice, repetition and perseverance with maintaining the collaborative focus.
Note that even if the person does just 2 minutes a day on (say) the
compassionate self this can be helpful. Take any opportunity, lying in bed in the bath waiting for a bus. Little and often is helpful compassionate washing up!
Appendixes
Given these key fears - what are your main coping behaviours how might you cope with these? What might you do to stop any possible feared outcome? ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________ What have we learnt from this exercise? ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________
Imagine for a moment what it must be like to live in a world where, at any moment, you fear that people could find out things about you or you could do things that make them rejecting and hostile, and/or your own feelings and thoughts about yourself are condemning, hostile and rejecting. Look around you and think that maybe you do not really fit here, you are an outsider and the more people got to know you the less they would want to know you. It is with this insight and understanding of the shamed mind that the therapist begins a journey into compassion as a way to try to find places of support, soothing and comfort. Debrief: now look around you and think of how pleased you are to be part of this journey where each of us are trying as best we can to understand compassion and how to apply it in our work, think of yourself as travelling with others. Note how you can shift positions and self-other roles via your focus.
For a minute or so we would like you to close your eyes or look down and think what your fear would be, if from this moment on, you were never self-critical again somehow we could remove this from your mind. Now with these thoughts in mind what we would like you to do is look back on your own self-critical thoughts from the first task we did and consider in what way they might be helpful to you - what do they want you to do or be?
2.
Learning the art of forgiveness however, can be important. Forgiveness allows us to learn how to change; we are open to our mistakes and learn from them.
5. Acceptance/tolerance. There can be many things about ourselves that we might like to change, and sometimes it is helpful to do that. However, it is also important to develop acceptance of ourselves as human beings as we are with a full range of positive and negative emotions. Acceptance isnt passive resignation, such as feelings of being defeated, or not bothering with oneself. It is an openheartedness to all our fallibilities and efforts. It is like having the flu and accepting that you have to go to bed perhaps but also doing all you can to help your recovery. 6. Developing Feelings of Warmth. This requires us to begin to experience and practice generating feelings of warmth for the self. To do this we can use images and practice feeling warmth coming into us. When we are depressed this feeling may be very toned down and hard to generate so we will have to practice. It can seem strange and sometimes even frightening so we can go a step at a time. 7. Growth. Compassion is focused on helping people grow, change and develop. It is life enhancing in a way that bullying often is not. When we learn to be compassionate with ourselves, we are learning to deal with our fallible selves, such that we can grow and change. Compassion can also help us face some of the painful feelings we wish to avoid. 8. Taking responsibility. One element of compassionate mind work is taking responsibility for ones self-critical thinking. To do this we can learn to recognise when its happening and then use our compassionate mind to provide alternative views and feelings. 9. Training. When we attack ourselves we stimulate certain pathways in our brain but when we learn to be compassionate and supportive to our efforts we stimulate different pathways. Sometimes we are so well practiced at stimulating inner attacks/criticisms that our ability to stimulate inner support and warmth is rather under-developed. Hence, now that we have seen how we can generate alternatives to our self-attacking thoughts, we can explore ways to help them have more emotional impact. It does not take away painful realities but it can help us to cope in a different way. The training part can be like going to a physiotherapist, where you learn to do exercises and build up certain strengths. The compassion systems in your brain are the ones we are trying to strengthen with our exercises.
The Compassionate Mind Foundation 2010 Page 61
Mindfulness
Developing mindfulness is very useful to help us with our compassionate exercises. Mindfulness is a way of paying attention to the present moment without judgment. So, for example, when walking down the street we are mindful when our mind is focused on our walking, where we are, enjoying the day and just being in that moment. In contrast, we could be walking and our head is full of other things, what we should have for dinner; how we could sort out financial problems; an argument you might have had. So we are living in our inner creations not in the moment that is surrounding us. Practicing mindfulness is a way of practicing directing our attention. Consider that we are a point of consciousness moving through time. Your consciousness does not exist in the moment just gone or in the moment to come, only now. Consciousness is interesting to think about for a number of reasons. It is like a spotlight. The power of the spotlight can light up many different things: a book on the table, a plant, a picture on the wall, an area of dirty carpet, but the spotlight is not the thing it lights up. Alternatively, consider water: it can contain poison or
medicine but also it is just water, not what it contains. Or consider a boat on the sea that can sail in calm waters or in storms - but the boat is not the water. We can think of our minds like this and try to reside in the spotlight, in the nature of consciousness - notice what the spotlight lights up but not be carried away by it or identify with the thing it lights up. Or we are like the boat. Now, sometimes our
The Compassionate Mind Foundation 2010 Page 62
consciousness will be filled with different feelings of anger or anxiety or unpleasant memories (we are sailing on stormy waters), but we can pull back from these and regain (and reside in) an awareness of simply being conscious. Don't worry if this seems a little tricky because we will practice as we go. Mindfulness is a way of understanding 'attention'. You can choose to give your attention a particular focus. For example, if I ask you to concentrate and 'attend' to the big toe on your left foot, you will suddenly have sensations from that part of the body. If you now switch your attention to the top of your head, you will experience different sensations again. So our attention can be thought of as a spotlight that can be moved around. It is learning how to be in that mechanism, in the attention, that is the key to mindfulness. Mindfulness is also about clarity of observation and attention. For instance, suppose you're going to eat an apple. How would you do this mindfully? First, look at the apple and note all of its colours and textures, and hold it in your hand and feel the quality of its skin. Dont rush, spend time just observing. When your mind wanders from your focus on the apple (as it most likely will) gently bring your focus back to it. In this exploration, you're not judging the apple, you're simply exploring its properties. Then, take a knife and peel it or cut into it. Once again, notice the effect that you have on the apple, the colour and texture of the fruit beneath the skin. Take time to really observe. Next, take a bite of the apple. Now focus on your sense of taste and what the apple feels like in your mouth. Next, chew slowly, feeling the texture in your mouth, noticing how the juice is stimulating your salivary glands and how the saliva feels in your mouth. Really focus on the taste. As you chew, notice how the apple becomes mushier. As you swallow, pay attention to the sensations of swallowing. So, you have explored the apple visually, by touch and feel, by smell and texture and by taste. If you had dropped the apple, you would have been able to hear what it sounded like but you dont need to do that today! In this interaction, there's no judgement; there's only your experience of your interaction with the apple. This is mindful attention being in the activity rather than distracted from it by other thoughts, and exploring all aspects of the
activity to the full. If you performed this activity, biting into an apple, without mindfulness, your mind would probably have wandered: This isn't a good apple where did I buy it? I ought to eat more fruit. Actually I dont like apples Oh, damn, I just cut my finger! In mindfulness we learn to notice the distraction (the wandering off thoughts) and gently and kindly bring our minds back on task and focus. Mindfulness is important because most of our lives are spent doing one thing and thinking about something else, and we're never fully in the moment. Our minds are
The Compassionate Mind Foundation 2010 Page 63
constantly distracted. Take driving, for example. We can get home and realise that we can't actually remember how we got there, because our minds were full of 101 other things. If something unexpected happened, say a group of naked motorbike riders flashed past us, our attention would have been awakened, or if the driver in front of us suddenly put on their brake lights, our attention would have been focused again. This is not an example of savouring the moment though, it's about being brought to alertness for a specific reason. Mindfulness is about being in the moment. Mindfulness is paying attention in a specific way and acknowledging the distractions. When our mind wanders we learn to note the distraction and gently and kindly re-focus the attention. There is a key thing to note here. You are not trying to achieve anything, so you cannot do this right or wrong. If you have thoughts of I'm not doing this right or I should be able to focus better than this or my mind seems impossible to focus note that this is typical of the thoughts we will have practicing this. Just notice these thoughts and kindly and gently bring your mind back to the focus of your attention. It really does not matter if your mind wanders 100 or 1000 times because all you're trying to do is notice this and return your attention. When we first try mindfulness, and also if were upset, our minds can feel chaotic with thoughts and feelings swirling around us; we feel like a pinball! This is typical but is not a problem that must be fixed or something done about. It may be distressing and undesirable but it is not a problem. If we are learning to swim we learn how to rest upon the water, to make our strokes - the water is not a problem to be solved. So if we find our minds rushing and difficult as we practice, we learn to rest it and simply observe our thoughts and feelings as best we can.
We're now going to use the same idea of mindfully peeling and eating an apple, but this time concentrate on our breathing. This will become a focus around which we will do some compassionfocused exercises later. The most important thing here is simply to practise the breathing without worrying if you're doing it correctly. These thoughts are common and understandable, but distractions. If they arise in your mind, simply notice them, call them your 'judging and evaluative thoughts, smile compassionately to yourself and bring your attention back to the task. There are many aspects to resting the mind and body so Im going to take you through a few key and simple relaxing exercises. The first one is called mindful relaxing and involves learning how to pay attention in a gentle and kind way. Once you are familiar with this you can do the exercise sitting down, lying down or even standing up and walking. It is, however, preferable to do it sitting down to begin with, so you get the idea of it. So find somewhere to sit comfortably. Okay, now that you are sitting comfortably, place both feet flat on the floor about shoulders width apart and rest your hands on your legs. Now what we can do is just gently focus on our breathing. As you breathe try to allow the air to come down into your diaphragm thats just at the bottom of your ribcage in the upside down V. Feel your diaphragm, the area underneath your ribs, move as you breathe in and out. Just notice your breathing and play an experiment with your breathing. Breathe a little faster or a little slower until you find a breathing pattern that, for you, seems to be your own soothing, comforting rhythm. It is like you are checking in, linking up, with the rhythm within your body that is soothing and calming to you. Now we can spend 30 seconds or so just focusing on our breathing, just noticing the breath coming down into the diaphragm, your diaphragm lifting and then the air moving out, through your nose. Sometimes its useful to focus on the point just inside the nose where the air enters. So, in through your mouth and out from your nose. Just focus on that for 30 seconds What did you notice? You may have noticed that actually, although it was only 30 seconds, your mind might have wandered off. You may have had thoughts like Whats this about? Will this help me? Did I do my job correctly yesterday? You may have heard various things outside the room; your attention may have been drawn to the postman pushing letters through the box, or whatever. The point about this is that our minds are indeed very unruly and the more you practise this short breathing exercise and the longer you can extend it, the more you will notice how much our mind simply bobs about all over the place. When you first do this kind of breathing focusing, it can be quite surprising just how much your mind does shift from one thing to another. This is all very normal, natural, and to be expected. So we need to train the mind and the only thing that is important in this training is not to try to create anything. You are not trying to create a state of relaxation. You are not trying to force your mind to clear itself of thoughts. All you are doing is allowing yourself to notice when your mind Foundation 2010 then, kindly and gently, bring your wanders and The Compassionate Mind
Page 66
So keep these things in mind when we get to the practice. So now our next exercise is going to be creating a safe place.
what do we want to become within ourselves? You see, throughout much of life we never stop and think about this, we don't think that we can deliberately practice becoming a certain type of person, but we can, we just have to decide to and then put in the time to practice. Here we are suggesting that if you choose to develop your inner compassionate self this can help you in many ways. Because of the way our brains are built it will help us to become kinder and have a greater sense of well-being; it may help us to become calmer and more at peace with our feelings. So the first compassionate imagery exercise can be practiced playfully but also with intent - learning to practice being a compassionate person. Acting: Another way to think of this is using acting techniques. If you were an actor learning to act, you might pay attention to key elements of a character. This might be a character that is angry, depressed, anxious, happy, and joyful or, of course, compassionate. So, as a keen actor, what you would try to do would be to create those experiences within yourself, try to be or become that character live it from the inside. To do this you might pay attention to the way this character thinks and sees the world, the tone of voice of the character, the postures and the general bearing of the character, the kinds of things they say and the way they say them. Okay, so the character we are going to become is a compassionate one, this is the part of us we want to feed, nurture and develop.
Find somewhere you can sit quietly and will not be disturbed and focus on your soothing breathing rhythm. When you feel that your body has slowed down (even slightly) and you are ready for your practice, imagine that you are a very deeply compassionate person. Think of all the qualities that you would ideally have as that compassionate person. Lets go through them: Focus on your desires to become a compassionate person and think, act and feel compassionately. Next imagine yourself with each of the qualities noted: imagine being calm and having wisdom (spend time just on this). Imagine yourself being sensitive with an ability to tolerate difficulties (spend time on just that). Imagine being warm and kind (spend time on just that). Imagine being non-condemning but also wanting to help, relieve suffering and produce change and flourishing. wise. Pay attention to your body as you bring this part of you to the fore. Spend a moment just feeling this expansion and warmth in your body. Think about your tone of voice and the kind of things youd say or the kind of things you would do or want to do. Spend one minute, more if you are able, thinking about your pleasure in being able to be kind. Remember, it doesnt matter if you feel you have these qualities or not, just imagine that you have them. See in your mind yourself having them, and work through them steadily, playfully and slowly. Sometimes we notice how each quality can affect our bodies differently. Remember that you may just get glimmers of things because your mind wanders or you can't really focus. This is very typical of what happens, just like if we were trying to learn to play a piano - wed be all fingers and thumbs to start with. Regular practice will help. Try to create a facial expression of compassion, maybe a slight smile or maybe a different expression to suit you. Imagine yourself expanding as if you are becoming more powerful, mature and
Another way you can access and practice your compassionate self is to spend a moment and remind yourself of a time when you felt compassionate; that is, calm and wise and wanting to help. You can think of your compassionate self as you at your best, imagining that inner sense of calm and the supportive voice. Use a compassionate expression when you recall this. Dont focus on a time when someone was very distressed because that might focus you on the distress. The aim is to focus on your feelings of wanting to help and your kindness. Compassion under the duvet Ideally try to practice becoming the compassionate self each day. If our lives are busy we can start by learning what can be called compassion under the duvet. When you wake up in the morning, try to spend a few minutes practicing becoming your compassionate self. As you lie in bed, bring a compassionate expression to your face, focus on your real desire to be wise and compassionate; remember inside you, you have the capacity for wisdom and strength, but you have to create space for it. Even two minutes a day, if practiced every day, may have an effect. You can also practice when you stand at the bus stop or just lying in the bath. After all, how often do we lie in the warmth of a bath and not really notice because our mind is wandering over all kinds of things mostly worries or things we need to do! This is not very relaxing! You may then find youll want to practice for longer periods of time or even perhaps find places where you can train more. Whenever you are aware of it, even sitting in a meeting, you can use soothing breathing and focus on becoming the wisest, compassionate, calm, mature self.
This exercise will help you take a more objective view of your difficulties and also begin to develop your own intuitive wisdom and abilities to heal. Once we no-longer fight with ourselves but become more accepting, and recognise the struggle that we can have in life (through no fault of our own), we might find it easier to gradually learn how to change.
We can move on to focusing and directing our compassionate self. To practice this find a time and place when you can sit quietly without being disturbed. Now try to create a sense of being a compassionate person, as best you can. Some days this will be easier than others even just the slightest glimmer can be a start. Now focus and bring to mind someone you care about (e.g. a partner, friend, parent or child) or an animal, or even a plant. When you have them in mind focus on directing towards them three basic feelings and thoughts: May you be well May you be happy May you be free of suffering
Keep in mind that it is your behaviour and intentions that are important - and the feelings may follow on behind. Be gentle, take time and allow yourself to focus on desires and wishes you create in yourself for the other person/animal/plant. Maybe picture them smiling at you and sharing these feelings. Okay, thats tricky if you are thinking of a plant, but imagine the plant as happy to receive your compassionate wishes. Spend time focusing on this genuine desire of yours for the other. Remember to be mindful in the sense that if your mind wanders that is not a problem; just gently and kindly bring it back to your task. Try to notice any feelings you have in yourself and your body that emerge from this focusing exercise. Dont worry if nothing much happens at a conscious level the act of having a go is the important thing. Like getting fit it may take some visits to the gym or training before you consciously notice feeling different, but your body will be responding straight away.
different feelings inside yourself. The funny thing is that because we don't really pay attention to what goes on in our minds we can allow ourselves to exist (ruminate and dwell) in places where we recall (or anticipate) other people being unkind or threatening to us. That means we spend time stimulating our threat system. When we do that we block out more helpful memories and brain patterns. The question is: What do we want to train our minds for? Where do we want to exist in the patterns we can create in our minds? Where do we want to shine the spotlight of our consciousness?
Please dont worry about remembering all of these qualities and emotions because you will be guided through them again when we do the imagery. Here are some questions that might help people build an image: Would you want your ideal compassionate image to feel/look/seem old or young; to be male or female (or non-human looking e.g. an animal, sea or light)? What colours and sounds are associated with the qualities of wisdom, strength, warmth and non-judgement? What would help you sense their commitment and kindness for you?
One of the key experiences is that your image really wants for you to be free of suffering, and/or to be able to deal with the difficulties, and to flourish. It knows that we all just find ourselves here, living as we do, trying the make the best of our minds and lives. It understands that our minds are difficult, that emotions can run riot in us and this is not our fault. Practice experiencing what it's like to focus on the feeling that another mind really values you and cares about you unconditionally. Now focus on the idea that your compassionate ideal is looking at you with great warmth. Imagine that they have the following deep desires for you: That you be well That you be happy That you be free of suffering
The key to the exercise is not the visual clarity. Indeed some people don't really see their images in any clear way at all. The key to the exercise is the focus and practice on the compassionate desires coming into you. Here the practice is to imagine another mind wishing for you to flourish. Now, you might have thought yes but this is not real, I want somebody real to care for me. That is, of course, very understandable and even doing this exercise could make you feel sad. That is because your intuitive wisdom recognises seeking for connectedness. The point to remember is that what we are trying to tackle is your own attitudes towards yourself, particularly feelings of shame or self-criticism. While it may indeed be desirable to find people who are caring, it's also very desirable that you create these feelings within you - so that you gradually learn to focus on compassion for yourself, rather than self-criticism. So try not to see it as an either/all, but as quite different processes between the compassion you give to yourself, and the compassion you'd like other people to give to you.
Worksheet for building your compassionate image Your absolute ideal in every way
How would you like your ideal caring, compassionate image to look/appear visual qualities?
How would you like your ideal caring, compassionate image to sound, e.g. tone of voice?
How would you like your ideal caring, compassionate image to relate to you?
In our groups we will be exploring the use of imagery to develop feelings and ideas of compassion. If you look back to the section on what is compassion you will see that we talked about the skills of compassion in terms of learning how to pay attention compassionately, learning how to think compassionately, learning how to behave compassionately (which will help ourselves and others flourish and improve) and, of course, learning how to create feelings of compassion. So, we can see compassion as directing many of the ways in which we think and react. And we can contrast this with what happens if the threat system takes control. Then our attention, thoughts, behavioural urges and feelings will be linked to anger or anxiety etc. You can see this in the diagrams below.
Imagery Fantasy
Compassion
Behaviour
Imagery Fantasy
Threat
Behaviour
Motivation
Emotions
Motivation
Emotions
Our emotions can direct our thinking in many ways. So when we're angry we think in angry ways, and when were anxious well think in anxious ways. Compassionate thinking requires us to think in a balanced way so that we are not too biased or emotionally controlled in our thinking. To help us we can ask ourselves some questions: Is this thinking helpful to me? Would I think like this if I weren't upset? Would I teach a child or friend to think like this? If not, how would I like to teach them to think about these things? How might I think about this when I am at my compassionate best?
The key point really is trying to be mindful of your thoughts and see how they can be pulled in certain ways, according to your feelings, but if you stand back and observe your thoughts with the intention of trying to find a compassionate, fair and balanced approach, with practice you may find this will come for you. So there's nothing magic in this and we will do various exercises together using your own wisdom and understanding of compassionate thinking.
difficult things and/or self acceptance and self peacefulness. Everything is orientated for that the way we think, our behaviours and our intentions. We are training our minds. Learning to think and reason compassionately can sometimes be helped along by writing letters to ourselves. In this exercise we are going to write about difficulties, but from the perspective of the compassionate part of ourselves. There are different ways you can write this letter. One way is to take your pen and paper and then spend some moments engaged with your soothing breathing rhythm. Next move into your compassionate self; remembering you at your best - at your calmest, at your wisest at your most caring. Imagine yourself as you would ideally like to be in terms of being mature and powerfully compassionate. Now try to feel your compassionate self. As you focus on it, feel yourself expanding slightly and feeling stronger. Imagine you are a compassionate person who is wise, kind, warm and understanding. Consider your general manner, tone of voice, and the feelings that come with your caring compassionate self. Adopt a kind facial expression. Try to feel the kindness in your face before moving on. Think about the qualities you would like your compassionate self to have. Spend time feeling and gently exploring what those qualities are like when you focus on them. Remember, it does not matter if you actually feel you are like this, but focus on the ideal you would like to be. It is your intentions that are important feelings may follow with practice. Spend at least one minute, longer if possible, thinking about those parts of yourself. Dont worry if this is difficult, just do the best you can have a go. When we are in a compassionate frame of mind (even just slightly), or in a pattern of trying to help a friend or someone we care for, we try to use our personal experiences of life wisely. We know that life can be hard; we offer our strength and support; we try to be warm and not judgemental or condemning. Now, just take a few breaths and try to sense and feel that wise, understanding, compassionate part of you arise in you. This is the part of you that will write the letter. So we try to write this kind of letter from a compassionate point of view. If thoughts of am I doing it right? or I cant get much feeling here arise, just note or observe these thoughts as normal comments our minds like to make, but re-focus your attention and simply observe what happens as you write, as best you can. There is no right or wrong, only the effort of trying it is the practice that helps. As you write, try to create as much emotional warmth and understanding as you can. You are practising writing these letters from your compassionate side. As you write your letter, try to allow yourself to understand and accept your distress. For example, your letter might start with: I am sad. I feel distressed; my distress is understandable because.. Note the reasons. Realising your distress makes sense. Then, perhaps you could continue with: I would like me to know that
For example, your letter might point out that as we become stressed or depressed, our depression or a distressed state can come with a powerful set of thoughts and feelings so how you see things right now may be the depression view on things. Given this, we can try and step to the side of the distress and write and focus on how best to cope. So we can write:
The Compassionate Mind Foundation 2010 Page 82
It might be helpful to consider. . . A second way of doing this is to imagine your compassionate image writing to you, imagining a dialogue with them, and what they will say to you. So, for example, my compassionate image might say something like: Hi Paul, Gosh, the last few days have been tough. Isnt it typical of life that problems arrive in groups rather than individually. Its understandable why youre feeling a bit down because . . . Hang in there because you are good at seeing these as the ups and downs of life. There have been times before when things have seemed dark but they pass and you have shown a lot of courage in dealing with this very tricky brain that is so tough at times. So you have developed abilities for getting through this and tolerating the painful things.
You will note that the letter points to my strengths and my abilities. It doesnt issue instructions such as: You must see these things as the ups and downs of life. This is important in compassionate writing. You dont want your compassionate letters to seem as if they are written by some smart bod who is giving you lots of advice. There has to be a real appreciation for your suffering, a real appreciation for your struggle and a real appreciation for your efforts at getting through. The compassion is a kind arm round your shoulders, as well as re-focusing your attention on what is helpful for you.
An example
Here is a letter from someone well call Sally, about lying in bed feeling depressed. Before looking at this letter, lets note an important point. In this letter we are going to refer to you rather than I. Some people like to write their letters like that, as if writing to someone else. See what works for you, but over time try to use I. So, you could read this letter and substitute I for you. Good morning Sally, Last few days have been tough for you so no wonder you want to hide away in bed. Sometimes we just get to the point of shutdown, dont we, and the thought of taking on things is overwhelming. You know you have been trying real hard but have felt exhausted through no fault of your own, I mean you havent put your feet up with a gin and tonic and the daily paper. I guess the thing now is to work out what helps you. Youve shown a lot of courage in the past in pushing yourself to do things that you find difficult. Lie in bed if you think that it can help you, of course, but watch out for critical Sally who could be critical about this. Also you often feel better if you get up, tough as it is. What about a cup of tea? You often like that first cup of tea. Okay, so lets get up, move around a bit and get going and then see how we feel. Tough, but lets try . . . So you see the point here: its about understanding, being helpful, having a really caring focus, but at the same time working on what we need to do to help ourselves. Now you might write this one in your head imagine a really kind and understanding part talking with you. At other times it is useful to actually use a pen and paper and write to yourself.
The Compassionate Mind Foundation 2010 Page 83
Self-critical people can struggle with this to begin with, and are not very good at writing compassionate letters. Their letters tend to be rather full of finger-wagging advice. So we have to work at this and practise. The point of these letters is not just to focus on difficult feelings but to help you reflect on your feelings and thoughts, be open with them, and develop a compassionate and balanced way of working with them. The letters should not offer advice or tell you what you should or shouldnt do. It is not the advice you need, but the support to act on it.
Therapist Note: The letter will contain all of the helpful attention, thinking, behaviour and feeling that were noted above. This requires the person to really focus on trying to be helpful and kind to themselves. You will find, however, that to begin with self-critical people write quite cold letters. They will often have words in like you dont need to feel down because or you should. These are invalidations and more authoritarian suggestions than compassionate ones. However they will change over time. Some people really enjoy learning to write letters to themselves, but it takes practice.
Compassionate Thinking
The Compassionate Mind Foundation 2010 Page 84
When we are stressed, harassed and worried and things go wrong, it is easy for our threat system to take control. Our thoughts are then focused on anxiety or anger. These are often unhelpful. Compassionate thinking involves slowing down, learning to become more aware of how our threat emotions, like anxiety or anger, are directing our thoughts. We then choose to intervene by standing back from those emotionally driven thoughts and, as kindly as we can, think about what is helpful. For example, we might think about what you would say or do to help a friend in the same situation. This learning to stand back from our emotional reactions, rather than let them dictate our thoughts and ruminations, is a key to training our minds. We can see a good example of this when we distinguish between shame-based selfcriticism and compassion-based self-correction. As we mentioned in the first part of this document, we all just find ourselves here, equipped with certain emotions that our genes have built for us, and our life experiences have shaped for us. So, much of what goes on in our minds is not our fault. However, people sometimes get the wrong idea about this and believe that nothing matters; it doesnt matter how we treat ourselves or others. This is not the compassionate way. The compassionate way is to take responsibility and try to improve things as best we can by learning from, and building from, our mistakes. If we just get lost in self-criticism and feelings of anger and frustration or disappointment this is not going to be helpful. So that is why it is important to distinguish shame-based selfcriticism from compassion-based self-correction. Some people believe that self-criticism is the only way to make them do things, to succeed or be good. For example, a person might say, If I didnt kick myself, Id never do anything. Or they might believe that unless they are critical and keep themselves on their toes, they will become arrogant, selfish and lazy. They use their self-bullying and selfcriticism to drive them on sometimes in rather unkind ways. In some cases, this view goes back to childhood where parents and teachers over-focused on the childs errors and not their positives. As a result, the child becomes good at self-criticism and selfpunishment but poor at seeing their good points, self-rewarding and valuing.
These distinctions are outlined in more detail in the table below: Compassionate Self-Correction is Focused on: * * * * The desire to improve Growth and enhancement Forward-looking Given with encouragement, support and kindness * Building on positives (e.g. seeing what Shame Based Self-Attacking is Focused on: * The desire to condemn and punish * Punishing past errors and is often backward looking * Given with anger, frustration contempt, disappointment * Focuses on deficits and fear of
one did well and then considering learning points) * Focuses on attributes and specific qualities of self * Focus and hope for success * Increases the chances of engage
exposure * Focuses on self as a global sense of self * Focus on high fear of failure * Increases chances of avoidance and withdrawal
Consider the example of encouraging supportive Consider the example of critical teacher with a teacher with child who is struggling. child who is struggling.
You can see that self-criticism is associated with threat-based emotions. Letting go of this type of self-criticism will help you, especially if you focus on compassionate self correction; your real desires to do your best and improve. For example, consider two teachers teaching a young child. One focuses on their deficits and picks on them when they make mistakes. The other teacher focuses on what the child does well and encourages the child to improve and learn from their mistakes and offers clear guidance. Which one will help the childs confidence? Which one do you really prefer? Compassionate self-correction is about being open to all our weaknesses, limitations and fallibilities (remember we did not design our brains) but with a genuine wish to improve. Hostile self-criticism is just unhelpful and can make us hide away. So practice compassionate self-correction when things go wrong for you or that frustration with yourself starts up. Compassionate self-correction is based on being open-hearted and honest about our mistakes with a genuine wish to improve and learn from them. No one wakes up in the morning and thinks to themselves, Oh, I think I will make a real cock-up of things today, just for the hell of it. Most of us would like to do well, most of us would like to avoid mistakes, most of us would like to avoid being out of control with our temper. We need to recognise that our genuine wish is to improve. Self-criticism, on the other hand, comes from a fear- and anger-based place. It is concerned with punishment and is usually backward-looking, related to things we have done in the past. The problem is you cannot change a single moment of the past, you can only change the future.
Compassionate Behaviour
Okay so we have been looking at our thoughts, how we can use imagery and how we can write to ourselves, what about behaviour - how can we develop compassionate behaviour. As we have frequently mentioned, it is our intentions and our behaviours that matter even if we don't always have the feelings to go with them. Compassionate behaviour is doing things to help ourselves and/or others to deal with suffering or develop, flourish and improve. Remember that there will be times when youre angry or frustrated and don't want to carry through on your commitment to looking after yourself properly. This is understandable of course, but, to the best of your ability, notice and be compassionate to your anger and frustration. Sometimes we just need to have some time to let things settle down; like sailing in the storm we
The Compassionate Mind Foundation 2010 Page 86
just have to wait for it to blow itself out. So if the feeling is to give up on any commitment you've made, then allow yourself to settle and then rekindle your commitment. It can help too if we can think about our values and deciding on what it is you really want to work for - sometimes we are not clear - so it can be helpful to think about this over the long term. How would you like to be in six months or a year? Remember to keep a lightness of touch, to be playful and hopeful.
Practice Diaries
Practice diaries are a way to keep notes about some of the exercises you will try, and can help you see how you are getting on. People often keep diaries to think and write about their thoughts, especially if theyre down. It can also be useful, however, to keep notes of your practice, your personal observations, what you're compassionate wise mind says, and your successes, no matter how small. In our group you will be keeping files and records of the notes from each session, and also of some of the practices that we have done.
in, smile compassionately and bring the attention back to exactly what it is you want to focus on. Again if these seem like a key problem for you, then stay with the processes that you find tolerable and build up from there. Only go with things you feel comfortable with. Another major block to compassion can be anger. Self-critical, depressed and anxious people can sometimes struggle with anger, and even admitting they feel angry about things. I have certainly met many people who have thoughts that its not compassion they want to develop, but to find a way to fight back, to stand up for themselves or even get their own back on people who have hurt them! Sometimes this anger is just a desire to be acknowledged and appreciated, and sometimes people are frightened of their anger, and that too can sometimes block compassion. So, for such folk, doing compassion exercises can actually make them feel a bit ashamed of their anger because they feel if they are compassionate they shouldnt feel angry. This is a misunderstanding of compassion. Some people believe that in order to be compassionate, they have to be nice people and nice people shouldnt feel angry, or irritable or unreasonable. They come to compassion training thinking that they have got to practice being nice people and get rid of their anger. However, compassion is actually about being honest and open to our anger, without self-judgement, but at the same time taking responsibility for what we do with it. In fact, the ability to acknowledge that we have great anger or rage can itself be a compassionate thing to do because its taking ourselves seriously and with honesty. The Dalai Lama (the head of the Buddhist community and renowned for his compassion) tells a story of how he used to like to fix watches. One day after working on a watch that he was struggling with he found his frustration mounting, until he picked up a hammer and smashed the watch to pieces! Its not so much whether or not we have frustration, anger or rage, its how we acknowledge it, our attitudes to it and how we express it thats important. Recognising how painful rage can be is compassionate. Coming to terms with the fact that anger rumination is harmful to us is compassionate; learning what to do about our anger is compassionate. Compassion is not about trying to soothe everything or sweep things under the carpet! We have a very difficult brain and anger can be powerful, which is why we need compassion for it. Sometimes people think that the compassionate approach is letting them off the hook, that its a soft and easy option. Its far from it. If you suffer from agoraphobia the compassionate approach is not to give up and sit in front of the television eating chocolate, as nice as that might be for a short time. The compassionate approach is to acknowledge that you are going to have to work with your anxiety and to practice getting out more and more each day. Compassion helps us to develop the courage we need to develop in order to confront and work with things we might be avoiding. So who ever told you compassion was a weakness or a simple option has misled you I'm afraid. Compassion is about honesty and developing courage, which is not always easy. So, rather than think of compassion as something fluffy, easy or soft, see it as how, through kindness, we can learn to face the powerful anxieties and rages, the difficulties and tragedies of our lives and gradually find some peace within. There is nothing soft or weak about this journey and sometimes it can move us in deep ways.
The Compassionate Mind Foundation 2010 Page 88
Summary
So in summary then we can see that we have a very difficult brain because of the way it has evolved over many millions of years. Within us are different patterns and potential states of mind. There is the angry self, the anxious self, the wanting to be loved self, the excited self, the proud self, the ashamed self - all coming with slightly different emotions, ways of thinking and desires to behave. These can also be affected by our background bodily states - whether we're exhausted or have a physical problem. And of course powerful emotional memories can be triggered in us that affect our bodies. If we come from difficult backgrounds some of the states of mind we typically experience are rooted in anxiety and anger because we haven't had the chance to develop other patterns - so we've always been on the defensive.
2.
Affect how I deal with life problems - what will be different how will I notice this happening and build on it?
3.
Affect how I interact with other people - what will be different how will I notice this happening and build on it?
4.
Affect how I choose and work towards life goals - what will be different? How will I notice this happening and build on it? (A goal can be short-term in the next few days, next weeks, months or over a life time)
5.
Affect how I deal with setback and life crises - what will be different how will I notice this happening and build on it?
6.
Affect any other life issues that are important to me - what will be different how will I notice this happening and build on it?
How can I build compassion into everyday life? How might I notice blocks to compassionate living and work compassionately with these?
Pointers Try to keep it relatively simple to start with - Just the four of five headings Focus on sharing and understanding together and encourage client to do his or her own or add to it Avoid language of cognitive distortion or maladaptive schema as this can be shaming for high shame clients Focus on your defence system has tried to keep you safe; better safe than sorry etc. natural, but with unintentional drawbacks e.g., little new learning, few opportunities for exploration
Forms for exploring unhelpful thoughts and generating compassion- focused alternative thoughts and ideas
Triggering Events, Feelings or Images Key questions to help you identify your thoughts. What actually happened? What was the trigger? Depressing, Upsetting Thoughts What went through your mind? What are you thinking about others, and their thoughts about you? What are you thinking about yourself, and your future? External shame: (what I think others think about me) Feelings What are your main feelings and emotions? Compassion-focused Alternatives to Self-Critical Thoughts What would you say to a friend? What compassionate alternatives might there be? What is the evidence for new view? (How) are these examples of compassion, care and support? Can you think these through with warmth? Empathy for own distress: Understanding and change in feelings Write down any change in your feelings.
Compassionate Attention:
Compassionate Thinking:
Compassionate Behaviour:
Function:
Function:
Simplified form for exploring unhelpful thoughts and generating compassion- focused alternative thoughts and ideas
Depressing, Upsetting Thoughts What went through your mind? What are you thinking about others, and their thoughts about you? What are you thinking about yourself, and your future? Compassion-focused Alternatives to Self-Critical Thoughts What would you say to a friend? What compassionate alternatives might there be? What is the evidence for new view? (How) are these examples of compassion, care and support? Can you think these through with warmth? Empathy for own distress:
Compassionate Attention:
Compassionate Thinking:
Compassionate Behaviour:
Prompts for helping us with distressing thoughts and generating helpful alternative thoughts, feelings, ideas and behaviours ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Distressing, Upsetting Events, Helpful, Compassionate Thoughts Helpful, Compassionate Behaviours Thought, Images or Feelings ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Note how your thoughts are related to key fears. Now focus on creating your compassionate image or sense of self and think about how your could look at with understanding and warmth e.g., how might you speak to a friend or someone you really cared for; what might a more balanced view be. So what would be a helpful thing for you to do now not what you think you should do but what in reality might be helpful for you. By focusing on what is helpful to you, you are finding your own way of working on these difficulties.
Reflection Sheets
Consider with those around you the three key ideas you have picked up today.
1.
2.
2.
3.
Reflection Sheets
Consider with those around you the three key ideas you have picked up today. 1.
2.
2.
3.
Notes
Notes