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