Therapist perspectives on working with fears,blocks and resistances to compassion in compassion focused therapy

Objective

A core aspect of compassion focused therapy (CFT) is addressing fears, blocks, and resistances (FBRs) to compassion. How CFT therapists do this with clients remains unclear. This study aims to explore the perspectives of well-trained, experienced CFT therapists regarding how they work with FBRs in the context of CFT.

Methods

A qualitative study was conducted. Participants were asked five open-ended questions regarding (a) their experiences of working with FBRs to compassion, (b) how they understand and formulate FBRs, (c) specific ways they address FBRs, (d) how other therapists might learn about working with FBRs, and (e) their top recommendations. A total of 64 participants completed the online questionnaire, and the qualitative data were analysed using thematic analysis.

Results

The analysis produced four interrelated superordinate themes: (a) Getting “alongside” and “behind”: The central role of formulation, (b) “It's not your fault”: Psychoeducation, (c) “Get experiential”: An emphasis on experiential interventions, and (d) “Respect the wisdom”: The importance of therapeutic process.

Conclusions

Working with FBRs to compassion is critical in CFT. Understanding the wisdom in the client's FBRs, and validating and de-shaming the client's FBRs are crucial. We provide clinical recommendations regarding working with FBRs as part of CFT.     

The Moderating Effects of Age on the Relationships of Self‐Compassion,Self‐Esteem,and Mental Health

This study investigated the interactive effects of self‐compassion, self‐esteem, and age on mental health. Numerous previous studies have found that self‐compassion has a significant positive association with well‐being but most of these studies were conducted with young adults represented by college students. This study extended the previous findings by comparing its distinctive functions in different age groups. A total of 1,813 adults whose age ranged from twenties to fifties (M = 39.28 years, SD = 11.27) completed a questionnaire measuring self‐compassion, self‐esteem, subjective well‐being, and depression. The results of hierarchical regression analysis indicated that the positive relationship between self‐compassion and subjective well‐being was rendered stronger with older adults. In addition, self‐compassion moderated the relationship between self‐esteem and depression regardless of age. These results imply that self‐compassion may be complimentary to self‐esteem in improving mental health, especially for older adults.     

Improving Women's Self‐Compassion Through an Online Program: A Randomized Controlled Trial

The benefits of self‐compassion interventions have been well documented in the counseling literature. Despite these benefits, access to such interventions remains a considerable barrier for a range of populations. We addressed the issue of limited access by using a randomized controlled trial to evaluate an online, self‐guided course on self‐compassion specifically targeted toward women. Fifty‐seven women were randomly assigned to receive immediate or delayed access to a 10‐week course designed to increase self‐compassion and reduce self‐judgment, shame, and perfectionism. Analysis of the data revealed that participants in the treatment condition experienced significant increases in self‐compassion and decreases in self‐judgment, shame, and perfectionism compared with participants in the wait‐list group. Results provide evidence that self‐compassion can be fostered in a nonclinical population of women through participation in a self‐paced online course. Related findings and potential implications, including the use of such interventions to address accessibility concerns, are discussed within the existing literature.     

Relationship between self‐worrying and self‐critical messages in clients with generalised anxiety engaging in emotion‐focused worry dialogues

Emotion‐focused therapy (EFT) has recently been adapted as a treatment for generalised anxiety disorder (GAD). One intervention used in this adaptation is a worry dialogue, in which the client enacts worry in one chair (“worrier”) and is facilitated to experience the impact of this worry in another chair (“experiencer”). Although not formally studied, anecdotal observations from therapists in the EFT for GAD treatment development study suggested that within worry dialogues there might be a link between client's self‐worrying and self‐critical messages. This study used data from 47 worry dialogues from fourteen study clients who received EFT for GAD. An observation based qualitative analysis of clients' self‐directed messages as present in in‐session worry dialogues was conducted using video/audio recordings of relevant sessions. Results indicate a relationship between self‐worrying and self‐critical messages. A total of 90 paired self‐worry and self‐critic messages across the 47 worry dialogues were logged. Six recurring clusters of themes/relationships were observed: (a) I need to be prepared for future negative events because… I'm weak and a failure; (b) I need to stop worrying… I'm flawed for being a worrier; (c) People will negatively judge me if I engage with them… because I'm not good enough; (d) If I don't worry, there will be negative consequences… and I will be responsible and will be unable to bear it; (e) I worry/ruminate that I cause(d) some damage… because I'm incompetent; and, (f) I must always be prepared against others taking advantage of me… because I'm weak. Given the observed close link between self‐critical and worry processes, it is important that therapists differentiate between these processes and remember to address both in therapy for GAD.     

Self‐Compassion as a Mediator of Mindfulness and Compassion for Others

Mindfulness and self‐compassion have garnered interest as tools for improving counselor wellness and performance, yet little is known about how they relate to compassion. Compassion—for oneself and others—is considered important to counselor well‐being and effective counseling. In Buddhist and current models, mindfulness is theorized to increase self‐compassion and, subsequently, compassion for others, but the study of these proposed relationships is limited. Using mediation analysis, the author confirmed self‐compassion as a mediator of mindfulness and compassion for others among 152 master's‐level counseling interns. Implications and practical application of mindfulness and self‐compassion for counselor development are discussed.     

Contribution of self‐compassion to positive mental health among Korean university students

Although evidence suggests self‐compassion can serve as an important predictor of positive mental health, few studies have examined the contribution of self‐compassion to mental health. This study examined the relations between six components of self‐compassion and three dimensions of positive mental health (Psychological, Emotional and Social Well‐being) in young Korean adults. A sample of 689 Korean college students were administered the Self‐Compassion Scale (SCS) and the Mental Health Continuum Short Form (MHC‐SF) to evaluate self‐compassion and positive mental health. A multiple indicators multiple causes (MIMIC) analysis revealed that Self‐Kindness significantly predicted all dimensions of positive mental health. Additionally, Over‐Identification significantly contributed to Emotional Well‐being, Common Humanity to Social Well‐being and Isolation to Psychological Well‐being. These results suggest Self‐Kindness is a key predictor of positive mental health and that specific components of self‐compassion are strongly related to specific dimensions of mental health in Koreans.     

Comment on “The Self‐Care of Psychologists and Mental Health Professionals” (Dattilio, 2015)

Professor Frank Dattilio's article “The Self‐care of Psychologists and Mental Health Professionals” provides an overview of stress and related mental health problems among psychologists, and a proposition that psychologists are not vigilant in regard to self‐care. Dattilio offers a range of self‐care strategies and recommendations, and highlights self‐care practices within various psychology frameworks, and concludes with some “healthy tips” for managing stress. In my commentary I underscore Dattilio's message that self‐care is of critical importance in psychology practice, given the responsibility of caring for others inherent in the work psychologists undertake. However, I raise additional points of consideration and suggest an alternative approach to addressing the self‐care needs of the profession. My commentary makes the following points: (a) the need to distinguish between psychology trainees and practising qualified psychologists when addressing stress and self‐care requirements in the profession; (b) the importance of developing a culture of self‐care among psychologists by providing self‐care instruction during training; (c) the need to temper research findings on stress and mental health among psychologists by the methodological weakness of the studies in this area; (d) adhering to the recent call from colleagues to shift from a focus on pathology and punishment to a positive acceptance, mindfulness, and values‐based approach for encouraging self‐care among psychologists; (e) the use of a systematic framework for organising the presentation of self‐care strategies that makes them more accessible; and (f) an appeal to professional bodies to take their responsibility in promoting self‐care in the profession.     

Compassion‐Based Meditation in African Americans: Self‐Criticism Mediates Changes in Depression

This study examines self‐criticism as a mechanism through which compassion meditation reduces depressive symptoms in low‐income African American men and women (N  = 59) who had recently attempted suicide. After completing several measures, including the Levels of Self‐Criticism Scale and Beck Depression Inventory‐II , participants were randomly assigned to receive either a six‐session compassion meditation (CM ) group (Grady Compassion and Meditation Program) or a six‐session support group. As predicted, path analysis results showed that treatment condition led to changes in self‐criticism from pre‐ to posttreatment, with those receiving CM showing greater reductions in levels of self‐criticism than those randomized to the support group. Path analyses also revealed that changes in self‐criticism fully mediated the link between condition and changes in depressive symptoms. These findings highlight the importance and value of targeting levels of self‐criticism in compassion‐based interventions to reduce the depressive symptoms of suicidal African Americans.     

Exploring the social side of self‐compassion: Relations with empathy and outgroup attitudes

Self‐compassion is a disposition involving compassionate attitudes toward the self when facing difficulties. We argued that specific self‐compassion components might influence indicators of openness to others, such as empathy and outgroup attitudes. We hypothesized that the component called common humanity versus isolation, involving the acknowledgement that one's sufferings are shared with all the other humans, would be positively related to the other‐oriented aspects of empathy, perspective taking and empathic concern, and to improved outgroup attitudes. We also hypothesized that the mindfulness versus over‐identification component, i.e., having a balanced view of one's situation avoiding exaggerations, would be associated with lowered personal distress. In three studies, with three independent samples, we regressed empathy and outgroup attitudes on self‐compassion components, while controlling for concurrent predictors such as self‐construal and attachment styles. Results supported our hypotheses, suggesting that improvements in empathy and outgroup attitudes may be fostered by positive individual dispositions.     

How self‐compassion moderates the effect of body surveillance on subjective happiness and depression among women

According to objectification theory (Fredrickson & Roberts, 1997), being treated as an object leads women to engage in self‐objectification, which in turn increases body surveillance and body shame as well as impairs mental health. However, very little is known about what factors could act as buffers against the detrimental consequences of self‐objectification. This paper seeks to understand the role of self‐compassion (the ability to kindly accept oneself or show self‐directed kindness while suffering) in the perception that women have of their own bodies. Results indicate that self‐compassion moderated the effect of body surveillance on depression and happiness separately among women. More specifically, for women low in self‐compassion, body surveillance was negatively associated with happiness, which was explained by increased depression. In sum, our results indicate that self‐compassion protects against the detrimental consequences of body surveillance.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.     

Contemplating Tragedy Raises Gratifications and Fosters Self‐Acceptance

Despite the reflective nature of tragedy, little research has focused on reflection's impact on “pleasure” and personal growth. Drawing from entertainment, literary, and health research, this study assessed the degree to which contemplating tragedy increases gratifications and promotes self‐acceptance. The moderating effects of life events were also examined. In an experiment, participants (N = 120) were randomly instructed to either watch a Hollywood drama and reflect, or only watch the movie (control). Results showed significant main effects on appreciation and enjoyment. Reflection increased gratifications for participants with remote loss (≥2 years) but not recent loss, and it strengthened the link between self‐perceptual depth and a 4‐week change in self‐compassion. The benefits and drawbacks of reflecting on tragedy are discussed.     

CULTIVATING LOVING KINDNESS: A TWO‐STAGE MODEL OF THE EFFECTS OF MEDITATION ON EMPATHY,COMPASSION, AND ALTRUISM

Abstract. We explore the role of meditative practice in cultivating experiences of compassion, empathy, and altruism and address an apparent paradox: Meditation often is associated with solitary retreat, if not preoccupation with one's own concerns. How, then, does such a practice promote compassion for others? We propose a two‐stage model. The first stage involves disengagement from usual preoccupation with self‐reinforcing, self‐defeating, or self‐indulgent behaviors and reactions; the second involves a focused engagement with a universal human capacity for altruistic experience, love, and compassion. Reference is made to the limited research literature and to clinical applications of loving kindness (metta) meditation in cultivating these processes.     

Self‐compassion Is Best Measured as a Global Construct and Is Overlapping with but Distinct from Neuroticism: A Response to Pfattheicher,Geiger, Hartung,Weiss, and Schindler (2017)

Pfattheicher and colleagues recently published an article entitled ‘Old Wine in New Bottles? The Case of Self‐compassion and Neuroticism’ that argues the negative items of the Self‐compassion Scale (SCS), which represent reduced uncompassionate self‐responding, are redundant with neuroticism (especially its depression and anxiety facets) and do not evidence incremental validity in predicting life satisfaction. Using potentially problematic methods to examine the factor structure of the SCS (higher‐order confirmatory factor analysis), they suggest a total self‐compassion score should not be used and negative items should be dropped. In Study 1, we present a reanalysis of their data using what we argue are more theoretically appropriate methods (bifactor exploratory structural equation modelling) that support use of a global self‐compassion factor (explaining 94% of item variance) over separate factors representing compassionate and reduced uncompassionate self‐responding. While self‐compassion evidenced a large correlation with neuroticism and depression and a small correlation with anxiety, it explained meaningful incremental validity in life satisfaction compared with neuroticism, depression, and anxiety. Findings were replicated in Study 2, which examined emotion regulation. Study 3 established the incremental validity of negative items with multiple well‐being outcomes. We conclude that although self‐compassion overlaps with neuroticism, the two constructs are distinct. © 2018 European Association of Personality Psychology     

PATIENT‐ANALYST “WITHNESS”: ON ANALYTIC “PRESENCING,” PASSION,AND COMPASSION IN STATES OF BREAKDOWN,DESPAIR, AND DEADNESS

This paper focuses on the analyst's “presencing” (being there) within the patient's experiential world and within the grip of the psychoanalytic process, and the ensuing deep patient–analyst interconnectedness, as a fundamental dimension of analytic work. It engenders new possibilities for extending the reach of psychoanalytic treatment to more disturbed patients. Here patient and analyst forge an emergent new entity of interconnectedness or “withness” that goes beyond the confines of their separate subjectivities and the simple summation of the two. Using a detailed clinical illustration of a difficult analysis with a severely fetishistic‐masochistic patient, the author describes the kind of knowledge, experience, and powerful effects that come into being when the analyst interconnects psychically with the patient in living through the process, and that relate specifically to the analyst's compassion.     

“No More” leads to “Want More,” but “No Less” leads to “Want Less”: Consumers' counterfactual thinking when faced with quantity restriction discounts

The current research examines the impact of point‐of‐purchase (POP) discounts on consumers' counterfactual thinking (CFT). Study 1 reveals that consumers tend to engage in upward CFT (what might have been better) rather than downward CFT (what might have been worse) in response to POP discounts. Study 2 shows that upward CFT depends on how the discount information is framed. A discount with a lower‐quantity restriction (e.g., “X % off if you buy at least Y items”) leads consumers to counterfactually wish to buy more, but a discount with an upper‐quantity restriction (“X % off – limit Y items per customer”) leads consumers to wish to buy less. Study participants in both conditions report they would buy the same POP‐suggested amount, but for completely opposite reasons. In Study 3, this convergence effect in purchase quantity disappears when the maximum and minimum restrictions are lifted, suggesting that quantity restrictions in POP discounts guide quantity decisions. Copyright © 2011 John Wiley & Sons, Ltd.     

A pilot exploration of the use of compassionate images in a group of self‐critical people

Self‐criticism has long been associated with a variety of psychological problems and is often a key focus for intervention in psychotherapy. Recent work has suggested that self‐critics have underelaborated and underdeveloped capacities for compassionate self‐soothing and warmth. This pilot study developed a diary for monitoring self‐attacking and self‐soothing thoughts and images. It also explored the personal experiences of a group of volunteer self‐critics from the local depression support group who were given training in self‐soothing and self‐compassion. Although using small numbers, this study suggests the potential value of developing more complex methodologies for studying the capacity for self‐compassion, interventions to increase self‐compassion (including imagery techniques), and their effects on mental health.     

An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.