“Sharing in people's pain is not an easy thing to do”: Cognitive Behavioural Therapists' understandings of compassion in the workplace

Objectives

Compassion is central to the aim of improving patient care and staff well-being within healthcare systems. To inform service development, explorations of experiences and meanings of compassion are needed. This study explored cognitive behavioural therapists ' understandings of compassion within their work environment.

Design

A qualitative study was conducted using semistructured interviews and interpretative phenomenological analysis (IPA).

Methods

Data were obtained from five practicing cognitive behavioural therapists.

Results

Two superordinate themes were developed, each with two subordinate themes. CBT therapists reported entering the profession with intrinsic motivation to care for others. They further developed an interest in compassion with exposure to clients and ongoing professional development in compassion-focused therapy (CFT). Compassionate work environments helped to facilitate compassionate practice; however, for many, workplaces were perceived to lack compassion. Challenges were encountered when negative workplace interactions left therapists feeling fatigued, distressed and demoralised. There was a desire for recognition and to be seen as more than a “work machine,” the experience of which was a threat to retaining therapists within the profession.

Conclusions

Current recruitment and training processes are producing staff with skills and motivation to deliver compassionate care. However, lack of compassion within workplaces can be a barrier to actioning these skills and motivations. Research needs to focus on how to effectively implement and run systems that are compassionate for both staff and clients. To provide compassionate care, staff need work environments that show compassion to them. These findings provide some insights into and practical suggestions regarding how this can be achieved.     

“A definite feel‐it moment”: Embodiment,externalisation and emotion during chair‐work in compassion‐focused therapy

Chair‐work is an experiential method used within compassion‐focused therapy (CFT) to apply compassion to various aspects of the self. This is the first study of CFT chair‐work and is focused on clients' lived experiences of a chair‐work intervention for self‐criticism. Twelve participants with depression were interviewed following the chair‐work intervention and the resulting data were examined using interpretative phenomenological analysis. Three superordinate themes were identified: “embodiment and enactment,” “externalising the self in physical form” and “emotional intensity.” The findings suggest the importance of accessing and expressing various emotions connected with self‐criticism, whilst highlighting the potential for client distress and avoidance during the intervention. The role of embodying, enacting and physically situating aspects of the self in different chairs is also suggested to be an important mechanism of change in CFT chair‐work. The findings are discussed in terms of clinical implications, emphasising how core CFT concepts and practices are facilitated by the chair‐work process.     

Personal factors related to compassion fatigue in health professionals

This study examines the role of some personal and professional factors in compassion fatigue among health-care professionals. Research participants included 182 (89 mental and 93 medical) health-care professionals who completed an assessment battery measuring compassion fatigue, emotion management, trait emotional intelligence, situation-specific coping strategies, and negative affect. Major findings indicate that both self-report “trait” emotional intelligence and ability-based emotion management are inversely associated with compassion fatigue; adaptive coping is inversely related to compassion fatigue; and differences exist between mental and medical professions in emotional intelligence, coping strategies, and negative affect. Furthermore, problem-focused coping appears to mediate the association between trait emotional intelligence and compassion fatigue. These findings shed light on the role of emotional factors in compassion fatigue among health-care professionals. Beyond enhancing our knowledge of practitioners' professional quality of life, the current study serves as a basis for the early identification of groups of practitioners at risk for compassion fatigue.     

Compassion satisfaction,compassion fatigue,and burnout in a national sample of trauma treatment therapists

Abstract

For behavioral health professionals working with traumatized clients, continuous and prolonged exposure to the stress of working with the myriad of trauma-related stressors experienced by their clients can lead to various responses including burnout, compassion fatigue, and compassion satisfaction. The present study investigates the impact of using evidence-based practices on compassion fatigue, burnout, and compassion satisfaction in a random, national sample of self-identified trauma specialists (N=532). The 30-item Professional Quality of Life Scale (Stamm, 2005) and the 19-item Trauma Practices Questionnaire (Craig & Sprang, 2009) were included in a survey to licensed social workers and psychologists from professional membership rosters. Age and years of experience proved to be powerful predictors of only two of the three criterion variables, with younger professionals reporting higher levels of burnout and more experienced providers endorsing higher levels of compassion satisfaction. The utilization of evidence-based practices predicted statistically significant decreases in compassion fatigue and burnout, and increases in compassion satisfaction. The utility of these findings in understanding the process of trauma transmission between therapist and client as well as directions for future research are discussed.     

Burnout,compassion fatigue and compassion satisfaction among nurses in the context of maternal and perinatal deaths

This study investigated the prevalence and levels of burnout, compassion fatigue and compassion satisfaction among nurses with exposure to maternal and perinatal deaths. A convenience sample of 83 nurses was selected for participation from six hospitals in Limpopo province, South Africa, comprising 98% females with an age range of 21 to 62 years, and 15 to 18 mean years of experience in maternal and perinatal care. The nurses completed the Professional Quality of Life Scale (ProQOL R-IV), which is a measure of burnout, compassion fatigue and compassion satisfaction. The analysis examined the prevalence and level of burnout, compassion fatigue and compassion satisfaction among the nurses. Most of the respondents (92%) reported with moderate burnout scores, and about 67% reported with moderate to high compassion fatigue scores, whilst 82% reported with compassion satisfaction scores. Moderate levels of high burnout and compassion fatigue can co-occur with relatively high compassion satisfaction among nurses in critical-care health services.     

EMPATHY AND THE EVOLUTION OF COMPASSION: FROM DEEP HISTORY TO INFUSED VIRTUE

This article poses a challenge to contemporary theories in psychology that portray empathy as a negative force in the moral life. Instead, drawing on alternative psychological and philosophical literature, especially Martha Nussbaum, I argue that empathy is related to the virtue of compassion and therefore crucial for moral action. Evidence for evolutionary anthropological accounts of compassion in early hominins provides additional arguments for its positive value in deep human history. I discuss this work alongside Thomistic notions of practical wisdom, compassion, misericordia, and the importance of reason in the moral life. The tension between “bottom up” accounts of empathy and that according to a theological interpretation of “infused” virtues also needs to be addressed. From a secular perspective, infused virtue is a projection of the ideal moral life, but from a theological perspective, it is a way of understanding how human capacities through the action of grace can reach beyond what seem to be the limits of psychological moral identity.     

The protective role of compassion satisfaction for therapists who work with sexual violence survivors: an application of the broaden-and-build theory of positive emotions

Therapists who work with trauma survivors, such as survivors of sexual violence, can experience compassion satisfaction while experiencing negative effects of trauma work, such as secondary traumatic stress. We examined whether the negative effects of secondary traumatic stress on therapist adjustment would be buffered by compassion satisfaction and whether the broaden-and-build theory of positive emotions could be applied to examine the factors (positive emotions and positive reframing) that relate to compassion satisfaction. Sixty-one therapists who work with sexual violence survivors completed measures of secondary traumatic stress, compassion satisfaction, adjustment, positive emotions and positive reframing. Hierarchical multiple regression analyses found that compassion satisfaction buffered the negative impact of secondary traumatic stress on therapist adjustment when adjustment was conceptualised as anxiety. Using non-parametric bootstrapping, we found that the relationship between greater positive emotions and greater compassion satisfaction was partially mediated by positive reframing. The findings indicate that compassion satisfaction is likely to be helpful in ameliorating the negative effects of secondary traumatic stress on anxiety in therapists who work with sexual violence survivors and that the broaden-and-build theory of positive emotions may provide a strong theoretical basis for the further examination of compassion satisfaction in trauma therapists.     

Meditation buffers medical student compassion from the deleterious effects of depression

Increasing data suggest that for medical school students the stress of academic and psychological demands can impair social emotions that are a core aspect of compassion and ultimately physician competence. Few interventions have proven successful for enhancing physician compassion in ways that persist in the face of suffering and that enable sustained caretaker well-being. To address this issue, the current study was designed to (1) investigate the feasibility of cognitively-based compassion training (CBCT) for second-year medical students, and (2) test whether CBCT decreases depression, enhances compassion, and improves daily functioning in medical students. Compared to the wait-list group, students randomized to CBCT reported increased compassion, and decreased loneliness and depression. Changes in compassion were most robust in individuals reporting high levels of depression at baseline, suggesting that CBCT may benefit those most in need by breaking the link between personal suffering and a concomitant drop in compassion.     

Notes for New Therapists

In this article, we draw on our experiences as therapists and supervisors to highlight the errors new clinicians tend to make and how they can be avoided. A critical issue is how to approach the client's narrative. We propose a stance of “respectful skepticism,” in which the factors that shape the client's truth can best be appreciated. This represents a middle way between gullible listener and prosecuting attorney. We also discuss common problems with client motivation, as well as the changing role of feelings in therapy, the importance of the therapeutic contract, the high cost of defensiveness, the concept of conversational domains, and the advantages of avoiding therapeutic platitudes, explanatory fictions, and jargon.     

Facilitating the client's experience of relational depth in counselling and psychotherapy: A thematic review

Aim

There is increasing interest in relational depth and its relevance and benefits for clients receiving therapy in a number of different therapeutic orientations. This research set out to draw together the available evidence from a wide range of therapies about clients' experiences of relational depth. The aim was to identify approaches that create the conditions where relational depth is more likely to be facilitated. The research focused on clients' views, given the increasing emphasis on their experiences in therapy.

Methodology

A systematic search of papers published in English between January 1996 and September 2022 was conducted using EBSCO Host, Google Scholar and citation chaining. Twenty-seven papers met the inclusion criteria, and a thematic analysis was conducted on these papers.

Findings

Six themes were identified: (1) establishing dialogue with the client's inner world, (2) working with attachment in therapy, (3) responding sensitively to the client's beliefs and values, (4) deepening the client's understanding of the therapist, (5) addressing ruptures in therapy and (6) the client's role in meeting at relational depth.

Conclusion

Facilitating the client's experience of relational depth can support and enhance many aspects of therapeutic practice and in itself may contribute to healing. Therapists who offer warmth and genuine engagement are more able to build confidence and trust, as long as these conditions are received by their clients. It is the clients who ultimately decide whether or not to share their deepest feelings.     

“Why would you want to do that work?” The positive impact on therapists of working with child victims of sexual abuse in Ireland: a thematic analysis

Abstract

Research on the impact on psychotherapists of working with trauma has typically focused on negative impact and protective strategies and supports for therapists working in this field, such as self-care strategies and supervision. Yet many clinicians speak of the rewarding and fulfilling experiences of working with those who have been sexually abused. This study explored the positive impact of working with children who have been sexually abused in a sample of psychotherapists in Ireland. Unstructured interviews were conducted with nine female therapists who work in a specialist sexual abuse service with child victims of sexual abuse. An inductive thematic analysis identified four key themes: “the struggle to talk about the positive impact”, “professional satisfaction from helping children”, “learning life lessons from children” and “the magical connection that happens in therapy”. The findings show that, despite therapists’ tendency to think about negative impact, when encouraged to do so they described finding the work professionally rewarding, experiencing an enhancement of their own attitudes and lives through learning from the children they worked with and feeling uplifted within the therapeutic relationship with the child. Suggestions are offered for future research that may provide a broader understanding of the positive impact of this work.     

Exploring the relationship between mindfulness,compassion and unfamiliar face identification

ABSTRACT

Research has related empathy to face recognition. Empathy is proposed as part of compassion, while compassion relates to self-compassion and mindfulness, which may be more effective in face recognition than empathy alone. Experiment 1 investigated the relationship between compassion, self-compassion and empathy, and unfamiliar face recognition memory and matching. Self-compassion, including its facets of mindfulness and common humanity, were related to better recognition, but not matching. Results did not support a relationship between face identification and empathy or compassion. Experiments 2 and 3 further investigated common humanity and mindfulness and found both constructs to relate to face recognition memory. Furthermore, aspects of mindfulness (i.e., act aware and describe) positively related to face recognition. Experiment 3 used an array matching task to further show that matching did not relate to mindfulness or common humanity. The present findings may inform new directions in face recognition research, aiming to practically assist face recognition.     

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.     

Yoga-integrated psychotherapy for emotion dysregulation: A pilot study

Aims & Objectives

Yoga has been evidenced as beneficial for physical and mental health. This study sought to pilot the acceptability and feasibility of a yoga-integrated psychotherapy (YiP) intervention, aimed at alleviating difficulties in emotion regulation. A further aim was to explore the perceived effectiveness of YiP in alleviating depression, anxiety and improving well-being.

Methods

Seven participants who scored significantly on the Difficulties in Emotion Dysregulation Scale (DERS) took part in a psychological assessment session followed by six weekly one hr therapy sessions. Participants completed self-report measures in each session to quantify the effects of each YiP session on emotion regulation, well-being, depression and anxiety. Following seven sessions, five participants completed qualitative follow-up interviews to explore subjective experiences of YiP and any perceived impacts.

Findings

An ANOVA that contained data from seven participants who completed all six sessions revealed that DERS scores were significantly lower, and well-being scores were significantly higher, at both mid and end-points than at baseline. Thematic analysis of qualitative interviews identified five themes: “YiP assists the client's psychological and emotional processing,” “YiP improves insight and focus,” “YiP is culturally sensitive,” “the body facilitates regulation and resilience” and “YiP is acceptable & impactful.”

Conclusion

The study presents promising findings for the integration of yoga into psychotherapeutic practice and indicates that YiP may have beneficial effects on emotion regulation and psychological well-being. Future research should use randomised controlled methodologies to examine the ability of YiP to alleviate a wide range of affective symptoms using a larger sample of participants.     

EVOLUTION OF RELIGIOUS CAPACITY IN THE GENUS HOMO: TRAIT COMPLEXITY IN ACTION THROUGH COMPASSION

In this third and last article on the evolution of religious capacity, the authors focus on compassion, one of religious expression's common companions. They explore the various meanings of compassion, using Biblical and early related documents, and derive general cognitive components before an evolutionary analysis of compassion using their model. Then, in taking on neural reuse theory, they adapt a model from linguistics theory to understand how neural reuse could have operated to fix religious capacity in the human genome. They present a teaching tool on “Religious Capacity in Action,” and develop an example of compassionate decision making in very early Homo sapiens in North Africa. They round out their analysis of compassion by exploring theory in neuroscience on a standard decision‐making model, and investigate what goes on in the human brain when a values‐based decision is made.     

Reiteration: The ‘Imperative of the Word’ and Echoing the ‘Significative Terms’

Abstract

The act of reiteration is viewed as a therapeutic reply that is especially responsive in the face of what Lacan (1977) and Heidegger (1927/1962) respectively refer to as “empty speech” and “idle talk.” By hearing and selecting those key signifiers and phrasings that bear the client's story of distress, the act of reiteration allows us to focus and address the “subject who speaks” rather than the commonsense storyline itself. As an active and continuing punctuation of the client's direct discourse at the level of the word, the act of reiteration is only the first moment of a more complete narrative reply. But in keeping the therapist ever grounded in the client's direct expressions, it is this first moment of reiteration that leaves the therapist positioned to be responsive to the client's discourse of “rhetorical displacements,” of intimation and allusion, as these “echo” from “elsewhere.”     

Why Do We Still Call Them “Paradoxes”

The fact that therapists label some events “paradoxical” may suggest that our current beliefs or theories are limited in their ability to adequately account for those phenomena. It is argued that our underlying belief in objectivity surrounds therapeutic “paradoxes” with a persistently paradoxical aura, and leads to confusion in our understanding of a variety of phenomena. Maturana's ideas regarding structure determinism, instructive interaction, and phenomenal domains are used to suggest an answer to these difficulties. It is claimed that the problematic status of many theoretical concepts (for example, communication, information, resistance, homeostasis, and pathology) is revealing of something quite important — that the experiential validity of instructive interaction repeatedly leads us into implicitly or explicitly employing instructive interaction in a domain where it can never be valid: the domain of theory and explanation.     

Can virtue be learned? An exploration of student learning experiences in ethics courses and their implications for influencing moral character

What does it mean to teach virtue, or to learn it? We consider this question through an institutional review board (IRB) supported research study attending to student learning experiences in undergraduate ethics courses at a Catholic university with an explicit commitment to social justice. This essay draws on and interprets qualitative data concerning the outcomes of select pedagogical approaches that involve exposing students to the experiences of others: the use of narratives; participation in structured experiential learning activities; and community engagement through deep listening and facilitated dialogue. We focus our interpretation around the implications of these pedagogies in relation to student understanding of and attitudes regarding three character traits identified as “other‐regarding” virtues in theological and philosophical scholarship – altruism, compassion, and solidarity. This paper considers the implications of these pedagogies and the practical effects of different sorts of teaching strategies on students' self‐understanding as moral agents.     

INCREASING OUR COMPASSION FOOTPRINT: THE ANIMALS' MANIFESTO

Our relationships with animals are wide‐ranging. When people tell me that they love animals and then harm or kill them I tell them I'm glad they don't love me. Many individuals, including scientists, ignore their responsibility when they interact with animals and fail to recognize that doing something in the name of science, which usually means in the name of humans, is not an adequate reason for intentionally causing suffering, pain, or death. “Good welfare” usually is not “good enough”. Existing regulations allow animals to be treated in regrettable ways that demean us as a species. Compassion is the key for bettering both animal and human lives. A good way to make the world a more compassionate place for animals is to increase our compassion footprint. We could begin by deciding that we will not intrude on animals' lives unless our actions are in the best interests of the animals irrespective of our desires. It is simple to make more compassionate choices about what we eat and wear and how we educate students, conduct research, and entertain ourselves at the expense of animals. The time to make these changes is long overdue.