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Compassion Focused Therapy for Psychosis

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Page 1: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Compassion Focused Therapy for Psychosis

Page 2: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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 caretakerCompassion for the parts of the self that feel

attacked, and for the attacker

Slide by Paul Gilbert

Page 3: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Contrast self-compassion to self-esteem

Self-Esteem

Access when things going well

Individuality/difference

Achievement/doing/drive

Competitive mentality

Self-Compassion

Access when not going well

Common humanity

Acceptance/being/content

Caring mentality

Slide by Paul Gilbert

Page 4: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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. Can’t assume that by reducing negative emotion the positives will ‘come on line.’

Two types of positive affect related to achievements/doing/excitementsaffectionate, 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

Page 5: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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 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. (page 12)

Slide by Paul Gilbert

Page 6: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 7: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 8: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Threat Relations

Conflicts of Strategies

Dominant Submissive

Care-Seeking

blocksblock

s

blocks

Each strategy can have a variety of forms, functions, behaviours and memories

Slide by Paul Gilbert

Page 9: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Therapeutic PhilosophyWe 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 life’s challenges

We can get trapped and stuck in self-protective systems and strategies

Compassion Focused TherapyTo 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

Page 10: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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

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

Page 11: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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

Page 12: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 13: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 14: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 15: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 16: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Imagining the self critical part of self

Now for a moment let’s 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

Page 17: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 18: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 19: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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

Page 20: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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

Page 21: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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

Page 22: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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?

Page 23: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Kindness, Attachment and Threat

Kindness from therapist or imagery

Activate attachment systemActivate memories

Neglectaloneness

Abuse, shame vulnerable

Activate learnt and current defences - cortisol

Fight, flightshut down

Fight, flightshut down

Slide by Paul Gilbert

Page 24: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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, can’t be sure what will be helpful

Page 25: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

“Experience the Practice for Yourself

First!”

Page 26: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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)

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 one’s mind, reflect and develop one’s mind

(See chapter in by Rimpoche and Mullen in Gilbert 2005; )

Slide by Paul Gilbert

Page 27: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

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-transcendent

• Strength as ‘calm authority’ fortitude, endurance, complete benevolence

• Caring as a genuine desire for one’s well-being –Commitment and motivation Slide by Paul

Gilbert

Page 28: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Other-Focused Compassion

Sit comfortably in chair with soothing rhythm breathing. Work on getting into the compassion role. Now imagine focusing on ‘desire for others to be happy and free from suffering’. (This can start off with people one knows and then extend outwards to eventually all sentient beings). Imagine facial expressions and voice tones.

Explore people’s experience - reflection/meditation.

Explore the value of compassionate self or compassionate imagery in generating and feeling the desire within oneself for others ‘to be happy and free from suffering’.

Explore blocks, fears and facilitators.Slide by Paul Gilbert

Page 29: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Imagining the self-compassionate part of self - Assuming a role

Now for a moment, imagine that a self-supporting, or compassionate part of yourself could be thought about as a person. Imagine becoming that person. Think of the ideal qualities you would like to have as a compassionate person. It does not matter if you are actually like this. Think about your age and appearance, your facial expressions and postures, you inner emotions of say gentleness – create a half or slight smile that conveys this. Now like an actor about to take on a part feel yourself into these. For this moment you are a compassionate person Slide by Paul

Gilbert

Page 30: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Extending Compassion to “Enemies”

• Enemies can be internal, like voices, critical parts• Distinguish compassion from submission, or “losing”• One way of framing this:

– Desiring the other to be happy and free from suffering “in a good way”• This carries with it the idea of balance,

– aiming for the other to be well but not at the expense of oneself

Page 31: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Compassionate Writing Exercises

• Pick a difficult event or issue– Write about it from a compassionate frame

• Focus on your breathing• Now bring compassionate image to mind• Focus on sensory qualities (trying to access care-focused mentality)

• What would your compassion part/image say?• How do they see this situation?

• What opportunities for growth and change might be here?

• What is a compassionate thing to do now?

Page 32: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Compassionate ReframeFocus on your breathing

Now bring compassionate image to mind

Focus on sensory qualities (trying to access care-focused mentality)

What would your compassion part/image say?

How do they see this situation?

What opportunities for growth and change might be here?

What is a compassionate thing to do now?Slide by Paul Gilbert

Page 33: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler

Page 34: Compassion Focused Therapy for Psychosis. What is Compassion? Gilbert defines the essence of compassion as “a basic kindness, with deep awareness of the

Slide by Christine Braehler