Compassion-focused therapy (CFT) aims to help promote mental and emotional healing by encouraging people in treatment to be compassionate toward themselves and other people. Compassion, both toward the self and toward others, is an emotional response believed by many to be an essential aspect of well-being. Its development may often have the benefit of improved mental and emotional health.

Trained mental health professionals may offer CFT in their practice to help and support individuals in treatment who wish to explore ways to relate to themselves and others with greater compassion.

History of CFT

Developed in the early 21st century by Paul Gilbert, the CFT approach incorporates theories, principles, and techniques from various schools of psychology, treatment modalities, and religion.

Some main components of the approach are aspects of:

CFT is grounded in current understanding of basic emotion regulation systems: the threat and self-protection system, the drive and excitement system, and the contentment and social safeness system. Treatment sessions highlight the association between these systems and human thought and behavior. The aim of CFT is to bring these three affect systems into balance.

In 2006 Gilbert founded the Compassionate Mind Foundation, based in Derby, UK. He published The Compassionate Mind: A New Approach to Life's Challenges in 2010 and was awarded the Order of the British Empire (OBE) in 2011 for his contributions to the field of mental health care.

How Does CFT Work?

According to CFT theory, the threat, drive, and contentment systems evolved throughout human history in order to facilitate survival. Early humans were eager to avoid or overcome threats, seek resources such as food or intimacy, and enjoy the benefits of being part of a social community. Proponents of CFT suggest these systems are still active and affect human emotions, actions, and beliefs today. If a threatening stimulus is received, for example, a person may experience different feelings (such as fear, anxiety, or anger), exhibit various behaviors (submission or a fight or flight response), and develop certain cognitive biases (jumping to conclusions, stereotyping, or assuming it is always better to be safe than sorry). 

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The drive system endeavors to direct individuals toward important goals and resources while fostering feelings of anticipation and pleasure. People with an over-stimulated drive system may engage in risky behaviors such as unsafe sexual practices or drug and alcohol abuse.

The contentment system is linked with feelings of happiness. These feelings are not associated with pleasure seeking, nor are they merely present due to an absence of threats. Rather, this state of positive calm is typically tied to an awareness of being socially connected, cared for, and safe. This soothing system acts as a regulator for both the threat and drive systems.

Techniques and Exercises in CFT

The primary therapeutic technique of CFT is compassionate mind training (CMT). CMT refers to the strategies typically used to help individuals experience compassion and foster different aspects of compassion for the self and others. CMT aims to develop compassionate motivation, sympathy, sensitivity, and distress tolerance through the use of specific training and guided exercises designed to help individuals further develop non-judging and non-condemning attributes.

People in therapy might learn: 

  • Appreciation exercises, or activities emphasizing the things an individual enjoys. These exercises may include making a list of likes, taking time to savor the moment when something enjoyable is noticed, and other positive rewarding behaviors.
  • Mindfulness, or the ability to pay attention to the current moment in a non-judgmental manner.
  • Compassion-focused imagery exercises, or the use of guided memories and fantasies to first stimulate the mind and then the physiological systems. The goal of compassion-focused imagery exercises is the production of a relational image that stimulates the soothing system.

When people experience difficulty related to feelings of self-attack, the therapist can assist them in exploring the functions and possible origins of these attacks, as well as possible reasons individuals may agree with or submit to them. This process may include visualization of the self-attacking aspect as a person. People in therapy may be asked to describe what the "person" looks like and any feelings it evokes in order to better understand the self-criticism. 

Those who have difficulty experiencing and/or expressing compassion may be asked questions designed to help them explore and remedy any factors potentially contributing to blockages preventing the expression of compassion. 

Issues Treated with CFT

CFT can be helpful to people who find it challenging to understand, feel, or express compassion, as therapy can be a safe place in which to discover any reasons behind this difficulty and explore methods of positive change. This type of therapy can also be effective at helping people manage distressing thoughts, behaviors, and feelings of any kind but may be particularly helpful when dealing with feelings associated with self-attack.

Other concerns treated with CFT include: 

CFT can be helpful to people who find it challenging to understand, feel, or express compassion, as therapy can be a safe place in which to discover any reasons behind this difficulty and explore methods of positive change. 

People seeking treatment for the above concerns may wish to first talk to the therapist offering CFT to see if the approach is a good fit for the particular challenge they are experiencing. CFT can help individuals achieve improved well-being overall but may not be the most relevant approach for some challenges. 

Training for CFT

Practitioners interested in providing CFT can obtain a post-graduate certificate from the University of Derby. The course, which is led by key individuals from the Compassionate Mind Foundation, consists of one academic year, beginning in September and concluding in May. It is led by key individuals from the Compassionate Mind Foundation. The majority of the course can be completed online, which allows people from all over the world to enroll. The course provides a virtual classroom, live supervision, video demonstrations, reading materials, and live seminars on a monthly basis, but it does require attendance at two 5-day study periods—one in September and the other in April.

Applicants to the program are required to have a postgraduate degree or its equivalent in a psychological health-related field such as clinical psychology, mental health nursing, or therapeutic counseling. Applicants also must be accredited as a therapist or in the process of attaining accreditation, as they will need to have access to people in therapy to whom they can provide individual or group CFT.

Limitations of CFT

While CFT may be effective for those who are comfortable with the concept of being soothed or cared for, not all people share this disposition. Some individuals in treatment may be afraid of compassion, while others may feel they are not worthy of being treated compassionately. Some persons may even find it challenging to understand compassion itself. 

Issues may also arise when performing exercises involving mindfulness and compassionate imagery. Some people may find it difficult to enter a state of mindfulness, and failure may lead to self-criticism. Other people may be unable to focus on or even sense compassionate imagery. The use of images of known people or events may also bring to mind unwanted associations and negative past experiences. Treatment may be less effective with those who are experiencing intense anger or rage.

References:

  1. Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J. & Gilbert, P. (2013). Exploring change processes in compassion focused therapy in psychosis: Results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 52, 199-214. 
  2. Gilbert, Paul. (2010). An introduction to the theory and practice of compassion focused therapy and compassionate mind training for shame based difficulties. Retrieved from http://www.compassionatemind.co.uk/downloads/training_materials/1.%20Workbook_2010.pdf
  3. Gilbert, Paul. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3), 199-208. DOI: 10.1192/apt.bp.107.005264. Retrieved from http://apt.rcpsych.org/content/15/3/199
  4. Gilbert, Paul. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41. DOI: 10.1111/bjc.12043
  5. Goss, K. & Allan, S. (2014). The development and application of compassion-focused therapy for eating disorders. British Journal of Clinical Psychology, 53, 62-77.
  6. Leaviss, J., & Uttley, L. (2014, September 12). Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413786