引言
Introduction Our human compassion binds us the one to the other, not in pity or patronizingly, but as human beings who have learnt how to turn our common suffering into hope for the future. —Nelson Mandela We’re all going to die, all of us, what a circus! That alone should make us love each other but it doesn’t. We are terrorized and flattened by trivialities, we are eaten up by nothing. —Charles Bukowski The education of a psychotherapist begins when he or she is a toddler and is first able to recognize the difference between “I” and “you.” It continues as we learn how the pain of others may cause us to feel pain. And it goes on (through the pain of graduate school) to become a lifelong journey of cultivating knowl- edge, compassion, and even some wisdom. For many of us, intensive, workshop- based training is one of the more engaging aspects of our continuing education in cognitive and behavioral therapies, such as acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), compassion-focused therapy (CFT; Gilbert, 2009a), and functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991). Participants ask a lot of themselves in these trainings, engaging with a considerable amount of conceptual material and, more importantly, working with their own emotions and personal history of suffering. Our work as psychotherapists asks us to step into difficult emotional spaces with our fellow human beings. Total strangers are willing to come to us, with courage or perhaps in desperation, looking for some way to alleviate or prevent the suffering they experience. They want to stop putting their lives on hold and start engaging more deeply with the world. Importantly, they are suffering, and they wish to find some relief. At the beginning of a weekend workshop in CFT, we often pause and invite our fellow clinicians to rest in the breath, drop into the present moment, and gently move into a space of mindful awareness. From that collected and kind attentional space, we reflect and remember that whenever we are referring to a “case,” we are speaking about an actual person. Each clinical example emanates from a real human being, who, just like us, has known ambition and loss, joy and regret—a person who wishes to be happy. We’d like to pause in the same way now, as we begin this book. Together, let us all remember our connection to our clients and to each other. The essence of compassion in ACT, and in life, resides in this sensitivity to and awareness of the suffering we all carry, and a deep motivation to take action to alleviate and prevent the suffering we encoun- ter in the world. This definition of compassion has ancient origins and current relevance; found in pre-Buddhist wisdom traditions, it has been carried through the Western intellectual tradition and is now emerging in twenty-first-century CFT. Throughout this book, we will cover technical and philosophical ground that may be challenging. We will encounter and reflect upon clinical applica- tions and exchanges that require bringing the best version of ourselves into the consultation room. By reading this book, you will engage in committed action to further develop your abilities in your role as a healer, teacher, or guide. We have committed our time and care to bringing the best of ourselves to this book and the work herein. Together, let us all honor the work we are engaging in as therapists, writers, readers, and clients—roles we have probably all held at one point or another—as we begin to approach a compassion-focused ACT. Those acquainted with the evolution of psychotherapy in the early twenty- first century may know ACT as a popular form of mindfulness- oriented, evidence-based therapy. Perhaps it is even a “third wave behavioral therapy,” as is sometimes said. However, for those who have been involved with the emer- gence of ACT over the last fifteen years, ACT is much more. It encompasses a philosophy of science that raises key questions about what we can and cannot know about the nature of truth and reality. It is grounded in a behavioral theory of language that challenges us to think differently about how we make mental connections among our experiences. Importantly, ACT also is a community, on an international level, with common purposes. The continuous cultural discus- sion that thrives in ACT training workshops, international conferences, super- vision groups, and e-mail lists is a central and dynamic aspect of the ACT community. In recent years, intense interest has been percolating in all of these settings, including interest in the nature of human compassion and how ACT practitioners can engage compassion to help alleviate the suffering they encoun- ter in their clients and in themselves. Metaphorically, the global ACT commu- nity is a family, and this family has begun to talk about how it can act more compassionately and, in that way, contribute to a more compassionate world. In a recent e-mail discussion, the common topic of how ACT relates to Buddhism was raised, and many people responded, ACT cofounder Steven C. Hayes among them. For all of the common ground between Buddhist practices and ACT, such as mindfulness and an emphasis on the observing self, Hayes raised an important point of distinction. To paraphrase his response, he noted how application of the scientific method and ongoing research into fundamen- tal psychological processes allows the ACT community, and Western scientists more generally, to engage in a focused and pragmatic strategy for developing empirical knowledge—a strategy that leads to a more rapid refinement of methods. The evolution of the ACT community’s approach to human suffering can, in essence, progress and change as we gain a better understanding of our theory and technique. As we approach compassion from an ACT perspective, this empirical lens, grounded in functional contextualism, will open up new ways of seeing and knowing, along with new techniques and new possibilities for our clients. Methods from CFT, FAP, and other compassion-informed disciplines serve as key elements in the work of bringing a focus on compassion to ACT. This provides both opportunities and challenges, as is so often true in our work at the frontier of applied psychological science. For example, when ACT practi- tioners encounter CFT, they find much that is familiar and encouraging, as well as clear distinctions between these approaches. CFT, originally developed by Paul Gilbert (2010) to better address shame-based difficulties across a range of diagnoses, is a form of evidence-based therapy that specifically targets the cultivation of compassion. Key processes, such as mindfulness, willingness, disidentification with mental events, and committed action in the service of valued aims, are present in both ACT and CFT. This allows ACT practitioners to deploy their clinical wisdom in bringing a focus on compassion to their work. CFT strongly emphasizes a particular valued direction and motivation, for both therapist and client: developing the capacity for awareness of suffering and the motivation and ability to alleviate or prevent the suffering we encounter. ACT, on the other hand, has an implicit emphasis on compassion that is emer- gent in its model; however, compassion has not historically been the central feature of the therapy or prescribed as a necessary valued aim. In a sense, the emphasis on mindfulness processes rather than compassion in the ACT litera- ture to date, relative to the CFT literature, mirrors the contrast of emphasis between the Theravada and Mahayana schools of Buddhism. Historically, the Theravada approach, which is older, suggests that compassion arises out of mindfulness itself, with an emphasis on vipassana meditation and ethical action in the world, whereas the Mahayana and Tibetan Vajrayana traditions have a much greater focus on the deliberate cultivation of compassion, putting this motivation in the center of their practices. In the Mahayana tradition, the ideal and experience of bodhicitta (the altruistic aspiration toward enlightenment of all beings) is prescribed as a key self-state to be induced and cultivated through imagery, meditation, and action. Similarly, CFT also places a great deal of emphasis on constructing a sense of a compassionate self in a way that may be new to many ACT practitioners. FAP, which is closely related to ACT in the functional contextual family, engages the psychotherapeutic relationship to directly shape new, more adaptive behaviors for clients in real time, during emotionally courageous and compas- sionate exchanges. It requires therapists’ honest engagement with their own emotional responses to others, and to their own suffering and personal history. In seeking to establish a sacred space of awareness where both client and thera- pist have an opportunity for personal transformation, FAP creates fertile ground and a wholesome context for the cultivation of compassion within an intimate and healing relationship. In bringing a focus on compassion to ACT, this context is key. As you proceed through this book, we invite you to consider how each concept and technique might be relevant to your own clinical practice. ACT, FAP, and CFT share common values of openness and adaptability. Each of these modalities is both a process model and a freestanding therapy. As such, this work is meant to be an entrée to compassion-focused work for the ACT practitioner. Rather than suggesting a radical reinvention of ACT methods, casting off its previous developments, or welding together techniques in the name of psychotherapy integration, we suggest gently exploring how we can bring a compassionate focus into our ACT work, along with an understanding of the basic scientific rationale for this move, an appreciation of the workability of engaging compassion in psychotherapy, and an attitude of engaged and active curiosity. For all of the talk of suffering and all of the difficult spaces we can walk through on a compassionate journey as therapists, there is room for joy and flourishing in compassion-focused work. May we all allow ourselves to be open to some of that joy. When concepts seem unconventional to a scientific tradition, the challenge is often one of appreciation and understanding, of cultivating a more expansive and elaborative engagement, rather than one of reductionism or dismissal. Importantly, one of the foundational papers in ACT was Steven Hayes’s 1984 article “Making Sense of Spirituality,” which brought the lens of functional con- textual assumptions to dimensions of experience that were thought to be off- limits to “serious science.” Interestingly, this paper was the seed for decades of growth in knowledge and research into flexible perspective taking and the self. Clearly, the strength and workability of the ACT rubric stands on its ability to approach the range of human phenomena, including compassion and the role of affiliative emotions in adaptive flexibility. We are committed to the ongoing evolution of compassion-focused ACT practice, and we offer this book in the service of that aim.