9 结束与新的开始
9 Completion and New Beginnings Some Eastern wisdom traditions, such as certain forms of Sufism, place a great deal of emphasis on how to draw a creative act to a close. If a process is allowed to unfold fully before it finally ceases to be, it is said to reach completion. Rather than coming to an abrupt end, where something is lost, or just fading out, which can feel like a zero-sum game, organically completing a series of actions creates new possibilities. It is said that with every completion a new beginning becomes possible. This is reminiscent of the processes involved in evolution and in life. Selection and variation result in adaptation, and as one generation of a species fades, new and more adaptive iterations may arise. Therefore, we have chosen not to provide a formal conclusion to this book in the hopes that as we com- plete this book together, with you the reader, we might generate new possibili- ties and new beginnings. As this book has demonstrated, bringing a focus on compassion to our ACT work is, in a way, a point of departure, and therefore can spark the creation of new directions and interventions. Integrating approaches such as CFT and FAP into the ACT context allows us to expand what is possible for us as therapists, and will hopefully spark creativity and inno- vation regarding research questions, theory, and specific interventions. Rather than concluding, we are aiming to begin. We hope that we have raised more questions than we have answered, and that our community carries these ques- tions forward. And how might we all move forward in exploring the applied science of compassion as psychotherapists? Certain key elements of ongoing education present themselves, and in this chapter we will address how to bring a compas- sion focus to each: supervision, training, and research and knowledge develop- ment. So before we come to the end of our journey together, let’s discuss these dimensions and reflect upon how we might forward the mission of integrating CFT into contextual behavioral approaches. Compassion-Focused Contextual Supervision Psychotherapy, especially for the private therapist, is often a lonely pursuit. Many therapists have few people with whom they can share their professional difficulties. Compassion-focused supervision can be an important step toward not feeling isolated. It can also provide a context in which therapists at all levels of expertise can hone their skills and grow, both professionally and personally. Furthermore, while therapists are generally adept at validating other people’s feelings and pain and responding with compassion to their clients’ suffering, they often struggle when it comes to applying these skills to their own difficult situations and judgments. The compassion- focused supervision relationship thus offers a perfect arena in which therapists can train their compassion and self-compassion repertoires. In addition to helping therapists develop new skills and deepen their knowl- edge, effective supervision also allows them to contact resources they already have. Even highly skilled therapists can get stuck at times and will benefit from the fresh perspective a supervision session can afford. In this way, the supervi- sion relationship holds the same sort of central position as the therapeutic rela- tionship does. In our view, cultivating compassionate flexibility in supervision involves both supervisor and supervisee collaboratively engaging in a variety of processes: • Being sensitive to emotional distress in the supervision relationship and, through a parallel process, in the clients discussed • Extending sympathy and automatically engaging emotionally with the distress encountered • Developing a capacity to tolerate distress in the service of alleviating and preventing human suffering • Getting unhooked from judgmental, condemning, and shame-based thinking • Creating conditions to further develop and hone empathic responding • Working to develop specific therapeutic skills and capacities essential to ACT and compassion-focused work The supervision relationship mirrors, in many aspects, the therapeutic rela- tionship. There is an implied hierarchy between supervisor and supervisee. Supervisees often come to supervisors seeking to solve difficult problems, often as a result of having faced emotions of helplessness and quite possibly negative self-judgments about their professional abilities and perhaps self-worth. And at times, supervision issues are “problems to solve” in the sense that there may be an exercise or particular intervention the supervisee could use to help therapy move along. The more the supervisee is familiar with and skilled in the approach, the fewer such “problems” there are to solve. As skill level increases, supervision questions become more about how supervisees can receive their clients’ emo- tions, and their own, from a stance of compassion. Supervisees differ in their needs depending on skill level, so a wise supervi- sor assesses both supervisee needs and level of skill. Supervisees who are new to ACT and the functional contextual approach may need to be oriented toward specific techniques and exercises. Therefore, a supervisor may suggest that a supervisee who struggles with defusion try a range of techniques, such as invit- ing clients to preface thoughts with “I have the thought that…”; noticing hooks and what they do next; doing the Leaves on the Stream exercise (Hayes, 2005); noticing the different thoughts and sensations that make up their aversive expe- rience in the moment; and so on. Suggesting metaphors, such as the Man in the Hole, the Children on the Bus (originally Passengers on the Bus), and the Tin Can Monster (all in Hayes et al., 1999), may also be useful. When it comes to training compassion, evocative exercises such as Visualizing the Compassionate Self, compassion-focused chair work, or systematic perspective-taking exercises may prove useful. At this stage, role-playing clients, first with the supervisor playing the therapist, then, increasingly, with the supervisee playing the thera- pist, is helpful. Supervisees who are familiar with the approach and well-read in the tech- niques need fewer such technical suggestions and may be better served by guid- ance that helps them identify functions of behaviors that play out for their clients. Identifying antecedents, whether physical or verbal, and the verbal and physical consequences of both problematic and improved behavior, comes into more acute focus. The aim is to help supervisees better identify with clients’ experi- ence as it happens and have a better sense for what could help. For example, identifying that a particular thought, such as “I’m not interesting,” serves as an antecedent for withdrawal in unfamiliar social situations can help the supervisee tailor interventions as needed. The supervisee might then elect to deal with the antecedent, perhaps by defusing from the thought by noticing it as hook, or to change the consequences of speaking to strangers, perhaps by linking this behav- ior, through values, to the kind of person the client wants to be. An important part of this phase is to help supervisees notice the anteced- ents and consequences of their own therapist behaviors. This can be done by modeling, with the supervisor asking the supervisees what effect supervisor behavior has on them. This can help supervisees learn to recognize and receive emotions as they show up in the moment in session. In this way, the supervisor makes use of processes parallel to those showing up in the supervisees’ thera- peutic relationships with clients. This type of intervention is illustrated by the dialogue below. Supervisor: o what do you imagine the antecedents to your client with- S drawing were? Supervisee:I ’m not sure. We were talking about homework and he just shut down. Supervisor:Had he done it? Supervisee:No, he hadn’t even made a start. Supervisor: o a bit like my suggestion that you make a note of client ante- S cedents and consequences? Supervisee:(Remains silent.) Supervisor: hat happened just now? I’m getting a sense that you just shut W down on me. Supervisee:I feel guilty, as if I was at school and hadn’t done my homework. Supervisor:Ouch! That must be painful. So what showed up? Supervisee:I felt judged and a bit ashamed. Supervisor:I’m sorry you felt this. Was that a hook for you? Supervisee:Uh-huh. Supervisor:And what did you do next? Supervisee:I shut down, I guess. Supervisor: es, I felt that. Would you say you bit the hook? And is that how Y the person you want to be would have acted? Supervisee: o, I wish I could have just said that I noticed those thoughts N and feelings showing up and that I could even see them as ante- cedents to my withdrawal. Supervisor: ight. And as you say that, I don’t feel you shutting down. Do R you think something similar might have been at play with your client? Supervisee: hat makes sense. I guess I got bogged down in trying to explain T how important the exercises were for the client’s progress. Supervisor:And what happened? Supervisee:He stayed shut down. Supervisor:o we’re doing good noticing all of these antecedents and S consequences… Supervisee:I guess if I’d asked him what was showing up for him, we then could have more easily done something with it. Right? Supervisor:See what happens when you do it. Whether therapists are seeking supervisors who might help them better create a context of acceptance, wisdom, and flexibility, or are developing their own ability to serve as supervisors with openness, courage, and empathy and oriented to the needs and experiences of supervisees, compassion and the ability to shift perspective on emotional experiencing remains central. Within the realm of a therapist’s emotional responses we can find a host of important infor- mation about clients’ valued aims and experience of suffering. By remaining open and defusing from our habitual responses to our own emotions, we can draw these experiences closer. Our characteristically human capacity for per- spective taking, and our ability to cultivate an emotional tone of warmth and care, can foster insight into what is going on in the mind of the other. We can imagine the function of the client’s or trainee’s emotional response and bring this information into case formulation and intervention with clinical wisdom and solid technique. The Workshops and Further Training The early twenty-first-century culture of training in mindfulness-, acceptance-, and compassion-focused behavior therapies typically involves psychotherapists attending workshops, reading background material, and hopefully seeking further training and supervision in order to deepen and apply their knowledge. As many of us know, workshop experiences can be intensely emotional and sometimes revelatory. When exploring ACT, CFT, and FAP with qualified trainers in a safe environment, many psychotherapists are able to take risks, look at their inner life through a new lens, and open themselves to strong emo- tions that they may have been avoiding or blocking. As therapists, we discover new possibilities through these experiences, and we come away with the chal- lenge of how to build on that learning. Several factors can help us build on the experience of participating in a workshop, attending a conference, or even reading a book, this one included: • Developing a regular personal practice of mindfulness and compassion meditation • Using the techniques we learn on ourselves, including role-playing, as part of a process of self-reflection • Seeking qualified trainers and supervisors and establishing ongoing edu- cational relationships with them • Connecting to communities, professional organizations, and local peer groups to create conditions that can further our education and capacities • Using online resources, recordings, social media, and e-mail discussion groups to facilitate and enhance our personal practice and education All of these experiences become possible as you connect with fellow travel- ers on your journey into compassion-focused ACT. At the end of this book, we have provided a list of resources that will allow you to pursue these paths. Hopefully this will elucidate ways in which you might choose to take your work further or in new directions. After workshop and training experiences, it can be easy to let new learning slip away as we are pulled back into the flow of life, and get caught up in habit- ual patterns. Sometimes, this might be just what we need. However, for our professional and personal growth, it is important to continue the journey, to keep on asking questions and assimilating new learning. All of the information in the Resources section is aimed at making it easier for you to pursue training and enrichment in ACT and compassion psychology if you wish to do so. Research and Knowledge Development While there is sufficient science to support the approach outlined in this book, many important directions for research in contextual psychology and the science of compassion remain, and endeavors in these fields will further the work. There is already a considerable amount of research supporting the fundamental pro- cesses of compassion and psychological flexibility, drawn from experimental behavioral science, affective neuroscience, developmental psychology, and psy- chotherapy outcome research. However, much work remains to be done. More research and randomized controlled trials regarding the efficacy of compassion- focused interventions, and compassion- focused ACT in particular, will be important for enhancing understanding and treatment methods. New and exciting directions that are beginning to emerge in research include more spe- cific and conceptually focused assessment tools for compassion, such as the examination of implicit cognition (Ferroni Bast & Barnes-Holmes, 2014), quali- tative interviews involving compassion and attachment (Gumley, 2013), and assessment of the two psychologies of compassion in the therapeutic dyad. How compassion might be trained at the level of organizations, communities, and societies also is important, and this is actively being explored at the Stanford University Center for Compassion and Altruism Research and Education, the Compassionate Mind Foundation, and the Charter for Compassion, as well as by members of the Association for Contextual Behavioral Science. By reading and engaging with this book, you are already playing a part in the emergence of compassion in the ACT community and in the world. Should you choose, you can expand on this, framing the ideas and questions that have arisen for you during your reading. If it suits your aims, perhaps you might orga- nize these questions around hypotheses for research or ideas for interventions, or as open questions in an online discussion group. The Path Forward Compassion emerges from a heartfelt recognition of the interconnection between all living things. As we are sensitive to the suffering we encounter and are moved to respond to do something about it, we naturally turn to one another for support, companionship, and collaboration. At this point in our evolution and history, there is far less distance than ever before between us, whether we are authors, readers, or researchers. Our communities and the vast networks of dedicated fellow travelers are ever more closely knit together. We hope that as we have shared this journey with you, you will share your journey with us. We are all joined in our common humanity, resting in kindness with the knowledge that we all wish to be happy, to be well, and to find peace and joy, including— and especially—in the face of great challenges. May you become available to your compassionate mind as it becomes avail- able to you. May the conditions that cultivate compassion and well-being orga- nize themselves around you and your clients. And may you flourish and continue to share your own wisdom, strength, and commitment with those who have come to you for care, with your loved ones, and with yourself. 248What matters most is how well you walk through the fire. —Charles Bukowski Love and compassion are necessities, not luxuries. Without them, humanity cannot survive. —Tenzin Gyatso, Fourteenth Dalai Lama