第一章 起源与核心主题
CHAPTER 1 Origins and Basic Themes In this chapter we’ll briefly explore the origins of CFT, and how it developed out of the desire to better help individuals who suffer from shame and self-criticism. We’ll also explore some of the basic ideas behind the CFT approach, with an emphasis on considering how the theoretical roots of CFT—found in evolutionary psychology, affective neuroscience, attachment theory, behavior- ism, and the power of cultivating compassion—are translated into what we do in the therapy room.
THE ORIGINS OF CFT The beginnings of CFT go back to the 1980s, in the form of observations by British psychologist Paul Gilbert. Paul approached psychotherapy from a diverse training background that included cognitive behavioral therapy, Jungian analysis, evolutionary psychology, neurophysiology, and attachment (Gilbert, 2009a). In his therapy work, Paul noticed that many of his clients seemed to have deep-seated self-criticism, shame, and self-loathing. He also noted that for these patients in particular, traditional cognitive therapy exercises like cognitive restructuring often didn’t work ter- ribly well. For example, these clients were able to identify their maladaptive thoughts, identify them as irrational, and perhaps even categorize them in terms of thinking errors they featured. They were able to look at the reality of their lives, and generate more rational, evidence-based alternative thoughts. But there was a problem: despite all of this work, they didn’t feel any better (Gilbert,2010). In these clients, Paul observed a lack of congruence between what they thought and what they felt—a cognition–emotion mismatch—that hampered their therapy. He found that reassuring thoughts were helpful only when they led clients to feel reassured. And in highly self-critical clients, they often didn’t. As a result of these observations, Paul set about finding ways to warm up the cognitive behav- ioral work he was doing with his clients, and began to notice dynamics that, although not often spoken to in his CBT training, very powerfully impacted his clients’ experience. For example, looking more closely at their experiences, he noticed that while many clients could generate new, evidence-based thoughts that seemed like they should be helpful, the mental “tone of voice” in which these thoughts were expressed was often harsh and critical. As a result of observations like these, Paul gradually developed what would become compassion- focused therapy. In doing so, he sought to help therapists make use of existing technologies of change while helping clients relate to their experiences in warmer, more compassionate ways. This developing approach focused on helping clients understand and work with their emotions to help themselves feel safe, and emphasized the cultivation of compassionate strengths that would help them approach and work effectively with their difficulties.
CFT: CORE IDEAS There are a few basic ideas that form the core of CFT. Let’s introduce some of these ideas now.
Shame and Self-Criticism Can Be Crippling As I’ve mentioned, CFT was originally developed to assist individuals who struggle with shame and self-criticism (Gilbert, 2010). Shame can be defined as an acutely painful affective state related to negative evaluations of the self as bad, undesirable, defective, and worthless (Tangney, Wagner, & Gramzow, 1992; Gilbert, 1998). We can distinguish between internalized shame—in which we harbor negative personal judgments of ourselves—and external shame, in which we perceive that others see us as inferior, defective, and unattractive (Gilbert, 2002). A growing body of literature has shown that shame and self-criticism isn’t very good for us. Research shows that shameful memories can function in similar ways to traumatic memories, becoming central to individuals’ identities in a manner that is linked with depression, anxiety, stress, and post-traumatic stress reactions (Pinto-Gouveia & Matos, 2011). Shame and self-criticism have been linked with a wide variety of mental health problems (Kim, Thibodeau, & Jorgenson, 2011; Kannan & Levitt, 2013), including depression (Andrews & Hunter, 1997; Andrews, Quian, & Valentine, 2002), anxiety (Gilbert & Irons, 2005), social anxiety (Gilbert, 2000), eating disorders (Goss & Allan, 2009), post-traumatic stress disorder (PTSD; Andrews, Brewin, Rose, & Kirk, 2000), borderline personality disorder (Rüsch et al., 2007), and overall psychological maladjustment (Tangney, Wagner, & Gramzow, 1992). In terms of psychological processes, shame has been linked to experiential avoidance—the unwillingness to be in contact with one’s private experiences such as emotions—which has itself been associated with various emotional difficulties (Carvalho, Dinis, Pinto-Gouveia, & Estanqueiro, 2013).
These negative self-judgments also appear to impact the course of treatment. Self-stigma, a shame-related experience in which individuals apply negative judgments to themselves related to internalized negative group stereotypes (Luoma, Kulesza, Hayes, Kohlenberg, & Latimer, 2014), has been associated with higher levels of inpatient treatment utilization in individuals experiencing severe mental illness (Rüsch, et al., 2009), lower levels of treatment adherence in patients diag- nosed with schizophrenia (Fung, Tsang, & Corrigan, 2008), poorer medication adherence (Sirey et al., 2001), and longer length of stay in residential treatment for addiction (Luoma, Kulesza, Hayes, Kohlenberg, & Latimer, 2014). These findings are particularly relevant, as the self-stigma experi- enced by the individuals in these studies was anchored to identification with group stereotypes about mental illness or addiction. This demonstrates the power of shame to magnify and exacer- bate problems of mental health in clients who may criticize, shame, and stigmatize themselves upon observing their own psychological struggles. A fundamental goal of CFT is helping clients shift the perspective they take toward their challenging thoughts and emotions from condemnation and judgment to compassionate understanding and commitment to helpful action. In this way, self- attacking and avoidance can give way to warmth and responsibility-taking.
Let’s consider an example of how shame can get in the way of working with challenging emo- tions. We can imagine a father who observes himself yelling at his children (perhaps prompted by his children’s fear-filled faces) and experiences shame: acute emotional pain prompted by the thought, I’m a terrible father. That’s a painful thought, and one that can set him up for more difficulty. First, from a CFT perspective, harsh self-criticism or shameful attributions are themselves power- ful threat triggers. They keep us stuck in feeling threatened, which organizes the mind (we’ll talk about this in future chapters) in ways that aren’t conducive to making positive changes like improv- ing one’s parenting. Rather than focusing his efforts on learning more effective ways to cope so that he doesn’t yell at his children anymore, this father is focused on his own inadequacy. The emotional pain that accompanies shame can also foster avoidance—that is, the feelings that come up following shameful thoughts like I’m a terrible father can be so painful that the father might quickly move to avoid by distracting himself, rationalizing his behavior, blaming his children for his reaction, or doing just about anything else to escape the experience. CFT places a strong emphasis on helping clients overcome such avoidance by shifting from a shaming perspective to a compassionate perspective that helps them approach and work with their challenges.
It’s also important that we don’t shame or stigmatize the experience of shame and self-criticism—we don’t want our clients to feel ashamed of feeling ashamed. It makes a lot of sense that they may have learned to cope in this way. Most of us don’t set out to create problems for ourselves through self- attacking. However, we live in a culture filled with messages presenting us with idealized images of how people are supposed to look, feel, and perform—images we can easily internalize, and to which we have no hope of measuring up. These damning comparisons can be magnified by our ability to perceive our own internal experiences versus those of others. We have almost unlimited access to our own struggles—difficult emotions, struggles with tasks or motivation, or thoughts and behaviors that don’t match our values. At the same time, we have very limited access to the internal experiences of other people—we mostly see what they choose to show us, and like us, they want to appear competent, intelligent, and attractive. We all tend to put on the “game faces.” Seeing this turmoil and struggle inside of themselves, and seemingly surrounded by people who look like they have it all together, it’s easy for clients to feel shamed and isolated, and to conclude, there’s something wrong with me. And this is before we even consider the many specific factors that can contribute to experiences of shame in our clients, including histories of trauma or bullying, harsh rearing envi- ronments, learning history, and potentially belonging to stigmatized groups. Given all of this, it makes a ton of sense that our clients may have learned to shame and attack themselves.
CFT’s perspective on shame and self-criticism doesn’t mean there isn’t room for helpful self- evaluation. There certainly is—sometimes our clients are doing things that are problematic, and they need to do things differently! It’s just that such self-evaluation works a good deal better when it’s presented in a warm manner that doesn’t overwhelm the threat response. For example, compas- sionate self-correction involves noticing when one is doing something harmful or unhelpful, allow- ing oneself to feel guilty about it, and turning the focus toward doing better in the future. Instead of I’m a terrible father, compassionate correction would look more like this: It makes sense that I would yell because of my own experience, but that’s not the sort of father I want to be. It’s time I committed to interacting with my kids in ways that model the things I’d like them to learn. What might help me do that?
Compassion: The Strength to Move Toward the Pain While shame can lead people to shut down and turn away from their struggles and suffering, we need ways to help clients move toward their pain, and work with it in helpful ways. In CFT, this is accomplished through the cultivation of mindfulness and particularly compassion. One question that may come up is Why compassion? There are lots of helpful virtues out there. Why are we choos- ing to make compassion the central focus of our therapy?
In CFT, we’ve spent a good deal of time working to define, operationalize, and apply compas- sion in working with our clients. A generally accepted definition of compassion reads something like this: sensitivity to suffering combined with the motivation to help alleviate (and prevent) it (Gilbert, 2010). This definition includes two separate but important components: sensitivity and motivation. CFT emphasizes compassion so greatly because we think that this is a particularly work- able orientation to have in the face of pain, difficulty, and suffering.
There’s a lot contained within this simple definition. First, it provides us with an approach orien- tation toward suffering—both in terms of being sensitive to its arising and in the emphasis on moving toward the suffering to help. This is very different from the avoidance that can drive so many of our clients’ difficulties. Compassion also contains warmth—suffering is approached with the motiva- tion to help. This warm motivation and affective tone can help us (and those we help) to feel safe in confronting difficulties, helping us shift from a threat-focused perspective to a mental state that is open, reflective, and flexible.
If we look even more deeply within the definition of compassion, we find that it contains other helpful capacities as well. If we’re to maintain this warm, approach orientation toward suffering we have to be able to tolerate it, so CFT, like dialectical behavior therapy (DBT; Linehan, 1993), places an emphasis on distress tolerance and emotion regulation. If compassionate action is to truly be helpful, it must be skillful, and so CFT works to help clients cultivate capacities like empathy, men- talization, and perspective taking.
Finally, many clients, particularly those coming into therapy with lots of shame and self- criticism, may have a very negative experience of themselves. In CFT, we try to provide clients with a unifying framework for the various aspects of compassion we’re helping them cultivate— which we call the compassionate self. The compassionate self is an adaptive version of the self that mani- fests the various aspects of compassion we work to cultivate in the therapy. In the beginning, this takes the form of imaginal perspective-taking exercises that are similar to method acting: the client imagines being at her very best—her most kind, compassionate, wise, and confident—considering what it would be like if she fully possessed these strengths. She then imagines how this compassion- ate version of herself would feel, pay attention, reason, be motivated, and behave.
As the therapy progresses, the compassionate self becomes a perspective that the client learns to shift into again and again, considering how she would understand and work with her difficulties from this compassionate perspective. All the while, she is working to cultivate compassionate strengths and establish them as habits, with the goal that over time, the space between the client’s idea of me and the compassionate self gradually diminishes, as these capacities become more a natural part of her everyday life. In this way, CFT shares ground with ACT and the positive psychology movement. The focus of the therapy isn’t simply on the alleviation of symptoms, but on the pur- poseful development of strengths—adaptive ways of living that are workable and which reflect the client’s most positive aspirations and values.
Building Blocks of Compassion: Shifting from Judgment to Understanding As we’ve discussed, highly self-critical and shame-prone clients attack themselves upon observ- ing many aspects of their experience—their feelings and thoughts, their reactions, and their rela- tionship difficulties. While compassion for oneself and others is a primary goal of CFT, we initially spend less time talking with clients about compassion, and more time setting the stage for it to arise. We do this by helping them understand the factors that lead to their challenging emotions, motives, and behaviors. Rather than try to convince our clients why they should have compassion for themselves and others, the idea is that when they really understand the challenges presented by having a human life, compassion will make sense to them, and will be likely to arise without the need for convincing. Of course, we will also talk about what compassion is, what it isn’t, and why it is helpful—but we want to set the stage for this by creating a context of understanding.
In CFT, we think it’s important to recognize that many of our struggles can be rooted in things we didn’t get to choose or design. This is part of a larger shift we want to help our clients make—one in which they move from a threat-based perspective of blaming and shaming to a compassionate stance of understanding and figuring out what would be helpful. If we look closely at the human story, we find many unchosen factors that shape our experience and the sort of people we will become.
THE CHALLENGES OF OUR EVOLVED BRAINS In CFT, human emotions and other cognitive functions are understood within the context of evolution. We group emotions into three types, according to evolutionary function: emotions and motives that center on identifying and responding to threats, those that are focused on pursuing and being rewarded for attaining goals, and emotional experiences of safeness, contentedness, and peace that are commonly linked with feeling connected with others. Emotions, motives, and behav- iors that are initially perplexing can make a lot more sense when we consider them in terms of their evolutionary function and the survival value they granted our ancestors. One quick example is the tendency to crave and be comforted by sweet, salty, fatty foods. Lots of people struggle with emo- tional eating, and how many of us have wished that we could crave broccoli the way we crave pizza or sweets? But in the environment our ancestors faced—one in which calories and nutrients were relatively scarce—sugar, salt, and fats granted survival value, making it more likely that those who readily consumed them when available would live to pass their genes along to future generations. From this evolutionary perspective, these cravings (and so many of the emotions we may find our- selves struggling with) make complete sense, even as they’re now a terrible fit with our current environment—one in which cheap, salty, sweet, fatty foods are to be found all around us.
The ways our brains and minds have evolved can create difficulties for us. From the tricky interplay of old-brain emotions and new-brain capacities for symbolic thought to the ease with which we automatically learn connections between different things, there is much about how our minds work that we didn’t choose or design, but which can be quite difficult to manage. This awareness can help create a context for self-compassion by depathologizing emotions and experi- ences which in isolation may feel like something that is wrong with me, but which in reality are part and parcel of what it means to be human in this day and age.
These environments, many of which we don’t get to choose or design, interact powerfully with the way our brains learn, sometimes to devastating effect. Through processes like respondent/ classical conditioning, operant conditioning, and social learning, as well as processes articulated through more modern elaborations of learning theory, such as relational frame theory (Hayes, Barnes-Holmes, & Roche, 2001; Törneke, 2010), our environments can teach us to fear the very interpersonal connections that should help us feel safe, and can systematically shape behaviors that will cripple us later in life.
In CFT, we want to help people begin to understand that much of what they feel and even how they’ve learned to respond was not of their choice or design—that these things are not their fault. This “not your fault” piece doesn’t mean that we’re letting anyone off of the hook or absolving people of their responsibility for their own behavior. It’s about being honest with ourselves about which factors we control in our lives, and which ones we don’t. In fact, it’s precisely because of all these factors we can’t control that we need to understand our minds and learn to work with the things we can affect. Our clients may not have chosen to have brains that were shaped by learning experiences to produce crippling fear and anxiety when faced with certain situations, but we can help them cultivate the ability to work effectively with these situations and affects, and to validate and support themselves in doing so.
There’s a powerful scene in the movie Good Will Hunting in which Robin Williams, playing a psy- chologist, holds up his client’s (Will, played by Matt Damon) file, thick with documentation of years of childhood abuse that Will had experienced. The dialogue went something like this: “I don’t know much, Will, but I know this.” He holds up the file. “You know all this shit? It’s not your fault. It’s not your fault.”
In the scene, he warmly repeats this phrase, again and again. Will is initially resistant to this idea, and fights back a bit, just like we and our clients might find ourselves doing. It’s not always easy to admit to ourselves that there’s a lot about our lives (and the way our minds work) that is not under our control. And like Will, if our clients’ lives have been filled with trauma, struggle, and suffering, this realization can be as heartbreaking as it is enlightening. But if we can help our clients honestly recognize the things in their lives that aren’t their fault—the experiences they didn’t choose to have, the powerful emotions that arise unbidden, the spontaneous thoughts that may go against their values, the habits they’ve tried unsuccessfully to change—and help them stop attacking and blaming themselves for these experiences, it can create a context that makes change possible.
In CFT, we want to help our clients make realizations like those described above. However, going into long-winded explanations generally isn’t helpful, and unlike the example from Good Will Hunting, we don’t typically back our clients into a corner and say, “It’s not your fault” over and over again. As we’ll discuss, CFT aims to be a process of guided discovery, making extensive use of Socratic dialogue and experiential exercises such as thought experiments, perspective-taking, and chair work to help clients develop an understanding of their experiences and how to work with them.
The Importance of Learning to Feel Safe As I’ve mentioned, CFT is heavily influenced by research in affective neuroscience. There is a wealth of scientific literature documenting the existence of evolved emotion-regulation systems that humans share with our ancestors, and the ways these basic emotions and motives play out in our brains and minds (Panksepp & Biven, 2012). This isn’t just part of the theory underlying CFT—it’s brought directly into the therapy session. Clients learn about different emotion-regulation systems and how basic motives and emotions can organize our minds and bodies through shaping patterns of attention, reasoning, physical responding, and so on, with a specific focus on learning to work with these systems to help balance emotions and cultivate the states of mind our clients want to have. This learning helps lay the groundwork for self-compassion, as clients’ understanding about the “how and why” of their challenging emotional experiences allows them to make sense of them.
In chapter 5, we’ll explore these basic emotion-regulation systems in detail, but it’s worth noting at the outset that a big part of CFT involves helping clients find a balance between emotions that are focused on threats, those that are focused on the pursuit of goals, and those that are linked with feelings of safeness and peace. These emotions shape our mental experience in varied and powerful ways. For example, threat emotions such as the anxiety, anger, or fear that dominate so many of our clients’ experiences are associated with a narrowing of attention, decreased cognitive flexibility, and tendencies to engage in strategies like rumination that fuel rather than soothe the state of feeling threatened (Gilbert, 2009a). Alternatively, when we feel safe, the mind is organized in entirely different ways—the scope of our attention and thinking opens, and we tend to become calm, peaceful, reflective, and prosocial (and, CFT would argue, better able to work with difficult emotions; Gilbert, 2009a). Unfortunately, many of our clients live in a world that can be almost entirely defined by experiences of threat. So a major therapeutic goal of CFT is helping our clients experience feelings of safeness and the mental shifts that come with them.
This can be a challenging therapeutic task. Humans evolved to feel safe primarily in contexts of affiliation—in connection with others (Gilbert, 2009a). Early social relationships and experi- ences of nurturing connections with others help shape both cognitive templates (Bowlby, 1982; Wallin, 2007) and the underlying neurological architecture (Siegel, 2012; Cozolino, 2010) that can help us to feel safe and successfully regulate our emotions (or not). Individuals who have experi- enced abuse, neglect, or other forms of insecure attachment environments (as exemplified in DBT’s invalidating environments; Linehan, 1993) may have implicitly learned to associate interpersonal rela- tionships with threat or disappointment rather than with soothing and safeness. This implicit asso- ciation can present a primary challenge for therapists—how do we help our clients learn to feel safe when experience has taught them that the things that are supposed to help them feel safe (close relationships) don’t work?
In CFT, we want to infuse safeness into both the content and the process of the therapy. We’ll spend a fair bit of time exploring this idea in later chapters. One of the reasons we’ve placed com- passion—a warm, sensitive, and helpful approach to working with suffering—at the center of CFT is that we want to help clients develop habits of relating to themselves and others in ways that can help foster felt experiences of safeness, as well as assist them to develop the underlying neurological systems that will support mental experiences of safeness in the future.
On the content level, our clients will learn numerous strategies for relating compassionately to their challenges and bringing about experiences of feeling safe. On the process level, the therapeu- tic relationship and therapy environment in CFT is designed to help create feelings of safeness and emotional balance in the client, as the therapist engages with the client in a compassionately col- laborative, warm, nonshaming, and encouraging manner. We’ll explore how this works when we look at the roles occupied by the CFT therapist, in chapter 3.
In this chapter, we’ve explored a number of themes that are core to the practice of CFT. Let’s consider a case example of how these themes might be interwoven in the course of a therapy session: Therapist: Jenny, we’ve spent some time talking about the fears you have that you’ll do something embarrassing in front of others, and how these fears affect your social life. It sounds like you’re feeling pretty ashamed about this. Have I got that right? Jenny: That’s right. I’m just such an idiot. I’m so scared that I’ll do something stupid that I don’t do anything. My friends invite me out, but I always bail at the last minute. I’m such a terrible friend. It’s amazing I have any friends at all. Therapist: So you make plans to go out and then cancel at the last minute? Jenny: Yeah. I make plans thinking it’ll be fun. But then I sit around thinking about how if I go out, I’ll dress the wrong way, or say something stupid that will offend everyone. I get so scared that I can’t bear the thought of going out, and so I cancel and just stay in. I’m just terrified and weak. Other people aren’t afraid of this stuff. They just go out and have fun. Therapist: Jenny, let me ask a question. When this fear of doing something embarrassing or offensive comes up for you, are you choosing to feel afraid? Are you deciding to feel that way? Jenny: I’m not sure I understand what you mean. Therapist: Well, let’s imagine you have the thought, I’ll do something embarrassing and everyone will think I’m an idiot. After that thought, are you thinking, I think I’d better get really afraid of that happening, or does the fear just arise in you? Jenny: I get terrified at things like that, but it’s not like I want to feel that way. Who would choose that? Therapist: Exactly. It sounds like this thought, I’ll do something embarrassing, is a very powerful threat cue for you—when you have thoughts like that, your brain registers: Oh, here comes a threat!—and then comes the fear. Does that make sense? Jenny: I guess so. Therapist: So if you’re not deciding to feel all this fear that you’re feeling so ashamed of, is the fear your fault? Jenny: I guess not. But I’m the one sitting there thinking all that stuff that makes me afraid. That’s my fault. Therapist: (smiling warmly) Is it? So you sit there and decide, Well, I could go out and have a happy evening with my friends, but instead I think I’d rather sit and think deeply about the inevitable humiliation I could face if I did that… Jenny: (laughing a little bit) I think I see what you mean. I guess I don’t choose that stuff, either. But I still do it. Therapist: As we’ve discussed, evolution has shaped our brains to be very sensitive to things we perceive as threatening us, and when that happens, they can produce really powerful emotions—to try and protect us. This is what kept our ancestors alive—they were really good at identifying and responding to threats. I mean, if your friends were asking you to go out and do something really dangerous, like swimming in a pond full of crocodiles or shooting heroin, would it make sense for you to be afraid? Jenny: It sure would! Therapist: It sounds like you’ve somehow learned that being embarrassed in public is really dangerous, so even being asked to go out triggers thoughts that you could do something embarrassing, which is terrifying. Jenny: When I was young—like in sixth grade—my family moved. At my new school, there was a group of girls who hated me. I still don’t know why. They made fun of me constantly. They spread rumors about me, called me names, told me over and over that no one liked me. It went on for weeks. I cried for hours every day, and started throwing up before school, just thinking about what I’d have to face when I got there. (Pauses, sobbing.) I couldn’t figure out what I’d done wrong. I didn’t know what was wrong with me, that they hated me so badly. Therapist: (pausing, then speaking kindly) That sounds terrible, Jenny. I’m so sorry that happened to you. Jenny: (tearfully) It was terrible. It was the worst experience of my life. Therapist: So does it make sense that you would learn that social situations can be very dangerous? Does it make sense that even now, you might imagine this rejection could happen again—and that imagining this could be terrifying? Jenny: (looking up, as facial expression lightens a bit) It does. Therapist: Is that your fault? Jenny: 22 No. No, it’s not my fault. In the example above, we can see several of the themes we’ve discussed playing out. We see that Jenny is crippled by both internal shame (there’s something wrong with me) and external shame (others don’t—or won’t—like me), which she relates to her experiences of social rejection that occurred many years before. This shame, and the fear related to it, results in Jenny avoiding social activities that would probably be very helpful for her.
In the example, the therapist quickly moves to explore and depathologize Jenny’s emotions and the thoughts that prompt them, in two ways. First, the therapist helps her recognize the dynamics around how the emotions arise in her mind (that she isn’t choosing to feel afraid). The evolutionary model is also referenced, helping anchor Jenny’s understanding of her emotions not to personal flaws, but to valid reactions of her evolved brain in response to a perceived threat. Second, the therapist prompts exploration of how Jenny’s fears are valid given her history of social rejection— how it makes sense that she would have learned to be very afraid of making social mistakes and the potential for others to quickly turn on her—and in doing this, begins introducing the concept that our social shaping can very powerfully influence our thoughts and feelings. While the word “compassion” is never mentioned, we see evidence of it throughout—in terms of both implicit process and explicit content. It can be found in the kind recognition of how terrible Jenny’s experience was for her, the willingness to look closely and courageously at the fears she’s experiencing, the focus shift from a perspective that judges and labels these experiences to one that seeks to understand them, and the exploration of how Jenny’s emotional reactions make sense when we understand them in context. Finally, we see that this unfolding process seems to help create feelings of both safeness and courage in Jenny, who spontaneously brings to mind and explores a traumatic socially shaming experience that she might have been inclined to avoid.
SUMMARY In this chapter, we explored the origins of CFT and some of the core themes that guide the therapy. These themes—the importance of deshaming and depathologizing the client’s experience, model- ing compassion and the courage to approach and work with suffering, prompting shifts from judg- ment to understanding, and the facilitation of experiences of safeness—are deeply woven into both the content and process of CFT. In chapter 2, we’ll dive more deeply into the topic of compassion, and how it is brought to life in the therapy session.