第二章 同情心概览

23CHAPTER 2 Introducing Compassion In CFT, we begin with a definition of compassion that is consistent with both the dictionary and the Dalai Lama: sensitivity to suffering with an accompanying motivation to alleviate or prevent it. In the context of CFT, compassion isn’t simply one of any number of values our clients might seek to pursue—­although it certainly can be chosen as a value to guide one’s life pursuits (one which we would obviously encourage). First and foremost, compassion in CFT is an orientation to suffering—­one that empowers us to approach suffering with the helpful motivation to work with it and alleviate it. Let’s take a moment to unpack this definition. In the context of compassion, we can consider sensitivity as referring to the ability to become aware of suffering, as well as the willingness to be moved by it. If our minds are unbalanced and powerfully caught up in experiences of threat or drive, we can find ourselves oblivious to suffering. It’s not that we don’t care, necessarily. It’s that we can become so powerfully focused on perceived threats or caught up in pursuing our goals that the suffering of others (or even ourselves) just doesn’t show up on the radar. Additionally, if our clients are going through the world with mind and body dominated by experiences of threat, opening themselves to suffering can be overwhelming. In such a situation, we can understand why they might resort to avoidance strategies in the effort to alleviate intensely felt distress. On the other hand, if things are balanced, with threat and drive emotions tempered by the ability to experience safeness and the mindful capacity to observe emotions without pushing them away, our clients can learn to notice their suffering, and to be warmly moved by it without becoming overwhelmed. Avoidance can give way to a willing, mindful, compassionate awareness: I’m really hurting right now. This argument with my spouse has really activated my fears of being abandoned. This is reallyCFT Made Simple hard for me. In considering this possibility, we see that a primary aspect of compassion we’ll be helping our clients develop is emotional courage—­the willingness to approach and connect with very difficult feelings, in the service of helping themselves work with these experiences. The second component of compassion involves the kind motivation to help alleviate and prevent suffering. While it may seem obvious that when presented with suffering, we’d want to help alleviate it, this isn’t always the case, particularly for clients with extensive histories of shame and self-­criticism. For such clients, observations of their struggles and pain may serve as anteced- ents not for helping but for self-­attacking, as they interpret these experiences as more evidence that there is something wrong with me—­that they are bad, flawed, or unworthy. Other clients may become fused with such experiences—so caught up in rumination and cycles of threat-­based thinking and emotion that they are unable to disengage from the experience and consider what they might be able to do about their pain. Here again, we see the importance of helping clients relate to their experience in nonshaming ways, to mindfully observe when threat responses begin to carry them away, and to connect with feelings of safeness. When this happens, it paves the way for compassionate reasoning to emerge, as ruminative thoughts like I can’t take this give way to compassionate questions, such as What would be helpful as I work with this difficult experience? Additionally, If we’re to help our clients maintain this helpful motivation to approach and work with suffering, we also need to help them develop confi- dence that they can engage in helpful action—­confidence rooted in a repertoire of useful skills for working with the pain of life. We need to give them tools, strategies, and practices that work. COMPASSIONATE ATTRIBUTES Now that we’ve explored a working definition of compassion, let’s spend a bit more time exploring how compassion is operationalized in CFT. This operationalization is depicted graphically in the Circle of Compassion in figure 9.1, below. In this figure, compassion is depicted as a collection of attri- butes, which are cultivated via the training of various compassionate skills, all of which occurs within a therapeutic context defined by warmth. Compassion in CFT involves the cultivation of various attributes that facilitate a skillful, approach-­based orientation toward pain, struggle, and suffering. Woven throughout these attri- butes is a focus on helping clients develop compassionate courage—­so that they can approach and work with the really difficult things, particularly the challenging emotions they may be inclined to avoid. Let’s briefly explore these attributes. 26Introducing Compassion Warmth Warmth SKILLS TRAINING Imagery Attention ATTRIBUTES Sympathy Sensitivity Care for well-being Feeling Compassion Nonjudgment Reasoning Distress tolerance Empathy Behavior Sensory Warmth Warmth Figure 9.1: The Circle of Compassion—­Compassionate Attributes and Skills. (From Gilbert, The Compassionate Mind [2009], reprinted with permission from Little, Brown Book Group.) Sensitivity As we’ve mentioned previously, sensitivity is a core component of our definition of compassion. In this context, sensitivity refers to helping clients open their awareness to experiences of pain, suffering, struggle, and difficulty. This openness may stand in stark contrast to the avoidance that may characterize their habitual coping methods. Sensitivity involves noticing these experiences, so that they show up on the radar. Rather than avoiding the difficult things in their lives, we help clients learn to actively and purposefully attend to them, which allows the possibility of being moved by them. Sympathy The sensitivity of compassion isn’t a cold awareness that things aren’t as we’d prefer them. It is infused with warmth—­containing a felt connection to the being that suffers, whether that being is us or someone else. Sympathy involves feeling a bit of heartbreak for the being that is suffering—­we are moved by their suffering. This sympathy is important, and it stands in stark contrast to the 27CFT Made Simple self-­criticism and shame that our clients often bring to therapy. Sympathy involves a softening of self-­to-­self and self-­to-­other relating. When clients can stop self-­attacking and allow themselves to be moved by their own suffering (or that of others), it helps them be motivated to face and work with this suffering, even knowing that doing so won’t be easy. With compassion, we are moved, and we want to help—­which brings us to the next attribute. Compassionate Motivation Compassion involves a sincere motivation to help prevent or alleviate suffering. With compas- sion, we accept and engage willingly with suffering, but we don’t wallow in it. In helping clients develop compassionate motivation, we’re helping them develop the motivation and courage to approach suffering with a specific intent—­to understand the suffering and the causes and condi- tions that lead to it, so they can engage in helpful activity to help alleviate or prevent it. We’re trying to help clients strengthen and learn to shift into a caregiving social mentality (we’ll discuss social mentalities a bit later), so that rather than being consumed by feelings of threat, their atten- tion, thinking, motivation, and behavior are focused on helping themselves and others. This moti- vation can give rise to the courage to face difficulties head-­on. This caring motivation isn’t something we’re manufacturing from scratch—­we’re working to awaken our clients’ natural capacity for caregiving and nurturance that evolved with our mammalian ancestors, enabling them to face tremendous hardship and danger to ensure the survival of their young. Distress Tolerance As we see in other therapy models, such as dialectical behavior therapy (Linehan, 1993), CFT incorporates distress tolerance as a capacity to be cultivated. In order to work directly and actively with suffering and the factors that lead to it, both clients and therapists need to be able to tolerate the discomfort that comes with doing so. Distress tolerance in CFT involves both the willingness to endure discomfort and the cultivation of the ability to self-­soothe—­to help ourselves feel safe and to make life a bit easier when there is pain that must be endured as we approach and work with suffering. Nonjudgment As we’ll see, compassion in CFT also involves helping clients develop mindful awareness. In addition to the sensitivity—­the noticing—­described above, compassion involves the ability to relate to one’s experience in accepting, nonjudgmental ways. In cultivating compassion, clients learn to replace the judging, labeling, and self-­blame that may accompany difficult experiences with a com- passionate awareness that seeks to understand these experiences. This leads us to the final compas- sionate attribute: empathy. 28Introducing Compassion Empathy Whereas sympathy involves being moved by suffering, empathy involves making efforts to understand the suffering as it exists from the perspective of the being that suffers. We want to help clients look deeply at the range of emotions arising within themselves and others. What am I actually feeling? How does it make sense that I might be feeling this way? Having suspended judgment, compassion seeks to understand the emotional landscape that is being traversed—­in therapy, and in life. Taken together, these compassionate attributes form a powerful orientation toward suffering, which unfolds from awareness to action. With compassion, we notice suffering, we are moved by it, and we want to help. In order to do this, we must work to tolerate distress, and to nonjudgmentally and empathically under- stand the causes and conditions that contribute to the suffering and difficulty. Armed with this motivation and understanding, clients and therapists are well equipped to draw upon a wide variety of powerful technologies to address psychological suffering—­which is why CFT can potentially be a helpful adjunct for those whose therapeutic work is rooted primarily in other modalities. COMPASSIONATE MIND TRAINING In helping clients cultivate the compassionate attributes described above, CFT focuses on assisting them in developing a number of compassionate skills. Let’s take a look at the skill-­training domains we’ll be targeting in helping our clients cultivate the compassionate attributes described above. Compassionate Thinking and Reasoning Compassionate thought work in CFT is twofold. First, it involves helping clients relate to thoughts mindfully—­nonjudgmentally noticing and accepting their thoughts as mental activity without getting caught up in clinging to them or pushing them away. Second, it involves the pur- poseful cultivation of compassionate ways of thinking, reasoning, and understanding—­ways of thinking that are validating, soothing, encouraging, and skillfully focused on working with suffer- ing. In CFT, compassionate ways of thinking are defined by helpfulness. These ways of thinking will be represented in multiple areas of the layered approach we’re taking in this book. First, we help clients develop compassionate understanding of their minds, emotions, and how things came to be the way they are in their lives. A bit later on, we focus on helping clients specifically cultivate com- passionate ways of thinking. Attention and Sensory Focusing A primary goal in CFT involves helping clients to work with their attention in skillful ways. First, we’ll help clients develop compassionate awareness through the cultivation of mindfulness, introduced in chapter 7. Mindfulness occupies a central role in CFT, both in increasing client 29CFT Made Simple awareness of how thoughts and emotions arise and play out in their minds, and in helping them relate to and work with these mental activities in accepting, nonjudgmental ways. CFT therapists also utilize specific sensory-­focusing exercises in training clients to focus their attention in ways that can help them soften the inertia of threat emotions, calm the body, and prepare the way for compassionate states of mind. One of the most common of these exercises is soothing rhythm breathing, introduced in chapter 4. Imagery CFT utilizes imagery extensively, both in helping clients work with difficult affective states and in developing and applying compassion in their lives. The latter is best exemplified by the Compassionate Self practice, introduced in chapter 9. This practice is an imagery-­based method-­ acting practice aimed at helping clients cultivate a compassionate, adaptive version of the self that provides an organizational framework for the development of a repertoire of compassionate strengths. We’ll also use imagery exercises to help clients learn to self-­soothe and create feelings of safeness in themselves. Feeling and Emotion One factor that perhaps distinguishes CFT from other cognitive behavioral approaches is the high premium we place on working with affect. Like other therapies, much therapeutic work in CFT is anchored around helping clients work with difficult emotions. However, CFT also involves a very intentional focus on the purposeful cultivation of compassionate feelings—­warmth, kindness, courage, affiliation (to self and others), and safeness. Both sides of this work cross many of the layers of therapy mentioned earlier—­the therapeutic relationship as a basis for the development of relational safeness, compassionate understanding and mindful awareness of our affects and how they play out in us, and the cultivation of compassionate skills for emotional soothing and for working with difficult emotions and experiences via chair work, exposure exercises, and imagery. Behavior The second component of compassion—­the motivation to help address and prevent suffer- ing—­is incomplete without compassionate action. In CFT, there is a strong focus on helping clients develop a repertoire of compassionate behaviors. Behavioral work in CFT is focused both on helping clients understand and work skillfully with sources of suffering and on building lives that are filled with meaning, fulfillment, and good relationships. In this work, CFT therapists draw upon behavioral theories of learning to understand the historical roots and conditions that maintain client difficulties, and to help clients relate to these challenges in compassionate ways—­as learned responses and coping strategies that were shaped by social forces they didn’t get to choose or control. 30Introducing Compassion Additionally, CFT therapists make use of a wide range of empirically supported behavioral interventions—­including behavior activation, exposure work, and social skills training—­depending upon the needs of the client. In CFT, all of these strategies are couched within an organizing framework of compassionate motivation and understanding. The idea is that we’re warming up the techniques, with the goal of softening their threatening aspects and potentially increasing client motivation and utilization. We want clients to experience these behaviors and strategies not as something I have to do (that I’d really rather not do) but as compassionately motivated efforts to care for themselves and develop strengths and competencies in the service of having good lives. SUMMARY In this chapter, we’ve introduced a working definition of compassion, and have explored how CFT operationalizes compassion in terms of attributes we help clients cultivate and specific skills we’ll be working to develop in therapy. As we saw in the introduction, CFT Made Simple takes an approach defined by layers of treatment: the therapeutic relationship, the development of compassionate understanding, the cultivation of mindful awareness, and the specific development and application of compassion. Each of these layers is centered around laying the groundwork for clients to mani- fest compassion in their lives: creating a therapeutic environment defined by relational safeness; facili- tating our clients’ understanding of the unchosen biological and social forces that have shaped their experience in ways that were not their fault; cultivating accepting, nonjudgmental awareness of their expe- riences; and purposefully working to develop a repertoire of compassionate strengths. In the next chapter, we’ll explore the first of these layers: the therapeutic relationship in CFT.