前言
Foreword In this beautifully and skillfully written book, Russell Kolts uses his experience to outline the key themes in compassion-focused therapy (CFT). It’s very easy to think that compassion approaches to psychological therapies are just about helping people be kind to themselves and others. In reality, the center of compassion—particularly in the therapeutic arena—is courage. Russell himself has worked with anger problems in prison inmates and has developed a CFT approach that he calls the True Strength program, highlighting compassion as the strength and courage to turn toward our suffering, and that of others. I must confess that I was dubious about “making therapies simple” because this can easily be seen as dumbing them down. It’s important to note that compassion-focused therapy is in some ways very complex: based in consideration of basic scientifically established psychological pro- cesses; the ways in which emotions, motives, and cognitions operate; and the manner in which humans are deeply socially embedded and organized through their social relationships. So when you read this in terms of “made simple,” don’t think that Russell is saying the therapy is “simple.” Rather, he is outlining some of the crucial concepts of CFT in the hope that they will be useful to you, and perhaps excite you to learn more. I’m delighted to say that Russell achieves his goal brilliantly and in a way I never could. I am one of those people who tend to see complexity rather than simplicity. So here is a wonderful guide to introduce you to the realities of the toughness, difficulties, and complexities of CFT—but, as Russell says, creating the layers and building blocks in relatively straightforward and simple ways. As explained in this book, CFT began in a relatively simple and straightforward way in the 1980s. It started with just noticing the importance of understanding the emotional tone people created in their heads when they tried to be helpful to themselves. For example, imagine you are trying to generate helpful thoughts when you’re feeling depressed. But imagine “hearing” and experiencingCFT Made Simple these thoughts in a very hostile way, as if you are irritated and contemptuous even as you say them in your mind. How will that be? Even an encouraging phrase like You can do it becomes venomous when communicated in a hostile mental “tone of voice.” You might try saying that to yourself in a contemptuous, sort of hostile way and notice how that feels. Notice whether you feel encouraged. Then imagine that you can really focus on warmth and empathic understanding in the words, focusing on the feeling—maybe as if you were hearing somebody who really cared about you say it with a heart that wishes for you to be free of your depression, or maybe as if hearing your own voice as supportive, kind, and validating with the same intention. Actually doing exercises like this is helpful, because in CFT getting personal experience by doing the practices yourself is key to the development of your therapeutic skills. What I found all those years ago was that while people could “cognitively” learn to generate new perspectives and coping thoughts, they often did so with a contemptuous or hostile, irritable tone. Indeed, they often found it very difficult to experience coping thoughts that involved two important aspects that are now recognized as being core to our understanding of compassion. First, they struggled to direct these thoughts toward themselves with a heartfelt motivation that is based on empathic concern to address the deeper causes of the difficulties (compassionate motiva- tion). Many patients actually blamed themselves, or thought they did not deserve compassion, or that compassion was weakness in some way—just too soft! Sometimes they were very avoidant of the causes of their suffering—for example, not wanting to address the traumatic experiences underpinning their depression, or the fact that they needed to make life changes. It takes courage to begin working on these difficult issues. Second, they tended to struggle with generating sup- portive, kind, understanding, and validating emotions when they actually created those thoughts in their mind (compassionate action). So CFT began with trying to think about how to help clients generate compassionate motivation and care-orientated emotions, and also within that motivation, to create certain kinds of emotional balancing within the mind. As Russell says, we use a standard definition of compassion—one that captures the heartfelt wish for suffering to cease, a preparedness to develop “sensitivity to suffering of the self and others with a commitment to try to alleviate and prevent it.” The prevention part is important, because the training that we do is aimed at reducing suffering both in the present and in the future. So the first psychology of compassion is about how we begin to address our suffering and really start to understand it. As Russell outlines here, there are many competencies that we are going to need, such as how we pay attention, how we experience being in contact with distress, how we tolerate our distress, and how we empathically understand it without being judgmental or critical. The second psychology of compassion is really about developing the wisdom of knowing how to be genuinely helpful. True helpfulness requires the development of wisdom—we must under- stand the nature of suffering before we are well equipped to work with it. Minds are very tricky and are full of conflicted motives and emotions. Also, although warmth and gentleness can be part of compassion, compassion requires a certain toughness, assertiveness, and a great deal of courage as well. Parents are prepared to argue with their children over their diets or going out late at night viiiForeword because they want to protect them, even though this may cause conflicts. In some therapy encoun- ters, clients are frightened of their anger or anxiety or grief. Therapists may then need to encour- age these clients to experience such emotions, even when a client is reluctant to do so, and even when doing so may not be pleasant at the time, because that is what’s required to help this client learn to experience and work with these difficult feelings. It’s a therapeutic skill and wisdom that allows the therapist to know how and when to do this. Indeed, some years ago, studies showed that some of the warmest therapists were behaviorists! That makes sense, because behavior therapy often has to encourage clients to engage with things they’d rather not connect with. CFT also uses evolutionary functional analysis to help us understand how our emotions work. As Russ clearly outlines, we consider emotions in terms of three functionally distinct types of emotion-regulation system: there are emotions for dealing with threats and trying to protect us, emotions that are stimulating us to go out and achieve and acquire resources, and emotions that give rise to feelings of contentment, safeness, and slowing down—which are sometimes linked to the parasympathetic functions of rest and digestion. Many of our clients are very out of balance with these emotions, and the capacity for contentedness and peaceful feelings can be almost impos- sible for them to access. Studies of the parasympathetic nervous system have shown that this system is out of balance in many people with mental health problems, with the major emotion- balancing and regulating systems not operating appropriately. In such cases, we have to help them get these feelings of safeness online. In this way, building and cultivating the capacity for slowing down, grounding, and experiencing safeness, connectedness, and affiliation are central treatment targets for CFT. This creates the competencies and strengths for people to then engage with feared material—be these things they need to do in the outside world, or in the internal one. Given that CFT is an evolutionary-based therapy, it will not be surprising to hear that it draws from attachment theory and its extensive research base. Attachment theory tells us that relation- ships with caring others can provide a secure base (which can be the platform to enable us to go out and try things, take risks) and a safe haven (a safe and secure base where we can be soothed, helped, and supported when we’ve gotten into difficulties). CFT helps clients begin to experience and develop this internalized secure base and safe haven. Once a person understands the nature of those three different types of emotion we visited earlier, then a lot of things fall into place. For example, when soldiers are trained, their secure base and safe haven can shift away from their families and toward their combat buddies—because that is indeed the source of their safeness in combat. When they go out on sorties they will be in high- stakes arousal, and when they come back they will calm down and find that safe haven within the company of their buddies. So the soothing systems have been rewired to respond in connection with these combat buddies. When they come home, they can then lose the secure base and safe haven that their brains have gotten wired up for, and there will be fewer intense “dopamine rushes.” Even though they are now at home with their families in a physically safe environment, it can be very difficult and even stressful, because those families are not now the source of the secure base and safe haven. ixCFT Made Simple CFT outlines these kinds of processes clearly because it contains an emotional model capable of dealing with that degree of complexity. This example is reflective of a common aspect of CFT: the CFT therapist is very interested in how patients are able to calm and ground themselves, feel connected to a secure base and safe haven, and then develop the courage necessary to engage with feared and avoided experiences. Key too is the development of the internal affiliative relationship; that is, one learns to relate to oneself in a friendly, supportive way rather than in a critical manner that will continue to stimulate the threat system. Good therapists want to know the evidence behind the therapies they utilize. Given the purpose of this book, Russell has not overwhelmed it with evidence, but makes clear that a lot of the evidence for CFT is process evidence. That is, we don’t have many theoretical concepts, but rather try to understand and draw upon what the science tells us about things like motivation and emotion—for example, what we know about the importance of the frontal cortex and how that develops during childhood or is affected by trauma. We know that the affiliative motives (such as attachment or group belonging) and emotions played a very major role in mammalian evolution and in particular the evolution of human intelligence. We also know that affiliative relationships are very powerful regulators of motives and emotions. It follows, therefore, that these would be targets for therapeutic intervention. The backbone of CFT is found in detailed knowledge of how our brains have become the way they are, understanding the evolutionary function of emotions, understanding core regulating pro- cesses of motives and how motives are linked to self-identity, and understanding how self-identity can be cultivated in the therapeutic process. All over the world now, we are beginning to recognize that the human mind is full of complex emotions and conflicts partly because of its evolved design—an awareness that is increasingly reflected even in popular culture, such as the Disney movie Inside Out (2015). The human brain is very tricky, easily pushed into doing bad things to others and harmful things to ourselves. Compassionate motives, however, help to bring harmony and reduce the risks of both. CFT is an integrative therapy, which makes use of many evidence-based intervention strate- gies. These include Socratic dialogue, guided discovery, identification of safety behaviors, focus on avoidance and exposure, inference chaining, reappraisal, behavioral experiments, mindfulness, body/emotion awareness and breath training, imagery practices, supporting maturation—and more besides. However, CFT also features a number of unique features: • Psychoeducation about our evolved “tricky” brains • Models of affect regulation with special focus on affiliation and the parasympathetic nervous system • A specific focus on the complex functions and forms of self-criticism and self-conscious emotions, highlighting distinctions between different types of shame and guilt • Building compassion-focused motives, competencies, and identities as inner organizing systems xForeword • Utilizing self-identity as the means for organizing and developing compassionate motives and competencies • Working with fears, blocks and resistances to compassion, positive feelings, and espe- cially affiliative emotions One of the key aspects of CFT is the idea that motives are major organizers of our minds. They are linked to phenotypes in complex ways that are beyond the scope of the current discussion. But for example, imagine that you are invited to a party and you are motivated by competitive social rank. You want to impress the people there, and avoid making mistakes or being rejected, and you want to take any opportunity you can to identify the more dominant members of the group and impress them. Now let’s change that motivation and imagine you have a motivation that’s focused on caring or friendship. Now your attention is not on who is dominant or whom you can impress (or how you can impress them), but on finding out more about them. You are interested in sharing values, and perhaps developing friendships. You will be considering people in terms of whether you like them and want to spend time with them or not. The ways we think, pay attention, and act are guided by motivations. Of course, beliefs and things like organizing schemas come into it—in fact, these are linked to motives—but the crucial issue is motivation. When we see how powerful these motives can be in organizing our minds, it becomes clear why compassion and prosocial motivations are central in CFT. Research has revealed that many people with mental health problems are motivated primarily through competitive social rank systems which play out in terms of harsh self-judgments, self-criticizing, and worries of being seen as inferior or incompetent in some way and rejected, often with intense feelings of loneliness. These individuals may often feel they are stuck in low-rank, low-status, or undesirable positions. Of course, there are others who are hyper-focused on attaining dominance; focused on getting ahead and taking control regardless of the impact it has on others. Switching to caring-focused or compassionate motivations can be a revelation to such clients, but can also be quite frightening. Different types of clients can experience resistance toward cultivating compas- sionate and prosocial motives rather than competitive social rank–focused ones. CFT teaches people how to think about different motivational and emotional states and to practice switching between them. When we learn how to create within us a wise, strong, compassionate motivation and then to anchor that motivation at the center of our sense of self, we discover that it brings with it a wisdom for how to deal with life crises, orienting us to our own suffering and those of others in very different ways. We discover that it’s a way of liberating ourselves from suffering and learning how to tolerate that which can’t be changed. A very simple depiction of the essence of why devel- oping a compassionate sense of self is important can be seen in “Compassion for Voices,” a very short film about how people who hear voices can develop a compassionate self: https://www .youtube.com/watch?v=VRqI4lxuXAw. Russell guides readers through the processes by which we need to pay attention to our bodies, learn how to identify which emotion motivational systems are operating through us (motives which can be activated quite automatically and exert considerable control over our thoughts and xiCFT Made Simple behaviors unless we develop more mindful awareness), and cultivate care-focused motives, emo- tions, and self-identity using a range of techniques drawn from standard therapies, contemplative traditions, and acting traditions. As Russell makes clear, the details of CFT can indeed be complex, but the layered approach presented here helps to organize these complexities in a straightforward, understandable way. I’m delighted to see Russell write this book in such a clear and easy-to- understand, step-by-step way. I hope it will entice you to learn more—perhaps to get more train- ing, and perhaps even motivate you to cultivate an ever-deepening compassionate motivation within yourself. As Russell points out, there’s nothing like personal practice and insight to see how these processes work. All that I can do now is to leave you in the talented and capable hands of your author and hope this inspires you to learn more about the nature of compassion and how we can bring it into therapy, and of course, into all aspects of our lives. —Paul Gilbert, PhD, FBPsS, OBE xii