第十章 同理思考与逻辑分析

127C H A P T E R 10 Compassionate Thinking and Reasoning In its approach to thought work, CFT incorporates components of both mindfulness and more traditional cognitive therapies. Consistent with mindfulness-­based approaches, CFT assists clients in developing an awareness and nonjudgmental acceptance of their unhelpful and challenging thoughts as mental events, refraining from clinging to these thoughts, arguing with them, or attempting to push them out of awareness. However, recognizing the power of thoughts both as implicit inputs to the emotional brain and as organizers of motivation and behavior, CFT shares ground with many cognitive therapy models in emphasizing the purposeful cultivation of helpful thinking patterns. Thought work in CFT is defined by an emphasis on compassionate thinking—­ thinking that is focused on understanding, bringing balance to the emotions, encouraging the self in facing difficult situations, and helping to develop compassionate strengths. As we saw in the letter-­writing exercise in the previous chapter, compassionate thinking is warm, validating, flexible, and focused on facilitating helpful action. Thought work in CFT is not seen as an isolated set of practices. Rather, it is a natural part of the continued development and elaboration of the compassionate self. How would this kind, wise, confi- dent, compassionate version of you think about this situation? How would you understand this experience from that deeply compassionate perspective? What would be helpful in working with this situation? It’s not just about generating compassionate thoughts—­ it’s about learning to shift more fully into this compassionate perspective. As we explore compassionate thinking with clients, we can remind them that different emo- tions and social mentalities organize our mental and bodily experience in very different ways, producing very different, interrelated patterns of attention, thinking, imagery, felt experience,CFT Made Simple motivation, and behavior—­with compassion organizing the mind in ways that are particularly useful in confronting and working with suffering. Threatened MindCompassionate Mind AttentionAttention Thinking and Reasoning Emotions Threat Imagery and Fantasy Compassion Motivation Behavior Thinking and Reasoning Emotions Imagery and Fantasy Motivation Behavior Figure 9.2: How threat and compassion organize our experience. (From Gilbert, The Compassionate Mind [2009], reprinted with permission from Little, Brown Book Group.) Before doing compassionate thought work, it can be useful to have clients engage in a brief Compassionate Self exercise, to have them shift into the perspective of the compassionate self before going forward. In this way, we’re linking the thought work to the overall story arc of therapy—­the cultivation and reinforcement of this adaptive, compassionate version of the self. WORKING WITH THREAT-­FOCUSED THOUGHTS Much of our clients’ psychological suffering can be triggered and maintained through patterns of thinking, and it’s well established that negative thought patterns regarding oneself, the world, and other people can play a central role in psychological distress (Beck, 1976). We’ve already intro- duced mindfulness, which plays an important role in compassionate thought work. Mindfulness practices help clients keep from becoming fused with such thoughts, as they become more adept at noticing the arising of unhelpful thoughts, refraining from judging them, and learning to redirect their attention rather than getting caught up in rumination. As we’ve seen in some of the clinical vignettes, when clients have well-­entrenched patterns of unhelpful thoughts, the CFT therapist will sometimes help them recognize these thoughts as prod- ucts of how different threat emotions and learned patterns of responding organize the mind. This can be done using language like “the anxious self,” “Depressed (client name),” or “the self-­critic.” “So, 130Compassionate Thinking and Reasoning Anxious Jenny is very good at listing off all of the ways this situation could go horribly wrong?” Or, “It sounds like your self-­critic has a lot to say today.” Using such language helps clients step back from these thoughts or critical messages and relate to them in a nonblaming way. It also helps anchor these experiences to themes of compassionate understanding that are woven through the therapy—­understanding these thoughts as natural products of how powerful threat emotions organize the mind as they attempt to protect us, or as habits that were learned via social shaping. We don’t hate the anxious or angry self—­we want to reassure and help her. Understanding such thoughts in this way can help take the sting out of them, and provides a structure for working with them compassionately. Let’s consider what this might look like: Therapist: Jenny, you’ve been able to keep up with your mindfulness exercises and have been practicing really consistently. Have you noticed anything new as you’ve been doing that? Jenny: It took a few weeks to remember to do it consistently, but I’m doing better. I feel like I’m getting a lot better at noticing all the thoughts that come up throughout the day—­especially the ones that get in the way of me doing things. Therapist: That sounds great. Could you tell me more about what you’ve noticed? Jenny: Well, I’ve noticed that before I do anything, I spend a lot of time thinking about all the things that could go wrong, particularly when it involves doing stuff with other people. I’m all the time having thoughts like, This is going to be terrible, or I can’t do this, or They aren’t going to like me, or I’ll look like an idiot. That sort of thing. Therapist: So it sounds like Anxious Jenny has a lot to say. Jenny: (Smiles.) She sure does! Anxious Jenny is working very hard. Therapist: She’s working very hard to try and protect you, isn’t she? She’s been burned before, and she’s working very hard to make sure you don’t get hurt like that again. Can we understand her perspective? Given your experience, does it make sense that she might be really vigilant? Jenny: (Pauses thoughtfully.) It does. It does make sense. Therapist: The tricky bit is that Anxious Jenny has a perspective that is very limited—­she sees only the danger, and sometimes sees danger when it really isn’t there. Does that sound right to you? Jenny: It does. I get worked up about all sorts of things. I get anxious about stuff I know isn’t a big deal. Stuff that doesn’t even matter. And I worry about it anyway. Therapist: Have you seen those life-­size cardboard cutouts of movie characters? 131CFT Made Simple Jenny: Yeah. A girl down the hall from me has some of those in her room. Therapist: From the front, they can look pretty real—­they’re life-­sized, and have lots of detail. From a distance, you might even think it’s a real person. Jenny: Yeah. She’s got Justin Bieber! Therapist: Justin Bieber? (Smiles.) Jenny: For real. She’s got Justin Bieber. I know, right? Therapist: (Chuckles.) That’s actually a good lead-­in to what I was getting at. If we think about Anxious Jenny—­this version of you that is completely organized around fear and anxiety—­it’s like she’s looking at a really scary cardboard cutout right from the front, so it looks like a real threat. So there’s this cutout of someone laughing at you, or a teacher who’s going to criticize you…or Justin Bieber. And this threat is right there, and from the front it looks really real. So she sees this, and gets really scared, and we can understand why. Jenny: (Nods.) Therapist: But imagine that Compassionate Jenny shows up, and she sees how scared Anxious Jenny is getting. Compassionate Jenny is kind, and wise, and courageous—­courageous enough to walk around the room and look closely, seeing the situation from all angles. What would Compassionate Jenny see? What would she understand? Jenny: She’d see that it wasn’t real. She’d see that this scary person isn’t really there, that it isn’t really dangerous. It’s just cardboard. Therapist: Would she understand why Anxious Jenny was so worked up? That from her side, given her experience, it looks really scary? Jenny: Yeah, she would. Therapist: Anxious Jenny is there, reeling off all these scary thoughts: Can’t you see it’s terrible? They’re going to attack us! We can’t handle this! What does Compassionate Jenny think of this? Jenny: Compassionate Jenny wouldn’t think too much about it. She knows that Anxious Jenny is just freaking out because she’s scared. Therapist: That’s it! That’s the wisdom of compassion! So this compassionate version of you can see the thoughts, and can understand where they come from, but can keep from buying into them. If Compassionate Jenny wanted to help Anxious 132Compassionate Thinking and Reasoning Jenny feel safe, what might she do? If this kind, compassionate, wise version of you were there, what would she say—­what would she want Anxious Jenny to understand? How would you reassure her? Would you tell her to stop being so stupid? (Smiles.) Jenny: (Smiles.) No. (Pauses.) I’d tell her that it’s okay, that these scary people aren’t real, that they only look that way because of where she’s standing. I might give her a hug and then take her by the hand and lead her to the side of the room, so that she could see they’re only cardboard. Therapist: That’s beautiful, Jenny. How do you think Anxious Jenny would feel if you were to do that? Jenny: I think it would help. Therapist: It occurs to me that you also wrote down a lot of really encouraging, compassionate thoughts in the compassionate letter we reviewed last session. Have you reread that at all this week? Jenny: I have, and it really helped. I really liked writing the letter, and reading it helped me calm down when those anxious thoughts were really getting ramped up. I read it before my small group met to work on the project in my communications class that I told you about, and it went pretty well. I even spoke up once or twice. Therapist: Jenny, that’s fantastic! Nice work. I’m proud of you. Jenny: I’m proud of me, too. In the vignette above, we see several aspects of compassionate thought work at play. First, we see a notable absence of Let’s replace that bad thought with this good one. The therapist begins by anchoring the work in Jenny’s ongoing mindfulness practice, and discussing the thoughts from a mindful perspective—­looking at them from the perspective of a curious, nonjudgmental observer. The therapist then introduces the language of “Anxious Jenny,” contextualizing the worrisome thoughts as products of how anxiety organizes the mind—­setting up this anxious version of the self not as an enemy to be criticized or hated, but as a sympathetic figure who is trying to help, but whose limited perspective (characterized via the cardboard cutout metaphor) often prevents her efforts from being truly helpful. The therapist then prompts Jenny to shift into the perspective of the compassionate self, preparing her to connect with more reassuring, helpful ways of thinking that aren’t focused on disputing or arguing with the anxious thoughts, but on soothing the anxious part of her, and broadening her perspective. The architecture in place, this discussion could then progress to working with thoughts around a specific challenging situation, in which Jenny (from the perspective of her compassionate self) 133CFT Made Simple could be prompted to offer encouragement, understanding, guidance, and problem solving around how to meet and work with the situation. In the vignette, this took the form of bridging from the current discussion to the compassionate letter we introduced in the previous chapter, which Jenny had used to help herself work with a situation she’d been dreading. As the vignette closes, we see how this success was able to fuel positive self-­to-­self relating in Jenny, as she spontaneously relates to herself with warmth (“I’m proud of me, too”) rather than criticism. We don’t have to use the “emotional self” language if we’re not comfortable with it. Instead, we can simply label such thoughts as products of the threat emotions that prompt them: “Sounds like you were having lots of anxious thoughts.” After clients are fairly well acquainted with the Compassionate Self exercise, we can prompt them to shift into this perspective: “What would your wise, kind, confident, compassionate self think about this situation? What might she advise us to do?” Again, the idea isn’t to dispute threat-­driven or self-­critical thoughts. It’s to acknowledge them and facilitate a shift to a gradually deepening compassionate perspective. Let’s explore this a bit further. COMPASSIONATE THINKING AND REASONING A primary attribute of the compassionate self is the capacity to think and reason in compassionate ways, and to develop these ways of thinking as habitual patterns of mind. Compassionate ways of thinking and reasoning are anchored in two fundamental objectives: understanding suffering, and helping to address, alleviate, or prevent it. As we help clients understand what compassionate thinking looks like, it can be useful to contrast compassionate ways of thinking with threat-­based ways of thinking: Threat-­Based ThinkingCompassionate Thinking Narrowly focused on the threatBroad, considers many factors in understanding the situation Focused on judging and labelingFocused on understanding Inflexible and ruminativeFlexible, problem-­solves Activates the threat systemActivates the safeness system; helps us to feel comfortable and at peace Directs hostility, fear, or disgust toward others Directs kindness toward others and ourselves and ourselves Judgmental and criticalNoncritical, empathic, and encouraging Focused on avoiding, dominating, or punishingFocused on helping ourselves and others, finding solutions that benefit everyone and harm no one 134Compassionate Thinking and Reasoning In exploring this contrast with clients, it’s important not to set things up in a threat-­based thinking is bad, compassionate thinking is good sort of way. Familiar with the three circles, clients can understand why the threat system organizes thinking in such narrow, constraining ways—­it’s designed to work that way in the face of immediate physical threats. However, they can come to recognize that in the absence of such threats, there are likely more helpful (or as ACT therapists might say, more workable) ways to understand and approach things. In contrast to threat-­based thinking, compas- sionate thinking often takes the form of asking questions (Gilbert, 2009a): • How does it make sense that I (or he or she) would feel (or think or behave) in this way? • What is triggering my threat system here? What feelings are coming up in me? • How would I understand this situation from the perspective of my kind, wise, confident, compassionate self? • What might help me feel safe so that I can work with this situation more skillfully? • What might be helpful as I tackle this challenge? What resources might help me work with this situation? • How might he or she be making sense of this situation? • What would my compassionate self think (or feel or say or do) in this situation? What would he or she encour- age me to do? Mentalizing In helping clients emphasize compassionate understanding in their thinking, it can sometimes be helpful to introduce the concept of mentalizing (Fonagy & Luyten, 2009; Liotti & Gilbert, 2011). Mentalizing involves examining actions and emotions by considering what is going on in the mind of the person who is behaving or feeling that way. What are the desires, feelings, needs, beliefs, and motivations reflected in these behaviors? Such consideration puts even frustrating or extreme behaviors into a context that opens the door for compassion—­such as the recognition that the patient who self-­harms does so in a desperate attempt to reduce emotional pain. Linking Thought Work to Compassionate Understanding As we’re helping clients develop compassionate patterns of thinking and behaving, it can be useful to relate what we’re doing to how things work in the brain—­linking the thought work back to the compassionate understanding we’ve been working to develop. We can prompt clients to consider that everything they do, say, think, or feel is reflected in the activation of corresponding patterns of cells in the brain, and that as these patterns are activated again and again over time, the pattern is strengthened and becomes easier to activate. As neuroscientists say, “Cells that fire together, wire together.” 135CFT Made Simple Over time, these connected patterns of cells become so well primed that they can be activated easily—­often without the client’s awareness—­which is why longstanding habits like self-­critical thinking can be so hard to break. The brain patterns underlying them have been strengthened over thousands and thousands of trials. This realization can assist the cultivation of self-­compassion in two ways: First, it can help clients ease up on self-­blame around their failures, as they understand that changing longstanding habits is difficult, not because they are weak or lack willpower, but because of how their brains work. It also helps clarify the way to change—­establishing and strength- ening new patterns in the brain by repeatedly shifting into the perspective of the compassionate self and practicing compassionate thinking, attention, and behavior consistently over time. Let’s take a look at how this might play out in a therapy session, using a “path in the woods” metaphor: Therapist: So we’ve chatted a bit about compassionate thinking and how it organizes us in different ways than anxious, threat-­based thinking. Jenny: (Frowns and looks down.) Therapist: Jenny, it looks like something just happened there for you. Could you tell me a bit about how you’re feeling right now? Jenny: I’m just frustrated. We’ve been talking about this, but these anxious, critical thoughts just keep coming. I try to think more positively but it’s like the anxious thoughts are always there, every time I want to do anything. It’s really discouraging. Therapist: (Leans in; remains silent.) Jenny: It’s like the thoughts are automatic. They just come up, and I get stuck in them. Therapist: It makes sense to me that it would feel discouraging—­some psychologists even call such thoughts automatic thoughts. I’d bet those anxious thoughts kind of are automatic, at this point. Like, in your brain, automatic. Would it be all right if we talked for a bit about why they’re like that? Jenny: (considering) Sure. Therapist: Imagine that there are woods behind my house, and every day for ten years, I walked in these woods—­walking a way that seemed to make sense, the same way every time. Over time, what would happen in the woods, on the ground where I was walking? Jenny: You’d wear in a path. Therapist: I sure would. And when it rains, where would the water run? Jenny: 136 Down the path.Compassionate Thinking and Reasoning Therapist: Exactly. Why would it do that? Would the water choose to run down the path? Jenny: No, it just would. It’s easier for it to run down the path than anywhere else. Like a path of least resistance. Therapist: Exactly. So what if I suggested our brains are like this forest? Every time we think or behave in a certain way, we’re walking a path—­activating a pattern of cells in the brain—­and the more we think or behave that way, the more “worn in” the pattern becomes. The pattern becomes strengthened over time, making it so that it lights up more and more easily. Eventually, it can light up almost automatically—­you think about a social situation, and that self-­critical pattern just lights right up, like a path of least resistance in your brain. So it seems like the self-­critical thoughts just show up automatically. It’s not our fault. It’s just how our brains work. Jenny: (after a thoughtful pause) That makes sense. It sucks, though. Therapist: (Smiles.) It certainly can suck! But it also gives us a clue about how to create change in our lives. Let’s say I was getting tired of that path—­perhaps because every time it rained, the rain ran down the path into my backyard, flooding it. How would I change this, assuming I didn’t want to give up going for walks? Jenny: You’d need to stop walking on the path. You’d need to find some other way to walk. Therapist: Exactly. I’d need to figure out a path that worked better, and walk that way instead. I’d probably forget sometimes, and walk the old path out of habit. So my job would be to try and notice when that happens, and then change over to the new path that goes where I want it to go. Can you see how this applies to those self-­critical and anxious thoughts? Jenny: I think so. They’re the really worn-­in path. Therapist: Yeah. That path is really easy to walk—­automatic, almost—­because it’s been worn in for years. The compassionate thinking path takes more effort. Jenny: It sure does. Therapist: But if I work really hard to notice where I’m walking, and remember to try and walk the new path most of the time, it becomes easier. Over time, the forest starts to look different, doesn’t it? Eventually, the old path erodes, and the new one slowly wears in. But the forest doesn’t change overnight just because I decide I don’t like the old path, does it? It takes consistent effort over time. Jenny: That makes sense. 137CFT Made Simple Therapist: Over time, if I make effort to consistently walk a new way, the new path will wear in—­it’s just how it works. So if I find myself accidentally walking the old path out of habit, what’s the best thing to do? I mean, besides getting really mad at myself? (Smiles and speaks warmly.) You know I’m joking, right? Jenny: (Smiles.) I get it. No, you’d want to just stop, and go over to the new path. Therapist: Exactly. This is the reason for the approach we’re taking with these anxious and critical thoughts. We want to increase mindfulness so that you notice when they come up—­when you are walking the old path out of habit… Jenny: (Nods.) Therapist: …so you can shift over and walk that new path, over and over, to strengthen brain patterns associated with compassionate ways of thinking. So that compassion becomes the path of least resistance. We’re not arguing with the anxious or critical thoughts. We’re just noticing that old pattern, letting go of it, and shifting over to strengthen the new one. What do you think about that? Jenny: Sounds good. It makes sense, anyway. Therapist: Let’s think about a situation in which those old, anxious patterns show up. This group project you have in your communications class is ongoing, correct? Jenny: (Cringes a bit.) Yeah…we’re meeting twice per week for the next two weeks. Therapists: Sounds like although you did well at the last meeting, you’re still not really looking forward to it. Do those anxious thought patterns come up before the meetings? Jenny: (still cringing a bit) Yeah. I still get really anxious about it. Therapist: What are some thoughts that come up? Jenny: That it’s going to be awful. That I’ll look stupid. Just running through all the different ways it could go wrong in my head. Therapist: So that’s the old path. Let’s work on what the new path would look like. Let’s imagine that we’ve mindfully noticed those thoughts and let them go. Now, let’s shift into the kind, wise, confident perspective of your compassionate self. We’ll start with thirty seconds or so of soothing rhythm breathing…slowing down the body…slowing down the mind. Jenny: (Shifts in her seat a bit, closes her eyes, and slows her breathing.) Therapist: (Waits thirty seconds to one minute.) Now imagining being filled with kindness, wisdom, and courage as you shift into the perspective of the compassionate self. This is 138Compassionate Thinking and Reasoning the part of you that wrote that compassionate letter—­the part that sees how hard it is for you to do things like that group activity, and wants to encourage you and help you feel safe. Give me a little nod when you feel like you’ve been able to connect a bit with that compassionate perspective. Jenny: (Waits a few moments; nods.) Therapist: What would this compassionate version of you think, as you prepare to go to the group meeting? How would you extend kindness and encouragement to the part of you that’s so anxious? As this compassionate self, what would you say? Jenny: I’d say that this is really hard, but I’ve done this before, and I can do it again. Therapist: What are some other things you’d say from this compassionate perspective? Jenny: That I’m not alone. There are other people in the group who seem to like me, people I like being around. I’d tell myself that I’m stronger than I think. I’d remind myself that when I spoke up last week, nothing terrible happened. That I can do this. Therapist: How does it feel to hear yourself saying these things? Jenny: It feels good. Kind of fake, but good. Therapist: Does it make sense that the new path would take a while before it felt as easy and natural as the old one? Jenny: It does. I need to remind myself of that. Therapist: How would your compassionate self remind you of that, when the compassionate thoughts feel a little fake? Jenny: She’d say that it’s because it’s a whole new way of thinking. Of course it wouldn’t feel as natural as the old path. Therapist: Exactly! It sounds like your compassionate self is figuring some things out. Jenny: (Smiles.) She’s trying. At first, clients can become demoralized when the voices of the critical or threat-­based selves seem so much more powerful than the new, compassionate ways of thinking. The idea is to provide clients with a context for understanding why this is so. This can even provide the basis for compas- sionate sympathy (“It’s really difficult for me that these anxious thoughts come up so automatically”). Given such a context, clients can see the power of shifting into a compassionate perspective again and again—­both for developing compassionate ways of thinking in the present moment, and for strengthening the underlying neural architecture that can make these ways of thinking more likely to arise in the future. 139CFT Made Simple SUMMARY In this chapter, we’ve explored ways to help clients apply compassion to their thinking and reason- ing. The idea is to cultivate compassionate ways of thinking so that over time, such compassionate thoughts will spontaneously arise more and more often. We’ll continue to explore how clients can relate compassionately to their struggles in the next chapter, which focuses on compassionate imagery.