第十一章 运用同理图像技术

140CC H A P T E R 11 Using Compassionate Imagery In order for compassion to become real for our patients, it needs to be felt at an experiential level. Increasingly, we’re discovering that imagery is an effective method for facilitating experiential work with clients (Hackmann, Bennett-­Levy, & Holmes, 2011). In the Compassionate Self exercise, we used imagery to help clients shift perspectives and practice compassionate ways of working with difficult situations. In this chapter, we’ll explore ways to use imagery to help clients manage distress and balance their emotions. AN ORIENTATION TO IMAGERY Since CFT makes frequent use of imagery, let’s consider how to effectively introduce clients to imaginal work. Often, when clients hear “imagine” or “imagery,” they think it means, “creating vivid pictures in the mind.” This idea can be an obstacle; while some clients will be able to effort- lessly create such vivid mental pictures, many others will struggle to do so. The key to overcoming this block is to help clients realize that imaginal work isn’t about making vivid pictures—­it’s about creating mental experiences (Gilbert, 2010). Let’s explore a method for introducing this practice to clients, developed by Paul Gilbert: Therapist: Jenny, as I mentioned in our last session, today we’ll introduce some imagery exercises to help you bring up feelings of safeness to balance your emotions when your threat system is really going. I thought it would be useful to talk a bit about how to use imagery before we get started. How does that sound? Jenny: Sounds good.CFT Made Simple Therapist: Besides the Compassionate Self exercises we’ve been doing, have you ever used mental imagery? Perhaps closed your eyes and tried to imagine something? Jenny: Last year I took a yoga class, and sometimes the teacher would have us imagine things—­like being somewhere like a beach, or being a tree, with life flowing into us from the ground beneath us. That sort of thing. Therapist: Cool—­how did you like it? Jenny: I liked it, but sometimes it worked better than others. I should take another yoga class, because it was really relaxing. Therapist: Sounds like a good idea—­yoga is fantastic, and it fits really well with what we’re doing. It’s good that you’ve had some experience with imagery. Sometimes people struggle with imagery work because they think it involves creating really vivid pictures in their minds. Some people can do that, but other people really struggle with it. Jenny: I think I know what you mean. I’m not really good at that. Therapist: (Smiles.) Me neither—­I’m not good at “seeing things” in my mind. But here’s the thing: what we’re after isn’t about creating vivid mental pictures, but creating mental experiences. Could we do a brief exercise to demonstrate what I mean? Jenny: (nodding interestedly) Sure. Therapist: Great. Let’s start by shifting into that comfortable, upright position we’ve been using for our exercises…feet flat on the floor, back straight, eyes closed. Let’s do thirty seconds or so of soothing rhythm breathing, slowing down the breath, and focusing on the sense of slowing. Slowing down the body, slowing down the mind. Jenny: (Closes her eyes and breathes slowly.) Therapist: (Waits thirty seconds.) I’m going to briefly prompt you to bring a few different situations to mind. As I do, just allow yourself to imagine the situation I’m describing. Jenny: (Nods.) Therapist: First, bring to mind how you got here this morning—­imagining the route you took when you were driving, riding, or walking here. (Waits thirty seconds.) Now, bring to mind your favorite dessert. (Waits thirty seconds.) Now, bring to mind the last vacation you took, or if one doesn’t come to mind, a vacation you’d like to take. (Waits thirty seconds.) When you’re ready, gently allow your eyes to open. 142Using Compassionate Imagery Jenny: (Waits a moment, then slowly opens her eyes, shifts, and smiles a bit.) Mmmm. Therapist: Were you able to get a mental sense of all the things I mentioned? Jenny: I was. It was nice. I didn’t want to stop. Therapist: Nice! It sounds like you were able to get a mental experience of those things—­ the route you took, the dessert, the vacation—­and like some emotions came up as well? Jenny: Yeah. It felt nice to imagine myself walking along the beach like I did last summer. Therapist: Excellent! That’s mental imagery. It’s about bringing an experience to mind, so we’ve got a good sense of it. Sounds like you’ve already noticed one of the benefits of imagery—­that our old, emotional brains respond to imagery by producing different emotions, like that pleasant feeling you got from imagining yourself back on the beach. Exercises like this can give clients a sense of what imaginal work is like, and can give them con- fidence that they can do it. We want to create a mental context in which the client is able to focus on the imagery exercises, minimizing distractions caused by self-­evaluative thoughts of whether or not they are doing it correctly. CREATING A SAFE PLACE One goal of CFT is to help clients learn to work with the three circles to balance their emotions, particularly when they notice themselves shifting into threat mode when a more balanced approach would be helpful, or when they observe they’ve been fueling feelings of threat through rumination or threatening imagery. Imagery can be a powerful tool for getting the safeness system online, and one way to do this involves safe place imagery. (Sometimes it’s referred to as “soothing space” imagery for clients who don’t like the term “safe place.”) In this practice, clients imagine themselves in a setting that creates feelings of safeness, calm, peacefulness, and belonging. Many therapists will have used imagery in this way. As in other such practices, we have clients focus on the various sensory details of this soothing place. In CFT, we add a dimension to the typical safe place practice by introducing an affiliative component to the imagery. This is done via specific instructions such as, “If there are other beings in this place, imagine that they welcome you, value you, and are happy to see you. In fact, imagine that this place itself values your presence—­as if you complete it, and it is happy that you are here.” Let’s consider how this practice might be introduced and facilitated in a therapy session: Therapist: Jenny, now that we’ve explored what we mean by imagery, I’d like to introduce a specific practice designed to help get your safeness system working for you—­to 143CFT Made Simple help you connect with feelings of calm and peacefulness when you notice your threat system is really going. How does that sound? Jenny: Why not? Therapist: Great. In a way, you’ve got a head start on this one. A few moments ago, you said you enjoyed imagining yourself back on that beach from your vacation—­so much that you didn’t want to stop. What did you like about that? Jenny: I love the beach. I love everything about it—­the smell, the feeling of sand under my feet, watching and listening to the waves, the sun. I like to walk on the beach for hours. It’s so peaceful. Therapist: That does sound wonderful. Jenny: It is. It’s my favorite thing to do. Therapist: That’s a perfect segue into our next exercise. This is called the “Safe Place exercise.” We’re going to imagine being in a place that helps you feel safe, comfortable, peaceful, and soothed. The idea is to create a mental experience of this place and the feelings that go along with being there. Sometimes it takes time to figure out what sort of place to use—­but it sounds like you may already have a good place in mind. Do you think the beach would work for this exercise? Jenny: The beach would be perfect. Therapist: Great. So let’s go ahead and get started. We’ll begin with some soothing rhythm breathing, to slow down our bodies and minds. Then I’ll prompt you to imagine the beach. I’ll ask you to describe what it’s like on the beach—­like it’s really happening—­so we can create a deep mental experience. Then I’ll be quiet and leave you to the imagery for about five minutes. If your mind begins to wander or you get distracted by thoughts, that’s no problem—­just manage it like we do with mindful breathing, by noticing you’ve become distracted and gently bringing yourself back to the beach. Ready to go? Jenny: Let’s do it. Therapist: Sitting in an upright, comfortable position, the eyes gently closing. Jenny: (Shifts a bit, closes her eyes, and slows her breathing.) Therapist: Allowing the breath to take on a slow, comfortable rhythm. Focusing on the sense of slowing. (Waits five seconds.) Slowing down the body, slowing down the mind. (Waits thirty seconds to one minute.) 144Using Compassionate Imagery Jenny: (Breathes slowly.) Therapist: Now, imagining yourself on that beautiful beach. Opening yourself to the soothing experiences there. When you’ve got the image, describe what you’re doing and experiencing. Imagine yourself, there on the beach, with all the sounds, smells, and images you love. Jenny: (Pauses for five to ten seconds.) I’m walking down the beach, and I can feel the sand squishing underneath my feet. I like the way it feels on my toes. Therapist: That’s perfect, Jenny. What else are you noticing? What does it feel like? Jenny: It’s warm and peaceful. The sun is shining on my face, and the wind is gently blowing through my hair. I can hear the waves and the sound of the seagulls. (Pauses for a few seconds.) I can smell the ocean. Therapist: Allow yourself to be filled with feelings of safeness, peacefulness, and joy at being in this wonderful place. Maybe allow a gentle smile to cross your face, as you enjoy being here. Jenny: (Smiles.) Mmmm. Therapist: Imagine that the seagulls you hear are happy that you are here with them. Likewise, if there are any people or other beings in this place, imagine that they welcome you. They value you; they’re happy you are here. (Waits twenty to thirty seconds.) Imagine that this place itself welcomes you. It values your presence, almost as if you complete it. It is happy you are here. Jenny: (Breathes peacefully.) Therapist: Let’s take some time to imagine being in this place, filled with feelings of safeness, peace, and contentment. Imagine all the sensations that come with being in this place. Jenny: (Continues to breathe peacefully.) Therapist: (Waits five minutes.) When you’re ready, gently shift your attention to the slow sensation of the breath, and allow your eyes to open. Jenny: (Waits twenty seconds or so, then gradually opens her eyes. Smiles.) Therapist: How was that? Jenny: That was really nice. Really peaceful. Therapist: Did you get a mental experience of this place, and the feelings that go with it? 145CFT Made Simple Jenny: I did. It felt completely comfortable and peaceful. Therapist: Were you able to imagine that the place and the creatures in it welcomed you? Jenny: Yeah. It was kind of like one of those children’s movies where the animals do funny things. I imagined seagulls flying along beside me, or looking up at me from where they were standing on the beach. It was fun to imagine that. Therapist: Were there any other people on the beach? Jenny: Not at first, but after you said that, I imagined a few lying on blankets, higher up on the beach, just lying in the sun and enjoying themselves. It was really peaceful. Therapist: That’s exactly how it’s supposed to work. Would you be up for practicing this two or three times over the next week? The idea is to really get used to visiting this place in your mind, activating those parts of your brain that help you feel safe, content, and peaceful. Jenny: I’d love to. Therapist: Fantastic. It helps to practice initially when you’re already feeling pretty calm, to get good at bringing up the imagery. Once that feels manageable, try using the imagery when your threat system is going and you want to balance things a bit by connecting with feelings of safeness. Does that make sense? Jenny: Sure does. Things went really smoothly in the vignette above, as Jenny had identified a likely “safe place” in the previous imagery exercise (an occasional advantage of using a “favorite vacation” prompt in introducing imagery), and she was very good at connecting with the image of the beach. She was also able to quickly move into the imagery and describe it in therapy. It won’t always go this smoothly. Some clients won’t have a place from memory, so we’ll work with them to consider what such a place might be like. Sometimes I start by briefly mentioning a few of my “places”—­a walk on a northwestern beach, sitting in a pine forest, even having a pint in a favorite English pub, sur- rounded by smiling faces and 300-­year-­old oak, my nose filled with the soothing aroma of a steak-­ and-­ale pie at my table. For clients who don’t transition as easily into imagery as Jenny did, we can provide sensory anchors, using our knowledge of what might be soothing to the client: “Imagine feeling the sun on your face, the smells and sounds of the ocean…” We want to say just enough to facilitate the imagery and feelings of peacefulness and soothing that accompany it, and then gently recede, leaving the client with the imagery. Some clients will need to experiment with a few different “places” before they find one to settle on. Finally, the body work is important—­setting the stage with soothing rhythm breathing and prompting a gentle smile can help clients more fully enter into the experience, adding yet another soothing implicit input into the emotional brain. 146Using Compassionate Imagery I really can’t say enough about this practice. While no practice works for everyone, I’ve seen men in prison for violent crimes, who had spent decades struggling with anger, use this practice to soothe themselves when they noticed their anger arising. These men used the imagery to balance their emotions and reengage to deal effectively and assertively with situations that previously would have led to verbal or physical aggression. THE IDEAL COMPASSIONATE IMAGE PRACTICE British psychologist Deborah Lee developed a practice called the “perfect nurturer” or “ideal com- passionate image” practice (Lee, 2005). This practice was designed to help self-­critical clients learn to self-­soothe and develop feelings of being accepted and cared for, by imagining an ideal figure who understands them, has compassion for them, and extends kindness, support, and encourage- ment. In this practice, the therapist works collaboratively with the client to identify characteristics that his ideal nurturer would have—­perhaps acceptance, kind concern, and affection—­and a deep understanding of what the client is going through. In contrast to experiences that clients may have had with people in their lives, it is emphasized that this nurturer is supportive, nurturing, and encouraging, and is never judgmental, critical, or shaming of the client. The therapist will also help the client develop an image of what this nurturer looks like and sounds like, and how they might interact. As with the safe place exercise above, the idea is to help the client create as vivid a mental experience as possible. If the client has someone in his life who embodies these qualities (or someone he imagines embodies the qualities, such as a spiritual figure), he can use this in his visualization. Some clients may initially struggle with the exercise, protesting that they’ve never had anyone like this in their lives. If this happens, we can emphasize that actually, none of us has someone like this—­someone who is perfectly understanding, supportive, and nonjudgmental. The idea is to imagine what a being like this would be like, and to imagine that person extending kindness, under- standing, and acceptance to us. Let’s consider what this practice might look like in a therapy session: Therapist: Jenny, I’m glad you like the safe place imagery we introduced last session. How did that go over the past week? Jenny: Really well. It’s my favorite piece of homework so far. I did it three times over the past week. Therapist: Excellent! Repeated practice really is the key. As you’ve done the practice, have you noticed anything that helps or gets in the way? Jenny: Well, it helps if I have a quiet place to practice. My dorm can be pretty noisy in the evening, which is when I have time. I ended up putting on headphones to try and make things a little more quiet, and then it occurred to me that I could probably download an mp3 of the sound of the ocean. So I went online and did 147CFT Made Simple that, and now when I do the exercise, I listen to the ocean sounds, which makes it seem even more real. Therapist: Wow! I should have you teaching this stuff! That’s a perfect example of compassionate thinking, Jenny—­noticing a problem or obstacle, and then instead of getting caught up in it and giving up, asking What might be helpful in working with this? When you did that, not only were you able to address the obstacle, but you found a way to make the practice work even better—­a way that hadn’t even occurred to your therapist. Jenny: That is pretty cool. Therapist: It sure is. I’m gonna steal that ocean-­mp3 idea, by the way. That’s pure gold! Jenny: (Laughs.) Feel free. Therapist: I thought we might try out another imagery exercise. Does that sound all right? Jenny: Sure. Therapist: As we’ve discussed, self-­criticism has been a struggle for you, and you’ve had experiences of being criticized and picked on by others—­really painful experiences. Jenny: (Gets a somewhat pained expression; looks down; speaks slowly.) Yeah. Therapist: I can tell those memories—­those experiences in your mind—­still bring a lot of hurt with them. We want to use imagery to help you have very different experiences—­experiences of being cared about, accepted, and understood. Jenny: (Looks up at the therapist.) Therapist: We’re going to imagine a perfect nurturer—­someone who absolutely cares about you, accepts you, deeply understands you, and wishes the very best for you. Someone who would never judge or ridicule you. How does that sound? Jenny: It’s hard to imagine. I’ve never had anyone like that. Therapist: None of us has, really. Real people can’t support us perfectly in that way—­and your compassionate image doesn’t even have to be a person. It could be an animal, or some other type of being. I know people who have used an ancient tree, for example. The idea is to imagine a being that could help you feel safe, accepted, understood, and supported. Let’s start by imagining the qualities your nurturer would have. What would this being be like? How would the being relate to you? 148Using Compassionate Imagery Jenny: Well, they’d be nice to me, and would never make me feel stupid. They’d accept me just as I am. Therapist: That’s great. So they’d be kind, and accepting. Anything else? Jenny: They wouldn’t judge or criticize me. They’d just like me. Therapist: They wouldn’t judge you. Maybe along with that, they would completely understand you, understand where you’re coming from…really liking you and wanting to help and encourage you when you’re struggling. Jenny: Yeah, that sounds good. Therapist: Let’s start with those qualities: kindness, acceptance, understanding, and encouragement. Let’s imagine what this kind being might be like—­if it is human or nonhuman, if it has a gender, what it might look like, that sort of thing. What do you think your perfect compassionate image might be like? Jenny: I don’t know… (Pauses, thinking.) Therapist: (Waits in silence.) Jenny: I think it would be a woman. An older woman, who’s gone through it and knows what it’s like to grow up as a woman and go through all this. Therapist: Someone who really understands, because she’s been through it. Jenny: Exactly. She could maybe see some of herself in me, and knows how to help me through it, because she’s gone through it herself. Therapist: What might she look like? Sound like? How would she act? Jenny: She’d have gray hair, and a really kind smile. She’d have a gentle voice, and would laugh a lot. She’d have a good sense of humor. Therapist: It sounds like she’d be a lot like your compassionate self—­kind, wise, and confident. Able to help you handle whatever comes up. Jenny: Exactly. Therapist: I think we have a great start, here. Would you like to start the exercise now? Jenny: Sure. (Shifts into an upright posture, closes her eyes, and slows her breathing.) Therapist: Starting with a minute or so of soothing rhythm breathing… (Waits twenty to thirty seconds.) Slowing down the body, slowing down the mind… (Waits twenty to thirty seconds.) 149CFT Made Simple Jenny: (Breathes quietly.) Therapist: Bringing to mind the image of this kind, wise, confident woman who cares deeply about you, understands you, and is there to support you. Jenny: (Face relaxes a bit; breathes quietly.) Therapist: Imagining her with you, smiling kindly at you. Imagine that she likes you, and wants you to feel understood. Imagine her extending kindness and compassion to you, in whatever way would be most helpful and soothing. Imagine what she might do or say. Imagine being filled with her kindness, understanding, and acceptance. Jenny: (Continues to breathe quietly.) Therapist: (Waits five minutes.) If anxiety or other difficult emotions come up for you, imagine her there, understanding and supporting you. Imagine her supporting you as you struggle, believing in you. She understands how hard it can be, and how that isn’t your fault. Imagine her extending kindness and support as you face these challenges. Jenny: (Breathes quietly.) Therapist: (Waits five minutes.) When you’re ready, allow your eyes to gently open, bringing the feelings of being accepted, understood, and supported with you, back into the room. Jenny: (Pauses a few moments, then slowly opens her eyes.) Therapist: How was that? Jenny: I really liked it. It was really beautiful, actually. Therapist: Can you tell me about it? Jenny: I could see her, and she was there with me…and at some point I figured out that this was my future self. And she understood exactly what I’m going through, and… (Begins crying softly.) Therapist: (Waits quietly with a kind smile, eyes tearing up a bit.) Jenny: (still crying) …and she wanted me to be happy. And she knew that I am going to be okay. That I’m going to make it. (Smiles softly.) Therapist: (Leans in, speaking gently.) You are going to make it, Jenny. Jenny: 150 (Smiles.) I’m starting to believe that.Using Compassionate Imagery In the example, we see how powerful this practice can be. There are certain elements demon- strated above that can deepen the experiential aspects of the practice. First, notice that before introducing the exercise, the therapist follows up on other imagery practices to see if there are obstacles to which they should attend. Jenny, like many clients, was able to problem-­solve and deepen her practice in working with an obstacle—­which the therapist warmly reinforces. Moving into the practice, the therapist speaks to a potential obstacle—­that Jenny doesn’t have anyone in her life like this—­by generalizing it (“None of us really has someone like that”), and elaborating on the nurturer’s qualities. Before moving into the imagery itself, the therapist facilitates a collaborative exploration of qualities Jenny would like her nurturer to have—­in terms of both the emotional qualities and ori- entation she will have toward Jenny, and the physical qualities that will facilitate the imagery. During the practice, the therapist prompts Jenny to first imagine the nurturer supporting her, and then how this might play out should anxiety or other difficulties arise for her. As always, the thera- pist checks in after the exercise, taking a cue from Jenny’s ideal compassionate image about how to support Jenny. Finally, you’ll notice that the therapist is visibly moved upon hearing about Jenny’s experience with the imagery. While this is not a planned part of CFT (that would be disingenuous), I included it because I became teary while writing the vignette and recalling such experiences in therapy. Of course, the therapist’s emotionality should never play out in a way that intrudes upon or detracts from the therapy, shifting the focus from the client to the therapist. However, I’ve found it can be a powerful experience for clients to occasionally see that the therapist is genuinely moved by their work in therapy. It’s important for the therapist to be a real human being with real feelings, and allowing that to show sometimes can create meaningful moments that deepen the therapy experi- ence. It can also model courageousness and acceptance for clients who may struggle in allowing themselves to experience or express their own emotions. As you might suspect, the exercise doesn’t always go as smoothly as it did with Jenny. As with all of the practices, we don’t want to force things if it becomes clear the practice isn’t working for the client (although we don’t want to give up at the first sign of resistance, either). For example, I had a client for whom this exercise consistently brought up deep pain associated with her experience of never having had anyone who seemed to offer her genuine caring—­the act of trying to imagine someone being so kind to her activated her attachment system in very threatening ways. For this client, it was much more helpful to use the Compassionate Self exercise to extend compassion to herself—­which didn’t trigger the same powerful emotional memories—­as well as working to develop real-­life relationships that provided her with real-­world experiences of acceptance and support. OTHER IMAGERY EXERCISES While I’ve focused on the safe place and ideal compassionate image practices, there are a number of other imagery exercises that are common to CFT. A recurrent theme in these practices is the 151CFT Made Simple flow of compassion—­into the self from outside, from the self to the self (or aspects of the self, like pain), and from the self to others. In each of these practices, there is an emphasis on trying to create experiences of receiving or giving compassion, complete with motivational aspects (to extend or receive compassion), the felt experience of being filled with compassion or the warmth of extend- ing it to others, imagery components (of being filled with compassion or it flowing out of the self to others), and sometimes repeated phrases (for example, May you have happiness, peace, and ease). There are a number of resources that detail examples of compassion-­focused imagery practices (e.g. Germer, 2009; Kolts & Chodron, 2013). I’ll briefly describe a few of these practices. Compassion for Distress, Threat Feelings, and Pain In this practice, the client shifts into the kind, wise, confident perspective of the compassionate self, and imagines sending compassion out to parts of the self that are experiencing distress, pain, or threat feelings like anxiety, anger, or sadness (Gilbert, 2009a; Kolts 2012; Gilbert & Choden, 2013). The client imagines feelings of compassion and warmth arising within, and imagines extend- ing that compassion out to the pain or discomfort. It can involve a visualization in which the com- passion is pictured as a warm-­colored light (the client picks the color) that surrounds, soothes, and kindly envelopes the aspect of the self that is in pain. Compassion for the Self In this practice, which is similar to many Buddhist practices, the client imagines being filled with compassion from an external or internal source. One variation involves imagining compassion flowing in from the universe or an external source (such as one’s compassionate image) in the form of colored light coming in through the heart or the crown of the head, filling the body, and creating feelings of safeness and ease as it flows in and fills the person. Another variation of this practice (which we touched on earlier) involves the client shifting into the perspective of the compassionate self and imagining that she is extending compassion to a struggling version of the self. In this practice, after a brief compassionate self induction, the vulner- able version of the self is imagined (anxious self, self-­critical self, angry self, and so on), perhaps in a difficult situation. From the perspective of the compassionate self, the client imagines extending warm, compassionate feelings toward the struggling self—­moved by how much this vulnerable self is struggling. Perhaps she connects with the feelings and good intentions behind the struggle. (In the case of Jenny, for example, the anxiety may be a reflection of how much she really wants to connect with others). She then imagines extending compassion to this vulnerable version of the self in whatever way would be most helpful, soothing, and reassuring. This practice can also involve repeating phrases out loud or imaginally, in a warm tone of voice, tailored to what would be most helpful. Common phrases used in compassion and loving-­kindness meditation (in which compas- sion is the wish that the being be free from suffering, and loving-­kindness is the wish that she has happiness) include things like: 152Using Compassionate Imagery May you be free from suffering, (name). May you be happy, (name). May you flourish, (name). May you find peace, (name). (Gilbert & Choden, 2013, 247) Variations of these phrases can be designed to focus on extending compassion to versions of the self that are experiencing specific sorts of difficulties, including anxiety (May you be free of agitation and anxiety. May you feel safe.), anger (May you be free of turmoil which stirs your anger and frustration), or self-­ criticism (May you be free of pain that causes this self-­criticism) (Gilbert & Choden, 2013). Statements involv- ing “being free” of difficult affective states should ideally be embedded within an overall practice that involves building up feelings of safeness, peace, and balance. Compassion for Others Increasingly, research shows that practices such as loving-­kindness and compassion meditation focused on the well-­being of others produces measurable benefits for the self in terms of both hap- piness and behavioral outcomes such as mindfulness, purpose in life, social support, and reductions in illness (e.g. Frederickson, Cohn, Coffey, Pek, & Finkel, 2008). While CFT places a strong focus on the development of self-­compassion, I think it’s important that the focus really be on developing compassion for everyone, with an acknowledgment that the self is included in this. Given that the safeness system is designed by evolution to respond to connection, the social gains that can be produced through development of increased compassion for others are clearly desirable for clients. Additionally, deepening compassion for others can play a primary role in the treatment of clients struggling with behaviors that can actually harm others, such as in problematic anger (Kolts, 2012). A number of practices can be used in cultivating compassion and loving-­kindness for others, many of which are adapted from Buddhist sources (e.g. Salzberg, 1995): • Loving-­kindness meditation: Imagine sending compassion out to another person—­a loved one, someone who is suffering, or even someone with whom the client is strug- gling. (It’s usually easier to begin with someone the client cares about and wants to help.) Shifting into the perspective of the compassionate self, the client visualizes sending kindness, warmth, and compassionate wishes to the other person. This can involve the client imagining his kindness and compassion extending to the other person in the form of light, filling that person with peace, ease, and happiness. It can also involve saying the phrases described in the “Compassion for the Self” section above, this time directed at the other person. The phrases can be tailored to the specific needs of the recipient, with the emphasis on feelings of warmth, compassion, and the desire to be helpful to the person. 153CFT Made Simple • The client can visualize another person (or actually look at the person), reminding herself that this person, just like everyone else, only wants to be happy and to not suffer. This brief practice can be done while walking, or waiting at a stoplight, or at any other time another person is present. The idea is to repeatedly get into the habit of becoming aware of others in a compassionate way. • As an extension of the previous practice, the client can visualize another person, with the awareness that just like everyone else, that person has a life that runs just as deep as the client’s—­just as filled with hopes, dreams, triumphs, tragedies, disappointments, and the full range of human experiences. The other person can be visualized going through the cycle of life from birth to death, being born as a helpless child, growing up and maturing (with all that entails), growing older, and dying, with the meditator imag- ining extending compassion and loving-­kindness to the individual throughout the process. This practice can be punctuated by the reflection, If I could contribute to this person’s life, what sort of life would I want them to have?, connecting with one’s deep wish that others could find happiness and freedom from suffering (Kolts, 2012; Kolts & Chodron, 2013). There are many other compassion and loving-­kindness practices that motivated clients can use to deepen their experience of compassion for themselves and others. In addition to books (e.g. Kolts & Chodron, 2013; Gilbert & Choden, 2013; Germer, 2009; Neff, 2011), a quick Internet search for “compassion and loving-­kindness meditation” brings up numerous written and guided audio practices that can be used to cultivate compassion for oneself and others. I’d recommend working collaboratively with individual clients to find specific practices that work for them. The key is to find ways to help clients learn to feel moved (warm sympathy rather than harsh criticism) when faced with their suffering and the suffering of others, and to develop feelings of warmth and the kind motivation to help. SUMMARY Imagery can be a powerful tool as clients grow in their capacity to work with emotions and extend compassion to themselves and others. In using imagery in therapy, the key is to begin with an idea of the underlying psychological processes we wish to facilitate. Is it helping the client create feel- ings of safeness in herself? Learn to accept compassion from an external source? Learn to develop and extend compassion toward her own pain and difficult emotions? Learn to develop and extend compassion to other people? With these processes in mind, we can select imagery exercises and structure a practice plan that will help clients gradually deepen their capacity to self-­soothe and to feel genuine compassion for themselves and others.